Downloaded from www.ajronline.org by 117.255.246.81 on 11/03/15 from IP address 117.255.246.81. Copyright ARRS. For personal use only; all rights reserved
1321
Commentary
Europe 1992: Radiology Henri
Consequences
for European
Health
care and health
care organizations
national
affairs,
in Europe
have
but this may change
in the near future. National politics are being influenced by the unifying changes taking place within the European Economic Community (EC), or what is generally referred to as “Europe 1 992.” To what extent unification will influence health care and radiology is still uncertain but is worthy of consideration.
The European
Economic
Community
The EC was created by the Treaty of Rome in 1957 primarily as a “custom-union.” The founding member states, Belgium, West Germany, France, Italy, Luxembourg, and the
Netherlands,
were joined
the United
Kingdom.
Spain
Portugal
and
in 1974 by Denmark,
In 1 981 Greece joined,
EC to 325 million.
bringing
Ireland,
followed, the
total
and
and in 1986 citizenry
In 1983 and 1984, a number
responded
to the
concerns
of the
captains
of industry
by publishing a “white paper” by one of their commissioners, Lord Cockfield. The white paper suggested measures for achieving a single European economic market, with an absolute free exchange of persons, services, goods, and capital and with no restrictive national regulations. A schedule was
Received
January
25, 1990; accepted
after revision
June
drafted
with January
reprint
requests
AJR 155:1321-1325,
i990
0361 -803X/90/1
as the target
starting
trade
date for
within
the
member states, while maintaining national values and identifies under the structure of a European government. In the broadest terms, a united Europe will include: (1) economic integration based on stable relationships between the different currencies; (2) unification with respect to quality of life, environment, and education; and (3) maintenance of the national identities of the member states.
The Europe 1992 phenomenon is essentially economic. Leaders of the movement are guided by a determination to enhance Europe’s ability to compete with Japan and the United States. But with economic integration, a certain political integration will be necessary, and that will affect social systems in the member states.
Some
Legal
Aspects
The Court of Justice
of the European
Communities,
estab-
lished in Luxembourg, is the highest authority within the Community for interpretation of Community laws and their relationship to the national laws of the member states [1]. The Court has ruled that within each of the member states two legal systems simultaneously apply: first, the traditional system governed by the national constitution and the laws of the country and second, a separate Community system with an independent set of Community laws. The Community law
14, 1990.
to H. E. SchUtte.
December
1 , 1 993,
the European Common Market. The main goal of the EC is to facilitate
Department of Diagnostic Radiology, Erasmus University and University Hospital Rotterdam-Dijkzigt,
Address
and
of the
of leading
businessmen from European multinational corporations (e.g., Dekker from Philips, Agnelli from Fiat) expressed concern for Europe’s future competitive trade status, in particular with Japan and the United States. In 1 985, the European Commis-
1
Care
E. SchUtte1
always been exclusively
sion
Health
556-1321
© American
Roentgen
Ray Society
Dr. Molewaterpl.
40, 301 5 GD Aotterdam,
The Netheriands.
1322
SCHUTTE
can be found in the Treaty of Rome (1 957) and in the legislation issued by the Community’s law-making bodies. Community law binds both citizens and member states and
Downloaded from www.ajronline.org by 117.255.246.81 on 11/03/15 from IP address 117.255.246.81. Copyright ARRS. For personal use only; all rights reserved
is implemented
in regulations
and directives.
A regulation
binds both the member state and the individual; it should be applied by all administrative authorities and courts in the member states, and its purpose is to create uniform law
throughout
the Community.
instructions
addressed
Directives
to every
are legally
member
state,
porated within a certain time in its national the function of a directive is standardization
binding
to be incor-
legislation. of laws.
Thus,
AJR:155,
provision
that
enables
insured
persons
December
of one
member
1990
state
to receive treatment in another member state provided that such treatment has been authorized by a competent national health care authority. The costs of treatment are at the
expense
of that authority,
yet expenditures
for care
vary
greatly between the member states (Table 1). On the other hand, private health insurance is regarded as an object of trade between the member states, as a service to which the free movement/free establishment policy applies. Because
almost 40% of the Dutch population Netherlands
is an attractive
market
is privately to foreign
insured,
health
the
insurers,
not only to insurance companies from the member states, but also via takeovers of established European insurance comEffects
on Health
Free Movement
Care
panies
of Persons
States.
One of the fundamental rights that the Treaty of Rome gives to all EC citizens is freedom to pursue their professional activity Specific
from Japan,
In most member
Switzerland,
and the United
states (except for Belgium
Germany), private health insurance fered than it is in the Netherlands, 2-7% of the population.
and West
is less competitively ofbeing purchased by only
in any of the 1 2 member states of the Community. directives concerning medical specialists and general
practitioners,
nurses responsible
pharmaceutical
chemists,
issued. These directives in another
member
services without state. In January of diplomas
and
for general dentists
have
not only establish
state,
but
also
Developments
care, midwives, already
been
permit
the
rendering
of
education
came
into
grounds
of nationality,
practice,
nor in fact. As for the immigrant
restrictions restrictions
neither
in law,
force.
Any
EC
nor in administrative
professional,
all
to their activities should be abolished if such are exclusively or principally to hinder the provi-
of services
by nonnational
Health
In 1 980,
egy was
actual establishment in another member 1989, a directive on the mutual recognition
of higher
The World
of Health
Policy
Organization
the right to practice
citizen who presents a proper diploma must be admitted to the profession. The member state should treat the traveling professional and the immigrant professional the same way as they treat their own citizens, without any discrimination on
sion
by companies
EC citizens.
the European
enunciated.
version
of the “health-for-all”
Subsequently,
in 1984,
strat-
38 regional
targets were adopted by the 32 member states of the European Region of the World Health Organization (EURO), including the 1 2 EC member states. The core objective is that by the year 2000 “health for all” must be under way, and the first of the 38 outcome targets (namely, “equity in health”) must be reached. The equity-in-health strategy of the World Health Organization [4] is to reduce differences in health
status
between
countries
and between
groups
within coun-
This pan-European policy was adopted outside the political, institutional, and legal framework of the EC and therefore lacks a clear legal and constitutional basis. But it hardly lacks political support of the member states and the Community at large. tries
by 25%.
Free Trade for Pharmaceuticals
The pricing of medical products and their inclusion in the scope of national insurance systems came under regulation in 1 989. On the basis of the provision
the European to control
for free trade
Court ruled that a national
the price
of pharmaceutical
products,
entiated between domestic and imported with one of the EC articles. The Court
intended that
Country
differ-
products conflicted acknowledged that
member states have the responsibility to combat that national price-restricting measures cannot discriminate against imported medicine.
Health
of goods,
measure,
TABLE 1: Costs of Health Care per Capita in Member States the European Community in 1986 vs Canada and the United States in 1985
inflation, but be used to
Care Eligibility
The social security objectives of the EC are limited to the coordination of existing national schemes, and as such do
Ireland Spain Portugal
not affect
Greece
legislation.
social specific
the content But
security situations
the
of the individual coordination
schemes may
national
of the
will be difficult, be inequitable.
almost
social
security
incomparable
and applications One
example
in
is the
Cost (U.S. dollars)
United States Canada France Germany The Netherlands Luxembourg Belgium Denmark Italy United
1710 1362 1039 1031 984 968 826 800 764
Kingdom
Note-Data
of
711
549 486 310 245 on European Community
Cooperation and Development Evens et al. [3].
[2J. Data
from the Organization on Canada
and United
for Economic States
from
December
AJR:155,
Professional
EUROPE
1990
the Union
Europ#{234}enne des M#{233}dicinsSp#{233}cialistes
Downloaded from www.ajronline.org by 117.255.246.81 on 11/03/15 from IP address 117.255.246.81. Copyright ARRS. For personal use only; all rights reserved
(UEMS) was founded as a private union of European specialists to defend the title of medical specialist
medical and the
specialist’s role in health care, to promote the quality of that care, to promote cooperation between national professional
organizations and solidarity between specialists, to promote the free exchange of medical specialists, and to defend their moral
and medical
interests.
EC in 1957, the UEMS Standing
Committee
1323
The AER, founded
Organizations
In 1956,
1992
With
became
the establishment
of the
an EC organization
and a
of Physicians,
the Comit#{233}Permanente
was established, in which all physicians of the EC member states are represented together with associate members from nonmember states as observers. The Comit#{233}Permanente is concerned with (1) promotion of the highest standard of medical training, practice, and health care within the EC; (2) promotion of free movement of medical specialists in the EC;
and (3) representation ofthe medical profession authorities of the EC.
to nonmedical
specialty
is recognized
represented in two thirds of the specialty that has been recognized
specialist
by the UEMS when it is 1 2 member
states.
Each
is represented in a monoof the UEMS, which studies the problems
section
raised by the Treaty of Rome qualifications, and the practice
date, 27 specialties
concerning definition, training of that particular specialty. To
have been recognized.
This achievement
should not be underestimated. In Italy, for instance, 148 medical specialties are proclaimed, which requires the UEMS to group these numerous subspecialties into fewer more broadly accepted categories.
Despite recognition of specialties, the basic curriculum of each has not yet been established. This has led to a commission
within
the
standardization
UEMS,
the
of training
main
function
programs
of which
is the
and determination
of
what good training programs should encompass. The EC also has been interested in medical training. A directive has created the Advisory Committee of Medical Training, an official body with equal representation from the responsible authority, the medical faculties, and the professional organization of each member state. The goal of this committee is to promote an
equal, high level of training and qualifications in the member states. Recently questionnaires were sent to organizations dealing with training programs in the member mine the status of these programs.
Consequences
states
to deter-
for Radiology
Professional organizations such as the European tion of Organizations for Medical Physics (EFOMP) European
Association
of
Radiology
(AER)
will
Federaand the
undoubtedly
attract the attention of the EC. The EFOMP, formed in 1 980, has surveyed the status of quality assurance among the 23 member countries in Europe
and informed 1988.
repre-
establishing and maintaining the highest educational standards. The unification of Europe undoubtedly has stimulated the AER to more activity. It organizes and sponsors
European
congresses
Society
and, with support
of North America
from the Radiological
and the European
try, now plans congresses instead of every 4 years,
on a permanent as in the past.
radiologic
indus-
site every 2 years, In 1 991 and 1993,
congresses will be held in Vienna, and to commemorate the 100th anniversary of Roentgen’s discovery, Berlin has been chosen as the site for 1995.
EC Directive
on Radiation
Protection
The (84/466/Euratom)directive [5] compelling the EC member states to establish fundamental measures for the protection of persons exposed to radiation for diagnostic or thera-
reasons
will have a direct
impact
in the near future.
The directive was issued in 1 984 along with some guidelines on how to improve radiation protection. Since then, each
of Specialties
A medical
federation
with
peutic Recognition
in 1 963, is an elected
senting all 28 radiology societies in Europe, including those in the 1 2 EC member states. The AER is especially concerned
the EC Commission
accordingly
in October
member state is adjusting its own directives. The EC directive addressed the following issues: (1) medical justification-the exposure of any person to ionizing radiation should be medically
justified
and
the
radiation
dose
should
subsequently
decrease to “as-low-as-reasonably-achievable” levels; (2) standards of qualification for persons who use radiation in health care; (3) protocols for quality assurance for radiographic
equipment;
radiographic physicist medicine.
(4) reduction
equipment;
when
equipment
European
Journals
Journal
publication
of the number
(5) availability
is used in radiotherapy
has not been directly
EC, but some international
of pieces
ofa competent
cooperation
of
medical
and nuclear
addressed
by the
may be desirable.
In
many European academic faculties, the journals in which publications appear and the number of citations these publications have received are used to measure the value of
research. Journals are rated by their “impact factor” [6]. As a consequence of emphasis on publication in high-impact journals, it is time to start working on one core European radiologic journal. There is no dominant large-circulation European journal (Table 2). Since 1987, the official journal of the Dutch Society has been the Journal of Medical Imaging. Stimulated by the Eu-
rope 1992 idea, I began, in my capacity
as chief editor of that
journal,
calling
of other
European
journals
explore
the opportunities
for possible
mergers.
Some
from
the letter
on the editors I received
from
Terry
Patton,
who
to
lines
is associated
with the British Journal of Radiology, reflect some nationalistic hesitancy. “In theory, I am sure that Europe could produce at
least one journal
comparable
to Radiology
or AJR and that
we (Europeans) are losing out because we are all trying to ‘go it alone.’ There are also people in U.K. who think that it is anomalous that we (UK) produce two journals (BJR and Clin
SCHUTTE
1324
TABLE
2: European
Radiology
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December
1990
Journals
Journal Acta Radiologica
AJR:155,
(founded
Society/
No. of
Affiliation
Members
Nordic
countries
British
Institute
No. of Full-
Cost
Subscriptions
2500
1500
1 800
3000
3300
1700
Belgian Society
900
1321
Commentary
Europe 1992: Radiology Henri
Consequences
for European
Health
care and health
care organizations
national
affairs,
in Europe
have
but this may change
in the near future. National politics are being influenced by the unifying changes taking place within the European Economic Community (EC), or what is generally referred to as “Europe 1 992.” To what extent unification will influence health care and radiology is still uncertain but is worthy of consideration.
The European
Economic
Community
The EC was created by the Treaty of Rome in 1957 primarily as a “custom-union.” The founding member states, Belgium, West Germany, France, Italy, Luxembourg, and the
Netherlands,
were joined
the United
Kingdom.
Spain
Portugal
and
in 1974 by Denmark,
In 1 981 Greece joined,
EC to 325 million.
bringing
Ireland,
followed, the
total
and
and in 1986 citizenry
In 1983 and 1984, a number
responded
to the
concerns
of the
captains
of industry
by publishing a “white paper” by one of their commissioners, Lord Cockfield. The white paper suggested measures for achieving a single European economic market, with an absolute free exchange of persons, services, goods, and capital and with no restrictive national regulations. A schedule was
Received
January
25, 1990; accepted
after revision
June
drafted
with January
reprint
requests
AJR 155:1321-1325,
i990
0361 -803X/90/1
as the target
starting
trade
date for
within
the
member states, while maintaining national values and identifies under the structure of a European government. In the broadest terms, a united Europe will include: (1) economic integration based on stable relationships between the different currencies; (2) unification with respect to quality of life, environment, and education; and (3) maintenance of the national identities of the member states.
The Europe 1992 phenomenon is essentially economic. Leaders of the movement are guided by a determination to enhance Europe’s ability to compete with Japan and the United States. But with economic integration, a certain political integration will be necessary, and that will affect social systems in the member states.
Some
Legal
Aspects
The Court of Justice
of the European
Communities,
estab-
lished in Luxembourg, is the highest authority within the Community for interpretation of Community laws and their relationship to the national laws of the member states [1]. The Court has ruled that within each of the member states two legal systems simultaneously apply: first, the traditional system governed by the national constitution and the laws of the country and second, a separate Community system with an independent set of Community laws. The Community law
14, 1990.
to H. E. SchUtte.
December
1 , 1 993,
the European Common Market. The main goal of the EC is to facilitate
Department of Diagnostic Radiology, Erasmus University and University Hospital Rotterdam-Dijkzigt,
Address
and
of the
of leading
businessmen from European multinational corporations (e.g., Dekker from Philips, Agnelli from Fiat) expressed concern for Europe’s future competitive trade status, in particular with Japan and the United States. In 1 985, the European Commis-
1
Care
E. SchUtte1
always been exclusively
sion
Health
556-1321
© American
Roentgen
Ray Society
Dr. Molewaterpl.
40, 301 5 GD Aotterdam,
The Netheriands.
1322
SCHUTTE
can be found in the Treaty of Rome (1 957) and in the legislation issued by the Community’s law-making bodies. Community law binds both citizens and member states and
Downloaded from www.ajronline.org by 117.255.246.81 on 11/03/15 from IP address 117.255.246.81. Copyright ARRS. For personal use only; all rights reserved
is implemented
in regulations
and directives.
A regulation
binds both the member state and the individual; it should be applied by all administrative authorities and courts in the member states, and its purpose is to create uniform law
throughout
the Community.
instructions
addressed
Directives
to every
are legally
member
state,
porated within a certain time in its national the function of a directive is standardization
binding
to be incor-
legislation. of laws.
Thus,
AJR:155,
provision
that
enables
insured
persons
December
of one
member
1990
state
to receive treatment in another member state provided that such treatment has been authorized by a competent national health care authority. The costs of treatment are at the
expense
of that authority,
yet expenditures
for care
vary
greatly between the member states (Table 1). On the other hand, private health insurance is regarded as an object of trade between the member states, as a service to which the free movement/free establishment policy applies. Because
almost 40% of the Dutch population Netherlands
is an attractive
market
is privately to foreign
insured,
health
the
insurers,
not only to insurance companies from the member states, but also via takeovers of established European insurance comEffects
on Health
Free Movement
Care
panies
of Persons
States.
One of the fundamental rights that the Treaty of Rome gives to all EC citizens is freedom to pursue their professional activity Specific
from Japan,
In most member
Switzerland,
and the United
states (except for Belgium
Germany), private health insurance fered than it is in the Netherlands, 2-7% of the population.
and West
is less competitively ofbeing purchased by only
in any of the 1 2 member states of the Community. directives concerning medical specialists and general
practitioners,
nurses responsible
pharmaceutical
chemists,
issued. These directives in another
member
services without state. In January of diplomas
and
for general dentists
have
not only establish
state,
but
also
Developments
care, midwives, already
been
permit
the
rendering
of
education
came
into
grounds
of nationality,
practice,
nor in fact. As for the immigrant
restrictions restrictions
neither
in law,
force.
Any
EC
nor in administrative
professional,
all
to their activities should be abolished if such are exclusively or principally to hinder the provi-
of services
by nonnational
Health
In 1 980,
egy was
actual establishment in another member 1989, a directive on the mutual recognition
of higher
The World
of Health
Policy
Organization
the right to practice
citizen who presents a proper diploma must be admitted to the profession. The member state should treat the traveling professional and the immigrant professional the same way as they treat their own citizens, without any discrimination on
sion
by companies
EC citizens.
the European
enunciated.
version
of the “health-for-all”
Subsequently,
in 1984,
strat-
38 regional
targets were adopted by the 32 member states of the European Region of the World Health Organization (EURO), including the 1 2 EC member states. The core objective is that by the year 2000 “health for all” must be under way, and the first of the 38 outcome targets (namely, “equity in health”) must be reached. The equity-in-health strategy of the World Health Organization [4] is to reduce differences in health
status
between
countries
and between
groups
within coun-
This pan-European policy was adopted outside the political, institutional, and legal framework of the EC and therefore lacks a clear legal and constitutional basis. But it hardly lacks political support of the member states and the Community at large. tries
by 25%.
Free Trade for Pharmaceuticals
The pricing of medical products and their inclusion in the scope of national insurance systems came under regulation in 1 989. On the basis of the provision
the European to control
for free trade
Court ruled that a national
the price
of pharmaceutical
products,
entiated between domestic and imported with one of the EC articles. The Court
intended that
Country
differ-
products conflicted acknowledged that
member states have the responsibility to combat that national price-restricting measures cannot discriminate against imported medicine.
Health
of goods,
measure,
TABLE 1: Costs of Health Care per Capita in Member States the European Community in 1986 vs Canada and the United States in 1985
inflation, but be used to
Care Eligibility
The social security objectives of the EC are limited to the coordination of existing national schemes, and as such do
Ireland Spain Portugal
not affect
Greece
legislation.
social specific
the content But
security situations
the
of the individual coordination
schemes may
national
of the
will be difficult, be inequitable.
almost
social
security
incomparable
and applications One
example
in
is the
Cost (U.S. dollars)
United States Canada France Germany The Netherlands Luxembourg Belgium Denmark Italy United
1710 1362 1039 1031 984 968 826 800 764
Kingdom
Note-Data
of
711
549 486 310 245 on European Community
Cooperation and Development Evens et al. [3].
[2J. Data
from the Organization on Canada
and United
for Economic States
from
December
AJR:155,
Professional
EUROPE
1990
the Union
Europ#{234}enne des M#{233}dicinsSp#{233}cialistes
Downloaded from www.ajronline.org by 117.255.246.81 on 11/03/15 from IP address 117.255.246.81. Copyright ARRS. For personal use only; all rights reserved
(UEMS) was founded as a private union of European specialists to defend the title of medical specialist
medical and the
specialist’s role in health care, to promote the quality of that care, to promote cooperation between national professional
organizations and solidarity between specialists, to promote the free exchange of medical specialists, and to defend their moral
and medical
interests.
EC in 1957, the UEMS Standing
Committee
1323
The AER, founded
Organizations
In 1956,
1992
With
became
the establishment
of the
an EC organization
and a
of Physicians,
the Comit#{233}Permanente
was established, in which all physicians of the EC member states are represented together with associate members from nonmember states as observers. The Comit#{233}Permanente is concerned with (1) promotion of the highest standard of medical training, practice, and health care within the EC; (2) promotion of free movement of medical specialists in the EC;
and (3) representation ofthe medical profession authorities of the EC.
to nonmedical
specialty
is recognized
represented in two thirds of the specialty that has been recognized
specialist
by the UEMS when it is 1 2 member
states.
Each
is represented in a monoof the UEMS, which studies the problems
section
raised by the Treaty of Rome qualifications, and the practice
date, 27 specialties
concerning definition, training of that particular specialty. To
have been recognized.
This achievement
should not be underestimated. In Italy, for instance, 148 medical specialties are proclaimed, which requires the UEMS to group these numerous subspecialties into fewer more broadly accepted categories.
Despite recognition of specialties, the basic curriculum of each has not yet been established. This has led to a commission
within
the
standardization
UEMS,
the
of training
main
function
programs
of which
is the
and determination
of
what good training programs should encompass. The EC also has been interested in medical training. A directive has created the Advisory Committee of Medical Training, an official body with equal representation from the responsible authority, the medical faculties, and the professional organization of each member state. The goal of this committee is to promote an
equal, high level of training and qualifications in the member states. Recently questionnaires were sent to organizations dealing with training programs in the member mine the status of these programs.
Consequences
states
to deter-
for Radiology
Professional organizations such as the European tion of Organizations for Medical Physics (EFOMP) European
Association
of
Radiology
(AER)
will
Federaand the
undoubtedly
attract the attention of the EC. The EFOMP, formed in 1 980, has surveyed the status of quality assurance among the 23 member countries in Europe
and informed 1988.
repre-
establishing and maintaining the highest educational standards. The unification of Europe undoubtedly has stimulated the AER to more activity. It organizes and sponsors
European
congresses
Society
and, with support
of North America
from the Radiological
and the European
try, now plans congresses instead of every 4 years,
on a permanent as in the past.
radiologic
indus-
site every 2 years, In 1 991 and 1993,
congresses will be held in Vienna, and to commemorate the 100th anniversary of Roentgen’s discovery, Berlin has been chosen as the site for 1995.
EC Directive
on Radiation
Protection
The (84/466/Euratom)directive [5] compelling the EC member states to establish fundamental measures for the protection of persons exposed to radiation for diagnostic or thera-
reasons
will have a direct
impact
in the near future.
The directive was issued in 1 984 along with some guidelines on how to improve radiation protection. Since then, each
of Specialties
A medical
federation
with
peutic Recognition
in 1 963, is an elected
senting all 28 radiology societies in Europe, including those in the 1 2 EC member states. The AER is especially concerned
the EC Commission
accordingly
in October
member state is adjusting its own directives. The EC directive addressed the following issues: (1) medical justification-the exposure of any person to ionizing radiation should be medically
justified
and
the
radiation
dose
should
subsequently
decrease to “as-low-as-reasonably-achievable” levels; (2) standards of qualification for persons who use radiation in health care; (3) protocols for quality assurance for radiographic
equipment;
radiographic physicist medicine.
(4) reduction
equipment;
when
equipment
European
Journals
Journal
publication
of the number
(5) availability
is used in radiotherapy
has not been directly
EC, but some international
of pieces
ofa competent
cooperation
of
medical
and nuclear
addressed
by the
may be desirable.
In
many European academic faculties, the journals in which publications appear and the number of citations these publications have received are used to measure the value of
research. Journals are rated by their “impact factor” [6]. As a consequence of emphasis on publication in high-impact journals, it is time to start working on one core European radiologic journal. There is no dominant large-circulation European journal (Table 2). Since 1987, the official journal of the Dutch Society has been the Journal of Medical Imaging. Stimulated by the Eu-
rope 1992 idea, I began, in my capacity
as chief editor of that
journal,
calling
of other
European
journals
explore
the opportunities
for possible
mergers.
Some
from
the letter
on the editors I received
from
Terry
Patton,
who
to
lines
is associated
with the British Journal of Radiology, reflect some nationalistic hesitancy. “In theory, I am sure that Europe could produce at
least one journal
comparable
to Radiology
or AJR and that
we (Europeans) are losing out because we are all trying to ‘go it alone.’ There are also people in U.K. who think that it is anomalous that we (UK) produce two journals (BJR and Clin
SCHUTTE
1324
TABLE
2: European
Radiology
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December
1990
Journals
Journal Acta Radiologica
AJR:155,
(founded
Society/
No. of
Affiliation
Members
Nordic
countries
British
Institute
No. of Full-
Cost
Subscriptions
2500
1500
1 800
3000
3300
1700
Belgian Society
900
