It already takes a lot of hard work to become a radiologist, so is it really worth even more the extra effort to obtain a European radiology diploma? Absolutely yes, according to a 16-person expert panel that put the case for the European Diploma in Radiology (EDiR) and the 11 European radiology subspecialty society diplomas. Obtaining a diploma is both a career enhancer and a contribution to the value of radiology as a medical profession, the panelists said.
The ESR strongly endorses examinations and diplomas substantiating the expertise of radiologists. "ESR endorsement ensures pan-European high standards in radiology education and practice," said ESR Education Committee chair Prof. Annemiek Snoeckx, head of Radiology at Antwerp University Hospital, at a special ECR 2025 session held on 28 February. "It also provides a standardized reference level for certification, and most importantly strengthens collaboration with subspecialty radiology societies."
Speakers from the ECR 2025 Joint Session of the ESR and UEMS, European exams and diplomas in radiology, chaired by Prof. Katrine Riklund, Umeå, Sweden, and Dr. Miraude Adriaensen, Heerlen, the Netherlands. Photo courtesy of Dr. Barbora Horehledova.
General endorsement criteria include program requirements, training standards in compliance with the ESR European Training Curriculum (Levels I, II and III), and requiring that diplomas be restricted to fully trained, licensed, and practicing radiologists who are ESR members. Renewal of diplomas used to be obligatory every five years, but the rules changed in June 2024.
The European Union of Medical Specialists (UEMS) and the Council for European Specialty Medical Assessment (CESMA) endorse diploma examinations as a means of harmonizing standards of training and accreditation of training, which may vary across Europe. Prof. Paolo Ricci of Sapienza University of Rome observed that by formally assessing the knowledge, medical competence, and skills of general and specialist radiologists, high-level equal quality and patient care will be achieved at the continental level.
UEMS-CESMA plays an essential role as an independent appraisal of exams. Required every five years, appraisal ensures exam content consistency and maintenance of minimum benchmark standards. The organizations also examine testing venues, security, methods applied for score calculations and benchmarks, and objectively maintaining fairness standards for all candidates.
Since 2011, more than 4,300 radiologists out of more than 6,100 candidates from 80 countries have been awarded the European Diploma in Radiology (EDiR), said scientific director Prof. Laura Oleaga of the Hospital Clinic Barcelona. There are now 5013 EDiR holders out of a total of 7219 candidates, including those who took the examination at ECR 2025.
Prof. Laura Oleaga.
This standardized exam for radiologists in Europe and beyond ensures a uniform assessment of the competencies of radiology trainees, validates the knowledge acquired during residency training, and confirms that a radiologist has the essential skills to practice effectively, she told ECR 2025 attendees. The 4.5-hour exam consists of multiple response questions, short cases, and clinically oriented reasoning evaluation based on European Training Curriculum for Radiology Level I and II. The pass rate is 70%.
The candidate requirements for diplomas awarded by subspecialty societies all share similar traits. They include proof of two years or more subspecialty practice following certification, reporting of specific quotas of exams, quotas for continuing medical education (CME), letters of support, ESR and subspecialty society membership, and attendance at multiple specified conferences.
| European exams and diplomas in radiology | |||||
|---|---|---|---|---|---|
| (Sub)specialty | Society | Diploma | ESR | CESMA | Title |
| General radiology | ESR/EBR | EDiR | yes | yes | EDiR |
| Breast | EUSOBI | EDBI | yes | EBBI | |
| Cardiac and vascular | ESCR | EBCR | yes | EBCR | |
| Chest | ESTI | ESTI diploma | yes | ||
| Emergency | ESER | EDER | yes | FESER | |
| GI and abdominal | ESGAR | Yes | yes | ||
| Head and neck | ESHNR | EDiHNR | yes | ||
| Interventional | CIRSE | EBIR | yes | yes | EBIR |
| Musculoskeletal | ESSR | Yes | yes | EDiMSK | |
| Neuro | ESNR/EBNR | multiple | yes | multiple | |
| Pediatric | ESPR | EDiPR | |||
| Urogenital | ESUR | Yes | yes | EDiUR | |
New diplomas continue to be added. In 2024, the European Society of Urogenital Radiology created a European Certification in Prostate MRI, which was rapidly endorsed by the ESR.
"Multiparametric MRI examination of the prostate has become the imaging tool in patients with suspected prostate cancer," said Prof. Lorenzo Derchi of the University of Genoa, Italy. "It is a demanding study in terms of both examination technique and image interpretation, and a radiologist working in prostate imaging must acquire high expertise in this field."
He referred to certification as a "good political move" because it positioned the radiologist as a high-value expert within a team of multidisciplinary physicians, and implied the credential would help defend prostate imaging turf from incursion by urologic surgeons.
Preventing online exam cheating
One benefit of online examinations is "global unrestrictiveness," and as long as the local organization "passes" the pretest society check, candidates can take an online exam anywhere in the world. But this situation also raises the possibility of cheating by candidates when taking an online exam.
To prevent this, passport and government ID cards confirm a candidate's identity before the start of an exam. For example, expert human proctors from the European Board of Radiology (EBR) monitor candidates during the exam and flag any suspicious behavior, which is then reviewed afterwards by the institution. At least one examiner and an external observer watch the candidate through his/her computer camera and a strategically located additional camera. Cameras verify that the exam room remains empty, that a smartphone is not being used, and that the candidate is completing the exam in a straightforward manner.
The entire exam process is videotaped. The proctoring system generates real-time alarms if the candidate's visual and body behavior varies from the norm. Videotapes of the entire exam are carefully scrutinized if alarms have been generated. If potential cheating behavior is identified, other measures are taken.
At ECR 2025, candidates were tested onsite at an official location, with monitoring examiners present. The examination was fully digital, and it took place on 25 February, with a total of 197 candidates. In 2024, there were 173 candidates, and in 2023, there were 106 candidates in 2023, according to the EBR. The top 10 countries represented were Poland, Portugal, Germany, Romania, Italy, Austria, Spain, India, Turkey, and Hungary. The results will be sent out on 24 March.
