HealthManagement, Volume 16 - Issue 1, 2016

The Eurosafe Imaging Initiative

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Birth of the EuroSafe Imaging initiative

Since its launch in 2014 by the European Society of Radiology (ESR), the EuroSafe Imaging initiative has placed radiation protection at the forefront of efforts to improve quality and safety in medical imaging in Europe in the most efficient and effective way possible.

The demand for medical imaging examinations is constantly growing with increasing pressure to meet the economic concerns of society and the health sector at large, making safety and quality in radiological practice and the risks of exposure to unnecessary radiation more important than ever.

The ESR has taken a major step in raising awareness of the importance of radiation protection at the clinical decision support level with the launch of EuroSafe Imaging at the European Congress of Radiology (ECR) in March 2014.

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 Federation of Neurological Associations (EFNA) on behalf of the ESR Patient Advisory Group, industry group COCIR and an observer from the European Commission. Other professions have also been invited, including cardiologists, orthopaedists and general practitioners.

The aim is to cover the vast majority of clinical scenarios, indications and recommendations in the areas of breast, cardiac, gastrointestinal, musculoskeletal, neurologic, thoracic, urologic, vascular and women’s Imaging.

EuroSafe Imaging’s mission to support and strengthen medical radiation protection across Europe following a holistic, inclusive approach, has been translated into the following main objectives:

• Promoting 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 better information and communication; and,

• Joining forces by bringing together a variety of stakeholders.

Soon after its launch, EuroSafe Imaging started implementing measures to deliver its mission by developing a comprehensive strategy in the form of the EuroSafe Imaging Call for Action. This was designed to support the International Atomic Energy Agency and World Health Organisation’s 2012 Bonn Call for Action, which identifies responsibilities and proposes priorities for stakeholders regarding radiation protection in medicine (International Atomic Energy Authority and World Health Organisation 2013).

Action Plan

EuroSafe Imaging’s 12-point action plan aims to 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.

ESR iGuide

Adapted from criteria developed by the American College of Radiology (ACR), an ESR expert group initiated the development process of European imaging referral guidelines, known as the ESR iGuide, a prototype of which was introduced during ECR 2015, with pilots continuing in 2016.

Clinical Audit

The ESR ’s Clinical Audit Tool was launched in 2016. The Standards and Audit Tool provides guidance on how to perform effective audit against the 18 Patient Safety Standards that the ESR considers represent essential good practice in any imaging service.

The standards cover all aspects of patient safety, but particularly focus on radiation protection of the patient and will ensure that radiology departments comply with the audit requirement of the EURATOM Directive. The tool and templates are free to download from the ESR website

Diagnostic Reference Levels (DRLs)

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

Education and Training

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’ and other orientation sessions were part of the implementation of Action 6 of EuroSafe Imaging’s strategy. The ECR in 2015 and again in 2016 included EuroSafe Imaging sessions. More information is available on the EuroSafe Imaging website (

Collaboration, Communication and Data Collection

With the launch of the cooperation with the research platform MELODI (Multidisciplinary European Low Dose Initiative) and the European Association of Nuclear Medicine, European Society for Radiotherapy and Oncology, EFRS , and EFOMP in 2014, the ESR showed its commitment to Action 7.

Implementation of Action 8 was also started, with the ‘Is Your Imaging EuroSafe?’ survey series incorporated in the ESR ’s monthly member e-newsletter ( gui/newsletter/newsletter.asp?languageId=1&newsletterId=48). The aim of these surveys is to build a European repository based on DRLs for those clinical indications most helpful for self-benchmarking, 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 (

The ESR also enhanced its cooperation with patients (Action 11), as its Patient Advisory 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 ( News/News/EuroSafe-Imaging-Campaign-Towards-Patient-Safety) and the addition of patient-centred information to the EuroSafe Imaging website (

Joining forces with a variety 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 Committee, the ESR also uses the initiative as a framework to actively engage with decision makers at the national, European and international level to effectively represent radiologists’ interests. This includes relations with EU institutions, IAEA , 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 Europe, including Image Wisely® and Image Gently®, while EuroSafe Imaging has pledged its support to the AFROSA FE project, an African radiation protection initiative launched at the 2015 Pan African Congress on Radiology (PACORI ) in Nairobi.


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