[Development of the 2024 Korean Guidelines for the Justification of Patient Imaging]

This study reports on the development and clinical applicability of the 2024 revised Korean Guidelines for the Justification of Patient Imaging with the goal of reducing unnecessary radiation exposure, thereby improving patient safety and quality of care.

A multidisciplinary team from six divisions developed the guidelines using the GRADE-ADOLOPMENT framework and patient/problem, intervention, comparator, outcome (PICO) structure. International guidelines were adapted using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool. Each recommendation was assigned a grade, evidence level, or radiation dose stage. A consensus was achieved through two rounds of Delphi. A pilot clinical decision support system (CDSS) and surveys were conducted to assess awareness and utilization.

Thirty-five recommendations were developed addressing 20 key questions. Among these, key topics included strong recommendations for the use of unenhanced brain CT in acute thunderclap headache and the use of ultrasound for fetal hydronephrosis, acute abdominal pain, and interstitial pulmonary fibrosis follow-up. Surveys showed high awareness (>60%), but low utilization (approximately 30%).

Although the 2024 guidelines, developed using internationally recognized methods, recommend enhancing restrictions on patient imaging, their limited clinical adoption remains a challenge. Institutional support, such as the integration of electronic medical records, policy incentives, and broader CDSS use, is essential for improving their implementation to reduce unnecessary radiation exposure, enhance patient safety, and increase healthcare efficiency.