EH 5_2015

www.supersonicimagine.com For everything that really counts in ultrasound UltraFast™ Imaging with - ShearWave™ Elastography - UltraFast™ Doppler EUROPEAN HOSPITAL  Vol 24 Issue 5/15 18 ULTRASOUND Training is necessary to work competently with this highly specialised technology Rheumatology depends on ultrasoundSwitzerland is among few European countries that require extensive supervised ultrasound training as a mandatory component in medical specialist training for rheumatologists. Ultrasound is an important tool for many rheumatic diseases because it suits diagnostic and therapy monitoring needs as well as targeted efficient ultrasound-guided interventions. Dr Giorgio Tamborrini, Medical Director, rheumatologist and specialist for musculoskeletal ultrasound at the Ultrasound Center of Bethesda Hospital, Basle, Switzerland, explains sonography is so important in rheumatology In Switzerland, as in most other coun- tries, the first stop for patients is usually a general practitioner (GP) – and the GPs decide when to refer patients to a rheumatologist. ‘We drafted guidelines for the early diag- nosis and management of rheuma- toid arthritis that define when and for which purpose an ultrasound exam should be performed,’ explains rheu- matologist Dr Giorgio Tamborrini. ‘The guidelines were published in a journal for internal medicine (Swiss Med Wkly. 2013;143:w13861), for internal medicine specialists to develop a feeling for the right time to do such an exam.’ The Swiss model has a crucial advantage: it ensures a patient with a suspected inflammatory rheumatic disease receives a complete diagnos- tic work-up by a trained and certified rheumatologist (SGUM, EFSUMB, EULAR, etc.), including high-reso- lution ultrasound. ‘This procedure allows us to diagnose arthritis, in the joints that are most commonly affect- ed, with high sensitivity and specific- ity,’ Tamborrini explains. Additionally, Doppler ultrasound shows ‘active’ rheumatoid arthritis, which plays a crucial role in therapy and prognosis of the disease. ‘A further advantage of ultrasound is the opportunity to view joints dynamically and in sev- eral planes. Moreover, the technol- ogy allows us to assess many joints in a short period of time,’ the rheu- matologist stresses. With patients who present with suspected rheuma- toid arthritis, generally both hands, elbows, knees and feet are examined to detect inflammations as well as existing damages to the cartilage or bones. According to Tamborrini, ‘all examination data are collected and documented in order to optimise patient management, as well as for research and quality assurance in the context of registry studies’. ‘Additional imaging modalities are used as required or when, for example, the carpal bones might be involved,’ he adds. In the latter case ultrasound is limited in its diagnos- tic capabilities and an MRI scan of the hand is indicated – performed in a radiology department that has proven experience in diagnostic imaging of the musculoskeletal sys- tem. ‘The majority of patients requir- ing diagnostic imaging for arthritis can be successfully examined with high- resolution ultrasound; a slice imaging modality is not required,’ Tamborrini points out. Conditions need differentia- tion via ultrasound ‘The word rheumatism is used to describe 200 different disorders. About 100 of them can cause joint pain or inflammation,’ he explains. Thus the rheumatologist must be familiar with all variants and be able to tell them apart. Inflammatory conditions must be differentiated from degenerative disorders, or from pathologies caused by post-traumatic changes. The combination of a thor- ough anamnesis and a differentiated exam by an ultrasound specialist can produce highly sensitive and highly specific findings that help to rule out or rule in specific disorders in a dif- Tenosynovitis of ECU tendon in rheumatoid arthritis (left) and active synovitis (right top) with erosions (right bottom) in the MCP joint Calcification in the infraspinatus tendon (arrow) shown in the posterior-transversal plane (top) and in 3-D (bottom) New convention dates and location The America Institute of Ultrasound in Medicine (AIUM) is returning to New York City for its 2016 Annual Convention. The Convention will now take place: March 17-21, 2016 New York Hilton Midtown

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