Idor 2019

What is International Radiology Day (IDOR)

International Radiology Day (IDOR) is celebrated worldwide by an initiative created by the European Society of Radiology (ESR), along with the Radiological Society of North America (RSNA) and the American College of Radiology (ACR), and supported by a number of entities and societies around the world. On this day, Radiologist Day is also celebrated in Brazil, following the decree of Law No. 13.118 / 2015, honoring and recognizing professionals in the field. 

“Sports image” was the theme chosen for this year's IDOR, with the purpose of highlighting the essential role that image professionals play in the detection, diagnosis, prognosis and treatment of sports-related injuries, increasing the quality of care and treatment of patients.

In Brazil, Dr. Ronaldo Magalhães Lins, a full member of the CBR, professor of musculoskeletal ultrasound, radiologist from Belo Horizonte and radiologist of the medical council of the national men's soccer team, was chosen for the interview as a specialist in Brazil. “The radiologist's role is critical in the sports medical team, but an athlete's multidisciplinary assessment comes first,” he says.

Check out the interview with IDOR 2019

Dr. Ronaldo Magalhães Lins, professor of musculoskeletal ultrasound, radiologist of Belo Horizonte and radiologist of the medical council of the national male soccer team

“The radiologist's role is critical in the sports medical team, but an athlete's multidisciplinary assessment comes first.”

In Brazil, various sports are practiced by a growing number of athletes, but nothing compares with football. The king of sports has changed a great deal over the course of the decade, with unmatched levels of intensity resulting in new types of injuries, which suits the evolution of the image. The radiologist's role is paramount in the sports medical team, but the athlete's multidisciplinary assessment comes first, according to Dr. Ronaldo Magalhães Lins.

European Society of Radiology: Sports radiology is the main topic of IDoR 2019. In most countries, this is not quite a specialty, but a focus within musculoskeletal radiology. In your country, is there a special focus on sports imaging within radiological training or special courses for interested radiologists?

Ronaldo Magalhães Lins: Here in Brazil, there is no special focus on sports imaging during the radiology residency, but the musculoskeletal area gives you images of various types of injuries. When radiologists have a special interest in sports medicine, they need to focus on subject-specific courses. Most existing courses are postgraduate Lato sensu in sports medicine, where the radiologist will have access to clinical, nutritional, physiological, biomechanical information and more. These courses are taught by doctors who specialize in sports medicine at some universities here in Brazil and abroad.

ESR (European Society of Radiology): Based on your experience, which sports produce the most injuries that require x-rays? Did you see any changes in this during your career? What areas / types of injuries present the greatest challenges to radiologists?

RL (Ronaldo Magalhães Lins): I work in private practice, in a school that teaches medical courses, and for soccer teams, including the Brazilian men's team. I spend most of my time in my clinic, and the schedule is partly sports radiographs. The same is true at the São Paulo Ultrasound Training Center. In football training centers, my time is entirely devoted to sports radiographs. Being part of a multidisciplinary team, we discuss each case of athletes together with a sports medicine practitioner - usually an orthopedist - a physical therapist, a physical trainer, and a physiologist. As a radiologist, I not only provide imaging diagnostics, but also, when necessary, guide interventions in athletes.

ESR: Please give a detailed overview of the sports injuries you are most familiar with and their respective modalities.

RL: When I started my career in sports medicine, some sports caused the most varied injuries, for example football, tennis, athletics and gymnastics. Today, sports produce high-performance athletes who, no matter what sport they play, are more prone to injury. Radiography techniques have offered an increase in the sensitivity of diagnosing sports-related structural injuries, and I do not believe that certain types of injuries are more difficult to confirm. The tricky task is to evaluate the clinical importance of image encounters, and when this change needs to be addressed during follow-up of an injury. As you know, an injury tends to remain visible on images even after clinical signs have shown a functional improvement. This is extremely true with MRI (magnetic resonance imaging) an extremely sensitive modality.

ESR: What diseases associated with sports activities can be detected by imaging? Can you give us examples?

RL: Working with football, I often see muscle injuries and strains. As for knee sprains, the most common are menisci and ligament sprains. Ankle sprains tend to affect lateral ligaments, especially the anterior talofibular ligament, which are present in 70% of isolated cases.

As for muscle injuries, we have both functional injuries, such as fatigue or late muscle pain, and structural injuries, such as disruptions due to stretching. In the latter, we have the involvement of downtime due to the abrupt change of speed, due to the different style in which athletes play today. If you compare soccer from ten years ago, when players normally ran 4-6km per game and at a low intensity, as football is today, with players running 10-12km at a high intensity of 40% per game, we can See why injuries are more prevalent, especially in the posterior thighs, the group of muscles activated during running. All repeat-induced pathologies, whether macro or micro traumatic, are very well diagnosed with imaging methods. Some examples are joint injuries such as osteoarthritis due to mechanical use of the joint, tendon disorders, muscle and ligament injuries, and stress and trauma bone fractures.

ESR: Radiologists are part of a team: for sports imaging, this consists of surgeons, orthopedists, cardiologists and / or neurologists. How would you define the radiologist's role within this team, and how would you describe the cooperation between radiologists, surgeons, and other physicians?

RL: The radiologist is essential for better patient management within the medical team. For all radiologists who want to work with sports imaging, I would like to point out that clinical thinking is extremely important to help with your performance. So we are great practitioners and not just imaging professionals. We should take advantage of the interaction with other professionals, such as orthopedists, physiotherapists, doctors and physiologists, to improve themselves every day. If you are confronted with sports injuries and have a good clinical basis, the correlation of images and clinical suspicion adds up to the accuracy of the diagnosis.

ESR: The radiologist's role in certain diagnoses with sports radiographs is obvious; How much involvement is there, regarding treatment and follow-up?

RL: The radiologist is an expert who helps define the diagnosis through imaging when a clinical suspicion is encountered. If necessary, it is possible to guide an intervention with images, in which case the radiologist will be there to help. In sports medicine, radiologists are much more involved because they evaluate the recovery process of athletes all the way back to training. During treatment, guided interventions may be required to improve the outcome, and there is no better method to do than the imaging method.

ESR: Is radiology effective in identifying and treating sports-related injuries and illnesses, but can it also be used to prevent them? Can the information provided by a medical image be used to improve athlete performance?

RL: Imaging is not used to prevent injury, but since we work with a multidisciplinary team, we use radiology to help athlete development and follow-up. For example, we can use images to detect asymmetries in a muscle or even diagnose signs of a degenerative tendon that may involve a functional deficit for the athlete.

ERS: Many elite sports centers use state-of-the-art medical imaging equipment and attract talented radiologists to operate them. Are you involved with any of these centers? How can knowledge at these locations be used for the benefit of all patients?

RL: Yes, I was invited to be part of the Brazilian men's soccer team, which was a reference in sports imaging in Brazil. This experience in high performance centers has made me grow professionally because evaluating an athlete from a multidisciplinary standpoint is much more efficient than just image alone. This has been my argument in daily interactions with all types of patients, seeking better diagnoses and efficient treatments.

ERS: Demand for imaging studies has steadily increased over the past decade, placing strains on the health care budget. Demand has also grown in sports medicine? What can be done to justify image requests and make the most of available resources?

RL: Advances in equipment have improved image quality and the demand for sports imaging has increased, especially due to the sensitivity of images when diagnosing sports injuries. These days it is not only possible to detect acute injuries, but it is also possible to detect minimal injuries that are of no clinical significance but may become an injury to the athlete in the future - and there are those we have detected to treat in advance. Interactions with other specialties is very important, mainly because it contributes to the knowledge of each imaging method, thus providing an appropriate prescription and avoiding unnecessary expenses.

ESR: Athletes are more prone to injuries that need medical imaging. How much greater is the risk of developing a disease related to frequent radiation exposure and what can be done to limit the negative impacts of overexposure?

RL: This is no longer a concern for two reasons. First, because equipment that uses ionized radiation comes with filters that significantly reduce the risk to the athlete. Second, and perhaps most importantly, for having other imaging means that can be used for diagnostics that do not use ionized radiation at all, such as magnetic resonance imaging (MRI) and ultrasound. We use these modalities more often.

ESR: Do you actively play sports and if so does it help you in your daily work as an MSK radiologist?