To the Editor,
We thank Barad et al. for their publication titled “To determine the role of ultrasonography as a primary imaging modality as compared to MRI in patients with shoulder pain.”[1] We admire their efforts as the use of musculoskeletal ultrasonography (USG) in patient care is relatively new, and for their noteworthy attempt to determine the relationship between USG and magnetic resonance imaging (MRI) findings. The authors describe how USG can be used as a primary screening method for rotator cuff disorders and other conditions that cause shoulder pain with the added benefit of cost-effectiveness. We would like to make a few observations.
This study compared USG to MRI of the shoulder and was conducted at the department of radiology. The study mentions the inclusion criteria as “Adult patients of age 18 years or above presenting with shoulder pain and undergoing USG and MRI in our institute,” however it is unclear whether all patients with shoulder pain were referred to the department of radiodiagnosis. “The findings on USG and MRI of 50 patients who presented with clinical signs and symptoms of rotator cuff injuries were compared,” says one sentence in the discussion section. A little more clarity with respect to the inclusion criteria would make this article even better. This is significant because the sample population may not fully reflect the clinical spectrum of shoulder ailments seen by the hospital’s doctors. Clinically, less severe cases of shoulder discomfort are unlikely to have been referred for the study because all these patients were supposed to be assessed by MRI in addition to USG.
Although the authors’ work is commendable, it is crucial to note that musculoskeletal USG is also performed by specialists in fields other than radiology.[2]
The authors conclude that USG is widely available. This needs to be seen in the light of the perceived putative issues surrounding the well-intended legislation, the PCPNDT Act.[3] Treating specialists are sometimes hesitant to maintain a USG machine.
Perhaps the way of achieving low-cost and affordable services is to strengthen USG services by developing a pool of treating specialists who are well-versed in the use of USG.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
- 1.Barad HV, Patel V, Patel S, Patel M. To determine the role of ultrasonography as a primary imaging modality as compared to MRI in patients with shoulder pain. J Family Med Prim Care. 2022;11:2119–22. doi: 10.4103/jfmpc.jfmpc_2509_20. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Bureau NJ, Ziegler D. Economics of musculoskeletal ultrasound. CurrRadiol Rep. 2016;4:44. doi: 10.1007/s40134-016-0169-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Tabaie S. Stopping female feticide in India:The failure and unintended consequence of ultrasound restriction. J Glob Health. 2017;7:010304. doi: 10.7189/jogh.07.010304. [DOI] [PMC free article] [PubMed] [Google Scholar]