A RETROSPECTIVE SURVEY OF MUSCULOSKELETAL ULTRASOUND SERVICES IN A UNIVERSITY HOSPITAL

Background: Musculoskeletal ultrasound (MSUS) has long been the domain of musculoskeletal radiologists. However, rheumatologists are increasingly applying MSUS in their clinical practice. Before developing musculoskeletal ultrasound services in the rheumatology department of University Hospital, Coventry, we undertook this retrospective survey of MSUS performed by musculoskeletal radiologists in order to assess the current workload as well as the impact of MSUS on the diagnosis and management of rheumatology patients. Objectives: 1. To assess the workload of MSUS service provided by the radiology department 2. To assess the influence of MSUS on the diagnosis and management of rheumatology patients Methods: - This is a retrospective review of MSUS scans performed by consultant radiologists with a special interest in MSUS from 01/01/07 to 31/03/07 (3 month period). – On all patients undergoing MSUS during this period, sources of referral and waiting times were documented. – On all patients undergoing musculoskeletal ultrasound, referred by the Rheumatology department, additional data was collected for areas scanned, indications, findings, influence on diagnosis and the impact on management. – Data collection was done from radiology CRIS system and patient clinical letters prior to and following the scan. Results: - A total of 382 patients were scanned during this 3 month period. 104 (27%) patients were referred by rheumatology, 37% by orthopaedics 13% by GPs. Overall 11% patients were scanned on same day, 19% within a week, 35% within 4 weeks and 24% patients had to wait for more than 8 weeks. – 51% of areas scanned were shoulders, hands 20%, wrists 12%, ankles 8% and feet 6%. – Most common indications were rotator cuff tendinopathy/tear (45%), synovitis (21%), tenosynovitis (12%), effusion (7%) and injection/aspiration (6%) – Most common findings were rotator cuff tendinothy (29%), normal scan (29%), rotator cuff full thickness tear (16%), subacromial bursitis (13%), degenerative (12%), synovitis (8%), effusion (8%), tenosynovitis (5%). Injections were done in only 2 patients. – Following the scan, the diagnosis was revised by the clinician in 23% patients and a definitive diagnosis was established in 75% patients. – In 43 (41) % patients, there was a change in management following the scan. 31% of these were referred to a surgeon, 31% had an intra-articular steroid injection, 8% had a change in disease modifying medication, 8% were referred to physiotherapy. In 6% patients, injection was withheld and disease modifying therapy was withheld in 12% patients. 2 patients were discharged following the scan. – Only 6% patients required a further investigation (MRI and arthroscopy) due to inconclusive MSUS. Conclusion: - A substantial amount of MSUS workload of radiologists is contributed by rheumatology. The number of rheumatology referrals as well as the waiting time is projected to increase further with increasing reliance on MSUS by rheumatologists. – There is a significant influence of MSUS on rheumatological diagnostic process with a definitive diagnosis being established in a large number of patients. – There is a small but significant impact of MSUS on management of rheumatology patients. References: 1. R.J. Wakefield, E. Goh, P.G. Conaghan, Z. Karim and P. Emery. Musculoskeletal ultrasonography in Europe:results of a rheumatologist-based survey at a EULAR meeting. Rheumatology 2003;42:1251–1253 Disclosure of Interest: None declaredCitation: Annals of the Rheumatic Diseases, volume 69, supplement 3, year 2010, page 713Session: Diagnostics and imaging procedures (Abstracts accepted for publication )