Photopic (tint) ultrasound in musculoskeletal radiology - a pilot visual-grading/acceptability study.

BACKGROUND: While grayscale ultrasound is the standard in musculoskeletal imaging, photopic imaging, where the entire image is colorized, may enhance visual perception by leveraging human color discrimination. Despite its theoretical benefits, its clinical value remains underexplored. OBJECTIVE: To assess the perceived interpretability/helpfulness, image quality, and visual appeal of photopic (tint) ultrasound imaging compared to conventional grayscale (B-mode) imaging in musculoskeletal radiology. METHODS: A retrospective analysis reviewed 20 musculoskeletal cases sequentially collected from two centers. B-mode images were recolored using various tints on Siemens Acuson S2000 and GE Logiq Fortis equipment. Two final-year residents specializing in musculoskeletal radiology independently rated image quality, visual appeal, and diagnostic value on a 5-point Likert scale. Inter-rater agreement was assessed using Cohen's Kappa. RESULTS: Tint images received consistently high scores, with a minimum rating of 4 across all categories. The images were rated a mean score of 4 for quality, visual appeal, and diagnostic value by both readers. Median and mode scores were 4 or 5 in all subcategories. High inter-rater reliability (Cohen's Kappa: 0.8) indicated strong agreement between reviewers. CONCLUSION: Photopic ultrasound imaging demonstrates high image quality, visual appeal, and perceived interpretability/helpfulness in musculoskeletal applications. The technique shows promise as a complementary tool to grayscale imaging, with potential benefits in teaching as well as clinical interpretation, particularly for trainees. Further research with larger cohorts and experienced radiologists is warranted.