Constant improvement in quality and safety of radiology, radiotherapy and nuclear medicine through clinical audit: the QUADRANT project - PDF Version


The European Union (EU) plays a significant role in the constant improvement in the quality and safety of radiology, radiotherapy and nuclear medicine. It recognises the importance of clinical audit through the Basic Safety Standards Directive (BSSD). Clinical audit is an important tool in effective clinical governance and is important in continuous improvement, from review of individual elements of practice to full external audit of the entire patient pathway within radiotherapy departments. The European SocieTy for Radiotherapy and Oncology (ESTRO) endorses the comprehensive external audit process that is managed by the International Atomic Energy Agency (IAEA) quality assurance team for radiation oncology (QUATRO), and many ESTRO members are active participants in this programme. The most important point of clinical audit is that it is a tool for quality improvement and not a regulatory process. The aim of an audit is to work with staff to identify areas in which improvement would be of benefit and to assist with the implementation of appropriate changes. It is important that all professionals who are key to the preparation and delivery of radiotherapy are committed to the audit process and are active participants in order to achieve a successful outcome.

However, the implementation of clinical audit at a national level across EU member states varies. To try to address this issue, the European Commission (EC) invited professional organisations to tender submissions. The aim was to consider ways in which the best elements of audit practices could be identified and to enable implementation so that all European patients could benefit. 

The European Society of Radiology (ESR) in collaboration with ESTRO and the European Association of Nuclear Medicine (EANM) have won a contract to carry out an evaluation of current clinical audit activities in radiology, radiotherapy and nuclear medicine across EU member states and to make recommendations and offer guidance to the EC. The work consists of five work packages, which include: an initial workshop to evaluate current practice; a survey of current practice and experience of audit implementation; and a follow up workshop to present the findings of the survey and generate discussion of potential future guidelines. The final work package will prepare recommendations and guidance for the EC and set a basis for improvement of the implementation and integration of clinical audit into national healthcare systems. 

The ESTRO representatives on the project are Michael Brada, Professor of radiation oncology at the Clatterbridge Cancer Centre in Merseyside, UK, and a former president of ESTRO; Primoz Strojan of the Institute of Oncology in Ljubljana, Slovenia; and Mary Coffey, Adjunct Associate Professor in radiation therapy at Trinity College, Dublin, Ireland, and chair of ESTRO’s radiation oncology safety committee; all three lead or co-lead individual work packages. The three ESTRO representatives will work together to ensure that the radiotherapy component of the project is comprehensive and appropriate for the speciality. 

The work started with a meeting with EC representatives in Luxembourg in February just before the shutters of the lockdown closed. To date, despite the intervention of Covid-19, the work has progressed with a survey and a proposal for a programme for the first workshop. This workshop may become a virtual meeting, depending on the pandemic.

The QuADRANT project is important for radiotherapy and is in line with the vision of ESTRO to support the highest quality of treatment and care for all cancer patients across Europe.

QuADRANT is funded by the EC tender contract N° ENER/2019/NUCL/SI2.816093

Michael Brada, Mary Coffey and Primoz Strojan

ESTRO representatives


Michael Brada
Professor of Radiation Oncology
Clatterbridge Cancer Centre
Liverpool, UK


Mary Coffey
Adjunct Associate Professor
Radiation Therapy
Trinity College
Dublin, Ireland


Primoz Strojan
Institute of Oncology
Ljubljana, Slovenia