ESTRO collaborates with several partners in the oncology field.


ESTRO has been collaborating with SIOP Europe on one of the work packages – dedicated to paediatric cancer –within the frame of the EU Joint Action on Rare Cancers (2016 – 2019, EU Health Programme) .

The Joint Action on Rare Cancers (JARC) is an initiative aiming to formulate policy recommendations on rare cancers – including paediatric malignancies – that can be implemented by Member States and in relevant EU initiatives.

The group of experts, where ESTRO representatives are included, has been mapping the radiotherapy (RT) paediatric guidelines availability and the departments in Europe providing RT to children. A paper has been published, addressing the delivery of good clinical practice compliant treatment in paediatric radiation oncology with a focus on patient-related care, education and training: Recommendations for the organisation of care in paediatric radiation oncology across Europe: a SIOPE–ESTRO–PROS–CCI-Europe collaborative project in the framework of the JARC.

“Constant improvement in quality and safety of radiology, radiotherapy and nuclear medicine through clinical audit”

(project accepted under call for tenders N° ENER/D3/2019-231-2)

The proposed 30-month European Commission tender project QuADRANT started in January 2020 and is led by the European Society of Radiology (ESR) together with the European Association of Nuclear Medicine (EANM) and the European SocieTy for Radiotherapy and Oncology (ESTRO) as consortium partners.

13th and 14th January 2022 : QuADRANT WP4 workshop

Work package 4 is responsible for preparing and organising a workshop, to discuss with representatives of Member States the need for further coordinated EU action on quality and safety of radiology, radiotherapy and nuclear medicine.
Consult here the programme, and click here to register for the workshop

QuADRANT workshop report
Read here the workshop report of workpackage 2: “Constant improvement in quality and safety of radiology, radiotherapy and nuclear medicine through clinical audit”

QuADRANT WP2 report


QuADRANT aims to promote constant improvement in quality and safety of radiology, radiotherapy and nuclear medicine through the implementation of clinical audit as part of Member States’ healthcare systems. More specifically, the project will
a) review the status of implementation of clinical audits in the Member States;
b) identify good practices in Member States and available guidance and resources for clinical audits, at national, European and international level;
c) provide further guidance and recommendations on improving the implementation and integration of clinical audits into national healthcare systems;
d) identify potential for further coordinated EU action on quality and safety of radiology, radiotherapy and nuclear medicine.


The updated Euratom legislation as outlined in the Basic Safety Standards (BSS) Directive 2013/59/Euratom, following on from an earlier directive, addresses the field of medical ionising radiation exposure and protection. The BSSD is broad ranging in its requirements and has major implications for European radiological, nuclear medicine and radiotherapy practice.

Key areas include:

  • Setting out generic safety standards for protection against ionising radiation exposure
  • Emphasising the need for justification and optimisation of medical exposure
  • Introducing/strengthening patient information requirements
  • Reinforcing/strengthening the requirements for recording and reporting doses relating to radiological procedures, also including accidental or inadvertent exposures, and for the setting up of Diagnostic Reference Levels (DRLs)

Importantly the BSSD, like its predecessor Directive, also specifically mandates carrying out clinical audit “in accordance with national procedures”, making clinical audit in support of implementation of BSSD requirements a legal necessity. Clinical audit is a well-established tool within modern healthcare and a key component of effective clinical governance, which can be used to improve patient care, safety, experience and outcomes. Clinical audit is defined within the BSSD as “a systematic examination or review of medical radiological procedures that seeks to improve the quality and outcome of patient care through structural review, whereby medical radiological practices, procedures and results are examined against agreed standards for medical radiological procedures, with modifications of practices, where appropriate and the application of new standards if necessary.” The term “medical radiological practices” also encompasses hybrid imaging, interventional cardiology procedures, nuclear medicine and radiotherapy techniques.


All three consortium partners work collaboratively with other organisations, including national and specialist societies and via their memberships, to promote and enhance BSSD compliance, and support clinical audit practice.

A pan-European study is timely to evaluate current levels of BSSD compliance and the development of supporting clinical audit processes, to understand why clinical audit’s use is so limited, and how to improve its broader implementation and to foster its full integration into existing audit programmes in healthcare. The study involving not only professional and national societies who may be responsible for external coordination of audit, but also other auditing organisations, competent authorities and health authorities. The EANM, ESR and ESTRO are well-placed to direct this undertaking using their knowledge and expertise in this field and their extensive professional networks; each associated medical speciality (Nuclear Medicine, Radiology, Radiation Oncology) is likely to have different experiences and requirements.

Learn more about QuADRANT.

The project has received funding from the European Commission under Service Contract N° ENER/2019/NUCL/SI2.816093.



Under the aegis of the European Cancer Organisation, and led by Prof Yolande Lievens, a working group on value based healthcare has been established, focusing on the applicability of existing value frameworks in the pharmaceutical sector towards non-systemic oncology treatment (e.g. radiation oncology and surgery). ESTRO experts are involved.

As a result, an article has been published “Towards an evidence-informed value scale for surgical and radiation oncology: a multi-stakeholder perspective” in which the case for improving health system understanding of the value of non-systemic oncology treatment is made with reference to scales for this purpose developed for systemic treatment. More information here.