Case Study
Medical Innovation Case Study Pt.1
Radiologist as game-changer—innovating medical solutions.
November 20, 2017

A private radiology practice in Casper, Wyo. proved an excellent petri dish for a minimally invasive MSK clinic that has become a destination for Olympians and local grandmothers alike.

Elite athletes from around the world are flying into Casper, Wyo., to be treated at a non-surgical MSK clinic by radiologist Joseph C. McGinley, MD, PhD. McGinley’s background in mechanical engineering and a radiology residency and fellowship at Stanford put him on a path to this central Wyoming city and a unique musculoskeletal clinical practice at Casper Medical Imaging, a Strategic Radiology practice.

I definitely could not have done this at any university practice, and probably wouldn’t have been able to pull off what I’ve been able to do here in most private practices. Sometimes things just come together for a reason.

Joseph C. McGinley, MD, PhD

McGinley began interviewing at universities and private practices across the country in 2010 when an opening in Casper, caught his eye. He and his wife, two former Philadelphians living in California, had previously passed through and took note of the beautiful outdoor landscapes. Tired of big city traffic and congestion, they flew out to meet with the practice. 
Casper Medical Imaging offered McGinley a position that week, and he immediately accepted. “It’s probably been one of the best career decisions I’ve made,” said McGinley. “We love it here, it’s a vibrant community and a great medical practice.” 

A new approach

McGinley arrived as the practice’s first MSK radiologist, intent on developing a new service line, and immediately began to treat patients with joint and tendon injections. 
Observing that minimally invasive interventions were improving patients’ quality of life without the need for surgery, he proposed to his partners the idea of starting a weekly clinic. “I have great partners,” McGinley notes.  “They saw the vision. They trusted this was going to happen.”  
Quickly, he had developed a steady stream of patient referrals and a personal clinical process he attributes to his undergraduate education in mechanical engineering and biomechanics.   
“I try to understand the patient’s underlying core problem and then address that problem,” McGinley explains. “ultimately addressing the patient’s symptoms. Traditionally in medicine, you are taught to recognize symptoms and come up with a diagnosis.”  

Problem solving, Botox®, patents

McGinley’s problem-solving approach to a 16-year-old female high school soccer player’s debilitating calf pain ultimately led to the patented treatment that would put Casper on the map. 
The patient’s family had spent two years trying conservative treatments in the hope that she could avoid a surgery. That’s when McGinley found an alternative. 
The technologist happened to scan higher than McGinley usually looks for artery entrapment, and he noticed that the first two images showed focal compression of her vein as she was pressing with dynamic maneuvers. Nothing in the literature linked functional venous compression with exertional compartment syndrome, so McGinley was uncertain whether it was significant. From an engineering standpoint, he understood this could theoretically cause the symptoms the patient was experiencing. 
Compressing her vein with an ultrasound transducer where her muscles were functionally compressed replicated her symptoms. The compressing muscle had a single nerve feeding it, so McGinley performed a nerve block on that muscle to see if the symptoms temporarily resolved, and they did. 
A CT scan showed there was no compression of the vein and no matter how hard she pressed, she was not able to recreate the symptoms, proof of McGinley’s theory, but not a treatment. 
Repeatedly, he returned to the problem: How could he get the muscle to function in a way that was ideal for the patient’s vascular flow but wouldn’t impinge on her ability to exercise and compete in sports? 
McGinley came upon the idea of using botulinum toxin, or botox, to temporarily paralyze the muscle. The procedure was scheduled and after two weeks her symptoms were resolved. The patient was able to successfully return to her competitive athletics at an elite level.  

Radiologists as game-changers

McGinley has since treated more than 400 patients from around the world—including Olympic athletes, professional soccer players, and competitive runners—for a syndrome that typically required an invasive surgery. 
“It was really rewarding,” recalls McGinley, who was featured in the March 2017 issue of Runner’s World. “I take the same approach with all of my patients in clinical practice.”  
McGinley believes that radiologists are uniquely capable of changing how the practice of medicine occurs. “We have high-tech imaging, the ability to make precise diagnoses, and we learn about the differential diagnoses on innumerable problems,” he says. “I think there are several other opportunities in radiology to take that next step and develop a clinical practice.”