HealthManagement, Volume 15 - Issue 1, 2015

The demand for medical imaging examinations is constantly growing, and safety and qualit y in radiological practice are more important than ever. The European Society of Radiology (ESR) has taken a major step in raising awareness of the importance of radiation protection with the launch of EuroSafe Imaging at the European Congress of Radiology (ECR) i n M arch 2 014.


With the establishment of this radiation protection initiative, the ESR has created a new and comprehensive framework for its efforts to improve quality and safety in medical imaging in Europe. The initiative is led by the EuroSafe Imaging Steering Commit tee, whose composition reflects the ESR’s multidisciplinary y approach. Charged with setting the campaign’s strategy and overseeing its implementation, the steering committee is chaired by ESR Past President Prof. guy Frija, and consists of representatives from the ESR, the European Federation of Organisations for Medical Physics (EFOMP), the European Federation of Radiographer Societies (EFRS), the patient organisation European F e d e r a t i o n o f N e u r o l o g i c a l Associations (EFNA) on behalf of the ESR Patient Advisory group, industry group COCIR and an obser ver from the European Commission. Outreach to other professions including cardiologists, orthopaedists and general practitioners is planned for 2015.


EuroSafe Imaging’s mission to support and strengthen medical radiation protection across Europe fol lowing a hol ist ic, inc lusive approach has been translated into the following main objectives:

• promot ing appropriateness and justification of radiological procedures;

• maintaining radiation doses within diagnostic reference levels (DRLs);

• promoting the application of the ‘as-low-as-reasonably-achievable’ (ALARA) principle;

• the use of up-to-date imaging equipment;

• developing a strategic research agenda in radiation protection

• empowering patients through bet t e r in f o rmat io n an d communication;

• joining forces by bringing together a variety of stakeholders.


In 2014, EuroSafe Imaging started implementing measures to deliver its mission by developing a comprehensive strategy in the form of the EuroSafe Imaging Call for Action, which was launched in September 2014. The EuroSafe Imaging Call for Action is designed to suppor t the International Atomic Energy Agency a n d Wo r l d H e a l t h O r ga niz at io n’s 2012 Bon n C all for Action, w hich identifies responsibilities and proposes pr ior i t ies for stakeholders regarding radiation protection in medicine (International Atomic Energy Authority and World Health Organization 2013).


EuroSafe Imaging’s 12-point action plan will make a significant contribution to each of the ten priority areas in the Bonn Call for Action, and it is also geared towards realising the campaign’s own objectives regarding appropriateness, DRLs, the ALARA principle, high quality equipment, as well as cooperation with patients and other stakeholders.


In the months following the publication of the Call for Action, considerable progress has been achieved on several fronts.


Implementation of Actions 1 and 9 started in November 2014, as an ESR expert group initiated the development process of European imaging referral guidelines, which will be adapted from criteria developed by the American College of Radiology (ACR). These guidelines will form the content for ESR iguide

(http://www.eurosafeimaging.or/information-for-referringprofessionals-2/clinical-decision-support), a Clinical DecisionSupport plat form for distribution in Europe to be developed in cooperation between the ESR, ACR and National Decision Support Company. A prototype of this system will be launched d uring E CR 2 015.


The development of the ESR’s clinical audit tool also progressed in 2014, as the level 1 clinical audit templates were finalised by the ESR Audit and Standards Subcommittee in early 2015. The of ficial launch of the ESR’s audit tool itself is slated for E CR 2 015.


In assuming the lead of a European Commission project on paediatric diagnostic reference levels (DRLs) entit led ‘PiDRL’ (, the ESR also contributed towards implementing measures to maintain radiation doses within DRLs (Action 3).


Education and training to improve radiation protection is of particular importance to the ESR, and the inclusion of 12 modules on radiation protection in its e-learning platform ‘Education on Demand’ as well as the EuroSafe Imaging radiation protection orientation session held at t he MIR 2014 Annual Meeting in Bologna, Italy in October 2014 were part of the implementation of Action 6 o f EuroSafe Imaging’s strategy.


With the launch of the cooperation with the research platform MELODI (Multidisciplinary EuropeanLow Dose Initiative) and the European Association of N u clear Medicine, European Society for Radiotherapy and Oncology, E F RS, an d E FOMP in 2014, the ESR showed its commitment to Action 7 of the Call for Action. Implementation of Action 8 was also started, as the ‘Is your Imaging EuroSafe?’ survey series was launched in the November 2014 edition of ESR News ( The aim of these surveys is to build a European repository based on DRLs for those clinical indications most helpful for selfbenchmarking, thereby also contributing to Action 3.


Conceived as an awareness campaign, communicating EuroSafe Imaging’s efforts to improve quality and safety in medical imaging (Action 10) is essential. EuroSafe Imaging has published articles in journals and newsletters, issued press releases, and created a promotional video in 2014 (Available from:


The ESR also enhanced its cooperation with patients (Action 11), as its Patient Advisor y group for Medical Imaging, founded in 2013, developed a ‘driver diagram of patient-centred care’. Other patient-related activities included the publication of an article on EuroSafe Imaging in the European Patients’ Forum’s newsletter

( -Towards - Patient -Safety/) and preparations to addmore patient-centred information tothe EuroSafe Imaging website.


Joining forces wit h a variet y of stakeholders (Action 12) is an essential part of the structure of EuroSafe Imaging. Not only does the campaign directly incorporate external stakeholders in the EuroSafe Imaging Steering Commit tee, t he ESR also utilises EuroSafe Imaging as a framework to actively engage with decision makers at the national, European and international level to effectively represent radiologists’ interests. T his inclu des relations with EU institutions, IAE A, WHO and Heads of the Radiological Protection Competent Authorities (HERCA), the association of regulatory authorities for radiation protection in Europe.


EuroSafe Imaging also aims to foster global cooperation on radiation protection by working with initiatives outside of Europe. A first meeting with the American campaigns Image Wisely® and Image gently® was held in December 2014 to establish a basis for future collaboration; a follow-up meeting has been set for ECR 2015. Furthermore, EuroSafe Imaging suppor ts the AFROSAFE project, an African radiation protection initiative to be launched in Februar y at the 2015 Pan African Congress on Radiology (PACORI) i n N airobi.


EuroSafe Imaging will also feature prominently again at EC R 2015, where planned activities include a dedicated poster exhibition, six scientific sessions and an information booth.


The ESR invites individuals and organisations to support EuroSafe Imaging’s mission of improving quality and safety in medical imaging by signing up to become Friends of EuroSafe Imaging at


About the ESR

The ESR is the world’s largest radiological society with more than 60,000 individual members from 155 countries, 43 institutional member societies across Europe, 15 European subspecialty & allied sciences member societies and 43 non-European associate institutional members. The ESR’s mission is to serve the healthcare needs of the general public by supporting science, education, research, and quality of service in the field of radiology.


International Atomic Energy Authority and World Health Organization (2013) Bonn call-for-action: joint position statement of the IAEA and WHO. [Accessed: 20 Januar y 2015] Available from /Documents/Whitepapers/conference/bonn-call-for-act ionstatement.pdf