Originally written for publication during ECR 2020 in March and updated in June.

The fundamental role of radiation for the diagnosis of paediatric illness is unquestionable. The benefits of radiological studies far outweigh the radiation risks when these studies are properly justified and performed. Justification and optimisation of radiological studies are the mainstays of radiation protection, particularly in children, as they are especially vulnerable to ionising radiation and have longer life spans to potentially develop long-term radiation-induced untoward effects. Therefore, healthcare providers need specific education and awareness when dealing with children who need radiological studies.

For these reasons, a Paediatric Imaging Working Group has been part of EuroSafe Imaging since its foundation in 2014. Its aim is to integrate ESR EuroSafe Imaging activity, promote safety and quality in paediatric medical imaging, support the appropriateness of paediatric radiologic examinations, promote the use and update of dedicated diagnostic reference levels, develop e-learning material to boost a safety culture in radiologic imaging of children, and improving communication with parents.

Since its foundation, the EuroSafe Imaging Paediatric Imaging Working Group has had a number of successes.

In cooperation with the ESR Imaging Referral Guidelines Working Group, referral criteria for paediatric imaging were adapted from the appropriateness criteria of the American College of Radiology and implemented in the ESR iGuide. The aim of this was to improve appropriateness in paediatric diagnostic radiology. ESR iGuide is currently available for free as web-based stand-alone decision support system for all ESR radiologist members.

The Paediatric Imaging Working Group, together with the European Society of Paediatric Radiology, participated in the PiDRL tender project (European Guidelines on Diagnostic Reference Levels for Paediatric Imaging). This 27-month project was sponsored by the European Commission and awarded to a consortium headed by the ESR, which included the European Federation of Radiographer Societies, the European Federation of Organisations for Medical Physics, and the Finnish Radiation and Nuclear Safety Authority. The specific objectives of the project were:

  1. to agree on a methodology for establishing diagnostic references levels for paediatric imaging, including plain radiography, fluoroscopy, CT and interventional radiology procedures;
  2. to update and extend the European diagnostic reference levels to cover more procedures and a wider patient age/weight range based on current knowledge.

The results of this project are now available in issue 185 of the European Commission’s Radiation Protection Series.

Since 2015, the Paediatric Imaging Working Group has regularly produced a series of tips & tricks for paediatric imaging. These publications are aimed at professionals and parents. They provide information on how to deal with common issues concerning radiation protection in children. These tips & tricks are freely available on the EuroSafe Imaging website and are also available on the ESR’s e-learning platform ‘Education on Demand’ as CME accredited courses.

Justification is one of the fundamental principles of radiation protection, especially in children. For this reason, the latest activity of the Group concerns a European-wide survey amongst radiologist members of the ESR to assess the awareness and availability of referral guidelines for justification of medical imaging in children, in addition to gathering information about their use in clinical practice. The results of this survey are due to be published shortly.

Claudio Granata has devoted his career to paediatric radiology. Currently, he is responsible for paediatric oncologic imaging at Giannina Gaslini Children’s Hospital in Genoa, Italy. He is also the lead of the ESR EuroSafe Paediatric Imaging Working Group and the incoming president of the Section of Radiobiology and Radiation Protection of the Italian Society of Medical Radiology.