Purpose or Learning Objective: Percutaneous thermal ablation of bone metastases is typically performed under general anesthetic (GA). We describe the use of conscious sedation during percutaneous image-guided thermal ablation of painful bone metastases.

Purpose or Learning Objective: Percutaneous radiofrequency ablation (RFA) combined with augmentation has emerged as a minimally invasive treatment for patients with painful skeletal metastases who do not respond to or have contraindications to radiation therapy. This study evaluated the incidence of tumor recurrence following RFA using bipolar electrodes combined with cement augmentation of skeletal metastases.

AIM: To identify the standard of core and subspecialist musculoskeletal (MSK) training across deaneries in the UK. MATERIALS AND METHODS: An online survey of 46 questions with responses in Likert scale or dichotomous formats was distributed to members of the Society of Radiologists in training, British Society of Skeletal Radiologists (BSSR), Training Programme Directors and the Royal College of Radiologists (RCR) Junior Radiology Forum representatives for national training schemes across the country. Responses were analysed descriptively with narrative analysis of free-text comments. RESULTS: One hundred and seventy-eight participants completed the survey. Forty-six percent (81/178) were core trainees (ST1-3), 47% (84/178) were subspecialist trainees, and 7% (13/178) were newly qualified consultants (<2 years in post). All (178/178) of the participants had a dedicated MSK rotation, with a duration of >= 3 months in 76% (136/178). Only onethird received a dedicated period in MSK ultrasound and only 60% (107/178) had been actively involved in interventional procedures during their training. Overall, 21% (37/178) and 42% (75/178) of participants rated the quality of their MSK training as excellent and good, respectively. The majority (93%, 168/178) thought that MSK training could be improved, especially for ultrasound (62%, 110/178) and interventional computed tomography (CT) or fluoroscopy (57%, 101/178). CONCLUSIONS: There are inconsistencies in MSK training offered in the UK. Although the majority of trainees are satisfied, there were gaps and potential threats to the quality of training. MSK training is witnessing substantial demand from trainees and workforce strategists necessitating tactical investments to standardise and enhance its quality. (C) 2021 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Purpose or Learning Objective: To outline the response of British radiologists to evolving national guidelines and highlight the impact of the COVID-19 pandemic on the treatment of musculoskeletal (MSK) conditions. Methods or Background: An online anonymized survey was distributed via the forum of the British Society of Skeletal Radiology (BSSR) in November 2020. Responses were collated using a standardized Google form of 21 questions. Results or Findings: A total of 135 BSSR members completed the survey. About 85% of respondents stopped performing corticosteroid injections (CSIs) during the initial lockdown of the pandemic, primarily influenced by national guidelines. Most respondents initially abstained from offering CSI procedures, and then by November, 68.7% of respondents were providing CSIs for high-and low-risk patients, 23% were only offering CSIs for low-risk patients, with 8% still not performing any CSIs. Approximately 40% of respondents reported routinely obtaining specific written consent regarding the risk of COVID19. An estimated 11,000 CSIs were performed by respondents between March and November 2020 with no reported significant complications related to COVID-19. The number of CSIs performed by BSSR members was reduced to < 80% in > 80% of responses, with an increased backlog of patients awaiting treatment reported by 73%. The average waiting time for routine outpatient CSI treatment was > 12 weeks in 53% of responses. Conclusion: The COVID-19 pandemic has had a significant impact on the clinical practices of MSK radiologists in the United Kingdom. Our survey highlights the rapid response of BSSR members as the national guidelines evolved. Most respondents are currently performing CSIs for MSK conditions when clinically indicated, with patient-enhanced consent. However, the pandemic has resulted in increased waiting times, delaying the treatment of patients who may be experiencing significant pain and disability. Further research is warranted to provide guidance regarding service recovery and offering CSIs around COVID-19 vaccination schedules.

AIM: To assess pain relief and local tumour control retrospectively in spinal metastases undergoing cryoablation. MATERIALS AND METHODS: Between May 2008 and September 2020, 46 metastases in 41 consecutive patients (mean age 59.7 +/- 4.4 [SD] years; range 27-84) were treated with cryoablation in 42 interventional sessions. Patient demographics, procedural data, complications, pain, and local tumour control were analysed retrospectively. RESULTS: Thirty-one patients (36 spine metastases; 32 sessions) were treated for pain relief and 10 (10 metastases; 10 sessions) for local tumour control. Clinical success was reached in 30/32 (93.8%) interventional palliative sessions. Mean pre-procedural numerical pain rate scale was 6.2 +/- 1.7 (SD), and dropped significantly to 3.5 +/- 1.8 (SD), 1.9 +/- 1.7 (SD), and 1.9 +/- 1.8 (SD) at 24-h, 1-month and at the last available follow-up (median 16.5 +/- 23.2 [SD] months), respectively. For patients requiring local tumour control, primary clinical success was reached in 6/10 (60%) spinal metastases at median 25-months follow-up. The overall complication rate was 8%, with no secondary fractures or iatrogenic thermal-mediated nerve injuries reported. CONCLUSION: Percutaneous image-guided cryoablation of spinal metastases is safe and effective in achieving pain relief and local tumour control. (C) 2021 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Purpose: To investigate the safety and clinical efficacy of bipolar radiofrequency ablation (b-RFA) with increased (> 70 degrees C) target temperature for the treatment of spine metastases with the intent of achieving pain relief or local tumor control. Materials and methods: Thirty-one patients with a total of 37 metastases who were treated with b-RFA with increased temperature and vertebroplasty from January 2016 to May 2019 were retrospectively included. There were 20 women and 11 men with a mean age of 62.4 10.5 (SD) years (range: 40-78 years). Patients and metastases characteristics, procedure details and clinical outcomes were analyzed. Results: Metastases were predominantly located in lumbar (22/37; 59.5%) or thoracic spine (13/37; 35.1%). Mean target temperature was 88.4 +/- 3.5 (SD) degrees C (range: 70-90 degrees C). Technical success was 100% (37/37 metastases). One (1/37; 2.7%) major complication unrelated to b-RFA was reported. One (1/37; 2.7%) metastasis was lost to follow-up. Favorable outcome was noted in patients receiving bRFA for pain management (16/20 metastases; 80%; mean follow-up, 3.4 +/- 2.9 [SD] months) or with oligometastatic/oligoprogressive disease (6/6 metastases; 100%; mean follow-up, 5.0 +/- 4.6 [SD] months). In patients receiving b-RFA to prevent complications, favorable outcome was noted in 6/10 metastases (60%; mean follow-up, 3.8 +/- 4.8 [SD] months). Conclusions: B-RFA with increased target temperature has an excellent safety profile and results in high rates of pain relief and local metastasis control in patients with oligometastatic/oligoprogressive disease. Suboptimal results are achieved in patients receiving b-RFA to prevent complications related to the growth of the index tumor. (C) 2020 Published by Elsevier Masson SAS on behalf of Societe francaise de radiologie.

AIM:To report the technique of percutaneous double oblique anterior access to the acetabulum and evaluate its feasibility and safety.MATERIALS AND METHODS:Pelvic computed tomography (CT) examinations of 60 patients (30 men and 30 women; mean age 62.6±13.2 years) were retrieved randomly from the picture archiving and communication system (PACS). A virtual intraosseous trajectory was defined on both sides on the axial CT images with the entry point marked 1 cm above the anterosuperior iliac spine and the endpoint defined just above the level of the ischial spine at the midpoint of the posterior acetabulum. Patient age, sagittal oblique angulation, axial oblique angulation, length of intraosseous trajectory, distance from the hip joint, thickness of the iliac bone cortex, and intervening structure(s) between the skin and the bone entry points were recorded.RESULTS:The mean sagittal and axial oblique angulations were 34.2±4.5° and 31.5±6.7°, respectively, and mean length of the intraosseous trajectory was 11.8±0.9 cm. The axial oblique angle and length of the intraosseous trajectory were significantly lower in the female than the male population (p<0.05). None of the virtual trajectories traversed the hip joint. In 112/120 trajectories (93.3%), there were no cortical breaches in the iliac bones. In eight trajectories in four patients, the virtual trajectory crossed either the medial iliac cortex (4/120; 3.3%) or the medial iliac cortex and the iliacus muscle (4/120; 3.3%).CONCLUSION:The anterosuperior iliac and ischial spines can be used safely and reliably as landmarks to perform the double oblique anterior approach.

Purpose: New innovations in musculoskeletal interventional oncology need validation and evidence to develop the most effective treatment options, pathways, and guidelines, thus optimizing outcomes and quality of life for patients, even more so for those in palliative care. Obstacles in patient recruitment exist in all trials, but the reasons for nonparticipation are less well understood. We reflect on our experience in magnetic resonance guided high-intensity focused ultrasound (MRg-HIFU) therapy of skeletal metastasis and correlate it with the current literature.

Purpose: To evaluate the added role of dual-energy computed tomography (DECT) in the detection and visualization of periprosthetic complications around metal implants in the pelvis and hip in the United Kingdom and the United States.

The purpose of the present article is to describe the technique of transforaminal insertion of an ultrathin thermosensor in the anterior epidural space in 13 patients treated by radiofrequency ablation. The mean time taken to position the thermosensor was 10.6 minutes (range, 5-38 minutes). Technical success was 93% (correct positioning in 13/14 levels). Additional hydrodissection was performed through the same access in 11 cases. No postoperative neural deficit was elicited in any of the cases.

OBJECTIVE:To investigate the safety profile of percutaneous cryoablation of renal tumours < 7 cm, utilising data extracted from an international multicentre registry. MATERIALS AND METHODS:A retrospective review of all immediate and delayed complications from a multicentre database was performed and was categorised according to the Clavien-Dindo classification. Statistical analysis was performed for both overall complications (all Clavien-Dindo) and major complications (Clavien-Dindo 3 to 5). The following criteria were identified as potential predictive factors for complications: centre number, modality of image guidance, tumour size (≤ 4 cm vs. > 4 cm), number of tumours treated in the same session (1 vs. > 1) and tumour histology. RESULTS:A total of 713 renal tumours underwent ablation in 647 individual sessions. In 596 of the cases, one tumour was treated; in the remaining 51 cases, several tumours were treated per session. Mean lesion size was 2.8 cm. Fifty-four complications (Clavien-Dindo 1 to 5) occurred as a result of the 647 procedures, corresponding to an overall complication rate of 8.3%. The most frequent complication was bleeding (3.2%), with 9 cases (1.4%) requiring subsequent treatment. The rate of major complication was 3.4%. The only statistically significant prognostic factor for a major complication was a tumour size > 4 cm. CONCLUSION:Percutaneous renal cryoablation is associated with a low rate of complications. Tumours measuring more than 4 cm are associated with a higher risk of major complications. KEY POINTS:• Percutaneous kidney cryoablation has a low rate of complications. • Bleeding is the most frequent complication. • A tumour size superior to 4 cm is a predictive factor of major complication.

Purpose: To perform a systematic review of technical details and clinical outcomes of percutaneous extra-spinal cementoplasty in patients with malignant lesions. Materials and methods: PUBMED, MEDLINE, MEDLINE in-process, EMBASE and the Cochrane databases were searched between January 1990 and February 2019 using the keywords "percutaneous cementoplasty", "percutaneous osteoplasty" and "extra-spinal cementoplasty". Inclusion criteria were: retrospective/prospective cohort with more than 4 patients, published in English language, reporting the use of percutaneous injection of cement inside an extra spinal bone malignant tumour using a dedicated bone trocar, as a stand-alone procedure or in combination with another percutaneous intervention, in order to provide pain palliation and/or bone consolidation. Results: Thirty articles involving 652 patients with a total of 761 lesions were reviewed. Mean size of lesion was 45mm (range of mean size among publications: 29-73 mm); 489 lesions were located in the pelvis, 262 in the tong bones of the limbs and 10 in other locations. Cementoplasty was reported as a stand-alone procedure for 60.1% of lesions, and combined with thermal ablation for 26.2% of lesions, implant devices for 12.3% of lesions, and balloon kyphoplasty for 1.4% of lesions. The mean volume of injected cement was 8.8 mL (range of mean volume among publications: 2.7-32.2 mL). The preoperative visual analogic scores ranged between 3.2 and 9.5. Postoperative scores at last available follow-up ranged from 0.4 to 5.6. Thirteen papers reported a reduction of the visual analogic scores of 5 points or more. Nerve injury was the most frequent symptomatic leakage (0.6%). Conclusion: Percutaneous extra-spinal cementopasty is predominantly performed as a standalone procedure and for lesions in the bony pelvis. It appears to be an effective tool to manage pain associated with malignant bone tumours. There is however a lack of standardization of the technique among the different publications. (C) 2019 Societe francaise de radiologie. Published by Elsevier Masson SAS. All rights reserved.

Poster: "ESSR 2017 / P-0308 / MRI features of post-arthroscopy pain syndrome (PAPS): Correlation with preoperative imaging and up to four years of follow up" by: "D. Dalili, T. M. Bansal, N. Khandwalla, Z. Shah, M. George, M. J. Bankes, A. Isaac; London/UK"

Poster: "ESSR 2017 / P-0302 / Fixing the Cage: What The Surgeon Wants to Know About Traumatic Rib Fractures" by: "A. Atinga, M. De La Hoz Polo, D. Dalili, R. A. Young, I. Sinha, E. A. Dick, D. Amiras; London/UK"