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It is well recognised that one of the major limitations of musculoskeletal ultrasound (US) is its operator dependency.1 This issue is currently being addressed by the OMERACT and the EULAR Working Party in Imaging, who are working towards the production of guidelines for the acquisition and interpretation of US images particularly with respect to inflammatory arthritis.2
There are many variables that might influence an US image. These include factors pertaining to the machine (type of machine and transducer and control settings) and those that are not machine related (ambient temperature, transducer pressure3 and patient positioning). Doppler US appears particularly sensitive to all these factors as has recently been highlighted by Torp-Pedersen and Terslev4 and Teh.5 It has previously been reported that there are differences in Doppler signals within muscles4 5 and tendons4 …
Competing interests: None.
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