Development of the Japan College of Rheumatology guidance on musculoskeletal ultrasound scanning protocol in rheumatology practice (revised edition)

Objectives To describe the methodological framework and consensus-based decision rules that underpin the revised guidance on musculoskeletal ultrasound scanning protocols in rheumatology practice. Methods A systematic literature search of musculoskeletal ultrasound imaging and assessment methods was conducted to extract candidate anatomical structures and the corresponding scanning techniques from the included articles. A Delphi survey of the Guidance Development Panel selected the sites for inclusion. Iterative consensus meetings defined standardised scanning procedures for each structure, including patient positioning, limb orientation, probe placement, scanning direction, and key anatomical landmarks to be captured on the ultrasound images. Results A total of 3 168 unique records were identified, of which 36 were included after screening. Based on the included articles and the first edition, a list of 159 candidate anatomical structures across the seven regions was compiled (including two structures added during the consensus process). Through the Delphi process, 50 structures were endorsed for inclusion in the guidance. An image atlas was produced presenting the standardised views used in routine practice and the scanning procedures for the recommended structures. Conclusions This revised guidance provides standardised musculoskeletal ultrasound scanning methods for rheumatic diseases based on a systematic literature search and structured consensus process.