Originally written for publication during ECR 2020 in March on the occasion of a planned joint EuroSafe Imaging-IAEA Session on ‘Building capacity and quality/ safety awareness in Africa’ and updated in June.

Despite its European focus, the scope of action of EuroSafe Imaging goes beyond continental borders. One of its objectives is to join forces with and to bring various stakeholders including international organisations together.

EuroSafe Imaging cooperates with and serves as a role model for some other radiation safety campaigns worldwide, including AFROSAFE. They all work under the umbrella of the International Society of Radiology’s Quality and Safety Alliance (ISRQSA), which is co-chaired by the EuroSafe Imaging Steering Committee Chair and the Chair of Image Gently.

Moreover, EuroSafe’s mother organisation, the European Society of Radiology, enjoys close contacts with the African Society of Radiology and featured the continent as a guest at ECR 2019 through ‘ESR meets Africa’.

Ivana Blažić, MD, PhD is radiologist and oncologist in Clinical Hospital Centre Zemun in Belgrade and member of the Communications Working Group of the International Society of Radiology (ISR).

Aside from its cooperation with equivalent campaigns, EuroSafe Imaging has also been the focal point of the ESR’s collaboration with the International Atomic Energy Agency (IAEA). The EuroSafe Imaging Call for Action 2018 builds on the first Call for Action, issued in 2014 to support the Bonn Call for Action 2012 prepared by the IAEA and the World Health Organization (WHO). By implementing the actions of the Call for Action 2018, EuroSafe Imaging significantly contributes to achieving the aims of the ten priority areas of the Bonn Call for Action.

Although imaging plays a key role in the prevention, diagnosis and treatment of communicable and non-communicable diseases as well as in emergency care, it has so far not been specifically addressed in the WHO’s universal health coverage (UHC) agenda and is still underused, or not appropriately used, in low and middle-income countries (LMICs). Governments, funders and national professional organisations in LMICs therefore have to be made aware of the role of radiology in healthcare. EuroSafe Imaging and the International Society of Radiology have drafted a joint paper with the aim to propose a plan to develop high-quality imaging services in underserved areas. The paper proposes ten points to increase quality and safety of medical imaging using ionising radiation, one of them being the support of regional quality and safety campaigns such as EuroSafe Imaging, Image Gently, AFROSAFE, ArabSafe, LATINSAFE and others to raise awareness of patients and healthcare workforce.

Guy Frija, MD, is Chair of the EuroSafe Imaging Steering Committee and Co-Chair of the International Society of Radiology Quality & Safety Alliance (ISRQSA). He is Professor Emeritus at Université Paris Descartes (FR), Professor at McMaster University (CA), and radiologist consultant at the Paris Georges Pompidou European Hospital (FR).

The IAEA’s International Basic Safety Standards1 and the European Basic Safety Standards (BSS) Directive2 could serve as a basis to reduce over and underuse of imaging, which affect both LMICs and developed countries. Access to state-of-the-art, fully digitised equipment and software, which is currently limited in LMICs, should become standard, and an early adoption of artificial intelligence (AI) should be promoted, which could be particularly useful in the detection of tuberculosis and for the management of COVID-19. To reduce unnecessary examinations, awareness of justification and optimisation needs to be raised. Therefore, EuroSafe Imaging initiated discussions with the IAEA on collaborating on regional IAEA projects to promote radiological quality and safety and to facilitate imaging referral guidelines in Africa. This would be an integral part of the ESR’s idea to set up ESR reference centres, following the EuroSafe Imaging Stars concept, with the mission to run an imaging department using state of the art equipment, to operate and manage imaging services in the surroundings and to provide training and continuing professional education.

The IAEA and the ESR have recently extended their practical arrangements on cooperation in the area of diagnostic imaging, including hybrid imaging, for another three years through 2023. The ESR is extremely grateful to the IAEA and greatly appreciates the longstanding fruitful collaboration. The ongoing support from the IAEA as well as from the WHO and other stakeholders will be crucial for EuroSafe Imaging to turn its vision for imaging in LMICs into reality.

1 International Atomic Energy Agency (IAEA): Radiation Protection and Safety of Radiation Sources: International Basic Safety Standards, accessed on Sept. 24, 2019
2 COUNCIL DIRECTIVE 2013/59/EURATOM, accessed on Sept. 24, 2019