Recommendations for musculoskeletal ultrasonography by rheumatologists: Setting global standards for best practice by expert consensus

Abstract

Objective. To establish an expert consensus of best practice for rheumatologists performing musculoskeletal ultrasonography (MUS).Methods. A panel of worldwide experts in MUS was identified by literature review, membership of teaching faculty, and peer recommendation. They were invited to take part in a 4-stage Delphi process employing 2 iterative rounds to establish a consensus of specific indications, anatomic areas, and knowledge and skills required by rheumatologists performing MUS. Results. Experts in MUS were identified (n ‫؍‬ 57; 37 radiologists, 20 rheumatologists). Successive rounds of this rigorousDelphi exercise enabled group consensus to be achieved in 30 of the proposed 37 categories comprising 8 of 13 indications (inflammatory arthritis, tendon pathology, effusion, bursitis, monitoring disease activity, monitoring disease progression, guided aspiration, and injection), 8 of 10 anatomic areas (hand, wrist, elbow, shoulder, hip, knee, ankle and heel, and forefoot), and 14 categories of knowledge and skills (physics, anatomy, pathology, equipment, clinical application and relevance, indications and limitations, artifact, machine function and operation, patient and probe position, planes and system of examination, image optimization, dynamic assessment, color Doppler, and power Doppler). Conclusion. We have produced the first expert-derived, interdisciplinary consensus of recommendations for rheumatologists performing MUS. This represents a significant advance that will not only direct future rheumatology MUS practice, but will facilitate informed educational development. This is an important step towards the introduction of a specific training curriculum and assessment process to ensure competent rheumatologist ultrasonographers.

The most appropriate therapeutic strategy for acute lower respiratory tract infections: a Delphi-based approach

“…For the purposes of the consensus statement, agreement among the respondents of ≥70% for each statement was considered consensus, according to previous Delphi studies. [13][14][15] The scientific steering committee evaluated the responses and grouped those for which no consensus was reached and that were selected for the following step. After the individual and anonymous online survey, the participants (plus the nine members of the steering committee) attended a meeting to share the results of the first-round voting.…”

Becoming a musculoskeletal ultrasonographer

“…These have contributed to the development of essential issues, MSUS training method and competency assessment in rheumatology [24][25][26][27][28][29][30][31]. More recently, training in ultrasound-guided injections for rheumatologists among countries has been tested and results demonstrated that the percentage of rheumatologists receiving training in the field is <10% in over 70% of countries that participated in the survey [32].…”

“…, Sectional anatomy , US physics and technology , Joint US scanning method , US pattern of normal musculoskeletal tissues , Pathological MSUS findings , MSUS artefacts , MSUS diagnostic criteria , Doppler technique , Documentation and report of US findings Later on, Brown et al produced an international interdisciplinary consensus on the specific indications, anatomic areas and knowledge and skills required by rheumatologists performing MSUS [27,28].…”

Use of musculoskeletal ultrasound in Japan: a survey of practicing rheumatologists

“…Some guidelines have been published on the use of MSUS in rheumatology [1][2][3][4][5][6], and some European countries have already incorporated MSUS into the rheumatology training curriculum and have developed training programs for MSUS [7,8]. It is not well known, however, how often Japanese rheumatologists currently use MSUS or how they are currently being trained in the technique.…”