Musculoskeletal (MSK) ultrasound performed by non-medical practitioners is a developing practice. The aim of this paper is:(1) to audit an experienced sonographer's (SJR) performance after one year's independent reporting against two experienced MSK radiologists (CJG, MC); and (2) to establish an audit standard against which such role development might be contrived. Images and reports from 250 MSK ultrasound examinations performed by a sonographer (SJR) were reviewed independently by two consultant MSK radiologists (CJG and MC). The examinations were graded for discrepancy, e.g. grade 1 -agree with the sonographer report; grade 2 -minor discrepancy unlikely to alter patient care; grade 3 -potentially significant discrepancy; grade 4 -definite, significant discrepancy likely to have adverse consequences for patient care. Two of 250 (0.8%) cases were excluded. Both radiologists agreed completely with the sonographer (grade 1) in 235 of the 248 cases (94.8%). In 13 cases there was discrepancy between the reports of SJR and the radiologists. The discrepancy was grade 2 in six of the 248 cases (2.4%), grade 3 in six of the 248 cases (2.4%) and grade 4 in one of the 248 cases (0.4%). In conclusion, this audit shows a high level of agreement between the sonographer and the consultant MSK radiologist reporting of MSK ultrasound. This level of agreement may set the standard for future quality assurance audit of sonographer MSK reporting.Over the last 20 years there has been a gradual rise in the number of non-medical imaging health professionals performing and independently reporting ultrasound examinations. 1,2 Such a development has taken place in line with recommendations from the professional bodies; The Royal College of Radiologists and The Society of Radiographers and national government initiatives for skill-mix and role extension, primarily in order to meet increasing service demand. 3 -7 Early evidence showed that sonographers were able to produce general medical ultrasound reports to a similar standard as those of radiologists, thus generating a degree of confidence in independent sonographer reporting. 8,9 Further studies showed high diagnostic accuracy and good agreement for independent radiologist and sonographer reporting of abdominal and pelvic ultrasound. 10,11 Non-medical practitioners have been involved in musculoskeletal (MSK) ultrasound for many years but this is still a developing practice. Recent publications in certain areas of MSK ultrasound show involvement of non-medical practitioners, e.g. inter-operator agreement studies in shoulder ultrasound, and radiologist versus podiatrist in rheumatoid MSK ultrasound of the forefoot. 12 -14 To our knowledge, there are no research or audit studies assessing sonographer reporting of MSK ultrasound examinations.In 2007, in order to meet service requirements, responsibility for performance and reporting of MSK ultrasound was delegated to a newly-appointed sonographer (SJR) with eight years MSK ultrasound experience gained at a different institution. This adva...
Ultrasound has a high degree of diagnostic accuracy in the assessment of rotator cuff tendons. Increasingly, ultrasound is being used to measure other parameters of rotator cuff pathology, including the size of the subacromial space, or acromiohumeral distance (AHD). Although this measure has been found to be clinically reliable, no assessment of its validity has been carried out. This technical study reports on the development of a novel ultrasound phantom of the shoulder and its use in validation of ultrasound measurement of AHD. There was a close agreement between AHD measures using ultrasound and the true subacromial space of the phantom model, providing support for the construct validity of this measurement. The phantom model has good potential for further development as a training tool for shoulder ultrasound and guided injections.
This case began as an investigation using computed tomography of a gluteal tuberculous (TB) abscess. This revealed an incidental testicular lesion that was subsequently evaluated with ultrasound. Ultrasound showed a well-defined testicular lesion, ipsilateral epididymal calcification and a hydrocoele. The presence of tuberculosis at other extrapulmonary sites combined with a positive response of the testicular lesion to anti-TB treatment made it possible to establish a diagnosis of TB epidiymo-orchitis. A reduction in the size of the testicular lesion on ultrasound surveillance enabled conservative management avoiding the need for orchidectomy or biopsy.
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