Ultrasound-guided musculoskeletal interventions and professional boundaries: an international expert opinion

The growth of musculoskeletal ultrasound (US) has led to an increasing trend of US-guided interventions also/sometimes being performed by allied health professionals who lack formal comprehensive medical training. This international expert opinion - developed through structured consultation among 20 Physical and Rehabilitation Medicine (PRM) physicians from 14 countries across five continents - addresses the patient safety, ethical, and medicolegal concerns arising from non-physicians performing such interventions. A narrative literature synthesis was conducted and iteratively reviewed by all contributing authors whereas formal consensus methodology was not employed. Having reviewed the international regulatory landscape, including regulations from the United States, Europe (Germany, France, Italy, Spain, Scandinavian countries, and the United Kingdom), and the Asia-Pacific region; we highlight inconsistencies that may compromise patient welfare. We call upon PRM associations to develop unified position statements establishing minimum competency standards. Policy recommendations would include establishing international complication registries, implementing enforceable supervision protocols, strengthening informed consent requirements, and ensuring transparent provider identification. Through these measures, professional organizations, regulators, and healthcare institutions can promote patient safety, transparency, and consistent standards worldwide.