Radiology in Taiwan
由於近幾年台中榮總多切面電腦斷層相關研究於國際上受到注目，2007 年 11 月，American Journal of Roentgenology 資深編輯顧問 Dr. Eric J. Stern 來信邀請我，為國際學術社群介紹台灣。於是我尋求當時中國民國放射線醫學會理事長周宜宏醫師協助，寫成本文 Radiology in Taiwan。
這篇文章正式刊載的網頁版本與 PDF 版本，於 2008 年 7 月號刊登，至今已經過了 12 個月，AJR 早已釋出線上免費全文。 這篇對於我的學術歷程當然是有其特殊意義的，雖然以目前國科會計算 RPI 的方式，這種文章並沒有什麼幫助，但我還是覺得意義非凡。
其次，Eric J. Stern 是幾本重要的 Chest Radiology 書籍作者，也是我實習與住院醫師時期的「虛擬老師」，更是我在 AJR 投稿第一次被退時的責任編輯（就是他跟我宣佈退稿噩耗的），而被他邀請、肯定，是很令人振奮的，表示我的確成長了。
最後，我寫成這文章的時候其實只是第一年主治醫師，在重視「年功序列制」、講究階級倫理與頭銜的傳統醫界，不管是「第一年」或者是「主治醫師」的頭銜，我原本不可能有代表台灣寫 Radiology in Taiwan 的機會(少說也要有20年、主任或院長的頭銜才行)，但國際上人家不是這樣看的。這事情讓我更確定，「國際社群」、「網路」才是我該去的地方，那是一個純粹競賽腦力、創意與實踐能力的有趣地方。
Radiology in Taiwan
I-Chen Tsai, MD
Department of Radiology, Taichung Veterans General Hospital, Taichung, and Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Yi-Hong Chou, MD
Department of Radiology, Taipei Veterans General Hospital, and National Yang-Ming University, School of Medicine, Taipei, Taiwan.
Address correspondence to: Y.-H. Chou, MD
Type of article: Perspective
Key words: Taiwan; Republic of China; Radiology; History
Taiwan is a small island that has always been influential in modern East Asia history. The radiology history of Taiwan dates back to 1951, when, following a series of conflicts, The Radiology Society in Taiwan, now the Radiology Society of the Republic of China was established. The ensuing 50 years has seen the burgeoning use of radiology and training of many radiologists in Taiwan.
In 1895, Wilhelm Conrad Roentgen reported the discovery of the X-ray  and Qing China was defeated by Japan in the First Sino-Japanese War (甲午戰爭) . According to the Treaty of Shimonoseki (馬關條約), Taiwan (台灣)  was ceded to Japan in perpetuity . There followed the importation of diagnostic and therapeutic X-ray machines to Imperial Japan to assist medical practice. An example of a machine of that vintage is shown in Fig. 1. In 1945, following Japan’s defeat in the Second Sino-Japanese War (1937-1945) and Word War II, Taiwan was taken over by the Republic of China (ROC) administration. Four years later, the ROC government retreated from Mainland China and moved their capital from Nanjing to Taipei, Taiwan’s largest city. At that time, several doctors established radiology services with the assistance of the governments of ROC and the United States (U.S.) . On the basis of Sino-American Cooperation in Science and Technology (1949-1958), the early Taiwanese radiology also benefited from the American side. Some ancillary radiology facilities were prenested from the U.S. (Fig. 2). The early pioneer radiologists from 1949 to 1960 established diagnostic services mainly in military hospitals, National Taiwan University Hospital, Veterans General Hospital (currently, the Taipei Veterans General Hospital), and National Defense Medical Center. In 1951, Dr. Jane Ching Wu (吳靜) established the Radiological Society of the Republic of China (RSROC) in Taiwan . With the assistance of Dr. Paul C. Hodges of the University of Chicago and the many radiologists who returned to Taiwan from the U.S. in the aftermath of World War II, radiology as a specialty gradually matured in the country . In 1987, the Society of Nuclear Medicine in Taiwan was established, followed in 1993 by the formation of the Taiwan Society for Therapeutic Radiology and Oncology. Since its inception, the RSROC has evolved into a society focusing on diagnostic and interventional radiology. In order to avoid confusion with the existing Chinese Society of Radiology  in the People’s Republic of China (PROC), the council of the RSROC is recently considering to rename the society as the Taiwan Society of Radiology.
The official journal of the RSROC is the Chinese Journal of Radiology, which commenced publication in March 1976 as a quarterly journal. The English language journal’s mandate is the publication of original research, workshop proceedings, technical notes, and case reports of the society’s members. The Chinese Journal of Radiology is currently cited by EMBASE/Excerpta Medica.
The current Taiwan medical education system is a modification of the American system . After senior high school, students undertake a seven-year medical university training period that includes a one-year rotating internship. Students who choose radiology as their career then undertake a four-year radiology resident training program that includes a six-month period of general medicine training. After passing the radiology board examination administered by the Department of Health, they are qualified as a radiologist.
Currently, most subspecialties work as subcommittees under the RSROC umbrella. Every year in March, the 733 radiologists (as of December 31, 2007), more than 130 trainees, and about 200 technical exhibitors attend the society’s annual meeting, which rotates between the major cities in Taiwan. Attendance at the 2007 meeting was 1050. There were 120 oral presentations, 115 scientific exhibits, and 36 technical exhibits. Experts in subspecialties delivered 40 lectures in 12 categories, and eleven foreign speakers were invited to give lectures in plenary and subspecialty sessions.
In the early years when radiology training in Taiwan was in its infancy, many radiologists sought resident training in the U.S. Many choose to remain in the U.S., where their achievements have been notable; examples include Dr. Chien-Tai Lu (University of Chicago, and University of Iowa Hospital), Dr. Y.P. Huang and Dr. Hsu-Chong Yeh (Mt Sinai Medical Center, NYC), Dr. Ay-Ming Wang (William Beaumont Hospital), Dr. Fong Y. Tsai (University of California, Irvine Medical Center), Dr. Lee C. Chiu (Iowa University Hospital and Saint Joseph Medical Center, Burbank, CA), and Dr. Vincent P. Chuang (M.D. Anderson Medical Center). Others returned to Taiwan to pioneer the emergence of diagnostic and inteventional radiology in the country; the list includes Drs. Lan-Chang Chiang and Chun Hsu (trained at the University of Pennsylvania), Dr. Virginia Y.C. Kuan (trained at Bellevue Hospital), Drs. Chun Yu and Chien-Fang Yang (trained at the University of Chicago), Dr. Tsun Chang (trained at Louvain University, Belgium), Dr. Tong-Chieh Yang (trained at Columbia University), Dr. Chien-Yao Hsu (trained at Baylor University College of Medicine), and Dr. Chang-Yi Yu (trained at Rochester University). In addition, Dr. Hodges, who first visited Shanghai, China in 1915, also assisted in the establishment of the Department of Radiology of Veterans General Hospital in Taipei in the early 1960s [10, 11]. With the maturation of the radiology training system in Taiwan and increased global collaboration, the radiology expertise of Taiwan now rivals any country. In recent years, residents and fellows have tended to complete their training in Taiwan rather than elsewhere. The robust quality of this training is reflected by the increasing contribution of Taiwan radiologists to leading radiology journals [12, 13].
After the National Health Insurance program started in Taiwan in 1995, almost all radiological examinations were reimbursed by the single health insurance company, the Bureau of National Health Insurance, which is run by the Taiwan government. Only some new high-end examinations, such as cardiac multi-detector computed tomography (CT) for coronary arterial disease, whole body magnetic resonance imaging (MRI) for health examination, and positron emission tomography/CT are not covered and are billed directly to the patient [14, 15]. The limited geography and dense population of Taiwan  means that services such as CT and MRI are readily available to a substantial portion of the population.
Today, Taiwan boosts many research groups of international caliber such as the Laboratory of Integrated Brain Research at Taipei Veterans General Hospital , MR research group at National Taiwan University and Tri-service General Hospital , and the MRI Laboratory at National Taiwan University Hospital , and the multi-detector CT team at Taichung Veterans General Hospital. The latter have pioneered the use of ultra-low dose multi-detector CT in neonatal congenital heart disease [20, 21]. Also of note, the first MRI health examination center in the world was established in Taiwan [14, 15].
The development of radiology in Taiwan reflects both the complex history of East Asia and the globalization of the world [2-4]. For an island country whose geographical area ranks only 139 of all countries on the globe , radiology-related publications have become prodigious, ranking tenth among by-country submissions to the American Journal of Roentgenology. Within 50 years, radiology in Taiwan has risen from the ashes of post-war devastation to world-class status, a remarkable legacy of a small group of Asian radiologists who strived to serve their people and who aspired for excellence.
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Figures and Figure Legends
Fig. 1. A vintage X-ray machine used in Taiwan following World War II. The machine is an example of X-ray equipment imported to Taiwan in the Imperial Japan era. It is no longer operational and is on display at the National Taiwan University Hospital. The design is similar to the first X-ray machine designed by Wilhelm Conrad Roentgen, with a power generator to produce high voltage electricity. The machine was manufactured by the Shimadzu Corporation, which remains active in the biomedical equipment market. The X-ray machine was used for several generations of patients during the Imperial Japan, Kuomintang martial law, and modern democratic eras. Even during turbulent and changing times, medical science remained important and politically impartial. (Photographed by Dr. I-Tzun Tsai)
Fig.2. An X-ray Stereoscope (Fred W. Borden, M.D., Designer and Manufacturer, San Jose, CA) presented from the U.S., had been used from late 1960s to late 1970s. Inserted is the label indicating 「Sino-American Cooperation」. (Photographed by Dr. Yi-Hong Chou)