EULAR Points to Consider (PtC) for the use of imaging to guide interventional procedures in patients with rheumatic and musculoskeletal diseases (RMD)
| Overarching principles | LoE | LoA |
| A. The imaging technique should be optimised according to the procedure and the anatomical site taking into account potential side effects, radiation exposure, availability, expertise and costs. | n.a. | 10.0 (0.2) 100%>8 |
| B. Imaging guided interventional procedures should be conducted under adequate aseptic conditions (as detailed in box 1). | n.a. | 10.0 (0.2) 100%>8 |
| C. Complex imaging guided interventional procedures should be conducted with adequate assistance by technical personnel. | n.a. | 9.5 (1.7) 91.7%>8 |
| Specific Points to Consider | ||
| 1. Imaging should be preferred over palpation to guide targeted* interventional procedures at peripheral joints and periarticular structures in patients with RMDs. | 3† | 9.7 (0.5) 100%>8 |
| 2. Ultrasound should be used as the first imaging modality for interventional procedures at peripheral joints. Fluoroscopy may be used as an alternative. | 3† | 9.1 (2.1) 95.8%>8 |
| 3. Imaging should be preferred over palpation to guide targeted* injections at structures encompassing peripheral nerves. Ultrasound should be the preferred imaging modality. | 3† | 9.9 (0.3) 100%>8 |
| 4. Imaging should be used to guide targeted* injections at the spine. | 5 | 9.9 (0.3) 100%>8 |
| 5. Imaging should be preferred over palpation for targeted* injections of the sacroiliac joint(s). | 3† | 9.9 (0.3) 100%>8 |
| 6. Healthcare professionals performing imaging guided interventional procedures must have adequate skills in the respective imaging technique and the interventional procedure. | 5 | 8.9 (2.9) 87.5%>8 |
Numbers in column ‘LoA’ indicate the mean and SD (in parenthesis) of the LoA (range 0–10 with 0=‘completely disagree’ to 10=‘completely agree’), as well as the percentage of task force members with an agreement ≥8.
*Targeted interventions are defined as procedures requiring a high level of precision to reach a specific anatomical area such as injection of small ganglia, cysts or tenosynovitis, including aspiration of small amounts of fluid or synovial biopsy.
†Levels of evidence were downgraded (from level 2 to level 3) because of bias related to randomisation, outcome assessment (trials and non-randomised studies), the population of interest (cross-sectional studies) and inadequate adjustment of potential confounders.
EULAR, European Alliance of Associations for Rheumatology; LoA, level of agreement; LoE, level of evidence; n.a., not applicable; RMDs, rheumatic and musculoskeletal diseases.