One European Training Ecosystem: A Unified Framework for Excellence in Radiology Training
Laura Oleaga¹ ORCID: 0000-0001-9702-0451
Miraude E.A.P.M. Adriaensen² ORCID: 0009-0009-0087-8116
Adrian P. Brady³ ORCID: 0000-0003-3473-0282
Colin P. Cantwell⁴ ORCID: 0000-0002-2532-9422
Paolo Ricci⁵ ORCID: 0000-0001-5212-0678
Katrine Riklund⁶ ORCID: 0000-0001-5227-8117
¹ Hospital Clínic Barcelona, Barcelona, Spain
² Zuyderland Medical Centre, Heerlen, Brunssum, Kerkrade, Sittard-Geleen, The Netherlands
³ University College Cork, Brookfield Health Sciences Complex, Cork, Ireland
⁴ St. Vincent’s University Hospital and University College Dublin, Dublin, Ireland
⁵ Policlinico Umberto I Hospital & Department of Radiology, Sapienza University of Rome, Rome, Italy
⁶ Department of Diagnostics and Intervention, Diagnostic Radiology, Umeå University, Umeå, Sweden
Corresponding Author:
Miraude E.A.P.M. Adriaensen, MD, PhD, MSc, EDiMSK ,Department of Medical Imaging, Zuyderland Medical Centre
Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands
Published: 09/10/2026
Abstract
Background
Radiology training in Europe has progressively evolved through collaboration between professional societies, accreditation bodies, and European medical organizations. Over the last three decades, the European Union of Medical Specialists (UEMS) and the European Society of Radiology (ESR) have jointly developed a coordinated framework designed to harmonize radiology education, assessment, accreditation, and continuing professional development across Europe.
Objective
This article presents the concept of a unified European radiology training ecosystem and examines the complementary roles of the European Diploma in Radiology (EDiR), the European Training Assessment Programme (ETAP 2.0), the Accreditation Council in Imaging (ACI), and the European Commission–supported EU-REST project.
Discussion
The European radiology training ecosystem is built upon interconnected pillars linking individual competence assessment, programme evaluation, accreditation systems, and European workforce and educational standards. The EDiR provides a harmonized assessment framework for individual radiologists, ETAP 2.0 evaluates training programme quality, and the Accreditation Council in Imaging supports continuing medical education accreditation through collaboration with the UEMS-EACCME®. The EU-REST project further strengthens this ecosystem by defining workforce, education, and training recommendations for radiology across the European Union. Together, these initiatives support harmonization, quality assurance, professional mobility, and patient safety.
Conclusions
The coordinated collaboration between the ESR and the UEMS has created a robust European radiology training ecosystem integrating education, assessment, accreditation, and workforce planning. This model provides an important framework for harmonized postgraduate medical training and may serve as an example for other medical specialties seeking to balance national diversity with European standards of excellence.
Keywords
Radiology training; postgraduate medical education; European Diploma in Radiology; ETAP; accreditation; continuing medical education; UEMS; ESR; EU-REST; workforce planning
Introduction
European radiology training has progressively developed into a coordinated educational ecosystem in which standards, assessment, accreditation, and quality assurance function as interconnected components rather than isolated processes. This perspective aligns closely with the recommendations emerging from the European Commission–sponsored European Union Radiation, Education, Staffing & Training (EU-REST) project.
A strategic collaboration between the European Union of Medical Specialists (UEMS) and the European Society of Radiology (ESR), formerly the European Association of Radiology (EAR), has existed for more than thirty years. Within this partnership, the UEMS has primarily defined professional standards and accreditation frameworks, while the ESR has developed educational structures, curricula, and assessment tools.
This collaborative ecosystem rests on four major pillars: assessment of individual competence through the European Diploma in Radiology (EDiR), programme quality evaluation through the European Training Assessment Programme (ETAP 2.0), accreditation through the Accreditation Council in Imaging (ACI), and broader workforce and educational recommendations established through the EU-REST project.
Together, these initiatives aim to support harmonized, transparent, and high-quality radiology training throughout Europe while preserving flexibility across different national healthcare systems.
Individual Competence: The European Diploma in Radiology (EDiR)
In 1995, the Radiology Section of the UEMS made the strategic decision not to establish a separate independent educational board. Instead, the European Association of Radiology and the UEMS Radiology Section chose to collaborate through the EAR Professional Organisation Committee and regular joint commission meetings involving senior representatives from both organizations.
This collaborative structure continued following the creation of the ESR in 2005 through the merger of the EAR and the European Congress of Radiology (ECR). Although organizational structures evolved over time, including the transformation of the Professional Organisation Committee into the ESR Quality, Safety and Standards Committee in 2014, collaboration with the UEMS remained continuous.
An important milestone in this partnership was the development of the European Diploma in Radiology (EDiR) through collaboration with the European Board of Radiology (EBR). Rather than creating a separate UEMS examination, the UEMS Radiology Section supported the EDiR as a unified European standard for competence assessment.
The EDiR now functions as an important harmonized assessment tool evaluating whether radiologists meet common European standards of knowledge and clinical reasoning. It contributes to professional mobility, comparability of training outcomes, and increased transparency within postgraduate radiology education across Europe.
Programme Quality: The European Training Assessment Programme (ETAP 2.0)
The European Training Assessment Programme was established in 2001 as part of the broader effort to harmonize radiology training across Europe under joint leadership of the UEMS Radiology Section and the EAR.
The original ETAP model required physical site visits to training institutions. Although effective, this approach was resource-intensive and limited the number of centres that could be assessed annually.
To modernize and streamline the process, the ESR and UEMS Radiology Section jointly established ETAP 2.0 in 2016. The programme transitioned to a fully online assessment platform enabling submission of institutional data, trainee surveys, assessment documentation, and videos presenting training facilities.
The modernized platform allows both institutions and assessors to access information flexibly and facilitates continuous communication throughout the assessment process.
Assessment panels include representatives from the European Board of Radiology, the UEMS, and junior assessors who are radiology trainees representing either the European Junior Doctors (EJD) organization or the ESR Radiology Trainees Forum (RTF). This structure ensures inclusion of both senior expertise and trainee perspectives.
The assessment process also includes structured online interviews with faculty members and trainees. Evaluation criteria are based on compliance with the UEMS European Training Requirements (ETR) and the European Training Curriculum for Radiology.
Following completion of the assessment, centres receive certification and a detailed report outlining strengths and recommendations for improvement over the subsequent five-year period.
ETAP 2.0 therefore functions not only as a quality assurance mechanism, but also as a developmental tool supporting continuous improvement within radiology training programmes.
Accreditation and Continuing Medical Education: The Accreditation Council in Imaging (ACI)
The European Accreditation Council for Continuing Medical Education (EACCME®) was established by the UEMS in 2000 with the objective of harmonizing and improving continuing medical education standards across Europe.
The EACCME® created an independent peer-review accreditation system allowing international CME activities to receive European CME credits (ECMEC®s). These credits gained international relevance through mutual recognition agreements signed with the American Medical Association in 2002 and the Royal College of Physicians and Surgeons of Canada in 2016.
Within radiology, the Accreditation Council in Imaging (ACI) functions as the accreditation body of the European Board of Radiology and collaborates closely with the UEMS-EACCME®.
The ACI supports accreditation of continuing medical education activities while aiming to simplify the accreditation process for educational providers and maintain high standards in imaging education.
Its goals include ensuring that CME activities meet the educational needs of modern radiologists, supporting high-quality educational delivery, and functioning as a unified voice for radiology education providers and professionals.
Beyond accreditation, the ACI also plays an important role in educational research. Through surveys conducted among ESR members, the ACI has investigated trends in radiology subspecialisation, continuing medical education delivery models, and recognition of subspecialty training across Europe.
These studies provide valuable insight into evolving educational needs within the European radiology community and support evidence-based educational policy development.
European Standards and Workforce Planning: The EU-REST Project
The EU-REST project was initiated in 2022 by the European Health and Digital Executive Agency (HaDEA) on behalf of the European Commission.
The project involved a multidisciplinary consortium led by the ESR and including representatives from the European Society of Nuclear Medicine, the European Society for Radiotherapy and Oncology, the European Federation of Radiographer Societies, and the European Federation of Organisations for Medical Physics.
The aim of the project was to evaluate workforce availability, education, and training needs for professions involved in the medical use of ionising radiation across the 27 European Union member states.
The final report, published in 2025, included several important recommendations regarding radiology education and training. These recommendations strongly align with the ecosystem already developed collaboratively by the ESR and UEMS.
The report recommends harmonization of radiology training duration and content across Europe and supports a five-year general radiology training programme followed by one-year fellowship-based subspecialty training aligned with Level 3 European Training Curricula.
The project also emphasizes the importance of standardized curricula, harmonized certification systems, structured practical training in radiation protection and quality management, and broader adoption of the European Diploma in Radiology as a common assessment standard.
Importantly, the EU-REST recommendations identify ETAP certification as an important prerequisite for training centre accreditation and support broader recognition of EACCME credits as the European standard for continuing medical education.
These recommendations contribute directly to the broader European Commission SAMIRA action plan, which seeks to ensure adequate education, training, and professional development for all professionals involved in medical applications of ionising radiation.
Discussion
The European radiology training ecosystem described in this article represents a rare example of long-term strategic collaboration between professional societies, accreditation structures, and regulatory medical organizations.
Rather than developing isolated educational initiatives, the ESR and UEMS have progressively created interconnected systems linking:
- Individual competence assessment
- Training programme evaluation
- Continuing professional development
- Workforce planning
- European policy alignment
This integrated approach strengthens transparency, harmonization, and quality assurance while preserving flexibility for national implementation.
Importantly, the ecosystem balances standardization with professional autonomy. Common European standards are promoted without eliminating national educational diversity.
The model also illustrates the importance of involving trainees, educational institutions, accrediting organizations, and policymakers within a coordinated educational strategy.
As workforce shortages, technological developments, and increasing subspecialisation continue to reshape radiology practice, harmonized European educational frameworks will likely become increasingly important for ensuring quality, mobility, and patient safety.
Conclusion
Over more than three decades, collaboration between the ESR and the UEMS has produced a comprehensive European radiology training ecosystem integrating standards, assessment, accreditation, and workforce planning.
The European Diploma in Radiology, ETAP 2.0, the Accreditation Council in Imaging, and the EU-REST recommendations function as complementary components of a coordinated framework supporting excellence in radiology education and professional development.
This ecosystem demonstrates how collaborative European structures can successfully harmonize postgraduate medical training while supporting transparency, quality assurance, professional mobility, and lifelong learning.
As European healthcare systems continue to evolve, the radiology model may provide a valuable framework for other specialties seeking to develop similarly integrated and sustainable educational ecosystems.
Open Access & Copyright
© 2026 The Authors. Published by the European Medical Specialist Review (EMSR) under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0).
How to cite this article
Oleaga L, Adriaensen MEAPM, Brady AP, Cantwell CP, Ricci P, Riklund K. One European Training Ecosystem: A Unified Framework for Excellence in Radiology Training. European Medical Specialist Review. Published 9 October 2026. https://doi.org/10.67452/EMSR.2026.017
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