OBJECTIVE: The purpose of our study was to review the experience of tracking radiologic procedures and radiation dose for individual patients in terms of impact on justification and optimization. MATERIALS AND METHODS: Examples were collected at the Hospital for Children and Adolescents in Helsinki, Finland, through a PACS system that covers 33 institutions in the Helsinki-Uusimaa Hospital District in which reviewing previous radiologic procedures or radiation doses helped in either avoiding the next procedure or provided insight that helped to strengthen dose optimization for CT. RESULTS: With the help of four case reports, our results show that availability of previous imaging studies and radiation dose figures helped to avoid additional new CT examinations by providing required information from previously performed CT examinations, indicate the need for imaging parameter optimization in one facility in view of a better situation detected in another facility, observe the need for further optimization with a specific CT unit and validate the outcome of successful optimization, and make a value judgment in a situation in which a patient has already undergone a number of CT examinations and a critical evaluation could avoid another one. Patient-specific optimization provides a more reliable and effective method than that of comparing average patient group values. Collective dose for a patient was not used in any situation in decision making. CONCLUSION: Patient-specific justification and optimization becomes possible using the tracking of radiologic procedures and radiation dose of individual patients.