The Icelandic Radiation Safety Authority
The Use of Radiation in Medicine: Emphasis on Justification in 2026
2nd January 2026
When X-ray radiation is used in medicine, the justification of every examination or treatment is one of the cornerstones of radiation protection. The potential harmful effects of X-ray radiation are well known; nevertheless, it is widely used in medicine because, overall, the benefits far outweigh the possible risks.
With improved access to computed tomography (CT) and a significant increase in the number of examinations, concerns have grown that justification of use in individual cases may be inadequate.
The European Joint Project on Justification of CT scans (EU-JUST) recently published its findings and recommendations on ways to improve the justification of CT examinations. Justification of CT scans was examined in particular because CT examinations now account for more than half of the radiation exposure that people receive from the use of radiation in medicine.
The main conclusions drawn from the EU-JUST findings were:
Systematic efforts to improve justification are effective
Availability and use of clinical guidelines for imaging are key to justification
Education and training in justification and clinical audits are essential
Justification should be monitored, and clinical audits of justification should also be carried out
Clinical guidelines and decision support systems are important tools and their development, availability and use should therefore be prioritised
There is a need to promote the concept of clinical audits and train people to carry them out
Part 2 of the EU-JUST report consists of guidance to assist radiology departments in improving justification: Guidance to Assist Radiology Departments in Improving Justification.
It includes, among others: outlined five practical steps to improve the justification of CT examinations:
Communicate with referring physicians/referrers
Define roles, responsibilities and authorities for referrals and justification
Establish policies and procedures for justification
Ensure access to clinical guidelines for imaging or clinical decision support systems (CDS)
Monitor and assess compliance of requests with accepted clinical guidelines for imaging
The HERCA campaign The Right Imaging for My Patient was the first step in a European justification initiative that will continue this year. Next winter, radiation protection authorities across Europe will specifically examine justification in a coordinated manner as part of their inspections. This will include, among other things, assessment of understanding and allocation of responsibilities in the justification process in general, whether criteria exist for which examinations are appropriate, and whether audits of examination justification are carried out.
Next year, a major European collaborative project, the SAMIRA Joint Action, will also begin in Europe, where the Icelandic Radiation Safety Authority will, among other things, participate in projects related to the justification of CT examinations.
In light of this, special emphasis will be placed on justification in the coming years in the Icelandic Radiation Safety Authority's supervision of the use of radiation in medicine.