Efficacy of a Concise Training Curriculum for the Joint and Activity Damage Exam (J.A.D.E) to Facilitate International Harmonization of Musculoskeletal Ultrasound in Hemophilia

Objective. Musculoskeletal Ultrasound (MSKUS) facilitates longitudinal follow-up of hemophilic arthropathy. The Joint and Activity Damage Exam (J.A.D.E) is a validated MSKUS protocol, enabling direct measurements of cartilage, soft tissue thickness, and osteochondral alterations over time. We previously demonstrated that non-radiologists could recognize articular landmarks and effusions after a 2-day CME-accredited course at the University of California San Diego (UCSD), which is currently the only accredited ultrasound course specific to hemophilia. Based on increasing international demand for J.A.D.E. proficiency, the curriculum was prepared for off-site teaching, and studied in South Africa for its efficiency.

Methods. In July 2023, the 2-day hands-on UCSD MSKUS training program (CME-accredited), employing 5 faculty trainers from UCSD, was conducted in Johannesburg for 12 South African Hemophilia providers from several Hemophilia Treatment Centers. Providers completed ~10-hour online training prior to the course. Participants underwent examinations of MSKUS knowledge, image-capturing techniques/quality, structure identification and J.A.D.E. measurement proficiency. Where applicable, results were compared to pre-course findings. One faculty member with arthritic joints served as live model for image acquisition, quality and real time J.A.D.E. measurements. A catalogue of scrambled normal and pathological structures was used for tissue identification. Image quality and J.A.D.E. measurement accuracy was determined in comparison to faculty acquired images and measurements. Descriptive statistics were used for analysis.

Results. After course completion, all participants reported significant improvement in MSKUS knowledge. Objective tissue identification proficiency within normal (95.9% [range 76.1 – 100]) and pathological (94.6% [range 88.7 – 98.9]) joints was high, and applicable to all tissues including bone, cartilage, soft tissue structures and effusions. Furthermore, participants acquired strong image acquisition techniques, demonstrated by (near) perfect image quality for the vast majority of J.A.D.E. views spanning many anatomical structures. The majority of J.A.D.E. measurements for soft tissue (synovium), cartilage and osteochondral alterations were within or very close to the range of faculty measurements.

After course completion, all participants reported significant improvement in MSKUS knowledge. Objective tissue identification proficiency within normal (95.9% [range 76.1 – 100]) and pathological (94.6% [range 88.7 – 98.9]) joints was high, and applicable to all tissues including bone, cartilage, soft tissue structures and effusions. Furthermore, participants acquired strong image acquisition techniques, demonstrated by (near) perfect image quality for the vast majority of J.A.D.E. views spanning many anatomical structures. The majority of J.A.D.E. measurements for soft tissue (synovium), cartilage and osteochondral alterations were within or very close to the range of faculty measurement.

Conclusion. The UCSD CME-accredited MSKUS training program providing a 2-day hands-on course preceded by an ~10-hour online curriculum is a concise and effective curriculum to provide proficiency in MSKUS image acquisition, interpretation, and accuracy of J.A.D.E measurements to novices. The findings highlight that J.A.D.E. measurements are easy to learn and that the curriculum is suitable for off-site teaching. This opens a uniform way to assess ultrasonographic joint tissue changes using J.A.D.E. in the long-term management of hemophilic arthropathy internationally.