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IAEA "X-Ray Vision" Conference: A Global Safety Milestone

Report from IAEA Radiation Protection in Medicine: X-Ray Vision meeting
8-12 December 2025

Background

Over 650 participants from more than 120 countries attended the International Atomic Energy Agency (IAEA) conference titled Radiation Protection in Medicine: X‑Ray Vision in Vienna, Austria. Attendees comprised medical professionals, regulators, patient representatives, researchers, and any others who shared an interest in radiation protection in healthcare. The conference provided a global forum to review progress, share experience, and identify priorities for the future of radiation protection in medicine.¹

This was the fourth conference in the series; it followed meetings in Malaga, Spain (March 2001), Bonn, Germany (December 2012) and Vienna, Austria (December 2017). Previous conferences had resulted in two landmark initiatives: the IAEA International Action Plan on the Radiation Protection of Patients² and the Bonn Call for Action,³ both of which have significantly influenced radiation protection policy and practice worldwide.

Mary Coffey, of Trinity College Dublin, Ireland, was the Conference President and the first female to hold the position in the conference series. Professor Coffey is chair of the working group on the Radiation Oncology Safety Education and Information System and a key member of ESTRO’s radiation oncology safety and quality committee (ROSQC).

Aims of the Conference

The primary objectives of the conference were to evaluate developments in radiation protection since the Bonn Call for Action, to assess whether the existing actions remained valid, and to determine whether a revised or updated call to action was required. Where appropriate, the conference sought to identify emerging themes that should shape radiation protection strategies over the next decade.

ESTRO and ROSQC Contribution

ESTRO was an official cooperating organisation for the conference. Carl Rowbottom, representing ROSQC, presented ESTRO’s work on radiation protection. The presentation highlighted ESTRO’s leadership in strengthening safety culture in radiation oncology and in promoting good radiation protection practices across the radiotherapy pathway.

A focus of the presentation was the distinction between radiation protection principles in therapeutic and diagnostic practices. While radiation protection in diagnostic practices places strong emphasis on minimising radiation dose to individuals, therapeutic practice involves the deliberate delivery of high radiation doses to achieve clinical benefit. In this context, the principles of justification and optimisation must be applied in a way that balances tumour control against acceptable levels of normal tissue toxicity, while maintaining a clear focus on patient safety and treatment quality.

Conference Themes and Topics

The conference addressed a broad range of topics relevant to radiation protection in modern medical practice, including:

regulatory frameworks and international guidelines;
technological developments that support improved radiation protection;
clinical decision‑making and justification for medical exposures;
safety culture, incident learning, and reporting systems; and
ethical considerations in radiation protection.

The conference also considered the global availability of competent professionals in radiation protection and the practical challenges of implementing radiation protection principles in diverse healthcare settings. Emerging technologies and practices, including artificial intelligence (AI), radiopharmaceutical therapy, and theranostics, were recognised as areas that will require particular attention in the next decade from a radiation protection perspective.

Main Conclusion of the Conference

The conference concluded that the actions set out in the Bonn Call for Action remained valid and relevant. However, there was a strong consensus that a contemporary update was needed to reflect changes in healthcare delivery, technology, and workforce challenges. As a result, the development of a new “Bonn+” Call for Action was endorsed, which would be aimed at guiding radiation protection in medicine over the next decade.

Emerging themes that members expected to be incorporated into Bonn+ include:

development of a more individualised, patient‑centred approach to radiation protection;
full integration of ethical principles into radiation protection practice;
the need for strengthened communication skills to support informed discussions of benefits and risks;
ways to ensure the safe and reliable use of AI in radiation protection contexts; and
ways to maintain a competent and sustainable workforce across all medical radiation disciplines.

The Bonn+ Call for Action is expected to be developed within the next 12–18 months. The IAEA emphasised the importance of collaboration in both the formulation and implementation of the updated framework.¹

Next Steps

As a cooperating organisation, ESTRO intends to continue its active involvement in the development of the Bonn+ statement and to support the statement’s dissemination and implementation once published. ROSQC will take part in these discussions to ensure that radiation oncology perspectives are fully represented and that patient safety and quality remain central to future international guidance.

Carl Rowbottom, PhD, MBA, FIPEM

Member of ROSQC

Director of Physics, The Clatterbridge Cancer Centre, NHS Foundation Trust

Visiting Professor, University of Liverpool

Liverpool, UK

References