Ultrasound Learning Curve in Gout: A Disease‐Oriented Training Program

Abstract

Objective. To describe the learning curve of rheumatologists with limited experience using ultrasound (US) attending an intensive disease-oriented training program focusing on the skills required to obtain and interpret US signs of monosodium urate (MSU) crystal deposits in joint and periarticular tissues. Methods. Three investigators participated in a 7-day training program involving 12 men with gout. The agreement between the expert and beginners was calculated in 4 sessions involving 8 patients with gout. The US assessment was performed at the second and third metacarpophalangeal joints, knee, tibiotalar and first metatarsophalangeal joints, second and third finger flexors, quadriceps and patellar posterior tibialis, peroneus longus and brevis, and Achilles tendons. The presence or absence of synovial fluid/synovial hypertrophy, double contour sign, intra-or periarticular and intratendinous tophi, bursitis, bone erosions, and tendon tears was recorded. Results. A total of 416 anatomic sites were studied. Kappa values and overall agreement percentages of qualitative assessments of US gout findings at the end of the exercise both showed moderate to excellent agreement, while in the first session they showed poor/fair agreement. At the end of the training session, sensitivity, specificity, and capability of the beginners were also improved. Conclusion. After 1 week of the disease-oriented training program, rheumatologists with limited experience in US were satisfactorily able to detect and interpret the main US signs indicative of MSU crystal deposits at different tissues in patients with gout.

Ultrasonography of the metacarpophalangeal joints in healthy subjects using an 18 MHz transducer.

“…The learning curve in musculoskeletal US was found to be an important aspect in the time of gaining skills in beginner ultrasonographers [33][34][35]. The 2 beginner members of team B rapidly achieved knowledge about MCP examination.…”

Evaluation of the Acquisition of Ultrasound Proficiency in Hand Surgery Fellows

“…First, we had a small study cohort of 6 participants. However, this small study cohort is comparable with other studies regarding similar topics, and the purpose of this study was to show a “proof of concept” of the effectiveness of short instructional sessions on US proficiency as a platform to build on for further work . Second, all of the participants in the study were completing their fellowship at the time of the study; thus, the generalizability to hand surgeons at different stages in their careers is unclear.…”

“…Other related studies reporting on US evaluations of musculoskeletal conditions by physicians who were previously inexperienced with the use of US have included instruction ranging from 5 hours to 7 days; however, in contrast, we provided only 30 minutes of instruction . This discrepancy may be explained in part by the heterogeneous populations participating in the studies.…”

Échographie dans les arthropathies microcristallines

“…Signes évocateurs de goutte À côté des signes non spécifiques évoqués précédemment, certains signes sont très évocateurs de goutte voire quasi pathognomoniques [5,6,[8][9][10]. L'apprentissage de l'échographie dans la goutte est par ailleurs simple, un programme d'entraînement de 7 jours pouvant suffire à acquérir les bases de cette technique [11] :…”