OAK BROOK, Ill. — Using ultrasound and a minimally-invasive procedure, radiologists can identify and treat patients who engage in a disturbing self-injury behavior known as self-embedding, according to a new study published in the online edition and October print issue of the journal Radiology.
“This is a new way for radiologists to impact public and mental health,” said the study’s senior author, William E. Shiels II, D.O., chairman of the Department of Radiology at Nationwide Children’s Hospital in Columbus, Ohio, and president of The Children’s Radiological Institute. “Radiologists can be in a position to interrupt a cycle of self-harm with effective, early diagnosis and referral for appropriate behavioral health and foreign body removal.”
Self-injury, or self-harm, refers to a variety of behaviors in which a person intentionally inflicts harm to his or her body without suicidal intent. It is a disturbing trend among adolescents, particularly girls. Prevalence is unknown because many cases go unreported, but recent studies have reported that one in five high school students has practiced deliberate self-injury at least once. More common forms of self-injury include cutting of the skin, burning, bruising, hair pulling, breaking bones or swallowing toxic substances. In cases of self-embedding, objects are used to puncture the skin or are embedded into the wound after cutting.
Dr. Shiels and colleagues studied 21 episodes of self-embedding behavior in 11 teenagers, including nine girls and two boys, age 14 to 18. Objects had been present for time periods between 2 days and an unknown number of years. Using ultrasound and/or fluoroscopic guidance, interventional pediatric radiologists removed 68 of the 76 embedded foreign objects found in the patients. The embedded objects included metal, glass, wood, plastic, graphite, crayon and stone. The objects were embedded during injuries to the arms, ankles, feet, hands and neck. One 18-year-old patient with repetitive behavior had self-embedded 35 objects over two years time, including staples, a comb tooth, a fork tine, a cotter pin and nail polish wands.
Ultrasound guidance allowed the researchers to detect the presence and location of wood, crayons and plastic objects, not detectable on x-ray examinations. Removal was performed through small incisions in the skin that left little or no scarring and was successful in all cases. There was one incident of fragmentation, but all fragments were removed.
“Early detection and removal of these foreign bodies are key steps for these teenagers to engage in effective therapy and interrupt their cycle of self-harm, so they can recover and grow as healthy and successful adults with good coping skills,” Dr. Shiels said.
“Self-embedding Behavior: Radiologic Management of Self-inserted Soft-Tissue Foreign Bodies.” Collaborating on this paper with Dr. Shiels were Adam S. Young, B.S., James W. Murakami, M.D., Brian D. Coley, M.D., and Mark J. Hogan, M.D.
Radiology is edited by Herbert Y. Kressel, M.D., Harvard Medical School, Boston, Mass., and owned and published by the Radiological Society of North America, Inc. (http://radiology.rsna.org/)
RSNA is an association of more than 44,000 radiologists, radiation oncologists, medical physicists and related scientists committed to excellence in patient care through education and research. The Society is based in Oak Brook, Ill. (RSNA.org)
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Indeed medical science generally, and radiology specifically has developed to such an extent that nothing can stay concealed in the human body. Often it is the radiologist who is the first one to notice these foreign bodies in a teenager’s body.
At admission in the ER(emergency room) the chest X-Ray is often the first investigation to be carried out, which is reported by the radiologist. If he/she notices any foreign body (in this case, nails, pins, needles, splinters etc.) then either a CT(computerized tomography) scan or an MRI(magnetic resonance imaging) is carried out to look at the deeper tissues injured by the foreign body in question as well as how severe the damage is and what can/should be done to rectify the self-inflicted damage.
It is then when deeper injuries, synchronous as well as metachronous injuries or inflictions can be diagnosed very precisely by the radiologist.
This self-embedding behaviour of teenagers has many social and psychological implications. In most of the cases there is an element of child abuse in early childhood years. Other forms of abuse like alcohol abuse and spousal abuse has also been implicated. These types of teenagers feel a sadistic type of pleasure in causing pain to themselves. This phenomenon is also prevalent in prisoners especially in the teenage group.
Early diagnosis by a radiologist is of utmost important. If there is an interventional radiologist available, then he /she can advance into the deeper tissues to retrieve the foreign body under Sonar or CT guidance without an open surgical procedure. Thus, according to the article, it is an effective way of treating the patient.