I believe in a kind of imaging more functionally oriented than descriptive. As a dedicated musculoskeletal radiologist I can use all of the modalities capable of making the best diagnosis, but I think that a dynamic ultrasound examination is crucial in some conditions. Try to think about a rubber band; if you take a picture of it in a static condition it might seem to be perfect, but what happens if you stretch it? The same thing happens with muscles, ligaments, tendons and joints. I always believe that ultrasound imaging is also dynamic for the operator itself, he must be there, here and now, never stop thinking about it. It is a sort of “mindfullness exercise”. This might make the difference in searching  “the sweet spot”
sweet def.002

in diagnostic imaging, that means finding the right way to make the right diagnosis. The patient is at the center of everything and all of the imaging modalities around. That is why I suggest to “pure sonographers” to have two good travelmates in this sort of journey: a good radiologist and a good clinician (orthopaedics, phyisiathrics, sport-medicine physician). During my teaching courses around the world, students often ask me what is needed to start ultrasound practice. I always answer in the same way: anatomy, anatomy, and again anatomy, in all of its modalities; essential, surgical, ultrasound, mri, xray, ct anatomy. I also always suggest to non-radiologists sonographers, to study a good Mri anatomy atlas; it contains the same scans of ultrasound imaging, but with better spatial definition. Firstly knowing the limits of ultrasound imaging, is another crucial point. I am not talking about the overestimated “operator dependence” problem; does any kind of activity not potentially influenced by the operator exists? Sun Tzu in “The Art of War” said:”“If you know the enemy and know yourself, you need not to fear the result of a hundred battles. If you know yourself but not the enemy, for every victory gained you will also suffer a defeat. If you know neither the enemy nor yourself, you will succumb in every battle.” At the same time knowing both the limits of ultrasound and the characteristics of all the pathologies we want to discriminate, can make the difference in making the correct diagnosis.  Studying ultrasound imaging might act as the perfect stimulus to begin a journey in the beautiful musculoskeletal diagnostic imaging world. But pay attention, because neither a course nor  congress or a book may teach you what you need to make the perfect diagnosis, if you miss the basic ingredients: the desire of knowing, passion for learning and for your job. Ask to yourself why you are interested in ultrasound imaging. Using again a quote from a famous past film I want to remind you: ” Walk left side, safe. Walk right side, safe. Walk middle, sooner or later, get squashed just like a grape. Here, ultrasound, same thing. Either learning ultrasound imaging, or not learning ultrasound imaging, is safe. If you learn ultrasound imaging “so and so”, you will get squashed just like a grape”. Understood?



Recent Posts

Talus Osteochondral Bruises and Stress Injury

about monitoring stress injury of the talar dome with dynamic MRI and CBCT exam

Today I present you the clinical picture of a medial talar bone edema and spongious impaction of an elite runner; I’d like to remind you that a bone bruise is a subchondral osseous fracture of the cancellous microarchitecture with accompanied local hemorrhage and edema, so less indication for ultrasound imaging in this case. Yes, with ultrasound we can perfectly see the cortical irregularity but nothing about the definitive staging of the disease, so don’t forget: MRI is the method of choice (Stress Fracture in Runners).

Talus Injury MRI

Three months after the study was completed with Cone-Beam Ct scan; try to identify risk factors and training errors predisposing to stress fractures is mandatory.

Talus Injury Monitoring

Talar Injury CT

I always use the dynamic MRI-CBCT examination before the return to activity.


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