Midlands Musculoskeletal Imaging
Consultant Radiologists - Dr SLJ James, Dr AM Davies, Dr Rajesh Botchu - Midlands Musculoskeletal Imaging
Midlands Musculoskeletal Imaging: 07909295224

Radiologists at Midland Musculoskeletal Imaging offer a wide range of services in diagnostic imaging. They perform various diagnostic procedures such as X-rays, MRI, bone densitometry, and bone scan. See below for more information on their services.


X-rays, AKA radiographs, are often the first line investigation for demonstrating bone and joint abnormalities. X-rays involve the exposure of the patient to a very small dose of ionising radiation to produce a 2D projectional image of part of the body in which all the anatomical structures are superimposed on one another. Frequently, a radiographic examination requires two separate X-rays to be obtained at right angles. In the past X-rays were printed out on film which could then be viewed on a light-box. Today, however, most X-rays are produced in a digital format that can be viewed on a computer/workstation . The digital information can be stored on a CD ROM which can then be sent to the referring clinician or the patient for future reference. While X-rays show exquisite bony detail soft tissue resolution is limited and so other imaging techniques may be utilised to demonstrate soft tissue pathology.


Fluoroscopy is a means of producing real time moving X-ray pictures by using a pulsed X-ray beam and displaying the images in real time on a TV monitor. Fluoroscopy can be utilised to ensure correct needle position for joint injections and interventional procedures.

Computed Tomography

Computed tomography, AKA CT, is an X-ray based imaging technique that produces cross-sectional images of the body. CT differs from X-rays in that the structures are not superimposed and so provide more anatomical detail. In a CT scanner the patient lies on a moving table while an X-ray tube, housed within a circular gantry, rotates continually emitting an X-ray beam. A series of detectors, also within the gantry, measure the emitted X-rays and powerful computers build up a picture of the cross-sectional anatomy. The computers can also reconstruct the image data to review the anatomy in different planes as well as 3D images. CT is particularly good a showing fine bony detail in complex anatomical areas such as the spine, pelvis and hindfeet. CT can also be used as an aid to interventional procedures such as CT-guided biopsy and vertebroplasty. The technique does employ a higher radiation dose to the patient than conventional X-rays.

Magnetic Resonance Imaging (MRI)

Over the last 20 years MRI has become one of the basic imaging tools employed by the medical profession. It has a unique ability to visualise all soft tissue and bony structures within the body with a combination of excellent spatial and contrast resolution.

An MRI scan involves the patient being exposed to a very homogeneous magnetic field. Radiofrequency pulses are employed to stimulate the area of the body under investigation and information returned from that region is used to build up an image of the area that is being investigated. In its simplest form it is a map of hydrogen ion concentrations within the body.

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Ultrasound imaging is a common diagnostic medical procedure that uses painless high-frequency sound waves to produce dynamic images (sonograms) of organs, tissues, or blood flow inside the body. The scan involves a hand-held probe (called a transducer) that is placed directly on and moved over the patient. A water-based gel is used to couple the ultrasound between the transducer and patient.

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Intervention Radiology

Interventional radiology is a branch of radiology where a diagnostic ortherapeutic procedure is performed under image guidance. This can involve the use of X-rays, CT or ultrasound to guide needle placement in the body and the exact method will vary depending on the problem which is being addressed. It is typically a minimally invasive procedure and has a rapid recovery time.

The accuracy of certain diagnostic procedures such as MRI (magnetic resonance imaging) and CT (computed tomography) can be improved by injection of a contrast agent into a joint (arthrogram). This aids in the diagnosis of some problems which occur within joints, particularly the shoulder and hip. This injection is usually done under x-ray guidance.

Other diagnostic procedures may involve a small sample of tissue being removed (biopsy). This may be from the soft tissues or bone and may be done under ultrasound or CT (computed tomography) guidance. This may be performed under local anaesthetic, sedation or general anaesthetic dependent on individual case requirements.

There is a vast array of therapeutic injections that can be performed under image guidance for a host of clinical indications. These commonly involve the use of a type of steroid and local anaesthetic. These injections are quick to perform and can be targeted at either joint or soft tissue related problems.

Nuclear Medicine (Isotope Bone Scans)

X-ray and CT scans have a great ability to demonstrate anatomical change but are insensitive in demonstrating physiological change. An isotope bone scan is a study that will map areas of altered bone metabolism within the body.

In order to produce a nuclear medicine image several important steps must be completed. Firstly a pharmaceutical with appropriate biological behaviour must be chosen. This compound must be successfully bound to a radioactive material without changing the biological behaviour of the original pharmaceutical. For an isotope bone scan the most commonly used pharmaceutical is methylene dyphosphenate a compound that is incorporated into bone. To make this radioactive it is bound with technetium a compound which emits gamma rays but has a very short biological half-life. This means that following the examination the vast majority of the injected material has been "lost" from the body within 24 hours.

The procedure is straightforward. Following injection of the radio-pharmaceutical into a patient's vein imaging for a bone scan will usually be undertaken 2 to 3 hours following injection. With some "3 phase" studies images will be acquired in the immediate post injection period as well as at a period 2 to 3 hours post injection. Patients are encouraged to drink between injection and imaging to hasten the excretion of unused radio-pharmaceutical. With an isotope bone scan once imaging commences 2 to 3 hours post injection the study is usually complete within 30 minutes.

Isotope bone scans can be used for the evaluation of the entire skeleton looking for disease remote from a known site of disease. It is commonly used to help in the evaluation of joint replacements which become symptomatic. It can be used in the evaluation of a variety of metabolic bone conditions as well as in the staging of underlying malignancies.


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Consultant Radiologists - Dr SLJ James, Dr AM Davies, Dr Rajesh Botchu - Midlands Musculoskeletal Imaging Dr Mark Davies Dr Steve James Dr Rajesh Botchu