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C. C. M. de Freitas et al.
have been broken, whether of knowledge, courage, challenge, or truths that turn
into lies and vice versa. But at the same time, we have learned that the current stage
of Internet technology allows us to remain connected and united and, better yet,
continue to exchange experiences and knowledge. In this new scenario, where
distances have been shortened with technology, the SBNR launched two main
projects.
The rst was a remote education platform for the Acute Management of Stroke
disease associated with COVID-19 in the same case. It was coordinated by Dr.
Francisco Jose Mont’Alvene, Prof. Marcos Lange (President of the Brazilian
Society of Cerebrovascular Diseases), Prof. Carlos Clayton Macedo, Prof. Joao
Jose Carvalho (Former President of the Brazilian Society of Cerebrovascular
Diseases), Dr. Fabricio Oliveira Lima (Brazilian Society of Cerebrovascular
Diseases) and Prof. Jose Batista Cysne (Educational coordinator). This course was
addressed to Interventional Neuroradiology and Neurology fellows and based on an
active pedagogy, addressing the specic learning objectives of each module: (1)
Initial patient management; (2) neuroimaging; (3) decision-making process for
reperfusion therapies; (4) patient management in Stroke Unit. Using distance learning pedagogy and Internet tools, it was possible to bring training centers closer by
sharing their experiences in teaching the learning objectives and standardizing and
improving care protocols, adding signicant value to the resident’s training to maintain the training of professionals. It’s evolved with more than 100 participants from
all over Brazil.
The second project was the CONNECTA BRASIL and SIG-CONNECTA Neuro,
which proposed a rapprochement between Brazilian Neuroradiologists so that we
could fraternally get to know each other better and exchange experiences through
virtual meetings. Many meetings were held every 2weeks or months in a virtual
environment, each lasting 2h, with a list of attendance and identication of all participants. This project took place in 2020 and 2021, coordinated by Dr. Elias Rabahi,
Dr. Wilson Novais, and Prof. Carlos Clayton M de Freitas for therapeutic meetings
and Dr. Felipe Pacheco from São Paulo, Dr. Pablo Coimbra from Ceará, Dr.
Leonardo Macedo from Minas Gerais, and Dra. Nina Ventura from Rio de Janeiro
for diagnostic meeting.
During this period of isolation, a fascinating association between Brazil and
other countries in South America created the most prominent online meeting that
we have ever seen on our continent, the GSANIT/CONNECTOR BRASIL.Many
colleagues were founders of GSANIT, such as Prof. Luiz Lemme, Dr. Ronie
Piske, Dr. Javier Echevarrieta, Prof. Orlando Dias, Dra. Azucena Davila Malaga,
Dr. Luiz Portela, Dr. German Abdo, Dr. Gelson Koppe, Dr. Eduardo Raupp, Dr.
Eduardo Bravo, Dr. Boris Pabon, Dr. Rodrigo Rivera Miranda, and others. Their
initiatives include organizing academic meetings and events, such as the annual
meeting in different South American countries, to discuss advancements and
strategies in neuro intervention in a free ambiance. They also offer a robust
library online (PNVS) with many case discussions and lectures, a vital tool for
education.
6 Recent History oftheBrazilian Society ofDiagnostic andTherapeutic Neuroradiology
85
The Old Became New
Despite the isolation and lockdown, the SBNR has found ways to stay connected,
share knowledge, and support each other. The COVID-19 pandemic has been challenging for all of us, but it has also shown our resilience and ability to adapt. As we
continue to navigate these difcult times, we must remember the strength and unity
we have demonstrated as a global community.
The Interventional Neuroradiology (INR) simulation started before 2016, but
only a few centers were used for training. Our rst contact with the Mentice simulator was on May 27, 2019, during the SBNR certication. After that, the SBNR
began to use the simulators in a hands-on course and certication.
We applied simulator-based learning with remote online teaching, adapting to
the lockdown moment and allowing professors and fellows to continue developing
their skills. The initiative aimed to maintain high standards of medical education
and ensure that professionals remained procient in advanced techniques, thereby
supporting the society’s mission to improve neuroradiology training in Brazil. In
2021, we successfully launched a turnaround initiative across 21 training centers
spread across the country, providing a comprehensive 1-week course to all participants. This approach exemplies the resilience and adaptability of medical education in challenging times.
The International Symposium of Neuroradiology embraces the lessons learned
during lockdown by offering attendees a unique and immersive experience.
Participants will engage in hands-on sessions focused on diagnostic neuroradiology,
allowing for in-depth discussions of challenging cases with experts in the eld. This
interactive format enhances learning and fosters a sense of community among professionals, ensuring a valuable experience for all involved.
SBNR’S Partnership withOther Institutions
In recent years, SBNR has strengthened its relationship with SOBRICE, SBN,
ABNc, SBDCV, SILAN, AMB, and CBR.This collaboration has facilitated numerous educational initiatives and support efforts focused on cerebrovascular disease in
Brazil. Together, they aim to address the profound effects of stroke and related
conditions.
SILAN BRAZIL 2004, an unforgettable meeting occurred in Costa do Sauípe,
organized by SILAN and SBNR.This event was marked by high-level case discussions, showcasing cutting-edge technology and featuring esteemed international
guests. The atmosphere was professional and friendly, fostering an environment
conducive to learning and networking. Participants left with new insights and connections, making it a memorable experience for all involved.
By pooling resources and expertise, the SBNR strives to improve patient outcomes
through innovative treatment strategies and comprehensive care models. Their work
86
focuses on news images and technologies, and the recent neurointervention approach
emphasizes pre-hospital care, treatment, rehabilitation, and long-term support for
stroke survivors. The Resilient Trial was a national research network that resulted
from this collaborative effort focused on stroke treatment. The trial aims to assess the
efcacy of new treatment modalities and interventions for stroke patients, and its success depends on the active participation and support of multiple societies and organizations. This collective action reects the commitment of the medical community to
continuously enhance the quality of care and treatment options for individuals
affected by stroke. This trial was approved and funded from the Brazilian Federal
Government. The Hospital Geral of Fortaleza (HGF) national reference in Stroke
care was the leading institution contributing to the Resilient Trial and Basic trial.
The rst neuroradiology coding manual was created in 2019, establishing
national parameters for charging professional fees. Last but not least, the societies
involved have been developing guidelines to ensure that the best available scientic
evidence is used to service patients with cerebrovascular disease [8].
Numerous impactful activities have occurred, such as meetings, congresses,
symposiums, and online case discussions focused on political and educational
objectives. It is worth highlighting the session at the national congress with deputies
to discuss the planning for implementing thrombectomy nancing in the country’s
SUS network.
C. C. M. de Freitas et al.
In Memory ofProfessors Pierre Lasjaunias, Luc Picard,
andRonie Leo Piske
Professor Pierre Lasjaunias, who passed away in 2008, was a renowned gure in
anatomy and neuroanatomy. He was a prolic author and dedicated educator, sharing his expertise in neuroradiology with students worldwide. Known for his strong
personality, Lasjaunias made signicant contributions to interventional neuroradiology, particularly in treating vein of Galen malformations. His sudden death profoundly impacted the medical community, underscoring the loss of a brilliant mind
and compassionate clinician who transformed patient care with his innovative
techniques.
Professor Luc Picard, a pioneer in interventional neuroradiology, passed away in
2021, leaving a profound legacy. His groundbreaking contributions to the eld and
his heartfelt commitment to curriculum development and ethical standards dened
the WFITN approach’s humanitarian spirit. Picard was deeply passionate about
interventional neuroradiology, demonstrating unwavering care for his patients and a
genuine concern for his student’s growth. His contributions have left an indelible
mark on the medical community, ensuring his inuence will be felt for
generations.
Dr. Ronie Leo Piske was a luminary in interventional neuroradiology whose contributions have left an indelible mark on the medical community. Born in São Paulo,
Brazil, and of French descent, Dr. Piske was a pioneer in neurointervention, a eld
6 Recent History oftheBrazilian Society ofDiagnostic andTherapeutic Neuroradiology
87
that combines radiology and neurology to treat complex brain and spinal conditions
using minimally invasive techniques.
His career was largely centered at the Hospital da Benecência Portuguesa in
São Paulo, where he served as professor and mentor to many aspiring neuroradiologists. Dr. Piske’s dedication to education and training helped shape the next generation of specialists, ensuring that his innovative techniques and compassionate
approach to patient care continued to inuence the eld long after his passing.
Dr. Piske was a skilled clinician and prolic researcher. His work was widely
published and frequently cited by peers, underscoring his role as a thought leader in
interventional neuroradiology. His research contributions have been instrumental in
advancing the understanding and treatment of neurological disorders, making complex procedures safer and more effective.
During his career, Dr. Piske consistently collaborated with other prominent gures in the eld, including Jacques Moret and Laurent Spelle. These alliances
encouraged a culture of innovation and excellence, reinforcing his status as a world
leader in neurointervention.
Dr. Piske’s legacy is reected in his professional achievements and the respect
and admiration he garnered from colleagues and patients alike. His commitment to
patient care, combined with his pioneering spirit, made him a beloved gure in the
medical community.
We honor Dr. Ronie Leo Piske, a devoted advocate for advancing medical science and enhancing patient outcomes. His work has laid the groundwork for future
advancements in neuroradiology, and his impact will resonate for generations.
Advancements andCollaborations
The Brazilian Society of Diagnostic and Therapeutic Neuroradiology (SBNR) has
made signicant strides in advancing neuroradiology in Brazil. This progress is
marked by the development of a comprehensive new curriculum, the establishment
of new training centers, and the breaking of traditional paradigms. These efforts aim
to enhance the quality and scope of neuroradiological practice in the country.
The new centers serve as hubs for education and research, fostering an environment of continuous learning and innovation. By expanding training facilities, the
SBNR is addressing the growing demand for specialized neuroradiologists and
ensuring practitioners have access to state-of-the-art resources and technology.
Since 2019, the Brazilian Society of Diagnostic and Therapeutic Neuroradiology
has organized the International Symposium of Neuroradiology (ISN), a pivotal
event in South America. The symposium covers cutting-edge topics such as high
technology, hands-on training, innovation, case discussions, and online surgery. In
2022, the SBNR introduced a women’s group for Neurointerventionists, highlighting their commitment to diversity and inclusion. This annual event provides a
unique platform for professionals to engage in immersive learning experiences, fostering advancements in neuroradiology.
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C. C. M. de Freitas et al.
The hands-on course, which began in 2021 with online monitoring, is now
offered by SBNR presence as a part of the curriculum and is available to fellows
twice a year.
Collaboration and advocacy are pivotal to SBNR’s strategy. By partnering with
national and international institutions, the society shares knowledge and best practices, fostering advancements in global neuroradiology. Their commitment to diversity is evident through the Women’s Group for Neurointerventionists. Engaging
with the federal government, SBNR advocates for public health improvements,
aiming to enhance the accessibility and quality of neuroradiological services in
Brazil. These efforts underscore the society’s dedication to advancing the eld and
improving healthcare outcomes.
In conclusion, the Brazilian Society of Diagnostic and Therapeutic Neuroradiology
has committed to advancing the eld through education, collaboration, and advocacy. By developing a new curriculum, establishing training centers, and engaging
with other societies and the government, the SBNR plays a pivotal role in shaping
the future of neuroradiology in Brazil. These efforts not only improve the standards
of practice but also contribute to the overall improvement of public health systems
in the country.
Future Challenges forInterventional Neuroradiology inBrazil
The future holds many uncertainties, yet we need to strategize in alignment with our
objectives. The executive committee of SBNR is prepared for the new and excited
challengers as:
1. Geographic distribution and access: Despite efforts to expand training centers,
signicant challenges may still exist in equitably distributing fused professionals
nationwide. The historical concentration of training centers in the Southeast and
South has caused many physicians to emigrate from their home regions, exacerbating inequities in the availability of specialists. The objective is to enhance
professional training while collaborating with government entities to invest in
public institutions. We can foster a more effective and impactful educational
environment by improving research, assistance, and teaching through high technology and resources.
2. Curriculum standardization: Although a standardized curriculum has been
developed and planned, uniform implementation across all training centers may
continue to be challenging. Ensuring that all centers strictly follow the standardized curriculum is crucial to maintaining the quality of training.
3. Integration of new technologies: The rapid evolution of medical technologies
requires that training programs continually adapt to incorporate new techniques
and equipment. Keeping up with technological innovations and integrating
effective forms into the curriculum may be an ongoing challenge. The cost and
sustainability of high-complexity medicine are challenges not only to income
countries but worldwide.
6
Recent History oftheBrazilian Society ofDiagnostic andTherapeutic Neuroradiology
89
4. International collaboration: Although there are fellowship and exchange pro-
grams with other societies worldwide, maintaining and expanding these collaborations to ensure that Brazilian professionals can access international best
practices can be challenging.
5. Continuing professional development: In addition to initial training, profession-
als must have access to ongoing professional development opportunities to
update their skills and knowledge throughout their careers.
We conclude with the photo taken during the 17th Congress of WFITN in
NewYork, USA.This photo symbolizes a nation ready to welcome the international
community at the World Congress 2028.
Readers are suggested to contact the corresponding author for gures if needed.
References
1. Bull JWD.Section of the history of medicine. Proc R Soc Med. 1970;63:637–43.
2. Manual do residente do Hospital das Clinicas da USP de Sao Paulo. https://doi.org/10.1590/
S0004- 282X1984000100017.
3. Zaclis J.Cerebral pan-angiography is the name we suggest for the visualization of all intra-
cranial blood vessels after injection of contrast medium in one of the carotid arteries. Arq
Neuropsiquiatr. 1959;17(1):1–22.
4. Sezana WE. Academia de Medicina de Brasilia. https://www.ameb.org.br/index.php/
academicos/membros/33- emeritos/138- wilson- eliseu- sesana.
5. Raupp SF.Radiculograa com contraste hidro-solúvel. Porto Alegre: Universidade Federal do
Rio Grande do Sul; 1960.
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6. Mont’Alverne F, etal. Management of acute stroke and urgent neuro-interventional procedures
during COVID-19 pandemic: recommendations on the Scientic Department on cerebrovas-
cular diseases of the Brazilian Academy of Neurology, Brazilian Society of Cerebrovascular
Diseases and Brazilian Society of Diagnostic and Therapeutic Neuroradiology. Arq
Neuropsiquiatr. 2020;78(7):440–9.
7. Barros NG. https://inrad.hc.fm.usp.br/residencia- medica- em- radiologia- e- diagnostico-
por- imagem/.
8. Pontes-Neto OM, etal. Brazilian guidelines for endovascular treatment of patients with acute
ischemic stroke. Arq Neuropsiquiatr. 2017;75(1):50–6.
C. C. M. de Freitas et al.
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Chapter 7
A History oftheBritish Neuroradiology
fromthePerspective ofBritish Society
ofNeuroradiologists
ChristopherRowland-Hill andDipayanMitra
Early Days
The British Society of Neuroradiologists was conceived in the late 1960s and after
preliminary gatherings, the rst ofcial meeting of the Society took place in London
in May 1970. Membership comprised consultant neuroradiologists from neuroscience centres throughout the UK.At the time it was typical for these centres to only
have 1 or 2 full-time neuroradiologists, and membership was less than 40.
Throughout the 1970s the main business of the Society was to organise a 1-day
annual scientic meeting (ASM), sometimes as a joint meeting with other societies,
including the ESNR in 1972 and the Society of British Neurological Surgeons
(SBNS) in 1973. Meetings were hosted by neuroscience centres within the UK on a
rotational basis. Probably the most important and inuential presentation at a BSNR
meeting was given by Dr. Jamie Ambrose in Glasgow in 1972, describing his experience of the world’s rst CT scanner at Atkinson Morley’s Hospital, London. The
Society also set up small working groups to deal with standards, manpower and
training and published reports covering these issues.
At the dawn of the 1980s, the Society was still exclusively male, welcoming the
rst female member in 1982. Whereas the 1970s had been the decade of CT, 1980
heralded the arrival of MRI with a presentation from Nottingham on NMR (as it was
then known) at the 1980 ASM.In 1981, the ASM extended to two days and included
a half-day Registrars Course with didactic teaching. With the emergence of
C. Rowland-Hill
Hull Royal Inrmary, Kingston upon Hull, UK
e-mail: chris.rowland-hill@nhs.net
D. Mitra (
Royal Victoria Inrmary, Newcastle upon Tyne, UK
e-mail: d.mitra@nhs.net
D. Birchall (ed.), A World History of Neuroradiology,
https://doi.org/10.1007/978-3-032-16653-1_7
*)
91© The Author(s) 2026
92
C. Rowland-Hill and D. Mitra
Interventional Neuroradiology as a major advance in treatment of neurovascular
conditions, an Interventional Neuroradiology Working Party was formed after discussion at the 1983 meeting in Leeds.
1990s
The Annual Scientic Meeting of the BSNR was by now rmly established as a
2-day event, including a half day of didactic lectures, held in early October. This
continued during the decade with the exception of 1997, when the ESNR was held
in Oxford.
In 1990, the United Kingdom Neurointerventional Group (UKNG) was formed,
open to all practising neurointerventionists, meeting twice per year to discuss scientic, clinical and technical developments and to present cases of interest. The meetings were generously sponsored by industry and, at most meetings, a leading
international neurointerventionist was invited to speak.
There were concerns that the formation of the UKNG might split the BSNR and
negatively impact on sponsorship for BSNR events. The Diagnostic Neuroradiology
Forum (DNF) was set up as a separate group of diagnostic neuroradiologists but
many felt that the BSNR already fullled this function. The DNF failed to establish
itself in sufcient numbers and was disbanded after a small number of meetings.
The 1995 BSNR ASM included the introduction of an eponymous lecture in
honour of Dr. James Bull, a key gure in the development of neuroradiology as a
speciality in the UK and who was a founder member and the rst President of the
BSNR. The inaugural lecture was delivered by Professor Michael Sage from
Adelaide on the topic of the Blood Brain Barrier. The James Bull Lecture is delivered every year at the ASM by a distinguished national or international speaker in
the eld of clinical or sometimes non-clinical neuroscience.
In 1996, the Society published the rst edition of Effective Neuroradiology. This
was a comprehensive 36-page guideline produced by a subcommittee chaired by
Professor Ian Isherwood, intended as a reference document for the provision of
neuroradiology services in the UK.The guideline encompassed facilities, stafng,
training, provision of neurointervention and integration with other clinical neurosciences. An appendix provides a snapshot of UK neuroradiology manpower in the
mid-1990s. There were 107 consultant neuroradiologists, averaging 2.6 per department and 8 training posts, of which 4 were based in London. There have been major
revisions of this document in 2003 and 2012; the 2012 version was titled Safe
Neuroradiology.
During the mid-late 1990s, there were discussions on whether or not a UK-based
higher qualication in neuroradiology along the lines of the American Certicate of
Added Qualication (CAQ), was required or desirable. Opinion was divided with
some strongly in favour. It was recognised that setting up such a qualication would
require considerable resource plus the support of the RCR, and ultimately, a UK
CAQ equivalent never came to fruition.
7 A History of the British Neuroradiology from the Perspective of British Society…
93
In 1998, the BSNR’s ASM was held overseas for the rst time, in Kinsale,
Ireland. At this time, the Irish Society of Neuroradiology was yet to exist. Further
overseas meetings occurred in Amsterdam (2003) hosted by the late Dr. Gareth
Davies and in Dublin (2017), the latter being a joint meeting with the Irish Society
of Neuroradiology.
Up until the late 1990s, Ofcers of the BSNR had been nominated by the
Committee with appointments ratied at the Annual Business Meeting held during
the Annual Scientic Meeting. Feedback from neuroradiology trainees at the
Kinsale meeting revealed that juniors felt the Society was undemocratic and out of
touch. At the 1999 Annual Business Meeting (ABM) it was agreed that thenceforth
candidates for the post of president and other Society Ofcers could be proposed
and seconded by any full member of the Society, followed by an election with all
full members entitled to vote. A Committee post of Junior Member was also established and the post of Educational Advisor was formalised.
Year 2000 Onwards
In the 1990s, Dr. Andrew Molyneux in Oxford had conceived the International
Subarachnoid Aneurysm Trial (ISAT), a randomised, multicentre trial to compare
the safety and efcacy of endovascular coiling with standard neurosurgical clipping
for such aneurysms judged to be suitable for both treatments. The trial was stopped
after 2143 patients had been enrolled. The results, published in the Lancet in 2002,
showed conclusively that outcomes at 1year post treatment were better in the endovascular group. This had major implications for neuroradiology in the UK.Although
the endovascular treatment of aneurysms had risen steadily through the 1990s, the
new high-level evidence-based need to provide coiling services on a 7- or at least
6-day basis was a major challenge for individuals, departments and national bodies,
including the UKNG and BSNR.
Radiology training in the UK at the time was, and still is, based on three years of
core training followed by two years of specialist higher training. Ideally, the
Fellowship of the Royal College of Radiologists (FRCR) is passed, by written and
viva examination, at the end of the third year of training or soon after. At the time,
two years of higher training was available for neuroradiology whether just diagnostic or diagnostic plus intervention. The feeling among several interventionists was
that two years was insufcient time to train adequately in both branches of neuroradiology. The BSNR’s push for three years of higher training for neurointerventionists was initially met with resistance by the RCR and GMC. Fortunately, our
colleagues in Interventional Radiology (non-neuro) were pursuing the same aim
and eventually Interventional Neuroradiology and Interventional Radiology were
incorporated into a 3-year higher training curriculum. The stage was set for expansion of training in neurointervention to meet the demand for the clinical service.
The business and meetings of the Society continued along the same lines during
the decade. Having had exclusively male presidents, in 2003, the Society elected its