OBJECTIVE : To assess the diagnostic yield and complication rate of image-guided percutaneous rib biopsy, comparing ultrasonography (US) to fluoroscopy and computed tomography (CT)-guided biopsy techniques. METHODS : A retrospective review was conducted of patients who underwent image-guided percutaneous rib biopsy at a single tertiary-care academic centre between January 2007 and June 2017. The diagnostic yield and complication rates were calculated and compared between the three imaging methods. RESULTS : A total of 70 consecutive, image-guided percutaneous rib biopsies were performed in 67 patients (48 in males, 22 in females, mean age of 68.2 years, age range 31-92 years). The image guidance method utilised for biopsy was US in 64.3% (45/70), CT in 18.6% (13/70), and fluoroscopy in 17.1% (12/70). The diagnostic yield for all cases combined was 97.1% (68/70) and 97.8% (44/45) for US-guided biopsies specifically. A complication of pneumothorax was encountered in 4.3% (3/70) of all cases combined and in 4.4% (2/45) of US-guided biopsies specifically. CONCLUSIONS : US-guided percutaneous rib biopsy has a high diagnostic yield and low complication rate, comparable to fluoroscopy or CT-guided biopsy.