Radiological and nuclear science and technologies provide a wide range of benefits to EU citizens in many areas beyond the production of nuclear energy, in particular for human health and in the fight against cancer.
Medical uses of radiological and nuclear technologies benefit patients all across Europe, and the EU is a global leader for supplying medical radioisotopes, and for developing radiological diagnostics and treatments. In addition, the EU has also led the way in establishing standards and legislation for quality and safety in radiology, radiotherapy and nuclear medicine.
Ionising radiation and cancer treatment
The radiological and nuclear technologies are indispensable in the fight against cancer. They contribute significantly to all stages of cancer patients’ care, including early detection, diagnosis, treatment and palliative care.
Radiological imaging, like mammography and computer tomography, is of key importance, as it uses x-rays for diagnosis, as well as for planning and guiding treatments. With about 500 million procedures carried out in the EU annually, it is by far the most widespread form of medical application of ionising radiation.
Nuclear medicine uses radioactive substances, mostly for diagnosis of cancer, cardiac and other diseases. In the EU, about 10 million procedures are delivered to patients each year. Nuclear medicine is therefore an important tool for cancer management, contributing to early cancer diagnosis and prognostic assessment, and increasingly available for therapy.
Radiotherapy uses high-energy x-rays, charged particles or radioactive sources for cancer therapy. With 1.5 million procedures in Europe annually, it is a crucial part of modern cancer care, and among the most effective, efficient and widely used cancer treatments available to patients and physicians.
Despite the many benefits that medical radiation technologies bring to patients across the EU, the growing use of these technologies have also caused a significant increase in the radiation exposure of the European population.
Medicine is now responsible for up to half of the total radiation exposure of EU citizens and more than 90% of the man-made. At the same time, a significant proportion of advanced radiological imaging is performed without a clear clinical need, and there is a potential for better adapting radiation doses and image quality to diagnostic needs. The rapid pace of technological innovation requires increased availability and improved staff training, as well as equipment upgrades and greater involvement of manufacturers in its clinical use.
There is a need to secure the European supply of medical radioisotopes in the long term, in order to maintain EU patients’ access to vital medical procedures and support the development of new cancer treatments. This will require significant investments in the supply chain for radioisotopes, particularly in securing source materials and new irradiation capacity. Many of the source materials in the production chain are not readily available in the EU, but are rather imported from limited stocks or production in third countries. In addition, the EU research reactors used to produce medical radioisotopes are ageing and will need to be replaced by 2030 to avoid radioisotope shortages.
Modern radiation-based imaging and therapy are constantly progressing, leading to new and improved approaches to diagnosing and treating cancer and other major diseases. Although private investments help support the technological innovation, it will likely not be enough to meet the needs of public health systems. It is therefore important that the EU identifies specific research needs, and that the EU keeps a dialogue with national authorities, medical professionals, industry, researchers and other key stakeholders.
SAMIRA action plan
The Strategic Agenda for Medical Ionising Radiation Applications (SAMIRA) is the energy sector's contribution to the Europe's Beating Cancer Plan, and a response to the EU Council's conclusion on non-power nuclear and radiological technologies and applications, from 24 May 2019.
The SAMIRA action plan is the EU’s first comprehensive plan for action to support a safe, high quality and reliable use of radiological and nuclear technology in healthcare. It builds upon previous achievements and will pave the way for future coordinated EU action. The action plan defines EU actions in 3 priority areas
- securing the supply of medical radioisotopes
- improving radiation quality and safety in medicine,
- facilitating innovation and the technological development of medical ionising radiation applications
While a large number of actions are included in the plan, there are specific flagship initiatives that will drive EU development for radiation in medical use.
First, the Commission will start a process towards establishing a European radioisotope valley initiative, aiming to maintain Europe’s global leadership in the supply of medical radioisotopes, as well as help accelerate the development and introduction of new radioisotopes and production methods.
Second, the Commission will launch a European initiative on quality and safety of medical applications of ionising radiation aiming to ensure that diagnostic and therapeutic uses of ionising radiation in EU countries are in line with high standards for quality and safety, in the interest of patients.
In addition, the Commission will support the development of a research roadmap for medical applications of nuclear and radiation technology. The Commission will further seek to create synergies between the Euratom research and training programme and the 'health' cluster of Horizon Europe.
SAMIRA actions and events
The SAMIRA initiative started with an evidence gathering and consultation phase in 2017. An international conference was organised by the Commission in March 2018, highlighting how societal challenges can be addressed by advancing SAMIRA and a study on the non-power applications of nuclear and radiation technology was published in 2019.
The Commission also hosted a technical workshop on 'Medical radioisotopes in the future', in 2019, to investigate the challenges and opportunities in this area and discuss them with relevant stakeholders.
The Commission and the Finnish presidency of the Council of the EU hosted another workshop on 'Management of spent fuel and radioactive waste arising from non-energy uses of nuclear and radiation technologies' in 2019. The workshop results contributed to the preparation of the Council conclusions from December 2019 on this subject area.
The Commission, together with the Dutch Ministry of Health, held a meeting on the security of EU supply of medical radioisotopes for beating cancer and the role of the Pallas project, in May 2021. The aim was to better understand what is needed to secure the future supply of medical radioisotopes in the EU for diagnostics and the development of innovative treatments of cancer, and to discuss how EU countries and the Commission can cooperate on specific radioisotope supply projects and initiatives. More information is available in the presentations and the report of the meeting.
Projects and grants
To further support actions under the SAMIRA umbrella, the Commission launched a study in 2020 with the objective of collecting additional information on the radioisotope supply chains in Europe, laying the ground for long term European cooperation in this area.
Similarly, the EU-funded QuADRANT project will promote constant improvement in quality and safety of radiology, radiotherapy and nuclear medicine through the implementation of clinical audit as part of EU countries’ healthcare systems.
Certain parts of the SAMIRA action plan are supported by wider EU programmes. The EU4Health Work Programme 2021 will support the quality and safety of radiation technology in diagnosis and treatment of cancer through action grants for projects. The opening date of the call for proposals is 29 July 2021 and the deadline 15 September 2021. Info sessions are organised on 13 and 15 July to present the procedure for grants and public procurement. EU4Health is managed by the Commission Directorate-General for health and food safety and the European health and digital executive agency (HaDEA).
The Euratom work programme 2021-2022, implementing the Euratom research and training programme 2021-2025, supports projects on the safe use and reliable supply of medical radionuclides and a European partnership for research in radiation protection through action grants. The opening date for call of proposals is 7 July 2021 and the deadline is 7 October 2021. During the Euratom Info Day detailed presentations of the Euratom research and training programme 2021-2022 will be provided.
- Study: Co-ordinated Approach to the Development and Supply of Radionuclides in the EU (October 2021)
- Strategic Agenda for Medical Ionising Radiation Applications (SAMIRA) SWD (2021) 14 final
- Factsheet: SAMIRA (Strategic Agenda for Medical Ionising Radiation Applications) (5 February 2021)
- Study: Medical, Industrial and Research Applications of Nuclear and Radiation Technology (February 2019)
- Nuclear Safety Directive Amendment (2014/87)
- Euratom Basic Safety Standards Directive (2013/59)
- Spent Fuel and Radioactive Waste Directive (2011/70)
- Staff working document on medical applications of ionizing radiation and security of supply of radioisotopes for nuclear medicine (SEC(2010) 974)
- Press release: SAMIRA Action Plan: Radiological and nuclear technology in support of Europe's Beating Cancer Plan (5 February 2021)
- Questions and answers: SAMIRA Action Plan (5 February 2021)
- Europe's Beating Cancer Plan
- European Observatory on the Supply of Medical Radioisotopes
- Radiation protection publications
- Medical devices in cancer management – World Health Organisation