The European Society of Radiology considers referral guidelines for medical imaging essential for improving appropriateness and justification of radiological procedures. Particularly at a time of increasing financial pressure on European healthcare systems and public concerns about the risks of exposure to radiation, it is more important than ever to ensure medical imaging is used in the most efficient and most effective way possible.
To address to gaps in the availability of imaging referral guidelines and the lack of guideline use in Europe, the ESR has developed ESR iGuide, a clinical decision support system for European imaging referral guidelines, leveraging decision support software developed by National Decision Support Company (NDSC). The aim is to provide a CDS platform at the point of care that provides evidence-based information and actionable decision support for imaging decisions. This is a vital step towards ensuring the appropriate use of radiation and avoiding unnecessary exposure.
A team of senior radiologists appointed by the ESR started developing European imaging referral guidelines in November 2014, based on the Appropriateness Criteria developed by the American College of Radiology. This review was overseen by a dedicated methodologist and resulted in a standard set of evidence-based guidelines for Europe. The guidelines are embedded into the ESR iGuide CDS platform for distribution in Europe. The ESR’s aim is to cover around 80 percent of requests in daily practice by reviewing the clinical scenarios, indications and recommendations for the topic groups Breast, Cardiac, Gastrointestinal, Musculoskeletal, Neurologic, Paediatric, Thoracic, Urologic, Vascular and Women’s Imaging. A permanent ESR Subcommittee on Referral Guidelines was set up within the Quality, Safety and Standards Committee, charged with maintaining the CDS guidelines and releasing annual updates, in cooperation with the American College of Radiology's Rapid Response Committee. The content development process is now coordinated through a joint ESR-ACR rapid response process.
Implementations in clinical practice started in 2016, and ESR iGuide is now live or being implemented in hospitals in more than 10 European countries.