Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5787_Библиотеки_им_академика_М_И_Перельмана.pdf
116
G. Scotti
1. Contribution à l’histoire de la Neuroradiologie Européenne—éditions Pradel,
Paris, 1989
2. Contribution to the History of European Neuroradiology—E.A. and
M.T.Cabanis, Paris, 1994
3. A History of Neuroradiology (1895– 2002)—Europa editions—Toulouse, 2002
Marco Leonardi is the author of the last extensive history of Italian neuroradiology. Since his work is, in a way, preliminary to ours, it is worth reporting how
Marco Leonardi had subdivided our history in the past century and envisaged its
development in the twenty-rst century.
The history of neuroradiology in Italy falls into four periods.
The rst period was the dawning interest of different neurologists and radiologists in
neuroradiology at the turn of the century until the early years of the First World War. It soon
became apparent that not only did radiologists require neurological training, but above all
neurologists required training in radiology. The radiology-neurology binomial symbolizes
the meeting point between two complementary disciplines. The third discipline, neurosurgery, was still missing at this time and its subsequent development was to become the driving force behind neuroradiology.
The second period, a relatively short one, covered the Forties and Fifties and was characterized by the training of Italian neuroradiologists abroad, rst in Sweden and later in
France. In Sweden they learned to appreciate the role of the neuroradiologist as a separate
gure, fully responsible for the risks entailed in invasive neuroradiological investigation,
and thus responsible for the indications for examination. Di Chiro and Ruggiero are the
leading exponents of the period…. This period of growing awareness and pinpointing targets ended in 1969 when new legislation reforming public hospitals included neuroradiology among the list of hospital specialties entitled to independent departments…..
The third period lasted from 1969 to date and was characterized by the growth of
newly established hospital departments…. Unfortunately, this period also saw the
development of a major conict with radiology. Over the past thirty years the divide
between professional approach of neuroradiologists and radiologists has widened in
Italy. While neuroradiologists are “organ” radiologists in the true sense, radiologists
bear the imprint of their technical specialty and include angiographers, computed
tomographers, ultrasonographers etc…..While radiologists believed they were defending the integrity of the great mother gure of radiology, they provoked a serious split
with neuroradiologists….Only recently has Radiology begun to change its attitude,
system specialists now work alongside organ specialists: pediatricians, gastroenterologists etc. Within this framework, the chances of reaching an understanding with neuroradiologists are much greater, there is a plan to set up a joint specialization school,
there is hope for future cooperation…
The fourth period is that of university acknowledgement of the neuroradiology discipline.
It was only at the end of the Eighties that Italian universities nally recognized the importance
of neuroradiology including the discipline in the Degree Course in Medicine. Initially conned to postgraduate specialization, neuroradiology teaching has now been extended to general medicine undergraduates. This important step forward should mark an increase in the
number of teaching posts….in 1995 an agreement was reached with the radiologists to amend
the Specialization in Radiology to offer two specialty courses: 1) Diagnostic and Therapeutic
Radiology and 2) Neuroradiology. The courses started in 1996–1997.
Some have considered the neuroradiology specialty in the school of radiology as limiting, mainly due to the relatively scant clinical curriculum compared with the large number
of radiology topics. However, this achievement does signify a clear-cut acknowledgement
crowning the efforts of three generations of neuroradiologists. A point of arrival, but also a
point of departure: future improvements will then be possible and will depend on our future
work and on the work of our successors.
11 History ofItalian Neuroradiology, 1990–2023
This optimistic scenario outlined in the conclusion of Marco Leonardi’s report lasted for
a short period, and a clear-cut university program that would have led to a specialty in
neuroradiology has not yet been achieved. A proposed parliamentary- specic law, presented by a neuroradiologist member of the Parliament, Dorina Bianchi (16 October
2013), was never approved. The possibility of dening a certied Neuroradiology path
within the Radiodiagnosis specialty course is currently being discussed.
In the following chapters, we will see the progress of neuroradiology in Italy
from 1990 up to now. We will rst have an overview of the growth of the number
and of the quality of physicians practicing neuroradiology, spread of hospital departments, academic positions, and society membership. We will then approach the
risks and the opportunities, for the next decades, that will require a clear vision and
a strong determination not only to grow further but also not to lose the positions and
recognitions acquired up to now.
117
AINR: Associazione Italiana di Neuroradiologia
In 2023, the members of the Italian Association of Neuroradiology (AINR), founded
in 1961, were 722, of whom 290 were females and 432 males. The growth has been
impressive: in 1990, the members of the society were less than 200.
The AINR is structured on a regional basis, with twelve representatives for the
20 regions (some regions are associated and have a single representative).
The members pay a regular annual fee; the board meets on a regular basis, and
the minutes of the meetings may be found by the members on the web page at the
following address: https://ainr.it
The AINR organizes a National Congress every 2years, a Pediatric National
Congress every 2years, and educational courses, pediatric and interventional meetings that will be outlined in the following chapter.
The association has a strict relationship and cooperation with the Collegio dei
Professori di Neuroradiologia, composed of the University Professors of
Neuroradiology.
Italian neuroradiologists may also be members of the association of radiologists
(SIRM—Società Italiana di Radiologia Medica), which has a specic section of neuroradiology. The current President of the Section is Alessandra Splendiani, Professor
of Neuroradiology at the University of L’Aquila. Neuroradiology is also associated
with neurologists and neurosurgeons in SNO (Scienze Neurologiche Ospedaliere).
Congresses, Meetings, andCourses
Until 2009, the AINR organized a National Congress on a yearly basis; subsequently, the national congress has taken place every other year. There is no xed
location and the congress is assigned by the executive committee on the basis of
proposed candidatures by the members.
118
G. Scotti
During the COVID-19 pandemic, the annual meeting was postponed by a few
months but not discontinued.
Besides the National Congress, AINR organizes a congress of pediatric neurora-
diology every other year; this takes place during the year when the National
Congress does not take place. The general assembly of members takes place every
year, either during the National Congress or the Paediatric Neuroradiology Congress.
Also, a yearly interventional meeting, as well as a range of other courses and meetings, are organized.
Furthermore, since 2019, educational courses that lead to a master in
Interventional Neuroradiology are promoted by the Collegio dei Professori
Universitari in cooperation with several Italian universities, as well as, since 2021,
a similar initiative that leads to a master in Diagnostic Neuroradiology. The registered participants just for the diagnostic master’s 2024 are 120.
The pediatric section has about 100 members; since 1992, the section organizes
a National Congress every 2years.
Itinerant courses are organized every 6 months (1 for Northern Italy, 1 for
Southern Italy), with the aim of basic training.
This report would not be complete without mentioning an original periodic
event, a gathering of neuroradiologists that goes under the name of “Club
Neuroradiologico Primavera”. Starting in March 1990, Professor Giovanni
Ruggiero promoted an original formula, a mixture of scientic meeting, social
and literary entertainment of neuroradiologists for 1week, usually in a location in
the mountains, with skiing breaks, or at the seaside. From 1990 to 2010, when the
Club was discontinued, a total of 19 reunions have contributed to strengthening
friendly and professional relationships among Italian neuroradiologists, somewhat selected and invited by the founder of the “club,” Professor Giovanni
Ruggiero (1922–2009).
Hospital Departments
The number of Hospital Departments of Neuroradiology has signicantly increased
since 1990. Neuroradiology is practiced in hospital structures of different complexity, denominated according to the internal organization of Italian hospitals as
Complex or Simple Operative Units. The complex units have complete autonomy
and are chaired by a Director (Primario) who is fully responsible. The simple units
may be part of a larger radiological department whose director, usually a radiologist, is ultimately responsible for the department and the neuroradiologist has a less
complete responsibility for the unit.
The last ofcial survey done by the AINR concerning the number and distribu-
tion of Services/sections of neuroradiology in Italy dates back to 1991 (La
Neuroradiologia in Italia, Censimento dei Servizi/Sezioni, Anno 1991. Editrice
Omicron—I quaderni del Radiologo—n. 3/1992).
This is the published table summarizing the results in 1991.
11 History ofItalian Neuroradiology, 1990–2023
North Center South Total
A—Autonomous NRD service 17 13 13 43
B—Aggregated NRD Service 5 2 4 11
Total 22 15 17 54
119
A personal updated non-ofcial survey allows us to witness a signicant growth
of the hospital departments, and can be summarized as such:
Neuroradiology Departments 2023
North Center South Total
Total 37 30 30 97
Notably, the size, workload, and number of doctors and technicians of the departments has signicantly changed with the development of complex modern technical
equipment and growth of the interventional activity.
Neuroradiology is practiced not only in Hospital Departments or University hospitals, but also in private clinics or diagnostic centers.
There is a large network of such facilities, usually well-equipped and highly
qualied. In these clinics, neuroradiology is practiced both by retired neuroradiologists, full-time staff members and by part-time consultant neuroradiologists working also in public hospitals.
The private centers usually receive both private patients and patients covered by
private insurances, as well as patients covered by the National Health Service.
Academic Positions, Teaching, andResearch
The academic career in neuroradiology is regulated by national rules: “idoneità”
and “concorsi,” that is, rst evaluation and promotion on the basis of scientic productivity, clinical involvement, and teaching activity and then appointment to
the chair.
There are three levels of academic seniority:
1. Ricercatore (R)
2. Associate Professor (PA)
3. Full Professor (PO)
The number of academic positions has grown signicantly since the early rst
chairs, in line with the growth and expansion of the discipline.
From the rst appointment of a university professor in Naples in 1976, the number of university professors has grown to:
120
15 in 1990 (4 PO, 11 PA), to reach
39 in 2020 (11 PO, 22 PA, 6 R) up to the number of
54 in 2023 (20 PO, 18 PA, 16 R) of whom 25% are female.
All the University Professors are committed to teaching and research activities of
their universities. Scientic research, however, is performed not only in university
departments but also in the majority of hospital centers. The quality of Italian
research in Neuroradiology is demonstrated by numerous prizes received by Italian
neuroradiologists, national and European grants obtained, and the high Impact
Factor of papers published in Italian and international journals.
The University Professors have their ofcial organization and representation in
the Collegio dei Professori di Neuroradiologia, whose current President is
Alessandro Bozzao.
G. Scotti
International Relationships
From 1990 until now, Italy has hosted and organized, besides national congresses
and courses, a signicant number of international meetings.
The presence of international guests as speakers has contributed to the strengthening of relationships with the most relevant and outstanding international colleagues in the eld of neuroradiology, both in Europe and in the rest of the world.
Some of them were, or have become, good personal friends of many Italian
neuroradiologists.
Just to mention a few, these include the late Derek Harwood Nash, Anne Osborn,
Tom Naidich, the late Michael Huckman, Danielle Balériaux, the late Luc Picard,
the late Pierre Lasjaunias, Claude Manelfe, Jordi Ruscalleda, Pia Sundgren, Tarek
Yousry, Rolf Jaeger, Karell Terbrugge, Olaf Flodmark, and Majda Turner.
Italian Neuroradiologists Abroad
The names of Giovanni Di Chiro and Domenico Dilenge, as neuroradiologists of
Italian origin and European culture and professional formation, who have become
prominent gures of North American neuroradiology in the last century, are
well known.
The role of Giovanni Ruggiero in promoting French neuroradiology in the 1960s
is also notable.
More recently, we must mention Guido Guglielmi, who moved from Italy to Los
Angeles, where he developed his world-renowned “Guglielmi detachable coils”
method to treat intracranial aneurysms.
Among other gures of Italian neuroradiologists who have reached outstanding
positions in hospital departments and universities outside Italy, we should mention:
11 History ofItalian Neuroradiology, 1990–2023
Donatella Tampieri, Professor of Radiology, Lead of the Section of Neuroradiology
at Queen’s University, Kingston, Canada
Alessandra Biondi, Professor of Radiology and Director of the Department of
Neuroradiology and Vascular Radiology. Besancon University Hospital,
Besancon, France
Alessandro Cianfoni, Head of Neuroradiology, Neurocentro della Svizzera
Italiana, Lugano
Felice D’Arco, Paediatric Neuroradiology Consultant at Great Ormond Street
Hospital for Children in London
Francesco Carletti, full-time consultant in Diagnostic Neuroradiology at the
National Hospital, Queen Square, London
Moreover, a large number of young Italian neuroradiologists have trained for
periods of varying duration, from months to years, in the most important European
or North American centers of diagnostic and interventional neuroradiology in the
period from 1990 to 2023.
121
Lost Colleagues 1990–2023
From 1990 to 2023, we have lost, among others, the following outstanding colleagues and leaders in neuroradiology:
Angelo Passerini (1925–2004), Giovanni Ruggiero (1924–2009); Vincenzo
Branca (1957–2010), Aristide Carella (1940–2011); Mario Savoiardo
(1939–2014); Francesco Galligioni (1930–2015); Massimo Gallucci (1960–2015);
Vittorio Bernasconi (1921–2016); Marco Leonardi (1944–2017); Maria Antonietta
Vaghi (1930–2018); Giuseppe Scialfa (1942–2022); and Francesco Smaltino
(1929–2022).
The Future
The task for the neuroradiologists of this decade, those who are now the actors and
directors of this “story,” is to complete the long march toward the specialty board
certication and also to be leaders in the practice and teaching of diagnostic and
interventional neuroradiology and in research in the eld of neurosciences.
The scenario in which they are asked to act, however, is changing at a spectacular
and unexpected speed.
From 1895, the year of the discovery of X-rays by Wilhelm Conrad Roentgen,
the major steps of our disciplines in the past century have been in the 1920s, the
introduction of contrast studies, followed by the advent of CT in 1972 and of MRI
in the early eighties. We are now, almost 40years later, probably facing a new revolution or signicant step forward with the pervasive advent of AI and radiomics.
122
G. Scotti
The “explosion” of articial intelligence (AI) and its generative side will dramatically change not only the medical practice, especially in its diagnostic aspect,
but also the modality of training future doctors and, in particular, specialists in neuroimaging, that is, the neuroradiologist.
Nobody has a crystal ball to look into the future, so we cannot know whether the
prophecy of Jacques Attali that envisages that medicine in 2050 will mainly be
“auto diagnosis” will come true. We denitely know that the gloomy prediction of
Geoffrey Hinton, who back in 2016 stated that “articial intelligence will do better
than radiologists and for this reason we should stop forming radiologists now,” was
wrong. We prefer to quote Curtis Langlotz, Professor of Radiology and Biomedical
Informatics, who has said: “Will AI ever replace radiologists? No, but radiologists
who use AI will replace radiologists who don’t.”
The role of the neuroradiologist will, however, denitely change and we must be
ready to be leaders in the eld and continue to value our role as physicians who not
only do not lose contact with the patient but also increase our role of being an inevitable interface between diagnostic data, their interpretation, and use, to give the best
advice and help to the patients. We must also be in a strict relationship with biomedical engineers, neuroscientists, and clinicians.
The inevitable progress and increase in complexity of the interactions in the eld
of neurosciences will probably lead and determine the relationship with the radiological family and be a further factor, together with the growth of neuro intervention, to push toward the denitive recognition of neuroradiology as a medical
specialty.
Acknowledgements I thank the following people for their help in revising and completing
this report:
Nicoletta Anzalone, Alessandro Bozzao, Sandra Bracco, Ferdinando Caranci, Nadia Colombo,
Andrea Falini, Simonetta Gerevini, Marcello Longo, Lillo Politi, Andrea Rossi, Alessandra
Splendiani, Donatella Tampieri, Fabio Triulzi.
National Congresses (Before 1990)
I—Florence, 1980—President: A.Nori
II—Milan, 1982—P: A.Passerini
III—Bari, 1983—P: A.Carella
IV—Alghero, 1985—P: P.Dettori
V—Milan, 1986—P: G.Scialfa
VI—Bologna, 1987—P: G.Cristi
VII—Positano, 1988—P: R.Elefante
VIII—Padova, 1989—P: K: Pardatscher
11 History ofItalian Neuroradiology, 1990–2023
National Congresses After 1990
9°—12-14 June 1991, Genova—P: Marco L.Rosa
10°—7-10 october 1992, Milano—P: G.Scotti
11°—10-12 June 1993, Ancona—P: U.Salvolini
12°—19-21 October 1994, Taormina—P: G.Pero
13°—19-21 October 1995, Roma—P: L.Bozzao
14°—16-18 October 1997, Cosenza—P: G.Santoro
15°—9-12 December 1998, Firenze—P: G.Dal Pozzo
16°—12-15 December 1999, Napoli—P: R.Elefante
17°—14-17 December 2000, Genova—P: P.Tortori Donati
18°—13-16 December 2001, Bologna—P: M.Leonardi
19°—15-18 May 2003, Verona—P: A.Beltramello
20°—22-25 September 2004, Milano—P: G.Scotti
21°—22-25 June 2005, Salerno—P: G.Sirabella
22°—4-6 October 2006, Milano—P: F.Triulzi
23°—20-23 June 2007, Bergamo—P: G.Bonaldi
24°—1-3 October 2008, Rome—P: L.M. Fantozzi
25°—9-12 December 2009, Firenze—P: G.Pellicanò
26°—19-22 October 2011, Padova—P: C.Carollo
27°—18-21 September 2013, Coppito (AQ)—P: M.Gallucci
28°—16-18 September 2015, Napoli—P: M.Muto
29°—27-30 September 2017, Milano—P: M.G Bruzzone, E.Ciceri
30°—2-5 October, 2019—Siracusa—P: C.Cristaudo, M.Longo, MP Pappalardo
31°—8–11 June 2022—Roma—P: A.Bozzao
32°—18–21 October 2023—Bergamo—P: S.Gerevini
33°—2025-Reggio Calabria—P: A.Armentano
123
Pediatric Section
I—1992, Padova—President: Carla Carollo
II—1994, Milano—7–9 April P: Fabio Triulzi
III 1996, Genova—P: Paolo Tortori Donati
IV—1998, L’Aquila—P: Massimo Gallucci
V—2000, Florence—11–12 May—P: Claudio Fonda
VI—2002, Bologna—22–24 November—P: Bruno Bernardi
VII—2004, Padova -15–17 April—P: Carla Carollo
VIII—2006, Ferrara—4–6 May—P: Ferdinando Calzolari
IX—2008, Catania—12–14 June—P: Giuseppe Pero
X—2010, Genova—10–12 December—P:Andrea Rossi
XI—2012, Ancona—28–30 June, P: Ugo Salvolini
XII—2014, Milano—2–4 October—P: Cristina Baldoli
124
XIII—2016, Rome—6–8 October—Ps: Bruno Bernardi and Andrea Rossi
XIV—2018, Brescia—11–13 October—P: R.Gasparotti
XV—2020, online—30 Nov-4 December (in conjunction with the Functional
Neuroradiology Section)—Pres: Massimo Caulo, Cecilia Parazzini,
Alessandra D’Amico
XVI—2023, Salerno—26–28 January, P: Alessandra D’Amico
The following list comprises the international meetings and courses organized
in Italy:
1961—Rome, 18–22 September. VI SNR Symposium Neuroradiologicum.
President: G.Ruggiero
1990—Milano, 4–8 September, European Course in Neuroradiology—Third Cycle,
First Course. Intracranial Nervous System. Organizer G: Scotti
1996—Milano, 17–21 September XXII Congress of the European Society of
Neuroradiology, ESNR.President G.Scotti
1996—Milano, September 18th: 6th Advanced Course of the ESNR—Functional
Neuroanatomy of Motion and Vision—Course Directors Giuseppe Scotti and
Denis Le Bihan
1998—Bologna, 22–27 May Fifth Cycle, Third Course—European Course in
Neuroradiology—Spine and spinal cord—President Marco Leonardi—Course
Director Cosma Andreula
2001—Ancona, 13–16 September 2001. 11th advanced Course and XXVII
Congress of the European Society of Neuroradiology, President Ugo Salvolini
2010—Bologna, 4–9 October. XIX SNR.Symposium Neuroradiologicum Pres.
M.Leonardi
2019—Naples, 21–24 October: 15th Congress of the World Federation of
Interventional and Therapeutic Neuroradiology (WFITN)—President Mario
Muto and Alessandra Biondi
G. Scotti
Honorary Members andGold Metal Awards
ESNR—European Society ofNeuroradiology
Antonio Sicuro, 1995
Guido Guglielmi, 2006
Giuseppe Scotti, 2012
Massimo Gallucci, 2015
Marco Leonardi, 2016
Mario Muto, 2023
11 History ofItalian Neuroradiology, 1990–2023
ASNR—American Society ofNeuroradiology
Marco Leonardi 2000
Mario Muto 2021
ASPNR American Society ofPediatric Neuroradiology
Paolo Tortori Donati—2016
Andrea Rossi—2023
ESPR—European Society ofPediatric Radiology
Paolo Tortori Donati 1998
Andrea Rossi 2024
Presidents or Board Members oftheInternational Societies
ofNeuroradiology
125
European Society forNeuroradiology
ESNR—Marco Leonardi—President 2008–2010
ESNR—Andrea Rossi—Vice President 2022; former Secretary General 2014–2022
Luigi Manfré Secretary General 2023—in ofce
Antonella Castellano and Nicoletta Anzalone Director of rst Level Course of ESNR
WFNRS
Giuseppe Scotti has been a “member at large” of the board of the WFNRS