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The EU-REST project, supported by the European Commission through the EU4Health Programme, has produced landmark guidelines for radiologist staffing and training across the EU. This initiative emerges from a critical need to address increasing demands for imaging services, inconsistencies in workforce planning and fragmented approaches to education. These guidelines reflect a comprehensive review of the current landscape, identify inefficiencies in traditional staffing models and offer a forward-looking framework adaptable to evolving technologies, practices and healthcare systems.
A New Basis for Radiologist Staffing
Historically, radiologist staffing has often been calculated using simplistic metrics such as population size, number of hospital beds or number of examinations performed. However, the EU-REST consortium determined that none of these indicators adequately capture the complexity and diversity of modern radiological work. Population-based formulas, for instance, fail to consider clinical demand variability, demographic differences and technological capacity. Similarly, equipment- or bed-based approaches overlook nuances such as imaging modality complexity, case mix and workload intensity.
In response, the project recommends a novel unit-based system, where staffing needs are calculated using “hours of machine/system/activity” as the baseline. This model accounts for the actual operating time of imaging equipment and associated radiological tasks, such as reporting and multidisciplinary team (MDT) participation. For each modality, a staffing multiplier is applied. For example, one hour of MRI or CT operation equates to 1.5 working hours of a qualified radiologist, reflecting reporting and administrative demands. This approach is not only scalable and adaptable across diverse EU healthcare systems but also allows projections for future expansions or technological changes.
Related Read: Addressing Healthcare Workforce Challenges in the EU
Comprehensive Education and Training Standards
EU-REST guidelines also aim to harmonise the duration, structure and content of radiology training across the EU. Despite some national discrepancies, a five-year training period is emerging as the de facto European standard. The project recommends formal adoption of the ESR’s European Training Curriculum (ETC), which defines progressive learning levels, from general training (Years 1–3) to more advanced, subspecialised education (Years 4–5) and optional fellowships beyond.
Crucially, the guidelines also highlight the need for uniformity in certifying radiologists’ readiness to practice. The European Diploma in Radiology (EDiR) is promoted as a harmonised exit examination, recognised or accepted in several EU countries. The guidelines also call for a minimum number of European Credit Transfer System (ECTS) hours and procedure volumes per subspecialty and for radiology training centres to undergo standardised quality assessment through the ETAP programme.
Furthermore, continued professional development is addressed. The EU-REST project endorses a Europe-wide adoption of EACCME-accredited education and recommends establishing minimum CME requirements across all EU Member States. This ensures that radiologists maintain competency as clinical standards and technologies evolve.
Practical Application and Broader Challenges
The hour-based staffing model is especially effective in accommodating local variations in practice and in addressing long-standing workforce issues. For example, the model considers not just the number of examinations but also factors like MDT involvement, interventional procedures and teaching. It allows for adjustments based on the presence of trainees, recognising both their contribution and supervision requirements.
However, workforce distribution remains a major challenge. Urban-rural disparities persist across the EU, with radiologists concentrated in larger cities and academic centres. The guidelines suggest that in addition to technical calculations, policy measures are needed to incentivise radiologist deployment in underserved areas.
The guidelines also acknowledge the growing influence of AI on radiology. While automation could streamline workflows, it might also generate additional findings requiring interpretation. As such, staffing recommendations must remain adaptable to unknown future changes in radiological practice. The proposed hour-based unit model allows for such flexibility.
Another major concern is the ageing radiologist workforce. In several EU countries, a significant proportion of radiologists are nearing retirement, with up to 35% expected to leave the workforce within five years. This underscores the importance of forward-looking workforce planning and investment in training sufficient numbers of new radiologists to maintain service levels.
The EU-REST project represents a significant advance in standardising radiology staffing and training across Europe. By shifting from outdated models to a flexible, time-based calculation system, the guidelines offer a more accurate and scalable method to plan workforce requirements. Combined with harmonised training standards and continuous professional development, these recommendations lay a foundation for a more resilient, equitable and responsive radiology sector in the EU. The success of these initiatives, however, will depend on their widespread adoption, national policy alignment and the ability to adapt to ongoing technological and demographic changes.
Source: Insights into Imaging
Image Credit: iStock
