I believe in a kind of imaging more functionally oriented than descriptive. As a dedicated musculoskeletal radiologist I can use all of the modalities capable of making the best diagnosis, but I think that a dynamic ultrasound examination is crucial in some conditions. Try to think of a rubber band; if you take a picture of it in a static condition it might seem to be perfect, but what happens if you stretch it? The same thing happens with muscles, ligamentstendons and joints. I always believe that ultrasound imaging is also dynamic for the operator itself, he must be there, here and now, never stop thinking about it. It is a sort of “mindfullness exercise”. This might be the difference in searching “the sweet spot”
in diagnostic imaging, that means finding the right way to make the right diagnosis. The patient at the center of everything and all of the imaging modalities around. That is why I suggest to “pure sonographers” to have two good travelmates in this sort of journey: a good radiologist and a good clinician (orthopaedics, phyisiathrics, sport-medicine physician). During my teaching courses around the world, all students often ask me what is needed to start ultrasound practice. I always answer in the same way: anatomy, anatomy, and again anatomy, in all of its modalities; essential, surgical, ultrasound, mri, xray, ct anatom
y. I always also suggest to non-radiologists sonographers, to study a good Mri anatomy atlas; it contains the same scans of ultrasound imaging, but with better spatial definition. Firstly knowing the limits of ultrasound imaging, is another crucial point. I am not talking about the overestimated “operator dependence” problem of the ultrasound; does any kind of activity not potentially operator-influenced exist? Sun Tzu in “The Art of War” said:”“I
f you know the enemy and know yourself, you need not fear the result of a hundred battles. If you know yourself but not the enemy, for every victory gained you will also suffer a defeat. If you know neither the enemy nor yourself, you will succumb in every battle.” At the same time knowing the limits of ultrasound and all of the pathologies that we want to discriminate, can make the difference in making the correct diagnosis. Studying ultrasound imaging might be the perfect stimulus to begin a journey in the beautiful musculoskeletal diagnostic imaging world. But pay attention, because neither course nor congress or book may teach you what you need to make the perfect diagnosis, if you miss the defining ingredients: the desire of knowing, passion for learning and for your job. Ask to yourself why you are interested in ultrasound imaging. Using again a quote from a famous past film I want to remind you: ” Walk left side, safe. Walk right side, safe. Walk middle, sooner or later, get squashed just like a grape. Here, ultrasound, same thing. Either you learn ultrasound imaging, or do not learn ultrasound imaging, is safe. You learn ultrasound imaging “guess so”, get squashed just like a grape. Understand?
