Musculoskeletal Ultrasound

What it does

Musculoskeletal Ultrasound reads joint, tendon, nerve and soft-tissue studies, and the coronal hip images of infant hip screening. The run detects the body region from the images, so a shoulder study, a wrist, a set of finger joints, an infant hip or a soft-tissue swelling is each read with the questions that belong to it.

For the shoulder it grades the rotator cuff: partial- or full-thickness tears, tendinosis, bursitis and effusion. At the wrist it outlines the median nerve and measures its cross-sectional area at the tunnel inlet. In inflammatory arthritis it grades synovial hypertrophy and power Doppler per joint into the combined score. For the infant hip it places the Graf landmarks, measures the α and β angles and assigns a Graf type. For soft-tissue infections it separates abscess from cellulitis and sizes any drainable pocket.

Intended use

Decision support in five different settings: the MSK radiologist or sports physician reporting a shoulder, the hand surgeon or neurophysiologist assessing carpal tunnel syndrome, the rheumatologist scoring synovitis at follow-up, the paediatric orthopaedist reading hip screening, and the emergency physician deciding whether an abscess can be drained. Anisotropy and manoeuvres not captured in stills limit what any reader can see, and the result says which views it relied on.

Who it is for

MSK radiologists, rheumatologists, orthopaedic and sports-medicine physicians, paediatric orthopaedists, hand surgeons, neurophysiologists and emergency physicians. Developers add the run to rheumatology registries, hip-screening programmes and orthopaedic reporting.

Accepted input

• Stills and cine: DICOM Ultrasound Image and Multi-frame objects, grey-scale and power Doppler.
• Infant hips: standard coronal images of each hip.
• Soft-tissue clips: cine across the swelling, for cavity size and cobblestoning.

Requirements

Requirement	Why
Coronal hip image in the Graf standard plane	The α and β angles are valid only on the standard plane; other images are flagged
Transverse wrist image at the tunnel inlet	Median-nerve cross-sectional area is defined there
Grey-scale and power Doppler images of each joint	Synovial hypertrophy and Doppler signal are combined into the score
SequenceOfUltrasoundRegions calibration	Areas, thicknesses and cavity size in millimetres

Optional context

Age (in weeks for an infant hip), side, the joint or region examined and the clinical question go in clinical_context.

The result

One JSON result in sections; only the sections that match the detected region are filled, and each records the images it used. Findings carry the joint and side.

Section	Content
Rotator cuff	Supraspinatus and other cuff tendons: partial- or full-thickness tear, tendinosis, bursitis, joint effusion
Carpal tunnel	Median-nerve outline, cross-sectional area at the tunnel inlet and a carpal tunnel syndrome probability
Synovitis	Grey-scale synovial hypertrophy and power-Doppler grade 0–3 per joint, with the combined score
Infant hip (Graf)	Ilium, acetabular roof and labrum landmarks; α and β angles; Graf type and femoral head coverage
Soft-tissue abscess	Abscess or cellulitis (cobblestoning), cavity size and whether a drainable pocket is present
Draft report	Opt-in (options.report): an English narrative that interprets the result for the reader (findings, impression, limitations); every number is checked against the findings

Standards

• Synovitis: EULAR-OMERACT 2017 combined synovitis scoring, grades 0–3 per joint.
• Infant hip: Graf method for standard-plane criteria, angles and hip type.
• DICOM: SR Measurement Report TID 1500; SEG for the median nerve and hip landmarks; GSPS for angle lines and calipers on the source image; Encapsulated PDF.

Measurement notes

The Graf type follows from the α and β angles measured on the image shown, and the angle lines are drawn on it, so the classification can be checked on the image. An α angle of 60° or more is a mature hip (type I). From 50° to 59° the hip is type II, split by age at 12 weeks into IIa and IIb. Below 50° the hip is critical or decentred (types IIc, D, III and IV), and the β angle and the position of the femoral head and labrum separate these types.

Related models

• us/regional-anesthesia reads recorded nerve-block clips.
• us/vascular reads duplex studies of limb vessels.