Use of ultrasound as routine diagnostic tool in arthritis a step closer
The use of ultrasound as a routine diagnostic tool by rheumatologists is getting closer, largely due to two new innovative educational projects funded by the Arthritis Research Campaign (arc).
Currently the imaging technique is only used in four or five major rheumatology centres such as Leeds, Glasgow, Newcastle, London, Bath and Belfast.
But although most hospitals in the UK have an ultrasound machine capable of taking the type of images necessary to aid diagnosis of inflammatory arthritis, the problem is that little training is available, and few rheumatologists have the expertise to use it - unlike in several European countries where it is in routine use.
The British Society for Rheumatology now run occasional introductory courses, but there remains no formalised educational structure for the training of rheumatologists in ultrasonography and few specific supplementary educational resources such as teaching aids or interactive reference material, to facilitate learning.
However, this is about to change. David Kane, a consultant rheumatologist and senior lecturer in rheumatology at the University of Newcastle, is currently developing an interactive multi-media CD ROM of musculoskeletal ultrasound of the peripheral joints of the upper and lower limbs as a teaching aid for rheumatologists.
Dr Kane has two arc grants totalling £60,000 to complete the CD ROM, which is currently being evaluated by rheumatologists and radiographers who attended the second BSR musculoskeletal ultrasonography course at the Royal College of Physicians in Glasgow, convened by Professor Roger Sturrock in November. Upgrade of ultrasound imaging equipment.
And Andrew Brown, a specialist registrar in clinical and academic rheumatology at the University of Leeds, has a three-year arc £137,000 educational research fellowship to develop, implement and evaluate an educational programme in ultrasonography for rheumatologists.
"There's a mystique about ultrasound, but although it's difficult, the technique can be learned, and it provides an extra diagnostic tool which can prove extremely useful," explains Dr Kane. "For example, in inflammatory arthritis clinical examination and blood tests do not always show up as abnormal but ultrasound will show clearly if a patient has synovitis in these cases.
"Clinical examination has its limitations and the use of musculoskeletal ultrasound has the potential to greatly improve the basic skills of clinical rheumatologists. The more people who are trained in this technique, the better it will be for patients."
"Currently there's no standard approach to training or competency assessment for rheumatologists who perform ultrasound, and if it's carried out by people with inadequate knowledge and skills there's a possibility that it will lead to unnecessary patient examinations and misdiagnosis, " adds Dr Brown.
"What we are doing in Leeds is developing an educational framework for the training and assessment of rheumatologists and allied health professionals, and which I hope in the future will be accredited by a professional body."
"This will guarantee that the highest standards in musculoskeletal ultrasonography are achieved, ensuring maximum benefits to patients and minimum risk to their welfare and safety."
