ESR iGuide is the European Society of Radiology’s solution to make imaging referral guidelines readily available and easily usable everywhere in Europe. Developed through an evidence-based methodology, the ESR’s guidelines will set a common standard for Europe. Through embedding these guidelines in the clinical decision support (CDS) platform ESR iGuide, users will be able to localise the recommendations according to their needs starting from the evidence-based core.

ESR iGuide is designed to be a user-friendly system available to referring physicians at the point of care. Distributed by the ESR's affiliate Quality and Safety in Imaging (QSI) GmbH, supported through partnerships with the American College of Radiology and National Decision Support Company, the ESR can rely on extensive experience in developing practical referral guidelines and a tried and tested technical platform. This also gives the ESR iGuide project a global dimension to increase international cooperation on developing evidence-based referral guidelines.

ESR Referral Guidelines SC

CDS and Referral Guidelines

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 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.

ESR-led EU Tender Project on Imaging Referral Guidelines in Europe

The purpose of ESR-led, EU-funded tender project Referral Guidelines for Medical Imaging - Availability and Use in the European Union was to review the situation in EU Member States regarding the fulfilment of their obligations under the Medical Exposure Directive Article 6.2 (97/43/EURATOM), which requires Member States “to ensure that recommendations concerning referral criteria for medical exposures, including radiation doses, are available to the prescriber of medical exposures”. The project started in December 2011 and finished in February 2013.

The professional organisations involved include the European Society of Radiology (ESR) as coordinator, the Royal College of Radiologists (RCR), the Société Française de Radiologie (SFR), the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) and the European Society of Paediatric Radiology (ESPR). In addition, an advisory board was composed of representatives from the relevant disciplines, as well as experts from the World Health Organization, the International Atomic Energy Agency and various national authorities.

The activities of the project focused on three main tasks:

  • Conducting an EU-wide study on the availability, development and implementation of referral guidelines for radiological imaging in the EU Member States. This web -based survey took place in the spring of 2012. (Work Package 1)
  • Organising a European Workshop with relevant representatives from the EU Member States. This workshop was held in Vienna on 20-21 September 2012. (Work Package 2)
  • Formulating conclusions and recommendations for national and community action. (Work Package 3)

The main findings and recommendations of the study were:

  • strong support for integrating referral guidelines into clinical decision support systems
  • clearer and stronger European measures to encourage both availability and use of referral guidelines
  • educational initiatives are highly favoured to improve implementation, followed by involvement of referring clinicians in guidelines development
  • reinforcement for use of imaging referral guidelines is essential through CDS and educational activities


Download the survey on imaging referral guidelines in Europe, a report on the project workshop, and the European Commission's final publication on the project below.

Survey on guidelines

Project workshop proceedings

RP 178 - EC Publication

ESR iGuide News


Contact us for more information on ESR iGuide.