0:00

So let's look at a little bit of the workup and

0:03

Diagnostic Imaging of lesions at the biopsy site.

0:07

So we have bone tumors that present as we've sort of

0:10

talked about skeletal pain being the presenting symptom very

0:13

often but many bone tumors

0:16

are often asymptomatic and benign and so they're can be

0:19

discovered for the most part incidentally you're Imaging

0:22

for something else or your palpating or patience palpating

0:25

on their body and they notice something of

0:28

concern a swollen area and maybe

0:31

they just present to the emergency room for some

0:34

other condition possibly trauma and then they notice that

0:37

on Imaging there is this tumor. So in

0:40

those individuals that are symptomatic however, the symptoms

0:43

can be pain swelling at the

0:46

tumor sign they can get some aggravation with exercise

0:49

or because of weakening within the

0:52

bone the trabecula, for example, you can have a pathologic

0:55

fracture that results. So now when you suspect a malignant

0:58

tumor it's very important to distinguish that between a primary

1:01

malignant versus metastasis. So when

1:04

we think about osteoma latest now, which is

1:07

Action this infection can be spread hematologistly

1:10

through the bloodstream or

1:13

because of direct inoculation. So direct inoculation could

1:16

be seen in the setting of an individual that's an ivy drug user. They're

1:19

in Needle goes directly into the

1:22

bone for example, and so that dirty needle now

1:25

is taking microbes from the environment and

1:28

then Traverse that through the

1:31

skin into the internal environment a diabetic

1:34

using their diabetic needle to give them the

1:37

insulin can cause the exact same phenomenon

1:40

to happen perhaps it's 30 moving from

1:43

the outside world two. Now, they're internal World

1:46

causing spread of that infection

1:49

that can spread sub periostially as

1:52

well. So when we look at a patient's history,

1:55

for example, whether they're an ivy drug user, they're a diabetic

1:58

or they're an immigrant from a country where TB is endemic

2:01

or perhaps they had joint surgery or perhaps

2:04

this trauma that can give us a clue into

2:06

The organism is as well all conditions work

2:09

microbes from the outside environment. Can then

2:12

enter the internal environment when a

2:15

patient presents with symptoms of infection, of

2:18

course, there is the classic.

2:20

Color the heat. Okay, we think

2:23

about the rule board the swelling and we think about the

2:26

dolor the pain, but of course if these sort

2:29

of symptoms are present in addition

2:32

to sort of pain and swelling around a joint

2:35

we can also get stiffness if these findings are

2:38

Regional to a joint.

2:40

So what's the role of the diagnostic Radiologists?

2:43

Oxygen Radiology plays a critical role in order to

2:46

distinguish between bone pathologies and that really helps us to

2:49

diagnose and subsequently guide management.

2:52

Tumors are particularly important because if

2:55

we know that it's a tumor do we

2:58

not know that it's malignant or benign? We don't so we

3:01

need the diagnostic Radiologists to help us to understand. What

3:04

are the characteristics that make this more likely to

3:07

be benign versus more likely to be malignant. If

3:10

it's something that's benign. For example, that workup

3:13

should stop there. This patient should not be

3:16

referred for a biopsy and it's

3:19

something that definitely happens. And so it's something that

3:22

we want to flag to ensure that Diagnostic Imaging

3:25

is exhausted and these patients

3:28

do not then inappropriately be shunted to

3:31

receive a procedure. That is

3:34

inappropriate.

3:35

So if a patient has a malignancy a suspected

3:38

malignancy, we want to

3:41

know if it's primary or metastatic because the treatment

3:44

for a primary tumor is very

3:47

different than one for a mestatic lesion.

3:50

The patient has a primary bone tumor when in fact, they actually

3:53

have a kidney cancer that metastasized to

3:56

the Bone you can imagine the treatment is going to be very different.

3:59

So that biopsy that can

4:02

then sort of be promoted and referred and recommended

4:05

by the diagnostic radiologist can be particularly critical

4:08

from a time sensitive nature for Expediting

4:11

this particular patients management and

4:14

care.