External clinical audits in clinical radiology in Finland.

Clinical audits have been implemented in Finland to healthcare organizations over 20 years. We introduce the outcomes of fourth round external clinical audits on medical radiological procedures following the implementation of the EU Directive (Basic Safety Standards). We analyzed 31 external clinical audits on radiological practices in 2018-2022. The summarized strengths and recommendations from the audits were collected from the main auditing organization's database. 306 recommendations were given, 18% related to definitions of responsibilities, 16% to internal procedural guidelines, 16% to personnel education, and 25% to quality assurance and utilization of self-assessments of radiological procedures. Private and small organizations received less recommendations than large and public operators. Moreover, 215 strengths were reported, focusing on the clarity of responsibilities (21%) and excellence in quality assurance (15%). Reaching and maintaining feasible radiological diagnostic accuracy by consideration of radiation safety requires continuous quality assurance and development facilitated, and monitored by clinical audits.