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Radiology today
Evaluation of a multidisciplinary training programme in magnetic resonance imaging of patients with axial spondyloarthritis: PROGRESSES Project
Evaluación de un programa de formación multidisciplinar en resonancia magnética en espondiloartritis axial: Proyecto PROGRESSES
R. Almodóvara,
Corresponding author
ralmodovar@fhalcorcon.es

Corresponding author.
, P. Zarcoa, E. Lozab, Á. Buenoc
a Unidad de Reumatología, Hospital Universitario Fundación Alcorcón, Madrid, Spain
b Instituto de Salud Musculoesquelética, Madrid, Spain
c Unidad de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Madrid, Spain
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it is essential to join forces and gain a deeper knowledge of MRI in patients with axial SpA&#46; To this end&#44; the PROGRESSES project was started&#46; In this project&#44; radiologists and rheumatologists collaborated for three years through training workshops to increase knowledge among radiologists of this disease and knowledge among rheumatologists of MRI use&#46; They also sought to achieve good communication and relationships between these two specialisms for multidisciplinary management of SpA as currently recommended by the T2T guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methodology</span><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">PROGRESSES project &#40;training programme in MRI in axial SpA&#41;&#46;</span> This is a project sponsored by the <span class="elsevierStyleItalic">Grupo para el estudio de la Espondiloartritis&#44; de la Sociedad Espa&#241;ola de Reumatolog&#237;a</span> &#91;Group for the Study of Spondyloarthritis of the Spanish Association of Rheumatology&#93; &#40;GRESSER&#41; and by the <span class="elsevierStyleItalic">Sociedad Espa&#241;ola de Radiolog&#237;a Musculoesquel&#233;tica</span> &#91;Spanish Association of Musculoskeletal Radiology&#93; &#40;SERME&#41; in order to&#58; &#40;a&#41; improve knowledge of axial SpA and MRI use in cases thereof and &#40;b&#41; promote collaboration between rheumatologists and radiologists&#46; Part of this project consisted of theoretical and practical workshops&#44; held on an annual basis for the last three years &#40;26 the first year&#44; 24 the second and third years&#41; throughout Spain&#46; The workshops were given by a rheumatologist and a radiologist who were experts in SpA and MRI from the same hospital to a group of rheumatologists and radiologists who attended based on geographic proximity in different areas on a national level&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Survey&#46;</span> A survey was designed to evaluate effects and possible changes in clinical practice following two years of workshops&#46; This survey &#40;in paper format&#41; was filled in by all participants &#40;rheumatologists and radiologists&#41; during the workshops in the 3rd year of the project&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The survey included the following questions&#58; &#40;1&#41; In the last year&#44; has communication with your rheumatology&#47;radiology department seemed easier&#44; more agile and more efficient&#63; &#40;answer from 1 to 5 where 1 is not at all easy&#44; agile or efficient and 5 is very easy&#44; agile and efficient&#41;&#46; &#40;2&#41; Changes in levels of interest and up-to-dateness among radiologists in SpA &#40;Assessment of SpondyloArthritis International Society &#91;ASAS&#93; criteria&#44; recommendations&#44; etc&#46;&#41; and in levels of MRI training among rheumatologists &#40;sequences&#44; slices&#44; types of lesion&#44; differential diagnosis&#44; etc&#46;&#41; &#40;answer yes&#44; no&#44; doesn&#8217;t know&#47;no answer&#41;&#46; &#40;3&#41; Changes in the number of axial &#40;spinal and sacroiliac&#41; MRIs to study patients with SpA &#40;answer yes&#44; no&#44; doesn&#8217;t know&#47;no answer&#41;&#46; &#40;4&#41; Availability of a protocol on technical requirements for the MRI study of SpA &#40;answer yes&#44; no&#44; doesn&#8217;t know&#47;no answer&#41;&#46; &#40;5&#41; If the previous answer was yes&#44; whether the protocol pre-dated the PROGRESSES project &#40;answer yes&#44; no&#44; doesn&#8217;t know&#47;no answer&#41;&#46; &#40;6&#41; Availability of standardised reports that enable the rheumatologist to properly interpret a patient&#39;s MRI &#40;answer yes&#44; no&#44; doesn&#8217;t know&#47;no answer&#41;&#46; &#40;7&#41; Outsourcing of MRI to centres outside of the hospital &#40;answer yes&#44; no&#44; doesn&#8217;t know&#47;no answer&#41;&#46; &#40;8&#41; Whether the PROGRESSES project has had a positive impact on the management and evaluation of patients with SpA &#40;answer yes&#44; no&#44; doesn&#8217;t know&#47;no answer&#41;&#46; &#40;9&#41; Aspects of their clinical practice to which MRI contributes most in SpA &#40;differential diagnosis&#44; early diagnosis&#44; evaluation&#44; activity&#44; clinical prognosis&#44; prediction of treatment response&#44; treatment monitoring&#41;&#46; &#40;10&#41; Whether the PROGRESSES project has improved and promoted multidisciplinary rheumatology&#47;radiology work &#40;answer yes&#44; no&#44; doesn&#8217;t know&#47;no answer&#41;&#46; &#40;11&#41; Whether there are still any barriers to the rheumatologist&#47;radiologist relationship in cases of SpA &#40;answer yes&#44; no&#44; doesn&#8217;t know&#47;no answer&#41;&#46; &#40;12&#41; How much more they can work on training in MRI in SpA to continue improving &#40;answer from 1 to 10&#44; where 1 is not at all and 10 is the maximum&#41;&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0035" class="elsevierStylePara elsevierViewall">A descriptive analysis of the data was performed&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">Altogether&#44; 147 participants &#8212; 96 rheumatologists and 51 radiologists &#8212; filled in the survey&#46; The main results are described below &#40;see also <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Regarding changes in communication between departments in the last year&#44; more than 50&#37; of those surveyed believed that it had distinctly improved&#46; This was clear both among rheumatologists &#40;mean 4&#46;25&#41; and among radiologists &#40;mean 3&#46;82&#41;&#46; In addition&#44; a large percentage of rheumatologists &#40;70&#46;5&#37;&#41; believed that the radiologists at their hospital had become more interested and up-to-date on SpA&#44; and 72&#37; believed that they were more involved in the importance of early detection of SpA&#46; Similarly&#44; 81&#46;3&#37; of radiologists thought that the level of MRI training among rheumatologists had improved&#44; and a very similar percentage believed that rheumatologists had come to contribute more and better information in orders for MRIs to study a patient with SpA&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In addition&#44; more than 80&#37; of rheumatologists and radiologists answered that larger numbers of axial MRIs had been performed to study patients with SpA in the last two years&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Regarding the availability of a protocol on technical requirements for the MRI study of SpA&#44; percentages of affirmative answers were 65&#46;5&#37; among rheumatologists and 55&#46;2&#37; among radiologists&#44; respectively&#46; Interestingly&#44; among centres with such a protocol&#44; more than 50&#37; of rheumatologists and somewhat more than 70&#37; of radiologists reported that it was already in place at their centres prior to the project&#46; In the same vein&#44; only about 50&#37; of participants reported that there were standardised reports that enabled the rheumatologist to properly interpret a patient&#39;s MRI&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">We found that 55&#37; of centres outsource MRIs&#44; and that most participants &#40;more than 80&#37;&#41; believe that the PROGRESSES project has had a positive impact on the management and evaluation of patients with SpA&#46; Concerning aspects of clinical practice to which MRI may contribute most in this disease &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; for rheumatologists they would be differential diagnosis&#44; early diagnosis and treatment monitoring&#44; and for radiologists they would be early diagnosis&#44; prediction of treatment response and treatment monitoring&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Among 95&#37; of rheumatologists and among 62&#37; of radiologists is a belief that the PROGRESSES project has improved and promoted multidisciplinary rheumatology&#47;radiology work&#46; However&#44; when asked whether there were still any barriers in the rheumatologist&#47;radiologist relationship&#44; 62&#46;4&#37; of rheumatologists and 55&#37; of radiologists answered yes&#46; Furthermore&#44; when asked to offer their opinion on whether they can work more &#40;maximum score of 10&#41; on training in MRI in SpA to continue improving&#44; rheumatologists&#8217; answers averaged 7&#46;65 and radiologists&#8217; answers averaged 8&#46;53&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">In this study&#44; we analysed the results of a survey designed to evaluate changes following two years of multidisciplinary &#40;rheumatology&#47;radiology&#41; theoretical and practical training workshops in MRI in axial SpA throughout Spain&#46; We also identified possible areas for improvement&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">First&#44; it should be noted that&#44; following 50 workshops&#44; many participants perceived positive changes in communication and collaboration between departments&#44; as well as greater interest in SpA among radiologists and in the level of MRI training among rheumatologists&#46; A multidisciplinary approach is strongly recommended in national and international guidelines and consensuses<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">1&#44;10&#44;11</span></a> and has proven to be highly beneficial for all&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">12</span></a> Curiously&#44; a larger percentage of rheumatologists than radiologists believed that the PROGRESSES project had improved and promoted multidisciplinary work&#46; Since MRI is still a service that the radiologist provides for the rheumatologist&#44; the establishment of new pathways for communication may be more beneficial to the latter&#46; These changes have manifested on a practical level in the form of increased numbers of MRI studies in axial SpA as well as better patient evaluation and management&#46; The emAR II study&#44; conducted in 2010&#44; revealed that less than 20&#37; of patients with axial SpA had had an MRI in the last two years in Spain&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a> as opposed to other European cohorts where the percentage of patients who had had an MRI was significantly higher&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">However&#44; other areas in which more work is needed have been detected&#46; There is a need for greater implementation of protocols on technical requirements for the MRI study of SpA&#46; There is also a need for standardised MRI reports that enable the rheumatologist to interpret them properly&#46; Finally&#44; more than half of patients believed that there were still barriers to the relationship between specialists&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">One of the main limitations of this study is that it is an opinion survey&#46; However&#44; we believe that the high rate of participation of specialists &#40;rheumatologists and radiologists&#41; after several years of workshops means that these results may reflect positive changes in day-to-day clinical practice&#46; In any case&#44; more studies which demonstrate that these workshops lead to better health outcomes in patients with SpA are needed&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Funding</span><p id="par0090" class="elsevierStylePara elsevierViewall">The PROGRESSES project was funded by <span class="elsevierStyleGrantSponsor" id="gs1">AbbVie</span>&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicts of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyse the impact of a multidisciplinary training programme in magnetic resonance imaging &#40;MRI&#41; for axial spondyloarthritis in daily clinical practice&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">After two years of training workshops for radiologists and rheumatologists&#44; we designed a survey to assess changes in&#58; &#40;1&#41; communication and collaboration between departments&#59; &#40;2&#41; radiologists&#8217; interest and keeping up to date in axial spondyloarthritis and rheumatologists&#8217; training in MRI&#59; &#40;3&#41; number of MRI studies done&#59; &#40;4&#41; availability of protocols about technical requirements for studying axial spondyloarthritis by MRI and of standardised reporting templates&#59; &#40;5&#41; evaluation and management of axial spondyloarthritis&#59; &#40;6&#41; areas of improvement&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">After 50 workshops&#44; 96 rheumatologists and 51 radiologists completed the survey&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Among radiologists and rheumatologists&#44; multidisciplinary training in MRI for axial spondyloarthritis seems to have a positive influence on teamwork as well as on the management and evaluation of patients with axial spondyloarthritis&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analizar el impacto en la pr&#225;ctica diaria tras una formaci&#243;n multidisciplinar en resonancia magn&#233;tica &#40;RM&#41; en espondiloartritis &#40;EspA&#41; axial&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Tras 2 a&#241;os de talleres formativos para radi&#243;logos y reumat&#243;logos&#44; se dise&#241;&#243; una encuesta para evaluar los cambios en&#58; comunicaci&#243;n y colaboraci&#243;n entre servicios&#59; inter&#233;s y actualizaci&#243;n de radi&#243;logos en EspA axial y formaci&#243;n en RM entre los reumat&#243;logos&#59; n&#250;mero de RM realizadas&#59; disposici&#243;n de protocolos sobre requerimientos t&#233;cnicos para el estudio por RM en EspA axial e informes estandarizados&#59; evaluaci&#243;n y manejo de la EspA axial&#44; y &#225;reas de mejora&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Tras la realizaci&#243;n de 50 talleres&#44; contestaron la encuesta 96 reumat&#243;logos y 51 radi&#243;logos&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La formaci&#243;n multidisciplinar en RM en EspA axial entre radi&#243;logos y reumat&#243;logos parece influir positivamente en el trabajo conjunto&#44; manejo y evaluaci&#243;n de los pacientes con EspA axial&#46;</p></span>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Question&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DK&#47;NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Do you believe that the radiologist at your hospital is more interested and up-to-date on SpA now &#40;ASAS criteria&#44; utilities&#44; recommendations&#44; management&#44; etc&#46;&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Do you believe that the rheumatologist at your hospital is currently better trained in MRI techniques in SpA &#40;sequences&#44; slices&#44; types of lesion&#44; differential diagnosis&#44; etc&#46;&#41;&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">81&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Has the number of axial &#40;spinal and SI&#41; MRIs to study patients with SpA increased in the last two years&#63; Answered by rheumatologists&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">86&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Has the number of axial &#40;spinal and SI&#41; MRIs to study patients with SpA increased in the last two years&#63; Answered by radiologists&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">At your hospital&#44; is there any sort of protocol on technical requirements for MRI to properly study patients with SpA&#63; Answered by rheumatologists&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">At your hospital&#44; is there any sort of protocol on technical requirements for MRI to properly study patients with SpA&#63; Answered by radiologists&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">If yes&#44; did this protocol exist prior to participation in the PROGRESSES project&#63; Answered by rheumatologists&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">If yes&#44; did this protocol exist prior to participation in the PROGRESSES project&#63; Answered by radiologists&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Are there any standardised reports that enable the rheumatologist to properly interpret a patient&#39;s MRI&#63; Answered by rheumatologists&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Are there any standardised reports that enable the rheumatologist to properly interpret a patient&#39;s MRI&#63; Answered by radiologists&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">At your hospital&#44; is MRI testing outsourced to other centres&#63; Answered by rheumatologists&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">At your hospital&#44; is MRI testing outsourced to other centres&#63; Answered by radiologists&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">In your opinion&#44; has the PROGRESSES project had a positive impact on the management and evaluation of patients with SpA&#63; Answered by rheumatologists&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">86&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">In your opinion&#44; has the PROGRESSES project had a positive impact on the management and evaluation of patients with SpA&#63; Answered by radiologists&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Do you believe that the PROGRESSES project has improved and promoted multidisciplinary rheumatology&#47;radiology work&#63; Answered by rheumatologists&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;65&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;15&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Do you believe that the PROGRESSES project has improved and promoted multidisciplinary rheumatology&#47;radiology work&#63; Answered by radiologists&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Do you believe that there are still any BARRIERS to the rheumatologist&#47;radiologist relationship in SpA&#63; Answered by rheumatologists&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Do you believe that there are still any BARRIERS to the rheumatologist&#47;radiologist relationship in SpA&#63; Answered by radiologists&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                0 => array:2 [
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                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2010"
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              "referencia" => array:1 [
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                        0 => array:2 [
                          "etal" => false
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                  "host" => array:1 [
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "First signs and symptoms of spondyloarthritis &#8211; data from an inception cohort with a disease course of two years or less &#40;REGISPONSER-Early&#41;"
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                          "autores" => array:6 [
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              "referencia" => array:1 [
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                      "titulo" => "Work disability in patients with ankylosing spondylitis"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Ariza-Ariza"
                            1 => "B&#46; Hernandez-Cruz"
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                  ]
                  "host" => array:1 [
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              "identificador" => "bib0095"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Performance of the Assessment of Spondyloarthritis International Society criteria for the classification of spondyloarthritis in early spondyloarthritis clinics participating in the ESPERANZA programme"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Tomero"
                            1 => "J&#46; Mulero"
                            2 => "E&#46; de Miguel"
                            3 => "C&#46; Fernandez-Espartero"
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                            5 => "M&#46;A&#46; Descalzo"
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                    0 => array:1 [
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Rudwaleit"
                            1 => "D&#46; van der Heijde"
                            2 => "R&#46; Landewe"
                            3 => "N&#46; Akkoc"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.2010.133645"
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            6 => array:3 [
              "identificador" => "bib0105"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Assessment in Spondyloarthritis International Society &#40;ASAS&#41; classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general&#58; the spondyloarthritis concept in progress"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46; Zeidler"
                            1 => "B&#46; Amor"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/ard.2010.135889"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2011"
                        "volumen" => "70"
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            ]
            7 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Age at disease onset and diagnosis delay in HLA-B27 negative vs&#46; positive patients with ankylosing spondylitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46; Feldtkeller"
                            1 => "M&#46;A&#46; Khan"
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                  ]
                  "host" => array:1 [
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                      "doi" => "10.1007/s00296-002-0237-4"
                      "Revista" => array:6 [
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              ]
            ]
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              "identificador" => "bib0115"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic delay in axial spondyloarthritis&#58; a cross-sectional study of 432 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46; Masson Behar"
                            1 => "M&#46; Dougados"
                            2 => "A&#46; Etcheto"
                            3 => "S&#46; Kreis"
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                            5 => "C&#46; Hudry"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jbspin.2016.06.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Joint Bone Spine"
                        "fecha" => "2017"
                        "volumen" => "84"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27450199"
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                      ]
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            ]
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              "identificador" => "bib0120"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treating axial spondyloarthritis and peripheral spondyloarthritis&#44; especially psoriatic arthritis&#44; to target&#58; 2017 update of recommendations by an international task force"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;S&#46; Smolen"
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                            2 => "J&#46; Braun"
                            3 => "M&#46; Dougados"
                            4 => "O&#46; FitzGerald"
                            5 => "D&#46;D&#46; Gladman"
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/annrheumdis-2017-211734"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2018"
                        "volumen" => "77"
                        "paginaInicial" => "3"
                        "paginaFinal" => "17"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28684559"
                            "web" => "Medline"
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                      ]
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                  ]
                ]
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            ]
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              "identificador" => "bib0125"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adult inflammatory arthritides&#58; what the radiologist should know"
                      "autores" => array:1 [
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