Skip to main content

Advertisement

SpringerLink
Log in

North American musculoskeletal ultrasound scanning protocol of the hip, knee, ankle, and foot: update of a Delphi consensus study

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Background/objective

A North American rheumatology consensus on tiered-mastery designation for anatomic views was developed in 2011 for course and fellowship teaching. This study updates the lower extremity joint scanning protocols aiming to inform musculoskeletal ultrasound curriculum development for the American College of Rheumatology affiliated Fellowship Programs.

Methods

Three Delphi rounds were conducted to reach consensus for tiered-level mastery designation for hip, knee, ankle, and foot scanning views. The survey was disseminated (Qualtrics™) to 101 potential participants with ultrasound teaching experience. High agreement was defined as ≥ 85% consensus and final tier designation as having >50% agreement for the preferred tier. Response changes were evaluated by McNemar’s chi-square test.

Results

Consensus regarding tier designations was reached for 80% of the views. Three knee views (anterior transverse suprapatellar, medial, and lateral longitudinal) and 2 ankle views (anterior and posterior transverse) achieved upgrades to tier 1 from 2. The transverse sacroiliac hip joint was downgraded from tier 2 to 3. The lateral longitudinal hip view was added with a tier 1 designation.

Conclusion

Updated scanning protocols support modifications reflecting current scanning methods delivered by North American rheumatologists performing point of care ultrasound that may inform educators involved in rheumatology ultrasound.

Key Points

• The anterior transverse suprapatellar, medial, and lateral longitudinal knee views; the anterior and posterior transverse ankle views; and the lateral longitudinal view hip view were perceived as important to master and perform routinely.

• The transverse sacroiliac joint view was suggested to be performed based on practice focus.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

All data are available upon request

References

  1. McAlindon T, Kissin E, Levon N et al (2012) American College of Rheumatology report on reasonable use of musculoskeletal ultrasonography in Rheumatology Clinical Practice. Arthritis Care Res 64:1625–1640

    Article  Google Scholar 

  2. Neogi T, Jansen TL, Dalbeth N, Fransen J, Schumacher HR, Berendsen D, Brown M, Choi H, Edwards NL, Janssens HJ, Lioté F, Naden RP, Nuki G, Ogdie A, Perez-Ruiz F, Saag K, Singh JA, Sundy JS, Tausche AK, Vazquez-Mellado J, Yarows SA, Taylor WJ (2015) 2015 Gout Classification Criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 67(10):2557–2568

    Article  Google Scholar 

  3. Aletaha D, Neogi T, Silman AJ et al (2010) Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2010:1580–1588

    Article  Google Scholar 

  4. Zhang W, Doherty M, Bardin T, Barskova V, Guerne PA, Jansen TL, Leeb BF, Perez-Ruiz F, Pimentao J, Punzi L, Richette P, Sivera F, Uhlig T, Watt I, Pascual E (2011) European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part 1: terminology and diagnosis. Ann Rheum Dis 70:563–570

    Article  CAS  Google Scholar 

  5. Plaza M, Nowakowska-Plaza A, Pracon G et al (2016) Role of ultrasonography in the diagnosis of rheumatic diseases in light of ACR/EULAR guidelines. J Ultrason 16:55–64

    Article  Google Scholar 

  6. Dasgupta B, Cimmino M, Maradit-Kremers H et al (2012) 2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis 71:484–492

    Article  Google Scholar 

  7. Berko N, Goldberg-Stein S, Thornhill B et al (2016) Survey of current trends in postgraduate musculoskeletal ultrasound education in the United States. Skelet Radiol 45:475–482

    Article  Google Scholar 

  8. Canella A, Kissin E, Torralba K et al (2014) Evolution of Musculoskeletal Ultrasound in the United States: Implementation and Practice in Rheumatology. Arthritis Care Res 66:7–13

    Article  Google Scholar 

  9. ACR MSKUS task force: American College of Rheumatology Musculoskeletal Ultrasound Task Force (2010) Ultrasound in American Rheumatology Practice: Report of the American College of Rheumatology Musculoskeletal Ultrasound Task Force. Arthritis Care Res 62:1206–1219

    Article  Google Scholar 

  10. Samuels J, Abramson SB, Kealey GS (2010) The use of musculoskeletal ultrasound by rheumatologists in the United States. Bull NYU Hosp Jt Dis 68(4):292–298

    PubMed  Google Scholar 

  11. Torralba KD, Cannella AC, Kissin EY, Bolster MB, Salto LM, Higgs J, Samuels J, Nishio MJ, Kaeley GS, Evangelisto A, De Marco P, Kohler MJ (2017) Musculoskeletal Ultrasound Instruction in Adult Rheumatology Fellowship Programs. Arthritis Care Res 72:859–870. https://doi.org/10.1002/acr.23336

    Article  Google Scholar 

  12. Backhaus M, Burmester GR, Gerber T, Grassi W, Machold KP, Swen WA, Wakefield RJ, Manger B, Working Group for Musculoskeletal Ultrasound in the EULAR Standing Committee on International Clinical Studies including Therapeutic Trials (2001) Guidelines for musculoskeletal ultrasound in rheumatology. Ann Rheum Dis 60:641–649

    Article  CAS  Google Scholar 

  13. Martinoli C (2010) Musculoskeletal ultrasound: technical guidelines. Insights Imaging 1:99–141

    Article  Google Scholar 

  14. American College of Radiology (ACR); Society for Pediatric Radiology (SPR); Society of Radiologists in Ultrasound (SRU). AIUM practice guideline for the performance of musculoskeletal ultrasound examination. J Ultrasound Med 2012; 31: 1473-1488

  15. Moller I, Janta I, Backhaus M et al (2017) The 2017 EULAR standardized procedures for ultrasound imaging in rheumatology. Ann Rheum Dis 76:1974–1979

    Article  Google Scholar 

  16. Delle Sedie A, Riente L, Filippucci E, Scirè CA, Iagnocco A, Meenagh G, Gutierrez M, Valesini G, Montecucco C, Grassi W, Bombardieri S (2011) Ultrasound imaging for the rheumatologist. XXXII. Sonographic assessment of the foot in patients with psoriatic arthritis. Clin Exp Rheumatol 29(2):217–222

    CAS  PubMed  Google Scholar 

  17. Iagnocco A, Filippucci E, Riente L, Meenagh G, Delle Sedie A, Sakellariu G, Ceccarelli F, Montecucco C, Bombardieri S, Grassi W, Valesini G (2012) Ultrasound imaging for the rheumatologist. XLI Sonographic assessment of the hip in OA patients. Clin Exp Rheumatol 30:652–657

    PubMed  Google Scholar 

  18. Di Geso L, Filippucci E, Riente L et al (2012) Ultrasound imaging for the rheumatologist. XL Sonographic assessment of the hip in rheumatoid arthritis patients. Clin Exp Rheumatol 30:464–468

    PubMed  Google Scholar 

  19. Riente L, Delle Sedie A, Sakellariou G, Filippucci E, Meenagh G, Iagnocco A, Cioffi E, Valesini G, Grassi W, Montecucco C, Bombardieri S (2012) Ultrasound imaging for the rheumatologist. XXXVIII Sonographic assessment of the hip in psoriatic arthritis patients. Clin Exp Rheumatol 30:152–155

    PubMed  Google Scholar 

  20. Sakellariou G, Iagnocco A, Meenagh G, Riente L, Filippucci E, Delle Sedie A, Scirè CA, Bombardieri S, Grassi W, Valesini G, Montecucco C (2012) Ultrasound imaging for the rheumatologist. XXXVII Sonographic assessment of the hip in ankylosing spondylitis patients. Clin Exp Rheumatol 30:1–5

    CAS  PubMed  Google Scholar 

  21. Meenagh G, Sakellariou G, Iagnocco A, Delle Sedie A, Riente L, Filippucci E, di Geso L, Grassi W, Bombardieri S, Valesini G, Montecucco C (2012) Ultrasound imaging for the rheumatologist. XXXIX Sonographic assessment of the hip in fibromyalgia. Clin Exp Rheumatol 30:319–321

    CAS  PubMed  Google Scholar 

  22. Riente L, Delle Sedie A, Filippucci E, Scirè CA, Iagnocco A, Gutierrez M, Possemato N, Meenagh G, Valesini G, Montecucco C, Grassi W, Bombardieri S (2010) Ultrasound Imaging for the rheumatologist XXVII. Sonographic assessment of the knee in patients with rheumatoid arthritis. Clin Exp Rheumatol 28(3):300–303

    PubMed  Google Scholar 

  23. Delle Sedie A, Riente L, Filippucci E, Scirè CA, Iagnocco A, Gutierrez M, Valesini G, Montecucco C, Grassi W, Bombardieri S (2010) Ultrasound imaging for the rheumatologist XXVI. Sonographic assessment of the knee in patients with psoriatic arthritis. Clin Exp Rheumatol 28(2):147–152

    CAS  PubMed  Google Scholar 

  24. Iagnocco A, Meenagh G, Riente L, Filippucci E, Delle Sedie A, Scirè CA, Ceccarelli F, Montecucco C, Grassi W, Bombardieri S, Valesini G (2010) Ultrasound imaging for the rheumatologist XXIX. Sonographic assessment of the knee in patients with osteoarthritis. Clin Exp Rheumatol 28(5):643–646

    CAS  PubMed  Google Scholar 

  25. Filippucci E, Meenagh G, Delle Sedie A, Sakellariou G, Iagnocco A, Riente L, Gutierrez M, Bombardieri S, Valesini G, Montecucco C, Grassi W (2011) Ultrasound imaging for the rheumatologist XXXVI. Sonographic assessment of the foot in gout patients. Clin Exp Rheumatol 29(6):901–905

    PubMed  Google Scholar 

  26. Iagnocco A, Filippucci E, Riente L, Meenagh G, Delle Sedie A, Sakellariou G, Ceccarelli F, Montecucco C, Bombardieri S, Grassi W, Valesini G (2011) Ultrasound imaging for the rheumatologist XXXV. Sonographic assessment of the foot in patients with osteoarthritis. Clin Exp Rheumatol 29(5):757–762

    PubMed  Google Scholar 

  27. Riente L, Delle Sedie A, Scirè CA, Filippucci E, Meenagh G, Iagnocco A, Possemato N, Valesini G, Grassi W, Montecucco C, Bombardieri S (2011) Ultrasound imaging for the rheumatologist. XXXI. Sonographic assessment of the foot in patients with rheumatoid arthritis. Clin Exp Rheumatol 29(1):1–5

    PubMed  Google Scholar 

  28. Jamadar DA, Jacobson JA, Caoili EM, Boon TA, Dong Q, Morag Y, Girish GAJR (2008) Musculoskeletal sonography technique: focused versus comprehensive evaluation. Am J Roentgenol 190(1):5–9

    Article  Google Scholar 

  29. Rempell JS, Saldana F, DiSalvo D, Kumar N, Stone MB, Chan W, Luz J, Noble VE, Liteplo A, Kimberly H, Kohler MJ (2016) Pilot Point-of-Care Ultrasound Curriculum at Harvard Medical School: Early Experience. West J Emerg Med 17(6):734–740

    Article  Google Scholar 

  30. Moore CL, Copel JA (2011) Point-of-care ultrasonography. N Engl J Med 364(8):749–757

    Article  CAS  Google Scholar 

  31. de Miguel E, Cobo T, Munoz-Fernandez S, Naredo E, Uson J, Acebes JC et al (2009) Validity of enthesis ultrasound assessment in spondyloarthropathy. Ann Rheum Dis 68:169–174

    Article  Google Scholar 

  32. Döring S, Provyn S, Marcelis S, Shahabpour M, Boulet C, de Mey J, De Smet A, De Maeseneer M (2018) Ankle and midfoot ligaments: Ultrasound with anatomical correlation: A review. Eur J Radiol 107:216–226

    Article  Google Scholar 

  33. Finoff JT, Smith J, Nutz DJ, Grogg BE (2010) A Musculoskeletal Ultrasound Course for Physical Medicine and Rehabilitation Residents. Am J Phys Med Rehabil 89(1):56–60. https://doi.org/10.1097/PHM.0b013e3181c1ee69

    Article  Google Scholar 

  34. American College of Radiology. ACR-AIUM-SPR-SRU Practice Parameter for the performance of the musculoskeletal ultrasound examination. 2017. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/US-MSK.pdf (Accessed August 19, 2020)

  35. Cannella AC, Kissin EY, Torralba KD, Lin C, Higgs JB, Bolster M, DeMarco PJ, Nishio MJ, Oberle E, Putterman C, Roth J, Ting T, Vega-Fernandez P (2019) Rheumatologic ultrasound (RhUS) Curriculum Supplement to the American College of Rheumatology 2015 Core Curriculum Outline. https://www.rheumatology.org/Portals/0/Files/Rhumatologic-Ultrasound-Curriculum-Supplement.pdf?ver=2020-07-07-213008-530

  36. Torralba KD, Choi KS, Salto LM, Fairchild R, Cannella AC, Kissin EY, Thiele R, Evangelisto A, Nishio MJ (2020) Musculoskeletal Ultrasound Scanning Protocol Consensus Statements on Scanning Conventions and Documentation in the US. Arthritis Care Res 72(8):1177–1184

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Yawkey 2C, Boston, MA, 02144, USA

    Janeth Yinh

  2. Division of Rheumatology, Department of Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA

    Karina D. Torralba

  3. Division of Rheumatology, Loma Linda University Medical Center, Loma Linda, CA, USA

    Kristal S. Choi

  4. Division of Immunology and Rheumatology, Stanford University, Stanford, CA, USA

    Robert M. Fairchild

  5. Division of Rheumatology, University of Nebraska Medical Center, Omaha, NE, USA

    Amy Cannella

  6. Department of Basic Sciences, Loma Linda University, Loma Linda, CA, USA

    Lorena Salto

  7. Division of Rheumatology, Boston University, Boston, MA, USA

    Eugene Y. Kissin

  8. Division of Rheumatology, University of Rochester, Rochester, NY, USA

    Ralf Thiele

  9. Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA

    Edward J. Oberle

  10. Division of Rheumatology, Nationwide Children’s Hospital, Columbus, OH, USA

    Edward J. Oberle

  11. Division of Pediatric Rheumatology and Division of Allergy/Immunology and Rheumatology, University of Rochester, Rochester, NY, USA

    Bethany Marston

  12. John Muir Hospital, Walnut Creek, CA, USA

    Midori Jane Nishio

Authors
  1. Janeth Yinh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karina D. Torralba
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kristal S. Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert M. Fairchild
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Amy Cannella
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lorena Salto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Eugene Y. Kissin
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ralf Thiele
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Edward J. Oberle
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Bethany Marston
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Midori Jane Nishio
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

for USSONAR

Corresponding author

Correspondence to Janeth Yinh.

Ethics declarations

All authors met requirements for authorship set by ICJME.

Ethics approval

This study was reviewed and approved by the Loma Linda University Medical Center Institutional Review Board.

Disclosures

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

ESM 1

(DOCX 18 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yinh, J., Torralba, K.D., Choi, K.S. et al. North American musculoskeletal ultrasound scanning protocol of the hip, knee, ankle, and foot: update of a Delphi consensus study. Clin Rheumatol 40, 4233–4242 (2021). https://doi.org/10.1007/s10067-021-05716-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-021-05716-5

Keywords

Search

Navigation