Abstract
Objectives
Justification of medical exposures from medical imaging is fundamental to radiation protection. Referral guidelines are intended to help physicians decide when an imaging study is justified. For two decades, referral guidelines have been a legally binding requirement for European Union member states. Recently, the European Society of Radiology (ESR) developed iGuide tool, which provides evidence-based referral guidance for imaging inclusive of children. The aim of this survey was to assess the availability, use and familiarity of referral guidelines for medical imaging in children and knowledge about the availability of ESR iGuide among ESR member radiologists.
Methods
Over a 2-month period (15 September–15 November 2019), 33,257 ESR member radiologists were invited to respond to an anonymised web-based questionnaire, which consisted of 12 multiple-choice questions.
Results
In total, 2067/33,257 responses (6.3%) were received from 52 countries. A total of 1068 out of 2067 (51.7%) respondents were aware that imaging referral guidelines are a legal requirement. One thousand five (48.6%) of all respondents did not know whether dedicated guidelines for imaging in children were available, and only 653 (31.2%) were aware of the mainstays of the available guidelines. Similarly, just 746 (36.1%) of all respondents were aware of ESR iGuide availability and features.
Conclusions
The information gathered confirms that effective and widespread adoption of imaging referral guidelines is lacking, especially in children. Further work is required to improve uptake and awareness.
Key Points
• Justification of medical exposures is fundamental to radiation protection and evidence-based referral guidelines are crucial for practical implementation of this principle.
• About half of survey respondents are aware that the availability of imaging referral guidelines is a legal requirement, despite this being mandated since 1997.
• The information gathered from this survey confirms that, especially in children, an effective and widespread adoption of imaging referral guidelines is lacking.
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Abbreviations
- EEA:
-
European Economic Area
- ESR:
-
European Society of Radiology
- EU:
-
European Union
- IAEA:
-
International Atomic Energy Agency
- PiDRL:
-
European Diagnostic Reference Levels for Paediatric Imaging
References
International Commission on Radiological Protection. The 2007 Recommendations of the International Commission on Radiological Protection; 2007, p. 14. ICRP Publication 105. Ann. ICRP 37 (6). Available via http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:31997L0043:EN:HTML Accessed 4 Apr 2020
European Commission Radiation Protection N° 178 (2014). Referral guidelines for medical imaging availability and use in the European Union. https://ec.europa.eu/energy/sites/ener/files/documents/178.pdf Accessed 4 Apr 2020
Hunink MGM, Becker CD, Bellin MF et al (2019) Methodology for ESR iGuide content. Insights Imaging 10:32–36
ESR iGuide portal https://www.myesr.org/esriguide. Accessed 4 Apr 2020
Malone J, Guleria R, Craven C et al (2012) Justification of diagnostic medical exposures: some practical issues. Report of an International Atomic Energy Agency consultation. Br J Radiol 85:523–538
Remedios D, Hierath M, Ashford N et al (2014) Imaging referral guidelines in Europe: now and in the future – EC referral guidelines workshop proceedings. Insights Imaging 5(1):9–13
ESR EuroSafe Imaging available via http://www.eurosafeimaging.org/ Accessed 24 Oct 2020
ACR Appropriateness Criteria (2017) Rating Round Information. Available via https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RatingRoundInfo.pdf. Accessed 4 Apr 2020
Radiation Protection 185: European Guidelines on Diagnostic Reference Levels for Paediatric Imaging (2018). Available via https://ec.europa.eu/energy/sites/ener/files/rp_185.pdf. Accessed 4 Apr 2020
Acknowledgements
This paper has been approved by the ESR Executive Council in May 2020. The ESR Patient Advisory Group (ESR-PAG) contributed with the lay summary paragraph.
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The authors state that this work has not received any funding.
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The scientific guarantor of this publication is Claudio Granata.
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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
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Lay summary
Referral guidelines are based on evidence and should guide referring physicians and radiologists in justifying radiological studies in order to minimise radiation exposure and at the same time optimise diagnostic performances.
These guidelines have to be implemented in Europe by EU directive and exist both for paediatric and adult patients. Following the referral guidelines is of utmost importance for children as the effects of radiation doses are more critical at a young age.
The European Society of Radiology has developed evidence-based referral guidelines specifically for children and developed at the same time a web-based tool to optimise referral, the ESR iGuide.
The present publication reports on a survey carried out among ESR members to assess the availability, use of and familiarity with the referral guidelines and their knowledge about the availability of the ESR iGuide.
With 2067 respondents from 52 countries in Europe and beyond, the survey gives food for thought. Just half of the respondents were aware that the availability of referral guidelines is a legal requirement, which also means that they are likely not using them. The same holds true for the referral guidelines for children, as about half of the respondents are unaware of their availability.
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Granata, C., Frija, G., Damilakis, J. et al. Referral guidelines for medical imaging in children: an ESR-EuroSafe Imaging survey on availability, awareness and use in clinical practice among European radiologists. Eur Radiol 31, 7984–7991 (2021). https://doi.org/10.1007/s00330-021-07906-w
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DOI: https://doi.org/10.1007/s00330-021-07906-w