I normally use UTC for control achilles and patellar tendons. For the moment just to study (because I use it in professional players) but, what do you think about its reproducibility? And the inter and intraobserver differences?
Unfortunately I cannot help with this query, but it is an area I am interested in. Can you direct me to any currnent articles on UTC for musculoskeletal problems. What have you or they found? Many thanks
Billy
Buenos dias Carles,
I am not a user of UTC at a clinical level but I have seen its use and value as presented by those who do use it regularly. My interest lies in using it as part of my forthcoming PhD studies for quantification of structure prior to looking at some other variables that I am interested in, in order to relate to clinical presentations. H van Schie and others presented during the recent Oxford tendon conference and the issue of reliability was raised. As far as I can tell, as an observer at this stage, there are two major considerations, and some minor ones such as which settings to use etc. for optimal viewing. I would welcome information on any further issues that you have come across as a user.
The first is identifying the outline of the tendon in greyscale mode. The error seems small given that its easy to identify margins in greyscale. The volume of tendon or region of interest for evaluation is then calculated by the software. Given the desire to quantify structure, achieving the same volume reliably is important.
The second parameter for consideration would be the amount of tension placed on the tendon to take up the slack prior to measurement. This seems to have been standardised by placing the participants' toes and knee against a wall (Achilles). This method has been used in two recent studies that I am sure you are already familiar with (Rosengarten et al 2014 and Docking et al 2014).
According to van Schie study in 2010 in BJSM, ICC for intertester is 0.92-0.95 and evaluation of AP thickness was 0.84. Docking et al 2014 report Minimum Detectable Change for echotypes I/II/III/IV 2.5%, 2.7%, 0.3% and 0.8% respectively in their study.
I would be very interested in hearing your experiences as a user an if your reliability studies match these figures. Have you developed any novel way of standardising further? This would be great importance to me, especially as part of my studies relies on accurate quantification of structure. Also can you expand on how valuable you consider this tool as a way of monitoring tendon health and for rehab as an adjunct to more common assessment tools, such as exercise tests in the clinic....or is it just a nice toy!!
Saludos,
Arturo
In my opinion, nowadays, its main problem is the reproducibility...it is difficult to calibrate correctly de device.
Although this, I think it has a very big potential, but for the moment, I don't feel confortable using it to assess the tendon quality in professional players...
interesting. what aspect of calibration is difficult? there seemed a lot of talk about window size to get the best image. is that what you mean?
have you tried your own intratester reliability studies with it?
do you feel that these problems are due to not being familiar with the device, have you been using it for a long time? i know some users found it quite challenging at the start until they got to grips with it.
The most difficult thing is to define the distance between the probe and the silicone mold. In my opinion is the key of the optimal results.
Talking about the intratester reliability I tried...and the results are not good enough.
I've been using UTC for one year and I have more than 10 years of experience in musculoskeletal sonography.
To tell the truth you can have a good idea of the tendon with this kind of exploration (as I make now), but it needs something more to be as objective as it pretends to be.
thanks for your swift reply.
so what would you do to address the issue of the mould and probe? i thought that was a fixed position and the probe then just tracks up the tendon once transducer tilt angle, rotation, gain, focus and depth is standardised. how did you address those features?
do the manufacturers suggest a specific way or is it subjective between users? if the latter, it would difficult to compare findings in different studies.
It is subjective the way you address the position of the probe, so that makes it difficult to compare findings.
The manufacturers suggest some ways of positioning, but not a standard position for everyone. Although that, the results are quite interesting.
I have about 10 years of experience with MSK US. I suppose I would not tell you something that you already didn't know yourself - reproducibility and reliability of MSK US highly depend on experience, expertise, location of the pathological process and US unit characteristics. Providing the first and tha last conditions are fulfilled, location would be extremly important , regarding the amount of pressure applied. For instance, pressure on lumbar multifidus or tibialis anterior tendon is important, but not crucial, beacuese measurements would differ slightly. But it is of utmost importance in analyzing flexor and/or extersor digitorum manus tendons, amount of effusion, dimensions...And one more thing, I think silicone molds are waist of time.
I agree, but the UTC device goes with a silicone mold, you can't avoid it...