Current evidence of BSSD compliance 

• In November 2018 an ESR survey [1] was conducted to identify the current status of uptake of the BSSD requirements. 
• It involved all radiology departments within EuroSafe Imaging Star Network (64% participation rate; 66 out of 103 departments of with 51 were from the EU). 
• The survey covered the key radiation protection aspects defined by BSSD and also the supporting processes of clinical audit/re-audit.  Specifically: (1) justification processes and patient information requirements, (2) use of diagnostic reference levels (DRLs) and more stringent requirements around recording and reporting doses from radiology procedures, (3) new dose limits for eye and for occupational/student exposures and (4) clarification of the role of the medical physics expert. 
• Results from the survey demonstrated poor compliance with most of the key BSSD radiation protection targets and there was a lack of supporting clinical audit process in place. 
• Only one area (the ability of CT equipment to record patient dose) had 100% compliance.
• Areas around DRLs demonstrated relatively the highest level of compliance. 
• Questions around justification and patient information, accidental exposure recording, dose limits for other personnel demonstrated relatively poor compliance. 

Mission journey

• ESR (European Society of Radiology) has worked with a purpose to raise awareness, educate and improve radiation protection in radiology departments within the EU Member States, in alignment with the BSSD requirments. 
• Major contributions to this include the EuroSafe Imaging Initiative (2014), ESR iGuide (2015), EuroSafe Call for Action (2018) and the most recently published Esperanto Guide to Clinical Audit, 2019 (http://www.myesr.org/article/2511) [4]. Please see Figure 4 for a timeline of events undertaken so far to date ( Fig. 4 ).