Rheumatology 2003; 42: 1001
© 2003 British Society for Rheumatology
Letters to the Editor |
Rheumatological ultrasound
University of Leeds, School of Medicine, Rheumatology, Rehabilitation Research Unit, Leeds, West Yorkshire and
1 Leeds General Infirmary, Leeds, West Yorkshire, UK
SIR, We read with interest the recent letter and editorial by Speed and Bearcroft [1, 2], who raise several important points regarding training of musculoskeletal ultrasound to rheumatologists. We agree that there is a need to establish guidelines for musculoskeletal ultrasound (US) competence for all sonographers. Currently radiologists follow training guidelines set out by the Royal College of Radiologists but these do not include a standardized competency exit assessment.
Recently one of us (AB) was awarded an ARC fellowship to develop a validated system for the training of rheumatologists. This will determine the appropriate areas and indications for a rheumatologist to perform an ultrasound assessment, the skills required as well as methods of assessing competency. There is already considerable experience across mainland Europe, with ultrasonography part of the core curriculum for many of the European rheumatology training programmes. An annual EULAR (European League against Rheumatism) course has been run successfully since 1997, with lectures and practical demonstrations made by both experienced rheumatologists and radiologists, and individuals from the UK figure prominently. An Oxford/Leeds US course has also run since 1996. In April this year the first advanced course (4th EULAR Sonography Course) took place in Madrid with a further basic level course planned for later this year. Thus, although the Cambridge course was the first to have the BSR (British Society for Rheumatology) label, there is already extensive UK activity in this area.
The review by Backhaus et al. [3] was not intended to be a training manual but an introduction to the basic requirements of ultrasound. As Speed and Bearcroft point out [1, 2], they do not quantify the levels of training required, which appeared to differ between institutions. Guidelines have been suggested for trainers, namely 5 yr musculoskeletal US experience with 5000 scans and 500 scans/yr.
The radiological literature has focused mainly on orthopaedic-related disorders, e.g. rotator cuff tears, tendon and ligament injuries, with much less attention to rheumatological areas, such as the detection of synovitis, enthesitis and erosions. We believe that rheumatologists offer a role complementary to that of radiologists, and it is unlikely that they would have a significant impact on the radiologist's workload as rheumatological ultrasound represents a new service. Rheumatologists need to know their limitations, and it is their duty to obtain and maintain an adequate level of training. A logbook is recommended until formal guidelines are established.
Ultrasound has been labelled the ‘stethoscope of the joint.’ It represents a major advance in clinical rheumatology. Contrary to the comment by Speed and Bearcroft, there is already evidence of the major impact that ultrasonography has on clinical activities within rheumatology [4]. The skills-based approach used in Leeds involves five musculoskeletal radiologists and three trained rheumatologists. We believe that such a system has major advantages, and provides a possible way forward for future clinical practice.
Notes
Correspondence to: P. Emery. E-mail: p.emery{at}leeds.ac.uk 
References
- Speed CA, Bearcroft PWP. Musculoskeletal sonography by rheumatologists: the challenges. Rheumatology 2002;41:241–2.
[Free Full Text] - Speed CA, Bearcroft PWP. Training in musculoskeletal sonography: a report from the first BSR course. Rheumatology 2002;41:346.
[Free Full Text] - Backhaus M, Backhaus M, Gerber T et al. Guidelines for musculoskeletal ultrasound in rheumatology: a review. Ann Rheum Dis 2001;60:641–9.
[Free Full Text] - Karim Z, Wakefield RJ, Conaghan PG et al. Impact of ultrasonography on diagnosis and management on rheumatic patients. Arthritis Rheum 2001;44:209–10.[CrossRef]
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