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

(project accepted under the 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 a multidisciplinary consortium including the EANM, ESR and ESTRO.


QuADRANT aims to promote constant improvement in the quality and safety of radiology, radiotherapy and nuclear medicine by implementing clinical audits 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 the Member States and available guidance and resources for clinical audits at national, European and international levels;
c) provide further guidance and recommendations on improving the implementation and integration of clinical audits into national healthcare systems;
d) identify the potential for further coordinated EU action on the 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 audits “in accordance with national procedures”, making clinical audits in support of the implementation of BSSD requirements a legal necessity. A 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 seek 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 that may be responsible for the external coordination of an 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

Work Programme & Reports

Information on the QuADRANT Work Programme (WP) can be found here. In addition, reports, such as the WP2 Workshop Report, are available under the respective work packages (WP 1-5).

The main findings have been summarised in a publication of the European Journal of Nuclear Medicine and Molecular Imaging (EJNMMI) in May 2023, accessible here.

In addition, the QuADRANT full report is available in the European Radiation Protection Series No. 198, accessible here.




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

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