The need for subspecialisation in radiology and the relationship of general and subspecialist radiologists is very diverse in different regions of the world according to the reports presented at the ESR International Summit, organised by the ESR during the European Congress of Radiology in March 2015 in Vienna. The International Summit is held once a year by the ESR and its national and international radiological partner societies from outside Europe with the aim to address and discuss selected subjects of global relevance in radiology. In 2015, the relationship between general and subspecialist radiologists was analysed. It was shown that the situation differs immensely between developed and developing countries; in developed countries, a considerable proportion of radiologists are subspecialty trained; subspecialty radiologists practise mainly in large and academic departments, and many radiologists practise as multispecialty radiologists. In many developing countries only general radiologists—if available at all—practise radiology, and imaging interpretation is often performed by physicians with very limited relevant training or in some cases even by non-physicians. Main messages • Subspecialisation and preservation of the integrity of the radiology profession are relevant for improved patient care. • Subspecialisation is needed in large departments, providing the basis for innovation and research. • Subspecialty sections should preferably remain within the overarching radiology department. • Shared facilities, efficient use of resources and common organisational structures are beneficial. • A multispecialty radiologist model is an option to build robust academic and private practices.