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168
R. E. Figueroa
Fig. 16.12 SILAN XXXII Annual Congress, Montevideo, Uruguay (October 2022): SILAN 2022
Program Poster
16
SILAN Society: History andInternational Impact 1988–2024
169
Fig. 16.13 SILAN XXXIII Annual Congress, Punta Cana, Dominican Republic (October 2023):
Leadership of SILAN 2023 Congress, from left to right: Dr. Javier Romero, chief of Neuroradiology
at Harvard University Massachusetts General Hospital and coordinator of SILAN 2023 scientic
program; Dr. Ramón de León Berras, President of SILAN 2023 Congress: Dr. Carlos Torres
Arbelaez, SILAN President; Dr. Roy Riascos, Vice-president of SILAN; Dr. Gelson Koppe,
Secretary of SILAN; and Dr. Juan Carlos Miranda, Treasurer of SILAN
170
R. E. Figueroa
Fig. 16.14 SILAN-HUGC Interventional Neuroradiology Scholarship program is sponsored by
Dr. Leopoldo Guimaraens at the Hospital Universitario General de Cataluña, Barcelona, Spain.
Several of the fellows from the SILAN-HUGC program
SILAN-Garrahan Pediatric Neuroradiology Scholarship: a 2-month scholarship
program to provide advanced training in pediatric neuroradiology to practicing neuroradiologists who are active SILAN members desiring to expand their scope of
practice. There are three positions awarded each year (2months each), sponsored by
Hospital Pediátrico Garrahan, Buenos Aires, Argentina. The program director is Dr.
Carlos Rugilo. This program has trained six fellows since its inception in 2022, and
three new awards have been granted for the year 2024.
SILAN-HUFJD
Interventional Neuroradiology program: the newest program
established in 2022 as a 2-year interventional neuroradiology training program at
the Hospital Universitario Fundación Jimenez Diaz, in Madrid, Spain. The program
director is Dr. Claudio Rodríguez, with the rst fellow completing his training in
June 2025.
16 SILAN Society: History andInternational Impact 1988–2024
171
The SILAN scholarships are funded through the economic support generated
from annual scientic meetings, membership dues, and unrestricted educational
grants from commercial partners, channeled through the SILAN Foundation, a notfor- prot entity created to support the training programs. The sponsoring institutions in Spain also provide complementary nancial support to compensate for the
higher cost of living locally. Over 250 trainees from 24 countries have beneted
from the SILAN programs over the span of 28years, with a direct total investment
by the SILAN society of approximately 1.2 million US dollars.
Since its humble beginnings with 24 founding members in Acapulco, Mexico, in
1988, SILAN has gone a long way and remains today the leading forum for continuous medical education and training in its member countries, with around 560 registered members from 24 countries. It currently sponsors the preeminent annual
international educational and scientic meeting in the Spanish and Portuguese languages, emphasizing the presentation and discussion of cutting-edge diagnostic and
interventional neuroradiology concepts and techniques. It has also served as the
engine for the development and strengthening of most national neuroradiological
societies in Spanish and Portuguese-speaking countries. SILAN’s strong support for
neuroradiologic education through the sponsorship of both diagnostic and interventional neuroradiology training programs has impacted all member countries by supplying many competent, well-trained neuroradiology practitioners, especially across
Latin American countries. The graduates from our programs have continued this
tradition of educational service, with many now involved in fostering local training
programs in their own countries. The longitudinal growth of the SILAN society and
its generous knowledge sharing continues to open opportunities for training to many
deserving students within the neurosciences, building upon the vision of our founding members and leading us into a future where the practice of our discipline
becomes more widely available and easily accessible to most people in our member
countries.
Information Resources
SILAN society ofcial website (www.silan.org).
SILAN: History of its Foundation, Development and Future: 1989 a 2001.
Author: Jesus Rodríguez Carvajal, published as a society service for its members
with support from Schering, Mexico, 2002.
Dr. Ramón Figueroa personal archives, 1993–2023.
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R. E. Figueroa
Open Access
This chapter is licensed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits use, sharing,
adaptation, distribution and reproduction in any medium or format, as long as you give appropriate
credit to the original author(s) and the source, provide a link to the Creative Commons license and
indicate if changes were made.
The images or other third party material in this chapter are included in the chapter’s Creative
Commons license, unless indicated otherwise in a credit line to the material. If material is not
included in the chapter’s Creative Commons license and your intended use is not permitted by
statutory regulation or exceeds the permitted use, you will need to obtain permission directly from
the copyright holder.
Chapter 17
History of South African Neuroradiology
CliveWyndhamSperryn, SallyCandy, EbrahimKader, AndreMacDonald,
DuncanDavidRoyston, VictorMngomezulu, Coertde Vries,
ShalendraKumarMisser, LeonJansevanRensburg,
andLindaTebogoHlabangana
Abbreviations
ASHNR American Society of Head & Neck Radiology
ASNR American Society of Neuroradiology
BSNR British Society of Neuroradiologists
C. W. Sperryn (*)
Neuroradiology, Morton and Partners, Cape Town, South Africa
e-mail: clive.sperryn@morton.co.za
S. Candy
Diagnostic Radiology, Groote Schuur Hospital/University of Cape Town, Cape Town,
South Africa
E. Kader
General and Neuro Interventional Radiology, Morton and Partners Inc, Cape Town,
South Africa
A. MacDonald
SCP Radiology, Panorama, Cape Town, South Africa
D. D. Royston
Lake Smit and Partners Radiology, Entabeni Hospital, Cape Town, South Africa
V. Mngomezulu
Diagnostic Radiology, Chris Hani Baragwanath Academic Hospital/University
of Witwatersrand, Johannesburg, South Africa
C. de Vries
Scholtz and Partners, Midstream Mediclinic, Centurion, South Africa
S. K. Misser
Radiology, Lake Smit and Partners, Durban, South Africa
L. JansevanRensburg
Division of Radiodiagnosis, Tygerberg Academic Radiology, Cape Town, South Africa
L. T. Hlabangana
Diagnostic Radiology, University of Witwatersrand, Johannesburg, South Africa
D. Birchall (ed.), A World History of Neuroradiology,
https://doi.org/10.1007/978-3-032-16653-1_17
173© The Author(s) 2026
174
C. W. Sperryn etal.
CHBAH Chris Hani Baragwanath Academic Hospital
CME Continuing Medical Education
CUBIC Cape Universities Body Imaging Centre
EDiHNNR European Diploma in Head and Neck Neuroradiology
EDiINR European Diploma in Interventional Neuroradiology
EDiNR European Diploma in Neuroradiology
EDiPNR European Diploma in Paediatric Neuroradiology
ESNR European Society of Neuroradiology
GDC Gugliemi Detachable Coil
HPCSA Health Professions Council of South Africa
IALCH Inkosi Albert Luthuli Central Hospital
ISMRM International Society of Magnetic Resonance in Medicine
KU Leuven Katholieke Universiteit Leuven
PLANET Pierre Lasjaunias Neurovascular Education Team
PACS Picture Archiving and Communication System
RIS Radiology information system
RXH Red Cross War Memorial Children’s Hospital
RSNA Radiological Society of North America
RSSA Radiological Society of South Africa
SAMRC South African Medical Research Council
SANIS South African Neurointerventional Society
SASNI South African Society of Neurological Imaging
SASPI South African Society of Paediatric Imaging
UCT University of Cape Town
WFNRS World Federation of Neuroradiological Societies
WFPI World Federation of Paediatric Imaging
The Context
South Africa has a population of 62 million with an age distribution typical for a
developing country with rapid urbanisation [1]. The 2019 Global Health Index [2]
ranks its healthcare 49th out of 89 countries. While occupying top position in Africa,
it lags countries such as India and the Philippines. These statistics mask an unusual
dichotomy of a 2-tier system, in which a beleaguered and underfunded public sector
is used by 86% of the population, and a small, but high functioning private sector
services the remainder [3].
A total of 750 radiologists are presently registered with the national licencing
body, the Health Professions Council of South Africa (HPCSA), including 439 specialists in full time private practice, 133in the Public Health system, and 253 registrars (residents) across ten training institutions [4]. This equates to 1.3 radiologists
per 100,000 population, compared with 8.6/100,000in the United Kingdom, 12.8in
the European Union, and ten in the USA.
Broken down further, there are 0.5 radiologists per 100,000in the state sector
compared with 4.65/100,000in private.
17 History of South African Neuroradiology
175
The Radiological Society of South Africa (RSSA) is a stewardship umbrella body
with 1086 members, including members in Namibia, Zimbabwe, and Botswana, foreign and retired members, and nuclear medicine physicians. The country comprises
nine provinces with historic inequalities in health care provision, medical training,
and specialisation patterns. Skills scarcity in SA requires most radiologists to function as generalists. Neuroradiology has been and remains a large component of modern imaging practice and, while many have availed themselves of subspeciality
training, few practitioners have the luxury of concentrating solely on neuroimaging.
The South African Society of Neurological Imaging (SASNI), constituted in
2011, has 153 members, Paediatric Imaging (SASPI) has 106, and the SA society of
Neuro-intervention (SANIS) has 21 members (0.03/100,000).
The Early Years
The Western Cape tertiary health care facilities, Groote Schuur Hospital afliated to
the University of Cape Town and Tygerberg Hospital, afliated with Stellenbosch
University, are considered to have been historically advantaged in terms of equipment and stafng.
The history of neuroradiology in the Cape is peppered with colourful characters
who shaped the growth of the sub-speciality with their unique personalities and
styles of teaching. Three eminent personalities stand out in the pioneering days:
Prof Lenny Handler, Prof Kaye de Villiers, and Prof Richard Hewlett.
Lenny Handler was the rst ofcial South African neuroradiologist. After his
Radiology training at the University of Cape Town (UCT) in 1965, he completed a
Neuroradiology fellowship at Wessex Neurological Centre, Southampton under Ted
Burrows, a neurosurgeon, ex Queen’s Square/Great Ormond Street. He returned to
South Africa to a neuroradiology post at Groote Schuur Hospital specically created for him by the head of Neurosurgery at the time, Prof. Kaye de Villiers. Despite
diametrically opposed personalities and often at loggerheads, the dynamic duo fostered the growth and recognition of the subspeciality, attending conferences and
presenting lectures on new topics, such as, “How to perform an angiogram”! Prof.
Handler pioneered procedures at Groote Schuur, such as direct stick carotid angiograms, air encephalography and myelography. Those who trained with him remember the days of manual subtraction cerebral angiography and myelography with a
mix of amusement and high anxiety. Catheter angiography came later, under the
impetus of Alan Goldin and Phil Harries Jones. Lenny remained active in registrar
training well past his ofcial retirement in 2001.
Modern neuroradiology is indebted to the physicists who made it possible. Allan
Cormack, who matriculated at Rondebosch Boys High and completed an MSc in
physics at the University of Cape Town in 1945 shared the 1979 Nobel Prize with
Sir Godfrey Hounseld for work he had published in 1963 and 1964 on the mathematics required to facilitate cross-sectional imaging [5]. Sir Godfrey Hounseld
developed the rst EMI scanner, sharing the rst results in 1972.
The genre-altering transition to cross-sectional imaging of the brain came with
the installation of the rst CT scanner at Tygerberg Hospital in 1976. A revolution
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C. W. Sperryn etal.
in its time, the single slice 64×64 matrix EMI unit was as far removed from
modern super-scanners as a model-T Ford was from a self-driving Tesla Electric
Vehicle. The Groote Schuur Complex followed shortly after with its rst CT
installation in 1977.
The rst MRI in the southern hemisphere, a 0.5T Elscint unit, was installed at
the Medical Research Council (SAMRC) Cape Town and commissioned in 1986.
Selected patients were transferred by ambulance to and from their base hospitals
across the Western Cape. Run by a young physicist, Bruce Spottiswood, it was used
exclusively for neuroimaging and the rst radiologists to be involved were Bates
Alheit and Jan Lotz, both of whom later moved into private practice.
Diagnostic Neuroradiology
The SAMRC became the home for two young radiologists who would play signicant roles in the advancement of the subspeciality—Roger Smith, a neurosurgeon
who had spent 4years of MRI Fellowship training under Walter Kucharczyk in
Toronto, and Leon Janse van Rensburg, who completed a 2-year Fellowship in the
unit, under the mentorship of Roger Smith and Richard Hewlett.
Roger and Leon were responsible for organising the rst MR imaging course in
Cape Town in November 1991 (Fig. 17.1). The international faculty included
Fig. 17.1 Magnetic resonance imaging workshop. (Courtesy of Prof. Leon Janse van Rensburg)
17
History of South African Neuroradiology
177
Richard Ehman and Walter Kucharczyk and marked the ofcial start of a subspeciality collaboration which continues to this day.
Leon Janse van Rensburg has been pivotal in the RSSA CME program in general
and neuroimaging and specically head and neck imaging. He was awarded a
Doctor of Science degree by the University of the Western Cape for his groundbreaking research on correlative CT, MRI, and histopathology of Maxillofacial
Tumours. As CME Chair, he brought a substantial number of neuroradiologists to
South Africa and is well known internationally having been on the WFNRS committee, involved in the ISMRM, and is an Honorary member of the ESNR, in recognition of his contribution to advancing Neuroradiology training outside of Europe.
Jan Lotz worked with Richard Hewlett at the City Park Hospital and, in 1992,
organised the “First African Neuroradiology” meeting with Prof. Anne Osborn as
the keynote speaker.
Prof. Richard Hewlett (Fig.17.2), locally and internationally renowned neuropathologist and correlative CT/MRI expert, was a key inuence on the development
and trajectory of radiologists and clinicians with an interest in CNS and head and
neck imaging throughout SA.Richard grew up in East Africa, attended the Prince
of Wales School in Nairobi, and studied medicine at the University of Cape Town
(UCT) where, as a junior lecturer in the anatomy department, he completed a PhD
on the anatomy of the rock hyrax(dassie). This was the start of a lifelong fascination
with pathology of the nervous system.
Fig. 17.2 Prof. Richard
Hewlett. (Courtesy of Dr.
Andre MacDonald)