Justification of x-ray examinations: General principles and an Irish perspective

The principles of justification and optimisation, and the establishment and use of Diagnostic Reference Levels are core tenets of the European Medical Exposures Directive [Council Directive 97/43], and ensuing legislation across Europe. In Ireland, the European Medical Exposures Directive [Council Directive 97/43] was enacted into national law in Statutory Instrument 478 of 2002. This series of three review articles discusses the status of justification and optimisation of X-ray examinations nationally, and progress with the establishment of Irish Diagnostic Reference Levels.The current article will outline the ICRP recommendations which preceded the European Medical Exposures Directive, describe how the Directive was transposed into Irish Statute, and review the literature associated with some of the justification concepts arising from the Statute in order to elucidate the prevailing practice regarding justification in Ireland. Three levels of justification are identified: general, generic and individual. The relationship between referral guidelines and generic justification is explored, and practical issues in the implementation of individual justification are considered with reference to the role of the radiographer.Two further articles in the series will adopt a similar approach in discussing optimisation, and the establishment and use of Diagnostic Reference Levels.