Task Force: Musculoskeletal Ultrasound Requires More Training

Ultrasound has become such an important diagnostic tool in inflammatory arthritis that a European League Against Rheumatism (EULAR) task force recommends that non-medical sonographers and rheumatologists obtain the same level of training for musculoskeletal ultrasound.

Ultrasound has become a core part of the diagnostic process for inflammatory arthritis, monitoring disease activity and therapeutic response, and for guiding interventions.

“The role of the nonmedical health professional has advanced, with many undertaking training and using musculoskeletal ultrasound to improve patient care and in doing so, increasing their scope of practice,” wrote Siddle HJ, Mandl P, Aletaha D, et. Al. in the Dec. 9 issue of the Annals of the Rheumatic Diseases.

Siddle and colleagues at centers across Europe presented seven points aimed at supporting education and training for health professionals that utilize ultrasound in diagnosing and treating rheumatic musculoskeletal disease. The group narrowed their focus in light of the high degree of variability found between European practitioners in an effort to recommend an agenda that could bring health professionals together. Seven points were agreed upon which met rigorous criteria with regards to category and strength of evidence (category 3-4 and strength level D respectively) as well as high levels of consensus agreement with each point achieving scores greater than nine out of 10.

EULAR Task Force Points

Role and Scope:

• Health professionals may use ultrasound to detect musculoskeletal abnormalities and contribute to clinical decision-making.
• Health professionals may use musculoskeletal ultrasound as a tool for research including health professional-led 3–4 D 9.3 (8.7 to 9.9) studies.

Training and Competency:

• Health professionals must be appropriately trained and assessed for competency in musculoskeletal ultrasound 4 D 9.7 (9.5 to 10.0) before applying it in clinical practice.
• The minimal competency requirements for performing musculoskeletal ultrasound must be the same for all ultrasound practitioners. Advanced training content may be adapted according to the needs of the health professionals.
• Health professionals appropriately trained may teach musculoskeletal ultrasound according to a standardized and formalized training program.

Application and Feasibility:

• The use of musculoskeletal ultrasound by health professionals must be based on levels of competency and the individual’s role within their institution/department, as directed by local and national regulations.

By using musculoskeletal ultrasound, health professionals may improve the clinical management of people with rheumatic and musculoskeletal diseases.

Although the evidence supporting these points is admittedly weak, their presentation is timely in a European environment where ultrasound use in musculoskeletal disease is increasing. While not a set of guidelines per se, the seven points are meant to reinforce European education and training for health professionals using ultrasound and should not be seen as inflexible but instead complimentary to local and national regulations.

The group stresses that non-medical sonographers should adhere to the same scope of practice as rheumatologists and as such, attain the same training and competency levels with regards to using musculoskeletal ultrasound.

The full set of seven points and explanations can be seen at: http://www.eular.org

References:

Heidi J Siddle, Peter Mandl, et. al. "The EULAR points to consider for health professionals undertaking musculoskeletal ultrasound for rheumatic and musculoskeletal diseases," Annals of the Rheumatic Diseases. Published Online First Dec. 9, 2016. DOI: 10.1136/annrheumdis-2016-210741