Baku hosted 5,000 athletes from 50 countries in 20 sports,
compared with 10,000 from 205 countries in 41 sports at London 2012.
Although there was a dedicated polyclinic,
there were significant differences in organisation and structure with only 6 radiologists rather than 40; MRI,
CT and radiography off-site but linked through a RIS-PACS system which was highly customised on site by First Solutions ( http://www.first-global.com ) to allow for the constraints of existing infrastructure but great expectations from European National Olympic Committees and teams.
Special consideration was made for a conference room for multi-disciplinary team meetings.
The smaller Baku radiological workforce meant that shifts were limited to the 12 hours,
9am-9pm whereas in the London Olympics a 16 hour day from 7am-11pm was possible.
Statistics showed that over 90% of imaging requests were made between 9am and 9pm with an on-call radiologist available for the few required outside normal hours (see Fig 1).
Most imaging was needed during track and field events for acute injuries and also on arrival of most teams for more chronic injuries to determine fitness for competition (see Fig 2).
Fig. 1: Fig 1. Baku imaging numbers displayed by the hour of the day. The majority (>90%) of investigations were needed between 9am and 9pm. An on-call radiologist was able to handle the small number of out-of-hours imaging. (Chart courtesy of Luis Moreno, First Solutions, PT.)
Fig. 2: Fig 2. Baku imaging numbers displayed by the day during the three weeks that the Polyclinic was operational. The Games started on 13.6.15 and finished on 28.6.15. The highest numbers were during the track and field events. (Chart courtesy of Luis Moreno, First Solutions, PT.)
In Baku there were 281 procedures,
mostly ultrasound (148,
53%) compared with 1711 in London,
mostly MRI (835,
48%) (see Fig 3).
The most common injuries were similar,
involving the lower limb and mainly muscle or tendon (Figs 4-8).
Fig. 3: Fig 3. Baku European Games and the London Olympics: Comparison of imaging investigations used. Non-ionising modalities comprised about 70% of all imaging with the bias towards ultrasound in Baku and MRI in London.
Fig. 4: Fig 4. Baku European Games and the London Olympics: Comparison of body areas imaged. Extremity imaging of injuries to the ankle, knee, thigh and shoulder accounted for over a third of investigations. The higher proportion of head and torso investigations in Baku was due to the higher number of fighting sports whereas the more common spine and knee injuries in London may have been due to a larger track and field component.
Fig. 5: Gymnast: fall from the rings. STIR MRI sequence showing a grade 3 complete avulsion of the biceps tendon of insertion.
Fig. 6: Grade 3 tear of the right adductor longus tendon from its origin in a long jumper. Longitudinal section ultrasound, right groin.
Fig. 7: Endurance athlete: Grade 4 chronic bone stress fracture of the right proximal femur with an acute adductor tear. Plain radiograph and STIR MRI image showing the corticated fracture margins of the proximal femoral fracture with no appreciable marrow oedema but considerable muscle oedema from the acute adductor grade 2 tear.
Fig. 8: Hurdler: Inversion ankle injury. Colour flow ultrasound showing a Grade 2 partial tear of of the anterior talofibular ligament (ATFL).
Image-guided interventions were few and,
like London,
limited by a “no needle” policy in the Village.
In both games,
the value of a multi-disciplinary team discussion room and an experienced radiological opinion was reiterated by polyclinic professionals and National Olympic Committee doctors.
Similar to London’s legacy of a dedicated polyclinic,
a scaled down clinic remains in Baku addressing local needs but the enhanced practice of musculoskeletal imaging has been a winner in both cities.
Azerbaijan like most host countries,
has had the added benefit of a legacy of sport and success (fig 9).
Fig. 9: Fig 5. Baku European Games and the London Olympics: Similarities and differences in outcomes.