March 2019

About ESR iGuide

ESR iGuide is a clinical decision support system for European imaging referral guidelines developed by the European Society of Radiology (ESR) based on the American College of Radiology (ACR) Appropriateness Criteria. Distributed by the ESR's Quality and Safety in Imaging (QSI) GmbH, ESR iGuide leverages a decision support mechanism developed by National Decision Support Company (NDSC).

Combining the medical expertise of the ESR with a user-friendly clinical decision support tool gives healthcare providers an efficient, traceable and reliable way of supporting the request of the most appropriate imaging exams for patients in daily practice. ESR iGuide provides users with guidelines and recommendations based on the latest medical evidence developed by leading experts in the field of radiology, integrates seamlessly into the clinical workflow and existing IT infrastructure, supprts and educates referring physicians, and gives patients confidence that they receive the best radiological healthcare.

Following an ESR-led European Commission study revealing that imaging referral guidelines are hardly used in Europe, the ESR initiated a project to make evidence-based guidelines available in a user-friendly way. ESR iGuide offers an ideal solution to this problem, as guidelines can be kept up-to-date while being available to referring physicians at the point of care within existing electronic clinical workflows.


Since 2014, the ESR works with the ACR and NDSC to make a Europeanised version of the ACR Appropriateness Criteria available to referring physicians in Europe. The ESR Referral Guidelines Subcommittee develops and maintains the ESR iGuide content, and is part of a joint ACR-ESR rapid response team coordinates updates to the guidelines as new versions are released periodically. QSI licenses the ESR's guidelines and provides technical and commercial services.

Follow this link for more information on the ESR imaging referral guidelines.


ESR iGuide pilot projects have been running since 2016, including in four hospitals in Croatia and in the Highlands Hospital in Jönköping. Further implementations are ongoing in several European countries. Results from Croatia indicate that up to one quarter of imaging referrals are not or only moderately appropriate according to the referral guidelines. By using ESR iGuide, up to three percent of referrals were cancelled, while in up to five percent of cases a more appropriate examination was chosen. In one of the hospitals, the appropriateness of referrals increased from 75 to 88 percent within nine months of implementing ESR iGuide. By utilising the data and analytics capabilities of ESR iGuide, further educating referrers can improve these results in future.

For more information on the results of the first ESR iGuide pilot implementations, view this ECR 2018 poster.

More information

Please visit our website for more information on ESR iGuide, the web portal, integration options, and the ESR Imaging Referral Guidelines Subcommittee.


For more information on access options for the stand-alone ESR iGuide web portal, please visit our website:


For more information on integration and implementation options for your healthcare organisations, please contact us for a tailored offer: