Jehad Al Watban
King Faisal Specialist Hospital and Research Center

The development of neuroradiology as a sub-specialty cannot be separated from the magnitude of development, which has occurred in Saudi Arabia within the past 30 years. There was tremendous development in all directions in an attempt to catch up with the most advanced institutes in the world beyond the dreams and the imagination of a third world country. In the beginning, when thousands of expatriate medical personnel were working in the Kingdom of Saudi Arabia, providing the best health care and aid, there were also hundreds of young Saudi doctors who were sent abroad to North America and Europe within the framework of training programs in order to specialize in various medical fields after graduation from medical school. As a result, from that time on, we witnessed the return of these highly trained and sub-specialized Saudi doctors in all areas of medicine including radiology.

As elsewhere in the world, the newly graduated medical students in general overlooked the challenge and importance of radiology for a period of time, partly because little attention was given in the Medical School to training in radiology. Only a few students had the vision early in their career regarding the rapidly increasing value of radiology in the process of disease management. For them radiology was a sub-specialty worthy of attention and they pursued their carriers in that direction. The structure of the training programs in the Kingdom and the requirements to be fulfilled by the trainees who were sent abroad to many developed countries were difficult and very demanding, yet highly set up to ensure the best quality of graduates.

Neuroradiology, because of the early migration of pioneers in neurology and neurosurgery into the Kingdom, gained attention in the training of radiology as a reflection of the development of neurosciences. For the first neuroradiol-ogists, the task was arduous. They had to change the whole concept of neuroimaging from looking at x-ray films by any physician involved in patient care to exploring more and more advanced and sophisticated imaging modalities, there-by exploiting their'full diagnostic potential and providing expert sub-specialty consultation. As time went on, it was clear - as elsewhere in the world - that diagnostic and interventional neuroradiology were standing giant in front of the other sub-specialties providing them with increasing support and appropriate information in the daily diagnostic and therapeutic decision-making process.
Neuroradiology in the Kingdom of Saudi Arabia established itself an

thrived through stimulating close collaboration with the other related medical communities, such as neurologists, neurosurgeons, ENT physicians, oncologists, ophthalmologists, pediatricians etc. Another rather distinctive particularity of neuroradiology in the Kingdom has been the excellent cooperation and mutual respect between native Saudi and expatriate neuroradiolo-gists joining forces with the common goal and mission to provide the best possible health care to the people of Saudi Arabia.

The gift of God to this country, the wealth and the wisdom of its leaders cannot be overlooked. Early in the development of Saudi Arabia, a tremendous amount of money was spent on the training of Saudi physicians in all sub-specialties and parallel to establishing hospitals with high quality health care using the best equipment available in other countries. Therefore, radiologists and medical trainees were exposed to the most sophisticated diagnostic radiology equipment early in their training. They became familiar with it even before they traveled to more developed countries to join qualified training programs. Expensive new MRI systems were already available in the Kingdom in the late 1980's, when many medical centers in North America still did not have them. The end result was fast path to sophisticated new developments by Saudi doctors to establish strong and highly qualified health care services in the region.

In the late seventies, there was an establishment - as part of the pioneering vision - of multiple health care insti-tutes addressing tertiary care needs in all aspects. The birth of many institutes like King Faisal Specialist Hospital and Research Centre, the Military Hospitals and the National Guard and University Hospitals took place. It was clear that expatriates had to be relied upon to build services due to the lack of sub-specialized native Saudi doctors. This was a decision that helped significantly to import knowledge and expertise in various aspects. Pioneers, such as Dr. Hassan Sharif, a prominent neuroradiologist who served as the Chairman of Radiology at the Military Hospital for many years, captured the vision of neuroradiology as a sub-specialty of immense potential growth and develop-ment. Through his dedicated hard work, he managed to ensure that appropriate diagnostic equipment, such as CT, MRI and angiography became available to promote the idea of neuroradiology, which encouraged young Saudi doctors to pursue their career path in this specialty. Others, such as the late Dr. Mohamed Al Banna, who became the Chairman of the Department of Radiology at King Faisal Specialist Hospital and Research Centre in 1985, played a further important role in establishing this sub-specialty by developing research and publications. Well known other neuroradiologists, like Dr. Randy Jenkins, also found the case material worthy of research and further enhanced it dur-ing the eighties. Other renowned international neuroradiolo-gists working in the King Faisal Specialist Hospital and Research Centre during the nineties included Dr. Jan Brismar, Dr. Robert Coates and Dr. Sven Larsson.
The new generation of Saudi neuroradiologists, represented by Dr. Tajahuddin Malabary (who became the Chairman of Department of Radiology at King Saud University) and Dr. Mohamed Abed Thagafi, the Chairman of Radiology Department at the Military Hospital, progressively took over key positions in the local institu-tions. Both played important roles in laying the foundations of modern neuroradiology practice in Saudi Arabia in the early 1990's. Courses and conferences were given major attention with a significant number of world-renowned neu-roradiologists being involved and visiting Saudi Arabia. Courses such as a distinguished MRI course was well recognized in the Military Hospital and continued every two years with its major focus on. neuroradiology alternating with another interventional neuroradiology symposium. Both were initiated and cosseted by Dr. Mohamed Abed Thagafi.

The idea of establishing a Pan Arabic Society of Neuroradiology came to life at an appropriate time where neuroradiology was trying to make its first footsteps towards a bright future. There was a growing interest internally and externally to develop a linkage in communication between the neuroradiologist in the Arabic Gulf countries. The identification of the Arab pioneers in neuroradiology all over the region was of utmost importance. Regular communica-tion to dissolve the differences and establish a strong and stimulating scientific community was the common dream to achieve in the future. Today the Pan Arabic Society of Neuroradiology has more than 50 members, representing seven countries. Several international meetings and courses were organized under the patronage of the Society, which is also member of the World Federation of Neuroradiology. One of the priorities of the Society today is to make the road easier for the next generation of the newly graduated doctor to sub-specialize in neuroradiology by transferring to them learned expertise in the shortest time possible and help therri achieve future goals that are only dreamed of now.

One aspect of radiology, which developed significant-ly in the past few decades, was interventional radiology. This is considered as a turning point in the history of radiology, as radiologists adopted a new therapeutic role toward dis-ease management. When the early pioneers in neuroradiol-ogy directed the attention of the healthcare administrators to the value of interventional therapeutic procedures in the management of patients, initially it was felt more appropri-ate to attract internationally known specialists to the Kingdom - even for short periods - to treat patients locally, rather than send them abroad. In this way, experience was slowly built in the highly sophisticated and rapidly developing sub-specialty of interventional neuroradiology. One has to highlight the role of Professor Pierre Lasjaunias in establishing interventional neuroradiology services in King Faisal Specialist Hospital and Research Centre in the late eighties. He visited the Hospital twice a year to manage the most challenging cases, as well as to lecture.

It did not take a long time until the hospital recognized the value of this top specialty and began to encourage Saudi radiologists to further gain the experience required to do these procedures safely. Dr. Jehad Al-Watban took over the torch, after successfully finishing his neuroradiology training in the Montreal Neurology Institute and accomplishing fellowships in interventional neuroradi-ology in leading European and North American Centers. He first became head of the Section of Neuroradiology in the King Faisal Specialist Hospital and Research Center in Riyadh and more recently the Chairman of the Department of Radiology. His vision of modern neuroradiology led to the development of high quality neuroradiology practice in the hospital that is now widely recognized as a prime neuro-radiology service provider both within the Kingdom of Saudi Arabia and in the entire Arab Peninsula. State-of-the-art diagnostic and therapeutic technologies including MR spectroscopy, functional MR, PET and all forms of endovascular treatment modalities are routinely used in order to provide the best possible tertiary health care for the increasing number of Saudi and international patients from the region; many of whom, a few decades earlier, would have had to seek adequate medical care in Europe or North America.

The high professional level in the Department attracted new Saudi and international neuroradiologists. A highly motivated neuroradiologist, Dr. Zoltan Patay joined the King Faisal Specialist Hospital in 1996 and became Head of the Section of Neuroradiology in 2001. His expertise helped to further develop advanced techniques in the domain of MR neuroangiography and through a stimulating collaboration with fellow neuroradiologists and clinicians, especially those working in the internationally renowned metabolic and genetic services, establish state-of-the art complex MRI work-up of neurometabolic diseases, including MR spectroscopy. His contribution helped to improve patient care and his educational skills left strong impression on all doctors and trainees who came across dealing with him. At present he joins forces - in the Section of Neuroradiology, which incorporates Head and Neck Radiology as well - with Dr. Klaus Neidl Van Gorkom, Dr. Johan Wallgren and Dr. Fahad Al-Mohaileb, a North American-trained Saudi neuroradiologist, who is implementing the most recent functional MRI and 3D image processing technologies that he acquired during his training in the Massachusetts General Hospital. Other highly trained Saudi neuroradiologists have also returned and started practicing elsewhere in the country, including Dr. Abdullah Al-Orainy in the King Saud University in Riyadh, Dr. Khalil Al-Kurdi in the Jeddah branch of the King Faisal Specialist Hospital and Research Center and Dr. Sattam Linjawi in the King Abdulaziz University in Jeddah.

A successful neuroradiology fellowship program has also been established in the King Faisal Specialist Hospital and Research Centre providing the country for the first time with locally trained sub-specialists. Dr. Eman Baksh, Dr. Ali Al-Zahrani and Dr. Fahad Al-Qahtani represent the first generation of these talented and highly motivated Saudi neuroradiologists.

Today King Faisal Specialist Hospital and Research Centre remains a hallmark of continuous cutting-edge technology. Since 1995, it was the first institution to harbor a PET scan center in the region. Such revolutionary technology served the neurosciences community tremen-dously in both clinical and research areas. Once again, international and Saudi pioneering efforts were revealed in the hard work of nuclear medicine specialists, Dr. John Powe, Dr. Siema Bakheet, Dr. Ayman Rifai and most recently Dr. Abdulaziz Al-Sugair, who obtained his specific expertise through a fellowship program in PET scanning at Duke University in the United States.
The Department of Radiology enjoys excellent international professional relationships too. Prominent neuroradiologists from all over the world frequently visit KFSH&RC and collaborate with their local colleagues in developing and implementing cutting-edge techniques.

Specialist Hospital and their contribution was highly appreciated.
Thanks to the dedicated efforts of the early groundbreaking pioneers and their followers, Saudi Arabia today enjoys a highly competent and professional service in both diagnostic and interventional neuroradiology, which meets the demand required around the country.