Minimizing Radiation Exposure in Imaging Studies: The European Experience

Abstract

In the European Community, a 1997/43 Euratom directive establishes that indication and execution of diagnostic procedures should follow three basic principles: the justification principle (article 3: “if an exposure cannot be justified, it should be prohibited”), the optimization principle (article 4: “according to the ALARA principle, all doses should be kept As Low As Reasonably Achievable”), and the responsibility principle (article 5: “both the referring physician ordering the test—the prescriber—and the practitioner are responsible for the justification of the test exposing the patient to ionizing radiation”). Any responsible prescription should follow these principles, also reinforced by the recommendations of the Medical Imaging guidelines of the European Commission (first released in 2001) and by the 2014 position paper on use of medical radiation issued by the European Society of Cardiology, stating that X-rays and gamma-rays are proven (class I) carcinogens and cardiologists should make every effort to perform the right imaging exam, with the right dose, to the right patient; an informed physician (or radiologist, or cardiologist) “cannot be afraid of the essential and often life-saving use of medical radiation, but must be very afraid of radiation unawareness.”