Musculoskeletal Imaging and Intervention Fellowship

Fellows and residents rotating at the Division of Musculoskeletal Imaging and Intervention participate in several daily and weekly didactic conferences that cover everything from the basics of plain-film interpretation to the most updated concepts on advanced imaging modalities and interventional techniques.

Division staff and fellows are very active in conferences with several specialties involved in musculoskeletal disorders. Weekly conferences with oncologic orthopedic surgery, sports medicine, spine surgery and rheumatology provide extensive exposure to complex cases and current management of a wide array of bone and joint disorders.

Mass General is a major referral center for bone and soft tissue neoplasms, providing an outstanding volume of image-guided biopsies for assessment of suspected metastases, primary and recurrent musculoskeletal tumors. Biopsies are performed using CT scanners or sonography, and a wide array of biopsy instruments is available for sampling of lesions. Around 300 image-guided musculoskeletal biopsies are performed per year at our institution.

Mass General has pioneered the use of radiofrequency energy for image-guided therapy and is a major destination for noninvasive treatment of osteoid osteoma. Approximately one or two CT-guided osteoid osteoma radiofrequency ablations are performed monthly, providing a unique opportunity for our fellows to gain experience in this advanced treatment modality. We also perform CT-guided radiofrequency ablation and cryoablation for osseous and soft tissue malignancies.

The Department of Radiology at Mass General is a fully digital environment, with a complete PACS, allowing image review and analysis at multiple different locations, regardless of point of origin. We have state-of-the-art MRI and CT equipment both at the main campus and at our satellite facilities (Charlestown, Waltham). This network generates around 10,000 musculoskeletal MR examinations per year including MR arthrograms and approximately 1,200 CT examinations per year. Sports medicine and oncology consultations on MR imaging obtained at non-Mass General sites provide additional exposure to interesting and complex cases.

Sonography of the musculoskeletal system is an exciting new modality recently implemented at Mass General. We utilize the most advanced US technology available for the evaluation of muscle and tendon abnormalities, joint derangements and Morton's neuroma. This service, which includes sonographically guided biopsies and procedures, has steadily grown in the past several years and is part of the fellowship rotations.

The Division of Musculoskeletal Imaging and Intervention is responsible for all non-emergent adult musculoskeletal plain radiographs obtained at Mass General, grossing around 30,000 examinations per year. Plain film cases are available through PACS and cover practically the whole spectrum of musculoskeletal disease, representing the basis for interpretation of advanced musculoskeletal modalities. Our fellows have plain-film rotations concurrently with interpretation of advanced modalities, providing well-balanced training in musculoskeletal diagnosis.

The Division of Musculoskeletal Imaging and Intervention plays a major role in image-guided pain treatment at Mass General. An excess of 2,000 fluoroscopy- and ultrasound-guided spine and joint injections per year are performed at our dedicated fluoroscopy unit on Yawkey 6. Our fellows have extensive exposure to all types of procedures involving the spine (e.g., epidural injections, cervical and lumbar selective nerve root blocks, cervical and lumbar facet injections, sacroiliac joint injections, rhizotomy) and joints (arthrograms, joint aspirations and injections).

In October 2004, the Division of Musculoskeletal Imaging and Intervention moved to the new Yawkey Building, located adjacent to the Mass General main campus. The move represents a major breakthrough with the creation of the Musculoskeletal Institute, combining musculoskeletal radiology, orthopedic surgery, rheumatology and physical therapy in an integrated facility. Additional 3.0- and 1.5-Tesla Siemens MR scanners, two MDCT scanners, two MSK interventional rooms and ultrasound service adjacent to dedicated musculoskeletal radiology offices and interpretation area have enhanced our ability to provide state-of-the-art medical care for patients with musculoskeletal disorders.