A European survey of lung cancer screening experts found significant training and education gaps across 14 countries, with only four having established training programs, highlighting the need for standardized curricula and competency standards as countries scale up screening initiatives.
- Only 4 of 14 European countries have established lung cancer screening training programs, with just France and the U.K. requiring mandatory training
- Experts ranked management of incidental findings as the most critical training gap, followed by confident use of nodule-management guidelines
- Lung cancer screening requires far more than technical CT skills, including participant selection, standardized protocols, structured reporting, and clear communication
- The European Lung Cancer Screening Alliance (ELCSA) was created to promote shared standards, training, and quality assurance across European screening programs
- Germany's proposed model places qualified community radiology practices at the center with specialist lung cancer centers providing independent second readings and consensus reviews
Only four of the 14 European countries represented in a new Strengthening the Screening of Lung Cancer in Europe project (SOLACE) survey had established training programs for low-dose CT lung cancer screening, highlighting uneven professional preparation as screening expands.
Published on 29 July in Insights into Imaging, the study’s first author was Dr. Rebecca Mura of the Department of Biomedical Imaging and Image-guided Therapy at the Medical University of Vienna in Vienna, Austria. It used an interviewer-administered survey conducted through individual Zoom interviews with 25 experts from 14 European countries, including radiologists, pulmonologists, thoracic surgeons, and other screening professionals.
Training remains uneven
All 14 countries reported an ongoing screening program, but only two had an established nationwide program. Twelve were running regional programs or pilot initiatives, and three planned to move toward nationwide implementation within five years.
Four countries had established training programs, six reported learning initiatives, and four were planning programs. Only France and the U.K. had mandatory schemes. Course formats, examinations, certification arrangements, and annual reading-volume requirements also varied.
Uptake of voluntary education remained limited. Respondents from only four countries mentioned the European Society of Thoracic Imaging’s voluntary certification, and just 77 European radiologists obtained it between 2022 and 2025.
The survey distinguished between training gaps, educational priorities, and essential competencies. Limited awareness of the need for dedicated training was rated the most relevant gap.
Management of incidental findings was the highest-rated area requiring improvement. Incidental finding management and guideline-based nodule management tied as the top professional competencies, followed closely by basic knowledge of AI tools and communication with screening participants.
SOLACE work continues through ELCSA
The survey was conducted within the EU-funded SOLACE project, which supports the structured implementation of screening and seeks to reduce differences in access, organization, and quality across European countries.
To continue this work beyond the project, the European Society of Radiology and European Respiratory Society established the European Lung Cancer Screening Alliance. ELCSA will promote shared standards, training, quality assurance, clinical guidance, and cooperation across Europe.
Germany tests a cross-sector model
Germany offers a current example of how training requirements connect with service organization. In a joint appeal from 29 June, the German Radiological Society, or DRG, the Professional Association of German Radiology, or BDR, and Radiologists Group RG20 called for screening to be implemented collaboratively across healthcare sectors.
Their model places qualified community radiology practices at the center of broad access and first readings, while lung cancer centers focus on second readings, consensus decisions, and further diagnostic workup.
Separately, Dr. Christian Bijan Fink of University Hospital Düsseldorf in Düsseldorf, Germany, described lung cancer screening as “more than a CT” in a LinkedIn post. He highlighted risk selection, standardized low-dose protocols, structured reporting, independent second reading, and rapid clarification of suspicious findings.
The German example reflects the survey’s broader message that training must be embedded within coordinated screening pathways, particularly for communication, incidental findings, and downstream clinical workflow.
The authors acknowledged the small, geographically uneven sample and noted that the findings reflect expert perceptions rather than objective assessments of training quality. Nevertheless, they concluded that Europe needs shared core curricula and minimum competency standards.
The study was funded through the EU4Health program. Among the proposed gaps, limited awareness of the need for dedicated training was rated the most relevant.
The full study can be found here.
