Clin. RadioI. (1975) 26, 1-4

R A D I O L O G Y I N T H E E U R O P E A N A S S O C I A T I O N A N D I N T H E C O U N T R I E S O F T H E E U R O P E A N E C O N O M I C C O M M U N I T Y

M. D. SNELLING

From the Meyerstein Institute of Radiotherapy, Middlesex Hospital, London

lHE European Association of Radiology is an association of national Radiological Societies of European countries. It was formed in 1962 at the :~',uggestion of French and German radiologists, soon ioined by those in Switzerland, Italy, Spain, Portu- gal, Luxembourg, Belgium and the Netherlands. The United Kingdom joined in 1966, the 'British Radiological Society' consisting, as in the Inter- national Society of Radiology, of a combination of the Faculty of Radiologists and the British Institute of Radiology.

Membership is limited to national Societies of Radiology who submit their printed statutes and lists of members. There is also provision for 'Scientific' membership for national Societies of Radiologists without these qualifications and for allied groups working in radiobiology, radio- protection, etc., and for 'Associate' membership for groups of non-medical scientists or industrialists working in collaboration with radiologists. The membership of the association now includes the Radiological Societies of Austria, Belgium, Den- mark, Eire, Finland, France, West Germany,

: Greece, Iceland, Italy, Luxembourg, The Nether- lands, Norway, Portugal, Spain, Sweden, Switzer- land and the United Kingdom.

The aims of the European Association of Radio- logy (E.A.R.) include the promotion of Radiology as a clinical discipline consisting of Diagnostic Radiology, Radiotherapy and Nuclear Medicine. There is a Congress held every four years, and Symposia on special subjects and recommendations are made by the Commissions on Training, Profes- sional Organisation and Statutes, and a Commission of 'Young Radiologists'. There are also Commis- sions concerned with the organisation of Congresses and with 'Informatique' - Communications, Data Recording, Glossary of Radiological Terms and the use of Computers in Radiology.

Internal organisation of the E.A.R. includes the appointment of Officers, a Standing Committee (Bureau) and a General Assembly.

The Officers include a President, a ~Secretary General, a Treasurer, a Vice-President and an Assistant Secretary. The President is elected by the General Assembly at the four-yearly Congress and

1

serves one term of four years only. The other Officers are elected by the Bureau - again for four years but they may be re-elected. The Bureau includes the Officers and the leaders of the national delegations.

The Genera ! Assembly consists of seven delegates from each member society. It meets at the four- yearly Congress, elects the President, elects new members, chooses the site of the next Congress and receives the reports of the Commissions. Each delegation elects its leader who is a member of the Bureau.

The United Kingdom delegates are nominated by the Councils of the British Institute of Radiology and the Faculty of Radiologists, care being taken to ensure that all modalities - Radiodiagnosis, Radio- therapy, Nuclear Medicine and Radiobiology - are represented. Care is also taken to include delegates representative of the different age groups involved.

The official language of the Society is French, but English and German are also used freely at com- mittees. The knowledge of at least one other language is therefore very desirable for all delegates.

COMMISSION ON TRAINING

The Commissions meet at least once a year, sometimes more often. The Commission on Enseignement and Training (Chairman - Professor Van der Scheuren of Belgium) has, during the last few years, achieved important agreement on the length of training - four years for Radiodiagnosis or Radiotherapy after preliminary general experience of at least one year after qualification. Since it is regretfully accepted that the category of 'General Radiologist' will continue in some European countries for a few years (not more), training for this will continue to be organised but will last five years. It is emphasised that in the first year of the training, basic training common to all branches of Radiology is obligatory - the 'Tronc Commun'. This includes basic teaching in Physics, Radio- biology and Radioprotection and their application to all forms of Radiology. An examination must be held on these subjects, and it is the recommendation of both this Commission and the Commission on

2 C L I N I C A L R A D I O L O G Y

Professional Organisation that legislation should be passed prohibiting any clinical use of ionising radiation by any medical practitioner who has not received this training in an approved Department of Radiology.

This four years' training must be full-time and spent in an approved department and must be followed by a final nationally organised examina- tion - where necessary the overall time may be lengthened but the training period must total the required four years' full-time study.

Sub-committees of the Commission are studying the syllabus and the many differences connected with the standardisation of training and examina- tions in different countries, and also the possibility of establishing examinations by the E.A.R. It can be seen that the first part of the FFR fulfils the requirements of the 'Tronc Commun' (as did DMRT Part 1) and that the final examination for the FFR similarly fulfils the requirements (although if it is taken in less than four years, additional practical experience will be necessary before registration). It will be noted also that the two years' pre-radiology general experience required of the FFR is one year more than that thought necessary by the E.A.R. Commission.

THE COMMISSION ON PROFESSIONAL ORGANISATION

This commission is chaired by Professor Demoul- lin of Luxembourg, and works in close collabora- tion with the Commission on Training and also with the Committee of the 'Specialty of Radiology' of the European Union of Medical Specialists (U.E.M.S.) - an advisory committee in the Euro- pean Economic Community, of which Professor Demoullin is also Chairman. The Commission on Professional Organisation is concerned with the position of the radiologist in European medicine, his relation to other specialties and to general prac- titioners and the duties, rights, and conditions of work of the hospital radiologist.

The Commission is also very much concerned with radioprotection and especially with the dangers associated with the irradiation of the general population during the use of ionising radiations in medicine.

It considers that because of the genetic risks to the population as a whole, legislation is necessary to confine the use of ionising radiation in medicine to medical practitioners who have received the training in the 'Tronc Commun' and that this training must be given in departments approved for the training of

radiologists. This basic training is not, however, regarded as sufficient for any medical practitioner to specialise in any type of Radiology. This work requires 'expertise' - the skill that comes from experience and includes the knowledge of the advantages and disadvantages of all procedures, which is essential if the maximum benefit to the patient is to be associated with the minimum irradi- ation of patient or personnel.

Because of the possible radiobiological effects of radiation on the population and the consequent importance of radioprotection which applies to all modalities, the Commission considers that Radio- diagnosis, Radiotherapy, and Nuclear Medicine should together be regarded as a single discipline - Radiology. The European Association and its Commissions believe firmly in this concept, and also believe that while within this single discipline the three modalities are separate and distinct, the closest collaboration is essential if each is to solve its own problems.

After the Amsterdam Congress in 1971 Professors yon Ronnen and Gros, President and Secretary General respectively of the E.A.R., wrote to the Departments of Health of each member country describing the hazards of radiation and the impor- tance of radioproteetion, and advising legislation to limit the use of ionising radiation in medicine to medical practitioners who had received approved training. Similar legislation has been suggested by Euratom in a recently circulated advisory document which may later form the basis of a directive from the Commission of the European Economic Com- munity. A paper on this subject is being circulated for the opinion of Member Societies. (Aspects of Radioprotection related to the design and manu- facture of equipment and standardisation of the regulations controlling this in the various European countries are being discussed by another body, the International Electrotechnical Commission.)

The Commission on Professional Organisation is also discussing the status, duties, responsibilities, privileges, conditions of work and remuneration of the hospital radiologist, and especially with his relation to the administration and budget of the hospital. A suggested 'Charter' is being circulated for the opinion of member societies.

The Commission of Professional Organisation, in collaboration with the 'Speciality of Radiology' Committee of the U.E.M.S., is also interested in the status, responsibilities, training and conditions of work of the radiographers in Europe. A report off this was produced by Professor Oliva (Italy) and another by Professor Zuppinger (Switzerland), who

R A D I O L O G Y IN THE EUROPEAN ASSOCIATION 3

is the Chairman of a group working on the same subject in the I.C.R. (E), the Commission on

Informat ion and Education of the International Society of Radiology. The Commission agreed that the taking of a radiograph should be defined as a medical procedure consisting of these stages - the first, the ordering of the procedure by a radiologist; the second, the taking of the radiograph in which a radiographer acts under the authority of the radiologist; and the third, the report by the radio- logist. The 'job content' and definitions of respon- sibility of the radiographer are not as yet defined and discussions are now taking place on these matters between representatives of the Commission of Professional Organisation of the European Association of Radiology, the Radiology Committee of the U.E.M_S. (E.E.C.) and the Officers and European representatives of the International Society of Radiographers and Radiographic Technicians (I.S.R.R.T.).

COMMISSION OF 'CONGRESSES'

This Commission, which is chaired ex-officio by the President, consists of members of the Bureau and members nominated by C.O.C.I.R. (Committee of Coordination, Industry and Radiology). It considers suggestions for future Congresses and reports to the Bureau, and to the General Assembly, which makes the final decision on the site of the next Congress.

CON[MISSION OF YOUNG RADIOLOGISTS ( ' D E S JEUNES')

This Commission, formed in 1972 and chaired by Dr Heilmann, consists of recently graduated specialists and is regarded as of great importance. It is concerned with recruitment, training, conditions of work and with the promotion of scholarships and

exchanges of young radiologists between the member countries of the E.A.R. It is hoped that member national associations will form similar groups who can be represented on this Commission (which itself is represented on the other Com- missions of the E.A.R.) and will also encourage travel and exchanges of trainees between their centres. An Association medal has been instituted to encourage original work by younger radiologists - the silver Boris Rajewsky medal. A bronze medal is also awarded for important service to the Associ- ation (the first was awarded to Professor Boris Rajewsky, the Founder-President, and the second to Professor Zuppinger, the first Treasurer).

THE COMMISSION ON ' INFORMATIQUE'

This Commission includes among its interests ali forms of scientific communications, including the compilation of a glossary of radiological terms and the use of computers in Diagnostic and Therapeutic Radiology. Professor Charles Gros (France), at a Symposium on Carcinoma of the Mammae held in Strasbourg, introduced a detailed programme on investigation and treatment of Carcinoma Mare- mac, Professor Penn (Holland) chairs a group of diagnosticians who are organising a Symposium in Amsterdam in 1974, while Miss Snelling (U.K.) chairs a group of radiotherapists who are reporting on the use of computers in data recording in Radio- therapy Centres in Europe. It is proposed to extend the work of this group to cover dosimetry (similar work on 'Informatique' in the Radiology Com- mittee of the E.E.C. includes the compilation of a glossary of radiological terms in European languages under the direction of Professor Roma Mini).

The Bureau and the Commissions work in close association with the 'Specialty of Radiology' Committee of the European Union of Medical Specialists (E.U.M.S.).

TABLE 1

COMMUNICATIONS IN THE E.A.R. NATIONAL RADIOLOGICAL S O i ~ I E T I E S ~

Delegates to ~ Leader of Delegates Delegate to Commissions General Assembly to Bureau report to Bureau

Bureau report to General Assembly

x~"~Natio~al Societ ie s

Departments of Health

4 CLINICAL RADIOLOGY

EUROPEAN ECONOMIC COMMUNITY

The Medical Association of each member country nominates two delegates to each of the specialist committess of the E.E.C. countries.

In the U.K. the British Medical Association, the recognised national medical association, delegates to the Faculty of Radiologists the nomination of delegates - these are at present Dr J. MacDonald and Dr M. D. Snelling. Dr Demoullin (Luxem- bourg) is Chairman of the Radiology Committee and of the Committee of Professional Organisation of the E.A.R., and a member of the Standing Committee of the E.U.M.S.

The Specialty Committees form part of the European Union of Medical Specialists, whose report, with those of the other Speciality Com- mittees, is forwarded to the Standing Committee of the U.E.M.S. This Standing Committee, and a similar Committee representing General Prac- titioners (U.E.O.P.), report to the 'Permanent Committee of Doctors', an Advisory Committee which submits a report on the views of the medical profession as a whole to the Administration of the E.E.C. in Brussels.

The importance of the U.E.M.S, and its specialists' committees lies in their power and responsibility to deliver to the Administration of the E.E.C. the advice of the medical profession before directives are formulated by non-medical administrators to be issued to the Governments of the member countries.

TABLE 2

COMMUNICATIONS IN THE E.E.C, COUNTRIES

National Medical Association

Delegates to Radiology Specialty Committee of U.E.M_S. (and to other Standing Committees)

Standing Committee of the U.E.M.S.

Permanent Committee of Doctors

E_E.C. Commission (Administrators)

Commissioners

Directive to Member Governments

Once that has been done alteration becomes impos- sible and legislation inevitably ensues.

The Membership and Agendas and recommenda- tions of the Commissions of the E.A.R. and of the Radiology Committee of the U.E.M.S. are very similar, and although advisory only, these Com- mittees are of great importance to Radiology. Since they represent a very large number of radio- logists their representation in the Administration of the E.E.C. and to the Department of Health of other European countries carries considerable weight.