Training tools

Minimum training requirements

TUI has proposed minimum training requirements for rheumatologists performing musculoskeletal ultrasound in rheumatoid arthritis and developed a logbook guide and pages to support training.

Theoretical training

  • Application, indications and limitations of musculoskeletal ultrasound (MSUS) in rheumatology
  • Basic B-mode and Doppler US physics and technology
  • Acquisition process: operator, machine, patient
    • Holding the probe and optimising 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 at least 18 hours with at least 50% of supervised practical sessions is recommended

Practical training

  • The trainee should perform a minimum of 30 normal and 70 pathological examinations (6 joint regions: 15 wrist/hand, 15 ankle/foot, 10 shoulder, 10 elbow, 10 hip, 10 knee; 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

© TUI 2019