1. Ultrasound APRIL 17, 2016 TORONTO, CANADA 1

2. Ultrasound Pre-courses Ed Oberle, MD/RhMSUS – Nationwide Children’s Hospital Tracy Ting, MD/RhMSUS – Cincinnati Children’s Hospital Patty Vega-Fernandez, MD/RhMSUS – Emory University Johannes Roth, MD – Children’s Hospital Eastern Ontario, Ottawa Beginner’s course, Wednesday evening – 12 participants Advanced course, Thursday morning – 16 participants Machines on loan from GE 2

3. Ultrasound – Beginners 4 hour session - Introduction to MSK US in pediatric rheumatology - How to start an ultrasound clinic - Introductory sonographic anatomy of wrist and fingers - Guided hands-on assessment of healthy volunteers PrePost 2.33.5US exam technique 23.3Describe normal anatomy 1.93.2US machine features and training opportunities 2.63.8Indications for MSK US Confidence scales (1 – none, 5 – very) 3

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5. Ultrasound - Advanced 5 4 hour session - Overview of US assessment of pathology and image optimization - Sonographic anatomy overview of knee and ankle - Guided hands-on assessment of active pathology PrePost 3.24.1US exam technique 2.93.9Describe normal anatomy, basic pathology 3.54.4Indications for MSK US Confidence scales (1 – none, 5 – very)

6. Comments on US course “Thank you for organizing this course; after all those hours with you guys, US started to make some sense ;)” “I wasn't sure if ultrasound would really be able to contribute anything to my patient care, or even if I would be able to perform it myself. After this course, I want to learn as much as I can about ultrasound and I can really see it impacting my future clinical care. “ “Really fabulous course. I would love to have additional similar courses in the future” "I just wanted to thank you for the wonderful course! I have learned a lot from you guys! Thanks for doing that!" “It was very helpful to have a pediatric focused course.” “Excellent!! Thank you. I would love to have this yearly (or maybe regional meetings).” “Great practice with different ages in children.” 6

7. Ultrasound – JIA Workgroup Purpose – For both research and clinical care, there remain several needs for defining MSUS in pediatric rheumatology including specific standardized images for each joint and standardized scoring system. 20 participants were present of varying skill level (8 completed or are enrolled in USSONAR, 7 actively using U/S in clinic, 3 ACR course, 2 fellowship training). Reviewed current literature on standardized view and scoring systems. Healthy discussion over current evidence and poor strength of scientific nature. 7

8. Ultrasound – Action items Prioritizing the following joints: knee, ankle, wrist Individual groups assigned to review literature on each joint to bring back to the ACR meeting for discussion on findings and proceeding forward with evaluation of standardized images Future practical exercises need to be performed to determine best views for inter-rater reliability and most sensitive views First will be in Cincinnati this summer Begin assessing items to be included for scoring (synovial recess: effusion, hypertrophy, cartilage, bony contour) Ongoing open communication with monthly teleconference meetings 8