Winter 2014 (Volume 24, Number 4)

CRUS: Focused on the Future

By Maggie Larché, MBChB, MRCP(UK), PhD;
Abraham Chaiton, MD, MSc, FRCPC;
Johannes Roth, MD; and
Christopher Lyddell, MBChB(UCT), DA(SA), FCP(SA)

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The Canadian Rheumatology Ultrasound Society (CRUS) was established as a not-for-profit organisation in 2010. Since inauguration, there have been three major foci: training, research, and practice implementation and billing.


Endorsed by the CRA, the annual national basic and intermediate courses have been established. Both include Canadian and internationally renowned tutors.

To date, 91 rheumatologists from across Canada have been trained with the basic course. The fifth year of the basic course begins in November 2014. This course consists of three weekends with didactic sessions, anatomy room demonstrations, and hands-on practice, interspersed by weeks of self-directed training and uploading of scanned images to a website for expert review and commentary.

The inaugural two-day intermediate/refresher course was held prior to the CRA Annual Scientific Meeting (ASM) in February of 2014; it counted
21 participants with four world-class international tutors.

The first of two three-day sessions of basic US training was held in
May 2014 in Riyadh, Saudi Arabia, for approximately 20 Saudi rheumatologists and allied health professionals.

Between 2012 and 2013 training was initiated in Toronto during the rheumatology fellowship, with 10 fellows taking part in six half-day sessions. This format is currently being reproduced at Ottawa and McMaster Universities. A joint US training for the rheumatology fellowship programmes in Ottawa and Kingston will take place in 2015. The University of Sherbrooke has been training rheumatology fellows in ultrasonography since 2008.

There has also been a WebEx curriculum with two-hour sessions discussing setting up a practice in US, using US as a treat-to-target tool, assessing vasculitis, and countering pitfalls and challenges.


The Prospective Observational Study to Evaluate the Use of MSK US to Improve Rheumatoid Arthritis Management: Canadian Experience (ECHO) includes 350 patients to evaluate musculoskeletal (MSK) US in improving rheumatoid arthritis (RA) outcomes. Other ongoing studies include an atlas of normal US findings in children, a foot imaging study to compare clinical and imaging findings in early RA, ultrasonographic measures of joint inflammation and serum biomarkers in patients with RA in clinical remission, and the international BIODAM study looking at biomarkers, including US, in RA.

The website is currently under construction. Members will be provided more content including an image library, important literature in the field of MSK US, access to professionally filmed lectures, and ask the expert/case review sessions. This will be on a restricted site accessible by password to the members of CRUS.

Practice Implementation

In collaboration with the Emergency Medicine specialty, a joint application to create a new Area of Focused Competence (AFC), Diploma in Point of Care Ultrasound (POCUS), has been submitted to the Committee on Specialties of the Royal College. The Royal College currently recognizes 13 AFC disciplines. If approved, university-based POCUS programs will confer the degree of DRCPSC to successful candidates who satisfy predefined training requirements, for each stream. This will be a postgraduate, national, competency-based degree program for rheumatologists unique to North America and Europe.

CRUS has a strong international presence, being part of the Outcome Measures in Rheumatology (OMERACT) groups and the Targeted Ultrasound Initiative (TUI). There are teachers and representatives in the Ultrasound School of North American Rheumatalogists (USSONAR), the American College of Rheumatology (ACR), the European League Against Rheumatism (EULAR), and the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM).

In future, we intend to: Continue the basic and intermediate CRUS courses; continue fellowship training and expand sites across the fellowship programs; develop the Royal College Diploma program; continue filming the lectures during the courses; launch the updated website; and continue lobbying for billing codes across the country to make POCUS a viable tool for every rheumatologist.

Maggie Larché, MBChB, MRCP(UK), PhD;
Abraham Chaiton, MD, MSc, FRCPC;
Johannes Roth, MD;
Christopher Lyddell, MBChB(UCT), DA(SA), FCP(SA)

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