European Network for Radiation-Free Spinal Deformity Assessment and Monitoring
of children worldwide affected by adolescent idiopathic scoliosis [1]
radiographic examinations per child during growth period [2]
higher breast cancer mortality in women with scoliosis exposed to repeated radiography [3]
European standards for radiation-free diagnostic alternatives
Standing full-spine radiography remains the gold standard for scoliosis diagnosis and monitoring. Yet multiple radiation-free technologies have been validated in individual centres. What is missing is standardisation, multicentre validation, and clinical guidelines. RADFREE-SPINE addresses these gaps through coordinated pan-European networking.
Five converging factors make this Action urgent and timely. European law already demands what RADFREE-SPINE delivers.
The European Council Directive 2013/59/Euratom (Basic Safety Standards) makes the ALARA principle (As Low As Reasonably Achievable) legally binding for all EU member states. Every hospital performing diagnostic imaging on children is required by law to minimise radiation exposure. RADFREE-SPINE provides the validated alternatives that make ALARA compliance achievable in scoliosis care. [4]
The European Commission's Strategic Agenda for Medical Ionising Radiation Applications (SAMIRA, 2021) specifically prioritises radiation dose reduction in paediatric imaging and calls for development of non-ionising alternatives. [5]
MDR 2017/745 requires multicentre clinical evidence for novel diagnostic devices before they can be recommended in clinical guidelines. A networking action is essential to coordinate this evidence generation across European centres. [6]
School scoliosis screening programmes are being re-evaluated across European nations. Several countries have discontinued screening due to the lack of validated radiation-free follow-up pathways. [7]
Emerging AI and machine learning techniques for curve progression prediction require large, multimodal, multinational datasets that no single centre can produce alone. [8]
RADFREE-SPINE integrates all available radiation-free spinal assessment modalities. A 2025 systematic review confirmed that ultrasonography and surface topography are the most promising techniques, but longitudinal multicentre validation is still needed. [9]
Coronal and sagittal curve measurement through internal spinal anatomy visualisation. Validated correlations of r = 0.87–0.94 with radiographic Cobb angle. [10]
Three-dimensional trunk surface reconstruction capturing rib hump, shoulder asymmetry, kyphosis, lordosis, and waistline deformity through optical methods. [11]
Segmental sagittal and frontal-plane spinal mobility measurement. Normative databases, anti-directional segmental motion patterns, and dynamic spinal behaviour assessment. [12]
Postural asymmetry, dynamic balance, plantar pressure distribution, and pelvic kinematics during walking. Functional dimension that static imaging cannot capture.
Neuromuscular activation patterns, paraspinal muscle asymmetry, co-contraction indices, and muscle recruitment strategies in scoliotic spines during static and dynamic tasks.
Standardised clinical measurement instruments for school-based screening and routine clinical evaluation. Accessible, low-cost, and field-deployable.
RADFREE-SPINE is built on an active research programme, not just a concept.
Demir E, M'hango A
This study directly compared three assessment modalities on the same AIS patients, specifically for sagittal spinal parameters. The 2025 systematic review by Bertsch et al. [9] identified that sagittal plane validation of radiation-free technologies remains insufficient, with only two prior studies available. Our pilot study addresses this gap head-on.
To our knowledge, this is one of the first studies to test 3D ultrasound, surface topography, and radiography on the same cohort with a sagittal plane focus. RADFREE-SPINE will scale this approach to 1,000+ patients across 10+ European centres.
Accepted for oral presentation at the International Research Society of Spinal Deformities (IRSSD) and Scoliosis Global Symposium (ScosyM), Novi Sad, Serbia, June 2026.
Each group answers a different question. Together, they build the evidence base for a radiation-free future in scoliosis care.
Standardise acquisition protocols for 3D ultrasound and surface topography systems. Conduct multicentre inter-operator reliability studies. Establish correlation thresholds with radiographic standards. Produce standardised SOP manuals.
Standardise IMU-based spinal mobility, gait analysis, pedobarographic, and surface EMG protocols. Develop normative AIS databases. Validate the RADFREE Diagnostic Triad. Create school screening guidelines, policy recommendations, and the RADFREE Clinical Measurement Handbook.
Conduct bibliometric mapping of the radiation-free assessment field. Build a FAIR-compliant multimodal European dataset. Develop AI-based curve progression prediction models. Release open-source analytical tools.
17 deliverables across 4 years. These are the flagship outputs.
First comprehensive landscape analysis of the radiation-free spinal assessment field. Published as a peer-reviewed paper.
Acquisition protocols for all radiation-free modalities: 3D ultrasound, surface topography, IMU, gait, EMG, and clinical tools.
Reliability studies across 5 centres with 200+ patients for structural assessment and 150+ patients for functional assessment.
Multicentre validation across 10+ centres comparing radiation-free technologies against radiographic standards.
Machine learning prototype for curve progression prediction using multimodal radiation-free data.
Evidence-based European clinical guideline for radiation-free school scoliosis screening, developed through Delphi consensus.
Open-access Clinical Measurement Handbook: the European reference document for radiation-free spinal assessment.
FAIR-compliant multimodal dataset (2,000+ patients) released for the global research community.
RADFREE-SPINE delivers measurable impact for patients, clinicians, researchers, and policy makers.
Reduced lifetime cancer risk for millions of children. Radiation-free monitoring throughout growth. Improved screening accessibility in resource-limited settings.
Standardised protocols and measurement handbook. Multilingual e-learning platform and SOPs. Open-source AI prediction tools for clinical decision-making.
Open European dataset (2,000+ patients). 25+ peer-reviewed publications. Bibliometric mapping. New research field: multimodal radiation-free prediction.
Evidence-based screening guidelines for adoption. Policy briefs for national health authorities and DG SANTE. Cost-effectiveness data for replacing radiographic monitoring.
We are currently building the core proposer team for the COST Open Call 2026 submission.
Considering joining the RADFREE-SPINE network? Here is what COST funds and what is expected.
COST funds networking, not research. This includes: travel and subsistence for meetings, Short-Term Scientific Missions (1-4 week lab visits), Training Schools (hands-on workshops), conference grants for young researchers, and dissemination activities. An Action receives approximately €600,000 over 4 years.
Proposers contribute their expertise to Working Group activities. This may include: attending 2-3 meetings per year, hosting visiting researchers (STSMs), contributing to protocol development and publications, and participating in consensus processes. No research funding is required from proposers.
COST prioritises Inclusiveness Target Countries (ITC): Türkiye, Poland, Greece, Serbia, Portugal, Romania, Croatia, Czech Republic, and others. ITC-based researchers receive priority for STSMs, Training School attendance, and conference grants.
At least 40% of proposers must be Young Researchers and Innovators (YRI), defined as under 40 years old. YRI receive priority access to all funded networking activities and a dedicated mentoring programme within the Action.
We welcome researchers, clinicians, and engineers working in radiation-free spinal assessment, surface topography, IMU-based biomechanics, surface EMG, gait analysis, AI/data science, school screening, and related fields.