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Prescriptive and risk-based methods including qualitative, semi-quantitative and quantitative approaches exist for the risk assessment of road tunnels. This paper provides an overview and a brief discussion of these methods and uses representative traffic and accident data in Greece in a typical tunnel conforming with the minimum infrastructure requirements of the European Directive 2004/54/EC to compare and discuss the resulting risk for each of these methods. Conclusions regarding the implementation of risk analysis methods and the use of the associated existing national guideline are drawn and recommendations for further developments in standards are provided. An integrated framework for the optimal selection of safety measures based on risk reduction and socio-economic considerations is proposed and its applicability in risk analysis of road tunnels is discussed. (C) 2016 Elsevier Ltd. All rights reserved.