We’ve been through the first two parts of the how to be successful series, nuclear medicine, and breast imaging. Part three, today, is all about how to be successful in MSK imaging. Like the previous weeks, I will talk a bit about the reading materials for this rotation and discuss when you should learn what. All the text links to books in this summary will lead you to Amazon, where I am an affiliate. Afterward, I will give you some more final thoughts about MSK imaging in general and how you can succeed in this rotation.
MSK Reading
MSK reading is a bit more varied than some of the other rotations and more decentralized. Different books are better than others for various topics. Because you need several different books on this rotation, it can be a bit more expensive. If you can try to borrow some of the books, you can save a bit of money. But if you decide to purchase them, they are good references to have nonetheless. Either way, using multiple books on this rotation will be much more efficient for studying MSK than using just one because no one book is comprehensive and intelligible enough for both the core examination and real-world practice.
In the following sections, I will divide what you need to read by each year of MSK. We will cover the following topics: trauma MSK, arthritis, musculoskeletal MRI, bone tumors, and other miscellaneous topics like musculoskeletal ultrasound.
First Year
First, you need to learn bone and joint plain film anatomy. So, in the beginning, especially, you will want to know about normal anatomy to get a better sense of how the different sorts of fractures look. If you are a first-year resident, review your anatomy books again from medical school (i.e., Netter’s or a cross-sectional atlas like Cross Sectional anatomy CT & MRI). You will then want to start with a book of the basics about common types of fractures, especially in an emergency setting. One of the resident-recommended books for this stage as a first-year resident would be the Fundamentals Of Skeletal Radiology. I used something similar many years ago. This book gives you some of the essentials of what you will need to know.
First Or Second Year
After knowing the critical information about MSK injuries, you will want to continue staying on the plain film theme and learning the arthritides. This topic is more about outpatient MSK imaging, but it is also critical for learning to become a consummate MSK imager. One classic book that I found very helpful is the book called Arthritis in Black and White. It is a classic, but it briefly summarizes the findings and distributions of different types of arthritides with pictures to help you out as well. You can read this one also during the first year of MSK or early in your second year.
Second Or Third Year
As a second and or third year, you also need an intelligible MRI MSK book that will give you all you will need to understand and interpret MSK MRI, a common area of difficulty in residency because of lack of exposure. Be careful not to buy the wrong book because many books make this fairly intuitive topic into something more complicated than necessary. So for this subject, check out Musculoskeletal MRI. I found this book “way back when” to be an excellent source for elucidating MSK MRI’s mysteries. It was one of my all-time favorite books in radiology because the author’s style is easy to read and logical. My residents still like it to this day.
Final Year
Finally, toward your last rotations before the core exam, you need some resources to fill in the blanks like bone tumors and MSK ultrasound. For these topics, many residents will look at MSK Case Series Review. Cases are the key to knowing the different types of bone tumors. If you want a more generic overall summary of these miscellaneous topics, you can check out the Musculoskeletal Requisites book.
All Years
Be sure to use a reference tool to check out normal variants, especially for the bones. Have a copy of Keats Normal Variants Atlas available when you read cases. You can also google your images, but it is easier to have a normal variant book handy. I often use this book when I am unsure if what I am seeing is pathological or normal.
Other Thoughts About MSK Imaging
In MSK imaging, especially, you need to be a little more definitive than other areas in radiology. If you see a fracture, call it a fracture. Don’t beat around the bush. You will find that Orthopedists and Emergency Physicians alike will need your final diagnosis to make their final treatment plans or surgeries. So, saying that you are not sure won’t cut the mustard unless, of course, there is real uncertainty in what you see on imaging.
Also, try to get to know your Orthopedists and ER physicians to determine how your calls correspond to what they see clinically or in surgery. Or, even better, examine the patients yourself after making a call. It is a great way to get to know if your diagnoses are correct.
And finally, for those who don’t have as much exposure to MSK MR, I would try to look at the cases that your attendings read on your own time. Then, compare your conclusions based on the history and images to the dictations of your attending. It’s a great way to learn what you need to know.
How To Be Successful In MSK Imaging
To become successful in MSK imaging, you need several ingredients. First, you need the right books (unfortunately, a lot of them for MSK!). It would then be best if you had the right attitude (coming down a little bit harder on diagnoses than some other subspecialties!) And then finally, you need a good point of reference for your calls (correlate with your patients, ER physicians, and Orthopedists.) If you utilize these resources, you are bound to become an excellent MSK imager!
