Novel Uses
Novel uses of ultrasound are currently being explored, including the best way to make use of all data captured from this instrument. Myma Albayda, MD, director of the Musculoskeletal Ultrasound and Injection Clinic and assistant professor of medicine in the Division of Rheumatology at Johns Hopkins University School of Medicine, Baltimore, has been studying the use of ultrasound for muscle evaluation in myositis.
In collaborating with engineers at the Applied Physics Lab at Johns Hopkins, she has used machine learning and deep learning techniques for image analysis. In a study of 80 subjects with myositis, more than 3,000 ultrasound images of seven muscles (observed bilaterally) were acquired. The authors used traditional machine learning techniques, as well as an automated deep learning method that employed deep convolutional neural networks (DL-DCNNs), to consider three problems of classification, including normal vs. any form of myositis, normal vs. inclusion-body myositis (IBM), and IBM vs. other types of myositis. They found that DL-DCNN-based classification improved the accuracy of all classification problems, while providing a fully automated approach to classification.6
The authors surmise that data-driven approaches picked up by deep learning assessment the entire image are superior to manually selected features. Dr. Albayda notes, “As the first application of artificial intelligence techniques to muscle ultrasound, this is promising for enhancing accuracy, efficiency and decreasing subjectivity with ultrasound studies.”
The ACR Position
In this context, it is no wonder the ACR published a position statement in 2018 noting that musculoskeletal ultrasound is a useful tool for the diagnosis, management and treatment of rheumatic conditions and that the ACR encourages rheumatologists to pursue “suitable training and a certification process of their choice.”7
With additional research and education in the field, it seems clear that ultrasound is a useful tool for rheumatologists now and will remain so for many years to come.
Jason Liebowitz, MD, completed his fellowship in rheumatology at Johns Hopkins University, Baltimore, where he also earned his medical degree. He is currently in practice with Skylands Medical Group, N.J.
References
- Bahner DP, Goldman E, Way D, et al. The state of ultrasound education in U.S. medical schools: Results of a national survey. Acad Med. 2014 Dec;89(12):1681–1686.
- Torralba KD, Cannella AC, Kissin EY, et al. Musculoskeletal ultrasound instruction in adult rheumatology fellowship programs. Arthritis Care Res (Hoboken). 2020 Jun;72(6):859–870.
- LoPresti CM, Jensen TP, Dversdal RK, Astiz DJ. Point-of-care ultrasound for internal medicine residency training: A position statement from the Alliance of Academic Internal Medicine. Am J Med. 2019 Nov;132(11):1356–1360.
- Baldini C, Luciano N, Tarantini G, et al. Salivary gland ultrasonography: A highly specific tool for the early diagnosis of primary Sjögren’s syndrome. Arthritis Res Ther. 2015 May 28;17(1):146.
- Monti S, Floris A, Ponte C, et al. The use of ultrasound to assess giant cell arteritis: Review of the current evidence and practical guide for the rheumatologist. Rheumatology (Oxford). 2018 Feb 1;57(2):227–235.
- Burlina P, Billings S, Joshi N, Albayda J. Automated diagnosis of myositis from muscle ultrasound: Exploring the use of machine learning and deep learning methods. PLoS One. 2017 Aug 30;12(8):e0184059.
- American College of Rheumatology Committee on Rheumatologic Care. Position statement: Musculoskeletal ultrasound. 2014 Feb; updated 2018 Aug.
Learn More
The ACR recognizes the importance of demonstrating knowledge and competency for performing musculoskeletal ultrasound, and has created a rheumatology-specific training and certification program.