This is the first survey to explore the European interventional and diagnostic training in different countries, and the questionnaire development and structure tried to synthesize and cover the main differences—but also to cluster some similarities—between neuroradiology educational programs and practices.
There is a wide variety of training in neuroradiology offering all over the world due to a widely variation of the structure and regulation of the training and, though less, to the variation of its duration . And throughout the world, the main differences of training programs are not limited to neuroradiology, but also to the structure and duration of the medical school curricula and radiology residency programs (teaching modules, duration, a faculty-to-resident ratio) .
Regarding the specific training in neuroradiology in Europe, some nations have a specialized fellowship only in interventional or in both diagnostic and interventional (Table 1) with the specificity of Portugal where neuroradiologists follow a separate training track and their residency is separate from the general radiology.
The definition of standards of training and practice can guarantee highest quality medical care and safety. This can be reached by accreditation and certification of training programs. There is a worldwide interest in the production of consensus documents in neurointerventional (NI) training which see the USA as the leader. Different neurosurgical, neuroradiological, and neurologic societies connected to NI have agreed on a training curriculum and related documents , proposing individual training, certification and requirements, and resources.
In the USA, there are also structured diagnostic radiology educational programs and neuroradiology fellowship training which are ACGMR-approved and based on concrete guidelines [7,8,9], including the implementation of national certifying examinations .
The survey’s results evidenced Europe’s lack of guidelines and standardization of training and practice, even if training and educational courses are provided in NI by ESMINT (ECMINT, European Course in Minimally Invasive Neurological Therapy; EXMINT, European Stroke Course; Stroke Winter School and ESMINT fellowship)  and ESNR, the latter organizing also diagnostic courses for different levels of learners (i.e., European School of Radiology (ESOR), European Course in Neuroradiology (ECNR), Higher qualifications) . The first-level (ESOR) course can be addressed to residents, and it is organized on a yearly basis as a 2-day course, while ECNR is recommended to radiologist with a minimum of neuroradiology training and divided in different modules of learning (1st, embryology/anatomy/malformations/genetics; 2nd, tumors and tumor-like lesions; 3rd, vascular diseases; 4th, trauma/degenerative/metabolic/inflammatory), while third-level courses are designed for neuroradiologists and provide higher qualification in interventional or spine, pediatric, or head and neck neuroradiology .
Generalizability of results
The limitations of this survey are based on the bias for the responders that were selected within the UEMS and main European societies’ representatives. In addition, some answers may not summarize all the complexity of one national reality, and sometimes, there were some differences in the replies from the referents coming from the same country. Anyway, in case of inconsistent answers, we were able to cross-check the validity of these replies by interviewing national representatives of neuroradiology societies.
In conclusion, this is the first study providing a picture of the current scenario of the neuroradiology training and practice in Europe. Active intervention is needed for harmonizing the heterogeneity of organization of NR training between the EU countries and for creating a common standard of knowledge. That can be achieved through the implementation of a standardized European program and a Charter for educational and training and then through establishment of a common certification and license.