The analysis of sludge samples generated during water treatment processes show that different radioisotopes of uranium, thorium and radium, among others can accumulate in that kind of samples, even the good removal rates obtained in the aqueous phase (by comparison of influent and effluent water concentrations). Inconsequence, drinking water treatment plants are included in the group of Naturally Occurring Radioactive Material (NORM) industries. The accumulation of radionuclides can be a serious problem especially when this sludge is going to be reused, so more exhaustive information is required to prevent the possible radiological impact of these samples in the environment and also on the people. The main aim of this review is to outline the current situation regarding the different studies reported in the literature up to date focused on the analysis of the radiological content of these sludge samples from drinking water treatment plants. In this sense, special attention is given to the recent approaches for their determination. Another important aim is to discuss about the final disposal of these samples and in this regard, sludge reuse (including for example direct agricultural application or also as building materials) are together with landfilling the main reported strategies.