Neuroimaging in European academic neurology: present status and future organization

Thanks to an ever increasing array of sophisticated techniques, neuroimaging has become an integral part of clinical neurology and a major tool in the neurosciences. Because, undoubtedly, the role of neuroimaging will grow even further, a Task‐force on Neuroimaging was created by the EFNS in June 1996 to assess how academic neurology in Europe should adapt to such rapid changes. The present report summarizes the conclusions reached by this task‐force. After a brief survey of the current optimal use and potential developments of neuroimaging in academic neurology, a set of recommendations and guidelines are proposed, which can be summarized as follows: The future place of neuroimaging in neurology departments: because neuroimaging has become an integral part of clinical neurology and neurosciences and is increasingly based on neurophysiological knowledge, it must be better incorporated within clinical neurology departments than it is at the present time. Although rare examples exist where large neuroimaging equipments belong to clinical neurology departments—in analogy to the situation that prevails for cardiology—this situation (which some might view as an “ideal case”) raises regulatory issues that are likely to get further enforced with European integration. A more realistic model is the large “neuro” department merging neurology, neurosurgery, clinical neurophysiology, neuroradiology, nuclear neurology and neurorehabilitation, according to which the equipment would be purchased and run on a service basis. This arrangement would imply not only huge savings, but also optimized patient case, better training, and improved opportunities for research. The role of the neurologist in the implementation and interpretation of neuroimaging procedures in relation to the other traditional medical disciplines: this is a complex issue because of differences in regulations among the different European countries and across the distinct neuroimaging techniques. Based on the situation that prevails in some European countries and in the US, the following recommendations are proposed as a generalized system to better incorporate neuroimaging within academic neurology: (i) that Neuroradiology, as an independent medical specialty dealing mainly with structural imaging, includes at least one, and preferably two, years of clinical neurology in its training; (ii) that a new medical (sub) specialty in “functional neuroimaging” (not including diagnostic structural imaging) be created, entailing either a full training in clinical neurology with additional training in functional neuroimaging, or perhaps more realistically, a less extensive neurology training allowing only some kind of partial clinical practice; and (iii) a system of “credentials”, according to which any certified neurologist could obtain additional certifications in specific neuroimaging techniques, including interventional neuroradiology, following proper (and accredited) training. The training in neuroimaging of future neurologists: to incorporate as soon as possible neuroimaging as part of the training in neurology, Chairs of Neuroimaging, must be created within academic neurology. The role of neuroimaging in post‐graduate education, professional meetings and neurological research urgently needs to be enlarged, especially within the framework of European neurology congresses.