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Pan-American League of Associations for Rheumatology (PANLAR) Recommendations and Guidelines for Musculoskeletal Ultrasound Training in the Americas for Rheumatologists

Pineda, Carlos MD*; Reginato, Anthony M. PhD, MD; Flores, Víctor MD; Aliste, Marta MD§; Alva, Magaly MD; Aragón-Laínez, Raúl Antonio MD; González, Araceli Bernal MD*; Bouffard, José Antonio MD**; Caballero-Uribe, Carlo Vinicio MD††; Chávez-López, Mario MD‡‡; Chávez-Pérez, Nilmo Noel MD§§; Collado, Paz MD¶¶; Díaz-Coto, José Francisco MD∥∥; Duarte, Margarita MD***; Filippucci, Emilio MD†††; Galarza-Maldonado, Claudio MD‡‡‡; García-Kutzbach, Abraham MD§§§; Javier Godoy, Francisco MD¶¶¶; González-Sevillano, Edgardo MD∥∥∥; Da Silveira, Inês Guimarães MD****; Gutiérrez, Marwin MD***; Hernández-Díaz, Cristina MD*; Hernández, Jaime MD††††; Lamuño-Encorrada, Montserrat MD‡‡‡‡; Marcos, Juan Carlos MD§§§§; Marín-Arriaga, Norma MD¶¶¶¶; Mendonça, José Alexandre MD∥∥∥∥; Michaud, Johan MD*****; Moya, Carlos MD†††††; Muñoz-Louis, Roberto MD‡‡‡‡‡; Neubarth, Fernando MD§§§§§; Quintero, Maritza MD¶¶¶¶¶; Reyes, Benjamín MD∥∥∥∥∥; Ruta, Santiago MD§§§§; Rodríguez-Henríquez, Pedro J. MD******; Solano, Carla MD******; Ventura-Ríos, Lucio MD††††††; Möller, Ingrid MD‡‡‡‡‡‡; Naredo, Esperanza MD¶¶the Pan-American League of Associations for Rheumatology (PANLAR) Ultrasound Study Group

JCR: Journal of Clinical Rheumatology: April 2010 - Volume 16 - Issue 3 - p 113-118
doi: 10.1097/RHU.0b013e3181d60053
Original Article
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Objective: To develop guidelines for Musculoskeletal Ultrasound (MSKUS) training for rheumatologists in the Americas.

Methods: A total of 25 Rheumatologists from 19 countries of the American Continent participated in a consensus-based interactive process (Delphi method) using 2 consecutive electronic questionnaires. The first questionnaire included the following: the relevance of organizing courses to teach MSKUS to Rheumatologists, the determination of the most effective educational course models, the trainee levels, the educational objectives, the requirements for passing the course(s), the course venues, the number of course participants per instructor, and the percentage of time spent in hands-on sessions. The second questionnaire consisted of questions that did not achieve consensus (>65%) in the first questionnaire, topics, and pathologies to be covered at each course MSKUS level.

Results: General consensus was obtained for MSKUS courses to be divided into 3 educational levels: basic, intermediate, and advanced. These courses should be taught using a theoretical-didactic and hands-on model. In addition, the group established the minimum requirements for attending and passing each MSKUS course level, the ideal number of course participants per instructor (4 participants/instructor), and the specific topics and musculoskeletal pathologies to be covered. In the same manner, the group concluded that 60% to 70% of course time should be focused on hands-on sessions.

Conclusion: A multinational group of MSKUS sonographers using a consensus-based questionnaire (Delphi method) established the first recommendations and guidelines for MSKUS course training in the Americas. Pan-American League of Associations for Rheumatology urges that these guidelines and recommendations be adopted in the future by both national and regional institutions in the American continent involved in the training of Rheumatologists for the performance of MSKUS.

Twenty-five rheumatologists who perform ultrasound used the Delphi method to develop standards for training in this important technique.

From the *Instituto Nacional de Rehabilitación, Mexico City, Mexico; †Division of Rheumatology, Rhode Island Hospital at the Warren Alpert School of Medicine of Brown University, Providence, RI; ‡Department of Physical Medicine and Rehabilitation, UT Southwestern Medical School and Private Practice, Dallas-Fort Worth, TX; §Departamento de Medicina, Sección Reumatología, Hospital Clínico, Universidad de Chile, Santiago, Chile; ¶Servicio de Reumatología, Hospital Edgardo Rebagliati Martins, Lima, Peru; ∥Servicio de Reumatología, Instituto Salvadoreño del Seguro Social (ISSS), Facultad de Medicina, Universidad de El Salvador, San Salvador, El Salvador; **Service of Radiology, Henry Ford Hospital, Detroit, MI; ††Unidad de Reumatología, Hospital Universidad del Norte, Barranquilla, Colombia; ‡‡Departamento de Reumatología, Centenario Hospital Miguel Hidalgo, Aguascalientes, Mexico; §§Unidad de Reumatología, Hospital General de Enfermedades, Instituto Guatemalteco de Seguridad Social, Guatemala City, Guatemala; ¶¶Department of Rheumatology, Hospital Severo Ochoa, Madrid, Spain; ∥∥Servicio de Reumatología, Hospital México Caja Costarricense del Seguro Social, San José, Costa Rica; ***Unidad de Reumatología, Medicina Interna del Hospital de Clínicas, Asunción, Paraguay; †††Clínica Reumatológica, Università Politecnica delle Marche, Ospedale “A. Murri,” Ancona, Italy; ‡‡‡Unidad de Enfermedades Reumáticas y Autoinmunes, UNERA, Hospital Monte Sinai, Cuenca, Ecuador; §§§Asociación Guatemalteca Anti-enfermedades Reumáticas, Facultad de Medicina, Universidad Francisco Marroquín, Guatemala City, Guatemala; ¶¶¶Departamento de Medicina Interna, Servicio de Reumatología, Hospital Escuela, Tegucigalpa, Honduras; ∥∥∥Servicio de Reumatología, Complejo Hospitalario Metropolitano Dr. Arnulfo A. Madrid, Bella Vista, Panama; ****Departamiento de Medicina Interna, Facultade de Medicina, Pontificia Universidade do Rio Grande do Sul, Porto Alegre, Brazil; ††††Servicio de Reumatología, Hospital Cooperativa Médica Florida, Florida, Uruguay; ‡‡‡‡Departamento de Reumatología, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico; §§§§Servicio de Reumatología, Hospital General San Martín de La Plata, Buenos Aires, Argentina; ¶¶¶¶Servicio de Radiología e Imagen, Instituto Nacional de Rehabilitación, Mexico City, Mexico; ∥∥∥∥Servicio de Reumatología, Pontificia Universidade Católica de Campiñas, Campiñas, Brazil; *****Service of Physiatry, CHUM-Hospital Notre-Dame University of Montreal, Montreal, Canada; †††††Rheumatologist in Private Practice, Mexico City, Mexico; ‡‡‡‡‡Servicio de Reumatología, Clínica Abreu-Reumatología, Santo Domingo, Dominican Republic; §§§§§Rheumatologist at Secretary of Health and Environmental, State of Rio Grande do Sul, Porto Alegre, Brazil; ¶¶¶¶¶Laboratorio de Enfermedades Reumáticas, Instituto Autónomo Hospital Universidad de Los Andes, Mérida, Venezuela; ∥∥∥∥∥Servicio de Reumatología, Hospital Central de la Policía, Bogotá, Colombia; ******Universidad Nacional Autónoma de México Diploma Course, Musculoskeletal and Articular Ultrasonography, Instituto Nacional de Rehabilitación, Mexico City, Mexico; ††††††Servicio de Reumatología, Hospital Central Sur de Alta Especialidad, Petróleos Mexicanos, Mexico City, Mexico; and ‡‡‡‡‡‡Servicio de Reumatología, Instituto Poal de Reumatología, Barcelona, Spain.

Supported by Harold Amos Medical Faculty Development Program grant RWJ 053507 (to A.M.R.).

Authors Carlos Pineda and Anthony M. Reginato contributed equally to this work. Esperanza Naredo and Ingrid Möller contributed equally to the design of this work.

Dr. Pineda had access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis; Study design: Naredo, Filippucci, Möller, and Pineda; Analysis and interpretation of data: Pineda; Manuscript preparation: Reginato, Pineda, and Flores; Statistical analysis: Pineda.

Correspondence: Carlos Pineda, MD, Instituto Nacional de Rehabilitación, Calzada México-Xochimilco No. 289, Col. Arenal de Guadalupe, México DF 14389, México. E-mail: carpineda@yahoo.com.

© 2010 Lippincott Williams & Wilkins, Inc.