title: Freehand direct arthrography of the shoulder using near real-time guidance in an open 1.0-T MRI scanner.
abstract: OBJECTIVE
  To assess the technical success and duration of magnetic resonance imaging (MRI)-guided freehand direct shoulder arthrography (FDSA) with near real-time imaging implemented in a routine shoulder MRI examination on an open 1.0-T MRI scanner, and to assess the learning curve of residents new to this technique.
  
  
  METHODS
  An experienced MRI interventionalist (the expert) performed 125 MRI-guided FDSA procedures, and 75 patients were treated by one of three residents without previous experience in MRI-guided FDSA. Technical success rate and duration of MRI-guided FDSA of the expert and the residents were compared. The residents' learning curves were assessed. The occurrence of extra-articular deposition and leakage of contrast media from the puncture site and the subsequent impairment of image interpretation were retrospectively analyzed.
  
  
  RESULTS
  Overall technical success was 97.5 %. The expert needed overall fewer puncture needle readjustments and was faster at puncture needle positioning (p < 0.01). The learning curve of the residents, however, was steep. They leveled with the performance of the expert after ≈ 15 interventions. With a minimal amount of training all steps of MRI-guided FDSA can be performed in ≤10 min.
  
  
  CONCLUSIONS
  Magnetic resonance-guided FDSA in an open 1.0-T MRI scanner can be performed with high technical success in a reasonably short amount of time. Only a short learning curve is necessary to achieve expert level.
authors: Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany. Christian.Wybranski@uk-koeln.de.
authors: Christian
authors: C
authors: Wybranski
authors: Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Medical School, Magdeburg, Germany.
authors: Ilya
authors: I
authors: Adamchic
authors: Institute of Biometry and Medical Informatics, Otto-von-Guericke University Medical School, Magdeburg, Germany.
authors: Friedrich-Wilhelm
authors: FW
authors: Röhl
authors: Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Medical School, Magdeburg, Germany.
authors: Jens
authors: J
authors: Ricke
authors: Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Medical School, Magdeburg, Germany.
authors: Frank
authors: F
authors: Fischbach
authors: Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Medical School, Magdeburg, Germany.
authors: Katharina
authors: K
authors: Fischbach
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004503:Education, Medical, Graduate; D005260:Female; D006801:Humans; D007396:Internship and Residency; D059032:Learning Curve; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009985:Orthopedics / Q000193:education*; D011871:Radiology / Q000193:education*; D012189:Retrospective Studies; D000070599:Shoulder Injuries / Q000000981:diagnostic imaging*; D012785:Shoulder Joint / Q000000981:diagnostic imaging*
keywords: Efficiency; Freehand direct shoulder arthrography; Interventional MRI; Learning curve; Near-real-time MRI guidance