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Editor in Chief rstanley{at}uabmc.edu
The new knowledge for the 21st century keeps right on rolling in.
In my junior year of medical school, I had the good fortune of spending a 1-month elective in pediatric radiology with Dr. Armand Brodeur, a charismatic educator and chief of the department at the Cardinal Glennon Children's Hospital, St. Louis. One of my memories of that personally very influential month was Dr. Brodeur's ability to detect the presence and diagnose the probable cause of what subsequently would be clinically determined to be intentional trauma to infants. Dr. Brodeur acquainted me with the early investigations of Drs. Fred Silverman and John Caffey, whose articles had appeared 9 and 16 years previously, but had not yet achieved worldwide recognition [1, 2].
In this month's issue, Dr. Paul Kleinman, himself an expert on the subject, provides us with a Centennial Commentary on Dr. Silverman's classic 1953 paper describing "unrecognized skeletal trauma" [3]. His insightful reflections released a flood of memories of my own early exposure to our amazing specialty.
Dr. Caffey's initial paper on the topic had also appeared in the AJR in 1946 [2]. The observations of these two giants of pediatric radiology have strongly influenced the current recommendations of the American College of Radiology and the American Academy of Pediatrics regarding follow-up of skeletal surveys in suspected cases of infant abuse.
Last August, in an editor's notebook, I presented my own book review of Mort Meyers' fascinating book, Happy Accidents. We have the good fortune, this month, of having another creation of Dr. Meyers' fertile mind in his perspective, "Back to the Future" [4].
It is the type of presentation that will compel the interested reader to reflect on her or his own career experiences with the scientific process. And similar to the point of Happy Accidents, significant advances often have come from humble and initially unappreciated insights and discoveries. I recommend both of these fascinating articles in this issue to the reader who desires to understand how real advances in our field often occur.
Although not a musculoskeletal (MSK) radiologist myself, I am delighted to see the abundance of excellent MSK articles this month. While I, in my uninformed state, would think that there is nothing more to learn about musculoskeletal anatomy? Dr. Torshizy and colleagues from the famous Resnick MSK division at UCSD provide new observations on the metatarsal heads as viewed cross-sectionally, affording ways to distinguish variants of normal anatomy from disease [5].
Who would have guessed 25 years ago how important the role of sonography and MRI would become in evaluating the musculoskeletal system. Only the true believers could have then.
Today, the uses for sonography and MRI are increasing logarithmically, as are evident from this month's additions to the growing literature. Tendons, ligaments, joint capsules, cartilage, muscles, and even bones and bone marrow are all fair game. And as I have marveled at before, the radiologist can now image the source of pain, when nothing seems abnormal by traditional radiographic approaches to imaging the skeleton.
Let me also call your attention to the ongoing debate over the relative merits of lung cancer screening, as reviewed by Ravenel et al. [6]. The general topic of screening is of great interest to me. There is nothing more controversial than the issue of whether screening for lung cancer with CT saves lives and lowers the overall mortality of this dreadful disease. While a combined ACRIN and NCI national randomized clinical trial is still gathering follow-up data on the subjects enrolled, as of today there have been no data to indicate that this type of screening will decrease the mortality of lung cancer. Ravenel et al. nicely summarize the state of our understanding of this hotly debated issue.
The depth and breadth of content in this month's issue is striking to me. Important topics including nephrogenic systemic fibrosis, anaphylaxis to iodinated radiocontrast media due to nonallergic hypersensitivity, and a nationwide survey of patient preparation practices for 64-MDCT coronary artery angiography are also included [7–9].
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