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4 Australian and New Zealand Society of Neuroradiology (ANZSNR) 1990 to Present…
63
council in its earlier years. At the 2023 AGM, it was ratied that the composition of
council ofcially included a Head & Neck/ENT representative and a Paediatric
Neuroradiology representative.
All ofce bearers are eligible for re-election for a second 3-year term. Most have
exercised this option and have been re-elected.
The rst ASM of the Society, convened by Prof. Brian Tress, was held in
Melbourne in April 1994 and was attended by 56 delegates with both luminary
international speakers and local faculty. Since the rst meeting, the Society has held
an AGM and ASM (some combined with international meetings), other than in 2021
when there were no meetings due to COVID.
At the second International Conference in Magnetic Resonance Imaging 5–9
April 1995, held in Melbourne, the neurological section of the MRI meeting, with
input from Prof. Tress and Dr. William Sorbey, was identied with ANZSNR, in
effect the second ASM of the Society.
The third ASM, under the banner of ANZSNR, and with Prof. Sage as convenor,
was held at the Adelaide Convention Centre South Australia and attended by 267
delegates. This was in fact a conference on radiologic-pathologic correlation. An
excellent scientic programme was organised providing an overview of neuropathology as relevant to imaging. Prof. Anne Osborn was supported by six leading
Australian Pathologists and Society members.
It was decided that most future Society ASMs would be small gatherings to foster local members to present their research, imaging, and INR experience. This philosophy was adopted and has paid dividends in developing local expertise, in-depth
knowledge, and clinical/scientic presentations.
The ASM is held in a different state each year, convened by local members of
the Society. A family friendly venue is always chosen. The learning is supplemented by social gathering including a gala dinner. The ASM has expanded in
both scope and content each time, from an initial one-and-half days’ meeting
with no parallel sessions to a two-and-half days’ meeting with parallel sessions,
covering neurointervention and neuro imaging, including spine and head and
neck, with some joint plenary sessions. An international and very able local faculty present an outstanding learning experience for both “the experts” and the
trainees. The attendance at the last few meetings is a marker of the quality and
friendly nature of the meetings. In 2020, there were 163 delegates. In 2022, the
attendance was 123in person with 48 virtual attendees. In 2023, there were 170
delegates. Trainee participation in oral and poster presentations are of a high
quality and improve with each ASM.Industry support has been greatly appreciated and each year there are many “hands on” interactive displays for participation by the delegates.
Cerebral angiography via femoral artery catheterisation was well established in
the 1980s. External carotid artery territory vascular malformation, stulae, and
tumours were being embolised at several centres as was the treatment of CC stulae using the Debrun detachable balloon system. In 1982, Dr. Trevor ApSimon
assembled a dedicated team of radiographers, nurses, and with Dr. Mark Khangure
established the rst INR team in Australia/New Zealand. The team performed its
64
M. S. Khangure
rst cyanoacrylate (super glue) brain AVM embolisation, using the Kerber calibrated leak balloon microcatheter in 1983. In the following years, Mr. David
Hartley, senior radiographer and member of the team, engineered “in house” latex
micro balloons and valve sealing detachable balloons, removing the need to tie the
balloons to the catheter. The latter were subsequently commercially manufactured
by Cook Australia. Detachable balloons lled only with iodine-based contrast
were unstable as the contrast either leaked or leeched out of the balloon. Prof.
Khangure developed a formulation of iodine-based contrast and soluble monomer
2-Hydroxyethyl Methacrylate (HEMA) with added ferrous ammonium sulphate as
the “contrast” to opacify and position the balloon. Addition of hydrogen peroxide
to the solution polymerised the HEMA to a solid insoluble polymer over about
2min, allowing minor repositioning of the balloon. This overcame the issue of
balloon deation. The team also developed safer ways of delivering superglue to a
specic location using additional nondetachable balloon catheters to arrest ow,
divert ow, and protect a major vessel with collateral connections to a vessel being
embolised. These techniques were also adopted at other centres, predominantly
for dural vascular malformation and stulae.
Post 1990
In 1991, the Federal Department of Health Australia (DOHA) recognised Royal
Perth Hospital as a Centre of Excellence and funded the INR unit to treat interstate
patients and train others to provide INR service in all states. Joint Centre of
Excellence status was granted to Royal North Shore Hospital and Royal Prince
Alfred Hospitals in Sydney with a single team of neuroradiologists. By the time of
Dr. ApSimon’s retirement in 1995, upwards of 200 brain, spine, and dural vascular
malformations were treated with superglue including the rst vein of Galen malformation in a neonate in 1994. The rst aneurysm to be treated by the Gugliemi
detachable coil (GDC) was in 1994.
The RPH unit participated in the International Subarachnoid Haemorrhage Trial
(ISAT) as the only centre from Australasia. RPH was the rst centre to commence
a fellowship programme, initially for INR and in later years for diagnostic neuroradiology and INR. (Prof. Tress established a fellowship programme soon after at
Royal Melbourne Hospital). Workshops were held at RPH to demonstrate and teach
interstate neuroradiologists the scope of INR.By the time the ndings of ISAT
were made available, in October 2002, INR teams were operating at multiple centres. All had at least one fellowship trained operator and all were well skilled and
competent. Many fellows acquired their training and skills in the USA, Canada,
and quite a few in Perth and some in the UK.Carotid artery angioplasty and stenting was being performed at many centres in patients with an elevated risk for surgical intervention.
4 Australian and New Zealand Society of Neuroradiology (ANZSNR) 1990 to Present…
65
Training
The RANZCR registrar training programme runs over 5years, covering all aspects
of radiology. In the nal year, the registrars can request to devote at least 6months
in a given subspeciality. For diagnostic neuroradiology, this provides a good foundation. In 1996, a subcommittee of the Society was established, chaired by Prof.
Khangure to consider the training requirements for neuroradiology, in particular
INR.The committee considered a minimum of a year (preferably 2years) of dedicated fellowship, after the nal year of training, and at an appropriate centre, was
desirable for diagnostic neuroradiology. For INR, a minimum of 2years at a centre
providing a comprehensive INR service was deemed appropriate. The fellows were
to document their training. The recommendations of the committees were endorsed
at the 1998 AGM.
Advancements in CTA, MRA, and Doppler ultrasound reduced the need for catheter angiography to very few clinical indications. The Society was concerned
regarding maintenance of skills by radiologists who would only perform the procedure a few times a year. Prof. M Khangure and Dr. W Chong, serving as RANZCR
councillors, raised their concerns regarding this issue and the potential for patient
harm. At Council meetings, they were tasked with obtaining a broad opinion from
all stakeholders the minimum numbers of cerebral angiographic studies that a
RANZCR fellow required over a 2-year period to maintain adequate skills. The
number suggested, after much debate by the Society and RANZCR Council, was
20! Following the publication of ISAT, in the early 2000s, there was subspecialisation of neurosurgery; centralisation with smaller numbers of vascular neurosurgeons and a smaller number of vascular neurosurgical units, in order for practitioners
to maintain skills. This, coupled with INR units, removed the need for catheter
angiography outside these centres, further improving patient safety.
From 2000 onwards to 2007, Prof Khangure organised a half-day meeting before
the ASM of the Society for INR members as mortality and morbidity (M&M) coupled with “difcult cases discussion” as a learning experience for all. This session
was well attended and continues to the present time.
From 2009 onwards (15thmeeting in August 2024), Dr. Jason Wenderoth (NSW)
and Dr. Hal Rice (now Assoc. Prof. Qld) organised an annual meeting, named Neuro
Exchange, for the expanding INR group over one and half days, discussing difcult
cases, M&M, new and evolving technologies, and often with industry experts on
site and presenting. These meetings, like the ANZSNR ASMs, were and are held in
different states in Australia and in New Zealand.
By 2010, INR units were performing mechanical thrombectomy for acute stroke.
The need to again expand the INR workforce was urgent. In addition to ANZSNR
members taking on this additional work and increases in fellowship training positions, locally and overseas, other craft groups were attracted. Prof. Alan Coulthard,
along with Prof. Khangure and Dr. Wenderoth as ANZSNR members, invited representatives of the Neurosurgical Society of Australasia (NSA) and Australia and New
Zealand Association of Neurologists (ANZAN) to a joint meeting, convened at the
66
M. S. Khangure
RANZCR premises, to discuss national training standards in INR.After a number
of meetings held over several months, chaired by a member of each group, agreement was reached as to the required training and a “Conjoint Committee for
Recognition of Training in INR(CCINR) was established.” Those already in INR
practice with a proven record were grandfathered, and those in training were to
produce the documents supporting their training. This was a great achievement in
providing patient safety; all practitioners requiring certication of INR by this tripartite committee. Many health institutions in Australia quickly adopted the CCINR
certication as a credentialing requirement for INR practice. The role of CCINR
was further endorsed under Prof. Mitchell as president with requirement that practitioners be CCINR certied to provide mechanical thrombectomy on the Medical
Benets Schedule.
Several Society members have been part of the local faculty at many RANZCR
ASMs delivering both diagnostic and INR presentations. Several members have
organised didactic neuro imaging courses outside of the Society’s ASM on a broad
range of topics, ranging from anatomy, pathology, routine clinical imaging to more
challenging MRI techniques. These have been well attended by both trainees and
consultants. Several members have presented and have been on the faculty of Asian
and Oceanic conferences, including AOSNHNR, JSNR, and KSNR.
Society Presidents
There have been six previous presidents and a seventh incumbent. They are:
Prof. Michael Sage, Prof. Brian Tress (3-year term each), Prof. Makhan (Mark)
Khangure, Dr. Winston Chong (now Professor), Prof. Alan Coulthard (two 3-year
terms each), and Dr. Peter Mitchell (now Assoc. Professor). The incumbent Dr.
Constantine (Con) Phatouros is serving his successive second 3-year term. The rst
three presidents are recipients of the Gold Medal of the Society presented to all 3 at
the 2019 ASM in Adelaide. Prof. Coulthard will be presented the Gold Medal at the
2025 ASM.
All presidents and their elected councils have incrementally advanced the standing of the Society. They have advocated for patient safety and well-being, which
includes developing and mandating the minimum training standards for neuroradiology. They have worked tirelessly with RANZCR councils and boards to lobby
governments for funding (Profs. Sage and Khangure were RANZCR presidents and
Profs. Coulthard and Chong long-term councillors of RANZCR and ANZSNR).
Prof. Khangure was an Australian Medical Association (AMA) councillor for
10years, enlisting the help of the AMA to engage with the Federal Department of
Health in pursuit of the recognition of the importance of radiology and INR in
patient management. They have worked with and collaboratively negotiated with
other stakeholders on issues relating to scope of practice. The expansion of the
ASMs, content and duration are self-evident of the improvement, as is the expansion of the membership numbers. The Society’s nancial position has also improved
4 Australian and New Zealand Society of Neuroradiology (ANZSNR) 1990 to Present…
67
from the larger number of delegates and industry sponsorship. The annual subscription for membership was maintained according to the national consumer price index
(CPI) and ASM registration kept as low as possible. In the early years, there was an
annual newsletter sent out with the Society’s agenda papers. This was increased to
two newsletters. Currently there are quarterly newsletters which follow each meeting of council. The importance of collegial contact and friendship with other neuroradiology societies in North America, Europe, and the Asia-Pacic region was
recognised and is a primary goal of the Society. Many international invited speakers
to the society ASMs became long-lasting friends.
In 2010, the Society provided a grant of $25,000 to Prof. Coulthard for a pilot
project in establishing a “Collaborative Research Network” using the ANZSNR
framework to improve neurological practice and research throughout Australasia.
Prof. Coulthard also took on the task of developing a web page for the society,
maintaining and improving it.
The Society’s constitution was updated twice in the early years. Prof. Peter
Mitchell, as President, commenced an in-house review of the constitution and the
committee’s proposals, including guidelines for awarding the Gold Medal. These
were approved at the 2018 AGM.The current council, under the leadership of Dr.
Phatouros, has reviewed and revised the constitution further with a legal expert
review to align it with contemporary requirements. Dr. Phatouros, with input from
several Society members, working with RANZCR, has led an ANZSNR delegation
over 2years, in collaboration with IRSA and RANZCR, to advocate for the recognition of INR as a speciality within radiology. RANZCR has lodged the submission
with the Australian Medical Council (AMC) for Interventional Neuroradiology and
Interventional Radiology to be recognised as specialities. This recognition will provide signicant patient benet and enable Radiology trainees to undergo subspecialisation into INR or IR at an earlier stage of training.
The secretarial support to the Society, provided by Prof. Sage, ended in 2011. Dr.
Mitchell, as incumbent secretary-general, assumed this task for a short period before
RANZCR agreed to provide some part time secretarial support. With an increasing
complexity in the Society’s activities, including managing the video-recorded ASM,
the need for full-time administration support became urgent. RANZCR was unable
to provide this. Dr. Phatouros, as current president, sought and appointed an excellent full-time administration support group for the society in November 2019,
wholly under the management of ANZSNR executive and fully funded by the
Society.
In 1999, the third AOCNHNR was convened in Adelaide under the auspices of
the ANZSNR with Prof. Sage as convenor. The format was similar to the very successful CME meeting held at the same venue. There were 350 delegates.
Prof. Tress requested the Society to support the nomination of Prof. Sage to the
Symposium Neuroradiologicum Nominating Committee to organise the Symposium
in 2006 under the auspices of ANZSNR.This nomination was fully supported and
was successful. The Society provided the seed money for the very successful
Symposium held in Adelaide in March. There were 743 delegates from all around
the world.
68
A joint ninth AAFITN/ 19th ANZSNR meeting, convened by Drs Chong and
Trost, was held in Melbourne in April 2010, attended by 620 delegates. There were
more than 40 invited speakers for both meetings from 15 neighbouring countries in
the Asia-Pacic region. This was the rst time these two societies had jointly participated in a meeting in Australasia. Dr. Chong was appointed president of AAFITN
in 2012.
A large group of Australasian Interventional Neuroradiologists attended the
2011 WFITN meeting in Cape Town, South Africa. Drs Hal Rice and Laetitia de
Villiers presented a bid to host the 2015 meeting under the auspices of ANZSNR at
the Gold Coast, Queensland. They were supported by Dr. Chong as current ANZSNR
President and Prof. Khangure as ex-President. Despite presentations from other
nations, the delegates voted for the Gold Coast, Australia as the next venue. Dr.
Chong was nominated as the meeting President by the WFITN executive with Prof.
Khangure as Honorary President. Prof. Coulthard as the ANZSNR President in
2015 hosted the meeting. A highly successful meeting was held in November,
attended by 1200 delegates from all parts of the world who enjoyed the scientic
programme and an excellent social programme.
M. S. Khangure
Current Status
There are 215 ANZSNR members, including student members. There are 164 fully
trained neuroradiologists and 46 in-training members.
There are eight diagnostic neuro fellows and eight INR fellows in Australian
departments and one diagnostic and an INR fellow in Auckland.
There are academic neuro radiology positions in Victoria, Queensland, and
Western Australia, including Professor Paul Parizel in Western Australia and
Professor Meng Law in Victoria. Both are widely recognised in the international
community for their research and teaching. National active researchers include
Prof. Trish Desmond, Assoc. Prof. Sandeep Bhuta, Prof. Peter Mitchell, Prof. Alan
Coulthard, and many other members with clinical publications in INR (collaborative material) and diagnostic neuroradiology. Prof. Mitchell has been very active in
the eld of stroke research and the rst to perform in human brain-computer interface implantation. Dr. Geoff Parker (NSW) has made important contributions in
intracranial venous stenting.
Publications
An extensive literature search for peer-reviewed publications, (Endnote Library
Compression File) for named society members yielded 1073 entries for the period
1990 to 2024. Over 30 publications a year from a small society membership is
pleasing.
4 Australian and New Zealand Society of Neuroradiology (ANZSNR) 1990 to Present…
69
The Society established a Research Committee in 2021 and has awarded its rst
research grant to a fellow in 2023 investigating the role of diffusion tensor imaging
in assessment of cervical nerve roots in patients with cervical radiculopathy. Several
applications for research grants in 2024 are currently in progress.
In 2021, the society was successfully registered with the Australian Charities and
Not-for-prots Commission, allowing it to receive charitable donations.
Current Objectives of the Society as per the 2024 Constitution
1. To advance, promote, and develop education and training in neuroradiology
2. To advance, promote, and develop standards for the practice of neuroradiology
3. To advance, promote, and support research in neuroradiology
4. To be the reference body for training and practice in diagnostic neuroradiology,
interventional neuroradiology, and head and neck radiology in Australia and
New Zealand
5. To promote fellowship and the exchange of ideas among neuroradiologists
6. To provide a forum for the presentation of papers and the dissemination of
knowledge in relation to diagnostic neuroradiology, interventional neuroradiology, and head and neck radiology
7. To promote close cooperation between neuroradiology and other branches of
medicine and the allied sciences
8. To promote close association with other neuroradiological groups such as
ESNR, ASNR, WFITN, AOSNHNR and WFNRS
9. To cultivate and maintain the highest principles of practice and ethics in respect
of diagnostic neuroradiology, interventional neuroradiology, and head and neck
radiology
10. To establish, administer, and contribute to any charitable or benevolent fund in
connection with or for the benet of deserving persons engaged in the pursuit
or practice of diagnostic neuroradiology, interventional neuroradiology, and
head and neck radiology
11. To confer, co-operate, or correspond with any association, societies, bodies, or
individuals, whether incorporated or not, in relation to any of the objects of the
Association, or on any other matter of interest to the Association or its members
Conclusion
The ANZSNR has performed a vital role in the development of the eld of neuroradiology in Australia and New Zealand over the past four decades. It has fostered the
subspecialisation of radiologists into the subspeciality areas of diagnostic neuroradiology, interventional neuroradiology, head & neck/ENT radiology, and spine radiology. It has provided an indispensable forum for national alliance and education.
This has further extended across international borders to symbiotic afliations with
international societies. The society has promoted and advanced research and teaching and functioned as an advocate to government and health institutions in
70
M. S. Khangure
advancing the practice of neuroradiology and maintaining high clinical and professional standards that serve the patient interest. All members of the council and executive have performed their duties in an honorary capacity without remuneration,
motivated primarily by the betterment of the profession. It is anticipated the Society
will ourish well into the future assisting our venerable subspeciality adapt to an
ever-changing clinical landscape whilst promoting collaboration, collegiality, and
clinical excellence.
Acknowledgments I gratefully acknowledge Dr. Constantine (Con) Phatouros for his contribution to this chapter.
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adaptation, distribution and reproduction in any medium or format, as long as you give appropriate
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This chapter is licensed under the terms of the Creative Commons Attribution 4.0
Chapter 5
Austrian Society ofNeuroradiology
(Österreichische Gesellschaft für
Neuroradiologie—ÖGNR)
ElkeR.Gizewski, HannesDeutschmann, GregorKasprian, JuliaFurtner,
MichaelSonnberger, andJohannesTrenkler
Introduction
Strictly speaking, Neuroradiology started in the Austria of Emperor Franz Joseph
with the work of Arthur Schüller. The radiologist Arthur Schüller received his doctorate and habilitation at the Faculty of Medicine of the University of Vienna with
the habilitation thesis: “X-ray diagnostics of diseases of the head” [1]. Schüller
coined the term “Neuro-Röntgenologie” for the rst time [2] and is now regarded
internationally as the “Father of Neuroradiology” [2].
E. R. Gizewski (*)
Department of Radiology, Neuroimage Core Facility, Medical University Innsbruck,
Innsbruck, Austria
e-mail: elke.gizewski@i-med.ac.at
H. Deutschmann
Division of Neuroradiology, Vascular and Interventional Radiology,
Department of Radiology, Medical University of Graz, Graz, Austria
e-mail: hannes.deutschmann@medunigraz.at
G. Kasprian
Department of Biomedical Imaging and Image-Guided Therapy, Medical University
of Vienna, Vienna, Austria
e-mail: gregor.kasprian@meduniwien.ac.at
J. Furtner
Research Center for Medical Image Analysis and Articial Intelligence,
Danube Private University, Krems an der Donau, Austria
e-mail: Julia.furtner@dp-uni.ac.at
M. Sonnberger · J. Trenkler
Institute of Neuroradiology, Neuromed Campus, Kepler University Hospital Linz,
Linz, Austria
e-mail: michael.sonnberger@kepleruniklinikum.at; johannes@trenkler.at
D. Birchall (ed.), A World History of Neuroradiology,
https://doi.org/10.1007/978-3-032-16653-1_5
71© The Author(s) 2026
72
E. R. Gizewski et al.
In today’s Austria after 1945, neuroradiological examinations have been carried
out by neurosurgeons, neurologists and less so by radiologists. First tendencies toward
an independent neuroradiology started in major neurological-neurosurgical hospitals
by departments in Linz (Benno Hammer) and Salzburg (Hermann Mösl) since 1969.
An important step was the foundation of a computed tomography (CT) study
group within the scope of the Austrian Society of Radiology by B.Hammer in 1978.
In the mid-1980s, magnetic resonance imaging (MRI) was included as well.
Jean-Paul Braun (at that time president of the European Society of Neuroradiology;
ESNR) initiated at the Symposium Neuroradiologicum 1986in Stockholm a round
table of neuroradiologists from Switzerland and Austria, resulting in organizing
joint-meetings of Swiss and Austrian neuroradiologists that took place in Salzburg,
Zurich and Udine 1986/87.
The Austrian Society of Neuroradiology (ÖGNR) was founded on May 5th, 1990.
Essential steps were the establishment of Neuroradiological divisions in the
General Hospital of Vienna/Medical University of Vienna in 1991, in the University
Hospital of Graz in 2003, University Hospital of Innsbruck in 2007 and the
University Hospitals of Tulln and St. Pölten since 2014. With the foundation of
University Hospitals in Linz and Salzburg, independent Institutes of Neuroradiology
were established (2016 and 2019, respectively).
There are ongoing efforts to establish a subspecialty in Neuroradiology, which is
supported by the Austrian Society of Radiology.
Organization
The ÖGNR is a non-prot scientic association aiming to promote diagnostic and
interventional neuroradiology in clinical practice, teaching and research in collaboration with radiology, neurosurgery, neurology, psychiatry, otorhinolaryngology, cranio-maxillofacial surgery, orthopedics, ophthalmology and pediatrics as well as in
collaboration with neurosciences. The society also intends a close collaboration with
the ESNR and with neuroradiological societies of countries surrounding Austria.
The executive committee with the leading president is responsible for the management of the society (Table5.1). It consists of the president, the vice-president,
the past president, the secretary and the treasurer. It is also possible to co-opt
Table 5.1 List of presidents of the Austrian Society of Neuroradiology
Presidents of the Austrian Society of Neuroradiology
1990–2000 Erwin Schindler
2000–2002 Mario Grobovschek
2002–2008 Erich Klein
2008–2016 Johannes Trenkler
2016–2020 Hannes Deutschmann
2020–2024 Elke Gizewski