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The recently implemented European Council Basic Safety Standards Directive (BSSD), 2013/59/Euratom lays down core radiation protection standards for European radiology departments, including a mandatory requirement for supporting processes of clinical audit. A repeat survey on behalf of the European Society of Radiology (ESR) was undertaken in February 2021, involving the ESR EuroSafe Imaging Star department network, to re-assess compliance with selected key BSSD requirements following an initial survey in 2018 where variable compliance was demonstrated. 61% (78/128) of eligible departments participated and overall the survey results revealed a mixed picture in terms of implementation of BSSD requirements when compared to the 2018 survey with both improvement and deterioration observed. This pattern was seen also in relation to supporting processes of regulatory audit and re-audit. Higher levels of “skipping” of responses were also observed in 2021. These findings were unexpected in light of the interventions in relation to audit (clinical and regulatory) and radiation protection undertaken by the ESR and other organisations in recent years, but can reasonably be explained by the onset of the COVID-19 pandemic, with consequent significant disruption of radiology services. The 2021 survey results do serve to highlight again the need for co-ordinated intervention involving relevant European bodies, organisations and governmental agencies to address the important issues raised by this survey. The European Commission clinical audit and radiation protection initiatives, QuADRANT, led by the ESR, and SAMIRA will act as important drivers for improvement in patient safety, experience and outcomes across Europe. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-021-01078-3.

BackgroundIn the case of breast cancer (BC), radiotherapy (RT) helps reduce locoregional recurrence and BC-related deaths but can lead to cardiotoxicity, resulting in an increased risk of long-term major cardiovascular events. It is therefore of primary importance to early detect subclinical left ventricular (LV) dysfunction in BC patients after RT and to determine the dose–response relationships between cardiac doses and these events.MethodsWithin the frame of the MEDIRAD European project (2017–2022), the prospective multicenter EARLY‐HEART study (ClinicalTrials.gov Identifier: NCT03297346) included chemotherapy naïve BC women aged 40–75 years and treated with lumpectomy and adjuvant RT. Myocardial strain analysis was provided using speckle‐tracking echocardiography performed at baseline and 6 months following RT. A global longitudinal strain (GLS) reduction >15% between baseline and follow-up was defined as a GLS-based subclinical LV dysfunction. Individual patient dose distributions were obtained using multi-atlas-based auto-segmentation of the heart. Dose-volume parameters were studied for the whole heart (WH) and left ventricle (LV).ResultsThe sample included 186 BC women (57.5 ± 7.9 years, 64% left-sided BC). GLS-based subclinical LV dysfunction was observed in 22 patients (14.4%). These patients had significantly higher cardiac exposure regarding WH and LV doses compared to patients without LV dysfunction (for mean WH dose: 2.66 ± 1.75 Gy versus 1.64 ± 0.96 Gy, p = 0.01). A significantly increased risk of subclinical LV dysfunction was observed with the increase in the dose received to the WH [ORs from 1.13 (V5) to 1.74 (Dmean); p <0.01] and to the LV [ORs from 1.10 (V5) to 1.46 (Dmean); p <0.01]. Based on ROC analysis, the LV-V5 parameter may be the best predictor of the short-term onset of subclinical LV dysfunction.ConclusionThese results highlighted that all cardiac doses were strongly associated with the occurrence of subclinical LV dysfunction arising 6 months after BC RT. Whether measurements of GLS at baseline and 6 months after RT combined with cardiac doses can early predict efficiently subclinical events occurring 24 months after RT remains to be investigated.

Medical applications of ionising radiation (IR) represent a key component of the diagnosis and treatment of many diseases, guaranteeing efficient health care. The use of IR in medicine, the largest source of general population radiation exposure, is potentially associated with increased risk of cancer and non-cancer diseases, which needs to be evaluated to provide evidence-based input for risk-benefit considerations. Efforts are also needed to improve the safety and efficacy of medical applications through optimisation. The EC Euratom programme enhances research in medical radiation protection. The four complementary multidisciplinary projects presented here contribute to (1) improving knowledge on exposure and effects of diagnostic and therapeutic applications and (2) transferring results into clinical practice. The common aim is to optimise use for individual patients, enhance education and training, ensuring adherence to ethical standards, particularly related to technologies based on artificial intelligence. MEDIRAD, SINFONIA and HARMONIC focus on improving exposure estimation and studying the detrimental effects of diagnostic and therapeutic medical exposures in patients and staff using different endpoints. EURAMED rocc-n-roll brings together the results of the projects and the recommendations generated by them to build, in collaboration with the EU Radiation Protection research platforms, a strategic research agenda and a roadmap for research priorities. The HARMONIC project has received funding from the Euratom research and training programme 2014–2018 under grant agreement No. 847707. The MEDIRAD project has received funding from Euratom’s research and innovation programme 2014–2018 under grant agreement No. 755523. The SINFONIA project has received funding from the Euratom research and training programme 2019–2020 under grant agreement No. 945196. The EURAMED ROCC-N-ROLL project has received funding from the Euratom research and training programme 2019–2020 under grant agreement No 899995. ISGlobal also acknowledges support from the Spanish Ministry of Science, Innovation and Universities through the “Centro de Excelencia Severo Ochoa 2019–2023” Program (CEX2018-000806-S), support from the Generalitat de Catalunya through the CERCA Program and support from the Secretariat of Universities and Research of the Department of Business and Knowledge of the Generalitat of Catalonia through AGAUR (the Catalan Agency for Management of University and Research Grants) (Project 2017 SGR 1487).

This review presents basic information on the dosimetric quantities used in medical imaging for reporting patient doses and establishing diagnostic reference levels. The proper use of the radiation protection quantity “effective dose” to compare doses delivered by different radiological procedures and different imaging modalities with its uncertainties and limitations, is summarised. The estimates of population doses required by the European Directive on Basic Safety Standards is commented on. Referrers and radiologists should be familiar with the dose quantities to inform patients about radiation risks and benefits. The application of effective dose on the cumulative doses from recurrent imaging procedures is also discussed. Patient summary: Basic information on the measurement units (dosimetric quantities) used in medical imaging for reporting radiation doses should be understandable to patients. The Working Group on “Dosimetry for imaging in clinical practice” recommended that a brief explanation on the used dosimetric quantities and units included in the examination imaging report, should be available for patients. The use of the quantity “effective dose” to compare doses to which patients are exposed to from different radiological procedures and its uncertainties and limitations, should also be explained in plain language. This is also relevant for the dialog on to the cumulative doses from recurrent imaging procedures. The paper summarises these concepts, including the need to estimate the population doses required by the European Directive on Basic Safety Standards. Referrers and radiologists should be familiar with the dose quantities to inform patients about radiation risks and benefits.

Methods or background Purpose or learning objective Conclusion Results or findings References Personal information and conflict of interest, Methods or background: The 57-month MEDIRAD project aims to enhance the scientific bases and clinical practice of radiation protection in the medical field and thereby addresses the need to better understand and evaluate the health effects of low-dose ionising radiation...

International audience; Background: Breast cancer (BC) represents a major public health burden worldwide. Significant advances in treatments have been made in recent decades. Among them, radiotherapy (RT) allows reducing local recurrence and deaths resulting from BC. However, RT for BC can lead to cardiotoxicity, resulting in an increased risk of long-term major cardiovascular adverse events (MACE). Consequently, to detect early subclinical cardiac alterations is of primary importance.Objective: One of the aims of the MEDIRAD EARLY-HEART study is to determine the short-term impact of BC RT on subclinical cardiac function by means of echocardiography and to explore the dose-response relationship. Methods: Launched in 2017, the ongoing EARLY-HEART study is a prospective multicenter cohort study including women with BC aged 40 to 75 years and treated by RT in the Netherlands, Germany, France, Portugal and Spain. All women were chemotherapy naive. Echocardiographic exams after the RT+6-month follow-up (FU) will be available in September 2021 to determine if significant subclinical cardiac function alterations occurred. A RT+24-month FU is currently ongoing to determine if eventual previous alterations persist. Myocardial deformation analysis was provided by the 2D-speckle-tracking echocardiography. The global longitudinal strain (GLS), its worsening > 10% and the global longitudinal strain rate (GLSR) will be considered to evaluate subclinical cardiac dysfunction. Results: The EARLY-HEART cohort included 258 women with BC, with a mean age of 58.2±8.1 years, 63.5% with left-sided BC. Presence of pre-existing cardiovascular (CV) risk factors were recorded to allow adjustments in further analyses: obesity was present in 21.0% of the sample (mean body mass index of 26.3±4.6 kg/m²), hypertension in 48.2%, diabetes in 5.4% and 47.8% were current or former smoker. RT total dose varied from 40.05 Gray (Gy) to 50.40 Gy, and 46.1% received a boost (mean boost dose of 11.9±1.9 Gy). Among the 258 patients, 63.9% received concomitant hormonotherapy. Regarding subclinical cardiac investigations at baseline (before RT), 242 patients (93.8%) performed echocardiography exams, yielding a mean GLS of -19.3±3.3%. Full echocardiography analyses after the 6-month FU will be available soon to explore potential alterations of myocardial function between pre-RT time-point, 6-month and 24-month post-RT time-points using paired t tests. Future EARLY-HEART analyses will also provide accurate absorbed dose of cardiac structures (whole heart, right and left ventricles, right and left atrium) based on 3D-dosimetry to explore dose-response relationships using multivariate regressions. Subgroup and sensitivity analyses will be performed. Results of analyses of the relationship between radiation dose and subclinical cardiac function will be presented.Conclusion: Using strain analysis from echocardiography, the impact of RT on subclinical cardiac function in patients with BC are being explored within the MEDIRAD EARLY-HEART project. Epidemiological data regarding early alteration of GLS could contribute to adaptions in clinical practice about CV monitoring.

Background/introduction Description of activity and work performed Conclusion and recommendations Personal/organisational information References, Background/introduction: MEDIRAD – the first EURATOM project dedicated to researching the implications of medical low-dose radiation – specifically aims to enhance the scientific bases and clinical practice of radiation protection in the medical field and addresses the...

Background/introduction Description of activity and work performed Conclusion and recommendations Personal/organisational information References, Background/introduction: Promoting quality and safety is one of the major objectives of the International Society of Radiology (ISR). In 2016, the ISR set up the ISR Quality and Safety Alliance (ISRQSA). ISRQSA acts as convener of and facilitator for continental, regional...

Background/introduction Description of activity and work performed Conclusion and recommendations Personal/organisational information References, Background/introduction: Quality and safety activities are among the top priorities of the International Society of Radiology ( ISR ). The ISR’s mission is 'to facilitate the global endeavours of its member organisations to improve patient care and population health...

Background/introduction Description of activity and work performed Conclusion and recommendations Personal/organisational information References, Background/introduction: The mission of the International Society of Radiology (ISR) is 'to facilitate the global endeavours of its member organisations to improve patient care and population health through medical imaging'. To this end, the ISR formally established the...