SHOULDER ULTRASOUND
COMPARISON
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Shoulder Portfolio:
Images in the left column taken March
2014.
Images in the center column taken
May 2014.
Comparison of Ultrasound Images
The images below were taken in March and May respectively. In March I had only just started in musculoskeletal sonography and had not completed many
examinations.
March Examination
This examination was conducted with heavy supervision. At this point I would consider myself a novice. As I was very new to the world of MSK my
supervising sonographer on this day had to assist me in many areas. I was assisted with probe orientation, image annotation, patient positioning, anatomy
orientation and my own ergonomic positioning. Although the images taken were diagnostic, there were several factors that could have been improved.
Places for improvement:
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Confidence – As I was very unsure of myself I often hesitated before taking an image. At times I would scan through a diagnostic image as I was
unsure that it was correct.
Probe orientation and anatomy knowledge – I had struggled with this throughout the scan as I was not used to scanning rounded anatomy. I was
also very confused about my hand position versus the orientation of the tendons.
Timing - The scan took almost 30 minutes to complete. This meant that the patient was relatively uncomfortable for an extending period of time.
The patient was given several breaks from position holding during the scan. .
Image quality – this will be reviewed further in the image comparison. The main areas include depth control, focus, the demonstration of fibres,
overcoming anisotropy.
May Examination
This examination was also conducted with supervision however it was much less than was needed for the March examination. Overall, I believe that my
technique has improved such that I would now consider myself as a beginner in this area. As I am still yet to complete and be confident in undertaking the
examination on my own I do not believe that I have reached the point of competency.
Areas of improvement:
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Confidence – I have become more confident in my ability to conduct the scan. I believe that this is due to my increasing exposure to this type of
ultrasound. At our practice this is a very common scan so there are many people to practice on.
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Probe orientation and anatomy – With my increased exposure to these scans I have become more aware of the skill required to produce a
diagnostic image. I am being trained by a variety of sonographers who have exposed me to their ways of obtaining or remembering how to obtain
the necessary images.
Timing – This scan took me 15 minutes to complete. I believe that this due to my improved knowledge and skill when conducting the scan. I do
however believe that as my training progresses this will change as when I am scanning on my own I will need to make decisions on my own rather
than rely on my tutors to agree that an image is acceptable.
Image quality – This will again be discussed further below however I believe that many of the above issues have been addressed.
Areas for Improvement
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Pathology recognition – For the most part during the scan I am still relying on my trainers to confirm if my assumptions about the condition of the
rotator cuff are correct. This again suggests that I am still at the beginner level and not yet competent.
Personal ergonomics – As I have conducted more of these scans I have less awkward with the way in which I conduct the scan. I still however find
myself occasionally slumping or over extending/flexing my wrist while concentrating on the scan.
Recognition of patients comfort – Although I have decreased amount of time that the patient is in the static position, at times during the scan when
I was focusing on the image I would fail to recognise the patient’s fatigue. I think that this is another indication that I am still in the beginning phase
and not yet competent in the examination.
Paige Fabre 13654584
Shoulder Ultrasound Image Comparison
An improvement of factors can be noted in
these images. The second image is more
magnified with a decreased depth and focal
zone more in-line with the biceps tendon
resulting in better visualisation.
Biceps Transverse Prox
Similar to the previous image and
improvement in factors have allowed for
better visualisation of the biceps tendon.
Moreover the bony surface is also more
clearly seen in the second image.
Biceps Mid
In these images of the biceps in long the
fibrillar pattern can be seen clearly however
the images are taken at slightly different
angles. Though the later image has better
imaging factors the earlier images has more of
the fibres parallel to the beam. This may be
due to the difference in patient habitus
however it is most likely user error. This is an
area I may need to improve on in the future.
Biceps Long Prox
These images are very similar in comparison.
The second image however is more detailed.
This is most likely due to the increased
attention paid to improving the image and
overall visualisation.
Biceps Long Dist
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The images of the subscapularis tendon are
where I see the most improvement so far. The
technical factors have been improved to allow
for better visualisation of the tendons. The
transducer position has also been improved in
the second image centring on the tendon
attachment allowing for better visualisation
and confirmation of the attaching fibres. The
use of TGC has also improved and is seen as
there is fewer artefacts noted the bone.
Subscapularis Long
The images here share a similar comparison to
the above. Artefacts in the image have been
reduced and the tendon is viewed more
clearly. The fascicles in the tendon are more
readily seen in the second image.
Subscapularis Trans
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Supraspinatus Trans Prox
Factors have again been improved in these
images. These images are a good example in
the difference in annotation during the
examinations. Different trainers have different
expectations of annotation required on the
images. This however makes a limited
difference in the diagnostic quality of the
image itself.
These images of the supraspinatus again
demonstrate the improvement in the
diagnostic quality.
Supraspinatus Trans Mid
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This comparison is a reminder to me that
constant machine manipulation is needed to
produce images of high diagnostic quality.
Supraspinatus Trans Distal
The following supraspinatus images
demonstrate the improvements made to
image quality. As seen in the images of the
subscapularis, there has been an
improvement in probe position allowing for
centring and overall better visualisation of the
fibres at the insertion.
Supraspinatus Long Ant
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On review of these images labelling of the mid
portion should be included as to avoid
radiologist confusion
Supraspinatus Long Mid
Supraspinatus Long Post
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These comparative images are a good
example of the improvement of imaging
improving diagnostic quality. Both images are
of symptomatically tender AC Joints however
the later image shows the bony surface of the
joint more clearly allowing for better
visualisation of the joint space.
AC Joint
Imaging factors have improved the second
image diagnostically. The differences in the
infraspinatus tendon of the second patent are
most likely due to the 25 year age difference
between them and the first patient.
Infraspinatus Long Insertion
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Further improvements in technique are seen
here however the image of the second patient
may have been improved with the use of a
lower frequency transducer.
Glenoid Labrum
SG notch imaging has again seen
improvement with the change in imaging
factors and technique. The bony element of
the notch is markedly clearer in the second
image.
Spinoglenoid Notch
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Though factors on both images have been
utilised improvement could have been made
to both. The second image is slightly
overgained. The first image has only one of
three focal zones in the region of the bursa.
Issues with these images I think are the result
of the challenges faced scanning this region
dynamically. This is something I will have to
work on in the future.
SAB in Abduction
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