Time constraints, costs and lack of training are preventing Australian rheumatologists from using musculoskeletal imaging, a survey suggests.

Researchers surveyed 36 rheumatologists following a musculoskeletal imaging special interest group workshop, with 97.2% reporting they used musculoskeletal ultrasound as part of clinical care and more than a quarter reporting using ultrasound for research and teaching.

When it came to frequency, just over half of rheumatologists surveyed used ultrasound weekly, 31% reported daily use and 11% reported monthly use, while one reported never using ultrasound. However, most respondents said they wanted to increase their ultrasound use.

The most frequent indication for musculoskeletal ultrasound use was for early diagnosis of rheumatic diseases, followed by monitoring response to treatment.

A further breakdown of results showed early diagnosis was reported by 94% of rheumatologists, patient education by 83% of rheumatologists, guiding injections by 75% of rheumatologists and managing remission by 69% of rheumatologists.

Two respondents also used musculoskeletal ultrasound for teaching registrars.

Rheumatologists most frequently identified time constraints in practice as a barrier to imaging use (97.2%), cost was reported by over half of respondents as a barrier (55.6%) and lack of training and experience in 22.2%.

As many as 77.8% of respondents had purchased an ultrasound machine for their clinical practice, while 25% had access to one through a hospital rheumatology department.

Findings published in WFUMB Ultrasound Open [link here] also showed half of practices were not accredited for a Medicare reimbursement for ultrasound.

The researchers also noted that 32 respondents had a Certificate in Clinician Performed Ultrasound credential and three had completed post-doctoral degrees in ultrasound research. However, only 80.6% felt appropriately trained and competent, a marked drop off from immediately after obtaining their qualification.

In regards to promoting increased musculoskeletal ultrasound use among Australian rheumatologists, the majority of respondents nominated more “hands-on” supervised training courses and more supervision of advanced trainees (72% for each).

A limitation was that only rheumatologists who had expressed interest in musculoskeletal ultrasound, most of whom had attended a educational course, were asked to complete the survey, which risked introducing sampling bias.

This likely overestimated interest in self-performed ultrasound, the authors said.