The ESR-led EU-JUST-CT project on improving the justification of computed tomography (CT) successfully concluded with the publication of its final report in the European Commission Radiation Protection Series (No. 205). The report presents the results of clinical audits of the justification of CT referrals carried out in seven EU countries simultaneously using a standard auditing methodology.
The EU-JUST-CT (European co-ordinated action on improving justification of computed tomography) project audited over 6,400 referrals for CT examinations carried out in public and private imaging facilities in seven pilot countries (Belgium, Denmark, Estonia, Finland, Greece, Hungary, Slovenia) to identify if the CTs were justified. To this end, the countries’ national radiation protection authorities provided a set of anonymised referrals collected in early 2022 to a pool of auditors established with the support of the country’s national radiology society. Each referral was assessed by two auditors, using the ESR imaging referral guidelines embedded in the ESR iGuide clinical decision support tool as a reference standard. This was the first time that the same methodology for auditing justification of CT examinations was used simultaneously in several EU countries.
The project revealed considerable disparities between countries as well as the need for further action to improve justification of CT examinations. According to the analysis, the appropriateness rates of the audited referrals varied between approx. 58% and 86%, and the proportion of examinations whose appropriateness could not be assessed due to lacking or insufficient clinical data ranged from 0.3% to 27%.
The audit methodology used in the project is publicly available on the EU-JUST-CT webpage and forms part of the European Commission (EC) Radiation Protection Series No 205 in order to encourage and facilitate audits of CT justification in other Member States and regions.
Another key element of the project and its final report is a guidance document for radiologists including concrete advice, examples of good practices and guidelines on how to implement the process of justification of individual imaging procedures using CT for adult and paediatric patients in a hospital or private practice. The draft guidance document was discussed in a project workshop held in Luxembourg and remotely in September 2023 before being finalised.
Welcoming the publication of the EC report, EU-JUST-CT project leader Prof. Boris Brkljačić, who is chair of ESR EuroSafe Imaging and former ESR President, spoke of an important step towards raising awareness of the legal aspects of radiation protection as well as enhancing compliance with the Basic Safety Standards Directive (BSSD) 2013/59/Euratom.
“The EU-JUST-CT project has revealed that further action is needed to improve justification. I am confident that our report, including the audit methodology and guidance for imaging departments, will encourage other EU Member States to carry out audits of CT justification with the aim to further advance patient safety and quality of care.”
Prof. Brkljačić and project co-lead Alexandra Karoussou-Schreiner of the Luxembourg Ministry of Health and Social Security underlined the outstanding teamwork behind the project. “Without the strong support from the consortium members, the national competent authorities, national radiology societies and participating hospitals of the seven pilot countries, the auditors as well as the statisticians from the Gertner Institute in Israel, this achievement would not have been possible.”
The project leaders also extend their gratitude to the representatives of the EC DG ENER for the smooth collaboration. The EU-JUST-CT team welcomes the EC’s intention to continue supporting audits and work on justification within the framework of the SAMIRA Action Plan and supports the EC’s efforts towards better implementation and increased commitment among Member States.
EU-JUST-CT (European co-ordinated action on improving justification of computed tomography) was a European Commission-funded project coordinated by the ESR. The general objective of the 36-month project that started in April 2021 was to improve the justification of computed tomography in the EU through the development and implementation of a common approach, methodology and co-ordinated action in this area among Member States. The work was part of the SAMIRA Action Plan, a key element of Europe’s Beating Cancer Plan and closely related to recent work on clinical audit e.g. the QuADRANT study.
The EU-JUST-CT project report ‘Results and recommendations from a first-time multi-national study on CT justification in the EU’ were published as part of the EC’s Radiation Protection Series (No. 205) in September 2024 and can be accessed here.
