To our knowledge this is the first TOWS analysis on the SWOT results/impact of E&T in RP aspects developed under previous EU framework programmes and EU-funded projects. Despite the success of the EuroSafe Imaging initiative, which is now in its sixth year of active engagement of its’ call for action to achieve international radiation protection goals this study has identified that there is a significant path ahead to achieve delivery, harmonisation and accreditation of radiation protection training across all stakeholders [14,15,16]. Extensive literature has been published in recent years which evidences the efforts of European collaborations and the critical work of medical physics and in the achievement of optimal radiation protection practices . Despite this extensive evidence literature base, our SWOT analysis and TOWS findings have identified that there is a need to prioritise resources and efforts to address the weaknesses and threats which have been identified through this study. To facilitate discussion of our findings four areas of consideration are presented.
Developing training material and trainers
The development of training material and trainers in a manner which is sustainable and facilitates continual refreshing to match technology advances is identified as core consideration for strategic framework planning . Whilst a significant portion of curriculum planning has already been prepared through the work of the MEDRAPET project the sustainable development of training materials is now required. This process needs to align to the continual advances in medical imaging technology and their subsequent radiation protection considerations. Currently, no single training network exists, therefore, it is timely for the stakeholders to consider how a truly holistic approach to radiation protection training could be launched for the benefit all professional disciplines and meet specific professional needs, as identified in this work (Table 2). The Framework to facilitate a truly pan European training network needs to consider how such a process could function at a European, national and local clinical level.
In recent years our access to digital education technologies, has substantially increased, particularly so during the COVID-19 pandemic [19,20,21]. Educators across multiple professional disciplines have managed this change in teaching practice and have thrived within the online learning environment [22, 23]. The SWOT findings highlight the importance of short online learning objects (Table 4b), this form of learning is promoted across teaching and learning research and the facility for efficient updating is of extreme importance in medical imaging . The willingness of learners to participate in online learning in recent literature is also extremely encouraging and an important consideration when developing material [25,26,27]. The potential for teaching delivery by a multidisciplinary group of experts at a European level, complimented by nationally supported local teaching, could in some part address the lack of suitably qualified trainers across Europe as identified in TOWS analysis as well as ensuring quality of content  The software and technologies used in education now incorporate greater intractability and the use of 2D, 3D and augmented reality software options, which can engage learners more effectivity than some traditional teaching pedagogies and should be incorporated in proposed training frameworks .
To achieve successful radiation protection training goals, it is essential that those administering ionising radiation in the clinical, research or industry environments see the benefit of training and possess a desire to train. Our findings highlight the importance of meeting profession-specific needs and a current lack of priority placed upon the importance of radiation protection training across professional disciplines, researchers, education institutions, national and European bodies (Table 2). In the most recent European investigation of radiographer radiation protection education in the IAEA, substantial differences in duration and quality of training were highlighted [30, 31]. The literature also highlights similar concerns related to radiation therapy training and the need to improve radiation safety awareness . Similarly, Walsh et.al (2019) identified a low baseline radiation safety knowledge for participating orthopaedic surgeons and trainees. These professionals are frontline workers administering ionising radiation daily and exemplify the need to consider tailored training in addition to core principles. The study highlighted that until now all EU projects have been focussed upon the training of E&T of Radiation Protection Officer (RPO), Radiation Protection Expert (RPE) and Medical Physics Expert (MPE) therefore it is understandable how the health professionals’ community may perceive a lack of professional relevance, and this must be addressed. However there remains a lack of suitably qualified staff to assist in training, predominantly those with a medical physics background, but also from across the stakeholder professions who would be required to assist with training a truly holistic training programme [33, 34].
The challenges ahead should not be underestimated, the impact of the COVID-19 pandemic has further impacted staff resources in both clinical and academic environments, in addition to the increased volume of articles related to professional burnout and the lack of funding for strategic staff contingency planning across healthcare disciplines published pre-COVID-19 [35,36,37]. In our analysis of how to maximise opportunities and minimise threats, the matter of financial support was identified with the suggestion of using finances to promote training developments to professionals’ communities; however, literature would indicate the need for increased staff resources to facilitate training time and training material development which incorporates realistic budgeting as core to the success of the proposed framework documentation [38, 39].
In addition to the development of training material, we must also consider training the trainers. Higher education institutions are well placed to assist with, considering their experience in teaching and learning pedagogies and access to a broad array of teaching technologies, experienced teachers and education technologists and their incorporation in the EuRnR Framework documentation is essential. To ensure trainers themselves are effective in the clinical, research, industry, and academic environments, it is essential that they themselves are “trained” to a high standard. This is reiterated across several sections of this study aligned to appropriate financial and staff resourcing.
Our findings also identify the need to improve the importance upon which professionals, managers and national agencies place on radiation protection training. The critical role that regulators have in ensuring training programmes are completed is clearly identified in the TOWS analysis (Table 3). EuRnR framework development must specify how regulators and national governments should engage and clarity is required in relation to EuRnR expectations of regulator collaboration. To achieve success the national regulators in turn need to consider how they can influence greater cohesion between the health and research and the EURATOM communities nationally under the single umbrella of radiation protection training in their efforts to protect the public .
Embedding RP training and accreditation
Once training materials and networks are developed our study has identified the importance of determining how a radiation protection network on a European scale, which has national and local on-site activity, could be embedded as mandatory practice by employers and regulators and potentially also have employment incentives potentially attached (Table 2). Furthermore, the issue of accreditation, quality control and training oversight was a recurring item of the SWOT investigation and TOWS analysis. The EuRnR strategic framework documentation will need to consider how accreditation processes are recognised by national regulators and professional groups as national legislation may demand national accreditation of training and not be legally permitted to recognise a pan European accreditation process. How this matter is managed is critical, as mandatory compliance with regulation agencies linked to government bodies is important in the achievement of sufficient funding for the development of a successful radiation protection training network and one which is mandated as a continued professional development requirement.
Strategic resource planning of RP training
As stated within the discussion at different junctures as with any training programme, the cost of development and implementation requires consideration: from the funding of time and expertise to develop teaching material, hosting virtual/online learning environments, teaching material delivery, trainer costs, academic and clinical site costs, accreditation costs and resourcing of quality review processes. All these items are significant and will differ across nations and locally across clinical, academic and industrial sites and how this can be managed requires intensive discussion and must be clearly and realistically addressed in the proposed EuRnR strategic framework documentation to be completed by this project.
In the past, most EU-funded programmes and projects were profession specific or not directly related to medical procedures. Nevertheless, considering the composition of the EuRnR consortium, the group brings together experts in RP from the most relevant health professions and researchers involved in the clinical use of ionising radiation (e.g. Radiologists, Nuclear Medicine Physicians, Radiographers, Medical Physicists, Radiation Oncologists), it was possible to minimise the described limitation, through several multi-professional group meetings, as a strategy to obtain consensus regarding the SWOT analysis and the respective TOWS actions. Future consideration does need to incorporate the expertise of E&T scientists as the EuRnR framework documentation is progressed.