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From the Associate Editor's Notebook |
prove001{at}mc.duke.edu
April was designated as the cruelest month by T.S. Eliot but he also noted that in that month lilacs are bred from the dead land [1]. However, April is also a month, in the words of Eliot, "mixing memory with desire" [1]. The memories of last year's successes and failures are wedded to this year's desire to start anew. To a baseball fan, April is often the least cruel month because, on Opening Day in April, all teams start out with identical won-lost records. Most of us are enthusiastic and refreshed by the coming of spring but none so much as the baseball aficionado. Even the normally taciturn Joe DiMaggio himself once stated, "You always get a special kick on opening day. You look forward to it like a birthday party when you're a kid. You think something wonderful is going to happen" [2]. Perhaps the 20th century great sage Yogi Berra stated it best when he said: "A home opener is always exciting, no matter whether it's at home or on the road" [3]. Perhaps the excitement in April lies in the transition from the dormancy of winter and preparation (during spring training) to activity. As Early Wynn, a Hall of Fame pitcher noted, "you know that when you win the first one, you can't lose them all" [2].
Although the AJR is not a sports magazine, it is interesting to reflect on the interfaces between the worlds of radiology and baseball. At the very least, the field of radiology plays a very important role in evaluating baseball players (and other athletes) on nearly a daily basis. Hardly a day goes by without an announcement that some baseball player or another is undergoing MR imaging for pain in a pitching arm or for a suspected meniscal tear. Review of the medical literature on imaging studies in baseball, which are much more commonly published in sports medicine journals than in radiology journals, is fascinating if one has any interest at all in sports. One radiologist, who actually serves as a consultant to a major league baseball team and performs sonograms on pitchers' elbows during spring training, has shown differences in the thickness and mechanical characteristics of the ulnar collateral ligament in the elbow of the pitching arm compared to the other arm in asymptomatic pitchers [4]. Another recent article measured signal intensity within rotator cuff muscles on T2-weighted images in amateur baseball pitchers before and after a large number of pitches (135 pitches, similar to the number thrown in a complete baseball game). MRI signal intensity was measured at time intervals for up to 96 hours after pitching. The study found increases in signal intensity on T2-weighted images consistent with edema in some muscles for up to 96 hours. This study is worth keeping in mind the next time a pitcher is asked to pitch on only 3 days of rest (rather than the usual 4 or 5 days of rest) in a pennant race or the World Series. It is also interesting to speculate what such studies would have shown on the shoulders of such pitching stalwarts as Iron Joe McGinnity, a Hall of Fame pitcher who was famous for starting both games of a doubleheader. In 1903 he performed this feat 3 times in one month and won all 6 games.
Baseball is part of everyday American life and it is not surprising that physicians have studied the effects of baseball events on the public. One of the more interesting studies was performed in 1994. One needs to be a New Yorker to fully appreciate the study, which is entitled "Impact of Yankee Stadium Bat Day on blunt trauma in northern New York City" [5]. The intent of the study was to determine the effect of the distribution of 25,000 bats at Yankee Stadium on June 3, 1990 upon the incidence of blunt trauma in northern New York City. The impetus for the study was the informal opinion of emergency department physicians that the incidence of bat-related trauma increased after Bat Day, which was disproved by the study. This conclusion proved fortunate, considering the article based on the study was published 4 years (and 3 Bat Days) after June, 1990.
One of the more interesting applications of radiology to baseball does not involve humans as study subjects, but bats. Alteration of bats by introduction of various foreign substances (such as cork or rubber) to improve performance of hitters is a subject of relatively intense scrutiny. The most famous recent incident of this nature occurred in 2003 when a bat used by Sammy Sosa (then of the Chicago Cubs) broke after he hit a ground ball, revealing cork in the center of the bat. In accordance with the growing trend to provide a noninvasive means of diagnosis, a number of radiological methods have been studied to examine bats for presence of foreign substances. The usefulness of various imaging techniques for the purpose of detecting cork within bats has even been compared. In 1987, the National Institute of Standards and Technology compared the usefulness of CT scanning, sonography, and various X-ray devices for ability to detect cork within bats [6]. The results (and radiological images of the corked bats) can be found at the following website: www.100.nist.gov/battampering.htm. In fairness to Sosa, following the shattering of his bat in June 2003, all 76 of his bats were confiscated from the Cubs' locker room before the end of the game and were radiographed. None was found to contain cork. In an interesting sequel to this event, officials at the National Baseball Hall of Fame asked Richard Baron (present Chair of the ARRS Scientific Program Subcommittee) to image two of Sosa's bats that had been donated to the Hall (including the one used to hit his 500th homerun) for the presence of cork [7]. CT scans of the bats showed no evidence of cork. Skeptics and baseball fans can view the CT scans at the following website: magazine.uchicago.edu/0308/campus-news/bat.shtml.
At this point, the reader may argue that anyone who could write an AJR Editor's Notebook about the opening day of baseball season needs to have his head examined. This brings us to one of the best anecdotes that link radiology and baseball, set in game 4 of the 1934 World Series between the Detroit Tigers and the St. Louis Cardinals. Dizzy Dean, the Cardinals' ace pitcher who was widely recognized for wild antics and homespun country humor, was on first base. Dean ran toward second base after a ground ball was hit. The Tiger's second baseman, Billy Rogell, threw to the first baseman but the throw hit Dizzy in the head, rendering him unconscious. Dean was taken from the field but awakened soon afterward and underwent radiography of the head, which was negative. A St. Louis newspaper reportedly ran the following headline the next day: "X-ray of Dean's head shows nothing!"
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