Radiologists often encounter imaging requisitions that lack important information needed for accurate diagnostic studies. Reason for exam Imaging Reporting and Data System (RI-RADS) is proposed as a grading system for evaluation of the quality of clinically pertinent information provided in imaging requisitions. Three categories of information are suggested as key indicators of quality: impression, clinical findings, and the diagnostic question. This scheme is intended to improve the quality of imaging requisitions and overall patient care.

Juxtacortical or surface tumors of bone are neoplasms arising from or just outside the cortex, and are composed of different histologic types. Although the imaging appearances of these lesions have similarities to their intramedullary counterparts, their location alters their radiographic and MR characteristics, creating difficulties in diagnosis. Meanwhile, several non-neoplastic lesions, such as stress reaction/stress fracture and indolent infectious processes, compound the differential diagnosis. Neoplastic juxtacortical lesions of bone have been classified into five categories: cartilaginous, fibrous, lipomatous, osseous, and metastatic tumors. Our goal in part two of this review is to illustrate the characteristic radiographic, CT and MR imaging features of various juxtacortical neoplasms, including pathognomonic imaging findings that can aid in diagnosis, and to develop an appropriate differential diagnosis for surface lesions based on imaging characteristics, lesion location and patient age.

PET is often underutilized in the field of musculoskeletal imaging, with key reasons including the excellent performance of conventional musculoskeletal MRI, the limited spatial resolution of PET, and the lack of reimbursement for PET for nononcologic musculoskeletal indications. However, with improvements in PET/CT and PET/MRI over the last decade as well as an increased understanding of the pathophysiology of musculoskeletal diseases, there is an emerging potential for PET as a primary or complementary modality in the management of rheumatologic and orthopedic patients. Specific advantages of PET include the convenience of whole-body imaging in a single session, the relative resilience of the modality compared with CT and MRI in the imaging of metallic implants, the ability to evaluate deep joints not amenable to palpation, and the potential for improved specificity of diagnosis with novel radiopharmaceuticals. In this review, we discuss multiple radiopharmaceuticals and technical considerations for PET/CT and PET/MRI that can be used in imaging of nontumoral bone and soft-tissue disorders. Both PET/CT and PET/MRI hold significant promise in the field of musculoskeletal imaging, and with further radiopharmaceutical development and clinical research, these hybrid modalities can potentially transform the current management of patients with orthopedic and rheumatologic disease.

Primary bone malignancies are characterized with anatomic imaging. However, in recent years, there has been an increased interest in PET/computed tomography scanning and PET/MRI with fludeoxyglucose F 18 for evaluating and staging musculoskeletal neoplasms. These hybrid imaging modalities have shown promise largely owing to their high sensitivity, ability to perform more thorough staging, and ability to monitor treatment response. This article reviews the current role of PET/computed tomography scanning and PET/MRI in primary malignancies of bone, with an emphasis on imaging characteristics, clinical usefulness, and current limitations.

RATIONALE AND OBJECTIVES:This study aimed to assess the quality of and analyze trends among clinical indications received for emergency room radiograph studies.MATERIALS AND METHODS:Clinical indications provided by the emergency room and rapid care for consecutive chest, abdominal, and musculoskeletal radiographs were reviewed. Chart review was performed to analyze the provided indications compared to clinical information known to the ordering providers. Chest and abdominal radiograph indications were graded according to symptoms and physical examination signs and relevant past medical history. Musculoskeletal indications were graded according to symptoms, mechanism of injury, and positive physical examination findings. Each study indication was graded on a scale from 0 to 2 according to scales modified from those of prior published studies. Grades were further stratified according to ordering location, time of shift, ordering provider level, and specific anatomy involved.RESULTS:For chest and abdomen studies, mean scores for symptom and physical examination and provided past medical history grades were 1.16 and 0.36, respectively. There was a trend toward a significant difference in mean medical history grades among ordering provider levels. For musculoskeletal studies, mean scores for symptom, mechanism, and physical examination grades were 1.04, 0.89, and 0.51, respectively. Mean symptom and examination grades for physician extenders were significantly less than those of attendings and residents. Mean symptom and mechanism grades for extremity studies were significantly less than those for spinal studies.CONCLUSIONS:For plain radiographs ordered through the emergency department, certain critical pieces of study indications tended to be underreported relative to other components. Furthermore, significant differences in select categories were seen among ordering provider levels and anatomic location.