History of the International Society for Strategic Studies in Radiology
The seeds of what is now known as the International Society for Strategic Studies in Radiology – or IS3R – were planted some 35 years ago by four academic radiologists: Dr. Melvin M. Figley of the University of Washington, Dr. Richard H. Greenspan of Yale University, and Drs. Charles A. Gooding and Alexander R. Margulis of the University of California, San Francisco (UCSF). Under the leadership of Dr. Margulis, this small committee organized the first “International Conference on the Impact of New Radiological Technology on Health Care, Research and Teaching,” which took place from March 3 to 5, 1978, at the Fairmont Hotel in San Francisco. The meeting was held under the auspices of the UCSF Department of Radiology. Its purpose, as explained by Dr. Margulis in his introductory remarks, was to “discuss the problems imposed on radiology, medicine in general, the medical schools, the leading hospitals and the society as a whole, by the explosive advances in [radiological] technology.”
Such an ambitious agenda demanded a diverse group of knowledgeable speakers and attendees, and accordingly, the committee gathered together what Dr. Margulis called “an array of participants and guests unmatched by any meeting.” In addition to academic radiologists, the attendees included leaders from industry and government, deans, professors of medicine and surgery, basic scientists, and hospital directors. While the majority of the 75 active participants came from the United States, 32 hailed from an assortment of countries scattered around the globe: Australia, Canada, Denmark, England, France, Germany, Israel, Japan, the Netherlands, Norway, Spain, Sweden, Yugoslavia and Mexico.
At the time of the meeting, health care costs accounted for approximately 9% of gross national product in the United States and posed a significant burden in other developed countries as well. “CAT fever” had already spread worldwide, and technologies for ultrasound and nuclear medicine were rapidly increasing in sophistication, making radiology one of the largest areas of capital expenditures in health care. As expressed by Dr. Margulis, the hope was that sharing ideas and experiences internationally would help the stakeholders present to develop practical approaches for deploying new imaging technologies “before less knowledgeable officials imposed them.” The program was densely packed with presentations, panel discussions, and open discussions. Among the many questions addressed were who should finance the testing of new technologies by academic departments; whether replacing conventional radiological procedures with new, more expensive technologies could be cost-effective; how medical and postgraduate training programs might need to be modified in light of new technologies and subspecialties; and whether the referring physician or the radiologist should determine the use of new technologies.
The exchange of ideas was lively and productive, and there was a general consensus that the meeting fulfilled an important need addressed by no other forum. Therefore, the UCSF Department of Radiology continued to present similar symposiums every two to three years. The fifth such symposium presented by UCSF was held from 27 to 29 August, 1992 at the Fairmont Hotel. The meeting was entitled “The Fifth International Symposium on the Impact of New Imaging Technology on Worldwide Health Care, Research and Teaching.” The addition of the adjective “worldwide” signified an increased emphasis on international inclusiveness and cooperation. By this time, the organizing committee was large and international, and the meeting was funded by donations from 22 companies from around the globe. Whereas the original meeting had focused exclusively on concerns affecting developed countries, the program of the 1992 symposium also addressed conditions in emerging countries, and it included presentations on outreach efforts to improve imaging and overall health care in the latter. In each session, a specific topic was addressed by speakers from multiple countries. The topics were as follows:
• The impact of the economy on advances in the practice of medicine and radiology
• What is the role of government in medical practice and progress?
• How does industry relate to radiology in developed and emerging nations?
• What changes have occurred in response to changing technologies?
• What is the role of electronic image transmission?
• What is the worldwide distribution of radiology resources and its effect on education and clinical care?
A total of 96 individuals from 26 countries, including Russia, China, Poland, Czechoslovakia, South Korea, Singapore, Austria, Italy, Belgium, Portugal, Finland, India and Guatemala, participated in the symposium. As before, they were a diverse group consisting of notable physicians, scientists, and other leaders from academia, industry and government.
In April 1994, a worldwide working group on cost-effectiveness in imaging was convened in Oxford, UK, under the leadership of Dr. Margulis of UCSF and Dr. Stephen Golding of the University of Oxford. The format was similar to those of the symposiums held previously at UCSF, but the group of participants was smaller and the agenda focused more narrowly on the need to justify the costs of radiology.
Participants from the United States, Belgium, United Kingdom, Germany, Sweden, Japan and Italy offered colleagues insights into their respective national healthcare systems, including reimbursement strategies. The group strongly favored an organized forum to consider these issues and agreed upon immediately beginning preparation of a larger international symposium, to be held in Oxford in 1995.
The meeting format chosen was similar to those of the earlier, UCSF symposiums, with selected participants from all areas of the profession as well as politicians and industry representatives. However, significant steps were taken toward greater formalization and public outreach: It was decided that the proceedings of the meeting would be published and an executive summary would be sent to each national radiological society as well as to relevant government agencies. The program would address important issues concerning international differences in technology assessment and outcomes, recent research developments, communication with politicians and governments, future developments in clinical and research areas, and quality of life factors and ethical considerations.
The “First International Symposium on Costs and Benefits of Radiology” was held in August 1995 at St. John's College, Oxford, UK and organized by Stephen Golding and Alex Margulis. It was attended by 86 delegates, of whom 55 belonged to the medical field. Fifty-three acted as speakers and 31 were industrial representatives; approximately 50 papers were submitted by the speakers and published as a supplement to Academic Radiology in April 1996 (volume 3, supplement 1). Tymothi Peters and Renee Sauers of the Department of Radiology at UCSF managed the overall administration of the symposium, while Stephen Golding and his staff at Oxford University managed many of the logistical details.
As the meeting was deemed a great success, a “Second Oxford International Symposium on the Cost and Benefits of Radiology” was held in August 1997 at the Mark Hopkins Intercontinental Hotel in San Francisco. The idea to accept invited speakers from the fields of medicine and industry as well as from government was discussed and revived. Ronald Arenson and Alex Margulis, both of UCSF, organized the scientific program. Tymothi Peters and Renee Sauers of the Department of Radiology at UCSF were asked to coordinate the meeting’s administration, logistics and finances. The main items on the program were the rationale for assessing costs and benefits, methodological issues, perspectives on government health insurance programs and industry from around the world, as well as cost and benefit initiatives in diverse countries. Compared to the previous meeting, the scientific level of the papers improved considerably, and the number of participants rose to 109. The need for scientific work and research in the field of cost-effectiveness was clearly demonstrated. The proceedings from the symposium were published as a supplement to Academic Radiology (volume 5, supplement 2) in September 1998. At the end of the meeting, the organizing committee decided that the request for a third symposium was justified and that the symposium would continue to occur biennially.
The “Third Oxford International Symposium” was held at the Hotel Intercontinental in Berlin, Germany in August 1999. Karl-Jürgen Wolf of the Free University in Berlin and Alex Margulis of UCSF were invited to organize the meeting. The scientific topics covered included approaches to assessing cost-effectiveness and contributions of radiology to achieving cost-effective patient care; government policies on health management; principles of reimbursement; the question of how industry copes with price versus quality; and the costs of research and education. Eighty-seven speakers and participants from around the world attended the meeting. The excellence of the research and presentations, and the highly interesting discussions, particularly those involving industrial representatives, gave the meeting a special flavor. The proceedings of the Berlin meeting were published in a supplement to European Radiology in 2000 (volume 10, supplement 3).
Before the Third Oxford International Symposium in Berlin, the need for a more formal organizational structure became clear. The formation of the new “International Society for Strategic Studies in Radiology” (IS3R) began at the meeting in Berlin. The name of the society was proposed by Dr. Elias Zerhouni of Johns Hopkins University, who would become Director of the National Institutes of Health in 2002. (Dr. Zerhouni had to resign from the Executive Committee of the IS3R during his government work but remained a strong supporter of the society and presented important keynote addresses from his new position.)
Statutes were established on proposals put forward by Karl-Jürgen Wolf in cooperation with Christian Herold and Peter Baierl of Vienna, Austria. It was decided that the society would have offices in both the United States and Austria, and the European Congress of Radiology (which would later become part of the European Society of Radiology [ESR]) kindly provided assistance. Tymothi Peters of UCSF was named Administrative Director and Brigitte Lindlbauer of the European Congress of Radiology was named Vice Administrative Director.
The Austrian authorities confirmed the founding of the IS3R in November 1999, and the constituent General Assembly took place in March 2000 in Vienna. An Executive Committee was elected and Hans Ringertz of Karolinska Institute, Sweden became the first president. He was succeeded by Dr. Gary Glazer of Stanford University (US) in 2003. The third president was Prof. Guy Frija of the Hôpital Européen Georges Pompidou (France), who was succeeded by Dr. Ronald Arenson of UCSF (US), Prof. Christian Herold of Medical University of Vienna (Austria), and Dr. Hedvig Hricak of Memorial Sloan-Kettering Cancer Center (US). The seventh and current president is Dr. Gabriel Krestin of Erasmus University (The Netherlands).
The society has always had, as a matter of principle, diverse international membership representation from Europe, the US and Asia. It has established strong relationships with industrial partners, who actively participate in its meetings. Corporate memberships were introduced in 2003 at the meeting in France.
The gradual expansion of the society led to a need for greater administrative capacity. Thus, in 2010, an arrangement was formalized whereby the American College of Radiology and the ECR would share responsibilities for managing the society’s administrative needs. The ACR became responsible for overall coordination of society administration and board and committee administration, while the ECR became responsible for managing individual memberships, compliance with Austrian law, and maintenance of the society’s website. Administration of finances and corporate memberships in the US and Europe were split between the ACR and ECR, respectively, with responsibility for meeting administration switching between the two organizations depending on the meeting location. Monika Hierath manages the society’s affairs for the European office through the ECR, and Pamela Mechler manages activities for the United States office through the ACR.
To serve the key objectives as originally defined and also to satisfy the changing interests of the world-wide radiology community and its patients, the society continues to evolve, expanding the international diversity of its membership and adapting the meeting programs and their formats to address pressing new subjects. The hallmark of its operations and meetings remains open, multilateral peer discussion and consultation.
IV. MEETING SUMMARIES
The fourth biannual symposium of the IS3R (the first since the society acquired its name and official status) took place in August 2001 in San Francisco. The organizers, Ronald Arenson of UCSF and Gary Glazer of Stanford University, entitled the meeting “Radiology Entering the New Millennium.” The president of the IS3R, Hans Ringertz of the Karolinska Institute, guided the proceedings. Current and future development of imaging technologies and emerging research areas were extensively discussed. Special attention was given to the creation of the National Institute of Biomedical Imaging and Bioengineering (NIBIB) of the NIH and a detailed discussion about governmental regulations was incorporated into the meeting program. Presentations also tackled daily problems related to management and computer applications. Furthermore, representatives from manufacturing and pharmaceutical companies participated in panel discussions. This format proved to be highly attractive to all participants and led to an extremely fruitful exchange of ideas. Keynote lectures were given by Alexander Margulis, then of Cornell University, who spoke about the strategic aims of international radiology, and Frank McCormick, Director of the Comprehensive Cancer Center and Cancer Research Institute at UCSF, who spoke about cancer therapy based on RAS and p53.
The fifth biannual symposium of the IS3R took place in August 2003 in Chantilly, near Paris, and was organized by Guy Frija, then Secretary General of the French Society of Radiology. The meeting was titled “Creating Strategies for the Next Decade.” IS3R President Hans Ringertz of the Karolinska Institute guided the proceedings, which focused on strategic professional questions related to professional demography, turf issues, imaging technology dissemination and innovation, and evidence-based radiology. A large part of the meeting was dedicated to the impact of research on radiology organization. The newly appointed director of the NIH and former member of the Executive Committee of IS3R, Elias Zerhouni, delivered a keynote lecture focusing on major trends in biomedical research. Other keynote lectures were delivered by Alexander Margulis of Cornell University, who spoke about opportunities and challenges for medical imaging at the start of the new millennium; Bruce Hillman of the University of Virginia, who spoke on developments in whole-body screening; Roderic Pettigrew, Director of NIBIB, who spoke on molecular imaging; C. Douglas Maynard of Wake Forest University, who spoke on the history of the radiological exposition; and George Charpak of the European Organization for Nuclear Research, who spoke about physics and medicine. Other presentations addressed changes in the regulation process of approval of new technologies and drugs. Translation of molecular imaging into practice was the focus of extensive discussions among leading researchers and the audience. The final day was dedicated to communication policies. Discussions between industrial partners and professionals focused on the role of radiological and technical exhibits and meetings, as well as on public information policy.
The sixth biannual symposium of the IS3R took place in August 2005 in Boston, Massachusetts. The meeting was organized by James Thrall of the Massachusetts General Hospital and Harvard Medical School and guided by IS3R President Gary Glazer of Stanford University. The title of the meeting was “Reinventing Radiology in the Digital and Molecular Age.” The symposium addressed how digital image acquisition supported by digital information and digital knowledge management systems had facilitated improved quality of care and increased the value created by medical imaging. Another focus of the meeting was the rapid development of molecular imaging techniques and the application of nanotechnology in medical imaging. Keynote addresses were delivered by Tommy G. Thompson, the former US Secretary of Health and Human Services, who spoke about globalization in health care; Bruce J. Hillman,of the University of Virginia, who spoke about the new imperative for quality and safety in radiology; Elias Zerhouni, Director of the NIH, who spoke about strategic directions for the NIH; and Raju Kucherlapati of the Harvard-Parnters Center for Genetics and Genomics, who spoke about genetics and genomics in clinical medicine. Participants also addressed major trends in the education of medical students with respect to imaging and important developments and needs in the training of residents and fellows in radiology. The proceedings of the meeting were published in the journal Radiology (Krestin GP, Miller JC, Golding SJ, Frija GG, Ringertz HG, Thrall JH. Reinventing Radiology in a Digital and Molecular Age: Summary of the Proceedings of the Sixth Biannual Symposium of the International Society for Strategic Studies in Radiology, August 25-27, 2005. Radiology 2007; 244:633-638).
The seventh biannual symposium of the IS3R was held August 23-25, 2007 at the Hotel Bayerischer Hof in Munich. The president of the IS3R, Guy Frija, then of the Hôpital Européen Georges Pompidou, guided the proceedings. The meeting was organized by Maximilian Reiser of the University of Munich and titled “Advancing Radiology through Informed Leadership”. The new fields and new challenges of interventional radiology were discussed in the first session. This included a glance at focused ultrasound as a new interventional technique. A session on the cost and quality of radiological care addressed quality management, optimization of workflow and performance measurements of radiological care, and quality issues in teleradiology. The morning of the second day was dedicated to molecular imaging and nanotechnology and highlighted both impediments to and opportunities for developing this new field in radiology. James Thrall, the chairman of radiology at the Massachusetts General Hospital, delivered a keynote lecture on the future of imaging research, in which he emphasized the importance of high-quality research for ensuring the ongoing success and relevance of radiology. Keynote lectures were also delivered by Ron Arenson of UCSF, who spoke about the healthcare market as an engine of growth in the 21st century, and Dietrich Habs of Ludwig Maximilians University, whose lecture was entitled, “Dream Beams: Brilliant X-rays and Particle Beams.” The afternoon session focused on cardiac imaging, oncologic imaging and emergency radiology. Speakers strongly emphasized the importance of radiology establishing itself as a truly clinical discipline. The morning of the last day was dedicated to regulatory hurdles to radiological innovations. The CEOs of the medical divisions of Siemens, GE and Philips provided their views of the current regulations and ventured a look into the future. The proceedings of the meeting were published in the journal European Radiology (Muellner A, Glazer GM, Reiser MF, Bradley WG Jr, Krestin GP, Hricak H, Thrall JH. Advancing radiology through informed leadership: summary of the proceedings of the Seventh Biannual Symposium of the International Society for Strategic Studies in Radiology (IS(3)R). Eur Radiol 2009;19(8):1827-36. doi: 10.1007/s00330-009-1370-1. Epub 2009 March 11).
In August 2009, the IS3R held its 8th biannual symposium in San Diego, California. The meeting was organized by William G. Bradley of the University of California, San Diego. The president of the IS3R, Ron Arenson of UCSF, delivered opening remarks and oversaw the proceedings. The program focused on the globalization of P4 Medicine as it relates to the practice of radiology and radiology research (P4 Medicine refers to Predictive, Personalized, Preemptive, and Participatory Medicine). Specific topics discussed included the role of imaging and imaging-related technologies in the early detection of disease and thus the preemption of the development of advanced, hard-to-treat disease; the potential of molecular imaging to enable personalized treatment selection and prevent the use of ineffective therapies; the importance of increasing interactions of radiologists with referring physicians and patients to raise awareness and recognition of the role of radiologists and facilitate patients’ participation in and understanding of their own care; and the need to increase awareness of the vital role of radiologists as imaging and radiation safety experts, who evaluate the necessity and appropriateness of examinations, monitor performance quality, and are available for post-examination consultations. Keynote lectures were delivered by Elias Zerhouni, Director of the NIH, who spoke on “P4 Medicine: The Future;” William R. Brody, the head of the Salk Institute in La Jolla and the former president of Johns Hopkins University, who spoke about “Contributions of Engineering to Advances in Imaging Technology;” and Sam Gambhir of Stanford University, who spoke on “Nanotechnology and Molecular Imaging.” The proceedings of the meeting were published in Radiology (Bradley WG, Golding SG, Herold CJ, Hricak H, Krestin GP, Lewin JS, Miller JC, Ringertz HG, Thrall JH. Globalization of P4 medicine: predictive, personalized, preemptive, and participatory—summary of the proceedings of the Eighth International Symposium of the International Society for Strategic Studies in Radiology, August 27-29, 2009. Radiology 2011; 258(2): 571-82. doi: 10.1148/radiol.10100568).
The IS3R held its 9th biennial meeting August 25-27, 2011 in Dubrovnik, Croatia. The title of the densely-packed program was “Integrated Diagnostics and Massive Computing: Convergence of Medical Imaging, Laboratory Tests, and IT solutions.” IS3R President Christian J. Herold of the Medical University of Vienna welcomed the participants and guided the proceedings, while Gabriel P. Krestin of Erasmus MC, University Medical Center Rotterdam, chaired the program planning committee. Meeting participants from both academia and industry discussed the opportunities and challenges for radiology that would likely arise from integrating medical imaging and laboratory diagnostics with the aid of advanced information technology (IT). Speakers outlined the promise of integrated diagnostics for providing more rapid and accurate diagnoses as well as greater operational efficiency, and hence its importance for meeting regulators’ growing demands for more effective and cost-efficient care. Specific topics discussed included obstacles to the adoption of advanced IT in healthcare, such as privacy and security concerns, infrastructure demands, and the need for standardization of data collection; how paradigm-changing diagnostic technologies, such as “lab-on-a-chip” devices, might be integrated with emerging imaging techniques to improve clinical practice; and the power of cloud computing for advancing health information exchanges, population imaging research, and clinical decision support. It was noted that as the physicians with the most expertise in IT, radiologists are well placed to take the lead in introducing IT solutions to promote integrated diagnostics and that new imaging approaches (such as molecular imaging approaches employing multiple tracers) have the potential to dramatically expand the diagnostic information available from imaging. Keynote lectures were delivered by Elias Zerhouni of Johns Hopkins University, who spoke about what would be new in radiology in the next five years; Ralph Weissleder of Harvard Medical School, who spoke on the topic “Diagnostics in the Era of Molecular Medicine;” Hans Ringertz of Linköping University Hospital, who spoke about supporting radiology in underprivileged countries; and Hedvig Hricak of Memorial Sloan-Kettering Cancer Center, who spoke about “Translational Concepts and Innovations in the Imaging of Metastatic Disease.” The proceedings of the meeting were published in European Radiology (Krestin GP, Grenier PA, Hricak H, Jackson VP, Khong PL, Miller JC, Muellner A, Schwaiger M, Thrall JH. Integrated diagnostics: proceedings from the 9th biennial symposium of the International Society for Strategic Studies in Radiology. Eur Radiol. 2012 Nov;22(11):2283-94. doi: 10.1007/s00330-012-2510-6. Epub 2012 Jun 15).
The 10th biennial symposium of the IS3R was held in Beijing, China, August 29-31, 2013. James Thrall of Massachusetts General Hospital/Harvard Medical School chaired the program planning committee, while Bernd Hamm of Charité Humboldt Universität and Jian-Ping Dai of Beijing Tian Tan Hospital served as co-chairs. IS3R President Hedvig Hricak of Memorial Sloan-Kettering Cancer Center delivered opening remarks and oversaw the proceedings. The title of the program was, “Imaging for the World: the Next Five Years.” The first half of the program focused on the role of diagnostic imaging (especially molecular imaging) and image-guided interventions in enabling precision medicine; special attention was given to the status of the development of imaging biomarkers for defining disease phentoypes and predicting outcomes. Executives from Bayer, General Electric, Philips and Siemens spoke in a dedicated session on industry views of precision medicine, and keynote lectures were delivered by James Thrall, who spoke about “Imaging in the Age of Molecular Medicine,” and Roderic Pettigrew, Director of NIBIB, who spoke about “Advancing Precision Medicine through Biomedical Imaging and Devices.” The second half of the program focused on current applications of imaging in health systems in various stages of development. Considerations discussed included infrastructure readiness, availability of trained personnel, economic impacts, research opportunities, and the effects of different regulatory environments. In honor of the late Gary Glazer of Stanford University, Christian J. Herold of the Medical University of Vienna delivered a keynote lecture on “Imaging for the World.” A special dinner was held to honor Dr. Alexander A. Margulis, who was awarded the first gold medal of the IS3R.