FOREWORD

Radiology has been a field of constantly advancing technology. Often, when they have occurred, many advances have been considered quantum leaps in technology. Repeatedly, when these quantum leaps have occurred, the previous generation of technology has been neglected. Unfortunately, it is only with hindsight that we can see what we have missed. The advent of multidetector CT has lead to one of the few second chances in radiology.

The last 15 years of musculoskeletal imaging have rightfully been the era of MRI. This has resuscitated the subspecialty and, arguably, brought it a greater prominence than it had ever previously achieved. These advances have allowed radiology not only to contribute to the diagnosis, but also to the understanding, of disease. However, a decade prior to the development of MRI was the development of CT. Overall, in medicine, CT was as much a revolutionary advance as MR. This was particularly true for abdominal and neurologic imaging, but at that time orthopedic CT imaging did not have the same impact. Frequently, CT displaced the physical examination whereby the radiological diagnosis became the clinical diagnosis. For more recently trained radiologists this is standard clinical practice; however, it was a novel concept 20 years ago.

In the last decade CT was overlooked. It was thought of as a mature technology and considered to have reached its zenith. It was regarded as a “high tech” plain film. How wrong we were. The development of multichannel CT has revolutionized CT imaging. The advances made in both speed and image resolution would have been inconceivable 10 years ago when MR imaging was peaking. This issue, therefore, is timely. Multichannel CT use has dramatically accelerated and significant portion of the patient volume is going toward orthopaedic applications.

Joshua Farber has been a leader in the continuing evolution of musculoskeletal radiology and was rightfully chosen to guest edit this issue because of his particular experience and expertise in multidetector CT. He is one of the foremost radiologists working in this area and many scientific contributions in the last five years have been made by him and his colleauges.

This issue begins with the fundamentals of multichannel CT. CT is no different than any other imaging modality in that an understanding of the basic physics of the modality is required in order to optimize images. This is followed by three specialized chapters: one concerning skeletal trauma, one focusing on arthrography and postoperative imaging, and one dealing with the wrist. The final chapter brings together advances in musculoskeletal imaging with those in image processing that are often necessary to optimize this data. The increasing use of powerful postprocessing techniques and computers results in interpretations based mostly, or entirely, on nonacquisition planes. This chapter deals specifically with the volume-rendering of tendons of the foot and ankle but the principles are applicable to other areas of musculoskeletal radiology as well as modalities other than CT.

As noted, this issue is timely and, in our opinion, likely to be well received. I would like to thank Dr. Farber and all contributing authors for continuing our goal of providing detailed evaluations of issues in musculoskeletal radiology and providing an educationally enlightening and important issue.