Learning musculoskeletal ultrasound

Aim: To evaluate if an acceptable diagnostic level of musculoskeletal ultrasonography(US) can be achieved by a US-novice when taught by an expert during a 4 month rotation in an outpatient clinic. Methods: All patients referred to an out-patient clinic with heel pain during one month (July 2013) were offered participation. No declined and 17 were included. The exam included 4 US images of both feet: a cross sectional scan of the thickest part of the Achilles tendon,a longitudinal scan of the plantar fascia anda cross sectional of the heel fat pad with and without pressure. These 8 images were repeated after a few minutes resulting in 8 pairs of images. After 2 months all the images were reviewed randomly in a blinded manner and measurements were performed.Hereby two different measurements on two different images were performed. The intra-tester reliability was compared by Intra-class Correlation Coefficient (ICC) and typical error (TE). Results: The US novice trainee achieved an acceptable good ICC (0.64 to 0.90)with agreements (TE 7.117.5%), albeit lower than the experienced doctorwith substantial ICC (0.90-0.97) and TE (3.4-6.7%). Conclusion: A 4 month rotation in an outpatient clinic with daily use of musculoskeletal ultrasound can lead to acceptable ultrasonographic skills in a novice with no prior ultrasonography experience.