title: How is shoulder ultrasound done in Italy? A survey of clinical practice.
abstract: OBJECTIVE
  To define when an ultrasound examination of the shoulder can be considered complete and how many examinations currently performed in Italy are actually complete according to that definition.
  
  
  METHODS
  Reports and images of previously performed ultrasound examinations of the shoulder of patients seen in 2014 for interventional procedures were reviewed for the following items, according to guidelines published by the European Society of Musculoskeletal Radiology: long biceps, subscapularis, supraspinatus, external rotators, acromioclavicular joint, subacromial bursa, subacromial space, coraco-acromial ligament, and the posterior recess. The first six items were considered mandatory in a complete shoulder ultrasound examination. The specialization of the performing physician was noted. The number of complete examinations performed by different physicians was compared with the number of incomplete examinations.
  
  
  RESULTS
  We analyzed 324 examinations (212 women, 112 men; mean age = 47 ± 12 years). The most frequently reported item was the supraspinatus tendon (83 %), the least frequently reported was the posterior recess (3 %). The image that was most frequently found was the long head of the biceps tendon (77 %), the least frequently found was the coraco-acromial ligament (3 %). The median number of images/examination was 6 (25th-75th percentiles, range 4-9). The mean number of unrecognizable images was 3 (2-4). A radiologist performed the examination in 269 patients (83 %). The rate of complete examinations was 47 %. The number of complete examinations performed by physicians from different specialties was not significantly different from that of incomplete examinations (P = 0.228).
  
  
  CONCLUSIONS
  Complete shoulder ultrasound examinations account for less than 50 % of those performed in clinical practice in some Italian regions. Standardized scanning protocols and structured reporting may help to improve this figure and consistency among providers performing these examinations.
authors.affiliation: Dipartimento di Medicina e di Scienze della Salute, Università degli Studi del Molise, Via De Sanctis 1, 86100, Campobasso, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Zappia
authors.affiliation: Servizio di Radiologia, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Aliprandi
authors.affiliation: Dipartimento di Radiologia, Azienda Ospedaliera Città della Salute e della Scienza, Centro Traumatologico Ortopedico, Via Zuretti 29, 10126, Turin, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Pozza
authors.affiliation: Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy.
authors.forename: Fabio Martino
authors.initials: FM
authors.lastname: Doniselli
authors.affiliation: Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gitto
authors.affiliation: Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20100, Milan, Italy. io@lucasconfienza.it.|Unità Operativa di Radiologia/Diagnostica per Immagini con Servizio di Radiologia Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20166, Milan, Italy. io@lucasconfienza.it.
authors.forename: Luca Maria
authors.initials: LM
authors.lastname: Sconfienza
mesh_terms: D000328:Adult; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D017006:Rotator Cuff; D012782:Shoulder / Q000000981:diagnostic imaging*; D012785:Shoulder Joint; D011795:Surveys and Questionnaires; D014463:Ultrasonography
keywords: Guidelines; Italy; Shoulder; Structured reporting; Ultrasound