Who we are, "ISR White Paper": The Value of The International Society Of Radiology

Author: Dr. Bibb Allen et al.
February 2018
Update: April 2022

The Value of The International Society of Radiology
The genesis of an international society for the use of x-rays in medicine began in 1925 in London, England with the first of a series of international radiology congresses that were hosted by national radiological organizations. In that first congress, attendees discussed the worldwide concern that there was no reliable way to measure patients’ radiation exposure other than assessing the degree of skin erythema. At that time, there were efforts underway in Britain, Norway, Germany and the United States to quantitatively define x-ray exposure, and after discussions in London it was concluded that an international effort was warranted to create standardized metrics. A second congress was held in Stockholm, Sweden, in 1928 which led to the establishment of the International Commission on Radiation Units and Measurements as well as the International Commission on Radiological Protection [1]. These ad hoc assemblies to discuss global issues facing the practice of radiology continued until 1953 when a more formal process for organizing international congresses was established. Although not officially incorporated until 1995, the International Society of Radiology has its roots in assembling the leaders of the national radiology societies to provide a unified voice for advancing the radiological sciences for our specialty and the patients we serve, and that remains the mission of the ISR today.
The International Society of Radiology (ISR) is a federation of the world’s national and continental radiological societies with a mission to facilitate the global endeavors of the ISR’s member organizations in order to improve patient care and population health through diagnostic medical imaging and image-guided interventions. This federation allows our profession to speak with a unified voice in dealing with global issues affecting the specialty of radiology, the patients and public we serve. The World Health Organization (WHO) and the International Atomic Energy Agency (IAEA) exert tremendous influence on global health issues through global and regional initiatives designed to improve population health. Furthermore, the WHO and IAEA also influence the appropriate use of medical radiation, and as such, their decisions, guidelines and regulatory efforts are of critical importance to our specialty. The ISR serves as a Non-State Actor in official relations with the World Health Organization.

The basis of these official relations is a plan for collaboration between WHO and the ISR with agreed objectives and activities for a three-year period. In the framework of this workplan, the ISR provided scientific and technical assistance to WHO’s response to COVID-19, above all in the development of the WHO Rapid Advice Guide on the use of chest imaging in COVID-19 [2] in spring 2020. Derivative products include a training module on chest imaging in COVID-19, Priority medical devices list for the COVID-19 response and associated technical specifications [3], technical specifications for procurement of imaging equipment, input to WHO’s work on post-COVID condition and manuscripts to peer review journals [4].

Starting 2021, the two organizations have held joint webinars to commemorate WHO Global Health Days and made the recordings available for free.

Another area of successful collaboration is the WHO Global Action Plan on Patient Safety. The ISR provided technical input for the development of the first draft action plan in February 2020, and an ISR-WFUMB-WHO Webinar on Safer Maternal and Newborn Care – the Role of Ultrasound was held to celebrate World Patient Safety Day 2021 [5].

Based on the survey that informed the WHO Rapid Advice Guide on COVID-19, the ISR published a paper on the use of imaging in COVID-19, which was selected as EuroMinnies 2021 Scientific Paper of the Year [6].

In November 2021, the ISR and the IAEA elevated their longstanding collaboration to a more formal level by signing Practical Arrangements on cooperation in the area of diagnostic and interventional radiology.

By representing the national radiological societies at the WHO and the IAEA on issues related to radiology, radiation protection and population health, the ISR is able to advance its two primary missions on behalf of the member societies: 1) Promoting global radiological quality and safety and 2) Bringing high quality radiological education, especially to underserved areas.

Promoting Global Radiological Quality and Safety
By acting as a convener of and facilitator for continental, regional, and national quality and safety campaigns in radiation protection, the ISR is able to promote the profession’s quality and safety mission with various international organizations such as the WHO, the IAEA and the International Council for Radiation Protection (ICRP). The ISR also works closely with other international radiology stakeholder groups such as the International Organization for Medical Physics (IOMP), the International Radiation Protection Association (IRPA), the International Society of Radiographers and Radiological Technologists (ISRRT), the World Federation of Pediatric Imaging (WFPI) and the World Federation for Ultrasound in Medicine and Biology (WFUMB) to promote a common international agenda on issues pertaining to medical imaging.  Although less well publicized compared to its activity on higher profile health issues, the WHO has also assumed an important leadership role in global radiation protection resulting in policies that influence the practice of radiology worldwide [7]. Additionally, the IAEA also plays an important role in international radiation protection efforts and works closely with the WHO on these issues. For instance, the IAEA publication Radiation Protection and Safety of Radiation Sources: International Basic Safety Standards [8] has an extensive section on medical radiation exposure, both for patients and health care workers, and the agency has developed the Safety Standard Series: Radiological Protection For Medical Exposure to Ionizing Radiation [9]. In December 2012, the WHO and the IAEA partnered to sponsor the “International Conference On Radiation Protection In Medicine – Setting the Scene for the Next Decade” [10], and based on those proceedings the organizations issued a joint position statement, the “Bonn Call For Action”, which identified ten essential areas designed to strengthen the radiation protection of patient and health workers overall; attain the highest benefit with the least possible risk; aid the full integration of radiation  protection into health care systems; help improve the benefit/risk-dialogue with patients; and enhance the safety and quality of radiological procedures [11]. The recent publication of ISR’s vision of repeated examinations based on the clinical benefit should be considered as an important landmark [12].
Numerous national and international organizations assisted the WHO and IAEA to assure alignment with the Bonn Call for Action, including the ISR quality and safety initiatives. In order to coordinate and facilitate an international quality and safety agenda, the ISR established the ISR Quality and Safety Alliance (ISRQSA) [13], which is the reconfigured ISR’s International Commission on Radiological Quality and Safety (ICRQS). By incorporating the radiology leadership, such as through the  “safe” campaigns, across the globe, the ISRQSA is well-positioned to act as a convener and facilitator for continental, regional and national quality and safety campaigns in radiation protection. Along with invited members from the ISR Executive Committee, the primary members of the ISRQSA are leaders from the following national and regional quality and safety campaigns:

These are independent professional organizations lead primarily by radiologists and supported by their regional radiological societies. Most of these are multi-stakeholder organizations that include medical physicists and radiographers/radiological technologists in their ranks, which amplify the effectiveness of the organizations and the ISRQSA. The primary objective of the ISRQSA is to coordinate the needs and objectives of the national and regional campaigns into a global plan to advance these efforts related to quality and safety. The specific goals of the ISRQSA will embrace contributions towards justification and optimization, equipment performance, regulatory guidance, effective communication, as well as research related to radiation protection in medical imaging. The ISRQSA is working the WHO and IAEA on a number of global issues affecting radiation safety [14]. The ISRQSA represented the ISR at the December 2017 IAEA International Conference on Radiation Protection in Medicine: Achieving Change in Practice” in Vienna to assess the progress in global radiation safety efforts since the Bonn Call to Action in 2012 and in several subsequent IAEA meetings and conferences.

Bringing High Quality Radiological Education to Underserved Areas   
The ISR acts as a convener and facilitator to bring radiological educational resources from a wide range of sources to resource challenged areas of the world with the ISR educational missions primarily accomplished through collaborations with other international organizations. The ISR collaborates with the WHO on a number of projects to educate physicians in underserved areas. The ISR has been involved in relevant events of the World Health Assembly, the WHO’s decision making body. “Imaging for Saving Kids – The Inside Story About Patient Safety In Pediatric Radiology”, for instance, was a WHO symposium held as part of the World Health Assembly 2015 [15]. A number of ISR representatives presented strategies for radiation protection in pediatric imaging that are available to the international community emphasizing educational activities which can instill a sense of engagement and accountability in healthcare providers by spreading amongst them a positive and resonating message that improves the imaging care of children, such as through catch words ‘when imaging kids, Image Gently’”. Designed to educate our patients and the public on issues surrounding the safe use of ionizing radiation, ISRQSA published a 5-part series of lectures entitled Radiation Protection Training Program for Patients/Public [16]. The ISR also advised the WHO in their publication “WHO List of Priority Medical Devices for Cancer Management” (2017) [17] which is designed to promote better access to cancer care by educating resource challenged areas about the most important imaging devices for cancer management. Finally, the ISR also partners with the WHO to promote tuberculosis detection in resource challenged areas [18] and held joint scientific virtual TB symposia [19] on the occasion of World TB Days. The ISR provided input to the WHO guidelines on systematic screening for TB, which were launched during the symposium in 2021. These activities include promoting the use of digital radiography, teleradiology and artificial intelligence algorithms to replace conventional chest radiographs, which are under-used in TB detection word wide due to lack of availability of individuals trained to interpret the examinations. The ISR GOED project [20] contains a wealth of enduring material for imaging tuberculosis and is available at no cost through a web-based format of recorded lectures, slide lectures and articles from ISR partners.

In addition,   ISR educational activities include various books/monographs and thematic open source, web-based enduring content through GOED [21]. GORAD is a global outreach program developed by the International Society of Radiology to advance radiology education throughout a global radiology community by aggregating current, practical, radiology literature with content targeted and dedicated to developing nations and underserved populations [22]. As the world of scholarship and education shrinks by virtue of the electronic tools available, it is appropriate for the international radiology community to look to current and future global needs for radiology education. Most major radiology journals publish online and offer educational content of tremendous value to radiologists and other related healthcare providers, but   access to just published content is only available to subscribers. Through agreements with these cooperating major radiology journals, the GORAD platform provides immediate open access to a limited amount of otherwise restricted access content, providing an electronic link back to the original on-line article at the time of first publication.

The ISR Resource Center [24] aggregates educational content around a number of topics and media case conferences, lectures and teaching files, imaging informatics resources and content for radiologic technologists and radiology educators.

Other activities to support LMICs

The ISR is one of the 27 supporting organizations of the Lancet Oncology Commission on Medical Imaging and Nuclear Medicine [24] launched in March 2021. Being the first-ever comprehensive effort to quantify imaging and nuclear medicine resources globally, it shows that scaling up access to imaging and nuclear medicine for cancer patients in low-and middle-income countries (LMICs) would yield considerable health and economic benefits. Under the Commission, the IAEA led a global effort to collect and collate data on equipment and workforce, with a focus on LMICs, through the IAEA Medical Imaging and Nuclear Medicine Global Resources Database (IMAGINE).

In August 2021 the ISR-endorsed paper on "How to improve access to medical imaging in low- and middle-income countries" [25] was published. It outlines a plan to upscale the role of imaging in the global health agenda and proposes a holistic approach for LMICs.

Finally, the ISR supports live programming through the International Congress of Radiology as well as ISR participation in regional and local meetings. In keeping with its missions to deliver education and training to radiologists in developing nations and facilitate the endeavors of the ISR’s member organizations to improve patient care and population health through medical imaging, the ISR has established the “Meet the ISR” program [19] which is intended to further the ISR mission by providing teams of ISR representatives to participate and contribute to ISR member national society or regional radiology meetings. The ISR Executive Committee has formalized a process by which requests from member organizations  apply for ISR participation as guests within   their local programs through the “Meet the ISR”.

Benefits of ISR Membership
By being part of the International Society of Radiology member societies have input into how the radiology community interacts with the international governmental organizations such as the WHO and the IAEA. No other national or regional radiology organization has the same input and level of interaction with these agencies as the ISR. Through the ISR, member societies can express the needs of their local communities to the WHO and the IAEA, and impact the regulatory decision being made by these governmental agencies. By participating in the ISR, member societies can also provide input regarding the educational needs of their communities and assist the ISR and its partner societies in providing education content tailored to their specific needs. More information about the ISR and membership information for radiology societies are available on the ISR website. The ISR will be most effective if all eligible societies work together to advance the practice the practice of radiology for radiologists to benefit our patients and global population health.

End Notes

  1. History Of The ISR.
  2. https://www.who.int/publications/i/item/use-of-chest-imaging-in-covid-19
  3. https://apps.who.int/iris/handle/10665/336745
  4. https://pubs.rsna.org/doi/full/10.1148/radiol.2020203173
  5. http://www.isradiology.org/blog/post/recording-available-now-isr-wfumb-who-webinar-safer-maternal-and-newborn-care-role-ultrasound
  6. https://link.springer.com/article/10.1007/s00330-020-07252-3
  7. Allen B. Who in the World Is the WHO?. Journal of the American College of Radiology. 2014 Nov 1;11(11):1011-2.
  8. http://www-pub.iaea.org/MTCD/Publications/PDF/Pub1578_web-57265295.pdf, http://www-pub.iaea.org/MTCD/publications/PDF/Pub1117_scr.pdf
  9. Jenia Vassileva. Implementation of New Basic Safety Standards at International and Local Levels. Presentation to the International Congress of Radiology, Dubai, UAE September 11, 2015.
  10. http://www-pub.iaea.org/iaeameetings/41578/International-Conference-on-Radiation-Protection-in-Medicine-Setting-the-Scene-for-the-Next-Decade
  11. http://www.who.int/ionizing_radiation/medical_exposure/Bonn_call_action.pdf
  12. https://link.springer.com/article/10.1007/s00330-022-08557-1
  13. http://www.isradiology.org/quality
  14. http://www.isradiology.org/quality#publications
  15. http://www.who.int/ionizing_radiation/medical_radiation_exposure/WHA68-Side-Event-Summary-Report.pdf?ua=1
  16. http://www.isradiology.org/training-program
  17. http://www.who.int/medical_devices/publications/priority_med_dev_cancer_management/en/
  18. http://www.who.int/tb/publications/global_report/en/
  19. http://www.isradiology.org/blog/post/who-isr-wfpi-world-tb-day-2022-scientific-symposium
  20. http://info.isradiology.org/goed_tb_project/imaging.php
  21. http://info.isradiology.org/gorad/buscador.php?t=3&IdRevista=119
  22. http://info.isradiology.org/goed_tb_project/goed.php
  23. http://www.isradiology.org/membership