Radiology residency across Europe: a fragmented yet converging path

Abstract Radiology has evolved into a central specialty at the core of modern medicine, with radiologists increasingly serving as integral members of multidisciplinary teams. Despite the specialty’s central role, the structure and content of radiology residency training remain highly variable across Europe. Differences persist in program duration, entry requirements, curriculum design, assessment modalities, and certification authorities, largely due to divergent national educational frameworks and healthcare policies. This fragmentation poses challenges to workforce mobility, training equivalence, and quality assurance. In response, the European Society of Radiology (ESR) has introduced harmonization initiatives, including the European Training Curriculum (ETC), the European Diploma in Radiology (EDiR), and the European Training Assessment Programme (ETAP), all aimed at promoting standardization while respecting national autonomy. This narrative review offers a comparative analysis of radiology training programs across European countries, with particular focus on admission pathways, curricular alignment with the ETC, implementation of research and subspecialty training, and variations in evaluation and certification. While most nations have adopted the ETC in whole or in part, practical implementation remains uneven. Entry mechanisms range from competitive national exams to local interviews, and while some programs include dedicated research time or thesis requirements, others lack structured scientific training. Furthermore, differences in legal and political frameworks influence how training is funded, organized, and certified. As Europe moves toward greater integration of specialist education, understanding these disparities is essential for developing a coherent, high-quality training landscape that ensures both clinical excellence and cross-border professional mobility. Key Points Question How heterogeneous are radiology residency structures and curricula across Europe, and to what extent do current frameworks address inconsistencies in training quality and standardization? Findings Radiology training across Europe remains markedly heterogeneous, while the European Training Curriculum, EDiR, and ETAP only partially mitigate variability in education, assessment, and quality standards. Critical Relevance Statement This narrative review critically evaluates persistent inconsistencies in European radiology training and demonstrates the limited but essential role of harmonization initiatives, supporting the need for stronger integration to ensure comparable competencies and improve clinical practice standards.