Training Professionals to Enhance Collaboration in Cancer Care

INTERACT-EUROPE 100 is an ambitious project aimed at providing cancer care professionals with the training necessary to enhance collaboration between the various specialties and professions involved in cancer treatment, including radiation oncologists, surgical oncologists, medical oncologists, cancer nurses, and many others.

The project promotes a patient-centered approach to quality cancer care through the development of multidisciplinary and multi-professional teams.

Project Details:

• Duration: December 2023 – December 2026 (36 months)
• Funding: Co-funded by the European Union under the EU4Health programme 2021-2027, as part of Europe’s Beating Cancer Plan
• Partners: 38 partner organisations from 15 European countries
• Objective: Implement a novel training curriculum for cancer care professionals

ESTRO’s role in INTERACT-EUROPE 100:

ESTRO is involved in various work packages of the project, particularly contributing to WP2 "Programme Design and Development" and WP3 "Programme Delivery."

In Work Package 2, led by Universitätsklinikum Heidelberg (UKHD), Heidelberg University of Education (HUE), and Turku University of Applied Sciences (UAS), ESTRO contributes to content creation and the development of modules and comprehensive resources for the inter-specialty training programme, with a special focus on radiation oncology.

In Work Package 3, led by the European School of Oncology (ESO), ESTRO supports the programme's delivery by providing experts for the Train the Trainers sessions at cancer centres.

ESTRO experts are involved in the following capacities and work packages:

• Luca Boldrini, Rome/IT – ESTRO representative for INTERACT 100
• Kim Benstead, Gloucestershire/UK – ESTRO representative for INTERACT 100
• Mario Levis, Turin/IT – ESTRO representative WP2
• Pierfrancesco Franco, Novara/IT – ESTRO representative WP3

Join INTERACT-EUROPE 100:

INTERACT-EUROPE 100 is currently recruiting 100 cancer centres from across Europe. Apply now to be among the 100 participating centres and offer your cancer care professionals an array of multidisciplinary training opportunities over the next three years.

Application Deadline: 30 September 2024

For more information and to apply, please visit the INTERACT-EUROPE 100 webpage: Impact - INTERACT-EUROPE 100 - European Cancer Organisation

Co-funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the European Health and Digital Executive Agency (HaDEA). Neither the European Union nor the granting authority can be held responsible for them.

SAMIRA study on the definition of Key Performance Indicators on Quality and Safety of medical applications of ionising radiation

This 24-month project was started February 2024 in response to the European Commission (EC) Directorate General for Energy’s (DG ENER) call for tenders for a Strategic Agenda for Medical Ionising Radiation Applications (SAMIRA) study on the definition of Key Performance Indicators (KPI) on Quality and Safety of medical applications of ionising radiation. Part of the SAMIRA action plan, the objective is to propose a set of common quality and safety indicators, focusing on the definition of KPI in the Quality and Safety of medical applications of ionising radiation. The key goal of the study will be to develop a common set of indicators that provide a quantitative and/or qualitative assessment of the effects and practical aspects of implementation of relevant Basic Safety Standards Directive (BSSD) requirements. The indicators should also allow evaluation of the effect of SAMIRA actions at the national and EU level.

Medical uses of ionising radiation are an essential component of modern medical diagnosis and treatment. However, there are high levels of heterogeneity regarding hospitals, health systems and applications for ionising radiation throughout European member states. There are also remarkable discrepancies in both access to equipment and the availability of appropriately educated staff to operate equipment safely.

This tender is proposed by the Technopolis Group in collaboration with the European Association of Nuclear Medicine (EANM), European Society of Radiology (ESR), European Society for Radiotherapy and Oncology (ESTRO), and individual experts. The consortium brings together the main European stakeholders with experience working in the medical application of ionising radiation.

ESTRO experts involved in this project:

• Dr. Cristina Garibaldi – Milano/IT
• Dr. Núria Jornet – Barcelona/ES
• Prof. Philippe Maingon – Paris/FR

OPTIMIZE-RT - Education programme to OPTIMIZE imaging doses in RadioTherapy CBCTs

The OPTIMIZE-RT project aims to improve the safety and effectiveness of radiotherapy for cancer patients by focusing on Cone-Beam Computed Tomography (CBCT) imaging. Daily CBCT scans are essential to ensure that radiotherapy treatments are delivered accurately, but they also expose patients to additional radiation, which increases the risk of developing secondary cancers. It is therefore critical that CBCT imaging is carefully optimised to deliver only the necessary radiation. OPTIMIZE-RT seeks to make CBCT optimisation training widely accessible to radiotherapy professionals.

Building on research conducted to identify the most effective methods for optimising CBCT imaging, the project will develop an educational programme to train radiotherapy professionals. All training materials will be freely available, and the programme will be piloted in participating hospitals. These hospitals will implement CBCT optimisation in clinical practice and provide feedback to refine the training. A comprehensive dissemination strategy will ensure broad reach, including online campaigns, a dedicated website, conferences, multiplier events, and webinars.

OPTIMIZE-RT will deliver a fully online asynchronous course on dose optimisation in CBCT imaging for radiotherapy. All training materials, research findings, and optimisation reports will be open access, ensuring transparency and sustainability. The project aims to train 20–30 radiotherapy professionals and educators in at least eight hospitals, publish two scientific articles, and present findings at eight international conferences. From the pilot alone, the project anticipates a reduction in unnecessary radiation exposure for approximately 4,000 cancer patients each year.

The project was initiated in October 2025 and will conclude in September 2028.

ESTRO is an Affiliate Partner, represented on the project by the ESTRO RTT Committee and its committee chair Yat Man Tsang, RTT, Toronto(CA).

RHYTHM - Radiation, Health, Safety and Quality for Youth: A Comprehensive Approach to Justification, Optimisation, and Education

The RHYTHM project aims to improve the quality and radiation safety of medical imaging for children, adolescents, and young adults, with a particular focus on CT, SPECT/CT, PET/CT, and CT as part of radiotherapy planning. Recognising the sensitivity of this population to ionising radiation and the critical need for optimised imaging practices, RHYTHM targets key challenges in justification, optimisation, availability, and accessibility of imaging services.

These challenges include inappropriate imaging practices, disparities in access to dedicated paediatric imaging equipment, and insufficient education and outreach to healthcare professionals and patients.
RHYTHM aims to address these issues through an interdisciplinary and collaborative approach, involving stakeholders from healthcare, industry, regulatory bodies, and patient advocacy groups. Key objectives include the development of evidence-based recommendations for referral guidelines, clinical guidelines, clinical decision support systems, and the development of optimized imaging protocols tailored to paediatric and young adult needs.

To achieve this, RHYTHM will utilise innovative tools and a European CT dose and image repository. This repository will enable benchmarking of radiation doses and standardisation of protocols by facilitating direct comparisons of scanner settings and image quality across institutions using similar equipment.

The project will also enhance capacity building through the creation of comprehensive education and training curricula tailored to multidisciplinary professional groups. Training materials, vodcasts, and patient case-based resources will be disseminated via platforms like ESR EuroSafe Imaging, ensuring broad accessibility and sustainability. Additionally, RHYTHM will implement outreach campaigns to raise awareness about imaging safety and the benefits of optimised practices among parents, young adults, and healthcare providers.

The project was launched in October 2025 and is set to conclude in September 2029.

Beate Timmermann, Radiation Oncologist, Essen/DE, represents ESTRO on the RHYTHM Advisory Board.

For additional information on the RHYTHM project, you may also visit the website of EIBIR here.

Upright radiotherapy: Learning, Innovation, Fellowship and Training (UPLIFT)

Radiotherapy (RT) is a mainstay of modern cancer treatment. Conventionally, RT is delivered to the patient lying on a treatment couch, while a beam steering device (gantry) aims the radiation from any angle around the target. Positioning the patients in upright body posture (upRT) instead enables to orient the patient arbitrarily toward a fixed beam. This enables smaller facility footprint and reduced treatment cost, placing upRT in the core of the United Nations sustainable development goals, and opening global access to advanced treatment options: 80% of cancer patients live in countries which host only 5% of the world’s RT resources. Moreover, upRT improves patient comfort and is associated with anatomical and physiological advantages, such as reduced breathing motion. It therefore comes as no surprise that, with new upright patient positioning & imaging solutions entering the market, upRT is enjoying a surge in interest. Yet, key scientific questions remain, international guidelines for upRT are lacking, and existing RT workflows are geared to lying patients. As the first clinics adopt new upRT technologies, there is a global need for trained professionals in industry, clinics, and academia, to reach the promised benefits for patient care.

UPLIFT builds this next generation of experts by addressing key research questions related to: treatment planning, clinical workflow, and equipment design. Leveraging latest upRT technology available through our world-class consortium, UPLIFT propels Europe to the forefront of the upRT paradigm shift. UPLIFT focuses on: Learning (through its academic and clinical centres of excellence); Innovation (through its leading industrial partners); Fellowship & Training (through an outstanding cross-sector programme of workshops, secondments & mentoring). Input from patient advocacy groups and an internationally renowned advisory board will maximise its impact. UPLIFT will revolutionize modern RT, making it more human, accessible, and sustainable.

ESTRO is an Affiliated Member on this project.

https://uplift-project.eu/

Right-time Adaptive Particle Therapy Of canceR - Personalisation through anatomical plus biological adaptation

Particle therapy (PT) is technologically one of the most advanced types of radiation therapy (RT). It conforms the therapeutic dose to a localised tumour while sparing healthy tissue, but alterations in shape, position and function of the tissue in the treated area can compromise its accuracy and effectiveness. Thus, understanding and reacting to such changes via immediate treatment plan adaption is strongly required to exploit the full potential of PT with best targeting accuracy. Such adaptations could enhance treatment efficacy, impact the patients’ quality of life, and provide opportunities for further personalized treatments, technological advancements and the safe and routine implementation of other advanced PT approaches such as hypofractionation.

The advent of several commercial devices facilitating online adaption in photon-based RT initiated a profound transformation in clinical practice with the ability to effectively treat more challenging tumour cases. Similar developments are still lagging behind in adaptive PT. To catch up and to make online adaptive PT (OAPT) a sustainable treatment approach in the future, two fundamental challenges must be solved. First, it demands seamless and precise functionality and safe solutions that offer clinical benefits in the context of the economic pressure on European healthcare systems. Second, a new generation of talented professionals with diverse intellectual capabilities, equipped with transferable skills and a holistic mindset, must be educated in all fields related to adaptive PT through a multidisciplinary and intersectoral training program.

The RAPTORplus network gathers excellent research institutions, PT centres, industrial corporations and public organisations and offers a platform for interdisciplinary and inter-sectoral research, training and education of their doctoral candidates in the field of medical physics focussing on right-time adaptive PT. To facilitate right-time adaptation means to enable fast and safe online treatment adaptations and to perform it whenever beneficial in the individual context, e.g. indicated by appropriate image-based biomarkers, biological models or other response data, and to omit otherwise. Accordingly, the individual research projects tackle the cost-efficient realisation of OAPT, the technological completion regarding in situ imaging and treatment verification for a broad and safe use of OAPT, and a further treatment personalisation by biomarker-based adaptation.

The RAPTORplus network delivers a comprehensive training program built upon its combined infrastructure and expertise in academia, clinical practice, and industry. Core activities include in-person training camps, online courses, and project-specific secondments, which are enriched by modules in science communication, entrepreneurship, and science policy, and complemented by opportunities to engage in international conferences and professional networks. The educated new generation of research leaders, medical physicists, and entrepreneurs will drive innovation in the coming era of right-time adaptive PT through their strong international, cross-sector collaborations.

The project was launched in January 2026 and will conclude in December 2029. It is funded by the European Union as a MSCA Doctoral Network under the Horizon Europe research and innovation programme 2021-2027 (grant agreement number 101226720). ESTRO is an Associated Partner of RAPTORplus.

https://raptor-consortium.com

https://www.linkedin.com/company/raptor-consortium

 - Medical Applications of Radiation – Learning from Incidents and Near Misses

SAMIRA Study on Reporting and Learning from Patient-Related Incidents and Near Misses in Radiotherapy, Interventional Cardiology, Nuclear Medicine and Interventional and Diagnostic Radiology
 

Initiated January 2023 / Concluded December 2024

The 24-month MARLIN project, started 1^st January 2023, will support the implementation of Council Directive 2013/59/Euratom and provide a comprehensive description of the current status of incident reporting. It is important that the use of ionising radiation in the diagnosis and treatment of diseases is carefully monitored and measures are taken to minimise both the frequency and harm caused by accidental or unintended exposures to patients, according to the relevant articles of the Basic Safety Standards Directive (BSSD). The use of incident learning systems (ILSs), anonymous notification systems where incidents and near misses can be investigated and possible flaws in a process can be identified and rectified, will be studied with regard to their compliance with the BSSD and other regulatory requirements and their role in improving patient safety.

This tender is led jointly by the European Institute for Biomedical Imaging Research (EIBIR), the European Society for Radiotherapy and Oncology (ESTRO) and the European Federation of Organisations for Medical Physics (EFOMP).

Final project report published

It is our pleasure to announce that the final project which is titled "Recommendations for reporting and learning from patient-related incidents and near misses in radiotherapy, interventional cardiology, nuclear medicine and interventional and diagnostic radiology", is now available on the European Union Publications Office website.

🔗 Access the report here

We extend our sincere gratitude to all experts and consortium members whose dedication and expertise made this project a success.

ESTRO experts are involved in the following work packages:
ESTRO experts will co-lead WP1, lead WP2, WP3, WP4 and co-lead WP5. The ESTRO Experts are:

• Dr. Carlos Prieto, Madrid/ES

• Dr. Nicolas Pourel, Avignon/FR

• Maeve Kearney, MPH, B.Sc (Hons), Dublin/IE

• Gianfranco Brusadin MSc, Paris/FR

WP1 - Survey on the implementation of the European legal requirements on reporting and learning from patient-related incidents and near misses in radiotherapy, interventional cardiology, nuclear medicine and interventional and diagnostic radiology.

WP2 - General and practice-specific guidelines on reporting and learning from patient-related incidents and near missies in radiotherapy, interventional cardiology, nuclear medicine, and interventional and diagnostic radiology.

WP3 - Carry out consultations and agree on consensus European guidelines.

WP4 - Project workshop.

WP5 - Project management, coordination, and dissemination.

Aim

The project aims to improve the reporting and learning from patient-related incidents and near misses in radiotherapy, interventional cardiology, nuclear medicine, and interventional and diagnostic radiology. The project will meet the following specific objectives:

a) Collect and analyse up-to-date information on the implementation of Council Directive 2013/59/Euratom requirements for reporting and learning from patient-related incidents and near misses in radiotherapy, interventional cardiology, nuclear medicine, and interventional and diagnostic radiology.

b) Develop best-practice consensus guidelines on the implementation of the above Directive in radiotherapy, interventional cardiology, nuclear medicine, and interventional and diagnostic radiology.

c) Discuss the results of the work with representatives of Member States and relevant stakeholders, with the view of stimulating further national and EU wide level efforts in this area.

For further information about MARLIN, you may also visit the website of EIBIR through the link here

Publications

Strengthening incident learning in radiotherapy practice: insights from the MARLIN study

EU-REST European Union Radiation, Education, Staffing & Training
 

Initiated September 2022 - Concluded August 2024

The 24-month European Commission tender project EU-REST started in September 2022 and was completed the 31 August 2024. It intended to answer the invitation to tender addressing Call HADEA/2022/OP/0003 for a service contract regarding analysis on workforce availability, education and training needs for the quality and safety of medical applications involving ionising radiation in the EU. The action contributes to the implementation of the Europe’s Beating Cancer Plan and is also part of the actions of the Strategic Agenda for Medical Ionising Radiation Applications (SAMIRA) Action Plan.

This tender was proposed jointly by the European Society of Radiology (ESR), the European Federation of Organisations for Medical Physics (EFOMP), the European Federation of Radiographer Societies (EFRS) and the European Society for Radiotherapy and Oncology (ESTRO).

Final project report published

It is our pleasure to announce that the final project report ‘Analysis on workforce availability, education and training needs for the quality and safety of medical applications involving ionising radiation in the EU – Status and Recommendations’ has been published on the EC website.
You may access the report here.

ESTRO wishes to extend a thank you to the involved experts and the consortium for the great work in this project.

Aim of the project

The project aimed to provide an analysis of workforce availability, education, and training needs to ensure quality and safety aspects of medical applications involving ionising radiation in the EU. In addition, it foresaw the development of staffing and education and training guidelines for key professional groups involved in ensuring radiation safety and quality of medical radiation applications in the EU member states.

The project met the following specific objectives:

• Collect and analyse data on workforce availability, education, and training needs to ensure quality and safety aspects of medical applications involving ionising radiation, as well as related stakeholder mapping.
• Draft guidelines for staffing and education andtraining for medical and other professionals involved in medical radiation applications in Member States and related stakeholder consultation.
• Develop conclusions and recommendations.

ESTRO and its experts were involved with Working Packages (WP) 1, 2 & 3.
The ESTRO Experts were:

Yavuz Anacak, radiation oncologist, Izmir/TR
Nuria Jornet, medical physicist, Barcelona/ES
Michelle Leech, radiation therapist, Dublin/IE
Mary Coffey, radiation therapist, Dublin/IE
Cristina Garibaldi, medical physicist, Milan/IT
Pedro Lara, radiation oncologist, Las Palmas/ES

WP1
Data collection and analysis on workforce availability, education and training needs involving ionising radiation.

WP1 aimed to collect up-to-date data on staffing, education and training of the key professional groups involved in ensuring radiation safety and quality of medical radiation applications in Member States. The collected data covered the areas of radiology, radiotherapy, nuclear medicine and other medical practices independently utilising ionising radiation, from an educational and training standpoint, with an emphasis on procedures delivering high(er) radiation doses to patients and/or staff.

ESTRO Experts involved:
Yavuz Anacak, radiation oncologist, Izmir/TR
Nuria Jornet, medical physicist, Barcelona/ES
Michelle Leech, radiation therapist, Dublin/IE

WP 2 - Drafting guidelines for staffing and education/training.

This work package used the information collected in WP1 to form the basis of guidelines for staffing and education and training. A series of guidelines was required to be covering the three disciplines: radiology, nuclear medicine and radiotherapy. The guidelines focused on staff activities and associated workforce requirements as well as the education and training needs of all disciplines with respect to the roles and responsibilities associated with each. Following their drafting, the guidelines underwent external peer review and stakeholder consultation. The training in radiation protection was also assessed. In particular it was monitored whether the training is included in the specialisation training, or it is with an independent registration.

ESTRO Experts:
Mary Coffey, radiation therapist, Dublin/IE (Lead)
Yavuz Anacak, radiation oncologist, Izmir/TR
Cristina Garibaldi, medical physicist, Milan/IT
Nuria Jornet, medical physicist, Barcelona/ES

WP 3 - Conclusions and recommendations on the EU workforce availability.

The objective of WP3 was to provide the conclusions and recommendations on the EU workforce availability, education and training needs for the quality and safety of medical applications involving ionising radiation, for Medical Doctors, Radiographers & Radiation Therapists, Medical Physicists and other health professionals using ionising radiation.

The conclusions and recommendations are based on the deliverables from WP1 and WP2, a literature review, and the outputs from a stakeholder consultation process made through an online survey.

ESTRO Experts:
Yavuz Anacak, radiation oncologist, Izmir/TR
Pedro Lara, radiation oncologist, Las Palmas/ES
Michelle Leech, radiation therapist, Dublin/IE

WP4 - Project management, Coordination and Dissemination

This WP ensured the overall coordination of the project and monitor implementation of the proposed workplan. WP4 was also responsible for the dissemination activities in alignment with the European Commission.

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

Initiated January 2020 - Concluded July 2022

(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

Aim

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.

Background

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.

Why QuADRANT?

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.