Clinical Applications, Challenges, and Recommendations for Artificial Intelligence in Musculoskeletal and Soft Tissue Ultrasound: AJR Expert Panel Narrative Review

Artificial intelligence (AI) is increasingly used in clinical practice for musculoskeletal imaging tasks, such as disease diagnosis and image reconstruction. AI applications in musculoskeletal imaging have focused primarily on radiography, CT, and MRI. Although musculoskeletal ultrasound stands to benefit from AI in similar ways, such applications have been relatively underdeveloped. In comparison with other modalities, ultrasound has unique advantages and disadvantages that must be considered in AI algorithm development and clinical translation. Challenges in developing AI for musculoskeletal ultrasound involve both clinical aspects of image acquisition and practical limitations in image processing and annotation. Solutions from other radiology subspecialties (e.g., crowdsourced annotations coordinated by professional societies), along with use cases (most commonly rotator cuff tendon tears and palpable soft tissue masses), can be applied to musculoskeletal ultrasound to help develop AI. To facilitate creation of high-quality imaging datasets for AI model development, focus should be given to increasing uniformity in musculoskeletal ultrasound performance by technologists and radiologists, and to annotation of images for specific anatomic regions. This AJR Expert Panel Narrative Review summarizes available evidence regarding AI's potential utility in musculoskeletal ultrasound, and challenges facing its development. Recommendations for future AI advancement and clinical translation in musculoskeletal ultrasound are discussed.