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President's Address |
1 From Saanichton, British Columbia, Canada. From the 2004 RSNA Annual Meeting. Received January 4, 2005; accepted January 14. Address correspondence to the author (e-mail: blentle{at}shaw.ca).
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Of course the Radiological Society of North America (RSNA) has always been international in its membership and leadership, as North America embraces Canada, Mexico, and the United States of America. Although a large majority of members come from the United States, I do not think those of us from other countries receive anything but benefits from this arrangement, although I am reminded that a Canadian prime minister once compared our dilemma in the "Great White North" to that of a mouse being in bed with an elephant. However, my theme is to suggest that radiology is transcending such international boundaries. Given the overarching international focus of this meeting, it is timely to examine the global experience as it impacts RSNA and radiology.
I will focus first on the primary missions of and commitment by RSNA to teaching and research, chiefly reflected in the Annual Meeting and the Society publications (Fig 1).
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Submissions of abstracts to the Annual Meeting reflect the same trend, with a steady increase of non–North American contributions. There has been something of the order of a 30% increase since 1997 or, as Dr Bisset pointed out in a recent issue of RSNA News, a percentage increase from 25% in 1988 to 56% in 2003. In contrast, the total number of accepted papers from North America at the Annual Meeting from 1993 until 2003 have, with the exception of the Centennial Year, remained unchanged.
The regional contributions of accepted and submitted abstracts from outside North America reflect a preponderance originating from western Europe followed by the Far East, although we might concede that these Eurocentric descriptions have to some degree outlived their usefulness, in that the so-called Far East is just over my horizon if I watch the sun set. We have examined these numbers in many dimensions. There is a not unexpected correlation between submission of abstracts and mean gross domestic product per capita, for example.
Not only has the number of scientific abstracts submitted from outside of North America increased but so has the number of countries from which these originate, with an increase from 32 in 1993 to 48 in 2003 (Fig 3).
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The nine respondents to the same small internal survey of North American specialty societies referred to earlier nearly all indicated that they anticipate their future growth will likely be in international attendance, and they are striving to increase that growth. RSNA already ranks highly on this score, in terms of both international attendance and fraction of abstract submissions (Fig 6).
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Most recently the European Congress of Radiology has pioneered electronic educational exhibits and reciprocated that help to RSNA. In this connection, Anthony Giddens in the 1994 Reith Lectures, defined globalization as interdependence, although globalization is burdened by so many meanings, hopes, and fears.
Thus, there is a worldwide trend toward individual and group internationalization by medical specialties, and radiology is in the forefront of this movement. Indeed it might be a cause for some introspection, not to say anxiety, if we found that our programs were working to the detriment of our sister societies. Instead, we find that this is not the case. For example, intercontinental attendance at ECR is also growing in parallel to that at RSNA.
It is of interest to look at the impact of another international meeting on this continent. The International Congress of Radiology held in June in Montreal, Quebec, Canada, which was a joint meeting with the Inter-American Congress of Radiology and the Canadian Association of Radiologists and which saw a strong representation not only from North America but also from Europe, South America, and indeed the wider world. There were 3500 registrants, including 1000 radiologists from 72 countries. Unlike the usual model of competitive inhibition—to use another biologic model—the Montreal meeting had had no discernible effect on the trajectory of increased attendance at the 2004 RSNA Annual Meeting.
We must, therefore, infer that there has been a perhaps unconscious but nevertheless broadly based determination by many radiologists to learn from each other and to do so on a scale that transcends borders. Like any good scientists, we might consider alternative hypotheses, but it is hard to conceive of other good explanations for these collective migratory patterns. Attendees at large international meetings tend not to patronize ski slopes, sun-bathed beaches, or the resorts of this world.
There are other global trends in education to note. RSNA itself has a number of educational outreach programs administered through the Committee on International Relations and Education, with the current chair being Dr Barry Goldberg. Other RSNA outreach programs originate with the Research and Education Foundation chaired by Dr Jerry Petasnick until this meeting. Under the auspices of the World Health Organization and the International Society of Radiology there are also a series of initiatives that owe much to Drs Harald Ostenson and Holger Petterson.
Also in this context, the International Atomic Energy Agency (IAEA) convened a meeting in May 2003. Because of its identification with unsealed sources of radiation, IAEA has an understandable track record in international education in nuclear medicine and radiation oncology. It sought a wider role in imaging by recognizing that, in radiation treatment–planning for example, imaging was both necessary and indivisible. Having preached sermons from that text, this was a message to which I could relate.
At this meeting we are honoring Dr George Klempfner, past president of International Society of Radiology. One of his initiatives as president was to convene a World Council of Radiology, which brought together the leadership and executive officers of the continental societies of radiology to discuss mutual issues and opportunities. One of its activities, executed by RSNA, has been to inventory international outreach in radiology. These initiatives are impressive at first glance but in reality only begin to address the desperate needs of developing nations.
Another international program in quality assurance and risk management originates from Dr Lawrence Lau and our colleagues in Australia and New Zealand and were discussed in a later session of the 2004 Annual Meeting. An RSNA initiative—IHE, or Integrating the Health Care Enterprise—has also become widely accepted internationally.
In looking beyond radiology to the wider world of scholarship, there are some parallel trends. From a global perspective, we have come to associate scholarship, pedagogy, and research with universities. But universities themselves began as institutions concerned with matters that may be described as predominantly spiritual or religious. The great growth in universities, however, was driven by the Enlightenment and the explosion of scientific inquiry in the 18th century.
We live in the middle of another revolution—the one in communications. This will inevitably transform education and knowledge generation in a context in which national boundaries will not be so much crossed as become invisible. The university of the future will need human contact and human interaction, because scholarship is a humanistic enterprise. However, knowledge and learning has already become global to the extent that universities now are, in effect, virtual institutions as much as physical ones. These changes are important to RSNA, as learned societies will become part of this virtual space with the Web-based programs of InteractED, developed with the leadership of Dr William Olmsted, as well as the electronic dissemination of our Journals.
A notable Canadian, Marshall McLuhan, invoked the idea that communications and the media revolution have led to the comfortable and perhaps sentimental notion he called the global village (Fig 7).
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Thus, this century leads us inexorably toward citizenship of a new world. It would be naive not to recognize the forces of reaction and darkness that must be overcome along the way, and a learned society such as this and a futuristic profession such as ours must believe they will be overcome. Therefore, it is important that we in the radiologic sciences have the wisdom to continue to look forward and outward, that we continue a commitment to scholarship of every kind and to scholarship that transcends boundaries. And it seems to me that is where I began.
T. S. Eliot wrote,We shall not cease from exploration
And the end of all our exploring
Will be to arrive where we started
And know the place for the first time
We started our exploration in considering the role of our Society on the international scene. We conclude with the realization that our specialty as a whole has already transcended borders, perhaps more than most. This can only auger well for the radiologic sciences, for ourselves, for our successors and, not least, for our patients. It is also a ray of hope for a wider world in desperate need of human caring and in urgent need of hope, not hate.
I thank my colleagues on the Board of Directors and RSNA staff for the lively discussions we have had in this context and the superb staff of RSNA for assistance with the data and analyses. Not least thank you all for being a part not only of this international future but also of this meeting.
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