Clinical Audit

Improving the quality of patient care through systematic review against defined standards

The ESR perspective on clinical audit

The ESR cooperates with institutions including the European Commission and the Heads of the European Radiation Protection Competent Authorities (HERCA) to ensure that clinical audit is applied properly to improve quality of patient care in Europe, but also to understand the regulators’ perspective for its efforts regarding audit.

In the context of the implementation of the Basic Safety Standards Directive, the ESR works with stakeholders to increase awareness of clinical audit among radiologists and to provide radiology departments with a toolkit to perform audits effectively.

The ESR Clinical Audit booklet - Esperanto 2022

The ESR Audit and Standards Subcommittee, under the guidance of David Howlett, Chair of the ESR Audit and Standards Subcommittee, and Núria Bargalló, Chair of the ESR Quality, Safety and Standards Committee, has developed the updated 3rd Edition of Esperanto, ESR Guide to Clinical Audit in Radiology.

This third iteration of Esperanto offers an enhanced clinical audit guide and an expanded section of audit templates. The purpose of this document is to further increase awareness and understanding of clinical audit within radiology departments across Europe and to support departments in developing effective clinical audit practice and processes.

The Esperanto booklet was named after the most successful constructed language in the world, Esperanto, created by the Polish ophthalmologist Ludwik L. Zamenhof, and offers an overview of the ESR Clinical Audit initiative.

Have you used the ESR’s template in your department? We’d be happy to hear about your experience! 

Esperanto is available in the following languages: English and Hungarian.

More information:

ESR-led projects

Audit Templates

Download our audit templates here:

List of audit templates:

  1. Complication rates and diagnostic adequacy rates for percutaneous CT guided lung biopsy
  2. Record of safety checklist and patient consent prior to interventional procedures
  3. Adequate discussion of treatment proposals of oncological patients in a multi-disciplinary meeting (MDM)/tumour board
  4. Improving referral process and guidelines – specific target: implementation of referral guidelines through iGuide – integrated directly into hospital ordering systems
  5. Protocols around radiological procedures, information in reports
  6. The practice of ‘routine’ preoperative chest X-rays
  7. Audit appropriateness of inpatient chest X-rays or abdominal X-rays
  8. What percentage of non-ionising imaging studies (MR/ultrasound) are consistent with referral guidelines
  9. Pain sensation during image-guided interventions
  10. Image quality in radiography
  11. Image quality in CT
  12. Justification of head CT
  13. Incidence of contrast extravasation during CT injection and impact on patients
  14. Impact of patient misidentification errors and subsequent error rates of this type
  15. Reject analysis of radiological images
  16. Impact of a local training programme on first line reporting accuracy by junior doctors
  17. Auditing the Appropriateness of CT referrals
  18. Adequate completion of radiology request forms for X-ray and CT
  19. Impact of departmental CT dose reducing protocol on image quality and diagnostic confidence
  20. Impact of variation in volume of injected contrast in CT on image quality, diagnostic confidence and dose
  21. Impact of adjusting frame/pulse rate in fluoroscopy on image quality, diagnostic confidence and dose
  22. Adequacy of CT colonography (insufflation/bowel preparation)
  23. Adequacy of irradiation beam size (collimation) in projection radiography
  24. Radiographic image labelling – use of anatomical side markers for projection radiography
  25. Reject rate for projection radiographs
  26. Existence of predetermined CT technical protocols for each specific indication
  27. How dose information should be transmitted to the patient
  28. Follow-up of patient with high skin dose as a result of an interventional procedure
  29. Key points on how to manage patient radiation protection
  30. Waiting time for outpatient ultrasound appointments
  31. Does the radiology department record statistics about patient satisfaction?

List of audit templates:

  1. Is there a departmental mechanism for providing patients (or their representative) with information relating to the risk/benefits associated with radiation dose from the medical exposure?
  2. Is there an established mechanism within the department to register and analyse accidental /unintended exposure?
  3. Is there a departmental policy for informing patients, or their representative, that they have undergone and accidental exposure?
  4. Is there a mechanism for record keeping and retrospective analysis of accidental or unintended medical exposures?
  5. Is there a mechanism for referring accidental exposure events to the medical physics expert (MPE) and informing the competent authority of significant events?
  6. Does the department utilise criteria, provided by the relevant radiation protection competent authority, for what constitutes an accidental or unintended significant exposure?
  7. Is there evidence of appropriate training for individuals (particularly non-radiologists) with responsibility for justification?
  8. Is there a departmental mechanism to confirm as necessary with the patient or patient representative and document the non-pregnancy status of individuals undergoing medical exposures?
  9. Is there a written protocol for the identification of who is responsible for the justification process?
  10. For radiation exposure related to health screening by invitation on asymptomatic individuals, is there a local policy affirming justification by a competent authority?
  11. What percentage of examinations involving ionising radiation are justified in advance of being performed?
  12. What mechanism exists on the request form for contacting referrers to permit pre-exposure justification discussions to occur if necessary?
  13. Is there a written protocol for who may be responsible for justification of X-ray / fluoroscopic / interventional ionising radiological procedures?
  14. Is there a written protocol for who may be responsible for justification of CT examinations?
  15. What mechanism is used to evaluate patient dose in high-dose procedures?
  16. What percentage of radiodiagnostic procedures have established diagnostic reference levels (DRL)?
  17. Specific technical requirements for equipment in use for medical exposures.
  18. Eye lens dose limits for occupational exposure.
  19. Initial education and training in radiation protection.
  20. Audit of education plus training in radiation protection, doses and side effects.
  21. Provision of clinical information to support justification.
  22. Staff dosimetry audit – this includes a draft adapted questionnaire.
  23. Evaluation of the role and responsibilities of the medical physics expert.

Become A Member Today!

You will have access to a wide range of benefits that can help you advance your career and stay up-to-date with the latest developments in the field of radiology. These benefits include access to educational resources, networking opportunities with other professionals in the field, opportunities to participate in research projects and clinical trials, and access to the latest technologies and techniques. 

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for radiologists, radiology residents, professionals of allied sciences (including radiographers/radiological technologists, nuclear medicine physicians, medical physicists, and data scientists) & professionals of allied sciences in training residing within the boundaries of Europe

  • Reduced registration fees for ECR 1
  • Reduced fees for the European School of Radiology (ESOR) 2
  • Option to participate in the European Diploma. 3
  • Free electronic access to the journal European Radiology 4
  • Content e-mails for all ESR journals
  • Updates on offers & events through our newsletters
  • Exclusive access to the ESR feed in Juisci

€ 11 /year

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for radiologists, radiology residents or professionals of allied sciences engaged in practice, teaching or research residing outside Europe as well as individual qualified professionals with an interest in radiology and medical imaging who do not fulfil individual or all requirements for any other ESR membership category & former full members who have retired from all clinical practice
  • Reduced registration fees for ECR 1
  • Option to participate in the European Diploma. 3
  • Free electronic access to the journal European Radiology
  • Content e-mails for all 3 ESR journals 4
  • Updates on offers & events through our newsletters
  • Exclusive access to the ESR feed in Juisci

€ 0

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  • Content e-mails for all 3 ESR journals 4
  • Updates on offers & events through our newsletters

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Reduced registration fees for ECR 2025:
Provided that ESR 2024 membership is activated and approved by August 31, 2024.

Not all activities included
Examination based on the ESR European Training Curriculum (radiologists or radiology residents).
European Radiology, Insights into Imaging, European Radiology Experimental.