GP3d - MRRead: A Novel Approach to Training Residents in MRI TMJ Interpretation

Abstract: Oral and maxillofacial surgeons (OMSs) are often tasked with diagnosing TMD in referred patients with persistent symptoms, for whom first-line therapies, such as rest and soft diet, have not provided relief. While a variety of imaging modalities are available to assess the TMJ, MRI is the most commonly used and the optimal method of TMJ evaluation. MRI scans display high resolution and excellent tissue contrast and allow for evaluation of joint biomechanics through dynamic imaging.2 Diagnosis of TMD using MRI is a critical step in the treatment process, yet it is still considered to be challenging and controversial. This represents a problem in the education and training of oral and maxillofacial surgery residents.
The purpose of our study was to create an online, web-based training module that would instruct a group of residents in the interpretation of a MRI TMJ scan in a logical, step-wise manner to locate and identify all relevant features of internal derangement. The investigator’s hypothesis was implementing the MRRead TMJ training module would improve residents’ competency in the interpretation of MRI TMJ features.
The investigators designed and implemented a prospective quasi-experimental trial. The population for this study included dental interns and residents. The primary outcome variable was the difference between the pre- and post-test scores of the participants and the frequency of missing internal derangement findings before and after the course. Secondary outcomes of interest are subjective data gathered from the course, including participants' feedback as well as subjective evaluation of the training module and perceived benefit. Another secondary outcome measured was the residents' self-reported confidence level in interpreting MRI TMJ scans on their own before and after completion of the course. Descriptive and bivariate statistics were used.
The population sample consisted of 68 residents, aged 20-47 (M = 29.1) years. When comparing the results pre- and post-course, the overall frequency of missed features of internal derangement decreased from 19.7 to 5.9, and the total score overall increased from 8.9% to 72.3%. Regarding secondary outcomes, the majority of participants indicated that they “agree” or “strongly agree” with a number of positive subjective questions asked. In addition, there was a statistically significant increase in the participants’ comfort levels in the interpretation of MRI TMJ scans.
The results of this study confirm the hypothesis that completing the MRRead training module (www.MRRead.ca) improves competency among residents in the interpretation of MRI TMJ scans and their identification of features of internal derangement correctly.



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2. Bag AK, Gaddikeri S, Singhal A, Hardin S, Tran BD, Medina JA, et al: Imaging of the temporomandibular joint: an update. World J Radiol 28:6(8):567-582, 2014

3. Al-Saleh MAQ, Alsufyani N, Lai H, Lagravere M, Jaremko JL, Major PW: Usefulness of MRI-CBCT image registration in the evaluation of temporomandibular joint internal derangement by novice examiners. Oral Surg Oral Med Oral Pathol Oral Radiol 123:2:249-256, 2017