How can the Indian Rheumatology Association (IRA) help standardize ultrasound training?

While the utility of ultrasound is undeniable, its practice in rheumatology needs to be better organized and standardized. If we fail to take ownership of it, other specialties will dominate the field. Just as Prof Dr. A.N Chandrashekaran from Chennai pioneered the DM Rheumatology program, leading to widespread recognition, the Indian Rheumatology Association (IRA) must act now.

A structured IRA-led ultrasound training program should be established, possibly in collaboration with EULAR. One approach could be,

1. Tying up with EULAR to create an IRA-EULAR course with a mix of Indian and international faculty.
2. Gradually developing a standalone IRA certification over time.
3. Incorporating ultrasound into DM and DNB rheumatology training, ensuring that it is formally examined.

Many institutions still lack ultrasound machines in their departments, often because the department head is unfamiliar with the technology. However, ultrasound should not be dismissed for this reason—it is simply a tool that can be learned, much like any other diagnostic skill.

If ultrasound is made a formal part of rheumatology training, with documented competencies and supervised assessments, it will be easier to justify its practice legally. Cardiologists perform echocardiography as part of their curriculum—why should rheumatologists be any different with musculoskeletal ultrasound?

Can rheumatologists formally report ultrasound findings?

Yes. Providing ultrasound as a service is no different from performing a joint injection or a lip biopsy. Reporting can be done formally or informally. While busy clinicians may simply note findings on an OPD slip, it is preferable to use standardized report formats for clarity and professionalism. Patients often expect a printed report, and a simple template can make a big difference.

One practical tip is to encourage patients to take pictures of their scans with their mobile phones. This saves time and provides them with immediate access to their imaging. Clinicians should also feel confident in their reporting. No one understands the clinical relevance of ultrasound findings in rheumatology better than a rheumatologist. While there may be hesitation in grading synovial hypertrophy or erosions, it is better to report what is confidently observed rather than avoid documentation altogether.

Should rheumatologists collaborate with radiologists or maintain independence?

While rheumatologists should gain expertise in ultrasound, it is equally important to maintain good relationships with radiologists. Instead of asserting superiority, it is beneficial to collaborate and involve them in institutional training programs. A confrontational approach, where rheumatologists claim expertise over radiologists, is counterproductive. Mutual respect ensures smoother working relationships and better patient outcomes.

At the same time, rheumatologists must take ownership of ultrasound training within their specialty. If we do not formalize this education, radiologists or other specialists will fill the gap. Structured training, curriculum integration, and collaborative efforts with established institutions like EULAR can ensure that ultrasound becomes a standard part of rheumatology practice.             

For rheumatologists what’s the best way to get started?

For rheumatologists looking to integrate ultrasound into their practice, the first step is simple: purchase a machine. Just as learning to drive requires owning a car, mastering ultrasound requires access to a machine. In government institutions, this process is easier, but in private practice, one must justify the investment.

To make a financial case for ultrasound, one can explain that each scan typically costs around ₹1,700 to ₹2,000. Over time, the machine pays for itself while significantly improving diagnostic accuracy. Additionally, incorporating ultrasound enhances a rheumatologist’s reputation and credibility.

Once a machine is available, learning begins. Rheumatologists should start by practicing independently and then enroll in structured training programs. Courses such as the EULAR Basic Ultrasound Course, APLAR training, or the IRA workshops at IRACON are valuable starting points. Gradually, proficiency develops—much like learning to drive.