Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Standardized Ultrasound Examination of the Hand in Patients with Rheumatoid Arthritis-a Multicentre Learning Experience: Education in Ultrasound of Rheumatoid Arthritis-EURA
Ellegaard1, K., Torp-Pedersen2, S., Christensen3, R., Stoltenberg4, M., Hansen5, Annette, Lorenzen6, T., Jensen7, D.
KE, Copenhagen, Denmark,
HR, Openhagen, Denmark,
PB, Copenhagen, Denmark,
SC, Esbjerg, Denmark,
MK, Aalborg, Denmark,
Parker Institute, Frederiksberg, Denmark
STP, Copenhagen, Denmark,
RC, Copenhagen, Denmark,
MS, Køge, Denmark,
DVJ, Hørsholm, Denmark,
Odense University Hospital, Odense, Denmark,
LJ, Openhagen, Denmark,
There is a lack of standardized US examination procedures in the rheumatological area and such standardized procedures are needed. Standardized examination procedures are important in order to improve the validity of the US measurements and to make it possible to compare US studies from different institutions.
The purpose of this study was to investigate the learning progress for rheumatologists trained in a standardized US examination of the hand in patients with rheumatoid arthritis (RA).
Ten rheumatologists from Denmark having varying experience in US were trained for two days in a standardized US examination of the wrist and MCP joints in pateints with RA. The examination contained both grey-scale and Doppler assessment. The tutors were two persons with intensive experience in US. After training, the rheumatologists performed the examination in their own clinics. All examinations were sent to the tutors for quality evaluation. The tutors evaluated the examinations according to a scoring sheet containing 16 positions (four in the wrist and 12 in MCP II-V). In each position nine items were scored.
Both the general examination technique and the Doppler examination technique were assessed. A high quality of the Doppler images is essential to obtain a valid measure of hyperaemia. Thus the general examination was accepted if >80% of the scores were correct, but the Doppler part was only accepted if >90% were correct.
Ninety-six patients were scanned in a total of 378 examinations. High level of scores was obtained very fast, however some persisting mistakes were made throughout the study despite the intensive evaluation and feed-back. 97% of the examinations scored >80% in the general examination and 47% scored > 90% in the Doppler examination. No correlation was seen between earlier US experience and scores obtained. Some participants had decreasing scores in the study period, which might be due to carelessness.
Skills in a standardized US examination can be achieved relatively fast making US suitable for clinical practice and both single and multi centre trials. However, to ensure high validity, the investigators must continue performing systematic US examination. This is of particular importance in the Doppler examination.
To cite this abstract, please use the following information:
Ellegaard, K., Torp-Pedersen, S., Christensen, R., Stoltenberg, M., Hansen, Annette, Lorenzen, T., et al; Standardized Ultrasound Examination of the Hand in Patients with Rheumatoid Arthritis-a Multicentre Learning Experience: Education in Ultrasound of Rheumatoid Arthritis-EURA [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1454