Peter L MunkUniversity of British Columbia & Vancouver General Hospital · Radiology Orthopedics and Palliative Care
Peter L Munk
MDCM, FRCPC, FSIR,FFRRCSI(Hon)
About
576
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Introduction
Effectiveness assessment of Cryo ablation of MSK metastases and fibromatosis
Additional affiliations
January 1998 - December 2012
January 1997 - present
January 1991 - December 1993
Education
September 1979 - June 1983
Publications
Publications (576)
Until recently, computed tomographic (CT) examinationsacquired at a radiation exposure equivalent to correspondingplain radiographs would be of grossly substandard imagequality, almost certainly resulting in a failure to adequatelyvisualize many anatomic structures. Over the past decade,successive technical breakthroughs have facilitateddiagnostic-...
A 49-year-old man with metastatic melanoma and pathologic fracture of the sternum was deemed to be a poor candidate for general anaesthesia. He suffered severe pain and range of motion limitation that did not respond to narcotic therapy. Ultimately, the lesion was managed with computed tomography-guided cryoablation and subsequent cementoplasty, an...
A large variety of different imaging guided interventions have become available to treat pain secondary to knee osteoarthritis. Radiologists may now play an important role in treating patients - not just in making imaging based diagnosis.
-With increased internet use many subscription journals began publishing parallel electronic versions - Open access journals are scholarly journals available online to readers without barriers – financial, technical or legal / copyright “equalizing access” to information
- This contrasts with predatory journals which is an exploitative open-access...
Recent advances in percutaneous image-guided techniques have empowered interventional radiologists with diverse treatment options for the management of musculoskeletal lesions. Of note, there is growing utility for cementoplasty procedures, with indications ranging from stabilisation of bone metastases to treatment of painful vertebral compression...
Retained needle fragments commonly serve as sources of recurrent infections with a potential to embolize to the heart and lungs and can lead to life-threatening consequences. Here, we report a case of a 46-year-old male with a history of intravenous drug user and chronic forearm wounds, presenting with sepsis. Several retained needles are identifie...
Dual-energy computed tomography (DECT) is an exciting application in CT technology conferring many advantages over conventional single energy CT at no additional with comparable radiation dose to the patient. Various emerging and increasingly established clinical DECT applications in musculoskeletal (MSK) imaging such as bone marrow edema detection...
Explores the stamp and postal issues commemorating the discovers of radioactivity. (The Canadian Philatelist Jan 2024)
Rontgen discovered the x ray in 1895 and almost immediately its medical applications were recognized and rapidly adopted. This article provides the historical background and extensively illustrates the many stamps and other postal items which have commemorated his discovery since that time
Radiologic knowledge of different fracture patterns involving the shoulder girdle is an important tool to generate clinically relevant reports, identify concomitant injuries, guide management decisions, and predict and minimize complications, such as nonunion, osteoarthritis, osteonecrosis, and hardware failure. Complex unstable injuries like scapu...
In the short report published by Siek and Spinek, the femoral metaphyseal lesion in question was described as potentially the first described case of a simple bone cyst (SBC) from a Polish background. However, on review of the single radiograph available, we feel the primary and differential diagnoses offered are misleading from a radiographic pers...
Cancer is a leading cause of death, with the spine being the most common site for skeletal metastasis. The spine is also a site for primary malignancy, such as sarcoma and chordoma, as well as non-neoplastic pathologies. An accurate diagnosis of spinal neoplastic diseases is crucial in determining appropriate management. With the advent of personal...
Hockey is a demanding contact sport with growing popularity around the world. This article is part of a review series in this issue of Seminars in Musculoskeletal Radiology that summarizes epidemiological research on the patterns of ice hockey injuries as well as provides pictorial examples for a radiologist's perspective. We focus on non-extremity...
Hockey is a fast-paced contact sport with a high incidence of injuries. Although injuries are more frequent among elite players, recreational hockey injuries are a common issue faced by primary care and emergency physicians. Lower extremity injuries in hockey are particularly important because they account for approximately a third of all injuries...
Ice hockey is a fast-paced contact sport with a high incidence of injuries. Upper extremity injury is one of the most common regions of the body to be injured in hockey. This imaging review will equip the radiologist with a knowledge of the more common and severe upper extremity injuries that occur in this sport.
Image guided percutaneous biopsy has become the initial procedure of choice in most cases for obtaining bone samples for histological and microbiological assessment. It is a minimally invasive procedure which offers multiple advantages over open surgical biopsy including maintenance of bone structure, minimal soft tissue injury, reduced need of gen...
Purpose: To determine the sensitivity and specificity of dual-energy CT (DECT) virtual noncalcium images (VNCa) with bone and soft tissue reconstructions in the diagnosis of osteomyelitis. Materials & Methods: Between December 1, 2014 to December 1, 2020, 91 patients who had 99 DECT performed for a clinical indication of osteomyelitis with correspo...
Different image-guided interventional procedures can be applied to patients with benign and malignant bone tumors, either to diagnose or treat, for palliation and pain management, or to facilitate other therapies such as surgery. We illustrate and review the most commonly used interventional radiologic procedures and their contribution to the manag...
This book is a comprehensive guide to Targeted Drug Delivery (TDD), also known as Intrathecal Drug Delivery (IDD), and offers an overview to this unique form of treatment. The medication is delivered by intrathecal pumps and is less common than some other techniques for interventional pain management, but is essential in conditions such as refracto...
Gout, a crystalline arthropathy caused by the deposition of monosodium urate crystals in the articular and periarticular soft tissues, is a frequent cause of painful arthropathy. Imaging has an important role in the initial evaluation as well as the treatment and follow up of gouty arthropathy. The imaging findings of gouty arthropathy on radiograp...
Introduction
Desmoid tumor is a locally-invasive neoplasm that causes significant morbidity. There is recent interest in cryotherapy for treatment of extra-abdominal desmoid tumors. This systematic review assesses evidence on safety and efficacy of cryotherapy in the treatment of extra-abdominal desmoid tumors.
Materials and methods
The systematic...
Periarticular calcification and ossification is a frequent finding on imaging and may sometimes pose a diagnostic challenge. The differential diagnoses for this radiological finding are wide and can be classified into broad groups such as idiopathic, developmental, trauma, burns, infection, tumor, connective tissue disease, crystalline, metabolic,...
Purpose
To retrospectively determine efficacy and safety of cryoablation in patients with desmoid tumors over a 10-year period at a single institution.
Materials and Methods
Between 25 February 2010 and 25 February 2020, 25 patients (12 - 80 years) with 26 lesions (mean pre-procedural tumor volume was 236.6 cm³) were treated over 44 cryoablation p...
Amyloidosis may be hereditary or acquired and the deposits can be focal, localized, or systemic in distribution. A discrete mass of amyloid deposition is called an amyloidoma and is the least common presentation. Soft tissue amyloidoma in an extremity is exceedingly rare. Amyloidomas can mimic malignant neoplasms both clinically and radiologically....
This important book fills a gap in the literature by focusing specifically on the role of interventional radiology in patients receiving palliative medicine and supportive care, a group in which the need for minimally invasive therapy is especially high. Detailed information and guidance is provided on use of the tools of interventional radiology f...
Artificial intelligence (AI) has been defined as a branch of computer science dealing with the capability and simulation of a machine to imitate intelligent human behaviour. Diagnostic radiology, being a computer-based service, is unsurprisingly at the forefront of the discussion of the use of AI in medicine. There are however differing schools of...
Objective
To offer an evidence-based account of the effect of 24/7/365 attending radiologist coverage on the turnaround time (TAT) of trauma-related radiographs finalized within 48 hours of exam completion, drawing data from an emergency radiology department of a tertiary care hospital in Vancouver, British Columbia.
Materials and Methods
This was...
Objective
To study the impact of 24/7/365 attending radiologist coverage on the turnaround time (TAT) of trauma and nontrauma cases in an emergency and trauma radiology department.
Patients and Methods
This was a retrospective chart review in which TAT of patients coming to the emergency department between 2 periods: (1) December 1, 2012, to Septe...
Purpose
To assess the pattern of result communication that occurs between radiologists and referring physicians in the emergency department setting.
Methods
An institutional review board–approved prospective study was performed at a large academic medical center with 24/7 emergency radiology cover. Emergency radiologists logged information regardi...
Aims:
Due to the rarity and varied natural history of desmoid-type fibromatosis, evidence-based treatment standards for this disease remain lacking. This study evaluated outcomes in patients with desmoid-type fibromatosis managed at a Canadian institution over two decades.
Materials and methods:
Records of 227 patients with desmoid-type fibromat...
CT is a readily available imaging modality for cross-sectional characterization of acute musculoskeletal injuries in trauma. Dual-energy CT provides several additional benefits over conventional CT, namely assessment for bone marrow edema, metal artifact reduction, and enhanced assessment of ligamentous injuries. Winter sports such as skiing, snowb...
Dual Energy CT Characterisation of Winter Sports Injuries
Case Report: Peripheral Amyloidoma of the Foot
Dual-energy computed tomography (DECT) has the potential to detect musculoskeletal pathology with greater sensitivity than conventional CT alone at no additional radiation dose to the patient. It therefore has the potential to reduce the need for further diagnostic imaging or procedures (e.g., joint aspirations in the case of gout or magnetic reson...
Chapter 11 discusses scapular trauma. The scapula is a flattened and triangular bone that is relatively rarely fractured. Scapular fractures can be caused from direct or indirect trauma. Trauma to the scapula can take many forms ranging from simple and nondisplaced scapular body fractures to complex injuries, such as scapulothoracic dissociation, w...
Chapter 13 discusses humerus trauma. Humerus fractures are common. Based on anatomic location, they are frequently divided into proximal humerus, humeral shaft, and distal humerus fractures. In the proximal humerus, the surgical neck is most commonly injured, whereas supracondylar fractures are most common among the distal humerus fractures. Fractu...
Chapter 8 discusses clavicle fractures. Clavicle fractures are common and are usually displaced. The frequent rate of injury to the clavicle at various age groups is likely because of early ossification and its superficial anatomical location. Causes of injury include direct impact because of direct fall or blow to the shoulder. Injury from indirec...
Chapter 9 discusses sternoclavicular joint trauma. The sternoclavicular joint is a synovial joint with a capsule and adjacent ligaments providing overall stability. Direct or indirect force to the shoulder from mechanisms, such as a motor vehicle collision, sporting injuries, or fall from a height, can cause sternoclavicular joint injury. The 2 mai...
Chapter 15 discusses radius and ulna trauma. Forearm fractures are common and may be isolated to the ulna or more commonly involve both bones. Fractures of the radius or ulna are usually because of direct trauma and are often displaced. Depending on their complexity, isolated fractures of the ulnar diaphysis may be treated nonoperatively or operati...
Chapter 14 discusses elbow trauma. The elbow is a hinge synovial joint that consists of the ulnohumeral, radiocapitellar, and proximal radioulnar joints. The olecranon and radial head fractures are common and may occur secondary to direct trauma or with transmitted forces from an injury such as a fall on an outstretched hand. The elbow is the secon...
Chapter 17 discusses hand trauma. Metacarpal and phalangeal fractures are common, as are dislocations of the interphalangeal and metacarpophalangeal joints. These injuries may be related to sports or work trauma or result from a fall. Osseous injuries are frequently associated with ligamentous or tendon injury. Most hand injuries are stable and can...
Chapter 16 discusses wrist trauma. The wrist is a complex joint consisting of 3 compartments, including the radiocarpal, midcarpal, and distal radioulnar joints. Fractures of the distal radius and ulna are common. Of the carpal bones, the scaphoid is the most frequently injured followed by the triquetrum. Carpal dislocations are less common and may...
Chapter 6 on rib trauma reviews the mechanism of injury and clinical features, imaging strategy, imaging characteristics, and treatment of rib fractures. Blunt chest trauma is a common cause of rib injury. This injury can vary in severity and cause respiratory compromise. Ribs usually fracture at the point of impact or posteriorly, where their anat...
Chapter 12 discusses glenohumeral joint trauma. The shoulder is one of the most frequently dislocated joints in the body. The glenohumeral joint is ball and socket articulation between the humeral head and scapular glenoid. The humeral head is significantly larger than the glenoid fossa, which predisposes this joint to instability. Anterior shoulde...
Chapter 7 provides an overall look at sternum fracture. The sternum is a flat bone at the anterior center of the chest, which protects the mediastinum. The sternum along with the ribs and vertebrae form the thoracic cage, which protects the thoracic organs and vessels. Fractures are usually associated with direct blunt trauma which most commonly oc...
Chapter 10 reviews acromioclavicular joint trauma. The acromioclavicular (AC) joint represents the articulation between the acromion process and lateral clavicle and is a synovial joint stabilized by 3 ligaments. AC joint injuries are most common in active/athletic young adults. The most common injury is AC joint dislocation sustained during contac...
Purpose:
To evaluate the safety and efficacy of oxygen-ozone treatment delivered via a novel, handheld ozone-generating device for improving pain and function in herniated disc patients.
Materials and methods:
A total of 39 patients with contained herniated lumbar discs received oxygen-ozone treatment at 1 of 3 centers. Treatment consisted of in...
Patellofemoral syndrome (PFS) is a common etiology of anterior knee pain, particularly amongst young female athletes. Despite recent advancements in the resolution of magnetic resonance imaging (MRI), there still remains a paucity of literature that has investigated the MRI findings associated with PFS. This pictorial essay will describe our instit...
Background
Pain, commonly localized to the trunk in individuals with COPD, may be due to osteoporosis-related vertebral deformity and chest wall hyper-expansion causing misalignment of joints between the ribs and vertebrae. The purpose of this study was to determine if thoracic vertebral deformity and arthropathy were independent contributors to tr...
IntroductionResearch productivity is one of the few quintessential gauges that North American academic radiology departments implement to determine career progression. The rationale of this study is to quantify the relationship of gender, research productivity, and academic advancements in the musculoskeletal (MSK) radiology to account for emerging...
Spinal metastases are the most commonly encountered tumour of the spine, occurring in up to 40% of patients with cancer. Each year, approximately 5% of cancer patients will develop spinal metastases. This number is expected to increase as the life expectancy of cancer patients increases. Patients with spinal metastases experience severe and frequen...
Background:
Metastases to the bone are common in cancer patients, and it has been estimated that up to 50% of patients with pelvic bone metastases will not achieve adequate pain control with medications alone. This has led to a paradigm shift over recent years towards the use and development of minimally invasive image-guided treatment options for...
Purpose of Review
Dual-energy computed tomography (DECT) has become a unique highly useful imaging modality in musculoskeletal (MSK) radiology practice. In this article, we provide a concise overview of the four main applications for DECT in (MSK) imaging: monosodium urate (Gout) detection, metal artifact reduction, bone marrow edema detection, and...
Pitfalls for the interventional radiologist can be broadly categorized as planning errors, perceptual errors, interpretative errors, and technical errors. This chapter will focus on the common and serious pitfalls which can occur during musculoskeletal intervention during bone augmentation procedures such as vertebroplasty, thermoablation of tumors...
An environmental-friendly radiology department should be a requirement of the future era. The aim of this article is to make radiologists aware of their responsibilities for a greener world. We have suggested a number of minor but important changes in various sections of a radiology department that can make the radiology department more environment...
Throughout recent years, Gabapentin has become increasingly used for the treatment of neuropathic pain. We report on a case of a 31 year old female who presented to the emergency department with unilateral leg pain, weakness, and swelling after increasingly titrating her Gabapentin dosage over three weeks. Magnetic resonance imaging confirmed the p...
The principal advantages of dual-energy computed tomography (CT) over conventional CT in the musculoskeletal setting relate to the additional information provided regarding tissue composition, artifact reduction, and image optimization. This article discusses the manifestations of these in clinical practice-urate and bone marrow edema detection, me...
Lower limb injuries account for most of all injuries suffered by athletes and the knee joint accounts for over half of these. The etiology of knee pain is multifactorial; a good history focusing on the mechanism of injury and the chronicity of pain is extremely useful in correlating with radiologic findings and establishing a clinically meaningful...
Objective:
Dual-energy CT (DECT) is an innovative imaging modality that allows superior detection of pulmonary embolism, enhanced detection of urate in gout, and improved assessment of metal prostheses when compared with conventional CT.
Conclusion:
The primary aim of this review is to describe these DECT protocols and compare each to its respec...
Different image-guided interventional procedures can be applied to patients with bone cancer, either to diagnose, to treat and cure, for palliation and pain management or to facilitate other therapies such as surgery. We illustrate and review the most commonly used interventional radiologic techniques and their contribution to the management of bon...