Background Acupuncture has been practiced for thousands of years as a modality of Traditional Chinese Medicine. A greater emphasis on Complementary and Alternative Medicine (CAM) has led to enhanced adoption of acupuncture in Western medicine. While traditional acupuncture relies on surface landmarks and empirical knowledge, modern imaging techniques offer the opportunity to more precisely understand the proximity of critical neurovascular structures to needled sites. Peripheral nerves are particularly vulnerable to inadvertent injury at acupoints underlying nerves are superficial to dense osseo-ligamentous structures. Despite these risks, there is limited data quantifying the spatial relationships between acupuncture needles and adjacent nerves. Ultrasound imaging provides a non-invasive, real-time method for visualizing both acupuncture needle placement and underlying anatomical structures. Accordingly, this study aims to map the relative distance between inserted acupuncture needles and nearby peripheral nerves at selected acupoints, providing an evidence-based framework for safer clinical practice. Methods Ultrasonography was utilized in a physician-led acupuncture clinic to assess the distance of the acupuncture needle to nerves (NTN) at two specific acupoints (ACPs): Pericardium 6 (PC 6) and Kidney 3 (KI 3). These two points were selected because of their high clinical significance, relationship to underlying nervous structures, and ease of visualization via ultrasound. With informed consent from patients attending their scheduled acupuncture appointments, a physician, trained and board certified in medical acupuncture, located the selected ACP. Ultrasonography was performed to identify the underlying nerves. The site was then cleaned, and an acupuncture needle was inserted to achieve de qi by the physician. Ultrasonography was performed at the site again to identify the location of the needle. The NTN distance is measured and recorded. Results The data collection and analysis are currently ongoing, and no results are yet available. Conclusion This study demonstrates the value of ultrasound in visualizing anatomical structures relevant to acupuncture practice. By mapping the spatial relationships between acupuncture needles and underlying peripheral nerves, this work contributes to a growing body of evidence aimed at improving the safety and anatomical precision of acupuncture treatments. Although data collection and analysis are ongoing, preliminary findings are expected to inform clinical decision-making and guide safer needling practices, particularly in regions where nerves lie superficially. Limitations include the variability in individual anatomical presentations and the technical challenges of standardizing needle insertion depth and angle. Future work will benefit from larger sample sizes and functional outcome data to further refine anatomical risk mapping in acupuncture.