Manual of Musculoskeletal Ultrasound: A Self-Study, Protocol-Based Approach,

This book is aimed at those new to ultrasound, but also those with general ultrasound experience who are extending their scope into the musculoskeletal field, and those with current MSK experience. This is a wide remit, and one that the authors certainly achieve.

The book is described as a self-study text that aims to address the well-known ‘long learning curve’ experienced by many learning the topic, by introducing a protocol-based rather than a problem-based approach, focusing on standardised image acquisition of normal appearances, thus allowing for the recognition of abnormal appearances.

To UK radiographers/sonographers, this is not a new method of learning; sonographers are more used to learning what ‘normal’ looks like and working with protocols to ensure that they are imaging and recording a defined set of images. However, there are few texts that explain and set out these protocols in such detail and so well.

The 25 chapters cover core ultrasound physics and instrumentation in a very interesting and readable way, comprehensive scanning of specific joints, most split into their anatomical ‘aspects’, and specific chapters on crystalline disease and enthesopathy. 

Each anatomical area gives as a minimum: anatomy, clinical comments (which includes descriptions of common pathologies), pitfalls, method (which includes protocol images with probe position) and references. I presume that the addition of chapters on crystal arthropathy and enthesopathy comes from the professional background of the authors as there are specific protocols that are used internationally to identify these specific arthritides and these chapters cover those protocols very nicely. 

The clinical comments section of each chapter gives some clinical background and indications for the use of ultrasound, which are really useful for those working in imaging.

The anatomy is simply described, using really straightforward diagrams, many with mnemonics to help the learner absorb and remember the more complex areas. 

A wide range of potential pathologies are described and comprehensively referenced with some indication of the likely ultrasound appearances. The excellent sections on pitfalls include issues with technique, artefacts and normal variants and are a welcome necessity.

Each protocol at the end of the chapter covers the focused area being scanned and uses normal, well annotated ultrasound images with corresponding probe position. These are excellent and will really help those who have a more visual learning style.

Popular chapters such as the shoulder are particularly well covered. Anatomical diagrams are accurate and cover the relationships between structures, giving the learner a more holistic view of the whole joint and surrounding soft tissues.

The diagrammatic interpretation of tendon tears covers an area that can be difficult to appreciate, and it is done very simply but comprehensively.

The book does not include ultrasound images of most of the pathologies described, or recommendations on reporting. The authors clearly state that this text should be read alongside other educational resources covering these areas and I agree that learning would not be complete without these components.  

In summary, I found this an extremely engaging and informative book and was surprised how the language and use of cartoons and mnemonics added to my enjoyment. Even for relatively experienced MSK ultrasound practitioners, there is always more to learn and the inclusion of those more difficult and less commonly scanned areas was really useful.

Although this book would not replace the role of a clinical mentor, when used in a training environment it could go some way to accelerate the learning process, enabling the learner to use normal volunteers in the first instance, only moving on to those with pathology once the basics have been learnt.

As the authors confirm, this manual must be used alongside those texts showing representative images of specific pathologies in order for the operator to correctly recognise and interpret abnormal ultrasound findings.