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Quick summary From Chinzanso Hotel to Tokyo Station:  Taxi (≈30 mins) ~ ¥5,000 ($34). Tokyo to Kyoto on Shinkansen:  Nozomi train, ~ 2 hr 15 min, reserved seat ~ ¥14,500 ($95) per adult. Book early as the seats may be limited. Japan Rail Pass - JRailPass.com スマートEX Carry-On Rules for Shinkansen: Suitcases under 160 cm (sum of L+W+H) can be brought onboard. Larger luggage requires reservation or baggage forwarding. Baggage forwarding (Tokyo→Kyoto):  Most services are next day delivery. If available, same-day service is ~ ¥4,000 - ¥6,000 (US$28 - $44) per bag depending on size and weight. Ask concierge or Yamato/Kuroneko counter for exact quote. Kyoto Station → Hyatt Regency:  Taxi ~¥2000 (US$14) / ~10 min. Full details here: 1) From Hotel Chinzanso Tokyo → Tokyo Station By taxi (fastest):  ~30 minutes (typical fare about ¥5000 ) depending on traffic. Most taxi drivers in Tokyo do not speak English, so be sure to have your destination written on a card in Japanese or have the hotel doorman arrange the service. By subway / bus (cheaper):  walk ~10 min to Edogawabashi Station , then subway/bus connections to central Tokyo — fares ~ ¥170–¥310 , journey 30–45 min depending on route. Tokyo Taxi 2) Tokyo Station → Kyoto Station (Shinkansen) Typical travel time:  ~ 2 hours 15 minutes  on Nozomi / fastest services; Hikari slightly slower. JR Central Japan Rail Pass - JRailPass.com Typical one-way fare (ordinary car):  broadly ¥13,000–¥14,500  (varies by train type—Nozomi, Hikari, reserved vs non-reserved). Book early for best fares (SmartEX, JR Central online). Japan Rail Pass - JRailPass.com スマートEX Booking tips Buy tickets or reserve seats in advance via SmartEX  / JR Central / station ticket counters, especially if you travel with luggage. SmartEX offers advance discounts for some fares. スマートEX JR Central Shinkansen - Bullet Train Luggage on the Shinkansen — what you need to know Standard rule:  Passengers may bring luggage, but large suitcases are regulated. Luggage with total dimensions over 160 cm  should be managed (either use the designated oversized baggage area or make a reservation for a seat with an oversized baggage area). Items with total dimensions up to 250 cm  may be allowed as carry items (subject to limits and seat/area availability). In practice, suitcases under 160 cm total (height+width+depth)  travel without special arrangements. JR Central West Japan Railway Company Practical advice If your suitcase is ≤160 cm  total (e.g., 65 cm × 40 cm × 30 cm ≈ 135 cm total), you can bring it on board and stow it in the overhead or behind seats. If >160 cm (but ≤250 cm total), you must reserve  a seat with an oversized-baggage area (last-row seats on some cars) — no extra ticket surcharge, but reservation is required. Reserve early. West Japan Railway Company JR Central Kyoto Station 3) Kyoto Station → Hyatt Regency Kyoto Taxi:  ~10 minutes, fare around ¥2000  depending on route and traffic. Local train + short walk:  ~15–20 minutes (cheaper option). See hotel access instructions on arrival. hyattregency.hotel-kyoto.com Baggage-forwarding (takkyubin) — a popular option Why use it:  Send your checked suitcases from Hotel Chinzanso to Hyatt Regency Kyoto so you travel light on the train (highly recommended). Most hotels accept and drop off for kuroneko/Yamato or Japan Post takkyubin. Typical pricing / timing (examples & guidance) Next-day delivery (standard, widely available): typical range ¥3000–¥5000 per item depending on size (smaller bags cheaper; 160-size suitcase frequently ~¥2,000–¥3,000 Tokyo→Kyoto). Same-day delivery: available from selected Yamato / Kuroneko counters on some routes — prices vary and same-day service depends on pick-up time and destination (ask the provider or hotel concierge). Expect higher fees than next-day, in the ¥4000–¥6000 per item range. Video Guide To Luggage Delivery Service How to arrange Ask Hotel Chinzanso concierge to reserve takkyubin pickup and confirm delivery date — they will handle forms in English. Contact the concierge team directly at concierge@hotel-chinzanso.com Provide your Hyatt Regency Kyoto reservation name and arrival date (note: confirm the hotel will accept forwarded bags). Keep a copy of the takkyubin receipt and tracking number; delivery is usually next-day, but confirm if you need same-day service. Conclusion Whether you choose the Global Radiology CME seamless Kyoto Transfer and 1 Day Tour , the Kyoto Transfer and 3 Day Tour ,  or plan your own trip we look forward to seeing you at the Business and Wellness mini-conference in Kyoto. --Natalie and Kevin Rice

Trauma. What is the diagnosis? • Xray of the Week Figure 1. What is the diagnosis? Figure 2 :  Coronal CT Images display a fracture through the right cervical rib (red arrows). Figure 3 :  Axial and Coronal CT Images display edema in the soft tissues adjacent to the fracture (yellow arrows). Fracture of the Right Cervical Rib Overview and Rarity Cervical ribs are true supernumerary ribs arising from the C7 transverse process and are a common congenital variant on cross-sectional imaging; on large CT series they are present in roughly 2.0% of adults and are under-reported unless actively sought. [1] A fracture of a cervical rib is an exceedingly uncommon event described only in isolated case reports and small case series; reported mechanisms include direct trauma, falls, and repetitive occupational load (eg, heavy backpack use). [2,3] Clinical Findings Patients typically present with focal supraclavicular or neck pain, a palpable tender mass at the thoracic inlet, or delayed symptoms of thoracic outlet syndrome (TOS) — most often neurogenic (paresthesia/weakness in the ulnar distribution) and occasionally vascular (upper-extremity ischemia, digital emboli). Many reported fractures initially present as atraumatic swelling or delayed neurogenic symptoms after a remote injury. [2,3] Imaging — Modality Selection & Technique Thin-section multidetector CT (bone kernel, ≤1.0-mm collimation) with multiplanar reformats is the modality of choice for identifying cervical ribs and confirming fracture (cortical discontinuity, step-off, displacement, callus or sclerosis in healing) because plain radiographs frequently miss fractures at the cervicothoracic junction due to overlap and suboptimal projection. [4] Post-processing strategies that improve detection and reporting accuracy include coronal/oblique reformats through the rib axis, curved planar or “unfolded” rib reconstructions, and single-in-plane rib-cage reformations — all of which increase sensitivity for osseous injury and streamline preoperative planning. [5] When neurovascular compromise is suspected clinically or when the fracture lies close to the subclavian vessels/brachial plexus, CT angiography (CTA) with neutral and provocative/postural maneuvers (abduction or elevation of the ipsilateral arm) can demonstrate dynamic arterial or venous compression, stenosis, aneurysm, thrombosis, or abnormal vessel course related to the fractured cervical rib. Helical CTA protocols and multiplanar 3-D reformations are particularly helpful for surgical planning. [6,7] Imaging Findings — What to look for • Cervical rib identification:  a continuous osseous structure originating from the C7 transverse process that may articulate (partially or fully) with the first rib or clavicle. [1] • Acute fracture features:  sharp cortical break or lucent fracture line with surrounding soft-tissue swelling, displaced fragments, and occasionally small adjacent hematoma. [4] • Subacute/chronic healing:  sclerotic margins, callus formation or pseudoarthrosis at an articulation site that can mimic chronic nonunion; correlation with clinical history is essential. [2,3] • Relationship to neurovascular structures:  focal narrowing or indentation of the subclavian artery/vein, abnormal vessel angulation/arching, or proximity to the lower brachial plexus should be documented; dynamic imaging may demonstrate postural exacerbation. [6,7] • Associated findings:  first-rib abnormalities, anomalous fibrous bands, or concurrent first-rib or clavicular fractures — include these in the report because they alter management. [7] Differential considerations (imaging) Differentiate true acute fracture from: unfused ossification centers or congenital pseudoarthrosis, chronic nonunion/pseudarthrosis of a cervical rib, an anomalous elongated C7 transverse process, or osseous lesions (eg, osteophyte, benign bone tumor). Cortical irregularity plus focal bone marrow/soft-tissue edema on MRI (if obtained) or clear cortical disruption on bone-window CT favor acute fracture. [5] Treatment & Prognosis Initial management of isolated, uncomplicated cervical-rib fractures is generally conservative: activity modification, short-term immobilization/analgesia, and physiotherapy. Surgical referral is indicated when there is persistent pain, symptomatic nonunion/callus mass, or objective neurovascular compromise (TOS) attributable to the fractured rib. Surgical options include supraclavicular or transaxillary resection of the cervical rib (with ± scalenectomy and addressing fibrous bands), and preoperative vascular imaging is recommended when arterial or venous involvement is suspected. Outcomes are generally favorable after appropriate decompression; durable symptom relief is reported in series where resection was indicated. [8,9] References Viertel VG, Intrapiromkul J, Maluf F, Patel NV, Zheng W, Alluwaimi F, Walden MJ, Belzberg A, Yousem DM. Cervical ribs: a common variant overlooked in CT imaging. AJNR Am J Neuroradiol . 2012;33(11):2191-2194. doi: https://doi.org/10.3174/ajnr.A3143 . PubMed Kamath GS, Borkar S, Chauhan A, Chidanand B, Kashyap N, Warrier R. Isolated cervical rib fracture. Ann Thorac Surg . 2010;89(6):e41-e42. doi: https://doi.org/10.1016/j.athoracsur.2010.02.035 . PubMed Dar RA, Wani SH, Mushtaque M. Isolated cervical rib fracture: a rare etiology of thoracic outlet syndrome. Case Rep Surg . 2011;2011:163792. doi: https://doi.org/10.1155/2011/163792 . PubMed Jelly LM, Evans DR, Easty MJ, Coats TJ, Chan O. Radiography versus spiral CT in the evaluation of cervicothoracic junction injuries in polytrauma patients who have undergone intubation. Radiographics . 2000;20(Spec No):S251-S259. doi: https://doi.org/10.1148/radiographics.20.suppl_1.g00oc20s251 . PubMed Dankerl P, Seuss H, Ellmann S, Cavallaro A, Uder M, Hammon M. Evaluation of rib fractures on a single-in-plane image reformation of the rib cage in CT examinations. Acad Radiol . 2017;24(2):153-159. doi: https://doi.org/10.1016/j.acra.2016.09.022 . PubMed Remy-Jardin M, Remy J, Masson P, Bonnel F, Debatselier P, Vinckier L, Duhamel A. Helical CT angiography of thoracic outlet syndrome: functional anatomy. AJR Am J Roentgenol . 2000;174(6):1667-1674. doi: https://doi.org/10.2214/ajr.174.6.1741667 . PubMed Raptis CA, Sridhar S, Thompson RW, Fowler KJ, Bhalla S. Imaging of the patient with thoracic outlet syndrome. RadioGraphics . 2016;36(4):984-1000. doi: https://doi.org/10.1148/rg.2016150221 . PubMed Sanders RJ, Hammond SL. Management of cervical ribs and anomalous first ribs causing neurogenic thoracic outlet syndrome. J Vasc Surg . 2002;36(1):51-56. doi: https://doi.org/10.1067/mva.2002.123750 . PubMed Moridzadeh RS, Gelabert MC, Rigberg DA, Gelabert HA. A novel technique for transaxillary resection of fully formed cervical ribs with long-term clinical outcomes. J Vasc Surg . 2021;73(2):572-580. doi: https://doi.org/10.1016/j.jvs.2020.07.064 . PubMed Kevin M. Rice, MD is the president of Global Radiology CME and is a radiologist with Cape Radiology Group . He has held several leadership positions including Board Member and Chief of Staff at Valley Presbyterian Hospital in Los Angeles, California. Dr. Rice has made several media appearances as part of his ongoing commitment to public education. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. In 2015, Dr. Rice and Natalie Rice founded Global Radiology CME to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field. In 2016, Dr. Rice was nominated and became a semifinalist for a "Minnie" Award for the Most Effective Radiology Educator. He was once again a semifinalist for a "Minnie" for 2021's Most Effective Radiology Educator by AuntMinnie.com . He has continued to teach by mentoring medical students interested in radiology . Everyone who he has mentored has been accepted into top programs across the country including Harvard, UC San Diego, Northwestern, Vanderbilt, and Thomas Jefferson. Follow Dr. Rice on Twitter @KevinRiceMD All posts by Kevin M. Rice, MD

Pt fell and his eye hit a metal object. What is the diagnosis? • Xray of the Week Figure 1. What is the diagnosis? Figure 2. (CT- Axial and Sagittal):  Non-contrast CT of the orbits demonstrates hyperdense material consistent with blood in the anterior chamber (red arrows) of the left eye, indicating a hyphema. There is also hyperdense material in the posterior chamber consistent with acute vitreous hemorrhage (yellow arrows). Note the normal left lens separating the anterior and posterior chambers of the right globe (green arrows). Hyphema with Vitreous Hemorrhage Hyphema refers to hemorrhage into the anterior chamber of the eye, most often secondary to blunt or penetrating trauma, ocular surgery, or coagulopathy [1,2]. Vitreous hemorrhage represents bleeding into the vitreous body, typically associated with trauma, proliferative diabetic retinopathy, retinal tears, or other vascular etiologies [1,2]. Figure 3. Traumatic hyphema c linical image:   Note the layering blood in the anterior chamber in this patient following blunt eye trauma. Contributor : Jesse Vislisel, MD - EyeRounds.org The University of Iowa. Creative Commons 3.0 https://webeye.ophth.uiowa.edu/eyeforum/atlas/pages/Hyphema/index.htm#gsc.tab=0 ) CT Imaging Findings On non-contrast orbital CT, hyphema appears as a hyperdense collection filling or layering in the anterior chamber, anterior to the lens [2-5]. (Figs. 1,2) Clinically, blood is seen layering in the anterior chamber (Fig. 3). Reported sensitivity for hyphema detection is approximately 77%, with specificity of 88% [3]. Vitreous hemorrhage demonstrates increased attenuation within the vitreous chamber, which may appear homogeneous or heterogeneous depending on the chronicity and amount of blood [1,4]. CT is particularly useful when ophthalmologic examination is limited due to periorbital swelling, pain, or suspected open-globe injury. It also provides assessment for associated ocular or orbital trauma including lens dislocation , foreign bodies, or globe rupture [2,3]. Ultrasonography can be used to assess for posterior segment issues like retinal detachment or vitreous hemorrhage [6]. Treatment & Prognosis Management is directed by ophthalmology. Traumatic hyphema is significant because it may lead to corneal blood staining, decreased corneal transparency, and vision impairment [3]. For hyphema, treatment is usually conservative including eye shielding, head elevation, and avoidance of anticoagulants. Surgical intervention may be required in cases of delayed clot resorption as this can lead to secondary glaucoma . Vitreous hemorrhage may resolve spontaneously, although persistent cases require vitrectomy. Prognosis is favorable for isolated cases, though risks increase with rebleeding, elevated intraocular pressure, sickle cell disease, or extensive posterior segment involvement [1,6]. References Spraul CW, Grossniklaus HE. Vitreous hemorrhage. Surv Ophthalmol . 1997;42(1):3-39. https://doi.org/10.1016/S0039-6257(97)84041-6 Sung EK, Nadgir RN, Fujita A, et al. Injuries of the Globe: What Can the Radiologist Offer? Radiographics . 2014;34(3):764-776. https://doi.org/10.1148/rg.343135120 Chazen JL, El-Sayed IH, Vance S, et al. CT in the evaluation of acute injuries of the anterior eye segment. AJR Am J Roentgenol . 2018;210(3):W107-W113. https://doi.org/10.2214/AJR.17.18279 Hallinan JTPD, Pillay P, Koh L, Goh K, Yu W. Eye globe abnormalities on MR and CT in adults: An anatomical approach. Korean J Radiol . 2016;17(5):664-673. https://doi.org/10.3348/kjr.2016.17.5.664 Gad K, Singman EL, Nadgir RN, Yousem DM, Pillai JJ. CT in the Evaluation of Acute Injuries of the Anterior Eye Segment. AJR Am J Roentgenol . 2017;209(6):1353-1359. doi: 10.2214/AJR.17.18279 Rabinowitz R, Yagev R, Shoham A, Lifshitz T. Comparison between clinical and ultrasound findings in patients with vitreous hemorrhage. Eye (Lond) . 2004;18(3):253-256. https://doi.org/10.1038/sj.eye.6700632 Kevin M. Rice, MD is the president of Global Radiology CME and is a radiologist with Cape Radiology Group . He has held several leadership positions including Board Member and Chief of Staff at Valley Presbyterian Hospital in Los Angeles, California. Dr. Rice has made several media appearances as part of his ongoing commitment to public education. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. In 2015, Dr. Rice and Natalie Rice founded Global Radiology CME to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field. In 2016, Dr. Rice was nominated and became a semifinalist for a "Minnie" Award for the Most Effective Radiology Educator. He was once again a semifinalist for a "Minnie" for 2021's Most Effective Radiology Educator by AuntMinnie.com . He has continued to teach by mentoring medical students interested in radiology . Everyone who he has mentored has been accepted into top programs across the country including Harvard, UC San Diego, Northwestern, Vanderbilt, and Thomas Jefferson. Follow Dr. Rice on Twitter @KevinRiceMD All posts by Kevin M. Rice, MD

What is the diagnosis? • Xray of the Week Figure 1. What is the diagnosis? Figure 2. Frontal chest radiograph reveals a curvilinear radiopaque tubular structure paralleling the right cardiac border (red arrows) —the classic “scimitar vein.” The right lung is also mildly hypoplastic. Figure 3. (Contrast-Enhanced CT):  Coronal images demonstrate the anomalous right pulmonary vein (red arrows) draining into the inferior vena cava (yellow arrows), confirming the diagnosis. Scimitar Syndrome (Congenital Pulmonary Venolobar or Hypogenetic Lung Syndrome) Definition & Epidemiology Scimitar Syndrome is a rare congenital condition characterized by partial anomalous pulmonary venous return (PAPVR), where pulmonary veins from the right lung drain into systemic veins—most commonly the inferior vena cava. The condition derives its name from the characteristic curvilinear vascular shadow on chest radiography, which resembles a scimitar sword. The estimated incidence is approximately 1–3 per 100,000 live births [1,12]. Imaging Findings On chest radiography, the hallmark finding is a vertically oriented, curved opacity along the right cardiac border representing the anomalous pulmonary vein, the “scimitar sign.” Associated features may include right lung hypoplasia, dextroposition of the heart due to reduced right lung volume, and sometimes systemic arterial supply to the right lower lobe. These findings, although classic, are variably present and require confirmatory cross-sectional imaging. [2,3,10,13]. Contrast-enhanced CT better delineates the anomalous venous drainage, confirms the connection to the IVC, and demonstrates associated anomalies—such as right pulmonary artery hypoplasia, anomalous systemic arterial supply from the aorta, bronchial anomalies and atrial septal defects, which frequently coexist. [3,16,11]. Clinical Relevance & Classification Two clinical variants exist: the infantile form, which often presents with pulmonary hypertension, heart failure, and more complex anatomy; and the adult/adult-variant form, frequently asymptomatic and diagnosed incidentally in adulthood [5,12]. Treatment & Prognosis Management depends on symptom severity and associated anomalies. Asymptomatic patients with adequate right lung function may not require intervention. Symptomatic infants with recurrent infections, pulmonary hypertension, or significant left-to-right shunt often undergo surgical rerouting of the anomalous vein to the left atrium, or coil/embolization of anomalous systemic arterial supply [6,7]. Prognosis is variable, with better outcomes in isolated cases without pulmonary hypertension or cardiac malformations [7]. References Dupuis C, Charaf LA, Brevière GM, Abou P, Rémy-Jardin M, Helmius G. The "adult" form of the scimitar syndrome. Am J Cardiol . 1992;70(4):502-507. doi: 10.1016/0002-9149(92)91198-d Roehm JOF, Jue KL, Amplatz K. Radiographic features of the scimitar syndrome. Radiology . 1966;86(5):856-859. https://doi.org/10.1148/86.5.856 Canter CE, Martin TC, Spray TL, Weldon CS, Strauss AW. Scimitar syndrome in childhood. Am J Cardiol . 1986;58(7):652-654. doi: 10.1016/0002-9149(86)90296-1 Masrani A, McWilliams S, Bhalla S, Woodard PK. Anatomical associations and radiological characteristics of scimitar syndrome on CT and MR. J Cardiovasc Comput Tomogr . 2018;12(4):286-289. https://doi.org/10.1016/j.jcct.2018.02.001 Konen E, Raviv-Zilka L, Cohen RA, et al. Congenital pulmonary venolobar syndrome: spectrum of helical CT findings with emphasis on computerized reformatting. RadioGraphics . 2003;23(5):1175-1184. https://doi.org/10.1148/rg.235035004 Berrocal T, Madrid C, Novo S, Gutiérrez J, Arjonilla A, Gómez-León N. Congenital anomalies of the tracheobronchial tree, lung, and mediastinum: embryology, radiology, and pathology. RadioGraphics . 2004;24(1):e17. https://doi.org/10.1148/rg.e17 Ngai C, Freedberg RS, Latson L, et al. Multimodality imaging of scimitar syndrome in adults: A report of four cases. Echocardiography . 2018;35(10):1684-1691. DOI: 10.1111/echo.14124 Kevin M. Rice, MD is the president of Global Radiology CME and is a radiologist with Cape Radiology Group . He has held several leadership positions including Board Member and Chief of Staff at Valley Presbyterian Hospital in Los Angeles, California. Dr. Rice has made several media appearances as part of his ongoing commitment to public education. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. In 2015, Dr. Rice and Natalie Rice founded Global Radiology CME to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field. In 2016, Dr. Rice was nominated and became a semifinalist for a "Minnie" Award for the Most Effective Radiology Educator. He was once again a semifinalist for a "Minnie" for 2021's Most Effective Radiology Educator by AuntMinnie.com . He has continued to teach by mentoring medical students interested in radiology . Everyone who he has mentored has been accepted into top programs across the country including Harvard, UC San Diego, Northwestern, Vanderbilt, and Thomas Jefferson. Follow Dr. Rice on Twitter @KevinRiceMD All posts by Kevin M. Rice, MD

What is this foreign body in the abdomen? • Xray of the Week Figure 1. What is this foreign body in the abdomen? Figure 2. Plain abdominal radiograph at approximately 30 hours after ingestion of patency capsule. A radio‑opaque foreign body (~2.6 cm × 1.1 cm) is noted in the abdomen, consistent with retained patency capsule. Figure 3. Enlarged and abdomen radiograph demonstrates foreign body consistent with Patency Capsule in the bowel. Patency Capsule: Imaging Appearance and Clinical Utility The patency capsule  is a dissolvable, radio-opaque capsule used to assess small bowel patency prior to capsule endoscopy (Figs. 1-3). It is particularly important in patients at risk for strictures, such as those with Crohn disease or a history of abdominal surgery [1,3]. The capsule is similar in size to a standard video capsule (approximately 26 mm × 11 mm ) and contains a barium-impregnated lactose core, sometimes with an RFID tag for scanner detection [1,2]. After oral ingestion, no specific bowel prep is typically required. Imaging is performed at ~28–30 hours  to confirm whether the capsule has passed [2,4]. If not seen on X-ray, functional patency is assumed. If visible, retention is suspected—though location (small bowel vs colon) can be difficult to determine on planar images alone [2,3]. If retained, CT can help confirm location and avoid false-positive findings [2,5]. Delayed imaging (e.g., at 72 hours) may further improve diagnostic yield without increasing risk [4]. The capsule begins to dissolve at ~30–33 hours, minimizing the risk of obstruction [1,2]. Conclusion The patency capsule is a valuable tool to assess small bowel patency and reduce the risk of capsule retention . Radiologists should recognize its appearance and assess for passage at ~30 hours post-ingestion, using adjunct imaging if needed. References Spada C, Spera G, Riccioni ME, et al. A novel diagnostic tool for detecting functional patency of the small bowel: the Given patency capsule. Endoscopy . 2005;37(9):793–800. https://doi.org/10.1055/s-2005-870246 Costigan C, O’Hara FJ, McNamara D. Patency testing improves capsule retention rates but at what cost? Front Med (Lausanne) . 2023;10:1046155. https://doi.org/10.3389/fmed.2023.1046155 Nemeth A, Kopylov U, Koulaouzidis A, et al. Use of patency capsule in patients with established Crohn’s disease. Endoscopy . 2016;48(4):373–379. https://doi.org/10.1055/s-0034-1393560 O’Hara FJ, Costigan C, McNamara D. Extended 72-hour patency capsule protocol improves functional patency rates in high-risk patients undergoing capsule endoscopy. World J Gastrointest Endosc . 2024;16(12):661–667. https://doi.org/10.4253/wjge.v16.i12.661 Kim YE, Kim YJ, Kim KO, et al. Patency Capsule and Cross-Sectional Imaging for Predicting Capsule Endoscopy Retention: A Systematic Review and Meta-Analysis. Dig Dis Sci . 2025;70(2):761–773. https://doi.org/10.1007/s10620-024-08835-6 Kevin M. Rice, MD is the president of Global Radiology CME and is a radiologist with Cape Radiology Group . He has held several leadership positions including Board Member and Chief of Staff at Valley Presbyterian Hospital in Los Angeles, California. Dr. Rice has made several media appearances as part of his ongoing commitment to public education. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. In 2015, Dr. Rice and Natalie Rice founded Global Radiology CME to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field. In 2016, Dr. Rice was nominated and became a semifinalist for a "Minnie" Award for the Most Effective Radiology Educator. He was once again a semifinalist for a "Minnie" for 2021's Most Effective Radiology Educator by AuntMinnie.com . He has continued to teach by mentoring medical students interested in radiology . Everyone who he has mentored has been accepted into top programs across the country including Harvard, UC San Diego, Northwestern, Vanderbilt, and Thomas Jefferson. Follow Dr. Rice on Twitter @KevinRiceMD All posts by Kevin M. Rice, MD

Don’t Miss This Unique Experience Imaging in Japan 2026  isn’t just a conference—it’s an opportunity to grow, connect, and be inspired  in one of the most extraordinary countries in the world. 📅 Conference Dates:  June 1–5, 2026  📍 Location:  Hotel Chinzanso Tokyo + Optional Mini-Conference at Hyatt Regency Kyoto  🔗 View the full program and register now → www.globalradiologycme.com/imaging-in-japan2026 Here are the top 10 reasons you should attend Imaging in Japan 2026: 1. Leading edge, captivating Scientific Program delivered by a World-Class Faculty Led by Scientific Director Neil M. Rofsky, the 2025 program will feature topics in body imaging, cardiothoracic imaging, MSK, neuroradiology, and emergency radiology. Faculty include some of the most respected names in the field: Donald Resnick, Ella Kazerooni, Amish Doshi, and Karen Lee. 2. Tokyo is ranked one of the top cities to visit in the world Travel + Leisure ranked Tokyo #3 in their readers favorite cities in the world in 2026. Forbes ranked Tokyo #3 of Best Cities in the world to visit in 2026. 3. Interactive and engaging Lunch Round Tables Back by popular demand, our daily Round Table sessions offer a chance to discuss current imaging and leadership topics in an informal setting with the faculty. These sessions are often cited by attendees as a highlight of the educational program. 4. The Chinzanso Hotel: A Hidden Gem in the Heart of Tokyo The conference venue, Hotel Chinzanso Tokyo, is a luxurious garden retreat tucked away in central Tokyo. You’ll attend sessions surrounded by centuries-old camellia trees, koi ponds, and stone paths—an inspiring and peaceful place to learn. 5. Kyoto: A Spiritual and Cultural Retreat Don’t miss the optional Wellness and Business Mini-Conference on June 5, 2026 at the Hyatt Regency Kyoto. Explore Japan’s former imperial capital, home to over 1,600 temples, zen gardens, and world-famous sites like the Fushimi Inari Shrine and Arashiyama Bamboo Forest. 6. Cruise and Dinner on Tokyo Bay Network with fellow  registrants and faculty while enjoying a spectacular evening cruise on Tokyo Bay, complete with dinner, drinks, and panoramic views of the city skyline and Rainbow Bridge.  7. Explore Tokyo’s Contrasts From the bustling energy of Shibuya Crossing to the quiet elegance of the Meiji Shrine, Tokyo is a city of contrasts. Shop in Ginza, experience a traditional tea ceremony, take a ride in a rickshaw or marvel at the views from Tokyo Skytree—all just a short ride from the conference hotel. 8. Soak in a Traditional Onsen Experience the healing waters of a Japanese onsen. Whether in Tokyo or Kyoto, you’ll find beautifully designed public baths and hotel spas that offer the perfect post-conference wind-down. 9. Savor Michelin-Starred Cuisine and Street Food Japan has more Michelin-starred restaurants than anywhere else on earth—but the culinary scene goes far beyond fine dining. Don’t leave without trying fresh sushi at Tsukiji Market, sizzling yakitori in a local izakaya, or warm taiyaki from a street vendor. 10. Ride the Shinkansen (Bullet Train) Fast, efficient, and a uniquely Japanese experience, the Shinkansen connects Tokyo and Kyoto in just over two hours.  Experience an exceptional radiology education alongside a memorable cultural journey at this distinctive conference by Global Radiology CME. The Imaging in Japan 2026 event offers professional growth, networking opportunities, and wellness for radiologists worldwide in a culturally vibrant country that seamlessly integrates ancient traditions with contemporary innovations.

61-year-old male with abdominal pain 15 days after capsule endoscopy. • Xray of the Week Figure 1. What are the important findings in this case. Figure 2. Frontal abdomen radiograph demonstrates foreign body consistent with capsule endoscopy device (pill cam) in descending colon. Capsule Retention and Risk Factors: Capsule endoscopy is used for evaluating small-bowel disorders, such as bleeds and Crohn disease.[1] This diagnostic procedure involves swallowing a pill-sized camera that records thousands of images of the alimentary canal including the small intestine, an area difficult to examine via traditional endoscopy. Retention of the camera-containing capsule is the main complication of capsule endoscopy. Traditionally, capsule retention (CR) is defined as the presence of a capsule in the digestive tract for a minimum of 2 weeks. Approximately 2% of all capsule endoscopies result in CR [2] The clinical indication for capsule endoscopy is correlated with different rates of CR. Retention rates for patients post-capsule endoscopy for chronic diarrhea or abdominal pain is approximately 2%.[3] For patients with a greater likelihood of small bowel strictures, retention rates increase to 13%.[4] The highest CR rates of 10-20% are in patients being evaluated for subacute small bowel obstructions.[5,6] Capsule retention can be often be prevented by assessment of functional patency with a Patency Capsule . Use of high-dose non-steroidal anti-inflammatory drugs, previous abdominal radiation therapy, and history of small bowel restrictions generally increase the risk of CR post-capsule endoscopy.[2] Imaging: In asymptomatic patients, plain abdominal x-ray 15-days following capsule ingestion is the preferred confirmation imaging of CR. If capsule endoscopy findings suggest potential CR, then performing an abdominal x-ray 7-days post-capsule ingestion is advisable, since most capsules are excreted within 3-7 days. Capsules that reach the cecum generally are secreted as cases of colonic CR accounting for less than 1% of all retention [7]. Computed tomography (CT) could be used to determine the capsule’s location if it is difficult to do so via x-ray. Treatment: Asymptomatic patients are monitored initially, given that 35-50% of patients with CR naturally excrete the capsule after more than 15 days.[8,9] Surgical or device-assisted enteroscopy retrieval of the capsule is indicated for asymptomatic patients 3-6 months following capsule ingestion. For patients with inflammatory bowel disease, the use of steroids has been shown to assist the excretion of capsules in up to 20-30% of all CR cases.[2] Importance of Prompt Management: Patients with missed CR could develop bowel obstruction and perforation.[2] Disintegration of the capsule could expose the camera’s lithium battery to the digestive tract, increasing the risk of mucosal damage. Identifying and managing CR is important to prevent avoidable gastrointestinal complications. ​​​​ References: 1. Lee HS, Lim YJ, Kim KO, et al. Outcomes and Management Strategies for Capsule Retention: A Korean Capsule Endoscopy Nationwide Database Registry Study. Dig Dis Sci. 2019;64(11):3240-3246. doi: 10.1007/s10620-019-05659-7 2. Rondonotti E. Capsule retention: prevention, diagnosis and management. Ann Transl Med. 2017;5(9):198. doi: 10.21037/atm.2017.03.15 3. Rezapour M, Amadi C, Gerson LB. Retention associated with video capsule endoscopy: systematic review and meta-analysis. Gastrointest Endosc. 2017;85(6):1157-1168.e2. doi: 10.1016/j.gie.2016.12.024 4. Cheifetz AS, Lewis BS. Capsule endoscopy retention: is it a complication? J Clin Gastroenterol. 2006;40(8):688-691. doi: 10.1097/00004836-200609000-00005 5. Cheifetz AS, Sachar DB, Lewis BS. Small Bowel Obstruction — Indication or Contraindication for Capsule Endoscopy. Gastrointest Endosc. 2004;59(5):P102. doi: 10.1016/S0016-5107(04)00509-7 6. Yang XY, Chen CX, Zhang BL, et al. Diagnostic effect of capsule endoscopy in 31 cases of subacute small bowel obstruction. World J Gastroenterol. 2009;15(19):2401-2405. doi: 10.3748/wjg.15.2401 7. Sachdev MS, Leighton JA, Fleischer DE, et al. A prospective study of the utility of abdominal radiographs after capsule endoscopy for the diagnosis of capsule retention. Gastrointest Endosc. 2007;66(5):894-900. doi: 10.1016/j.gie.2007.06.066 8. Fernández-Urién I, Carretero C, González B, et al. Incidence, clinical outcomes, and therapeutic approaches of capsule endoscopy-related adverse events in a large study population. Rev Esp Enferm Dig. 2015;107(12):745-752. doi: 10.17235/reed.2015.3820/2015 9. Rondonotti E, Soncini M, Girelli C, et al. Small bowel capsule endoscopy in clinical practice: a multicenter 7-year survey. Eur J Gastroenterol Hepatol. 2010;22(11):1380-1386. doi: 10.1097/MEG.0b013e3283352ced Eric Errampalli is a passionate medical student at the University of Missouri – Kansas City Six-Year BA/MD Program , with a steadfast commitment to becoming a radiologist. His fascination with the field stems from its integral role in healthcare and the endless possibilities for technological advancements waiting to be made. At UMKC, Eric has made significant contributions to the Radiology Interest Group, serving in various executive roles and currently as the interventional radiology chair. His leadership has inspired his peers to explore the field and discover the boundless opportunities for growth and impact. Beyond UMKC, Eric's interests have risen to a national level, as he serves on the Society of Interventional Radiology Medical Student Council Education Committee and TheRadRoom IR Team . Through these platforms, he has been instrumental in shaping the future of interventional radiology education and promoting awareness of the field among medical students. Eric's passion for innovation extends beyond the classroom, as he strives to help drive change in the field of radiology through his medical entrepreneurial ventures. He believes that entrepreneurship can unlock untapped potential in the field and pave the way for transformative breakthroughs that can improve patient outcomes and revolutionize healthcare. To stay up to date on Eric's journey and learn more about his work, follow Eric on Twitter @EricErrampalli and connect with him on LinkedIn www.linkedin.com/in/eric-errampalli/ All posts by Eric Errampalli Kevin M. Rice, MD is the president of Global Radiology CME and is a radiologist with Cape Radiology Group . He has held several leadership positions including Board Member and Chief of Staff at Valley Presbyterian Hospital in Los Angeles, California. Dr. Rice has made several media appearances as part of his ongoing commitment to public education. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. In 2015, Dr. Rice and Natalie Rice founded Global Radiology CME to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field. In 2016, Dr. Rice was nominated and became a semifinalist for a "Minnie" Award for the Most Effective Radiology Educator. He was once again a semifinalist for a "Minnie" for 2021's Most Effective Radiology Educator by AuntMinnie.com . He has continued to teach by mentoring medical students interested in radiology . Everyone who he has mentored has been accepted into top programs across the country including Harvard, UC San Diego, Northwestern, Vanderbilt, and Thomas Jefferson. Follow Dr. Rice on Twitter @KevinRiceMD All posts by Kevin M. Rice, MD

63 year old male. Headache for 1 month and unsteady gait. What is the diagnosis? • Xray of the Week Figure 1. Brain CT. Name the significant findings. Figure 2. A, B, C: Non-contrast axial CT displaying subtle bilateral isodense subdural hematomas. There is medial displacement of gray matter with left (orange arrows) worse than right (red arrows). Shift of midline structures to the right is also a clue to the diagnosis. D: Non-contrast coronal CT indicating isodense subdural hematoma (orange arrows). Note again the midline shift to the right. Figure 3. Post op CT brain on same patient. Note the lower attenuation fluid after treatment. Partial evacuation of hematoma with hypodense regions indicating residual fluid and blood products (red and orange arrows). Discussion: Subacute subdural hematomas (SDH) are usually due to clinically undetected acute SDH. Two leading causes are tearing of the bridging vessels due to abrupt acceleration-deceleration of the head or accumulation around a parenchymal laceration (1). This trauma leads to blood accumulation between the arachnoid and dura layers of the brain (2). Risk factors include cerebral atrophy (elderly patients or chronic alcoholics), anticoagulation use, or recent thrombolysis (3). The patient may or may not have a history of head trauma. Common presenting features include headache, decreased memory, confusion, and motor dysfunction (4). SDH can cross suture lines since they occur deep to the dura mater; this differs from epidural hematomas which usually do not cross suture lines since blood cannot extend beyond the point where the dura attaches to the cranial sutures (5). Subacute subdural hematomas are categorized as isodense biconcavities on CT. When blood clots degrade, the density decreases and becomes more similar to the brain parenchyma. Furthermore, subacute (and chronic) SDHs may show septations within an iso/hypodense hematoma due to reactive granulation tissue formation (6). Subacute hemorrhages can be challenging to recognize because of the isodense characteristics. Therefore, one must also look for signs of mass effect such as asymmetry of the lateral ventricles, shifting of midline structures, sulcal effacement, and sulci that do not extend into the skull (Figs. 1-2) (7). Management of subacute SDH is determined by whether a patient is symptomatic or exhibiting signs of mass effect; those who are asymptomatic may be candidates for conservative treatment (8). Mainstay surgery modalities include twist-drill craniostomy, burr-hole craniostomy, and craniotomy (8). Figure 2 shows this patient following bilateral craniotomy. ​​​​ References: Williams KA Jr, Kouloumberis P, Engelhard HH. Subacute subdural hematoma in a 45-year-old woman with no significant past medical history after a roller coaster ride. Am J Emerg Med . 2009;27(4):. doi: 10.1016/j.ajem.2008.08.005 Pierre L, Kondamudi NP. Subdural Hematoma. [Updated 2019 Dec 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532970/ Lupescu IC, Stefanescu VC, Lupescu IG, Dulamea AO. Subacute Subdural Hematoma Presenting as Non-Fluent Aphasia. Maedica (Bucur) . 2019;14(1):63-66. doi: 10.26574/maedica.2019.14.1.63 Yadav YR, Parihar V, Namdev H, Bajaj J. Chronic subdural hematoma. Asian J Neurosurg . 2016;11(4):330-342. doi: 10.4103/1793-5482.145102 Heit JJ, Iv M, Wintermark M. Imaging of Intracranial Hemorrhage. J Stroke . 2017;19(1):11-27. doi: 10.5853/jos.2016.00563 Grainger and Allison. Adam Kenji Yamamoto and Ashok Adams: Grainger & Allison's Diagnostic Radiology, 54, 1387-1410 Emergency Radiology. Glenn D. Barest, Asim Z. Mian, Rohini N. Nadgir and Osamu Sakai: Emergency Radiology: The Requisites, Chapter 1, 1-60 Cai Q, Guo Q, Zhang F, et al. Evacuation of chronic and subacute subdural hematoma via transcranial neuroendoscopic approach. Neuropsychiatr Dis Treat . 2019;15:385-390. Published 2019 Jan 30. doi: 10.2147/NDT.S193548 Deven Champaneri is a medical student at Edward Via College Osteopathic Medicine (VCOM) – Carolinas and plans to pursue residency in diagnostic radiology. While he was rotating through various specialties, he realized his passion for DR and valued its role in all aspects of medicine. He graduated from the University of South Carolina in 2017 with a degree in Business Marketing. During his undergraduate studies, he was involved with multiple volunteer organizations, such as Camp Kemo a summer camp for children with cancer and Palmetto Richland Children’s Hospital . Currently, he mentors at-risk high-school students and tutors students for Step 1/COMLEX 1. In his spare time he enjoys, golfing, backpacking, cooking, and spending time with family. UPDATE 2025: Dr. Champaneri is now a radiology resident at Medical University of South Carolina Follow Deven Champaneri on Twitter @ devenchampaneri All posts by Deven C hampaneri Kevin M. Rice, MD is the president of Global Radiology CME Dr. Rice is a radiologist with Renaissance Imaging Medical Associates and is currently the Vice Chief of Staff at Valley Presbyterian Hospital in Los Angeles, California. Dr. Rice has made several media appearances as part of his ongoing commitment to public education. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. In 2015, Dr. Rice and Natalie Rice founded Global Radiology CME to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field. In 2016, Dr. Rice was nominated and became a semifinalist for a "Minnie" Award for the Most Effective Radiology Educator. Follow Dr. Rice on Twitter @KevinRiceMD All posts by Kevin M. Rice, MD

Global Radiology CME is pleased to congratulate the Award Winners for Best E-Posters and The Donald Resnick MSK Quiz at Imaging in Prague 2019. Awards were presented at The Gala Dinner at the Prague Municipal House on June 10, 2019. Neuroradiology E-Poster: Victor Teng - Flexion MRI in Hirayama Disease Dr. Teng is a radiologist at National University Health System Singapore. He was presented with the Award by Dr. Blake Johnson, Co-Scientific Director and Neuroradiology Faculty for Imaging in Prague 2019. Body Imaging E-Poster: Grace Rubin - Breast Tuberculosis - A review of 62 cases Dr. Rubin is Clinical Head of Radiology, at Helen Joseph Hospital in Johannesburg, a University of Witwatersrand affiliated academic hospital. She was presented with the Award by Dr. Neil Rofsky, Body Imaging Faculty at Imaging in Prague 2019. MSK Imaging E-Poster: Junsiyuan Li - Fibrolipomatous Hamartoma of the Median Nerve Dr. Li is a senior radiology resident at Singapore General Hospital, SingHealth. He was presented with the Award by Dr. Phillip Tirman, Co -Scientific Director and MSK Imaging Faculty at Imaging in Prague 2019. Donald Resnick MSK Quiz Award: Andrew Kingzett Taylor Dr. Kingzett Taylor serves as an MSK radiologist at Pacific Radiology, located in Wellington and Manawatu, New Zealand. He completed a visiting fellowship at the MSK Section of UCSF and the San Francisco MRI Centre. Dr. Donald Resnick, an ACR Gold Medalist and esteemed MSK Imaging faculty member of Global Radiology CME, is seen presenting him with the Award. More award winners here .

This prestigious award is presented by Professor Resnick to the winner of his annual MSK imaging quiz at the Global Radiology CME conference. Participants are challenged with complex MSK imaging cases at the start of the day, with answers revealed during the final time slot of the MSK session. Dr. Resnick's reputation for presenting captivating and often surprising cases adds an element of intrigue to the session, making it a highlight of the conference for many attendees. The trophy symbolizes not only excellence in MSK imaging but also the dedication and commitment of the winner to the field. Join us at our next conference to test your skills and compete for this coveted award. 2025  - Shown above is Dr. Donald Resnick, the world's leading authority in musculoskeletal imaging, presenting the prestigious Global Radiology CME  Resnick MSK Quiz Award  to Dr. Andrew Whan of Barwon Medical Imaging in the Melbourne region of Australia during Imaging in Greece 2025 . Dr. Whan completed his radiology training at Austin Hospital, earning the Gold Medal as the top candidate in the Royal Australian and New Zealand College of Radiologists (RANZCR) Fellowship Exam. In 2001, he undertook advanced fellowship training in MRI and breast imaging at Austin Hospital, followed by additional fellowship training in musculoskeletal MRI in Perth. Dr. Whan currently serves as an Examiner for RANZCR  and holds the position of Associate Professor and Tutor at Deakin Medical School , Deakin University. 2024 - Pictured above is the authority in MSK imaging, Dr. Donald Resnick presenting the coveted Global Radiology CME annual Resnick MSK Quiz Award to Andrew Kingzett Taylor of Pacific Radiology in New Zealand at Imaging in Copenhagen 2024 . This marks his second win, following his previous award in 2019. Dr. Kingzett Taylor was a visiting fellow to the musculoskeletal section at the University of California, San Francisco in 1998 and 1999. 2023 - Pictured above is the MSK radiology luminary and prolific writer, Dr. Donald Resnick presenting the much sought after Global Radiology CME annual Resnick MSK Quiz Award to Stuart Rubin of Windsong Radiology in Buffalo, New York at Imaging in Israel 2023 . Dr. Rubin did a MSK fellowship at Columbia-Presbyterian Medical Center in New York, NY. He comes from a family of three generations of doctors. In addition to his father and grandfather, his siblings are all physicians. 2022  - Dr. Donald Resnick, the legendary MSK radiologist, is seen presenting the prestigious Global Radiology CME annual Resnick MSK Quiz Award to Nancy Prendergast of University Radiology Group in New Jersey, USA at Imaging in Dublin 2022 . Following medical school at Brown University and radiology residency at New York University Medical Center, Dr. Prendergast completed a Musculoskeletal Radiology fellowship at New York University Medical Center in 1993. 2019 - Dr. Donald Resnick, the 2018 ACR Gold Medalist, is shown in the image awarding the inaugural Global Radiology CME Resnick MSK Quiz Award to Andrew Kingzett Taylor of Pacific Radiology in New Zealand at Imaging in Prague 2019 . Seen above, Dr. Resnick expressed his admiration for Dr. Kingzett Taylor's exceptional performance in interpreting the complex cases.

26 M jumped to catch a baseball and landed on his left foot while rotating to the right . Diagnosis? • Xray of the Week Figure 1. The patient jumped to catch a baseball and landed on his left foot while rotating to the right . Diagnosis? Figure 2. Lateral Subtalar Joint Dislocation . (A) AP radiograph demonstrates the talus (yellow arrow) with anatomical alignment to the distal tibia. The calcaneus (blue arrow) and navicular are rotated laterally. (B) Lateral radiograph demonstrates the talus (yellow arrow) with anatomical alignment to the distal tibia. The calcaneus (blue arrow) is rotated laterally. Subtalar Joint Dislocation Subtalar joint dislocation is a rare but significant orthopedic injury characterized by the disruption of the talocalcaneal and talonavicular articulations while preserving the tibiotalar and calcaneocuboid joints. It accounts for approximately 1% of all dislocations and typically results from high-energy trauma, such as motor vehicle accidents, falls from height, or sports injuries. Medial dislocations, also known as acquired clubfoot , constitute about 80% of cases, whereas lateral dislocations ( acquired flatfoot ) account for the remaining 20%. Posterior and anterior dislocations are exceedingly rare. Etiology and Pathophysiology The injury mechanism involves forced inversion or eversion of the foot with an axial load. Medial dislocations result from inversion forces, leading to disruption of the lateral ligamentous structures and impingement of the talar head against the extensor tendons. As in this case, lateral dislocations result from eversion forces, causing injury to the deltoid ligament and potentially the posterior tibial tendon. Associated fractures, particularly of the lateral process of the talus or the anterior calcaneal process, are present in up to 50% of cases and may complicate reduction. Imaging Findings Radiographic evaluation is the first-line imaging modality, with anteroposterior, lateral, and oblique foot radiographs demonstrating misalignment of the talocalcaneal and talonavicular joints (Figs. 1,2). Medial dislocations present with the talar head displaced laterally and the calcaneus medially, while lateral dislocations exhibit the opposite pattern. Fractures of the lateral talar process, anterior calcaneal process, or posterior malleolus should be carefully assessed. CT imaging is invaluable in evaluating associated fractures, assessing articular congruity post-reduction, and planning surgical intervention if necessary. Multiplanar reconstructions can aid in identifying subtle talar dome impaction or osteochondral injuries. MRI is reserved for evaluating ligamentous and tendinous injuries, particularly in chronic or irreducible cases. Treatment and Prognosis Closed reduction under sedation or anesthesia is the primary treatment modality. Reduction is typically achieved by applying traction and reversing the mechanism of injury, followed by immobilization in a short-leg cast or boot for 4–6 weeks. Open reduction may be required in cases of interposed soft tissue or osteochondral fragments preventing closed reduction. Post-reduction imaging, including CT, should be obtained to confirm alignment and exclude occult fractures. The prognosis is generally favorable if early, stable reduction is achieved. However, complications such as post-traumatic arthritis, subtalar instability, and avascular necrosis of the talus may occur, particularly in cases of delayed treatment or associated fractures. Long-term outcomes depend on the severity of cartilage damage and the presence of concomitant injuries. References Bohay DR, Manoli A 2nd. Subtalar joint dislocations. Foot Ankle Int . 1995;16(12):803-808. doi: 10.1177/107110079501601212 Richter M, Wippermann B, Krettek C, Schratt HE, Hufner T, Therman H. Fractures and fracture dislocations of the midfoot: occurrence, causes and long-term results. Foot Ankle Int . 2001;22(5):392-398. doi: 10.1177/107110070102200506 Prada-Cañizares A, Auñón-Martín I, Vilá Y Rico J, Pretell-Mazzini J. Subtalar Dislocation: Management and Prognosis for an Uncommon Orthopaedic Condition. Int Orthop. 2016;40(5):999-1007. doi:10.1007/s00264-015-2910-8 - Pubmed Rammelt S & Goronzy J. Subtalar Dislocations. Foot Ankle Clin. 2015;20(2):253-64. doi:10.1016/j.fcl.2015.02.008 - Pubmed Ruhlmann F, Poujardieu C, Vernois J, Gayet L. Isolated Acute Traumatic Subtalar Dislocations: Review of 13 Cases at a Mean Follow-Up of 6 Years and Literature Review. J Foot Ankle Surg. 2017;56(1):201-7. doi:10.1053/j.jfas.2016.01.044 - Pubmed Cheruvu M, Narayana Murthy S, Siddiqui R. Subtalar Dislocations: Mechanisms, Clinical Presentation and Methods of Reduction. World J Orthop. 2023;14(6):379-86. doi:10.5312/wjo.v14.i6.379 - Pubmed Kevin M. Rice, MD  is the president of Global Radiology CME and is a radiologist with Cape Radiology Group . He has held several leadership positions including Board Member and Chief of Staff at Valley Presbyterian Hospital  in Los Angeles, California. Dr. Rice has made several media appearances as part of his ongoing commitment to public education. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. In 2015, Dr. Rice and Natalie Rice founded Global Radiology CME to provide  innovative radiology education at exciting international destinations, with the world's foremost authorities in their field. In 2016, Dr. Rice was nominated and became a semifinalist for a "Minnie" Award for the Most Effective Radiology Educator.   He was once again a semifinalist for a "Minnie" for 2021's Most Effective Radiology Educator  by AuntMinnie.com . He has continued to teach by mentoring medical students interested in radiology . Everyone who he has mentored has been accepted into top programs across the country including Harvard, UC San Diego, Northwestern, Vanderbilt, and Thomas Jefferson. Follow Dr. Rice on Twitter @KevinRiceMD All posts by Kevin M. Rice, MD

What is the device in the chest? What are potential complications? • Xray of the Week Figure 1. What is the device in the chest? Figure 2. Frontal and lateral chest radiograph demonstrates foreign body consistent with Bravo pH Capsule in the esophagus. Figure 3. Enlarged and lateral chest radiograph demonstrates foreign body consistent with Bravo pH Capsule in the esophagus. Bravo pH Monitoring System: Radiologic Considerations and Clinical Implications The Bravo pH monitoring system is a catheter-free, ambulatory device designed to evaluate esophageal acid exposure over 48–96 hours. It is widely used in the diagnosis of gastroesophageal reflux disease (GERD), particularly in patients with persistent symptoms despite medical therapy or in those being considered for anti-reflux surgery. The system consists of a small pH capsule that is temporarily affixed to the esophageal mucosa via endoscopy and transmits pH data to an external receiver. The capsule typically detaches within 5 days and passes though the GI tract into the stool. Radiographically, the device is typically positioned about 5–6 cm above the gastroesophageal junction. Unlike traditional catheter-based monitoring, Bravo improves patient tolerance and compliance, leading to more accurate symptom correlation and better diagnostic yield. Complications of Bravo pH Monitoring Although Bravo pH monitoring is minimally invasive, several potential complications have been reported, including: Chest pain and discomfort, occurring in 15–20% of patients, occasionally severe enough to require early capsule removal. Dysphagia or globus sensation, particularly if the capsule is placed too proximally. Mucosal ulceration and bleeding, especially in patients with pre-existing esophagitis or delayed esophageal clearance. Capsule misplacement or detachment failure, leading to inaccurate pH readings and potential patient discomfort. Aspiration or prolonged capsule retention, although rare, requiring endoscopic retrieval if retained beyond 30 days. Radiologic Considerations: Bravo pH Capsule on Imaging Although not an imaging-based diagnostic tool, radiology plays a key role in evaluating capsule placement and identifying complications. Confirming Capsule Placement The Bravo capsule appears as a small, radiopaque metallic-density structure in the distal esophagus, typically 5–6 cm above the gastroesophageal junction, on fluoroscopy, chest X-ray, or CT (Figs 1-3). Fluoroscopy can confirm proper adherence in cases of chest discomfort or suspected misplacement. Assessing for Complications CT imaging may reveal adjacent mucosal thickening, edema, or ulceration in patients with persistent symptoms. In suspected prolonged retention, an abdominal X-ray can confirm whether the capsule has passed through the GI tract or remains in place beyond the expected detachment period. In rare cases of suspected esophageal perforation, contrast esophagography may demonstrate extraluminal leakage . Avoiding Misinterpretation The Bravo capsule can be misinterpreted as a foreign body or endoscopic clip, particularly in oncologic imaging. Awareness of its expected location and morphology prevents unnecessary biopsy or surgical consultation. Conclusion The Bravo pH monitoring system remains integral to GERD diagnosis, offering prolonged, catheter-free acid monitoring. However, it presents unique radiologic challenges, as it can be mistaken for a foreign body, endoscopic clip, or pathologic mass. Understanding the expected imaging characteristics, potential complications, and appropriate differential considerations allows radiologists to optimize patient management and avoid unnecessary procedures . References Gyawali CP, Kahrilas PJ, Savarino E, et al. Modern diagnosis of GERD: the Lyon Consensus. Gut . 2018;67(7):1351-1362. DOI: 10.1136/gutjnl-2017-314722 Savarino E, Bredenoord AJ, Fox M, et al. Expert consensus document: Advances in the physiological assessment and diagnosis of GERD [published correction appears in Nat Rev Gastroenterol Hepatol. 2018 May;15(5):323. DOI: 10.1038/nrgastro.2018.32 .]. Nat Rev Gastroenterol Hepatol . 2017;14(11):665-676. DOI: 10.1038/nrgastro.2017.130 Gawron AJ, Pandolfino JE. Ambulatory reflux monitoring in GERD--which test should be performed and should therapy be stopped?. Curr Gastroenterol Rep . 2013;15(4):316. doi: 10.1007/s11894-013-0316-6 Sigakis CJG, Mathai SK, Suby-Long TD, et al. Radiographic Review of Current Therapeutic and Monitoring Devices in the Chest. Radiographics . 2018;38(4):1027-1045. DOI: 10.1148/rg.2018170096 Bredenoord AJ, Pandolfino JE, Smout AJ. Gastro-oesophageal reflux disease. Lancet . 2013;381(9881):1933-1942. DOI: 10.1016/S0140-6736(12)62171-0 Weusten BL, Roelofs JM, Akkermans LM, Van Berge-Henegouwen GP, Smout AJ. The symptom-association probability: an improved method for symptom analysis of 24-hour esophageal pH data. Gastroenterology . 1994;107(6):1741-1745. DOI: 10.1016/0016-5085(94)90815-x Spechler SJ. Epidemiology and natural history of gastro-oesophageal reflux disease. Digestion . 1992;51 Suppl 1:24-29. DOI: 10.1159/000200911 Naik RD, Meyers MH, Vaezi MF. Treatment of Refractory Gastroesophageal Reflux Disease. Gastroenterol Hepatol (N Y) . 2020;16(4):196-205. PMCID: PMC8132683 Yadlapati R, Pandolfino JE. Personalized Approach in the Work-up and Management of Gastroesophageal Reflux Disease. Gastrointest Endosc Clin N Am . 2020;30(2):227-238. DOI: 10.1016/j.giec.2019.12.002 Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R; Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol . 2006;101(8):1900-1943. DOI: 10.1111/j.1572-0241.2006.00630.x Richter JE, Pandolfino JE, Vela MF, et al. Utilization of wireless pH monitoring technologies: a summary of the proceedings from the esophageal diagnostic working group. Dis Esophagus . 2013;26(8):755-765. DOI: 10.1111/j.1442-2050.2012.01384.x Zerbib F, Roman S, Bruley Des Varannes S, et al. Normal values of pharyngeal and esophageal 24-hour pH impedance in individuals on and off therapy and interobserver reproducibility. Clin Gastroenterol Hepatol . 2013;11(4):366-372. DOI: 10.1016/j.cgh.2012.10.041 Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol . 2022;117(1):27-56. DOI: 10.14309/ajg.0000000000001538 Boeckxstaens GE, Rohof WO. Pathophysiology of gastroesophageal reflux disease. Gastroenterol Clin North Am . 2014;43(1):15-25. DOI: 10.1016/j.gtc.2013.11.001 Tutuian R, Castell DO. Reflux monitoring: role of combined multichannel intraluminal impedance and pH. Gastrointest Endosc Clin N Am . 2005;15(2):361-371. DOI: 10.1016/j.giec.2004.10.002 Spechler SJ. Comparison of medical and surgical therapy for complicated gastroesophageal reflux disease in veterans. The Department of Veterans Affairs Gastroesophageal Reflux Disease Study Group. N Engl J Med . 1992;326(12):786-792. DOI: 10.1056/NEJM199203193261202 Kevin M. Rice, MD is the president of Global Radiology CME and is a radiologist with Cape Radiology Group . He has held several leadership positions including Board Member and Chief of Staff at Valley Presbyterian Hospital in Los Angeles, California. Dr. Rice has made several media appearances as part of his ongoing commitment to public education. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. In 2015, Dr. Rice and Natalie Rice founded Global Radiology CME to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field. In 2016, Dr. Rice was nominated and became a semifinalist for a "Minnie" Award for the Most Effective Radiology Educator. He was once again a semifinalist for a "Minnie" for 2021's Most Effective Radiology Educator by AuntMinnie.com . He has continued to teach by mentoring medical students interested in radiology . Everyone who he has mentored has been accepted into top programs across the country including Harvard, UC San Diego, Northwestern, Vanderbilt, and Thomas Jefferson. Follow Dr. Rice on Twitter @KevinRiceMD All posts by Kevin M. Rice, MD