February 2023

The ESR is delighted to announce that the outcomes of the QuADRANT project, which was launched in January 2020 and successfully concluded in July 2022, have now been published by the European Commission as part of their Radiation Protection Series.

The new publication, ‘Current status and recommendations for improving uptake and implementation of Clinical Audit of Medical Radiological Procedures: QuADRANT, a European study on Clinical Audit of Medical Radiological Procedures’ provides an overview of European clinical audit implementation; identifies good practices and resources; provides guidance and recommendations to improve clinical audit uptake; and, identifies potential for European action on quality and safety in the three project disciplines, radiology, radiotherapy, nuclear medicine.

The project was 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. It was founded upon the Basic Safety Standards Directive (BSSD) 2013/59/Euratom, which sets out the EU legal framework for protection of human health against the harmful effects of ionising radiation exposure.

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.” Clinical audits are part of a continuous, dynamic learning and supportive process where continuous improvement is the goal and the BSSD requires that clinical audit be implemented in EU Members States ‘in accordance with national procedures.’ Nevertheless, clinical audit has not been implemented widely. The QuADRANT project evaluated 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. QuADRANT also forms an important component of the European Commission SAMIRA initiative, a part of the wider Beating Cancer plan.

National stakeholders (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) gathered at an online workshop held in December 2020 to discuss and raise awareness of the legal requirements, as well as the benefits of, clinical audit in diagnostic and interventional radiology, nuclear medicine, and radiotherapy. This was followed by an extensive survey into the implementation of clinical audit in the Member States, conducted between March and May 2021, which sought to identify potential barriers to effective participation in clinical audit and what provisions/changes might facilitate improvement in the 27 EU Members States as well as Iceland, Norway, Switzerland and the UK. The survey findings were then presented at a second online workshop held in January 2022. The information gathered in the survey, as well as information gathered at the workshops and through interviews with leading experts on clinical audit and radiation safety, lead to the projects final outcomes, which the European Commission published in January 2023 as Radiation Protection Series No.198.

Professor David C. Howlett, the QuADRANT project leader states: “QuADRANT was an important project, led by the ESR on behalf of the European Commission, evaluating the current status of clinical audit uptake and implementation across Europe. QuADRANT was multi-society and multi-professional in nature and it is a great credit to all those involved that QuADRANT was completed on time and so successfully fulfilled its objectives despite the challenges of the COVID pandemic. QuADRANT has identified key challenges and barriers to clinical audit within existing healthcare systems, but has also highlighted many areas of good practice, as well as valuable European and international resources in clinical audit. The project final document makes a series of recommendations for the use of the European Commission, aiming to improve clinical audit awareness and involvement across Europe. QuADRANT can act as an important step forwards, enhancing patient safety, experiences, and outcomes.”

A dedicated session on the QuADRANT project has been planned for the ECR 2023.

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Mr. David ZIZKA
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Phone: +43‐1‐5334064‐545
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