Diploma in Musculoskeletal Radiology
The European Diploma in Musculoskeletal Radiology will be a recognised European qualification for MSK radiologists and will help to standardise training and expertise across Europe.
The Diploma is endorsed by the European Society of Radiology (ESR).
The Diploma confirms specific competencies a of radiologist can perform, interpret and report radiography, ultrasound, MR imaging (incl. arthro-MR) and CT (incl. arthro-CT) examinations of the musculoskeletal system. In addition, it certifies the skill to perform musculoskeletal system-related interventional procedures.
The Diploma represents a recognised qualification in musculoskeletal imaging and will assist its holders in the promotion of their skills and experience when dealing with other clinical colleagues and with the general public/patients.
The training of candidates has to be in line with previously established basic principles of radiology training as laid out in the ESR European Training Curriculum for Radiology
- Subspecialisation should take place after the designated time for radiology residency. In exceptional cases, partial Subspecialisation may already start within the years of differentiation (E.g. UK / NL). Radiology Residency should preferably last no less than five years. For candidates with less than five years of training only: Proof of experience as a supervised staff radiologist is required.
- At least two years of subspecialty training are required. Maximum one year of subspecialty training can be done before board certification.
- The level of knowledge requested from candidates has to correspond to the curricular contents for full subspecialisation in the field of radiology provided by the ESR European Training Curriculum for Subspecialisation in Radiology (Level III).
The examination is only open to fully-trained, licensed, and practicing radiologists.
To be able to:
1. have detailed knowledge of anatomy and physiology of bones and joints (incl. synovial and non-synovial) of the upper extremity, lower extremities and bone pelvis
2. have detailed knowledge of anatomy of the axial skeleton (i.e. cervical, dorsal, lumbosacral spine), intrinsic back muscles and related soft-tissues (e.g. discs, ligaments, spinal nerves)*
3. have detailed knowledge of anatomy of the soft-tissue structures that are pertinent to the musculoskeletal system (e.g. tendons, muscles, nerves, ligaments, fascial planes, vessels and connective spaces) in the upper extremity, lower extremity, pelvis, thoracic cage, abdominal wall and neck
4. have basic knowledge of biomechanics and pathophysiology of the muscle-tendon-bone unit
5. have knowledge of the main steps and timings of skeletal maturation in the paediatric age group, including ability to define skeletal age and recognize appropriate/abnormal skeletal growth
6. have basic knowledge of the most common anatomical variants, congenital and developmental anomalies of the skeleton and soft-tissue structures that are pertinent to the musculoskeletal system and recognize differences between normal variants and pathology
7. have extensive knowledge of common and uncommon musculoskeletal diseases in adults and children and of how these diseases manifest, both clinically and on imaging, including:
a. traumatic injuries of the axial (*) and appendicular skeleton (e.g. recognition of common and uncommon fractures and dislocations; understanding of the basic mechanisms of injury and distinguishing stable from unstable injuries; knowledge of fracture healing and complications of healing such as delayed union, malunion and nonunion, complex regional pain syndrome etc…)
b. overuse pathologies (e.g. labral tears, shoulder impingement syndromes, overuse tendinopathies and tears, retinacula-related disorders, exertional compartment syndromes etc…)
c. arthropathies and neurologic/muscular disorders and connective tissue diseases (e.g. aging, rheumatoid arthritis, psoriatic arthritis and psoriatic spondyloarthropathy, ankylosing spondylitis, scleroderma, systemic lupus erythematosus, mixed connective tissue disease, juvenile idiopathic
arthritis, idiopathic inflammatory myopathy, gout, crystal-related arthritis, neuropathic osteoarthropathy etc…)
d. infectious disorders (e.g. cellulitis, pyomyositis, abscess, septic arthritis, diabetic pedal infection, HIV-related, atypical mycobacterial infections etc…)
e. metabolic and endocrine diseases (e.g. osteoporosis, hyperparathyroidism, renal osteodystrophy, amyloidosis, Gaucher disease, storage diseases, osteogenesis imperfecta, Marfan, Paget, hypertrophic osteoarthropathy, sarcoidosis, tuberous sclerosis etc…)
f. congenital syndromes (e.g. flatfoot and clubfoot, osteochondrodysplasia, failure of growth and development of cartilage and fibrous tissue, anomaly in density and modeling, dysostosis, chromosomal anomalies etc…)
g. bone and soft-tissue tumors and tumor-like conditions (i.e. systematic assessment of a solitary lesion of bone and its categorization as aggressive or nonaggressive; appropriate differential diagnosis based on patient’s age, lesion location and characteristics – boundaries, matrix, periosteal reaction, soft-tissue extension; knowledge of systematic, safe and cost-effective radiologic work-up of bone lesions, including biopsy approach and compartmental anatomy etc…)
8. recognize normal postoperative findings and complications of common orthopaedic procedures and hardware placement, including findings of loosening and infection of orthopaedic hardware
9. recognize skeletal and soft-tissue injuries (incl. sports injuries, skeletal manifestations of child abuse), common congenital syndromes and clinically relevant developmental dysplasias (e.g. focal growth disturbances, DDH, coalitions, dysplasias, irritable hip, spinal deformity) in the paediatric age group
10. have detailed knowledge of interventional MSK procedures, including interventions of the spine such as discography, nerve root injections, epidural injections, facet/SI joint injections, vertebroplasty, kyphoplasty (if there procedures are operated)*
11. have an appreciation of the role of nuclear medicine and densitometry techniques in the musculoskeletal system
12. Dual energy CT -applications
*Imaging of the axial skeleton doesn’t characterize the activity of musculoskeletal radiologists in many countries across EU.
Eligibility criteria / Necessary application documents
Collection of necessary application documents may start from year 4 of general radiology education
- Certificate of completed training (Members in training are not entitled to take part in the examination)
- RIS documentation or logbook with a total record of the candidate’s experience in musculoskeletal radiology countersigned by the candidate’s programme director.
- A letter of support from the programme director or department head.
- At least 50 CME credits in MSK events recognized by the ESSR*
- Proof of ESR and ESSR membership in the year(s) of the application and the examination
- Attendance of 2 annual meetings of the ESSR
- Being first author of an Accepted Abstract for a national/international MSK event recognized by the ESSR
*MSK events recognized by the ESSR will be marked as such in the online ESSR congress calendar on the website and in its social media channels. Besides others, such events include ESSR Subcommittee Events, European Congress of Radiology, International Meeting of the Skeletal Society, European School of Radiology, and annual meetings of national radiological and/or musculoskeletal societies.
– Participation in ESSR webinars
– Participation in ESSR subcommittee events and courses
– Participation in the ESOR MSK Fellowship in a recognized training center
Once met these requirements, the candidate can apply for the diploma and will undergo a final examination at the annual ESSR or ECR Congresses.
Once met the eligibility criteria, the candidate can apply for the diploma and will undergo a final examination at the annual ESSR or ECR Congresses according to the ESR rules.
Please note: an active registration for the respective congress is required to attend the examination.
Only a limited number of candidates can be accepted for the examination at each meeting. Applications will be accepted on a first come, first served basis – date of receipt of application form! Early application is therefore recommended.
Next Examination: tbc
The examination takes place twice a year, once at the ESSR congress and once during ECR. The examination will be performed with up-to-date technical and educational tools.
The examination consists of written and oral components, both contributing 50% of the total score for the exam. Both parts of the examination (oral and written) have to be passed.
After the examination, an examiners meeting will be held. At this meeting, the results of both components of the exam will be added together to produce a total score for the examination for each candidate.
a) Written Exam
• 40 multiple choice questions (1 correct /4 answers)
• The exam lasts 60 minutes
• Candidates will be tested in all aspects relevant to MSK radiology
b) Oral Exam
• Examiners will test the candidate discussing cases at the workstation in a maximum of 20 min long session.
• The exam will be held in English.
Each candidate will be examined by ESSR representatives.
ESSR examiners are appointed by the Executive Committee of the ESSR.
Eligibility criteria of ESSR examiners:
– each ESSR examiner has to be an ESSR member AND
– has made an active contribution to the field of MSK radiology as judged by CV (publications, teaching, committees etc.)
The handling fee is the following: EUR 400,-
In case a candidate did not pass the European Diploma in Musculoskeletal Radiology he/she has the possibility to retake the examination one year later. A reduced fee of € 200.00 will be granted for a re-examination for member in good standing.
The ESSR Diploma certification has 5 years validity.
Renewal of the Diploma might be requested by the candidate by providing proof of completion of the following items during the 5 years of Diploma validity:
- provision of at least 20 CME credits per year in MSK events recognised by the ESSR
- active ESR and ESSR society memberships
- filled-out renewal application form
No written/oral exam will be required for renewal. A renewal fee of EUR 30,- will be charged.
Successful candidates will be awarded the “Diploma of Musculoskeletal Radiology” by the European Society of Musculoskeletal Radiology and may add the title “EDiMSK – European Diploma in Musculoskeletal Radiology” to their names.
The title is active and allowed to be used until the respective expiration date of the diploma.
Do you want to apply for the ESSR Diploma?
Test your skill in advance …
From this link [document #1] you can download the pdf file with the 40 multiple-choice questions that the examination board has used in the last session of the ESSR Diploma. At the end of your self-test, you can check your performance by downloading the correct answers from this link [document #2] . As a rule, candidates are required to give at least 70% (28/40 questions) correct answers to pass the written part of the exam.
During the oral part of the exam, candidates are required to discuss relevant imaging findings and make the diagnosis. Here you can find a few images of the case that was under discussion in the last session of the ESSR Diploma. The case refers to a 45 year-old woman with recent onset of right anterolateral hip pain. Which is the diagnosis?
Click here to see the images and diagnosis as PDF
Click here to see the images and diagnosis as PPTX