RANZCR: New Chair of the College’s Clinical Radiology Research Committee

The Royal Australian and New Zealand College of Radiologists (RANZCR) Inside News September 2020

Professor Paul Parizel

Professor Paul Parizel was appointed as the inaugural David Hartley Chair in Radiology, based at Royal Perth Hospital (RPH), in September 2019. The chair was established by the University of Western Australia to improve clinical governance, education and research, and to develop closer ties within the medical professions and also with the wider community of WA. Born and raised in the historic city of Antwerp, Belgium, he completed his medical school education at the University of Antwerp before working at the Antwerp University Hospital and undertaking Fellowships at centres of international renown including at Massachusetts General Hospital and Harvard Medical School.

In February, Prof Parizel was appointed as Chair of the College’s Clinical Radiology Research Committee (CRRC).

When did you move to Australia and why?

I arrived in Perth, WA on Sunday 22 September 2019, which happened to be my birthday. I had signed my contract more than a year earlier, but it took a very long time to get all the red tape sorted out. In fact, there were times that I was not even sure if I would ever succeed in getting all the documents together.

My reasons for coming to Australia were manifold. For more than 30 years, I have been friends with Professor Mark Khangure, and thanks to him, I’ve had the occasion to visit Perth several times, and always was impressed by the high professional and ethical standards of radiology in Australia.

In 2002, during the Annual Scientific Meeting, held in Adelaide, I became an Honorary Fellow of the College and served as Kodak visiting professor. Somewhere, in the back of my mind, I had always been thinking how nice it would be to work in Australia and share my professional experience with younger colleagues. There is a famous quote by Ralph Waldo Emerson that states that “life is a journey, not a destination”. To travel successfully on the journey of Life, one needs an ambitious plan, a steady compass, and—importantly—the ability to avoid the doldrums and make good use of the prevailing winds.

In Europe, I finished my terms as President (2017) and Chairman of the Board (2018) of the European Society of Radiology (ESR), and as President of the European Congress of Radiology meeting in Vienna in 2017. It seemed like a perfect moment to consider a new professional and personal challenge. And what better place to do so than in Perth, Western Australia, one of the nicest cities on the face of this earth?

How does your experience of radiology in Australia compare to your experience in Belgium?

First of all, I would like to say that I am grateful for the opportunity to share some of my thoughts and visions with the readers of Inside News.

There is an expression in French that says ‘plus ça change, plus c’est la même chose’ (the more things change, the more they stay the same). In a way this holds true for working as a radiologist in Australia. Compared to Belgium, there are many similarities in the work we do, and in the organisation and structure of radiology departments. The technical platform at RPH is very similar to what I had in my department at Antwerp University Hospital. The patient population in a tertiary referral centre is very diverse, interesting, and, at times, challenging. RPH is unique in that we see many patients referred through the State Major Trauma Unit and the State Spinal and Scoliosis Service. However, a similarity between Australia and Belgian is the juxtaposition of a public health system and a private system, both with their specific and individual roles.

Of course, there are also some differences in the type of examinations and protocols we perform, but overall I would say that the similarities are far, far greater than the differences.

What are your areas of interest within radiology?

I trained as a neuroradiologist and have always been interested in imaging of the brain and spine in a variety of disease conditions. In the last 10 years, my main areas of interest have been imaging in traumatic brain injury patients and the implementation of quantitative imaging and artificial intelligence techniques within our field. However, as chair of the Department of Radiology at Antwerp University Hospital, and as supervisor of many PhD and Master students, I always considered that it was my duty to keep abreast of developments in other areas of radiology as well. Our discipline has undergone such an amazing transformation in the past couple of decades. Radiology, or imaging in the broadest sense of the term, has become the crossroads in any modern hospital.

What motivated you to get involved with the College?

As stated previously, I fondly remember the 2002 ASM in Adelaide, and I remember being very much impressed by the traditions and solid organisation of the College. During my years as a member of the board of directors of the ESR, I have had several meetings with College representatives, in particular with the College's President, Dr Lance Lawler.

I strongly believe that for a medical practitioner, engagement with their professional organisation is important, both for individual professional development and growth, and perhaps even more importantly, to engage in the training of junior radiologists. It is our responsibility to ensure that the next generation of radiologists has a future that will be just as exciting and productive as the professional career that my generation has had until now.

Human interaction between professionals is the force that enables the transfer of knowledge, and the development of scientific collaboration, and the College is an essential catalyst to drive these processes.

Why is research so important to the specialty?

Radiology, or medical imaging in the broader sense, has become a very broad, horizontally integrated field, cross-linking with many, if not most other specialties in medicine. This is a great strength and offers wonderful opportunities for research. Conversely, the time is long gone that imaging could be considered the exclusive domain of radiology. Many of our clinical colleagues have discovered the potential of performing imaging-driven research and have learnt to explore the potential for using quantitative imaging biomarkers.

We as radiologists are by no means any longer the sole custodians of imaging equipment or even of image analysis software. It is therefore of paramount importance to teach (junior) radiologists how to conduct research, how to best interface with clinicians, and how to use software applications to extract information from the big data sets, which are the constituent parts of all cross-sectional imaging techniques.

We must provide radiology excellence to the next generation, which can best be done through fostering research.

What is your vision for the CRRC and research at the College?

With the CRRC, the College has an instrument to develop and steer the present and future course of our discipline. In my view, our plan should be to stimulate and foster excellence in research, and to enable the intellectual awakening of radiologists, by offering support and encouragement. But, our CRRC should be much more than just an instrument to select the best presentations and publications, or to award prizes and Fellowships.

In my view, research is an essential component in the delivery of excellent patient-centred health care. Radiology is moving along a trajectory from an ‘art’ to a ‘science’, from producing ‘pretty images’ to quantitative data sets.

Our communication with clinicians is moving away from descriptive reports in flowery prose, towards standardised, structured reporting. These developments will force radiologists to transmogrify their ‘analogue’ minds to the requirements of a digital, quantitative and researchdriven working environment.

These changes are also reflected in the spectrum of what we do as radiologists: the focus has shifted away from performing brilliant feats of diagnostic wizardry to the more mundane tasks of accurately staging and following up patients with known diseases.

Thanks to advancements in medicine, some previously fatal diseases have been reduced to chronic conditions. The growth of precision medicine is likely to become a key issue in how we perform and interpret imaging studies. Radiology plays a much more important role in the diagnosis, follow-up and outcome prediction of patients with chronic disorders (all kinds of cancer, degenerative disorders, inflammatory diseases) by developing biomarkers based on volumetric measurements, perfusion studies (blood flow), spectroscopy (metabolic information), hybrid imaging (molecular information) and functional studies.

The future of medicine is researchdriven, and the engagement of radiologists will help us to grow, as individuals and as doctors. Ideally, through the CRRC, we can help to create and develop a culture so that radiologists can be a part of, or even take the lead in, imaging-driven research studies.

Importantly, through research, we can attract the best and brightest young minds to our discipline, and offer them perspectives in academic and professional development.

We need to encourage an environment of innovation and improve the breadth and scope in the delivery of radiology services. This is essential to the future growth and success of radiology in the care for our patients.