Graciano Paulo

To enhance patient safety in nuclear medicine (NM) across Europe by operationalising MARLIN recommendations for implementing incident learning systems (ILSs), including barriers/enablers and practical implementation guidance. A mixed‑methods study (combining a survey, semi‑structured interviews, and a targeted literature review) was performed within the MARLIN project. This was a 24‑month initiative conducted under the European Commission's Strategic Agenda for Medical Ionising Radiation Applications (SAMIRA) Action Plan, involving European organisations such as EANM, EIBIR, ESTRO, and EFOMP. Surveys were distributed to Clinical Facilities (CFs), Competent Authorities (CAs), and professional societies (PSs). Interviews were used to explore implementation barriers and examples of good practice. Data were analysed using descriptive statistics and thematic analysis. The study revealed significant variability in the criteria for defining and reporting significant radiation events in NM across Europe. While all surveyed countries had designated authorities for managing reported events, only 11/23 had specific criteria for NM. The study identified key enablers and barriers to ILS implementation, including the need for a just culture to encourage reporting without fear of punitive measures. The guidelines recommended criteria for significant radiation events in NM and the organisation of ILSs. The MARLIN study provides a comprehensive framework for the systematic implementation of ILSs in NM, highlighting the importance of standardised reporting criteria in several categories, multidisciplinary involvement, and a culture of safety. Addressing the identified barriers and promoting a coordinated effort among stakeholders are crucial for enhancing patient safety in NM across Europe.

Background and purposeIncident Learning Systems (ILSs) are central to patient safety in radiotherapy (RT), enabling learning from adverse events and near misses. Despite EU regulatory legal requirements, substantial variability persists across Europe in the implementation and effectiveness of ILSs in RT. This paper presents RT-specific recommendations derived from the MARLIN study to support harmonised, risk-informed implementation of ILSs.MethodsThe 24-month MARLIN study conducted under the SAMIRA Action Plan, employed a structured literature review, an online European survey of clinical facilities, competent authorities and professional societies, expert interviews, and a multi-stakeholder consensus workshop. Survey data from 172 respondents in 28 countries were analysed to identify current practices, barriers and enabling factors for ILS implementation in RT.ResultsAlthough all responding countries reported transposition of the Directive, marked heterogeneity was observed in criteria for reporting significant RT events, feedback mechanisms and use of international databases. Fear of punitive consequences, limited resources, lack of training in incident analysis and insufficient dissemination of lessons learned were identified as key barriers. External-beam radiotherapy showed more mature ILS implementation than brachytherapy. MARLIN recommends category-based event classification, RT-specific taxonomies, multidisciplinary local incident-learning committees, and stronger collaboration between clinical facilities, competent authorities and professional societies.ConclusionThe MARLIN recommendations provide a practical framework to strengthen ILS implementation in RT, promote a just culture, enhance learning from incidents and support regulatory compliance, ultimately improving patient safety and quality of care across Europe.

Purpose: Since the initial edition of this Guideline was published in 2010, it has become increasingly clear that occupational protection involves more than just radiation protection. Additionally, radiation exposure to operators and staff occurs from sources other than fluoroscopy. This Guideline has been updated to incorporate these topics and to reflect new information on occupational protection in interventional radiology. Methods: The CIRSE Standards of Practice Committee, in conjunction with SIR, established a writing panel of twelve clinicians, medical physics experts, and others with internationally recognised expertise in occupational protection in interventional radiology. The writing panel identified regulations, guidelines, and radiation protection documents from international and national sources, including governments, radiation protection organizations, and professional associations. Additionally, the writing panel performed a pragmatic search on PubMed for relevant studies published in English between 2011 and 2025. The final recommendations were developed by consensus. Results: The revised Guideline provides advice and guidance to physicians, radiographers, nurses, medical physics experts, and all other staff involved in interventional radiology. It also includes an online-only Annex with additional, in-depth coverage of several of the included topics.

Background: Advanced imaging techniques play a pivotal role in oncology. A large variety of computed tomography (CT) scanners, scan protocols, and acquisition techniques have led to a wide range in image quality and radiation exposure. This study aims at implementing verifiable oncological imaging by quality assurance and optimization (i-Violin) through harmonizing image quality and radiation dose across Europe. Methods: The 2‑year multicenter implementation study outlined here will focus on CT imaging of lung, stomach, and colorectal cancer and include imaging for four radiological indications: diagnosis, radiation therapy planning, staging, and follow-up. Therefore, 480 anonymized CT data sets of patients will be collected by the associated university hospitals and uploaded to a repository. Radiologists will determine key abdominopelvic structures for image quality assessment by consensus and subsequently adapt a previously developed lung CT tool for the objective evaluation of image quality. The quality metrics will be evaluated for their correlation with perceived image quality and the standardized optimization strategy will be disseminated across Europe. Results: The results of the outlined study will be used to obtain European reference data, to build teaching programs for the developed tools, and to create a culture of optimization in oncological CT imaging. Conclusion: The study protocol and rationale for i‑Violin, a European approach for standardization and harmonization of image quality and optimization of CT procedures in oncological imaging, is presented. Future results will be disseminated across all EU member states, and i‑Violin is thus expected to have a sustained impact on CT imaging for cancer patients across Europe.

In March 2021 the International Atomic Energy Agency (IAEA) organised an online Technical Meeting on Developing Effective Methods for Radiation Protection Education and Training of Health Professionals with attendance of 230 participants representing 66 Member States and 24 international organizations, professional bodies and safety alliances. By means of a pre-meeting survey, presentations by experts, topical panel discussions and post-meeting feedback to the meeting summary, the meeting identified strengths, common weaknesses and possible solutions and actions for improving radiation protection education and training of health professionals. Available guidelines and resources for radiation protection training were also reviewed. The meeting discussion resulted in a strong consensus for the need of: (a) international guidance on education and training in radiation protection and safety for health professionals, (b) an international description of minimum standards of initial and ongoing competence and qualification in radiation protection for relevant professional groups, considering the available recommendations at international and regional levels. The proposed actions include provisions for train-the-trainer credentialing and facility training accreditation, balance betwee the online and face-to-face training, improved on-the job training, as well as improved inclusion in training programmes of aspects related to application of new technologies, ethical aspects, development of communication skills, and use of software tools for improving justification and optimisation. The need for making the ongoing training practical, applicable, and useful to the trainee was highlighted. The international consultation initiated by the IAEA was appreciated as a good approach to understand and promote coordination and collaboration at all levels, for best results in education and training in radiation protection of health professionals. Implementing such a holistic approach to education and training in radiation protection would contribute towards qualification and competence of health professionals needed to ensure application of high standards for quality and safety in medical uses of ionizing radiation.