ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 110

Consensus-Building on a Rheumatology Musculoskeletal Ultrasound Scanning Protocol for Rheumatology Fellowship Programs

Karina Torralba1,2, Midori Jane Nishio3, Ralf G. Thiele4, Robert Fairchild5, Kristal Choi6, Lorena Salto6, Amy C. Cannella7 and Eugene Y. Kissin8, 1Internal Medicine/Rheumatology, Loma Linda University, Loma Linda, CA, 2Division of Rheumatology, Department of Internal Medicine, Loma Linda University, Loma Linda, CA, 3John Muir Hospital, Walnut Creek, CA, 4Medicine, University of Rochester Medical Center, Rochester, NY, 5Stanford University, Palo Alto, CA, 6Loma Linda University, Loma Linda, CA, 7Section of Rheumatology, University of Nebraska Medical Center, Omaha, NE, 8Boston University, Boston, MA

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: ,

Session Information

Date: Sunday, November 5, 2017

Title: Education Poster

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Musculoskeletal ultrasound (MSUS) is currently taught at 95% of adult United States Rheumatology fellowship programs. Only 30 (41%) programs have a formal curriculum. MSUS curriculum development for rheumatology fellowship programs is ongoing with ACR support. In 2011, at Rochester NY, a group of rheumatology MSUS experts developed a document on documentation, scanning conventions, and tier designations (1, Rheumatology sonographers need to know and need to perform routinely; 2, Rheumatology sonographers need to know but do not need to perform routinely; 3, Rheumatology sonographers may know about & may perform based on individual practice focus) for each view of the major joints. The objective of this study is to update consensus of the 2011 Rochester document to serve as the foundation for the development and implementation of a rheumatology MSUS curriculum for fellowship training programs.

Methods: A 96-item IRB-approved survey was developed for use in a Delphi study. Apart from demographics (8), there were 86 questions testing for agreement/disagreement on documentation (5), scanning conventions (5), and tier designations for 8 peripheral joint-specific areas (76).  108 lead faculty at 113 rheumatology fellowship programs were identified based on prior surveys. 101 respondents (including the 38 who developed the 2011 document) were selected based on selected criteria including lead MSUS faculty experience, course instruction, ACR-RhMSUS certification, or publication in MSUS. The survey was disseminated via Qualtrics¨. Survey initiation and completion indicated consent for study participation.

Results: 55 (55%) rheumatologists responded: 39 (71%) were full time academic faculty, 40 (73%) had certification, with a third of the respondents certified via ACR-RhMSUS pathway.  51 (59%) questions achieved high (³85%) agreement. Questions with less than 85% agreement all concerned tier designations. 13 questions with 30-60% disagreement favored tier 1 designation over 2011 tier 2. Table 1 lists areas of disagreement.

Conclusion: Initial phase of consensus-building reveals 41% disagreement on areas related to anatomic-region tier designation.  Many respondents favored Tier 1 over Tier 2 for many of those items, indicating a shift in overall expert opinion towards including more views in the MSUS mastery requirements. Further clarification through subsequent rounds of this Delphi study is needed to resolve areas of disagreement, and facilitate development of a standardized MSUS fellowship curriculum.

Table 1. Delphi Study Round 1: 2011 vs 2017 Consensus, Joint Views

MSUS Joint Views

2011

2017 Results

Tier

Agree, n (%)

Disagree, n (%)

Tier

Shoulder

Acromio-clavicular joint, longitudinal

2

34 (61%)

20 (36%)

1

Posterior transverse

2

46 (83%)

8 (14%)

1

Dynamic impingement

2

41 (74%)

12 (21%)

1

Suprascapular transverse

2

36 (65%)

17 (30%)

3

Axillary longitudinal

2

37 (67%)

18 (31%)

3

Elbow

Olecranon bursa

2

46 (83%)

8 (14%)

1

Posterior transverse medial

2

44 (80%)

6 (10%)

3

Posterior longitudinal medial

2

45 (81%)

8 (14%)

3

Wrist

Scapholunate ligament, dorsal transverse

2

39 (70%)

15 (27%)

1

Radial orthogonal compartment 1 tendons

2

39 (70%)

15 (27%)

1

Ulnar transverse

2

33 (60%)

20 (36%)

1

Volar longitudinal median nerve

2

34 (61%)

21 (38%)

1

Dorsal orthogonal extensor compartments 2-5

2

39 (70%)

14 (25%)

1

Hand

Dorsal orthogonal MCP joint/PIP joint in flexion

2

45 (81%)

7 (12%)

3

MCP radial/ulnar orthogonal

2

35 (63%)

20 (36%)

1

PIP joint transverse (dorsal and volar)

2

43 (78%)

12 (21%)

1

Hand inflammatory arthritis scan set

2

33 (60%)

20 (36%)

1

Hip

Anterior transverse femoral neck

2

37 (67%)

18 (32%)

1

Lateral hip transverse

2

45 (81%)

10 (18%)

1

Snapping hip dynamic scan

3

46 (83%)

8 (14%)

2

Transverse sacral iliac joint

2

25 (45%)

28 (50%)

3

Knee Views

Anterior transverse suprapatellar

2

22 (40%)

33 (60%)

1

Anterior transverse in maximum flexion

1

45 (81%)

10 (18%)

2

Anterior transverse infrapatellar

2

37 (67%)

18 (32%)

1

Medial longitudinal

2

29 (52%)

26 (47%)

1

Lateral longitudinal

2

32 (58%)

23 (41%)

1

Posterior transverse medial

2

41 (74%)

13 (23%)

1

Ankle

Anterior transverse

2

27 (49%)

27 (49%)

1

Dorsal longitudinal midfoot joints

2

43 (78%)

6 (10%)

1

2

6 (10%)

3

Medial longitudinal perimalleolar

2

38 (69%)

16 (29%)

1

Lateral longitudinal

2

38 (69%)

16 (29%)

1

Lateral oblique subtalar joint

2

46 (83%)

6 (10%)

1

Posterior transverse

2

30 (54%)

25 (45%)

1

Plantar orthogonal

2

42 (76%)

12 (21%)

1

Foot

Dorsal transverse symptomatic MTP joint

2

38 (69%)

17 (30%)

1

Tier Designations: Tier 1, Rheumatology sonographers need to know and need to perform routinely;

Tier 2, Rheumatology sonographers need to know but do not need to perform routinely; Tier 3,

Rheumatology sonographers may know about & may perform based on individual practice focus
Disclosure: K. Torralba, None; M. J. Nishio, None; R. G. Thiele, Amgen, 8,AbbVie, 8,BioClinica, 5,Fujifilm SonoSite, 9; R. Fairchild, None; K. Choi, None; L. Salto, None; A. C. Cannella, None; E. Y. Kissin, None.

To cite this abstract in AMA style:

Torralba K, Nishio MJ, Thiele RG, Fairchild R, Choi K, Salto L, Cannella AC, Kissin EY. Consensus-Building on a Rheumatology Musculoskeletal Ultrasound Scanning Protocol for Rheumatology Fellowship Programs [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/consensus-building-on-a-rheumatology-musculoskeletal-ultrasound-scanning-protocol-for-rheumatology-fellowship-programs/. Accessed .

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