May 2021

The European Society of Radiology is proud to have been awarded the European Commission Tender ‘European co-ordinated action on improving justification of computed tomography’ (acronym: EU-JUST-CT). 

The project started on 7 April 2021 and will last until March 2024. The formal kick-off meeting with the European Commission took place yesterday, on 20 May 2021.  

The project is led by Prof. Boris Brkljacic (University of Zagreb School of Medicine, HR) and co-led by Ms. Alexandra Karoussou-Schreiner (Ministry of Health, LU) and aims to improve justification of computed tomography in Europe through co-ordinated action. 

Project objectives: 

  1. Collect up-to-date information about justification of CT examinations in Europe. 
  1. Develop a common methodology for auditing justification of CT examinations. 
  1. Carry out co-ordinated pilot audits of justification of CT examinations in a minimum of five different European countries. 
  1. Discuss the status of justification of CT examinations with the Member States and identify opportunities for further action. 

Justification of medical exposures in Europe is a highly important and timely topic, and justification of CT imaging is of paramount importance and in the focus of medical professional societies, radiation protection authorities and the European Commission. Pediatric imaging is especially important in this regard. The significant level of inappropriate use of medical exposures was demonstrated in many studies, including those performed by International Atomic Energy Agency (IAEA) (2009) “Report of a consultation on justification of patient exposures in medical imaging”. In several European countries national audit studies on appropriateness of CT and MRI examinations were performed, with different results, and the ESR is strongly promoting dissemination and use of imaging referral guidelines. 

ESR iGuide, ESR’s European evidence-based imaging referral guidelines embedded in a Clinical Decision Support (CDS) environment will be used as the standard against which the CT referrals will be audited during the project. Several successful pilot projects using ESR iGuide in Europe and beyond have already demonstrated significant improvements in appropriateness. 

Following yesterday’s formal kick-off meeting with the European Commission, the concrete next steps of this project will be: 

  • To carry out a survey among national competent authorities and national radiology societies to enquire about current practices around CT justification, including the use of referral protocols, and whether an audit of justification of CT procedures has been performed in their countries.    
  • To discuss the methodology for CT justification audits with the countries/regions that have expressed interest and to start recruitment of auditors.    

This project is another important milestone for ESR and its collaborative work with other organisations, including its national and subspecialty societies, professional societies of related disciplines, radiation protection regulators, and ministries of health, to promote and enhance compliance with the European Council Directive 2013/59/Euratom – Basic Safety Standards (BSS Directive), and support improvement of justification

Updates will be available continuously at  


This project has received funding from the European Commission under Service Contract N° ENER/21/NUCL/SI2.844392