Acquisition and Documentation of MSKUS Images and Reporting

Dr Lee Ka Wing GavinDirector, Rheumatology Centre, Hong Kong Sanatorium & Hospital

Hon. Clinical Associate Professor, Department of Medicine, University of Hong Kong

Hon. Clinical Associate Professor, Department of Medicine & Therapeutics, Chinese University of Hong Kong

24-26 Sept 2016, SHANGHAI

Acquistion of MSK ImagesAcquisition and Documentation of MSKUS Images and Reporting

Archive of USG Image Data

Objectives

• Studies can be retrieved for reviewed and compared

• (Retrieved for formal reporting)

• Education, teaching and training

• Audit on the performance of USG scanning

• (Medico-legal)

Storage of Images

Acquisition of Image

• Static image • Dynamic / Cine loops

Storage of Data

Review & Retrieve

Studies and Images retrieval

• Sorting of studies• Patient name

• Patient specific ID

• Examiner

• Date of examination

• Type of examination

Exploring Data Files

Exploring from USG machines

• USB

• DVD / CD

• Storage media (hard drive) / Server

Purposes

• Educational purpose

• Audit

• Long-term storage

Problem with Data Archive

• Large memory space needed (images / movies) – increase with high resolution images• USG machine system hard disc unlikely to

be adequate • Requiring transferring / export to

separate server or hard disc

• Security of data (personal data privacy)

• Organizations of the data after storage – tedious

Data Archive

Picture Archiving & Communication Systems (PACS)• Digital system permitting imaging

(1)viewing, (2)storage and (3)distribution of imaging findings acquired in digital format

• Networking consideration• Centralized US laboratory• Satellites / Scattered throughout

• Data transmission• Data port• Wireless transmission (WIFI)

Picture Archiving & Communication Systems

• Global PACS

• Mini-PACS: e.g. limited to USG

• Sub-PACS: modular development

Reporting FindingsAcquisition and Documentation of MSKUS Images and Reporting

What We Have in Our Daily Practice - Imaging

Different Modalities

• Plain radiograph

• CT scan

• MRI scan

• PET/CT scan

• Ultrasound – other than USG

• ECHO

Formatting of Report

• Image hard copy

• Image data in electronic files (CD)

• Written report on findings

• Numerical analysis

What is a Good Report

What is a Good Report

Eight Cs

• Clarity

• Correctness

• Concise

• Completeness

• Consistency

• Consultation

• Confidence

• Communication

Other attributes:

• Timeliness

• Standardization

Preparing an Ultrasound Report

• Patient information

• Date of examination

• Indication for examination

• Regions examined

• Referring physician

• Operator / reporting physician

General Guidance for Preparing USG Report

• Appropriate anatomic and sonographic terminology should be used

• Avoid abbreviation

• Measurements• Commonly used anatomic measurements should be listed

• Organ or tissue variations from normal size or abnormal mass

• Comparison with prior relevant imaging studies if available

• Specific diagnosis or differential diagnoses should be included

• Impression or conclusion should be included

• Recommendation for follow-up studies should be provided if clinically applicable

http://www.aium.org/resources/guidelines.aspx

USG report – The Content

• Descriptive

• Clinically oriented

• Joints scanned during the session

• Pathology identified• Joint – effusion / synovial hypertrophy /

synovitis

• Bone – erosion / osteophytes

• Cartilage

• Periarticular structural change – tendon / bursa / ligament

USG Report – Picture / Image

Selection of image

• ***Selecting images with most significant or representative findings

• Joint examined

• Orientation of probe

• Standardized scan position

• Labeling of abnormalities detected

Main Items to be Reported in Practice in MSK USG

1. Described the equipment used

2. Provide a description of all the pathological findings using scoring methods or appropriate measurements

3. Provide a list of normal structures only if directly linked to the motivation for the examination

4. Provide a final comment on the findings according to the motivation for the examination

5. Indicate the need for other examinations if appropriate

6. Indicate the diagnosis if appropriate

7. Avoid comments on the relevance of findings

8. Attach an adequate number of images to the pathological findings described in the text

9. Report only essential information on the images

Iagnocco A, et al. Rheumatology 2014;53:367-373

Equipment

Equipment

Equipment

US machine usedType & frequency

of probe

Photo by iphone 2G Photo by iphone 7

Main Items to be Reported in Practice in MSK USG

1. Described the equipment used

2. Provide a description of all the pathological findings using scoring methods or appropriate measurements

3. Provide a list of normal structures only if directly linked to the motivation for the examination

4. Provide a final comment on the findings according to the motivation for the examination

5. Indicate the need for other examinations if appropriate

6. Indicate the diagnosis if appropriate

7. Avoid comments on the relevance of findings

8. Attach an adequate number of images to the pathological findings described in the text

9. Report only essential information on the images

Iagnocco A, et al. Rheumatology 2014;53:367-373

USG Report

Use of diagram

• Compact

• Use of semiquantitative assessment of GS / PWR / erosion

• Overview of the whole skeletal system

• Too many information in a single diagram

• Difficult to label the sites / scanning position where the abnormality detected

http://targetedultrasound.net/tools/

USG Report – The Content

Other indications

• Vasculitis

• Subcutaneous masses

• Sjogren’s

• Skin (in scleroderma)

Pitfalls and Problems

Problems

• Too brief

• Too long

• Too vague

• Loss of ‘focus’

• Not standardized

Errors

• Wrong label / patient identity

• Wrong side

• Missing important pathologies

ConclusionAcquisition and Documentation of MSKUS Images and Report of Findings

Conclusion

• MSK USG is an increasingly popular tools in assisting the diagnosis and monitoring of rheumatic diseases

• Acquisition and storage of good quality images is important for future review in patient management, training and quality assurance

• Report of the MSK USG findings is an important document to facilitate the communication between health care professionals

Reference

AIUM Practice Parameter for Documentation of an Ultrasound Examinationhttp://www.aium.org/resources/guidelines.aspx

The Italian MSUS Study Group Recommendations for the format and content of the report and documentation in musculoskeletal ultrasonography in rheumatologyIagnocco A, et al. Rheumatology 2014;53:367-373

Ultrasonography and PACSF Stacul. Eur J Radiol 1998;27:S196-S199

Joint ESR-EFSUMB recommendation on archiving and reporting ultrasound (US) examinationsEFUSMB Newsletter. Ultraschall in Med 2012;33