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Bundesministerium für Umwelt, Naturschutz, Klimaschutz und nukleare Sicherheit

Recommendation

  • medical radiation exposure

Recommendations for medical imaging procedures

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Recommendation by the German Commission on Radiological Protection

Adopted at the 339th meeting of the SSK on 27/28 October 2025

 

Which imaging procedure is recommended for which medical inquiry?

  • Physicians who order imaging procedures should be given recommendations on the most appropriate procedures. This guidance document contains such recommendations and is published here in an updated version. This should help to avoid unnecessary radiation exposure and simultaneously optimise medical diagnostics. 

    • Which imaging procedure is recommended for which medical inquiry?
    • What needs to be considered regarding specific cases, e.g. children or specific therapeutic procedures?
    • What dose is associated with the various imaging procedures?
    • Imaging procedures are recommended for various medical inquiries in a catalogue, which is mostly divided into body regions. They are graded as primary procedures, further procedures or special procedures.
    • Like the previous editions, this “Recommendations for medical imaging procedures” is intended to assist physicians in selecting the appropriate imaging procedure for each individual inquiry. Its purpose is to provide better care for patients and to take into account aspects of radiation protection. Furthermore, it should be used as a useful teaching aid in student education, radiation protection courses and further medical training.
    • Any practitioner using medical imaging procedures is obliged to provide and document the justification for the chosen procedure and its specific application to the individual patient. 

Abstract

In 2006, the German Commission on Radiological Protection (SSK), commissioned by the Federal Ministry for the Environment, Nature Conservation, and Nuclear Safety, produced the first catalogue recommending appropriate procedures for various diagnostic and interventional inquiries. This guide was well-received by the medical community. Since medical diagnostic and therapeutic procedures continue to evolve, regular updates of this catalogue are necessary. This updated fourth edition of the “Recommendations for medical imaging procedures” allows physicians to select suitable imaging procedures for patients in the light of most recent medical advancements. The objective of the catalogue is to optimise medical diagnostics and to simultaneously avoid unnecessary radiation exposure. However, it does not relieve the practitioner of the duty to establish and document the justification for any chosen procedure using ionising radiation and its specific application to the individual patient. 

Since the release of the previous editions, many constructive suggestions for changes and improvements have been provided by physicians, scientific societies, and working groups. These have been evaluated by an SSK expert group and have now mostly been included in the current version either directly or with modifications. 

Furthermore, recommendations on the use of imaging for many medical inquiries have been revised and adapted to the current state of science. Changes in the significance of individual procedures have also been made; for example, ultrasound and magnetic resonance imaging have gained greater importance in the assessment of certain medical questions. The spectrum of indications for PET-CT has also been expanded. In addition to the comprehensive breast cancer screening program (mammography screening) of asymptomatic women between 50 and 75 years of age, recommendations for the use of digital breast tomosynthesis and stereotactic and tomosynthesis-guided biopsy could be taken into account for clinical indications. For the comprehensive mammography screening programme in Germany of asymptomatic women aged 50 to 75, as well as the examination additional recommendations for the use of digital breast tomosynthesis and stereotactic as well as tomosynthesis-guided biopsy, have been taken into account. 

An HTML web version is in preparation.

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cite

Strahlenschutzkommission (SSK). Orientierungshilfe für bildgebende Verfahren, verabschiedet in der 339. Sitzung der Strahlenschutzkommission am 27./28.10.2025. www.ssk.de/publikationen/2025-10-28-orientierungshilfe

 

 

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