Background/Purpose: Correct interpretation of musculoskeletal ultrasound (MSUS) requires thorough knowledge of normal 3D anatomy, but several authors report deficiencies in anatomy skills among rheumatologists. Cadaver-based anatomy review courses improve clinical and injection skills, but the value of such courses in MSUS training is unclear. During 2010-12 we delivered two cadaver based, MSUS anatomy courses for the British Society of Rheumatology (BSR), and a  self assessment questionnaire was devised to measure confidence to perform key MSUS learning objectives before and after the course.

Methods: The two day course in March 2012 consisted of orientation lectures with MR imaging; expert led, small group workshops handling cadaveric specimens; simultaneous access to real-time ultrasound on live models; and ultrasound practice on patients with pathological anatomy. Ten item confidence logs based on BSR core competency outcomes and ability to diagnose EULAR pathologies were completed by the delegates before, after and four weeks following the course. Standardised imaging protocols with anatomy checklists devised by tutors from the BSR ultrasound special interest group were used to guide scanning technique and to assess delegate ability to locate specific anatomic structures with ultrasound.

Results: Twenty delegates attended the course. Delegate feedback rated the course very highly (Overall mean satisfaction score = 4.25, 1=poor, 5=excellent). Confidence logs collected from all 20 delegates demonstrated low levels of confidence in core domains pre-course (mean 3.5/10), improving to mean 5.5/10 immediately post-course (paired t test p< 0.001) with significantly improved confidence at 4 weeks compared to baseline in 7/10 domains (paired t test p< 0.05, see table).

Competency outcome	Delegate Confidence (0-10)
	Pre-Course	End of course (all p< 0.001)	Four Weeks (* p< 0.05)
Perform structured assessment of each anatomic area	3.3	6.0	5.7*
Identify, demonstrate and interpret anatomy	3.4	6.0	6.0*
Identify, demonstrate and interpret pathology	3.2	5.5	6.0
Use US to guide aspiration and injection	3.4	5.1	5.8*
Correlate US with other imaging modalities	3.2	5.7	6.5*
Prepare a written report and archive images	2.7	4.5	5.5
Understand clinical relevance and apply to patient management	5.3	6.3	7.8*
Correctly diagnose EULAR basic pathology	4.3	5.6	6.5
EULAR intermediate pathology	3.4	5.1	5.3*
EULAR advanced pathology	2.3	3.6	3.1*

 

Anatomy checklists were completed and returned by 13 delegates. Most structures were located at the shoulder, elbow, wrist, knee and ankle (68-72% of structures located) though fewer structures were visualised at the hip (44%).

Conclusion: This cadaver based anatomy review course produced significant improvement in confidence across a range of MSUS competencies including interpretation of normal anatomy, which was maintained after 4 weeks. Expert led, small group workshops handling cadaveric specimens with simultaneous practice of MSUS on live models is an effective model for MSUS anatomy training. This method of teaching was highly regarded by the delegates, and imaging protocols and checklists are a useful tool for self assessment.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/rheumatologists-ultrasound-confidence-and-interpretation-of-normal-anatomy-are-improved-by-a-cadaver-based-sonoanatomy-course/