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Imaging SIG Infographic Contest

Imaging SIG Infographic Contest

Imaging SIG Infographic Development

The Imaging SIG is continuing to develop a series of infographics. The first two were recently published with a focus of advocacy for imaging referral in physical therapist practice. The next will focus on physical therapists using ultrasound imaging in practice. Please consider a creative contribution for visual appeal and impact. The creator of the infographic selected as or contributing the most to the final product will receive a $500 honorarium and recognition from the Imaging SIG. All AOPT members, including student members, are included in this invitation.

Target date for submission: October 10th.

Please click here to access the submission form. 

Files of infographics containing the content sought by the Imaging SIG and meeting the technical requirements may be submitted as described below.

Content:

  1. Include a suggested title
  2. Purpose: Advocacy informative to other medical providers, the public, and payers.
  3. Structure:
    1. Must use standard colors and fonts consistent with AOPT branding (please click here for this information).
    2.  Must submit single page draft in a mobile format (consistent with Twitter and Instagram posts) & print format (must be 8.5” x 11” or smaller).
    3. Must preserve an “unflattened” working version for future editing within Adobe Photoshop, Adobe Lightroom, Adobe Acrobat, Microsoft Publisher, or Microsoft PowerPoint.
    4. The lower two corners should be reserved for AOPT and Imaging SIG logos.
    5. Submissions must be original material, must not use copyrighted material, and must cite any sources used.
  4. Concepts: Include both the diagnostic and rehabilitative aspects of physical therapists using point-of-care ultrasound.

Target audience: Other providers, including physicians, the public, and payers. Assure language appropriate for public consumption.

Key Points with Benefit to the Patient:

  1. Immediate accessibility of ultrasound  
  2. Allowing immediate decisions for patient management/time savings
  3. Potentially reductions in cost of care vs. other forms of imaging

Capabilities of Ultrasound:

  1. Ultrasound allows the physical therapist to visualize the anatomic structures during function or during the clinical examination, better informing the clinical examination and enhancing the differential diagnostic process
  2. Ultrasound is an appropriate form of imaging rather than MRI or other advanced imaging modalities to guide care at a much lower cost.
  3. Ultrasound can measure the relative amounts of muscle activity to identify excessive or insufficient muscle recruitment to guide specific exercise prescription.
  4. Measurement of the mechanical properties of tissue with elastography.

Additional Supportive Concepts: The infographic will include a visual representation of the expedited process of a physical therapist using ultrasound imaging to augment the clinical examination to facilitate immediate decision-making toward appropriate care and potentially bridging to the rehabilitative application of ultrasound.

Ultrasound imaging is increasingly recognized within the American College of Radiology Appropriateness Criteria.

A recent national survey indicates wider use and growing importance of ultrasound in physical therapist practice

(Rogers & Caramagno, 2020). Rogers A, Caramagno J. Analysis of Practice for the Physical Therapy Profession: Report Memo 2020. Prepared for Federation of State Boards of Physical Therapy, 2020 No. 092.

Physiotherapists internationally use diagnostic ultrasound extensively to improve clinical care of patients. A recent survey of physiotherapists in 49 countries revealed 38% of those responding used ultrasound imaging for a variety of clinical uses (Ellis et al., 2020).

Ellis R, Helsby J, Naus J, Bassett S, Fernández-de-Las-Peñas C, Carnero SF, Hides J, O'Sullivan C, Teyhen D, Stokes M, Whittaker JL. Exploring the use of ultrasound imaging by physiotherapists: An international survey. Musculoskelet Sci Pract. 2020 Oct;49:102213. doi: 10.1016/j.msksp.2020.102213. Epub 2020 Jun 27. PMID: 32861368.

Potentially contributory evidence summaries include:

External Recognition
Physical therapists in the US are recognized as proficient providers of diagnostic ultrasound by two external organizations focused on the use of ultrasound to enhance patient care. The American Institute for Ultrasound in Medicine (AIUM), an education focused and multi-disciplinary association, consists of more than 9000 providers with the common goals of safe and effective use of ultrasound. Inteleos is the parent organization of the American Registry for Diagnostic Medical Sonography® (ARDMS®) and the Alliance for Physician Certification & Advancement™ (APCA™) and provides individual provider credentialing. Physical therapists are eligible for the Registered in Musculoskeletal Sonography (RMSK) credential the same as physicians. Inteleos is an international organization of over 158,000 members in 70 countries, advocating for expanding knowledge, proficiency, patient safety and equity in healthcare. Physical therapists performing ultrasound imaging to assist in patient management decisions has been supported by physician groups and multi-disciplinary organizations because of the positive impact on patient care, including the Medical and Scientific Advisory Council of the National Hemophilia Foundation (Bakeer et al., 2021; Gallastegui et al., 2021).

Bakeer, N., Dover, S., Babyn, P., Feldman, B.M., von Drygalski, A., Doria, A.S., Ignas, D.M., Abad, A., Bailey, C., Beggs, I., Chang, E.Y., Dunn, A., Funk, S., Gibikote, S., Goddard, N., Hilliard, P., Keshava, S.N., Kruse-Jarres, R., Li, Y., Lobet, S., Manco-Johnson, M., Martinoli, C., O’Donnell, J.S., Papakonstantinou, O., Pergantou, H., Poonnoose, P., Querol, F., Srivastava, A., Steiner, B., Strike, K., Timmer, M., Tyrrell, P.N., Vidarsson, L. and Blanchette, V.S. (2021), Musculoskeletal ultrasound in hemophilia: Results and recommendations from a global survey and consensus meeting. Res Pract Thromb Haemost, 5: e12531. https://doi.org/10.1002/rth2.12531

Gallastegui N, Barnes RFW, Hanacek C, Kruse-Jarres R, Steiner BUK, Quon DV, Bailey C, von Drygalski A. The Role of Point-of-Care Musculoskeletal Ultrasound for Routine Joint Evaluation and Management Considerations in Hemophilia Clinic [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 1). https://abstracts.isth.org/abstract/the-role-of-point-of-care-musculoskeletal-ultrasound-for-routine-joint-evaluation-and-management-considerations-in-hemophilia-clinic/.

In an exploratory study accompanied by a systematic review, physical therapists using ultrasound had substantial levels of agreement with radiologists in determining if patients with shoulder pain needed to be referred for additional medical consultation or undergo sustained care by the physical therapists. The ultrasound examination provided supplementary evidence to the clinical examination to allow more informed decision-making. Thus, physical therapists in their primary care role had enhanced decision-making when informed by ultrasound imaging results (Thoomes-de Graaf et al., 2019).

Thoomes-de Graaf M, Ottenheijm RPG, Verhagen AP, Duijn E, Karel YHJM, van den Borne MPJ, Beumer A, van Broekhoven J, Dinant GJ, Tetteroo E, Lucas C, Koes BW, Scholten-Peeters GGM. Agreement between physical therapists and radiologists of stratifying patients with shoulder pain into new treatment related categories using ultrasound; an exploratory study. Musculoskelet Sci Pract. 2019 Apr;40:1-9. doi: 10.1016/j.msksp.2019.01.005. Epub 2019 Jan 11. PMID: 30660988.

In a study of 103 patients with upper extremity disorders, 97% of patients perceived the use of ultrasound by physical therapists as assisting in their own understanding of their conditions. 89% of patients agreed or strongly agreed that knowledge of the ultrasound imaging results enhanced their beliefs in capability of self-management, rather than additional referral to other providers or diagnostic procedures (Lumsden et al., 2018).

Lumsden G, Lucas-Garner K, Sutherland S, Dodenhoff R. Physiotherapists utilizing diagnostic ultrasound in shoulder clinics. How useful do patients find immediate feedback from the scan as part of the management of their problem? Musculoskeletal Care. 2018 Mar;16(1):209-213. doi: 10.1002/msc.1213. Epub 2017 Sep 27. PMID: 28952187.

Whitaker et al. described physical therapist use of ultrasound in 4 domains: rehabilitative, diagnostic, interventional, and research. Historically, the authors describe physical therapist use of diagnostic ultrasound to identify tendon abnormalities, to screen for tendinopathy risk, and assess humeral torsion or acromiohumeral distance in persons with rotator cuff pathology, haemarthrosis within the joints of persons with haemophilia, nerve excursion in entrapment neuropathy or ligament integrity after injury to inform rehabilitation (Whitaker et al., 2019).

Whittaker JL, Ellis R, Hodges PW, OSullivan C, Hides J, Fernandez-Carnero S, Arias-Buria JL, Teyhen DS, Stokes MJ. Imaging with ultrasound in physical therapy: What is the PT's scope of practice? A competency-based educational model and training recommendations. Br J Sports Med. 2019 Dec;53(23):1447-1453. doi: 10.1136/bjsports-2018-100193. Epub 2019 Apr 25. PMID: 31023858; PMCID: PMC6900235.

In a study of 234 patients seeking care through the emergency department and receiving ultrasound imaging, 134 (57%) patients had procedures avoided because of the information provided by the ultrasound (Situ-LaCasse et al., 2018).

Situ-LaCasse E, Grieger RW, Crabbe S, Waterbrook AL, Friedman L, Adhikari S. Utility of point-of-care musculoskeletal ultrasound in the evaluation of emergency department musculoskeletal pathology. World J Emerg Med. 2018;9(4):262-266. doi: 10.5847/wjem.j.1920-8642.2018.04.004. PMID: 30181793; PMCID: PMC6117542.

The substitution of musculoskeletal ultrasound for MRI, when appropriate, would hypothetically lead to savings of more than $6.9 billion in the period from 2006 to 2020 (Parker et al., 2008).

Parker L, Nazarian LN, Carrino JA, Morrison WB, Grimaldi G, Frangos AJ, Levin DC, Rao VM. Musculoskeletal imaging: medicare use, costs, and potential for cost substitution. J Am Coll Radiol. 2008 Mar;5(3):182-8. doi: 10.1016/j.jacr.2007.07.016. PMID: 18312965.

In a study specifically evaluating cartilage injury in the elbow, ultrasound criteria in this study achieved superior accuracy compared with MRI criteria (96% vs. 73%; P < .05) in comparison to operative results (Yoshizuka et al., 2018).

Yoshizuka M, Sunagawa T, Nakashima Y, Shinomiya R, Masuda T, Makitsubo M, Adachi N. Comparison of sonography and MRI in the evaluation of stability of capitellar osteochondritis dissecans. J Clin Ultrasound. 2018 May;46(4):247-252. doi: 10.1002/jcu.22563. Epub 2017 Dec 6. PMID: 29210084; PMCID: PMC5947599.

Despite the existence of evidence-based diagnostic recommendations and the potential cost-savings of using musculoskeletal ultrasound instead of MRI in certain clinical situations, ensuring appropriate use of imaging among health professionals remains difficult for various reasons. In the context of healthcare budgets restraints, use of imaging must be shown scientifically, to improve patient outcomes and be cost-effective. Current evidence recommends musculoskeletal ultrasound as the primary imaging modality in the investigation of rotator cuff disease (Bureau & Ziegler, 2016).

Bureau NJ, Ziegler D. Economics of Musculoskeletal Ultrasound. Curr Radiol Rep. 2016;4:44. doi: 10.1007/s40134-016-0169-5. Epub 2016 Jun 20. PMID: 27398265; PMCID: PMC4914528.

“MSUS is not a substitute for history and physical examination; rather, it augments the provider's ability to deliver immediate state-of-the-art and quality patient care” (Cannella et al., 2013).

Cannella AC, Kissin EY, Torralba KD, Higgs JB, Kaeley GS. Evolution of musculoskeletal ultrasound in the United States: implementation and practice in rheumatology. Arthritis Care Res (Hoboken). 2014 Jan;66(1):7-13. doi: 10.1002/acr.22183. PMID: 24115730.

Additional peer-reviewed supportive evidence may be included to substantiate the key messages of the infographic. 

Please click here to access the submission form.