Position Statement

Musculoskeletal ultrasound imaging standards in the UK: British Society of Skeletal Radiologists (BSSR) position statement

Interview with Drs Danoob Dalili and Ramy Mansour on BIR Podcast


There has been some concern expressed by UK regulator, the Professional Standards Authority regarding the risks

arising from Independent sonographer practices. The Professional Standards Authority presented evidence demonstrating that there are instances of harm occurring because of errors made by non-radiologists performing musculoskeletal ultrasound (MSKUS), particularly MSKUS-guided interventions. This document summarises British Society

of Skeletal Radiologists position for Musculoskeletal use of ultrasound in UK, representing the agreed consensus of experts from the British Society of Skeletal Radiologists Ultrasound committee. The purpose of this position statement
is to review the current practices affecting the delivery of MSKUS. Recommendations are given for education and training, audit and clinical governance, reporting, and medicolegal issues.

Key Recommendations

Delivery by Radiologists

  • Should adhere to the BSSR key principles (see full open access paper)
  • Maintain up to date knowledge of RCR, BSSR and NICE
  • Include MSKUS early on in radiology training, to engage
    and attract high calibre trainees, incentivising them to pursue
    a career in MSK as a radiology subspecialty.
  • Develop leadership competencies that enable MSKUS
    radiologists to create and manage safe patient pathways across
    complex scenarios (e.g. COVID-19 guidelines).

Delivery by non-Radiologists

  • Adhere to the BSSR key principles (see full open access paper) or establish their own within
    similar frameworks, jointly approved by the RCR.
  • Develop services and workforce.
  • There should be equal access to specialist MSKUS services for
    all UK citizens.
  • Multidisciplinary working models should be adapted where
    possible, to utilise skill mix and local expertise whilst ensuring
    a standardised and highly maintained level of services to all
    attending patients.
  • Improving registration: MSKUS national register for all
    procedures, both diagnostic and/or therapeutic. To record all
    clinical incident data, complications and who performs the
    studies to be used for appraisal and revalidation.
  • Provide evidence of good medical practices, including
    PROMs, clinical outcomes and impact on patient’s presenting
  • Provide evidence for value-based health-care provision, e.g.
    one-stop-shop, improved outcomes and patient pathways.
  • Indemnity should be agreed and standardised to all MSKUS
    providers taking into consideration the level of complexity and
    knowledge required to deliver services, with track records of
    each speciality. This should be eligible for annual review and full disclosure of any complaints, serious incidents or side-effects are documented as part of appraisal.

Supplementary material

14th October 2021

British Society of Skeletal Radiologists

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