Low Dose Radiotherapy for the Treatment of Inflammatory Periarticular Disorders: An American Radium Society (ARS) Appropriate Use Criteria (AUC).

Objectives: To summarize the current evidence for low-dose radiation therapy (LDRT) in the treatment of inflammatory periarticular disorders (PAD) (tendinitis, enthesitis, fasciitides, and bursitis), including patient selection, optimal RT technique, and associated risks.

Methods: A systematic literature review was designed using the Population, Intervention, Comparator, Outcome, Timing, and Study Design (PICOTS) framework and was assessed using the Cochrane and PRISMA methodologies. Eligible studies included prospective and retrospective studies published between January 1, 1996, and January 1, 2026. Clinical variant cases were developed as examples to illustrate practical applications of consensus recommendations. RAND-UCLA consensus methodology (modified Delphi) was used to rate the appropriateness of the treatment options.

Results: LDRT is considered an appropriate treatment as a second-line treatment of chronic plantar fasciitis refractory to other therapies. LDRT may be an appropriate second-line treatment for other types of chronic, refractory PAD not associated with tendon full-thickness tears. LDRT is not usually appropriate as first-line treatment for early-stage PAD or in cases with complete tendon tears.

Conclusions: The level of evidence to support the use of LDRT for the treatment of inflammatory PAD is limited. Based on the available evidence, LDRT may be considered for second-line treatment in appropriately selected patients.