Radiologist-patient communication of musculoskeletal ultrasonography results: a choice between added value and costs

Background Literature on radiologist-patient communication of musculoskeletal ultrasonography (US) results is currently lacking. Purpose To investigate the patient's view on receiving the results from a radiologist after a musculoskeletal US examination, and the additional time required to provide such a service. Material and Methods This prospective study included 106 outpatients who underwent musculoskeletal US, and who were equally randomized to either receive or not receive the results from the radiologist directly after the examination. Results In both randomization groups, all quality performance metrics (radiologist's friendliness, explanation, skill, concern for comfort, concern for patient questions/worries, overall rating of the examination, and likelihood of recommending the examination) received median scores of good/high to very good/very high. Patients who had received their US results from the radiologist rated the radiologist's explanation and concern for patient questions/worries as significantly higher ( P = 0.009 and P = 0.002) than patients who had not. In both randomization groups, there were no significant differences between anxiety levels before and after the US examination ( P = 0.222 and P = 1.000). Of the 48 responding patients, 46 (95.8%) rated a radiologist-patient discussion of US findings as important. US examinations with a radiologist-patient communication regarding US findings (median = 11.29 min) were significantly longer ( P < 0.0001) than those without (median = 8.08 min). Conclusion Even without communicating musculoskeletal US results directly to patients, radiologists can still achieve high ratings from patients for their communication and empathy. Nevertheless, patient experience can be further enhanced if a radiologist adds this communication to the examination. However, this increases total examination time and therefore costs.

Ultrasonographic Features of Arthritis in Patients With Primary Sjögren's Syndrome and Its Clinical Significance

Background: This study aim to observe the feature of joint involvement in the patients with primary Sjögren’s syndrome (pSS) by musculoskeletal ultrasound (US) and analyze its relationship with clinical manifestations and disease activity.Methods: US examinations were performed in a total of 1200 joints of 40 patients with pSS. A semi-quantitative grading method (0 to 3) for scoring synovial hyperplasia, PD synovitis, bone erosion, tenosynovitis was used. The clinical and laboratory data were collected, disease activity was assessed. The correlation between US lesions and disease activity assessment and clinical manifestations were analyzed.Results: The musculoskeletal ultrasound lesions in patients with pSS mainly involved the small joints of the hands and wrists, and the lesions were mild. The semi-quantitative score of musculoskeletal US was positively correlated with ESSPRI. The occurrence of musculoskeletal US lesions was associated with immunological abnormalities and inflammatory markers, and patients with high IgG, RF, and inflammatory markers were prone to abnormal US findings.Conclusion: The incidence of arthritis in patients with pSS is high, and the musculoskeletal US has its characteristics. The musculoskeletal ultrasound semi-quantitative method can effectively evaluate arthritis in patients with pSS, and the US score of arthritis has a certain correlation with the overall disease activity. US can provide reference for the diagnosis of arthritis and disease activity assessment in patients with pSS.

Accuracy of Ultrasound-Guided Pudendal Nerve Block in the Ischial Spine and Alcock’s Canal Levels: A Cadaveric Study

Background Blockade of the pudendal nerve (PN) using ultrasound (US) guidance has been described at the levels of the ischial spine and Alcock’s canal. However, no study has been conducted to compare anatomical accuracy between different approaches in targeting the PN. Objective To investigate the accuracy of US-guided injection of the PN at the ischial spine and Alcock’s canal levels. This study also compared the accuracy of the infiltrations by three sonographers with different levels of experience. Subjects Eight Thiel-embalmed cadavers (16 hemipelvises). Methods Three physiatrists trained in musculoskeletal US imaging with 12 years, five years, and one year of experience performed the injections. Each injected a 0.1-mL bolus of colored dye in both hemipelvises of each cadaver at the ischial spine and Alcock’s canal levels under US guidance. Each cadaver received three injections per hemipelvis. The accuracy of the injection was determined following hemipelvis dissection by an anatomist. Results The injections were accurate 33 times out of the total 42 attempts, resulting in 78% accuracy. Sixteen out of 21 injections at the ischial spine level were on target (76% accuracy), while the approach at Alcock’s canal level yielded 17 successful injections (81% accuracy). The difference between the approaches was not statistically significant. There was also no significant difference in accuracy between the operators. Conclusions US-guided injection of the PN can be performed accurately at both the ischial spine and Alcock’s canal levels. The difference between the approaches was not statistically significant.

An evaluation of the effectiveness of teaching anatomy to rheumatologists through combined musculoskeletal sonoanatomy and human cadaveric dissection

Objective Our aim was to evaluate the effectiveness of teaching anatomy through combined musculoskeletal sonoanatomy and human cadaveric dissection for rheumatologists practising musculoskeletal US. Methods The principal focus was on scanning and then dissecting relevant musculoskeletal structures. Outcomes measured included confidence levels and objective knowledge. A mixed-methods approach of evaluation and descriptive statistical data analysis was performed. Results The change in confidence ratings by delegates after the teaching event as represented by the mean difference (s.d.) (s.e.m.) for identification of surface anatomy was 1.846 (1.281) (0.355), with Student’s paired t = 5.196 and P=0.000223. The mean difference (s.d.) (s.e.m) for performing IA injections was 1.538 (1.266) (0.351), with Student’s paired t = 4.382, P=0.001, and for recognizing sonoanatomical structures it was 1.769 (1.235) (0.343), with Student’s paired t = 5.165 and P= 0.000235. There was a significant increase in correct identification of anatomical and sonoanatomical knowledge in the pre- and post-course assessments. Rotator cuff interval region improved from 13 to 73%, P = 0.004; knee tendons insertion sites from 47 to 93%, P = 0.016; and muscles not adjacent to joints from 27 to 93%, P = 0.002. Conclusion Dissection of joints enabled a three-dimensional relational mind map of the relevant regions of the human body, producing clarity in understanding regional relational topographic anatomy and sonoanatomy. The combination of US and cadaveric dissection improved learners’ satisfaction, confidence and knowledge in areas where soft tissue complaints are common, which is likely to lead to accurate early diagnosis and cost-conscious, better overall care.

Imaging Artifacts in Musculoskeletal Ultrasound

Chapter 119 discusses imaging artifacts in musculoskeletal US. Artifacts may be produced with B-mode grayscale and Doppler US imaging. These artifacts occur when the US beam deviates from ideal physical beam assumptions. It is important for radiologists to have an understanding of these artifacts so as to distinguish them from pathology. Side lobe, beam-width, posterior acoustic enhancement and shadowing, posterior reverberation, ring down, comet-tail, mirror image, anisotropy, refraction, and speed displacement artifacts are seen with grayscale imaging. Background noise, mirror image, aliasing, twinkle, transducer pressure, motion, and blooming artifacts are seen with Doppler imaging. Understanding of US artifacts is crucial to avoid mistaking artifacts for true pathology.