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E2128. Harder to See What’s Not There: Case-Based Review of Osseous Lesions
Authors
  1. Ilana Warsofsky; Brigham and Women's Hospital
  2. Nora Yousefzadeh Grunin; Brigham and Women's Hospital
Background
Musculoskeletal symptoms are one of the most common complaints in the primary care setting, urgent care facilities, and emergency room. In particular, acute and/or chronic pain is the most common symptom causing patients to seek care. After a clinician reviews the focused history and physical exam findings, patient’s patients often undergo initial examination with radiographs. Radiologists must manage high volume workloads, including plain film interpretation, while rendering the most accurate interpretation. Therefore, this educational exhibit aims to review basic search patterns on many types of plain films including spine, joint, extremities, and pelvis. It is important to have a trained eye to catch subtle findings on plain films to provide the most accurate interpretation and help patients.

Educational Goals / Teaching Points
The goals of this exhibit targeted to the audience of residents, fellows, and attending radiologists include (1) review search patterns to identify osseous lesions particularly subtle lucent / lytic lesions (2) teach principles of how to evaluate such osseous lesions, (3) correlate radiograph findings with advanced imaging such as CT and MRI when applicable, (4) create differential diagnosis based on patient’s clinical presentation and imaging findings, and (5) highlight what radiologists need to report to the ordering providers to best help patients.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
A case-based review of radiographs including spine, extremity, joint, and pelvis will be included in this educational exhibit to highlight the importance of a strong foundation of human anatomy and importance of fundamental search patterns to accurately identify abnormalities in evaluation of musculoskeletal complaints. Many malignancies often metastasize to bone. In addition, there are many mimics of malignant tumors. Correlation with advanced imaging including CT, MRI and nuclear medicine studies including PET/CT and bone scan will be included to help the reader build a strong foundation in musculoskeletal radiology.

Conclusion
High clinical volume necessitates optimal search patterns to reduce error in radiology. The goal of this educational exhibit is to review, in a case-based format, appropriate search technique in plain films, how to identify subtle findings particularly in the case of lucent / lytic lesions, and to emphasize the appropriate recommendations for workup of plain film findings.