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What did you just say? "Sonography of bones?" Bones are well visualized by almost all other imaging methods. "Dem bones, dem bones, dem dry bones!" Why would you want to expend the time and effort to evaluate the skeletal system by sonography? Sonography and bones seem to go together about like oil and water. And furthermore, orthopedic surgeons don't seem disposed to appreciate findings displayed by sonography. Orthopods like basic imaging; keep it simple: "Show me dem bones!" Most orthopods aren't into subtleties. When it comes to imaging, they don't like to be required to use too much imagination.
OK, you have a point about the imaging proclivities of orthopods, but we can't lay all the blame at the feet of the orthopedic surgeons. Rheumatologists, general internists, and family practitioners, among others, also refer patients for imaging of the musculoskeletal system. Radiologists are generally enamored of high tech and prefer CT or MR imaging when given the choice. Our comfort level is much greater with CT or MR imaging than with sonography when faced with a problem in the musculoskeletal system. Furthermore, most specialists in sonography have scant knowledge of orthopedics and, as a result, limited experience in the evaluation of musculoskeletal diseases. Finally, most specialists in musculoskeletal imaging have limited skills and less experience in the performance of sonography.
Ideally, specialists in diagnostic radiology should be competent and equally facile and comfortable with all imaging techniques. Radiologists should not be restricted in their choice of imaging. They should have at their disposal all imaging techniques and be able to select the most cost-efficient and effective method to address the case at hand.
Fellowship training programs have improved in assuring that trainees achieve a level of competence in all imaging techniques that are applicable to their field of endeavor. The requirements for accreditation of radiology fellowship programs in various subspecialties by the Residency Review Committee (RRC) for radiology and the availability of CAQs (certificates of added qualifications) from the American Board of Radiology promote competence in this regard.
Sonographic equipment is readily available and sonographic examinations are generally cost-effective. True, bones are not the best medium for sonographic interrogation, but even at that you can determine if the surface of a bone is sound—that is to say, intact, not broken.
There is, of course, more to the musculoskeletal system than just bones. And the time is long gone when all we radiologists could see in our images was bones. Radiologists are now responsible for imaging all components of the musculoskeletal system: tendons, muscles, ligaments, and associated major nerves, arteries, and veins. And, fortunately, each of these structures has a distinctive sonographic appearance. Examine the potential for sonography in the evaluation of musculoskeletal disorders. You might be surprised by what you find.
In this issue John Lin and his colleagues from the University of Michigan Medical Center [1] present the first of a four-part series of pictorial essays devoted to musculoskeletal sonography. The series is an illustrated tutorial, a primer to get you started. The articles are to be published in four consecutive issues of the Journal, September through December 2000. These essays explore the full range of potential applications of this technology to the evaluation of musculoskeletal disorders. The first essay, in this issue, acquaints the reader with the basic principles of musculoskeletal sonography, describes sonographic characteristics of the principal musculoskeletal structures, and alerts the reader to commonly encountered artifacts. The two subsequent essays in October and November describe the sonographic features of various pathologic conditions centered on specific joints. The focus of the fourth and final essay in December will be on musculoskeletal tumors and sonographically guided interventions.
As an added bonus, these authors have also made the subject of these four pictorial essays available on the Internet at www.rad.med.umich.edu, which accesses a home page. There, under Clinical Divisions, click on Musculoskeletal and then click on Musculoskeletal Ultrasound Web Exhibit. To boot, the scientific exhibit of these authors, based on this Web site, was awarded a Silver Medal at this year's centennial meeting of the American Roentgen Ray Society in Washington, DC. The Web site is essentially an expanded, interactive version of the articles that we are publishing. Get online! Check it out!
Add sonography to your musculoskeletal diagnostic armamentarium. Sonography can assist in the solution of vexing musculoskeletal conundrums. It is quick and the results are immediate. No waiting around. The answer is right there on the screen in front of you. And besides, sonography is a hands-on examination requiring personal attention that is greatly appreciated by the patient. Be sure to take the opportunity to review your findings with the patient. Patients like that.
We are indebted to John Lin and his colleagues at the University of Michigan for all their efforts on our behalf. Go Blue!
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