Open Access Open Badges Research article

Feasibility of a standardized ultrasound examination in patients with rheumatoid arthritis: a quality improvement among rheumatologists cohort

Karen Ellegaard1*, Søren Torp-Pedersen1, Robin Christensen12, Michael Stoltenberg3, Annette Hansen4, Tove Lorenzen5, Dorthe V Jensen6, Hanne Lindegaard7, Lars Juul8, Henrik Røgind9, Per Bülow10, Stavros Chrysidis11, Marcin Kowalski12, Bente Danneskiold-Samsoe11314 and Henning Bliddal11314

Author Affiliations

1 The Parker Institute, Copenhagen University Hospital, Copenhagen, Denmark

2 Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark

3 Department of Rheumatology, Køge Hospital, Koge, Denmark

4 Department of Internal Medicine and Rheumatology C, Gentofte University Hospital, Gentofte, Denmark

5 Department of Rheumatology, Vejle Hospital, Vejle, Denmark

6 Rheumatologic Clinic, Hørsholm Hospital, Hørsholm, Denmark

7 Department of Internal Medicine C, Section of Rheumatology, Odense University Hospital, Odense, Denmark

8 Department of Rheumatology, Copenhagen State University Hospital, Copenhagen, Denmark

9 Department of Rheumatology H, Frederiksberg Hospital, Frederiksberg, Denmark

10 Department of Rheumatology H, Bispebjerg Hospital, Copenhagen, Denmark

11 Department of Rheumatology, Esbjerg Hospital, Esbjerg, Denmark

12 Department of Rheumatology, Aalborg Hospital, Aalborg, Denmark

13 Centre for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark

14 Copenhagen University, Copenhagen, Denmark

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BMC Musculoskeletal Disorders 2012, 13:35  doi:10.1186/1471-2474-13-35

Published: 12 March 2012



Quality improvement is important to facilitate valid patient outcomes. Standardized examination procedures may improve the validity of US.

The aim of this study was to investigate the learning progress for rheumatologists during training of US examination of the hand in patients with rheumatoid arthritis (RA).


Rheumatologists with varying degrees of experience in US were instructed by skilled tutors. The program consisted of two days with hands-on training followed by personal US examinations performed in their individual clinics. Examinations were sent to the tutors for quality control. The US examinations were evaluated according to a scoring sheet containing 144 items. An acceptable examination was defined as > 80% correct scores.


Thirteen rheumatologists participated in the study. They included a total of 104 patients with RA. Only few of the initial examinations were scored below 80%, and as experience increased, the scores improved (p = 0.0004). A few participants displayed decreasing scores.

The mean time spent performing the standardized examination procedure decreased from 34 min to less than 10 minutes (p = 0.0001).


With systematic hands-on training, a rheumatologist can achieve a high level of proficiency in the conduction of US examinations of the joints of the hand in patients with RA. With experience, examination time decreases, while the level of correctness is maintained. The results indicate that US may be applied as a valid measurement tool suitable for clinical practice and in both single- and multi-centre trials.

Ultrasonography; Rheumatoid Arthritis; Wrist