The growing awareness of the necessity to justify the costs of radiology brought together an international group of radiologists under the guidance of Dr. Alexander Margulis of the University of California San Francisco. The first meeting of this world wide working group on cost effectiveness in imaging was held in Oxford, United Kingdom in April 1994. Members of the group from the United States, Belgium, United Kingdom, Germany, Sweden, Japan and Italy offered their colleagues an insight into the respective national healthcare systems including reimbursements strategies. The group strongly favored the idea of an organized forum to discuss these issues and agreed upon immediately beginning preparation of a symposium to be held in Oxford in August of the following year. It was decided to provide a special format of the meeting with a restricted number of participants from all areas of our profession as well as politicians and industry representatives. While proceedings of the meetings were to be published, an executive summary was to be sent to each National Society and respective government agency. The program would have to touch on important issues facing the field of international differences in technology assessment and outcomes, discussion of latest research developments, communication with politicians and governments, future perspectives and developments in clinical and research areas, an inclusion of quality of life factors and ethical considerations.

The ‘First International Symposium on Costs and Benefits of Radiology’ was held in August 1995, again in Oxford, United Kingdom. The meeting organizers were Stephen Golding of Oxford University and Alex Margulis of the UCSF. The great success of this first meeting reinforced the organizers and the initial founders in their basic idea of the need for such a forum. Therefore, a second meeting titled ‘Second Oxford International Symposium on the Cost and Benefits of Radiology’ was held in San Francisco in August 1997. The organizing committee decided that the request for a third symposium was justified.
Prior to the third international symposium to be held in August 1999 in Berlin, Germany it became obvious that there was a need to incorporate the work of the participants into a more formal structure of a society. The meeting in Berlin represented the launching of the new ‘International Society for Strategic Studies in Radiology’ (IS³R). Statutes were established based on propositions made by the local organizer Karl-Jürgen Wolf in cooperation with Christian Herold and Peter Baierl from Vienna. It was decided that Vienna, Austria, would be the seat of the society’s office and the ECR office was asked to assist. The Austrian authorities confirmed the founding of the society in November 1999 and the constituent general assembly took place on March 7, 2000 in Vienna. An Executive Committee was elected. Hans Ringertz from Sweden became the first president of IS³R. He was succeeded by the second president of the society Dr. Gary Glazer from Stanford, California in 2003. The present officers of the society are Gary Glazer, President, Hans Ringertz, Past President, Alex Margulis, Honorary President, Guy Frija, President-Elect, Ronald Arenson, Vice President, James Thrall, Treasurer and Christian Herold, Secretary. The Executive Board consists of a number of additional members: Stephen Golding (UK), Hedvig Hricak (USA), Gabriel Krestin (NL), Alex Margulis (USA), Maximillian Reiser (D), Lenny Tan (SIN) and Gustav K. von Schulthess (CH). The society presently has 59 active members from 16 countries, 25 members are residents of European Countries, 15 originate from the United States and 6 members are from Asia. The society has strong relations with industrial partners who actively participate in the discussion forum. In 2003, corporate memberships were established with most of the active industrial partners.

Brief summary of past meetings

The first international symposium on the cost and benefits of radiology which was held in August 1995 at Saint Johns College Oxford University, United Kingdom, was organized by Stephen Golding of Oxford and Alex Margulis of the University of California, San Francisco. This first meeting was attended by the 86 delegates of whom 55 belonged to the medical field. 53 acted as speakers and 31 were industrial representatives, approximately 50 papers were submitted by the speakers and published as a supplement to Academic Radiology in April 1996 (volume 3, supplement 1). The meeting opened new horizons on the costs and benefits of radiology which was recognized by all participants. At the conclusion of the meeting, the organizing group decided to embark on the preparation of the next meeting.

The ‘Second Oxford International Symposium on the Cost and Benefits of Radiology’ was held at the Mark Hopkins Intercontinental Hotel in San Francisco in August 1997. The idea to accept invited speakers from the fields of medicine and industry as well as from government was discussed and revived. Ronald Arenson and Alex Margulis, both of the University of California, San Francisco, acted as organizers of the scientific program for the meeting. Tym Peters and Rene Sauers of the Department of Radiology at UCSF were asked to coordinate the meetings’ administration, logistics and finances. The main items on the program were the rational for assessing costs and benefits, methodological issues, the worldview of governments’ health insurance and industry as well as world wide cost and benefit initiatives. Compared to the previous meeting, the scientific level of the papers improved considerably and the number of participants rose to 109. The need for scientific work and research in the field of cost-effectiveness was clearly demonstrated. The proceedings from the symposium were again published as a supplement to Academic Radiology in September 1998 (volume 5, supplement 2). The organizing committee met at the end of the meeting and decided that the request for a third symposium was justified.

The ‘Third Oxford International Symposium’ was held at the Hotel Intercontinental in Berlin, Germany in August 1999. Karl-Jürgen Wolf of the Free University in Berlin and Alex Margulis of UCSF were invited to organize the meeting. The meeting in Berlin benefited again from the previous experiences in Oxford and San Francisco. The scientific topics covered definitions, approaches, tools and applications on cost-effectiveness, government policies on health management, principles of reimbursement, the question of how industry copes with price versus quality, as well as the costs of research and education. Eighty-seven speakers and participants from around the world followed the invitation and enjoyed the meeting. The excellence in research and presentations followed always by highly interesting discussions, particularly those involving industrial representatives gave the meeting a special flavor. The proceedings of the Berlin meeting were published in a supplement to European Radiology in 2000 (volume 10, supplement 3).

The first meeting of the newly established IS³R took place in August 2001 in San Francisco. The organizers Ronald Arenson of UCSF and Gary Glazer of Stanford California entitled the meeting ‘Radiology Entering the New Millennium’. The symposium developed more and more towards a real discussion forum for present and future strategies in our profession Strategic aims of international radiology, updated and future directions of technology development of imaging modalities, and new emerging research areas were extensively discussed with the participants. Special attention was given to the creation of the National Institute of Biomedical Imaging and Bioengineering (NIBIB) of the NIH and an extensive discussion on governmental regulations was incorporated into the meeting program. Participants tackled also daily problems related to management, computer applications, while industry panels from manufacturing and pharmaceutical companies completed the spectrum of conversations. This format proved to be highly attractive to all participants and led to an extremely fruitful exchange of ideas.

The fifth international symposium and second meeting of IS³R took place in August 2003 in Chantilly, by Paris under the organization of Guy Frija of the University of Paris. The meeting was titled ‘Creating Strategies for the Next Decade’. The symposium focused on strategic professional questions dealing with professional demography, turf issues, imaging equipment dissemination and innovation, and evidence-based radiology. An extensive part of the meeting was dedicated to the impact of research on radiology organization. The newly appointed director of NIH, and former member of the Executive Committee of IS³R, Elias Zerhouni, delivered a keynote lecture focusing on major trends in biomedical research. Participants discussed changes in the regulation process of approval of new technologies and drugs. Translation of molecular imaging into practice was the focus of extensive discussions among leading researchers and the audience. The final day was dedicated to communication policies. Discussions between industrial partners and professionals focused on the role of radiological and technical exhibits and meetings as well as on policy of public information.