The role of musculoskeletal radiologists in emergency and trauma settings: current and emerging imaging modalities

MSK radiologists play a critical role in emergency and trauma settings, where rapid and accurate imaging interpretation is essential for timely diagnosis and treatment. The increasing complexity of trauma cases has driven the adoption of advanced imaging modalities beyond conventional radiographs and computed tomography (CT). Dual-energy CT (DECT) and magnetic resonance imaging (MRI) have revolutionized MSK imaging, offering superior tissue characterization and improved detection of occult fractures, bone marrow edema (BME), infections, and soft tissue injuries. Emerging technologies, such as portable MRI and photon-counting CT (PCCT), further enhance diagnostic capabilities by enabling bedside imaging, reducing radiation exposure, and providing ultra-high-resolution images. MSK radiologists are integral to immediate diagnosis, triaging, differentiating acute from chronic injuries, guiding surgical interventions, and performing image-guided procedures. DECT in particular has proven invaluable in detecting BME, reducing metal artifacts, and improving soft tissue contrast, while MRI remains the gold standard for evaluating soft tissue injuries and occult fractures. Portable MRI offers a radiation-free alternative for point-of-care imaging, especially in spinal cord and soft tissue injuries. PCCT, with its superior spatial resolution and material decomposition capabilities, holds promise for advanced fracture detection and reduced radiation doses. Additionally, 3D printing has emerged as a transformative tool for preoperative planning, surgical simulation, and personalized implant design. Despite challenges such as cost, accessibility, and technical limitations, these advancements are reshaping trauma imaging. As technology evolves, MSK radiologists will continue to integrate these innovations to optimize patient care in emergency and trauma settings, ensuring faster, more accurate diagnoses.