Radio buttons do not return correct data from pivot table.

Why should only that one item be returned for WEST?

This will return all items based on which option button has been selected.

Private Sub test()

    Set sh = ActiveSheet

    On Error Resume Next
    Application.ScreenUpdating = False

    With Sheets("DETAILS").PivotTables(1).PivotFields("Element")

        .ClearAllFilters
        For Each ptitem In .PivotItems
            ptitem.Visible = ptitem.Name Like "*" & sh.Shapes(Application.Caller).OLEFormat.Object.Caption & "*"
        Next ptitem

    End With

    Application.ScreenUpdating = True

End Sub

Private Sub test()

Set sh = ActiveSheet

On Error Resume Next
Application.ScreenUpdating = 0

With Sheets("DETAILS").PivotTables(1).PivotFields("Element")
   
        .ClearAllFilters
    
        For lngindex = .PivotItems.Count To 1 Step -1
            Select Case UCase(Left(.PivotItems(lngindex).Name, 4))
            Case "NORT"
                .PivotItems(lngindex).Visible = sh.OptionButtons(1).Value = 1
            Case "SOUT"
                .PivotItems(lngindex).Visible = sh.OptionButtons(2).Value = 1
            Case "WEST"
                .PivotItems(lngindex).Visible = sh.OptionButtons(4).Value = 1
            Case "EAST"
                .PivotItems(lngindex).Visible = sh.OptionButtons(3).Value = 1
            End Select
        Next

End With

Application.ScreenUpdating = 1

End Sub

Although I think you might be better off creating a new field for Areas N/S/E/W and filtering the report by those.

What indicates the items that are confidential/old/irrelevant?

You'll need to write the code so it excludes the elements you don't want.

Since there's no criteria for that I can't see any other way then hard-coding what not to display

Private Sub test()

Set sh = ActiveSheet

On Error Resume Next
Application.ScreenUpdating = 0

With Sheets("DETAILS").PivotTables(1).PivotFields("Element")
   
        .ClearAllFilters
    
        For lngindex = .PivotItems.Count To 1 Step -1
            Select Case UCase(Left(.PivotItems(lngindex).Name, 4))
            Case "NORT"
                .PivotItems(lngindex).Visible = sh.OptionButtons(1).Value = 1
            Case "SOUT"
                .PivotItems(lngindex).Visible = sh.OptionButtons(2).Value = 1
            Case "WEST"
                If .PivotItems(lngindex).Name = "WEST.01.06.1" Then
                    .PivotItems(lngindex).Visible = sh.OptionButtons(4).Value = 1
                Else
                    .PivotItems(lngindex).Visible = 0
                End If
            Case "EAST"
                .PivotItems(lngindex).Visible = sh.OptionButtons(3).Value = 1
            End Select
        Next

End With

Application.ScreenUpdating = 1

End Sub

I still think you should add another data field that contain information for those records you want displayed.