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Aids to General Practice

Medical imaging has now reached the stage where it is essential for doctors in all branches of clinical practice to choose the most appropriate method bearing in mind the escalating cost of health care. Cheapest is not always best. The method chosen will depend primarily on the patient's presentation. In most cases of musculoskeletal trauma, plain radiography is the first choice and most likely will remain so in the forseeable future. The same can be said for persistent bone or joint pain and to show pulmonary metastases, but a knowledge of the various imaging modalities is necessary for the more complex clinical problems such as diagnosing a pyroarthrosis, excluding bone metastases or a cause for pain when the plain film appears normal. Nuclear medicine, in most instances, will be the screening method to uncover bone metastases, except in myeloma, but often also for locating abscesses and for radiographically occult fractures, to give only a limited number ofexamples. However, MRI is proving indispensable for the management of orthopaedic problems such as backache, shoulder and knee pain, and muscle tumours. More than half the text, not surprisingly, is devoted to MRI with a long section on its display of normal anatomy in illustrations of high quality that are clearly labelled. The various pathologies are equally well covered but sonography and computed tomography combined receive less attention than nuclear medicine. Nevertheless this is a valuable addition to the literature on the new imaging methods, and is highly recommended to those involved in the diagnosis and management of patients with musculoskeletal problems.