Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Yawkey 2C, Boston, MA, 02144, USA.
Division of Rheumatology, Department of Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA.
Clin Rheumatol. 2021 Oct;40(10):4233-4242. doi: 10.1007/s10067-021-05716-5. Epub 2021 Apr 5.
BACKGROUND/OBJECTIVE: A North American rheumatology consensus on tiered-mastery designation for anatomic views was developed in 2011 for course and fellowship teaching. This study updates the lower extremity joint scanning protocols aiming to inform musculoskeletal ultrasound curriculum development for the American College of Rheumatology affiliated Fellowship Programs.
Three Delphi rounds were conducted to reach consensus for tiered-level mastery designation for hip, knee, ankle, and foot scanning views. The survey was disseminated (Qualtrics™) to 101 potential participants with ultrasound teaching experience. High agreement was defined as ≥ 85% consensus and final tier designation as having >50% agreement for the preferred tier. Response changes were evaluated by McNemar's chi-square test.
Consensus regarding tier designations was reached for 80% of the views. Three knee views (anterior transverse suprapatellar, medial, and lateral longitudinal) and 2 ankle views (anterior and posterior transverse) achieved upgrades to tier 1 from 2. The transverse sacroiliac hip joint was downgraded from tier 2 to 3. The lateral longitudinal hip view was added with a tier 1 designation.
Updated scanning protocols support modifications reflecting current scanning methods delivered by North American rheumatologists performing point of care ultrasound that may inform educators involved in rheumatology ultrasound. Key Points • The anterior transverse suprapatellar, medial, and lateral longitudinal knee views; the anterior and posterior transverse ankle views; and the lateral longitudinal view hip view were perceived as important to master and perform routinely. • The transverse sacroiliac joint view was suggested to be performed based on practice focus.
背景/目的：2011 年，为了课程和奖学金教学，北美风湿病学制定了关于解剖视图分层掌握的共识。本研究更新了下肢关节扫描方案，旨在为美国风湿病学院附属奖学金项目的肌肉骨骼超声课程开发提供信息。
进行了三轮 Delphi 研究，以达成髋关节、膝关节、踝关节和足部扫描视图分层掌握的共识。该调查（使用 QualtricsTM）分发给了 101 名具有超声教学经验的潜在参与者。高共识定义为≥85%的一致性，最终分层指定定义为首选分层的>50%的共识。通过 McNemar 的卡方检验评估响应变化。
对于 80%的视图，达成了分层指定的共识。三个膝关节视图（髌上横向、内侧和外侧纵向）和两个踝关节视图（前横向和后横向）从 2 级升级到 1 级。横向骶髂髋关节从 2 级降级到 3 级。增加了外侧纵向髋关节视图，并指定为 1 级。
更新的扫描方案支持反映北美风湿病学家进行即时护理超声时当前扫描方法的修改，这可能为参与风湿病学超声的教育工作者提供信息。
关键点
前横向髌上、内侧和外侧纵向膝关节视图；前横向和后横向踝关节视图；以及外侧纵向髋关节视图被认为是重要的，需要掌握并常规执行。
横向骶髂关节视图建议根据实践重点进行操作。
