The 100th annual American Roentgen Ray Society (ARRS) meeting was recently held in Washington, D.C. The categorical course topic for this meeting was Emergency and Trauma Radiology. No matter what subspecialty one pursues, radiologists will always be called upon to review and interpret emergency and trauma cases. This is a basic and critical service that we provide for our referring clinicians. In my opinion, every radiologist should be familiar with these cases and the findings that determine successful patient management. At the end of the course it was announced that there were nearly 800 attendees. This is one of the largest audiences ever for the ARRS, so I must not be alone in my views regarding this important topic.

This review course was expertly taught by a staff which was chosen by the editors (O.C. West, M.D., R.A. Novelline, M.D., and A.J. Wilson, M.B., Ch.B.). The course was subdivided into groups of lectures focused on the head, spine, chest, abdomen, pelvis and extremities. The schedule provided more than enough time for lively panel discussions dedicated to answering questions from the attendees. All of the speakers remained after each session and continued to answer questions.

The syllabus was well written and contained high quality images. I particularly enjoyed the editorial content relating the personal experiences of the speakers in managing and diagnosing trauma cases. This information would be difficult to obtain in a typical journal article. The sections were well referenced for those who might wish to pursue more in–depth reading on the various topics presented.

Due to my interest in emergency radiology, I unfortunately did not get a chance to attend all of the musculoskeletal paper presentations. However, I managed to attend session 10 which included papers on the upper extremity. This session started out with an excellent review of MRI diagnosis of triceps tendon tears given by F. Feldman, M.D. and her colleagues at Columbia. Dr. Feldman pointed out a potential pitfall in the diagnosis of triceps tendon tears. If the triceps tendon appears wavy with internal calcification distally, one should be careful as the calcification may represent an avulsed bone fragment in a patient with an intact tendon.

Another lecture of interest to me focused on cartilage lesions of the superior humerus visualized by MRI. This was presented by K.W. Carroll and colleagues from Duke. These can be a source of pain to patients and the MRI exams should be checked carefully for these lesions. A thought provoking presentation was given by C.B. Chung regarding MR arthrography. She discussed using either a posterior or anterior approach for needle placement and contrast injection depending on the patient's symptoms. In situations where there is anterior instability, a posterior approach may be better as contrast extravasation in the anterior soft tissues will limit the exam. A posterior approach was also advocated in patients who are suspected to have SLAP lesions. The author claimed no significant increase in procedure difficulty or patient complaints with the posterior approach. It is done with patients placed prone with the symptomatic arm in internal rotation. I intend to try this on some of our patients.

Closing presentations claimed better resolution for 8 Tesla magnets compared to 1.5 Tesla magnets for wrist imaging. I am not sure I am sold on this and, not knowing the price of these magnets, I believe I will sit back and wait for articles to address this issue or let my neuroradiology collegues champion this cause for now.

I was fortunate to sit in on part of session 21, musculoskeletal radiologic techniques. G.E. Gold and collegues presented interesting data from research conducted at Stanford and U.C. San Diego regarding MR arthrography using inversion recovery sequences for fat suppressed imaging in low field strength magnets (.2T). This paper reported two optimal concentrations of contrast that can be used, 250–500 uM and 6,000–8,000uM. The contrast will be bright on both IR and T–2 weighted images at 350uM concentrations while at 6,000 uM concentrations they found the contrast bright only on the IR sequences. The question of using saline as a contrast agent was proposed by a member of the audience, however the presenter noted that T–2 weighted images would then be needed and that would add to the scanning time.

An interesting presentation by G. Flusser explained how shoulder arthrography could be performed without fluoroscopic guidance, simply be palpating anatomic landmarks. This presentation also included an excellent filmed demonstration. If one can palpate the distal clavicle, humerus and coracoid process, a needle can be placed between the coracoid and humeral head pointed in a slightly caudal direction. As lidocaine is introduced through the needle, the syringe is removed periodically. Once there is return of the injected lidocaine, the joint space has been reached. This presentation provided excellent discussions; most in attendance seemed extremely interested. After hearing the earlier lecture on the values of the posterior approach, I now have two new methods to consider for MR arthrography. It was noted by one person in attendance that studies have reviewed this technique with mixed results. However, others in attendance commented that they use this technique with great success.

One drawback to this year's meeting was the lack of seating and small room size for many of the instructional courses. I think this was most obvious for course 111, diffuse hepatic lesions. I counted approximately 40 people standing against the walls of the lecture room with even more people sitting on the stairs leading to the balcony where additional attendees could be seen sitting on the floor for the full hour. Although more seating was added by the end of the week, there still seemed to be a shortage of seats. Usually at the end of each meeting I fill out the evaluation forms and suggest different cities for the upcoming meetings. After this year I believe that any meeting venue will do provided I don't have to sit on the floor during the lectures.

All of the instructional lectures I attended were excellent; I attribute this to the strong support for the ARRS by its members.