Musculoskeletal Imaging

MSK Knee Image for radiology

The musculoskeletal imaging section of OHSU Diagnostic Radiology provides comprehensive evaluation of bones, joints, muscles, and nerves. A complete spectrum of imaging modalities is employed, including MRI, CT, ultrasound, x-ray and fluoroscopy, and all studies are performed on state of the art equipment. We use the latest imaging techniques in order to address the specific concerns of our referring clinicians.

The section also maintains a robust musculoskeletal interventional practice, offering a wide array of services performed on a daily basis. These include fluoroscopic- and CT-guided joint injections; CT-guided spine, pelvic, and extremity bone and soft tissue biopsies; ultrasound-guided biopsies, aspirations, and injections; and CT-guided osteoid osteoma RFA (radiofrequency ablation).

All musculoskeletal radiologists are certified by the American Board of Radiology and have completed musculoskeletal fellowships. Meet the MSK Radiologist Team.

We work closely with referring clinicians in orthopedic surgery, sports medicine, physical medicine and rehabilitation, rheumatology, and other clinical services and in order to provide the best possible care for our patients. We hold weekly and monthly case conferences with referring clinicians to discuss patient care, imaging findings, and intervention.

In addition to our busy clinical service, the musculoskeletal faculty takes great pride in providing exceptional teaching in the radiology residency program and musculoskeletal radiology fellowship. Direct teaching occurs throughout the day at the workstation and in the procedure suite, complemented by weekly didactic and case conferences. A complete teaching curriculum ensures that our trainees are taught the most current topics and procedural techniques.

We also have several ongoing academic projects including scientific research, educational exhibits, international teaching efforts, and national, regional, and institutional lectures.

Routine and advanced imaging provided

X-Ray of a hand for radiology

Fracture Imaging | Ligament Imaging | Muscle and Tendon Imaging | Joint Instability Evaluation | Cartilage Evaluation | Rheumatologic Disease Imaging | Spine Alignment Evaluation | Bone and Soft Tissue Tumor Imaging | MR and CT Arthrography | Diagnostic and Therapeutic Joint Injections | Hardware Assessment | Bone Biopsy | Spine Biopsy | Muscle and Other Soft Tissue Biopsy | Osteoid Osteoma RF (Radiofrequency) Ablation | Iliopsoas Bursography | Muscle and Tendon Ultrasound | Imaging of Peripheral Nerves

MSK Heel Image for radiology

Fellowship

The Musculoskeletal (MSK) Radiology Fellowship is a non-ACGME program, requiring a 1 year commitment. Candidates must be Board Certified or Board Eligible radiologists and eligible for an unrestricted Oregon state medical license prior to beginning the fellowship. Candidates for fellowship are selected through the Musculoskeletal Fellowship Match. You can get additional information about the match and registration from the above link to the Society of Skeletal Radiology website.

The MSK section is composed of four full-time faculty members and two fellows. OHSU is home to multiple state of the art CT and MRI scanners; the vast majority of joint imaging is performed on 3T scanners. The program has two fellowship positions and offers a comprehensive education in all facets of musculoskeletal radiology. The fellowship aims to produce well-rounded musculoskeletal radiologists in a collegial environment who are expert diagnosticians and interventionalists. These aims are achieved through a  combination of teaching, clinical work and ample opportunities for research including protected academic/meeting time.

The diagnostic MSK service interprets a large number of imaging studies daily, including radiography, MRI, CT, and ultrasound. The diverse case mix includes high-end sports MR and an active bone and soft tissue sarcoma service (Knight Cancer Institute). Fellows work side-by-side with attendings, reviewing cases throughout the day and receiving one-on-one teaching, gradually assuming more responsibilities as the year progresses. In addition to interpreting studies, fellows also develop a deep understanding of MRI and CT protocols by tailoring examinations for each patient, working closely with technologists to modify protocols according to specific clinical questions and troubleshooting challenging scenarios.

The section also performs a large number of procedures each week, including fluoroscopic-guided therapeutic injections/aspirations and MR arthrography, CT-guided biopsies/interventions including spine, miscellaneous injections, RF (radiofrequency) ablation, and ultrasound-guided biopsies/interventions. This includes all MSK-related procedures for pediatric patients via Doernbecher Children’s Hospital. Fellows are an integral part of this service and work closely with referring clinicians to decide on appropriate plans of action and patient management.

The Musculoskeletal section is actively engaged with referring clinical colleagues and our fellows are often the first line of communication between services.  These critical relationships are maintained and strengthened through weekly Rheumatology-Radiology and Orthopedic Oncology-Pathology-Radiology conferences and bimonthly Orthopedic Sports Medicine-Radiology conferences which provide valuable insight into the needs of referring providers as well as feedback on imaging interpretation and procedures. In addition to daily clinical teaching and multidisciplinary conferences, the MSK fellowship curriculum includes a monthly lecture series dedicated to covering highly subspecialized topics to ensure our fellows have as complete an education as possible. Finally, the fellowship training is supplemented with journal club, arthroscopy correlation, biopsy rad-path correlation and hands-on ultrasound didactics.

Fellows leave the program well-prepared for both private practice and academic settings with strong procedural skills, a balanced fund of knowledge and a solid framework for approaching even the most difficult problems in musculoskeletal imaging.

Annual total imaging volumes

Radiography – 57000 I MSK CT – 1500 I MSK MRI – 3700 I MSK Diagnostic US – 75 I Osteoid Osteoma RFA – 8 I CT-guided bone/soft tissue biopsy – 150 I US-guided biopsy – 50 I Fluoroscopic-guided injections/aspirations – 500

Facilities

OHSU Main Hospital I Doernbecher Children’s Hospital I Portland VA Medical Center I Center for Health and Healing I Knight Cancer Institute

Lectures and conferences

  • Fellowship Lecture Series- Two to three Thursdays per month at 7:15am MSK faculty provide 30-45 minute lectures based on the musculoskeletal radiology fellowship curriculum.
  • Musculoskeletal Case of the Day- Daily 4pm interesting case conference for residents and fellows.
  • Resident Lecture Series- Approximately 30 resident lectures are given by MSK faculty to residents and fellows. Near the end of fellowship, fellows will usually give at least one lecture to the residents with faculty support.
  • Journal Club- Approximately six meetings per year discussing pertinent/hot topics in the MSK literature.
  • Hands-On MSK Ultrasound Didactics- Six to 12 faculty-guided joint focused US didactics per year.
  • Radiology-Pathology Correlation- Quarterly conference reviewing all MSK bone and soft tissue biopsies for concordance, QA, and interesting cases/techniques.
  • Radiology-Arthroscopy Correlation- Quarterly conference reviewing interesting arthrograms that underwent arthroscopy for concordance and QA.
  • Joint MSK-Neuroradiology Spine Biopsy Correlation- Biannual inter-departmental conference reviewing spine biopsy results for concordance, QA, and interesting cases.

Tumor boards and working conferences

Fellows are assigned to cover tumor board and multiple working conferences with faculty throughout the year:

  • Sarcoma Tumor Board- Wednesdays at 12pm
  • Rheumatology Interesting Cases- Wednesdays at 10:15am
  • Orthopedic Radiology-Arthroscopy- Quarterly at 6:30am
  • Trauma-Radiology- Bi-annual at 7:30am

Call responsibilities

Fellows take approximately 6 general call weekends a year starting in September for which they cover all STAT and inpatient radiographs. Fellows also take approximately 8-10 short call shifts per year from 5pm-9pm in which they cover non-neuroradiology ED plain films and cross-sectional imaging (CT and US).  Finally, fellows take part in the MSK backup spine biopsy call pool approximately 6-8 weekends a year which runs concordantly with the assigned general call weekends.

Vacation and conferences

Each fellow earns up to 22 days of vacation and up to 10 days of CME conference time.

Academic time

Half-days per week starting in September.  More academic is available at faculty discretion given fellow interest/involvement in scholarly projects.

Scholarly activity

Fellows are encouraged, but not required to engage in a scholarly project.  Ample opportunity exists to work on abstracts for presentation at national and international meetings or manuscripts for publication.

Professional development account

Fellows are currently offered funds, up to $3000/year, to reimburse for educational materials, books, and CME or board review courses.

Recent publications

  • Radiographic evidence of soft tissue gas fourteen days after total knee arthroplasty is predictive of early prosthetic joint infection. Accepted AJR Am J Roentgenol, epub Fall 2019
  • Nomenclature of subchondral non-neoplastic bone lesions. AJR Am J Roentgenol, epub ahead of print July 2019. DOI: 10.2214/AJR.19.21571. PMID: 31339354
  • Practical approach and review of brachial plexus pathology with operative correlation: what the radiologist needs to know. Semin in Roentgenol 2019;54:92-112. DOI: 10.1053/j.ro.2018.10.002. PMID: 31128744
  • Pearls and pitfalls of fluoroscopic-guided foot and ankle injections: what the radiologist needs to know. Epub ahead of print. Skeletal Radiol 2019. DOI: 10.1007/s00256-019-03226-9. PMID: 31062056
  • Naviculocuneiform and second and third tarsometatarsal articulations: underappreciated normal anatomy and how it may impact fluoroscopic guided injections. AJR Am J Roentgenol 2019;212:874-882. DOI: 10.2214/AJR.18.20347. PMID: 30673336
  • Advanced imaging of multiple myeloma bone disease. Front Endocrinol 2018;7:436. DOI: 10.3389/fendo.2018.00436. PMID 30131767
  • Imaging of benign fibular tumors and their mimics. Can Assoc Radiol J 2018;69:293-302. DOI: 10.1016/j.carj.2018.03.007. PMID: 30078399

Recent presentations

  • Radiographic evidence of soft tissue gas fourteen days after total knee arthroplasty is predictive of early prosthetic joint infection. Radiologic Society North America, Chicago IL, Dec 1-6, 2019
  • Joint prosthesis. Radiologic Society of North America, Chicago IL, Dec 1-6, 2019
  • RSNA Diagnosis Live: Keeping radiology weird-spot diagnoses from the Pacific Northwest. Radiologic Society of North America, Dec. 2019, Chicago, IL
  • Nomenclature of subchondral non-neoplastic bone lesions. Society of Skeletal Radiology, Scottsdale, AZ March 10-13, 2019
  • To drill or not to drill, that is the question. Society of Skeletal Radiology, Scottsdale, AZ March 10-13, 2019
  • Naviculocuneiform and second and third tarsometatarsal articulations: underappreciated normal anatomy and how it may impact fluoroscopic guided injections. Society of Skeletal Radiology, Scottsdale, AZ March 10-13, 2019
  • Avulsion injuries and tendon ruptures of the hand and wrist: a review of frequently encountered and uncommon radiologic diagnoses including mimics. Radiologic Society of North America, Chicago, IL Nov 24-Nov 30, 2018 (Cum Laude, accepted for RadioGraphics publication 2020)
  • Pearls and pitfalls for soft tissue and bone biopsies from quaternary orthopedic oncology referral centers: A cross-institutional review. Radiologic Society of North America, Chicago, IL Nov 24-Nov 30, 2018 (Cum Laude, accepted for RadioGraphics publication 2020)
  • Incidental or life-threatening? A case-based review of osteochondroma related pathology from mechanical complications to malignant degeneration. Radiologic Society of North America, Chicago, IL Nov 24-30, 2018 (Certificate of merit award winner)
  • Imaging of rotator cuff reconstructions for massive rotator cuff tears: what the radiologist needs to know. Radiologic Society of North America, Chicago, IL Nov 24-30, 2018
  • RSNA diagnosis Live: Keeping radiology weird-spot diagnoses from the Pacific Northwest. Radiologic Society of North America, Dec. 2018 Chicago, IL

Application information

All fellowship positions for 2019-2020 have been filled. We are currently accepting applications for an available position for the 2020-2021 fellowship.

To apply, please mail:

  • One completed and signed universal application form
  • Curriculum vitae
  • Personal statement
  • Three letters of recommendation
  • Photocopy of the Dean's letter from your medical school or ECFMG certificate

*standard white paper, single sided and no staples please

Address the packet to:

Barry Hansford, M.D. - MSK Radiology Fellowship Director
ATTN: Kim Eastman
Mail Code:L-340
Oregon Health & Science University
3181 S.W. Sam Jackson Park Road
Portland, OR 97239

A confirmation letter or email will be sent to you once all documents are received.
Foreign applicants must be legally able to work in the U.S., or eligible to obtain work authorization.
For additional information or questions, contact Kim Eastman, MSK Fellowship Coordinator at 503-494-2570.