WHO-ICRQS Referral Guidelines Project
IRQN "Referral Guidelines for Diagnostic Imaging"

The World Health Organization (WHO) launched a Global Initiative on Radiation Safety in Healthcare Settings in 2008.  The International Radiology Quality Network (IRQN) established a Referral Guidelines Working Group in 2009.

Several organizations have developed clinical referral guidelines to guide the selection of diagnostic imaging procedures.  However these guidelines are currently not available in many countries, and even when available, they are not yet well integrated into daily practice.  To address these challenges, the 34 participants from 19 countries who attended a WHO Global Initiative consultancy on “Referral Guidelines for Appropriate Use of Radiation Imaging” in March 2010 have agreed to undertake a referral guidelines project (Project).

The Project aims to promote safe use and appropriate selection of diagnostic imaging, and to ensure these procedures are justified and indicated by providing a practical guidance tool and supporting its implementation.  The Project includes activities to improve clinical referral guideline awareness, access and use.  The use of clinical referral guidelines supports good medical practice, patient-centered care, procedure justification, and radiation safety.  Referral guidelines are important procedure justification tools as mentioned in “Bonn Call-for-Action” http://www.who.int/ionizing_radiation/about/med_exposure/en/index3.html and the new International Basic Safety Standards. http://www-pub.iaea.org/books/IAEABooks/8930/Radiation-Protection-and-Safety-of-Radiation-Sources-International-Basic-Safety-Standards

Members of the Project Core Group and Special Interest Groups reviewed the available evidence-based guidelines and identified a set of clinical conditions, which share the same recommendations for appropriate imaging.  Following the incorporation of stakeholder feedback, “Referral Guidelines for Diagnostic Imaging” was finalized and used for pilot testing in different settings and regions.  The pilot exercise was conducted to identify referral guideline awareness, access and use and to collect practitioner feedback on guideline topics and presentation preferences.  The feedback informed future actions in this and other related referral guidelines projects.

The IRQN joined the ISR in 2013 and the International Commission on Radiological Quality and Safety (ICRQS) was formed in 2014 to be responsible for radiological safety and quality matters for the ISR.  The existing IRQN activities are handled by the ICRQS.  Accordingly, this Project is re-named as the WHO-ICRQS Referral Guidelines Project.

“Referral Guidelines for Diagnostic Imaging” consists of three sections.   Section I deals with the basic principles of diagnostic imaging and good medical practice, biological effects of diagnostic imaging and radiation protection.  The material is sourced from a range of publications (2, 3, 4, 5, 6, 7, 8, 9).  Section II provides a package of referral guidelines for selected conditions, based on common recommendations from the American College of Radiology, the Department of Health, Western Australia, and the Royal College of Radiologists (1, 3, 10).  Section III documents the references, and includes a list of abbreviations and the Project participants.  The Project team acknowledges the original sources and thanks the organizations for the use of the material in Sections I and II. 

Extract of references
1- American College of Radiology (2013) ACR Appropriateness Criteria®. Available at: http://www.acr.org/Quality-Safety/Appropriateness-Criteria. Accessed 26 December 2013
2- Canadian Association of Radiologists (2012) Diagnostic Imaging Referral Guidelines.Canadian Association of Radiologists, Quebec http://www.car.ca/en/standards-guidelines/guidelines.aspx. Accessed 26 December 2013
3- Department of Health Western Australia (2013) Diagnostic Imaging Pathways. Available at: http://www.imagingpathways.health.wa.gov.au/includes/index.html. Accessed 26 December 2013
4- European Commission (2000) Radiation Protection 118. Referral Guidelines for Imaging. Available at: http://ec.europa.eu/energy/nuclear/radioprotection/publication/doc/118_en.pdf. Accessed 26 December 2013
5- International Atomic Energy Agency (2014) Radiation Protection and Safety of Radiation Sources: International Basic Safety Standards. IAEA Safety Standards Series GSR Part 3, IAEA, Vienna
6- International Atomic Energy Agency (2013) Radiation Protection of Patients website. Available at: https://rpop.iaea.org/RPoP/RPoP/Content/index.htm. Accessed 26 December 2013
7- International Commission on Radiological Protection (2007) ICRP Publication 105. Radiological Protection in Medicine. Ann ICRP 37(6):1-63
8- Lau LS, Ng KH (ed) (2014) Radiological Safety and Quality – Paradigms in Leadership and Innovation. Springer, Dordrecht
9- Royal Australian and New Zealand College of Radiologists (2001) Imaging Guidelines. 4th edn. Royal Australian and New Zealand College of Radiologists, Sydney.
10- Royal College of Radiologists (2011). iRefer: Making the best use of clinical radiology. 7th edn. Royal College of Radiologists, London.

To view “Referral Guidelines for Diagnostic Imaging” simply click the thumbnail image.

Please kindly note
This set of clinical referral guidelines was prepared for pilot testing to collect practitioner feedback.  The recommendations might not be appropriate for some settings.  Also, technology and practice are rapidly evolving and therefore referral guidelines need to be regularly updated. You should consult a radiologist if at all uncertain.  This publication serves primarily as an example of how clinical referral guidelines could be presented and used.


WHO-ICRQS Referral Guidelines Project Participants

- Collaborators and Observers

- Special Interest Group Members

- Core Group Members
Dr. Michael G Kawooya, African Society of Radiology
Dr. Lawrence Lau, International Commission on Radiological Quality and Safety
Dr. María del Rosario Perez, World Health Organization
Dr. Martin Reed, Canadian Association of Radiology

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