For the justification of imaging, with ESRiGuide a success has been achieved by developing and adopting appropriateness criteria and by implementing them as a computerized decision support tool. By following the Basic Safety Standards Directive (2013/59/Euratom, BSS) as well as the recommendations from the WHO about patient safety and adherence and from and IAEA, more elements are needed to standardize imaging referrals, thus supporting computer-assisted diagnosis (CAD) systems in the form of ESRiGuide. There is a need to develop recommendations for optimizing the referral process in a way that all requirements of the BSS Directive (2012/59/Euratom) are fulfilled and that the referral process is more standardized with, on the other hand, options for the personalization of the referral. The results of a recent ESR survey about the current status of uptake of the European BSS Directive showed a generalised lack of compliance with the BSS Directive and underscores the need for active communication.
Specific aspects of the justification as described in the BSS Directive are
· obtaining information on previous examinations which includes cumulative dose issues,
· providing information on the potential benefit versus risk of radiation, screening, and on information about the risk of ionizing radiation to patients and other individuals involved,
· non-medical exposures, new types of practices, practice not justified in general, exposure for medical or biomedical research,
· protection during pregnancy and breastfeeding as well as children,
· using the concept of effective dose according to the final statement of the IAEA technical meeting 2019,
· the importance of medical ethics, law, health economics and communication, further of CT, dental imaging and of problems with mobile and portable equipment according to the IAEA (2009).
The involvement of all stakeholders with appropriate role definitions is necessary and includes referring physicians and other healthcare professionals, radiologists and nuclear medicine specialists, radiographers, and patients.