A remote ultrasound imaging approach for monitoring rotator cuff calcific tendinopathy

Rotator cuff calcific tendinopathy is a common pathological condition characterized by calcium deposits within the rotator cuff tendons, leading to severe pain and restricted shoulder mobility. This pathology progresses through distinct stages, during which the hardness of the calcification gradually decreases. The gold-standard treatment is ultrasound-guided percutaneous irrigation; however, this procedure can only be performed once the calcification has softened sufficiently to allow calcium deposit removal via needling and saline solution lavage. For this reason, the timing between diagnosis and intervention is highly variable and unpredictable, necessitating a reliable method to assess calcification maturation and optimize treatment planning for improved clinical outcomes.Ultrasound imaging is highly operator-dependent, and its use as a monitoring tool in clinical practice is limited by the need for specialized expertise and restricted access to expert evaluations.In this work, we propose a proof-of-concept for two tele-ultrasound approaches that enable remote ultrasound acquisition: (a) a tele-guided procedure, in which a radiologist provides remote guidance during image acquisition, and (b) an offline remote monitoring, in which ultrasound images are acquired independently without real-time assistance. Both procedures were evaluated at two distinct time points.Four regions of interest were identified from the best frames selected by the radiologist, and quantitative metrics, potentially correlating with calcification maturation, were extracted (e.g., bone reflection index, contrast, roughness, skewness and kurtosis). An expert radiologist reviewed the results and deemed the ultrasound images acquired with both procedures clinically informative and suitable for guiding treatment decisions. Additionally, the quantitative metrics showed a strong correlation with clinical findings.Clinical Relevance- This proof of concept demonstrates the potential of two remote ultrasound monitoring approaches to support clinical decision-making in the management of rotator cuff calcific tendinopathy. In the long term, integrating automated processes could facilitate the extraction of quantitative metrics from patient-acquired images, providing an objective assessment of disease progression. This approach has the potential to revolutionize rotator cuff calcific tendinopathy monitoring by ensuring more timely interventions through a remote and quantitative framework.