Plain Film Radiography in Sports

Introduction

Sports and exercise medicine is a budding new medical specialty that relies on interdisciplinary practice. Sports and exercise medicine physicians will most effectively deliver appropriate treatment care to the individual. The physician will have close contact with the radiologists. The radiologists will take appropriate imaging for accurate diagnosis and prepare proper treatment planning, such as the decision to return to play.

What Is Sports and Exercise Medicine?

• Sports and exercise medicine is a new specialty that concerns the medical care of exercising individuals.

• It involves diagnosing and managing exercise-related injuries and therapeutic exercises in individuals with chronic diseases.

• Also, it prevents the increased morbidity and mortality rates associated with inactivity.

• It comprises a multidisciplinary team that has a significant effect on performance.

• The team members are doctors, therapists, strength and conditioning trainers, sports scientists, radiologists, and surgeons.

• Among all, the physician will have close contact with radiologists.

What Is the Relationship Between Sports Exercise Medicine and Radiology?

The role of imaging in clinical sports medicine is described in four areas. They are:

• Confirmation of accurate diagnosis.

• Information about treatment planning and return to play.

• Screening and pre-participation assessment.

• Technical assistance for specific procedures.

To get a proper diagnosis, the clinician must consider the internal and external factors that affect the treatment plan. The internal factors include athletes' age, fitness level, biomechanics, previous injuries, and present health condition. The external factors include a training program, environmental stressors, equipment, and level of competition.

What Are Plain Radiographs?

Radiography is performed by transmitting ionizing electromagnetic waves through bony structures and soft tissues. It produces an image based on the absorption of X-ray photons.It is the most commonly used diagnostic imaging in sports medicine. Plain radiographs use a heterogeneous beam of X-rays projected toward a detector. It produces an image based on the density and composition of the intervening objects.

What Are the Risk Factors of Taking Plain Radiographs?

• Tissue damage.

• Younger age.

• Females.

• Imaging radiosensitive region.

• Pregnant women.

What Are the Advantages of Plain Film Radiographs?

• Low cost.

• Widely available.

• Highly utilized for the evaluation of pathology.

• Proper diagnosis.

• Portable application- Can be conducted in an inpatient or outpatient setting for patients who cannot undergo standings.

• Improves patient outcomes by precise diagnosis and treatment localizations without delay or high cost compared to other imaging modalities.

What Are the Disadvantages of Plain Film Radiographs?

• Caution should be taken for young children and pregnant women.

• Radiation dose should be monitored in case of taking repeated images.

• A functional assessment (the individual's ability to tolerate) should be done before imaging.

• The use of barium sulfate contrast media sometimes causes throat swelling, difficulty in breathing, and more. Individuals having asthma are more likely to develop allergic reactions. Individuals with cystic fibrosis have higher chances of bowel blockage.

• The use of contrast media causes severe dehydration, which results in constipation. It also increases the chances of intestinal perforation.

• Using iodine contrast media sometimes causes severe reactions such as skin rashes, wheezing, abnormal heart rhythms, high or low blood pressure, shortness of breath, difficulty breathing, throat swelling, cardiac arrest, and convulsions.

What Are the Necessary Precautions to Be Followed While Taking X-Rays?

• The use of a thyroid collar helps to prevent the thyroid gland from exposure.

• Lead apron to avoid the scattered radiation from entering the body.

• In pregnancy, the individual should inform the physician about the medical condition.

• Also, should avoid abdominal X-rays during pregnancy.

What Are the Special Features of Plain Radiographs in Clinical Practice?

• Diagnosing fracture and joint dislocations.

• Following fracture treatment is helpful in demonstrating proper alignment and stabilization of the fracture fragments.

• Guidance for orthopedic surgery.

• Assessment for trauma.

• Evaluating osteomyelitis.

• Diagnosing and assessing pneumonia, asthma, chronic bronchitis, and other pulmonary pathology.

• Evaluating clinical cardiomegaly (increase in heart size) and heart failure.

• Evaluating arthritis, abnormal bone growth, and other metabolic bony changes.

• Evaluating bowel obstruction and perforation.

• Diagnosing and evaluating scoliosis.

• Detecting bone cancer.

• Evaluating non-accidental injury.

• Evaluating growth plates and skeletal maturity.

• Locating foreign objects in soft tissues.

• Diagnosing retropharyngeal abscess.

What Are the Specific Diagnostic Criteria That Justify the Use of Radiographs?

• History: The need for radiography depends on the history of the individual. This includes onset, location, duration, frequency, quality, aggravating and relieving factors, neurological concerns, associated symptoms, and radiation.

• Physical Examination: The need for radiography is determined after the following physical examination. These include inspection, palpation, range of motion, neurological examination, and special blood investigation.

What Are the Film Processing Errors?

• Heel Effect: A visual error related to X-ray production.

• Artifact: Error in the perception of the image seen visually.

• Exposure: Over-exposure results in increased bone visibility, and lower exposure results in increased soft tissue visibility.

• Movement: The image will be blurred in case of movement of the individual during exposure.

• Film Processing: Error during film processing results in a difference in the contrast and density of the image.

• Air: The presence of air gives a black appearance.

• Fat: The presence of fat gives a gray appearance.

• Muscle: The image will have a mid-grey appearance in the presence of muscle interference.

• Bone: Spongy bone appears light gray, while dense bone appears white.

• Contrast Media: Gives a white appearance to the image.

• Metal: The presence of jewelry gives a white appearance.

What Are the Radiographic Errors?

• Enlargement of Image: This occurs when the object is placed closer to the beam.

• Elongation of Image: This occurs due to increased beam angle. The object in the periphery appears smeared compared to the object at the center.

• Foreshortening of Image: This is the opposite of elongation.

• Superimposition of Image: This occurs when anatomic structures overlap one another.

Conclusion

The complex nature of some injuries and the need for rapid diagnosis increases the need for accuracy and urgency in managing the elite athlete. In clinical practice, radiology plays an essential role in the diagnostic process and decision-making to return to play. Radiological procedures are also useful in informing the decisions of elite athletes. Hence, radiological help is most needed in the field of sports medicine. In general plain radiography is a well-established modality and is the most commonly used diagnostic image.