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Author: Dr. Bibb Allen
February 2018

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. 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 93 years later.

The International Society of Radiology (ISR) is a federation of the world’s national 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 representative Non-Governmental Organization (NGO) with the World Health Organization and is radiology’s primary advisor to the WHO and the IAEA and represents the national radiological societies at the WHO and the IAEA on issues relation to radiology, radiation protection and population health. It is through this role that 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 Society of Radiographers and Radiological Technologists (ISRRT) and the International Organization of Medical Physicists (IOMP) 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. 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 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 [4]which has been targeted for revision in the near future [5]. 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” [6], 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.

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 recently established the ISR Quality and Safety Alliance (ISRQSA), 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 will be 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, 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.  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 the ISRQSA will have additional responsibilities as a result of this conference.   The ISRQSA News continues to provide readers with news from numerous stakeholders from around the world.

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. “Imaging for Saving Kids – The Inside Story About Patient Safety In Pediatric Radiology” was a WHO symposium held as part of a recent World Health Assembly. 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’”. Other similar partnerships with the WHO include providing technical advice to WHO for the implementation of the project on Radiation Safety Culture in Medicine jointly organized by WHO, IOMP and the International Radiation Protection Association (IRPA), the purpose of this project is the development of a framework supporting the establishment and maintenance of a radiation safety culture in healthcare facilities as an integral component of safety culture programs in medical settings . Designed to educate our patients and the public on issues surrounding the safe use of ionizing radiation, ISRQSA recently published a 5-part series of lectures entitled Radiation Protection Training Program for Patients/Public. The ISR also advised the WHO in their publication “WHO List of Priority Medical Devices for Cancer Management” 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. 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 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. 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. 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 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.

Finally, the 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 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 web-site. 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.