TUI MINIMUM TRAINING REQUIREMENTS FOR RHEUMATOLOGISTS WHO PERFORM
MUSCULOSKELETAL ULTRASOUND (MSUS) IN RHEUMATOID ARTHRITIS
Theoretical training
 Application, indications and limitations of MSUS in rheumatology
 Basic B-mode and Doppler US physics and technology
 Acquisition process: operator, machine, patient:
o Holding the probe and optimizing the B-mode and Doppler settings
 Sonographic pattern of the different musculoskeletal tissues
 MSUS B-mode and Doppler artefacts and pitfalls
 Standard sonographic scans of the shoulder, elbow, wrist and hand, hip, knee, ankle
 and foot
 Image report and documentation
 Use of colour and power Doppler to detect synovial inflammation
 Ultrasound detection of the following pathologies: joint synovitis (i.e. synovial hypertrophy
and joint effusion), tenosynovitis, bony cortex abnormalities (i.e. bone erosions)
 Scoring of synovial and tenosynovial inflammatory activity with B-mode and Doppler
 Assessment of structural joint damage
Attendance in a basic and intermediate MSUS course, each of at least 18 hours and at least 50% of
supervised practical sessions is highly recommended.
Practical Training
 The trainee should perform a minimum of 30 normal and 70 pathological (6 joint regions: 15
wrist/hand, 15 ankle/foot, 10 shoulder, 10 elbow, 10 hip, 10 knee) examinations (total 100 US
examinations) under supervision in RA patients (70) and healthy subjects (30).
 Examinations should encompass the full range of conditions listed above.
 The TUI logbook should be kept by the trainee, listing the number and type of examinations and
reporting and documenting the ultrasound findings.