The use of musculoskeletal ultrasound (MSKUS) by rheumatologists in the United States has been increasing. Resistance to its adoption in the past included promotion of the use of magnetic resonance imaging, cost, and training barriers. With the advent of rapid technologic advancements, affordable portable machines are now within reach of the practicing rheumatologist.
A survey of rheumatologists revealed that the penetration of use of MSKUS has significant growth potential. Of the 512 Rheumatology fellows polled, 30 indicated current use of MSKUS. Of the 6000 U.S. American College of Rheumatology (ACR) members polled, 126 indicated current use of MSKUS. In an internal survey of 40 rheumatology program directors by the ACR, 35 programs reported an interest in training in MSKUS.
Rheumatologists who are considering embarking on learning and using sonography in their daily practice may be intimidated by the learning curve and by incorporation of this modality into their practice.
In 2005, there was sufficient interest to form a focus group of predominantly North American rheumatologists interested in sonography ( www.MSK-USS.org ). Its aim is to promote collegiality among national and international rheumatologists practicing MSKUS and to foster training and research in MSKUS.
To gauge how ultrasound was being adopted in rheumatology practice, the pattern of use of sonography among North American rheumatologists was evaluated by an electronic poll of the membership of MSK-USS.org. Most of the polled rheumatologists reported scanning patients personally. Limited scans on new and established patients were conducted at the same office visit, whereas longer scans were scheduled for a dedicated visit. One third of the group reported using sonography for injection guidance in up to 60% of local injections. The polled rheumatologists indicated that they did not have a protocol for scanning patients with inflammatory arthropathies on a regular basis but instead scanned according to clinical need.
Training
There are only a handful of academic rheumatology centers that perform MSKUS or offer training for fellows. Training in MSKUS has hence relied on courses and self-learning. No national standardized ultrasound courses have been organized.
The ACR has been arranging MSKUS workshops since 1999. They have proved popular; the number of workshops offered has increased over the past 2 years, and advanced-level workshops have been added. Workshops also are being offered at ACR regional meetings. Longer courses for rheumatologists have been offered nationally by a few universities and locally by some medical societies. They usually span 2 to 3 days and cover didactic and practical sessions. They have been aimed at beginner- to intermediate-level students. The American Institute of Ultrasound in Medicine (AIUM) has offered categorical courses at its annual meetings and arranges an annual interventional course.
In addition to courses and standard textbooks, several online resources have been useful to rheumatologists interested in MSKUS. A summary of these is given in Table 25C-1 . Practice guidelines have been published by the AIUM and are under revision. They include indications for scanning and a general description of acquiring sonographic scans at various joints. Some physicians have adopted the EULAR Musculoskeletal Ultrasound Working Group acquisition guidelines. For the beginner, these guidelines have the advantage of providing a more detailed explanation of probe orientation and standardization. Examples of standard scans obtained by the use of this technique are available online.
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