Thursday, December 2 | 10:40 a.m.-10:50 a.m. | SSQ12-02 | Room E451A
One of the great things about ultrasound is that its portability and simplicity make it easy to use compared to other imaging modalities. But that might not be so great from a healthcare utilization perspective, according to researchers from Thomas Jefferson University in Philadelphia, who found that nonradiologists are utilizing ultrasound at a dramatically higher rate than radiologists.The use of musculoskeletal ultrasound has risen rapidly among nonradiologist physicians such as podiatrists, rheumatologists, primary care physicians, and physical medicine and rehabilitation specialists, according to presenter Richard Sharpe, MD. In fact, utilization has risen so rapidly that insurers in four states -- Illinois, New Mexico, Oklahoma, and Texas -- for a time denied all claims for nonoperative spinal and musculoskeletal ultrasound, a policy that was rescinded in February 2010.
Thomas Jefferson researchers wanted to document the magnitude of growth in musculoskeletal ultrasound utilization; the group examined source data from the Physician/Supplier Procedure Summary Master Files from the U.S. Centers for Medicare and Medicaid Services from 2000 to 2008.
Overall, they found that in 2000, Medicare reimbursed for 56,000 musculoskeletal ultrasound studies, a number that rose 279% to 213,000 studies in 2008. The increase corresponds to a utilization rate of 171 procedures per 100,000 beneficiaries in 2000, a rate that grew to 610 procedures per 100,000 beneficiaries by 2008.
The volume of musculoskeletal ultrasound procedures performed grew at twice the rate among nonradiologists compared to radiologists during the study period, and nonradiologists are the most frequent users of musculoskeletal ultrasound in the office setting. Nonradiologists accounted for 71% of increased ultrasound musculoskeletal utilization from 2000 to 2008.
Insurers will most likely encourage the imaging community to adopt standards for performing musculoskeletal ultrasound, but such standards currently don't exist, according to Sharpe. The implementation of such standards would most likely benefit patients.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
