EIBIR 1 - EIBIR Stage bonus session 1

Author Block: E. Nischwitz¹, A. Kerpel-Fronius², J. Chorostowska-Wynimko³, M-P. Revel⁴, I. Horvath², M. K. Vasakova⁵, T. Gerriet Blum⁶, H. Prosch⁷, H-U. Kauczor¹; ¹Heidelberg/DE, ²Budapest/HU, ³Warsaw/PL, ⁴Paris/FR, ⁵Prague/CZ, ⁶Berlin/DE, ⁷Vienna/AT
Purpose: With strong evidence from clinical trials demonstrating that lung cancer screening (LCS) improves patient outcomes, it is now critical to reinforce these findings by evaluating LCS participant data from newly implemented pilots and programs. A central objective of the Strengthening the Screening of Lung Cancer in Europe (SOLACE) initiative is the systematic collection of real-world data (RWD) across its 19 data-providing sites.
Methods or Background: The SOLACE consortium unites 37 partners from 15 EU Member States across a variety of medical specialties. This multidisciplinary team focuses on supporting the implementation of equitable LCS. The three SOLACE pilots focused on the engagement of previously underrepresented groups in LCS, including women, hard-to-reach individuals, and individuals with co-morbidities linked to lung cancer risk.
Results or Findings: With multidisciplinary input, a core common data model was developed to capture key LCS findings and harmonize the heterogeneous results across the 19 data-providing sites. Both individualized and aggregated data were centrally collected within the SOLACE Database. These data span the entire screening pathway, including demographic and recruitment information, smoking history, screening results, radiation dose, and follow-up and treatment information, when applicable.
The SOLACE Database will contain 25,000 total participant records, including 18,000 individualized records. Previously underrepresented groups in LCS will account for over 90% of the individualized dataset.
Conclusion: The SOLACE Database will enable the systematic evaluation of the benefits and risks of LCS, efficacy of recruitment methods, as well as facilitate the in-depth analysis of sub-populations. This rich resource of RWD will provide critical evidence to guide the equitable implementation of LCS across Europe.
Limitations: Data sharing is limited to the SOLACE consortium; however, the consortium is committed to ensuring the wide dissemination of the findings and insights derived from this dataset.
Funding for this study: This project is co-funded under the EU4Health Programme 2021–2027 under grant agreement no. 101101187.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: M. Zapparoli, C. Barbosa de Souza, R. Guimarães, L. A. Brolini Delle Urban, A. Tachibana; São Paulo/BR
Purpose: The implementation of socio-environmental practices in diagnostic imaging services is still a challenge in
Brazil. Certification through the CBR Socio-Environmental Seal allows for the assessment and encouragement of
advances in sustainability, considering three certification levels: Bronze, Silver and Gold. This study evaluates nine diagnostic imaging institutions to identify the level of certification they would achieve if they were assessed by the seal, highlighting challenges and opportunities for improvement
Methods or Background: A survey was conducted based on the 73 criteria of the CBR Socio-Environmental Seal, distributed across six
pillars: environmental management, human rights, suppliers, infrastructure, labor practices and society. The institutions
classified their practices as compliant, partially compliant or non-compliant.
Results or Findings: Of the nine services assessed, seven would achieve Bronze level, one institution would achieve Silver level and
one would not achieve certification. The main obstacle to advancing towards certification is low compliance with
environmental and social criteria. The average compliance with Bronze level criteria was 78%, while at Silver level it was
35% and at Gold level, 12%.
Conclusion: Most imaging services are still in the early stages of socio-environmental maturity. The CBR Socio-
Environmental Seal represents a structured path to boost sustainability in radiology, encouraging continuous
improvements and strengthening sustainable practices.
Limitations: There is no limitation.
Funding for this study: There is no financing.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: M. Zapparoli, L. A. Brolini Delle Urban, C. Barbosa de Souza, R. Guimarães, A. Tachibana, H. Carrete Jr, A. M. C. DE SOUZA; Curitiba/BR
Purpose: The CBR Socio-Environmental Seal was created to certify imaging services that adopt sustainable
practices, considering three maturity levels: Bronze, Silver and Gold. The certification process encourages continuous
improvement and strengthens socio-environmental governance in the sector. This paper presents the methodology of the CBR Socio-Environmental Seal, detailing the criteria evaluated and their
application in radiology.
Methods or Background: The certification is based on 73 criteria distributed across six pillars, structured into three levels: 27 criteria for
Bronze, 24 for Silver and 22 for Gold. The assessment is carried out through self-assessment, document audit and
evidence analysis.
Results or Findings: The most demanding pillars at the Gold level are environmental management (7 criteria) and human rights (5 criteria). At the Silver level, there is greater demand in infrastructure (6 criteria) and suppliers (4 criteria). The Bronze level mainly requires labor practices and operational safety.
Conclusion: The CBR Socio-Environmental Seal structure allows for a comprehensive assessment of the socioenvironmental
practices of diagnostic imaging services. Adopting this certification can raise quality and sustainability
standards in the sector.
Limitations: There is no limitation.
Funding for this study: There is no financing.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: M. Zapparoli¹, J. E. Peixoto², M. B. Schaefer³, L. A. Brolini Delle Urban³, A. Tachibana³, L. F. Chala³, C. Barbosa de Souza³; ¹Curitiba/BR, ²Rio de Janeiro/BR, ³São Paulo/BR
Purpose: To ensure the quality of diagnostic mammography and minimize radiation doses for women, the Brazilian College of Radiology and Diagnostic Imaging (CBR) created, in 1992, a voluntary Quality Certification Program. In 2012, the Ministry of Health introduced a federal regulation establishing the National Mammographic Quality Program, mandatory for all 5,176 units in the country, under the responsibility of the National Cancer Institute (INCA/MS) and the National Health Surveillance Agency (ANVISA). This study provides an overview of the implementation and results of two national mammography quality certification programs in Brazil between 2017 and 2021.
Methods or Background: These programs assess radiation dose and phantom image quality in x-ray mammography units through a postal system. Each unit that passes this initial assessment must submit five complete patient examinations. The quality of images and reports is reviewed by radiologists and medical physicists.
Results or Findings: During the study period, 1,007 mammography units from 953 facilities applied for certification, representing 19.5% of all units, located in 205 cities across 20 of the 27 Brazilian states. A total of 934 (92.8%) passed the radiation dose and phantom image quality assessment. Of these, 556 (59.5%) also passed the clinical image and report review, achieving certification. The main issues related to mammography quality were linked to radiologist performance in positioning and interpretation.
Conclusion: The implementation of the two national certification programs in Brazil was carried out by a small workforce and at reasonable cost, using postal resources to accommodate the many units and the vast distances within the country. However, overall program effectiveness (certified/applied units) was 55.2%. The main reason was that 39.5% of units did not submit the required examinations for review. Ongoing efforts are needed to improve effectiveness.
Limitations: There is no limitation.
Funding for this study: There is no financing.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: M. Zapparoli, A. Tachibana, C. Khawali, R. Guimarães, C. Barbosa de Souza; São Paulo/BR
Purpose: Accreditation of diagnostic imaging services is an essential tool to guarantee exam quality and safety, directly impacting diagnostic accuracy and treatment effectiveness. In Brazil, programs such as PADI, CBR, ONA, QMENTUM and ACSA promote excellence, but adherence remains low with regional disparities. This study analyzes accredited imaging services compared to institutions in the National Registry of Health Establishments (CNES), identifying regional gaps and reinforcing the importance of accreditation for accurate diagnosis and adequate treatment.
Methods or Background: Data were collected from accreditation programs (CBR – PADI and Stamp; ONA – Levels 1, 2 and 3; QMENTUM – International and Diamond; ACSA – Excellent, Advanced and Optimal). The total number of imaging services was extracted from CNES (accessed February 24, 2025). The analysis compared accredited services by state, calculating an accreditation index: accredited services divided by CNES institutions classified as 121–Imaging Diagnostic Service, categorized as private, public and non-profit.
Results or Findings: Of the 6,871 registered services, only 605 are accredited (8.8%). There is wide variation among states: Minas Gerais has the highest index (0.35), followed by Goiás (0.17) and the Federal District (0.14). Maranhão, Pará, Paraíba, Rio Grande do Norte and Roraima have none. São Paulo has the largest absolute number of accredited services (199), but a moderate index (0.13), showing the need for stronger incentives even in states with greater infrastructure.
Conclusion: Low adherence reflects structural and financial challenges. Accreditation is essential to ensure quality and patient safety, directly impacting treatment outcomes. Incentive strategies and public policies can foster equity, ensuring access to accurate, reliable diagnoses nationwide.
Limitations: There are no limitations.
Funding for this study: There was no funding for this work.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: P. Serrano¹, C. Soler-Pons¹, S. Flor¹, J. Soto², V. Sóñora³, F. J. Medina Álvarez⁴, A. Orduña Galán⁴, L. Marti-Bonmati⁴; ¹Valencia, Spain/ES, ²Madrid/ES, ³La Coruña/ES, ⁴Valencia/ES
Purpose: To assess the maturity of European hospital Data Warehouses (DWHs) within the EUCAIM consortium, focusing on their ability to generate high-quality datasets for secondary use, aligned with the federation’s requirements for Real World Data Holders.
Methods or Background: A descriptive cross-sectional study was conducted using a structured self-assessment questionnaire distributed to participating hospitals. Respondents included data scientists, IT specialists, and data protection officers. The questionnaire explored technical characteristics, data domains, standards and vocabularies, accessibility, governance, privacy and legal frameworks, and hardware capacity. Responses were scored on a 0–3 scale to create comparable maturity profiles. Aggregated scores were analyzed visually and statistically, and hospitals were grouped using k-means clustering and expert review.
Results or Findings: The survey revealed a diverse DWH maturity landscape. Most hospitals reported having a DWH with varied capabilities, including ETL processes, backup policies and imaging data integration. Use of common data models and standardized vocabularies was widespread but uneven. Governance and de-identification procedures were present in several institutions, while others lacked formal documentation. Three clusters emerged: entry-level, intermediate and/or transitioning, and advanced hospitals.
Conclusion: DWH maturity varies across European hospitals due to institutional and national challenges. EUCAIM can guide improvement by providing feedback, fostering collaboration, and connecting less mature institutions with advanced ones, enhancing their ability to generate on-demand datasets for research and supporting observational studies in the European Health Data Space.
Limitations: Results are based on 24 hospitals; analyses will evolve as more join. Hospitals face financial, technical, and legal challenges, including limited funding, lack of skilled staff, resistance to change, complex data integration, and regulatory uncertainty around data protection and anonymization. Investment in education, governance, and pilot projects show promising progress, highlighting the need for coordinated strategies.
Funding for this study: Funding was provided by EUCAIM, a project co-funded by the European Union under Grant Agreement 101100633.
Has your study been approved by an ethics committee? Not applicable
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Author Block: R. Catalán Flores¹, C. Soler-Pons¹, J. Munuera Mora¹, R. Martínez Martínez¹, V. Kalokyri², K. Nikiforaki², I. Karatzanis², S. Sfakianakis², L. Marti-Bonmati¹; ¹Valencia/ES, ²Heraklion/GR
Purpose: Secondary use of clinical data requires robust anonymization to protect privacy. In medical imaging, re-identification risk is critical due to data sensitivity. This work shows the evolution from ChAImeleon to EUCAIM, highlighting advances in anonymization and risk assessment.
Methods or Background: Several efforts were undertaken in the ChAImeleon project, including the development of a custom de-identification profile and the organization of a Re-identification Challenge. In this challenge, 68 participants attempted to re-identify pseudonymized DICOM studies from multiple European sites, modalities, and regions. The studies had been de-identified using methods developed in ChAImeleon and ProCancer-I. No participant was able to trace back patient identities, confirming the robustness of these approaches. These findings highlight both the effectiveness of the applied protocols and the need for standardized methods to further strengthen future anonymization practices.
Results or Findings: Building on the outcomes of ChAImeleon, the EUCAIM project extends anonymization efforts to a federated, multicenter context. Key deliverables include guidelines and a risk analysis framework, the EUCAIM Anonymizer—an automated tool for the project-specific de-identification—and the Wizard Tool, which supports its validation. Integrated within the EUCAIM architecture, these resources ensure consistent data protection and harmonized practices across participating sites.
Conclusion: Reliable anonymization has been demonstrated for large imaging cohorts, enabling secure secondary use of clinical data. Lessons from ChAImeleon have been consolidated in EUCAIM through practical tools. These efforts strengthen trust in the secondary use of anonymized clinical imaging data and support responsible data sharing for research.
Limitations: Despite these advances, risk models remain dependent on the continuous evolution of re-identification techniques. Ongoing validation is necessary across heterogeneous datasets and institutions, and the usability and adoption of the proposed tools may still vary according to local infrastructures.
Funding for this study: ChAImeleon and EUCAIM are two relevant European projects funded by Horizon 2020.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Both European projects and the Re-identification Challenge, which is part of the ChAImeleon project, have been approved by the Ethics Committee of the institutions involved.