Starting on the International Day of Radiology on 8 November 2016, a number of national radiation protection authorities from 18 European countries conducted a special series of inspections in radiology departments and practices. The aim of these inspections was to assess the application of the justification principle. By monitoring existing practices, the European authorities identified routes for further improvement in patient radiation protection.

As part of an initiative launched by HERCA, a number of radiology departments and practices across Europe received a special round of inspections from their national radiation protection competent authorities during November 2016 - January 2047 period. The focus of these inspections was on compliance with the justification principle, which requires that each medical imaging procedure should contribute sufficiently to patient care to outweigh the possible detriment caused by radiation exposure.

The national radiation protection authorities conducted the inspections in accordance with their own rules and routines, while using the same HERCA inspection template. The template follows the logic of the normal justification process and verifies to what extent the referrers, the radiological practitioners and other staff adhere to the corresponding procedures: does the referral provide sufficient information for the radiological practitioner to assess the imaging request? Are the practitioners’ assistants sufficiently aware of what is expected of them? Are others working under their responsibility sufficiently qualified for their tasks? Does anyone check if the requested procedure fits the purpose best and if it complies with national and international guidelines? Do they verify if any similar medical imaging procedures have been conducted recently? Etc.

The goal of this HERCA initiative is to monitor to what extent the justification principle is put into practice in diagnostic radiology across Europe and to identify potential routes for improvement. The findings will be presented in a report that will be published on the HERCA website.

It is HERCA’s hope that any improvement of the justification process in diagnostic radiology will not only lead to improved radiation protection, but will also contribute to an overall improvement of health care in its member states.

Examples of national initiatives in justification field

Norway (NRPA): The Norwegian Radiation Protection Authority has together with Akershus University Hospital made an information film about justification within medical imaging. The aim of the film is to increase the awareness of justification and for  use in education of health professionals.

Luxembourg (Ministry of Health): The Ministry of Health of Luxembourg and the Ministry of social security joinlty approved and action plan for promoting the use of the recommandation prescription in medical radiology, in order to reduce the number of unjustified radiology procedures. This action plan includes an audit of the compliance of medical imaginf prescriptions. The first part was released this summer.

Belgium (FANC/AFCN): Communication campaign on justification within medical imaging (available in French, German and Dutch)


Media Press Release

Information Leaflet

Results of a coordinated inspection initiative assessing justification in radiology - pre-print of a paper presented at the International Conference on Radiation Protection in Medicine: Achieving Change in Practice, 11-15 December 2017, Vienna, hosted by the International Atomic Energy Agency


HERCA Technical Secretariat,

HERCA inspection week Leader, Eva Godske Friberg,

Previous activities of HERCA in justification field

Workshop on how to inspect justification and optimisation in diagnostic radiology

HERCA position paper on Justification