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From da Vinci to definitive diagnosis: how training in sports ultrasound harnesses sound, science and skill
  1. Jon Patricios1,
  2. Michael Rossiter2,3,
  3. Corey Cunningham4,5,
  4. Jane Fitzpatrick5,6,
  5. Anja Hirschmueller7,8,
  6. Thamsanqa Mweli1,9,
  7. Beverly Roos1,
  8. Jane S Thornton10,11
  1. 1Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  2. 2Faculty of Sport & Exercise Medicine, Edinburgh, UK
  3. 3Hampshire Hospitals NHS Foundation Trust, Basingstoke, Hampshire, UK
  4. 4Medical, NSW Institute of Sport, Sydney, New South Wales, Australia
  5. 5Australasian College of Sport and Exercise Physicians, Melbourne, Victoria, Australia
  6. 6Centre for Health and Exercise Sports Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
  7. 7ALTIUS Swiss Sportmed Center AG, Rheinfelden, Switzerland
  8. 8Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Freiburg, Germany
  9. 9Dr Sulman and Partners, Netcare Rosebank Hospital, Johannesburg, South Africa
  10. 10Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
  11. 11Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
  1. Correspondence to Professor Jon Patricios, Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein 2000, South Africa; jpat{at}

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Viennese neurologist Dr Karl Dussik’s 1942 paper Über die Möglichkeit hochfrequente mechanische schwingingen als diagnosticsches hilfsmittel zu verwerten (On the possibility of using ultrasound waves as a diagnostic aid)1 could be considered the precursor of modern ultrasound curricula, building on scientific findings that began with Leonardo da Vinci, who first recorded experiments listening to sound transmitted through water by placing a tube into the sea to evaluate what he could hear as early as 1490.

The beginning of musculoskeletal ultrasound

Medical use of ultrasound was popularised in gynaecology and obstetrics from the 1950s. Other fields such as cardiology, surgery, urology and vascular medicine followed in channelling the diagnostic power of ultrasound technology.2 Musculoskeletal medicine and the application of ultrasound in sports settings had a relatively late start. In 1996, Gibbon published the first textbook on the topic, “Musculoskeletal Ultrasound: The Essentials” describing a “mini-atlas of the normal and abnormal sonographic appearances of the adult joints”.3

Global sports ultrasound—still worlds apart

The reach of musculoskeletal ultrasound into Sports and Exercise Medicine (SEM) practice and curricula is disparate, varying in several aspects including quality, regulation and accessibility. Such discrepancies may be further exaggerated by varying image resolution concomitant with equipment features and cost.

In the UK, ultrasound training is not a mandatory part of the SEM curriculum but is seen as an additional sub-speciality skill. It is usually achieved via an instructional course and then a written and practical assessment, leading to a Certificate of Competence. The …

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  • Twitter @jonpatricios, @sportsdocaus, @janesthornton

  • Contributors JP conceived the format of the paper with the assistance of JST. JP contacted international SEM organisations to propose coauthors to collaborate on the paper. MR (United Kingdom), CC (Australia), JF (Australia), AH (Switzerland), TM (South Africa), BR (South Africa) and JST each submitted curricula from their countries and organisations‘ sports US curricula. Each author contributed to the section pertaining to their region. All authors reviewed and edited 3 iterations of the manuscript. JP collated all information and redrafted each iteration before submitting the final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests JP and JST are Editors of BJSM; BR has received honoraria from various ultrasound manufacturers for presenting sports ultrasound courses.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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