The initial step, performed during a 2-day exercise, aimed at evaluating intraobserver and interobserver reliability for scoring static images and scoring images acquired in real-time while scanning patients.
Reading static images (day 1). Static images, representing a broad range of different degrees of synovitis in the metacarpophalangeal (MCP), wrist, proximal interphalangeal (PIP) and metatarsophalangeal joints (MTP) of patients with RA attending the Rheumatology Department of Ambroise Paré Hospital in Boulogne-Billancourt (France) were anonymised by the convenor (MADA). Images were obtained using the preliminary OMERACT definition for synovitis which includes both GS (SH and effusion) and PD findings. Images were acquired according to the EULAR recommendations16 (link) with a longitudinal scan obtained using either a dorsal or volar (plantar) view. Seventeen musculoskeletal sonographers (from Denmark, France, Germany, Hungary, Ireland, Italy, Netherlands, Spain, UK and USA) simultaneously but independently scored the images, which were presented randomly presented with 60 s for evaluating each image. No patient information was made available. Participants were asked to score GS and PD using both a binary (presence/absence) and SQ grading from 0 to 3 (normal, minimal, moderate, severe), according to their own daily practice, on a preprinted data collection sheet.
Acquiring and reading images (day 2). A practical exercise was then conducted the following day scanning and scoring synovitis. Eight patients with RA17 (link) were recruited from the same Rheumatology Department each having only mild to moderate hand deformities in order to eliminate possible acquisition difficulties due to severe structural deformities including ankylosis. The study was conducted in accordance with the Declaration of Helsinki and each participant gave written informed consent. The examinations were performed on the same day, in the same room, using eight identical machines (Technos MPX - Esaote Biomedica, Genoa, Italy) equipped with a 10–14 MHz broadband linear array transducer. The machines were calibrated with identical Doppler settings (frequency of 10.1 MHz, pulse repetition frequency of 750 Hz and Doppler gain of 50–53 dB). In this way, the impact of machines on the results was minimised. Fourteen rheumatologists who participated on the first day, in step 1, participated on the second day; all were blinded to the clinical details of the patients (ie, presence or not of active disease). Each patient was assigned to one machine and the sonographers then rotated from one machine to the next in a predefined sequence with 10 min allocated for scanning and recording the findings on a standard score sheet. In each patient, the second to fifth MCP and second to fifth PIP joints were scanned bilaterally using a GS and PD longitudinal scan in the midline of the joint on both the dorsal and volar aspects. Sixteen MCP joints were scanned twice in order to assess the intraobserver reliability.
Reading static images (day 1). Static images, representing a broad range of different degrees of synovitis in the metacarpophalangeal (MCP), wrist, proximal interphalangeal (PIP) and metatarsophalangeal joints (MTP) of patients with RA attending the Rheumatology Department of Ambroise Paré Hospital in Boulogne-Billancourt (France) were anonymised by the convenor (MADA). Images were obtained using the preliminary OMERACT definition for synovitis which includes both GS (SH and effusion) and PD findings. Images were acquired according to the EULAR recommendations16 (link) with a longitudinal scan obtained using either a dorsal or volar (plantar) view. Seventeen musculoskeletal sonographers (from Denmark, France, Germany, Hungary, Ireland, Italy, Netherlands, Spain, UK and USA) simultaneously but independently scored the images, which were presented randomly presented with 60 s for evaluating each image. No patient information was made available. Participants were asked to score GS and PD using both a binary (presence/absence) and SQ grading from 0 to 3 (normal, minimal, moderate, severe), according to their own daily practice, on a preprinted data collection sheet.
Acquiring and reading images (day 2). A practical exercise was then conducted the following day scanning and scoring synovitis. Eight patients with RA17 (link) were recruited from the same Rheumatology Department each having only mild to moderate hand deformities in order to eliminate possible acquisition difficulties due to severe structural deformities including ankylosis. The study was conducted in accordance with the Declaration of Helsinki and each participant gave written informed consent. The examinations were performed on the same day, in the same room, using eight identical machines (Technos MPX - Esaote Biomedica, Genoa, Italy) equipped with a 10–14 MHz broadband linear array transducer. The machines were calibrated with identical Doppler settings (frequency of 10.1 MHz, pulse repetition frequency of 750 Hz and Doppler gain of 50–53 dB). In this way, the impact of machines on the results was minimised. Fourteen rheumatologists who participated on the first day, in step 1, participated on the second day; all were blinded to the clinical details of the patients (ie, presence or not of active disease). Each patient was assigned to one machine and the sonographers then rotated from one machine to the next in a predefined sequence with 10 min allocated for scanning and recording the findings on a standard score sheet. In each patient, the second to fifth MCP and second to fifth PIP joints were scanned bilaterally using a GS and PD longitudinal scan in the midline of the joint on both the dorsal and volar aspects. Sixteen MCP joints were scanned twice in order to assess the intraobserver reliability.
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