The EuroSafe Imaging campaign is an initiative of ESR (European Society of Radiology).
One focus of EuroSafe is to help practitioners in EU member states in the implementation process of the European Directive 2013/59/EURATOM (EU-BSS) [1,2] with working groups established as part of EuroSafe.
An ESR survey among EU member states  in 2018 revealed a heterogeneous and partially incomplete implementation of the EU-BSS, in particular criteria for classification and managing unintended exposures. Only 53% of responding countries had implementations of article 63 and 96 of the EU-BSS on “significant events” into national law. Furthermore for Computed Tomography (CT) only 37% and for Interventional Radiology (IR) only 47% of countries had definitions of significant events based on physical dose parameters instead of plain text or effective dose (ED).
In 2019, EuroSafe launched a new Working Group (WG) on “Dose Management” with the aim to provide European recommendations on the implementation of dose management in clinical practice. The WG follows Action 4: “Promote dose management systems to establish local, national, and European DRLs” of the EuroSafe Imaging Call for Action 2018  (Fig. 1).
Occupational exposures are not the focus of this WG, but may be included later.
Dose Management Systems (DMS) are recommended but not mandatory for X-ray equipment users, to follow new radiation protection requirements like the EU-BSS. DMS are designed to medical practitioners, radiographers and medical physics experts (MPE) to support their tasks and duties of radiation protection in accordance with local and national requirements. In particular, the requirement according to the ALARA-principle, to perform X-ray examinations with the aim to achieve a minimum dose level but maintaining a sufficient image quality
related to find the best way of optimization technique in radiation procedures. Clinical radiation protection includes some specific tasks which can by supported by DMS (Fig. 2):
- Checking compliance with Diagnostic Reference Levels (DRL) [5,6]
- Collecting dose data to establish local or national DRLs
- Prevention, detection and helping in reporting of unintended exposures
- Optimization of patient exposure, especially in the field of computed tomography (CT) and interventional radiology (IR)
- Structured consolidation of dose documentation, reporting and tracking
- Notification if local or national alert levels are exceeded
- Local, regional or national benchmarking of patient exposure for modalities and procedures
The list describes typical features of a DMS to achieve the goals in radiation protection. DMS are becoming a more and more important tool in daily routine for quality assurance (QA), optimisation and the work of imaging teams (radiologists, radiographers and MPEs). Special aspects of the role of DMS in benchmarking CT examinations are given in [7,10].
Different opinions from members of the WG on dose management have been taken into account. The WG includes independent experts and representatives from ESR, EFOMP (European Federation of Organisations for Medical Physics), EFRS (European Federation of Radiographer Societies) and observers from DMS vendors (industry companies).
The EuroSafe WG on “Dose Management” is closely linked to EuroSafe WG on “Dosimetry for imaging in clinical practice” which provides recommendations on appropriate clinical dosimetry.