Of 250 questionnaires distributed, 126 (50%) were completed and returned. The respondents were all from the UK (61 consultants, 51 specialist registrars, 14 others). Table 1 shows a breakdown of the 126 respondents, their use of MSUS and levels of experience in performing MSUS. Out of 126 respondents, 117 (93%) said they use MSUS imaging in the management of their patients, with 41/126 (33%) indicating that they are performing MSUS themselves, but only two respondents had more than 5 years' experience. Out of 126 respondents, 76 (60%) refer their patients to other departments for MSUS, principally radiology (71/126, 56%).
Table 1Musculoskeletal ultrasound use and levels of experience in 126 respondents
MSUS is used by rheumatologists to examine all peripheral joints regions with MSUS practitioners using MSUS more frequently than MSUS referrers in all joint regions. The most common areas examined using MSUS are small joints of hands and feet, shoulder, wrist and soft‐tissue areas. The most common indications for MSUS are for the diagnosis of tenosynovitis, synovitis and enthesitis, and for injection guidance. Practitioners use MSUS more frequently than referrers for novel uses of MSUS such as diagnosis of erosions, for disease monitoring and for research, while referrers requested MSUS more frequently for evaluation of soft‐tissue tumours, probably reflecting that this is a radiology subspecialty (see fig 1).
Figure 1Indication for MSUS performed by rheumatologists. The graphs show the different uses of MSUS among those responders who perform MSUS themselves and those referring for MSUS. Data show the percentage of responders who indicated they use (more ...)
The principal reasons given for not performing MSUS were: the lack of training in MSUS 60/80 (75%); expense of equipment 36/80 (45%); lack of time 26/80 (33%); radiology service being sufficient 16/80 (20%); other reasons 16/80 (20%). Out of the 126 respondents, 68 (54%) had undergone some training in MSUS. The most common forms of training undertaken were: informal training from radiologists 32/68 (47%); attendance at a BSR course 27/68 (40%); informal training from rheumatologists 23/68 (34%); attendance at a EULAR course 17/68 (25%); attendance at other courses 13/68 (19%); self‐taught 11/68 (16%); informal training by others 3/68 (4%).
Respondents were asked who they thought should train rheumatologists in MSUS. Seventy‐seven per cent of respondents thought it would be appropriate for consultant radiologists to teach MSUS, whereas 63% thought that consultant rheumatologists could teach MSUS, and 33% thought that sonographers could teach MSUS. Six per cent stated that other personnel such as specialist registrars and advanced practitioners could be involved in teaching MSUS. Respondents were then asked how training should be done, bearing in mind what would be practical in their daily routine. Fifty‐two per cent chose a programme of regular training sessions, 11% chose concentrated intensive courses, 35% chose both, 13% chose opportunistic teaching in addition to one or both, and 2% stated other options such as a BSR course, attendance at clinics and identification of a specific tutor.
Respondents were asked how competence in MSUS should be assessed, by ranking the following methods from 1 (highly appropriate) to 3 (least appropriate). Responses, presented here in order of mean rank score, were: mentor appraisal (1.5); formal appraisal (1.8); portfolio (2.0); not required (2.9). The respondents were asked to rank six educational tools from 1 (most useful) to 6 (least useful). Responses, again presented in order of mean rank score, were: mentor (2.0); courses (2.2); DVD (3.2); textbook (3.8); website (4.1); logbook (4.3). Other suggested educational tools included a sabbatical and journals.
Benefits of rheumatologists performing MSUS
The mean waiting time for MSUS is 1.3 months (range 0–6 months) within rheumatology departments and 2.1 months (range 0–12) within radiology departments. Thirty‐eight per cent of scans performed within rheumatology departments are done so on the same day as the investigation is ordered, compared with MSUS imaging done within radiology departments by radiologists where only 1% of scans are performed on the same day as the investigation is ordered. Sixty‐seven per cent of all scans within rheumatology departments are being performed within 1 month of referral compared, with 45% of all scans within radiology departments.