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European co-ordinated action on improving justification of computed tomography
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European co-ordinated action on improving justification of computed tomography

Results and recommendations from a first-time multi-national study on CT justification in the EU

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Appropriate justification and optimisation of all medical imaging procedures involving patient ionising exposure are essential elements of good and safe clinical practice. Adherence to the principles of ALARA (as low as reasonably achievable) and, particularly in radiotherapy, ALARP (as low as reasonably practicable) are essential for good practice. Diagnostic radiological imaging is the most widespread form of medical application of ionising radiation with an excess of 500 million procedures carried out in the EU annually. The significant rise in the use of computed tomography (CT) over recent decades is a particular subject of concern due to its increased availability, over-utilisation and suboptimal justification and optimisation practices. It has led to a significant increase in the patient radiation doses in advanced economies and is now responsible for more than half of the medical radiation exposure of the EU citizens. The Basic Safety Standards Directive (BSSD) 2013/59/Euratom requires medical exposures to be ‘justified’, to ensure that their health benefit outweighs the individual detriment that the exposure might cause, taking into account the efficacy, benefits and risks of available alternative techniques. The Directive further requires individual radiological procedures to be justified in advance taking into account the specific objectives of the procedure and the patient’s characteristics and prescribes a justification process under the clinical responsibility of a practitioner and involving the referring physician. The Directive also requests Member States to introduce referral guidelines for medical imaging, which should be made available to the referrers. The European Commission carries out compliance checks of national legislation and supports Member States’ implementation of the legal requirements through scientific seminars, studies and guidance. Several studies have shown a significant rate of unjustified CT exams, in the range of 20- 40% overall and reaching more than 70% for some procedures. Effective strategies for significant improvement of the CT justification have also been demonstrated. Recognising the significance of the above issues, in December 2015 the European Council issued Conclusions on “Justification of medical imaging involving exposure to ionising radiation”. The Council Conclusions call upon Member States to undertake actions to improve the situation, including strengthening the application of clinical audits in relation to justification and the implementation of referral guidelines for medical imaging. The EU-JUST-CT Project on audit of justification of CT examinations is embedded in a broader European Commission initiative: Strategic Agenda for Medical Ionising Radiation Applications (SAMIRA) initiated by European Commission DG Energy, a key pillar of the Europe’s Beating Cancer Plan.
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