Ukraine / Dr. Natalia Nehria

European Society of Radiology: Sports imaging is the main theme of IDoR 2019. In most countries, this is not a specialty in itself, but a focus within musculoskeletal radiology. In your country, is there a special focus on sports imaging within radiology training or special courses for interested radiologists?

Natalia Nehria: Nowadays, a lot of people are involved in sporting activities. Sport is a significant part of people’s lives which is why radiologists should pay attention to it. In Ukraine, we unfortunately do not have special training courses in sports imaging. Despite this, a number of radiologists are interested in sports imaging.

ESR: Please describe your regular working environment (hospital, private practice). Does sports-related imaging take up all, most, or only part of your regular work schedule?

NN: I work in a private imaging centre with 16 radiologists where we have two 1.5T MRI machines. Approximately 40% of our examinations are orthopaedic, most of which are sports-related injuries.

ESR: Based on your experience, which sports produce the most injuries that require medical imaging? Have you seen any changes in this regard during your career? What areas/types of injuries provide the greatest challenge to radiologists?

NN: From what I can tell, football-related injuries are the most common, from both professional to amateur players. I deal with football traumas on a daily basis; however, I should also mention that we have some seasonal traumas stemming from snowboarding or skiing. Special attention should be given to child or adolescent trauma in radiology practice as the number of traumas continues to grow.

ESR: Please give a detailed overview of the sports injuries with which you are most familiar and their respective modalities.

NN: We see sprains or ruptured ligaments, tendons, muscles, ruptured meniscus or labrum, chondral and osteochondral lesions; however, bone fractures represent the majority of the cases. We also see brain injuries. Any of these traumas can be seen in various sports and we must work with all of them.

ESR: What diseases associated with sporting activity can be detected with imaging? Can you provide examples?

NN: We often see degenerative joint changes, often associated with sports, especially if the patient visits a doctor long after symptoms arise. We often see degenerative changes in the knee in cases of ACL (Anterior Cruciate Ligament) rupture or in the shoulder joint in chronic anterior instability cases.

ESR: Radiologists are part of a team; for sports imaging this likely consists of surgeons, orthopaedists, cardiologists and/or neurologists. How would you define the role of the radiologist within this team and how would you describe the cooperation between radiologists, surgeons, and other physicians?

NN: When radiologists work as part of a team, the patient receives many benefits. We cooperate with surgeons quite closely and learn from each other. Radiologists often watch operations and explain imaging results to colleagues. In most cases, it positively affects treatment and follow-up.

ESR: The role of the radiologist in determining diagnoses with sports imaging is obvious; how much involvement is there regarding treatment and follow-up?

NN: There was a case in my practice where a problem with the patient’s muscle returned because he had resumed sporting activity too early. The problem could have been prevented if the radiologist and physician had been in communication.

ESR: Radiology is effective in identifying and treating sports-related injuries and diseases, but can it also be used to pre-empt them? Can the information provided by medical imaging be used to enhance the performance of athletes?

NN: If one is able to carefully analyse damaged muscle by studying its anatomy, length, thickness (including tendon fibres), pennation angle (the angle which the muscle fascicles are attached to the tendon) and trauma circumstances, we could predict the performance of athletes and thereby find a way to enhance them. I enjoy research in muscle pennation and believe it holds great potential.

ESR: Many elite sports centres use cutting-edge medical imaging equipment and attract talented radiologists to operate it. Are you involved with such centres? How can the knowledge acquired in this setting be used to benefit all patients?

NN: It has always been a dream of mine to be involved in such projects. If you do something every day, you will quickly become highly skilled. This is definitely beneficial for the patient, especially regarding professional sports where the stakes are much higher.

ESR: The demand for imaging studies has been rising steadily over the past decades, placing strain on healthcare budgets. Has the demand also increased in sports medicine? What can be done to better justify imaging requests and make the most of available resources?

NN: In sports medicine, the demand for imaging has also increased. In every situation, a detailed and comparative calculation should be done in order to decide what is more cost effective; simple investigation or a more complex approach.

ESR: Athletes are more prone to injuries that require medical imaging. How much greater is their risk of developing diseases related to frequent exposure to radiation and what can be done to limit the negative impacts from overexposure?

NN: The risk of unhealthy radiation exposure in sports medicine is comparatively low. Nevertheless, we should consider replacing imaging involving x-ray or CT scans with non- ionising methods, where they are not needed.

ESR: Do you actively practise sports yourself and if yes, does this help you in your daily work as MSK radiologist?

NN: Yes, I do practice sports. I think it helps me better understand our patients; their feelings and needs.