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Historical Perspectives |
1 From the The University of Alabama at Birmingham. Received August 16, 1999; accepted September 30. Address reprint requests to R.G.F., 2766 Summit Circle, Birmingham, AL 35216.
Index terms: Education • Radiology and radiologists, history
During the second half of the 20th century, knowledge of the science and art of radiology expanded at an astounding rate. With regard to all systems of the human body, the diagnosis and treatment of disease and our knowledge of both structure and function underwent extensive revision as a result of intensive research. As a consequence, what existed during the early and middle decades of the century as "general" radiology evolved into a number of subspecialties (1) that separated from the mainstream because of special interests that were deserving of more intense study than they might be given if they were diluted in the broad field of general radiology.
The Society for Pediatric Radiology and the American Society of Neuroradiology are specialty societies that were founded in 1958 and 1962, respectively. With the natural process of evolution, the creation of a society devoted to the study of the normal chest and chest diseases was inevitable, and by the end of the 6th decade, a third specialty society formed along organ system lines was conceived. What became known as the Fleischner Society will celebrate its 30th anniversary in the year 2000, and we believe a brief history of its evolution is of potential value to other specialties in general and to those concerned primarily with imaging in particular. In this historical review, emphasis is placed on the interdisciplinary character of the society that has given biologic and clinical relevance to a milieu in which imaging is the prime focus.
The inaugural meeting was held in December 1969, when eight radiologists in the United States and United Kingdom met in Chicago to discuss the formation of a group that would provide a forum for the presentation and discussion of scientific matters of mutual interest and the promotion of international collaboration in research of chest disease. The founders included Robert G. Fraser, MD, Leo Rigler, MD, Benjamin Felson, MD, George Simon, MD, Norman Blank, MD, Richard Greenspan, MD, Eric Milne, MD, and Morris Simon, MD. Also invited to attend this meeting was Felix Fleischner, MD, a distinguished radiologist from Boston who enthusiastically supported the concept and aims of the society. Unfortunately, Dr Fleischner died tragically in August 1969, 3 months before the inaugural meeting.
Felix Fleischner had had a distinguished career in chest radiology in Europe in the 1930s but was forced to emigrate to the United States because of tragic events in Austria and Germany. Fortunately, he was warmly welcomed in Boston and thus was able to enjoy a second distinguished career in that city and elsewhere in America. Thus, there was consensus among the founders to name the society after Fleischner in recognition of his dedication to teaching and research and his great compassion and kindness.
There are six objectives of the Fleischner Society, as laid out in the bylaws: (a) to be a nonprofit educational, international society of physicians and scientists interested in the normal and diseased chest, who meet to cooperate in advancing knowledge in this field and to conduct teaching conferences with an emphasis on chest imaging for physicians and scientists; (b) to foster the continuing development of the clinical specialty of chest imaging as an art and a science; (c) to improve the methods of teaching radiologic diagnosis of chest disease; (d) to stimulate interest in the study of chest disease and the research of chest imaging; (e) to promote close fellowship and exchange of ideas among chest radiologists and others interested in diseases of the chest; and (f) to provide meetings for the reading and discussion of papers and the dissemination of knowledge.
These objectives admittedly reveal a predominantly radiologic focus, but the fifth aim introduces an aspect that gives the society one of its unique qualities—a multidisciplinary approach. From the beginning, specialists from a widely diversified base—pulmonologists, physiologists, thoracic surgeons, pathologists, and morphometrists—all of whom possessed a major interest in the normal chest and its diseases, have been included in the society's membership. It was recognized that the interaction between imaging specialists and nonimaging specialists would permit a cross-fertilization of knowledge, which is vital to the full understanding of chest disease and would prevent the imaging specialists from wallowing in their own misconceptions. Thus, members could delve deeply into the technical aspects of imaging with the knowledge that the nonimaging specialists would add biologic and clinical relevance.
In the 30 years of the Fleischner Society's existence, the proportion of radiologists to nonradiologists has consistently been approximately two-thirds to one-third, a proportion that maintains the imaging focus yet establishes the multidisciplinary aspect of the society that places it in a unique position to accomplish its goals. The need for an international membership also was emphasized from the onset; countries that have been represented have included the United States, the United Kingdom, Canada, France, Italy, Sweden, Switzerland, Austria, Japan, Korea, Greece, and Belgium.
From the beginning, active membership in the Fleischner Society has been by invitation only and limited to a relatively small number of individuals, generally less than 65. The limitation to the number of members was applied because of the vital discussion that it was hoped the meetings would engender: In a small group, discussion can be meaningful and free, whereas in a large group, discussion tends to be stifled. However, the society has been thoroughly aware of the need to recruit young new investigators into the membership from time to time as a buffer against senescence and sterility of ideas, a periodic rejuvenation that is made possible by natural attrition and voluntary elevation of older members to senior status. There are currently 27 members who have assumed senior status; during the 3 decades of the society's existence, 20 members have died.
As can be seen from the bylaws listed earlier, the first three objectives of the society emphasize its strong educational motive, and this has evolved into a series of postgraduate courses. The society meets for 5 or 6 days a year, during which a 3-day postgraduate symposium is offered to physicians, surgeons, radiologists, pulmonologists, and others interested in the normal chest and chest diseases. As with many other aspects of the society's operations, the programs of the postgraduate symposia developed in an evolutionary manner. From the beginning, the hallmark of all the programs has been the formal lecture during the plenary session; however, several innovative concepts have been introduced from year to year in response to critical comments by the registrants. Small group sessions in the form of refresher courses or tutorials were introduced early and have been invariably popular.
One of the memorable events during the postgraduate course is the Fleischner Lecture, which is delivered by a member who is chosen by the incoming president each year. Established in 1970 as a memorial tribute to the society's namesake, this lecture is invariably a highlight of each meeting. The first lecture, which was delivered by Leo Rigler during the Williamsburg meeting in 1971, set the standard by which all future lectures were measured.
The postgraduate symposium is usually preceded by a scientific meeting of the society, during which members present their current research. The programs have consisted of 20–25 presentations, generally of 10 minutes duration, followed by 5 or 10 minutes for discussion. By and large, the scientific meetings have been joyful occasions: Over the years, colleagues in different disciplines have become good friends and sometimes scientific collaborators, reflecting the respect for the knowledge and skill displayed by their counterparts—that is, the respect imaging specialists have for nonimaging specialists and vice versa. It has been conceded by many that although the postgraduate symposium is important in carrying out the society's educational objectives, the linchpin that holds the society together is the scientific meeting.
At its annual meeting in San Diego in 1978, the society established a memorial fellowship to honor its deceased members. Originally called the George Simon Fellowship in honor of one of the founders who had died the year before, the name was broadened more recently to the Memorial Award to include all deceased members. This award is given annually to a nonmember of the society who is 40 years of age or younger for the best scientific investigation carried out during the previous year. The recipient is invited to attend the next year's meeting to present his or her findings, with all expenses paid. Many young investigators, both imaging specialists and nonimaging specialists, have been awarded this prize over the years, and some have eventually become active members of the society.
The decision was made early in the society's deliberations to vary the location of annual meetings in both North America and abroad, a variation that would serve to attract registrants from local regions. During the 30 years from 1969 to 1999, U.S. cities have received the largest number of visits by far (19 times); Canada hosted four meetings; England, two; and Yugoslavia, Sweden, Austria, Switzerland, and Italy, one meeting each. Registration at the annual symposia has usually ranged from 300 to 400 individuals, with the lowest number (n = 120) registering in 1986 in Hawaii and the highest number (>800) registering in Italy in 1994. Whenever possible, the scientific meeting of the society has been held at a location that is different from that of the symposium, usually within a half-day journey by bus and often culturally enriching.
Our enthusiasm for the structure and function of the Fleischner Society is not meant to indicate criticism of the operations of other societies devoted to study of the chest. For example, both the American Thoracic Society and the American College of Chest Physicians are multidisciplinary and international in scope and have achieved legendary accomplishments in the fields of education and research in diseases of the chest. In essence, the major difference between the Fleischner Society and these two organizations is simply the small number of members and the focus on imaging in the former group. The Society for Thoracic Radiology, as its name implies, is an association of radiologists whose teaching and research are directed toward imaging; we believe that the postgraduate educational endeavors of this body have been received with enthusiasm over the years. We applaud the tremendous contributions to our knowledge of the normal chest and its diseases made by each of these societies.
A few predictions for the future appear to be appropriate. The challenge in the next century to those who focus on imaging as an exciting way to provide fresh insights into the pathogenesis of disease is to visualize dynamic events at the cellular or molecular level. The challenge remains to relate structure to function, only now at the microscopic rather than macroscopic level. The technical challenges will no doubt be formidable, but the driving force will still need to be clinical, that is, one that provides insights into pathophysiology and the enhancement of disease diagnosis and treatment. The near future will be affected greatly by advances in computer technology, which will result in many changes in our current imaging strategies for thoracic disease. Digital imaging techniques that are applied to radiology, such as direct digital capture, faster computed tomographic scanners, faster interactive magnetic resonance (MR) imaging units, and novel imaging-guided therapies, are very likely to be developed; some are already in progress. In addition, intelligent methods for image analysis that are designed to enhance our diagnostic and therapeutic capabilities are very likely to be implemented during the next few years. Less certain is the further development of in vivo molecular and functional imaging methods that are based on MR imaging, positron emission tomographic scanning, or novel optical imaging methods with molecule-specific contrast agents; these techniques may become a very fruitful area of fundamental imaging research. Whether these approaches can be scaled up for performance in humans is still very uncertain but worth exploring.
It is almost certain that the number of disciplines that will need to be represented in the Fleischner Society will increase in the future to reflect the ongoing state-of-the-art technologies during this time of rapid evolution. Nonetheless, it is our belief that the Fleischner Society has in its first 30 years functioned as a unique model of a small multidisciplinary association to the benefit of its members, the biomedical community and the public it serves.
References
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