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Dr O’Keeffe MB, MRCP(UK), FFR RCSI, FRCR (UK) is a consultant radiologist in St James’s Hospital Dublin since 2010. She completed her undergraduate medical training in Trinity College Dublin and her postgraduate Radiology training in St James’s Hospital in Dublin before undertaking fellowships in Oncology Imaging in the Mater Hospital, Dublin and Breast Radiology and Women’s Imaging in Cambridge, UK. She was appointed as a Senior Lecturer in Trinity College in 2010. She has since spent two years as a Consultant Radiologist in St Bartholomew’s Hospital, London with a special interest in Breast Radiology including breast screening. Her other special interest is in Women’s Imaging including infertility and gynaecological cancer. She serves on university and national bodies including the National Cancer Control Programme.

Global Radiology CME is pleased to announce Niall Sheehy, FFR RCSIwill be speaking at this year's Global Radiology CME course in Dublin, Ireland - Imaging in Dublin 2022. Dr. Niall Sheehy is a consultant radiologist in St James's Hospital Dublin. He trained in radiology as part of the Faculty of Radiologists Radiology Training Scheme between 2002 and 2006. He did fellowships in PET/CT and Nuclear Medicine in The Dana Farber Cancer Institute and the Joint Programme in Nuclear Medicine in Harvard Medical School. He is a Clinical Senior Lecturer in Trinity College Dublin and the current Dean of the Faculty of Radiologists of the Royal College of Surgeons in Ireland.

Dr. Martina Morrin FFR RCSI, FRCR is a Consultant Radiologist in Beaumont Hospital Dublin. She trained in Radiology at the Mater Misericordiae hospital Dublin as part of the Faculty of Radiologists Radiology Training Scheme between 1994 and 1997. She did a fellowship in Abdominal Imaging at Beth Israel Deaconess Medical Center, Harvard Medical School(1997-1999) and subsequently spent 7 years on staff at that institution. She is associate Clinical Professor in radiology in the Royal College of Surgeons in Ireland. Her main research interests are in the field of abdominal imaging particularly CT colonography, gastrointestinal and urinary tract imaging.Dr. Morrin has lectured extensively at national and international conferences (including ESGAR, SGR, ARRS and RSNA) on a range of topics including CT colonography,rectal cancer and hepatobiliary imaging. She has authored and co-authored numerous articles and book chapters. She has contributed to national and international guideline development for colorectal cancer management, CT colonography and perianal fistula imaging. She acted as Irish National Coordinator Radiology training scheme 2009-2011. She acted as National Radiology Lead for Irish Bowel Screen colorectal cancer screening programme (2014-17). She acts as reviewer for several radiology and clinical journals.

"I look forward to the meeting and traveling to Dublin." - Donald Resnick, MD, FACR Global Radiology CME is honored to have ACR Gold Medalist, Donald Resnick, join us in Dublin for Imaging in Dublin 2019. Donald L. Resnick, MD, Professor Emeritus of Radiology and Former Chief of Osteoradiology at the University of California, San Diego (UCSD), has devoted more than 30 years to musculoskeletal radiology education. Dr. Resnick has written over 1100 scientific and educational articles (more than 100 published in Radiology), 72 book chapters, and 16 books on musculoskeletal radiology. Dr Resnick is a renowned lecturer, having given over 50 named lectures throughout the world including the Wilhelm Conrad Roentgen Honorary Lecture at the European Congress of Radiology and the Ho Hung Chiu Medical Education Foundation Lecture in Hong Kong. His list of dozens of awards and honors includes the American Roentgen Ray Gold Medal, Diagnostic Imaging Magazine’s 20 Most Influential People in Radiology, Medical Imaging Industry’s Top 10 Radiologists, twice-awarded AuntMinnie.com Most Effective Radiology Educator, and an Honorary Doctorate from the University of Zurich.Dr Resnick is a member of 9 radiology societies, and is a past president of the International Skeletal Society. In addition, he is an Honorary Fellow of 6 radiology societies in Europe and Asia. He serves on a multitude of departmental, hospital/medical school, and national committees. He has served on editorial boards and as a manuscript reviewer for 18 leading journals including AJR, Radiology, and RadioGraphics. More than 150 clinical fellows and 400 international research fellows, from over 20 countries throughout the world, have received one-on-one training through his fellowship programs. Amazingly, 70% of these fellows pursued academic careers after their training. More than 1000 visitors have come to his base of operations, formerly known as “The Bone Pit”, and now aptly dubbed "The Bone Palace." Dr. Resnick presenting the Global Radiology CME Resnick MSK Quiz Award to Andrew Kingzett Taylor from New Zealand at Imaging in Prague 2019

James Meaney FRCP, FFR RCSI, FRCPI is a Radiologist at St. James’s Hospital and a Clinical Professor in Trinity College Dublin. After undergraduate training in NUI Galway, he specialized in Radiology working in Liverpool, UK, University of Michigan, Ann Arbor and University of Leeds, UK before returning to Dublin in 2001. Prof. Meaney is director of the Thomas Mitchell Centre for Advanced Medical Imaging, which hosts a 3T MRI research scanner. His clinical and research interests span all areas of body CT and MRI, particularly magnetic resonance angiography. He has published over 80 papers in peer reviewed international journals and owns 8 patents related to MRI technology, is a former Trustee of the ISMRM and has been awarded Fellowship of the ISMRM. He is a former president of the MRA Club (now The Society4MRA). He has published 2 textbooks, numerous chapters and two radiology educational Apps.

PROF. JOHN THORNTON MB Bch BAO FRCSI FRCR FFRRCSI Prof. John Thornton is a Consultant Diagnostic and Interventional Neuroradiologist in Beaumont Hospital, Dublin. He completed medical training in University Hospital Dublin. He obtained surgical fellowship with Royal College of Surgeons Ireland. His radiology training was also through Royal College of Surgeons Ireland. He completed training in Neuroradiology in University of Illinois at Chicago and Northwestern University in Chicago. He has a special interest in neurovascular imaging and endovascular intervention for cerebral aneurysms, AVMs, vascular stenosis and acute ischaemic stroke. He has ongoing participation in clinical research and was the Co-Principal Investigator for the ESCAPE (Endovascular Treatment for Small Core and Anterior Circulation Proximal occlusion with Emphasis on minimizing CT to recanalization times) trial in Ireland. He recently co-authored several papers on aspects of endovascular treatment of acute stroke. He is currently Director of the National Thrombectomy Service, Joint Clinical Lead for Stroke in Beaumont Hospital and Head of Governance Group. He has led the development of emergency endovascular treatment of stroke in Ireland, establishing a nationwide network and works to promote the development with the Health Service Executive/Department of Health. He leads on the National Quality Improvement Programme involving hospitals admitting acute stroke patients throughout Ireland aiming to improve hyper-acute stroke care. This includes the introduction of many interventions to improve efficiency.

Global Radiology CME is honored to announce the appointment of Neil Rofsky, MD, MHA, FSCBTMR, FISMRM, FACR, Professor and Chair of UT Southwestern's Department of Radiology and the Effie and Wofford Cain Distinguished Chair in Diagnostic Imaging as the Scientific Director of this year's Global Radiology CME course in Dublin, Ireland - Imaging in Dublin 2022. A word from our Scientific Director: "I am delighted to serve as the Scientific Director of this year's annual Global Radiology CME course. It is indeed my privilege to be leading a meeting in Dublin, Ireland, where I look forward to catching up with many friends, former trainees, and valued colleagues. Global Radiology blends the highest quality CME with an incredibly fun social agenda, a variety of engaging educational activities and, uniquely, an expanding and accessible scientific component. With a relaxed and friendly vibe this organization delivers on your educational needs. Your time with Global Radiology is time well spent! I look forward to seeing you in Dublin." Neil Rofsky, MD, MHA, FSCBTMR, FISMRM, FACR, is Professor and Chair of UT Southwestern’s Department of Radiology and holder of the Effie and Wofford Cain Distinguished Chair in Diagnostic Imaging. Dr. Rofsky also serves as Director of Translational Research for the Advanced Imaging Research Center (AIRC), a collaboration of UT Southwestern and the University of Texas at Dallas. A native of New York, Dr. Rofsky received his medical degree from New York Medical College and then completed an internship in internal medicine at Middlesex University Hospital. He received advanced training through a nuclear medicine fellowship program at the University of Utah Medical Center; a radiology residency program at the New York University Medical Center; and fellowships in abdominal imaging and magnetic resonance imaging at New York University Medical Center. Dr. Rofsky served as Co-Director of the Clinical Imaging Steering Committee (CISC) of the NCI for 2 terms, and completed his responsibilities in November, 2018. He was recently awarded a Masters Degree in Healthcare Administration from Columbia University’s Mailman School of Public Health. Previously, he served on the Board of Directors for the International Society for Magnetic Resonance in Medicine (ISMRM) and the Society of Computed Body Tomography & Magnetic Resonance (SCBTMR) also fulfilling the role of President of the SCBTMR. His research interests have focused on Body MRI/MRA having previously been awarded an R01 NCI grant on prostate cancer. He has authored more than 180 peer-reviewed publications, numerous review articles and editorials, several textbooks, and presents regularly at such medical societies as the Radiological Society of North America, the ISMRM and the SCBTMR.

Welcome back to Global Radiology CME Live on site June 5 - 8th, 2022 in Dublin, Ireland - the city Lonely Planet has named one of the 10 best cities to visit in 2022. Our venue, The Banking Hall in the historic Westin Dublin, is located directly across the street from Trinity College which was established in 1592 by Queen Elizabeth I and is home of the Book of Kells. The extravagant illustrations and ornamentation of the Book of Kells is considered unsurpassed. With figures of humans, animals and mythical beasts in vibrant colors this illuminated manuscript is the treasure of the Library at Trinity College Dublin. The Westin is also a short walk to the Temple Bar District, known for its trendy restaurants and vibrant music scene. A trip to Dublin would not be complete without a pint of Guinness, or a shot of Irish Whisky, while listening to traditional Celtic music. With close to 17 hours of daylight in June you will have ample time to explore prehistoric castles, and hike or drive along the rugged coastline of Ireland's Wild Atlantic Way. For those who are ready to travel, Ireland is currently in the process of lifting many Covid restrictions as case numbers have fallen dramatically thanks to a high vaccination rate and an excellent healthcare system. We are committed to providing a safe and healthy environment and will be strictly adhering to government policies. On December 7, 2021 according to The Government of Ireland over 90% of the population over age 12 were fully vaccinated, with almost 92% of the eligible population aged 12 and over having received at least 1 dose. On January 24, 2022 over 82 percent of the population over age 5 were fully vaccinated, with over 85 percent of the eligible population above age 5 having received at least 1 dose. https://covid19ireland-geohive.hub.arcgis.com/pages/vaccinations Global Radiology CME is ready to welcome back our old friends and meet new ones. Ireland is ready to welcome back tourists to the birthplace of Oscar Wilde and Bono and to let you discover for yourself why James Joyce wrote "when I die Dublin will be written in my heart!" We understand there are a lot of uncertainties. If Covid restrictions force us to cancel you will have the option to receive a full refund for your registration fees or rollover to our 2023 conference. When booking air or hotels we strongly urge you to check the cancellation policies and highly recommend you explore travel insurance options that best suit your needs. For more information on Imaging in Dublin please click here: www.globalradiologycme.com/imagingindublin2022 or feel free to contact Natalie directly. This is a unique opportunity to meet radiologists from all corners of the globe in an intriguing location, and learn from some of the best specialists in their field. Indulge all your senses and join Global Radiology CME for the trip of a lifetime to Dublin, Ireland in June, 2022! We have had registrants from: Australia, Austria, Belgium, Brazil, Bulgaria, Canada, China, Denmark, France, Germany, Greece, Hong Kong, Hungary, India, Indonesia, Ireland, Israel, Lithuania, Malaysia, Netherlands, New Zealand, Norway, Philippines, Saudi Arabia, Singapore, Slovenia, South Africa, Spain, Sweden, Switzerland, Thailand, Turkey, Uruguay, United Kingdom, United States of America, and Zambia.

Ireland welcomed back vaccinated tourists just under 2 weeks ago and Dublin is returning to normal. Take a live peek at The Temple Bar Pub in Dublin, just a 5 minute walk from the Global Radiology conference venue, The Westin Dublin Hotel. As of July 31, 2021 over 86% of adult population in Ireland have received at least one dose and 71% of eligible adults are now fully vaccinated. Join our outstanding faculty along with radiologists from around the world June 5-8, 2022 on the Emerald Island at Imaging in Dublin 2022! Link to a live webcam of the Temple Bar: https://www.earthcam.com/world/ireland/dublin/?cam=templebar

10 year old with right eye pain • Xray of the Week Name the condition and clinical significance. Figure 1. Axial CT scan of the orbits. Figure 2. Axial CT scan of the orbits. A: Punctate calcification at the right optic nerve head junction (red arrow) and normal left optic nerve head junction (green arrow).B: Magnified view of the right orbit showing punctate calcification at the right optic nerve head junction (red arrow). Discussion: Introduction: Optic nerve drusen are abnormal collections of mucoprotein matrix, acid mucopolysccharides, and ribonucleic acids that accumulate within the optic nerve, on the surface of the optic disc, and in the peripapillary retina [1]. Drusen are initially “buried” within these locations but become more visible as they calcify and nerve fibers atrophy [1]. They occur in 0.4% of children and become visible at 12 years of age, on average [1]. A correct diagnosis of optic nerve drusen is important because this condition can be easily misdiagnosed as papilledema, which leads to unnecessary imaging and procedures such as lumbar punctures [1]. Pathogenesis: There are three theories on the formation of optic nerve drusen. One theory is that a disturbance in axonal metabolism results in reduced axoplasmic flow [1]. Another theory is that congenitally dysplastic discs have a predisposition towards drusen formation [1]. Finally, it is possible that a small scleral canal compresses the optic nerve, leading to ganglion cell death with calcification of mitochondria [1]. Presentation: Although the majority of optic nerve drusen are asymptomatic, children with symptomatic optic nerve drusen can present with headache, vomiting, or seizures [1]. Optic nerve drusen can also cause visual field defects, especially if they are superficial rather than buried. Visual field constriction is also seen in 50% of eyes with superficial drusen, but only 17% of eyes with buried drusen [1]. The most common visual field defect is a nasal inferior arcuate scotoma, making up about a third of all visual field defects associated with optic nerve drusen [1]. On ophthalmologic exam, patients can have an afferent pupillary defect if the optic nerve drusen are asymmetric or unilateral [2]. Complications: If left untreated, optic nerve drusen can lead to a variety of complications, the most important of which is blindness. Optic nerve drusen can rarely lead to retinal vascular abnormalities that lead to anterior ischemic optic neuropathy and eventual vision loss [4]. Figure 3. CT scan of the orbits. A: Sagittal oblique view of the right orbit showing the punctate calcification at the optic nerve head junction (red arrow). B: Sagittal oblique view of the left orbit showing the normal optic nerve head junction (green arrow). Diagnosis: Superficial optic nerve drusen can be seen on fundoscopic exam as an elevated, nodular optic disc with blurred margins [3]. The drusen appear as multiple whitish-yellow granules and are often bilateral [2]. Buried optic nerve drusen are more difficult to appreciate but can be seen adjacent to vessels or the optic disc margin. Besides a fundoscopic exam, imaging modalities such as ultrasound, CT scan, or fluorescein angiography can assist in diagnosing optic nerve drusen. Figure 4. Ultrasound of the right globe in a different patient, a 57 year old female with right orbital pain. An optic nerve drusen is seen as a hyperechoic nodule (yellow arrow) with posterior acoustic shadowing (blue arrow). Ultrasonography is superior to other methods for detecting superficial drusen and can identify around 50% of buried drusen due its sensitivity to calcium deposits buried deeply in the optic tissue [2,4]. On ultrasound, the drusen generally appear hyperechoic with posterior shadowing [2] (Fig. 4). They are commonly located on the nasal side of the optic disc [2]. Although CT scan can miss smaller drusen, it is still capable of detecting calcified optic nerve drusen [1]. In this example, a right optic nerve drusen was discovered on CT scan of the orbits as seen in Figures 1-3. Treatment: Currently, there are no effective treatments for optic nerve drusen. If the patient is asymptomatic, they can be observed with serial visual field testing [3]. If visual field defects occur and start to progress, patients can be treated with topical ocular hypotensive therapy. Surgical treatment options include optic nerve sheath fenestration or radial optic neurotomy. Neither are considered the standard of care, but there have been reports of successful treatment [3]. ​​​​ References: Chang MY, Pineles SL. Optic disk drusen in children. Surv Ophthalmol. 2016;61(6):745-758. doi:10.1016/j.survophthal.2016.03.007 Tuğcu B, Özdemir H. Imaging Methods in the Diagnosis of Optic Disc Drusen. Turk J Ophthalmol. 2016;46(5):232-236. doi:10.4274/tjo.66564 Allegrini D, Pagano L, Ferrara M, et al. Optic disc drusen: a systematic review : Up-to-date and future perspective. Int Ophthalmol. 2020;40(8):2119-2127. doi:10.1007/s10792-020-01365-w Kumaev B, Soule E, Rao D, Fiester P. Optic Disc Drusen. Appl Radiol. 2020;49(6):54-55. https://www.appliedradiology.com/communities/CT-Imaging/optic-disc-drusen Leslie Shang is a 6th-year medical student at the University of Missouri – Kansas City Six-Year BA/MD Program and an aspiring radiologist. At UMKC, she serves as the social media coordinator of the Radiology Interest Group. She is also the vice president of the Help a Life Organization (HALO) which serves free meals to patients at the student-run free clinic and provides educational lectures to students on healthy eating and diet counseling for patients. In her free time, she enjoys exploring new restaurants in Kansas City, hiking, and spending time with friends. Follow Leslie on Twitter @LeslieFShang All posts by Leslie Shang Kevin M. Rice, MD is the president of Global Radiology CME Dr. Rice is a radiologist with Renaissance Imaging Medical Associates.He has held many leadership positions including Chair of Radiology, Chief of Staff and Hospital Board member 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

66 year old female with abdominal pain. Diagnosis? • Xray of the Week Figure 1. What are the important findings? Figure 2. Axial CT - A: Large filling defect in the left atrium. Note the slight enhancement indicating it is a neoplastic mass rather than thrombus, (red arrow) suggesting myxoma. The large size is also compatible with myxoma rather than thrombus. B: Wedge shaped region of lack of enhancement of the spleen suggesting infarction (green arrow). Discussion: Cardiac myxomas (CM's) are the most common type of primary neoplasm of the heart. The overall incidence is 0.0017 to 0.02% with most presenting as benign tumor located in the left atrium (60-75%) [1]. Most cases are sporadic without a known etiology with women aged 30-60 years twice as often affected. There is an autosomal dominance inheritance clusters known as Carney syndrome, however, seen in only about 3-10% of all cases [2]. Grossly, CM's present as slimy, friable lesion with smooth or villous surface, the latter having a greater potential for embolic complications [2,3]. They can be sessile, arising from a broad base, or emanate from a stalk or pedicle with average diameter of 5-6 cm and can grow as large as 15 cm [2,5]. Most tumors are pedunculated, located in the atria and found in the region of the fossa ovalis [1,2] as seen in Figure 2A. Younger patients (<40 years old) with non-left atrial location or multiple CM's should be evaluated for “syndrome myxoma,” which are associated with blue nevi, cutaneous lentiginosis, peripheral tumors and endocrine neoplasms [1,4,5]. Clinical symptoms can be caused directly by the tumor from obstruction or in form of embolization. Symptoms are from intracardiac obstruction seen in 52-67% of patients [5]. They are either due to obstruction of the mitral opening or a wrecking-ball effect, resulting in valvular damage leading to mitral regurgitation [4]. They can also present as pulmonary edema, dyspnea, orthopnea, malaise, syncope, and palpitations [1]. The second most common complication is embolization (30-40%) resulting in neurologic sequala (12-30%) or systemic infarction (4.1-23%) of limbs, splanchnic, or coronary circulations [2,5,6,7]. It is important to note that embolic events are not size-related and frequently occur in small tumors as well [3]. Our patient was one of the rare cases presenting with splanchnic infarction as seen in Figures 1 and 2. Diagnosis of CM's is usually an incidental finding on imaging for other indication in asymptomatic patients [4]. Tentative diagnosis is made on imaging upon exclusion of thrombus or vegetation and presence of a mobile mass attached by stalk or a stalk left after mass had embolized systemically [1]. Echocardiography (Transesophageal > Transthoracic) is the diagnostic test of choice followed by cardiac MRI and CT scans to help better visualize the intracardiac mass for preoperative planning [2,3]. If a stalk or pedunculated mass is not visualized on the echo, MRI can be used to diagnose CM's and help differentiate from thrombus or pseudotumor [3]. On MRI, CM's show heterogenous in cine imaging because of interspersed calcifications or hemosiderin-related artefacts, hyperintense on T2 weighted and isointense on T1-weighted images [2,3]. If MRI is contraindicated or inconclusive, a CT can be performed which would show a left atrial mass with a narrow attachment to the atrial septum and a heterogenous low attenuation [2,3]. CMs can be differentiated from a thrombus on CT by assessing for size, origin, shape, mobility, and prolapse. CMs are larger, originate in fossa ovalis (vs. appendage in thrombi), villous shaped (vs. polypoid in thrombi), greatly mobility, and occurrence of prolapse through mitral valve whereas thrombi never prolapse [8]. Treatment is prompt surgical excision to avoid risk of systemic embolization, cerebral infarction, and sudden death [6]. Overall prognosis is excellent with recurrence rates of 1-5% secondary to incomplete resection, intraoperative tumor seeding or tumor multifocality [2]. The 5-year survival rates are 83% for benign tumors, 30% for malignant neoplasms, and 26% for metastases [5]. ​​​​ References: Bernatchez J, Gaudreault V, Vincent G, Rheaume P. Left Atrial Myxoma Presenting as an Embolic Shower: A Case Report and Review of Literature. Ann Vasc Surg. 2018;53:266.e13-266.e20. doi:10.1016/j.avsg.2018.04.024 Jain S, Maleszewski JJ, Stephenson CR, Klarich KW. Current diagnosis and management of cardiac myxomas. Expert Rev Cardiovasc Ther. 2015;13(4):369-375. doi:10.1586/14779072.2015.1024108 Colin GC, Gerber BL, Amzulescu M, Bogaert J. Cardiac myxoma: a contemporary multimodality imaging review. Int J Cardiovasc Imaging. 2018;34(11):1789-1808. doi:10.1007/s10554-018-1396-z Maraj S, Pressman GS, Figueredo VM. Primary cardiac tumors. Int J Cardiol. 2009;133(2):152-156. doi:10.1016/j.ijcard.2008.11.103 Hoffmeier A, Sindermann JR, Scheld HH, Martens S. Cardiac tumors--diagnosis and surgical treatment. Dtsch Arztebl Int. 2014;111(12):205-211. doi:10.3238/arztebl.2014.0205 Frizell AW, Higgins GL 3rd. Cardiac myxoma as a mimic: a diagnostic challenge. Am J Emerg Med. 2014;32(11):1399-1404. doi: 10.1016/j.ajem.2014.08.044 Burke A, Jeudy J Jr, Virmani R. Cardiac tumours: an update: Cardiac tumours. Heart. 2008;94(1):117-123. doi:10.1136/hrt.2005.078576 Scheffel H, Baumueller S, Stolzmann P, et al. Atrial myxomas and thrombi: comparison of imaging features on CT. AJR Am J Roentgenol. 2009;192(3):639-645. doi:10.2214/AJR.08.1694 Savan V. Patel is a medical student and aspiring diagnostic radiologist at Rowan University School of Osteopathic Medicine in New Jersey. During his time as a medical student, Savan served as the vice president of Inclusion, Diversity, Equity, and Action (IDEA) council. Prior to medical school, he earned MS in Pharmaceutical Sciences with summa cum laude at Rowan University where he published research on novel compounds composed of cyanopyrrolidines and β-amino alcohol scaffolds tested in vitro against Dipeptidyl Peptidase IV (DPP-IV) enzyme, a key regulator of incretin hormones in the management of type 2 diabetes. He graduated magna cum laude from Rowan University where he completed his studies in biochemistry with a minor in biology. Outside of medical school, Savan loves to travel with his wife, cook new cuisines and listen to Bollywood music. All posts by Savan Patel 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

33-year-old male in a high-speed motor vehicle collision. What percent of these injuries are complicated by nerve damage? • Xray of the Week Figure 1. X-ray of knee dislocation. Introduction: Knee dislocations, also known as tibiofemoral joint dislocations, are defined as a complete disruption of the tibiofemoral articulation [1,2]. It is a multi-ligamentous injury with most injury patterns consisting of bi-cruciate tears in combination with either medial collateral ligament (MCL) or lateral collateral ligament (LCL) injury [2-4]. Epidemiology: Knee dislocations account for less than 0.5% of joint dislocations [1,2]. However, the true frequency of knee dislocations is unknown due to spontaneous reductions following dislocation. High energy trauma is the most common cause of knee dislocations. Motor vehicle collisions (MVC's), sports, falls, and industrial accidents are the most common reported mechanisms of injury [1-3]. MVC's account for more than 50% of the reported mechanisms of injury [2]. Diagnosis: Knee dislocations can be clinically obvious if the knee is in an abnormal position and the patient has a history of acute trauma. However, in cases where the dislocation is spontaneously reduced prior to medical evaluation, the diagnosis should be assumed whenever gross instability of the knee is detected following acute high energy trauma [5]. Advanced imaging, such as magnetic resonance imaging (MRI), can confirm the diagnosis by showing bi-cruciate ligament injury or the complete tear of three or four of the major ligaments (posterior cruciate ligament, anterior cruciate ligament, MCL, and LCL) that stabilize the knee [2]. Table 1. The Kennedy knee dislocation classification system [4,6]. Dislocation Classification: Kennedy proposed the first classification scheme in 1963 that was based on the position of the displaced tibia in relation to the femur (Table 1.) [6]. Although this classification system is well established and easy to use, many cases cannot be classified using Kennedy’s system because up to 50% of traumatic knee dislocations are reduced at the time of initial medical evaluation [2]. Several alternative systems have been proposed for classifying knee dislocations [7,8], but none of the systems are ideally predictive of treatment and prognosis [2]. Treatment: The initial treatment of a knee dislocation is immediate reduction and assessment of the patient’s neurovascular status [2,4]. Closed reduction is preferred, but posterolateral knee dislocations may require open reduction [2,4]. Next, anatomic reduction is confirmed using anteroposterior and lateral radiography, and a thorough exam is performed to look for ligamentous injury [2]. Conservative versus surgical treatment of the ligamentous injuries is dependent on which ligaments were injured, the severity of injury to those ligaments, and the patient’s activity level [4]. Lastly, the patient’s injured leg is placed in an immobilizer at 15 to 20 degrees of flexion [1]. Complications: ​​​​Knee dislocations are surgical emergencies since patients can develop neurovascular compromise when diagnosis and treatment are delayed. The popliteal artery is susceptible to injury when the tibiofemoral joint disarticulates because the popliteal artery is tethered proximally at the adductor hiatus and distally behind the fibrous arch of the soleus muscle, and it has limited ability to accommodate the acute increase in distance across the popliteal fossa that occurs during dislocation [1-5]. Eighty-six percent of these injuries require amputation if vascular repair is undertaken after eight hours, and 11% require amputation if vascular repair is undertaken before eight hours [1,2,4,5]. The incidence of vascular injury ranges from 7 to 64% amongst various reports, and about one-third of knee dislocations are complicated by peroneal nerve injury [1-4]. References: Seroyer ST, Musahl V, Harner CD. Management of the acute knee dislocation: the Pittsburgh experience. Injury. 2008;39(7):710-718. doi:10.1016/j.injury.2007.11.022 Walker RE, McDougall D, Patel S, Grant JA, Longino PD, Mohtadi NG. Radiologic review of knee dislocation: from diagnosis to repair. AJR Am J Roentgenol. 2013;201(3):483-495. doi:10.2214/AJR.12.10221 Kapur S, Wissman RD, Robertson M, Verma S, Kreeger MC, Oostveen RJ. Acute knee dislocation: review of an elusive entity. Curr Probl Diagn Radiol. 2009;38(6):237-250. doi:10.1067/j.cpradiol.2008.06.001 Henrichs A. A review of knee dislocations. J Athl Train. 2004;39(4):365-369. PMID: 16410830 Reckling FW, Peltier LF. Acute knee dislocations and their complications. J Trauma. 1969;9(3):181-191. doi:10.1097/00005373-196903000-00001 KENNEDY JC. COMPLETE DISLOCATION OF THE KNEE JOINT. J Bone Joint Surg Am. 1963 Jul;45:889-904. PMID: 14046474. Schenck RC Jr. The dislocated knee. Instr Course Lect. 1994;43:127-136. PMID: 9097143 Boisgard S, Versier G, Descamps S, Lustig S, Trojani C, Rosset P, Saragaglia D, Neyret P. Bicruciate ligament lesions and dislocation of the knee: mechanisms and classification. Orthopedics Traumatology Surgery Research. 2009; 95:627–631. English translation of original French: https://core.ac.uk/download/pdf/82436597.pdf Corey Brown is a medical student at Meharry Medical College in Nashville, TN. He is vice-president of his school’s radiology interest group and a member of Rad Boot Camp. Prior to medical school, he attended Queens University of Charlotte and the University of Toronto. He graduated with degrees in biochemistry and biomedical engineering. As a graduate student, Corey volunteered at Milestone Christian Ministries and worked with Maple Leaf Sports and Entertainment as a Soccer Senior Sport Lead Coach. He enjoys barbering and watching sports in his free time. Follow Corey Brown on Twitter @coreybrwn All posts by Corey Brown 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