Current Use and Barriers to Point-of-Care Ultrasound in Rheumatology: A National Survey of VA Medical Centers.

INTRODUCTION: Point-of-care ultrasound (POCUS) can assist rheumatologists in monitoring disease activity, establishing diagnoses, and guiding procedural interventions. POCUS use has been increasing, but little is known about current use and barriers among rheumatologists. The purpose of this study was to characterize current POCUS use, training needs, and barriers to use among rheumatologists in practice. METHODS: A prospective observational study of all Veterans Affairs (VA) medical centers was conducted using a web-based survey sent to all chiefs of staff and rheumatology chiefs about current POCUS use, training needs, barriers, and policies. RESULTS: All chiefs of staff (n = 130) and rheumatology chiefs at VA medical centers (n = 95) were surveyed with 100% and 84% response rates, respectively. The most common diagnostic POCUS applications were evaluation of synovitis, joint effusion, tendinopathies, bursitis, and rotator cuff. The most common procedural applications were arthrocentesis and joint, bursa, and tendon injection. Most rheumatology chiefs (69%) expressed interest in training for their group. The most common barriers to POCUS use were lack of trained providers (68%), funding for training (54%), training opportunities (38%), funding for travel (38%), and ultrasound equipment (31%). Lack of POCUS infrastructure was common, and few facilities had POCUS policies (20%), image archiving (25%), or quality assurance processes (6%). CONCLUSION: Currently, half of rheumatology groups use diagnostic and procedural ultrasound applications. Most rheumatology groups desire training, and lack of training and equipment were the most common barriers to ultrasound use. Deliberate investment is needed in ultrasound training and infrastructure for systematic adoption of POCUS in rheumatology. Graphical Abstract available for this article. TRIAL REGISTRATION: NCT03296280.

Computed tomography coronary angiography versus stress myocardial perfusion imaging for risk stratification in patients with high occupational risk.

PURPOSE: To compare the performance of myocardial perfusion imaging (MPI) versus cardiac computed tomographic angiography (CCTA) in patients with a low pretest likelihood of obstructive coronary artery disease and high-risk occupation. MATERIALS AND METHODS: We performed a retrospective chart review of all MPI and CCTA studies performed at our institution from January 2006 to May 2008. The primary outcome measure was the incidence of referral to invasive coronary angiography (ICA). RESULTS: There were 512 MPS and 170 CCTA studies performed during the study period that met the study criteria. The average age was 35±10 for the CCTA arm and 45±5 for the myocardial perfusion scans (MPS) arm, which was statistically significant (P<0.001), with similar sex distribution between the 2 arms (21% female patients in the MPI arm and 20% female patients in the CCTA arm). The incidence of referral to ICA was 15.8% (81/512) after MPS versus 2.4% (4/170) with CCTA (P<0.001). Among patients referred for ICA, the false-positive rate was 93% (75/81) and 50% (2/4) with MPI and CCTA, respectively (P=0.043). CONCLUSIONS: Compared with MPI, CCTA significantly reduced ICA referral and false-positive noninvasive imaging rates among symptomatic patients with a low probability of coronary artery disease but high occupational risk.