Background
CAR (Computer Assisted Radiology) began with support for an initiative by the Senate of Berlin in May 1983 directed at the creation of a new congress on information technology in biomedicine. It was one of many government subsidized technical congresses in the divided Berlin that was intended to increase the city's vital contacts with the outside world. Initially, computer graphics and computer vision in biomedicine were proposed as the meetings foci, with the human body as the principal theme. A first definition of CAR, based on CT, was made in 1984 (Ref. 1).

With strong international participation, the first CAR conference and exhibition took place at Berlin's International Congress Center (ICC) in June 1985. The main tracts for the three-day conference were as follows:

• digital imaging, e.g. CT, MR, DR, US, SPECT, and PET
• picture archiving and communication systems (PACS)
• medical workstations for viewing, analyzing and interpretating biomedical images
• computer assistance in radiological diagnosis, radiation therapy and surgery

The initial CAR meeting program included computer assisted surgery (CAS) topics, such as computer assisted orthopaedics and computer assisted stereotactic surgery. The expected impact of CAR was recognized by Prof. Heinz Oeser, formally a President of the Deutsche Röntgengesellschaft (DRG) (Ref. 2) " CAR wird die Entwicklung der Medizin entscheidend beeinflussen, mitbestimmend bei der Gestaltung des Gesundheitswesens wirken - richtungsweisend als Flaggschiff der gesamten Medizin." (CAR will decisively effect the development of medicine, impacting the structure of the healthcare system - giving direction as the flagship of medicine.)

A contribution from Prof. Tamon Inouye from Japan stated (Ref. 3) "Future developments in computer assisted radiology can be achieved only in deeper and wider international cooperation beyond the concept of conventional cooperative work in radiology".

International participation
CAR '85 and subsequent CAR's were aimed at radiologists, physicians, computer scientists, engineers and physicists. Special emphasis was placed on interdisciplinary and international activities, and this has been maintained throughout all of the CAR conferences.
 
In particular, there were joint meetings with the EuroPACS Society in 1991, Image Management and Communication (IMAC) in 1993, the Society for Computer Applications in Radiology (SCAR) in the United States in 1990, 1992 and 1994, and with the International Society for Computer Aided Surgery (ISCAS) and Computed Maxillofacial Imaging (CMI) in Paris, France in 1996. 

Since 1996, a close cooperation has been established with ISCAS, leading to the extension of CAR to Computer Assisted Radiology and Surgery (CARS). In the following, CARS congresses took place in Berlin, Tokyo, Paris, San Francisco and London. With this spirit of active international presence, other organizations such as Computer Aided Diagnosis (CAD), Cardiovascular Imaging (CVI) and EuroPACS have followed to cooperate closely with CARS.

Interdisciplinary cooperation
Progress in specific computer assisted techniques (e.g. digital imaging, computer aided diagnosis, image guided surgery, surgical robotics, MEMS, etc.) combined with computer assisted integration tools (e.g. PACS, Electronic Medical Record (EMR), middleware,  telemedicine, etc.) now offers a valuable complement to or replacement for existing procedures in healthcare. Physicians are employing PACS and telemedicine systems as enabling infrastructures for improving quality of and access to healthcare. Tools based on CAD and CAS facilitate completely new ways in patient care.

To ensure that these tools benefit and include the patient, collaboration between various disciplines, specifically radiology, surgery, engineering, informatics and healthcare management is a critical factor.

Various subspecialties in surgery are bringing image guided interventions into clinical practice. Advances in medical imaging (soon to include molecular imaging), image processing and display, surgical simulation, surgical navigation and robotics as well as surgery adapted PACS infrastructures are the driving forces for this development. The S-PACS (Surgical Picture Acquisition and Communication Systems) will have the greatest impact on the workflow in the “OR of the Future” and can only be successfully realized with intensive interdisciplinary and international cooperation. A representative spectrum of current goals and topics of CARS is reflected in the CARS 2003 Proceedings (Ref. 4).

The informal federation of societies and congresses of CARS 2010 in Chicago (ISCAS, CMI, CAD, EuroPACS and CAR) provides the necessary cooperative framework for advancing the development and application of modern computer assisted technologies in healthcare. These five organizations with their specific scientific/medical topics complement one another. They give a world-wide lead in interdisciplinary and international cooperation which will be the foundation of healthcare in the 21^st Century.  

CARS committees and participants
As a result of widespread clinical acceptance of computer assisted methods and tools, more than half of the symposium organizing and program committees for CARS are radiologists or surgeons, the remainder being computer scientists and engineers.

The international participation in CARS is highly significant, since the approximately 1000-1200 participants of CARS meetings typically come from over 45 countries and the members of the program committee are divided approximately equally between Europe, the United States and Asia. The program committee has the difficult task of selecting approximately 190 paper and 150 poster presentations from between 500 to 600 abstracts submitted annually.

Future CARS meetings

• CARS 2010 - June 23-26, Geneva, Switzerland
• CARS 2011 - Berlin, Germany

References

1. Lemke, H.U.: Computed Tomography - A basis for Computer Assisted Radiology. Kongressführer, 65. Deutscher Röntgenkongress, Baden-Baden, May 1984.
2. Oeser H.: CAR - Flaggschiff der Medizin. Proceedings CAR '85, Springer Verlag. pp 621-622.
3. Inouye T.: Research and Development Activities towards Computer Assisted Radiology in Japan. Proceedings CAR '85, Springer Verlag. pp 623-627.
4. Lemke, H.U., Vannier, M.W., Inamura K., Farman A.G., Doi K., Reiber J.H.C. Proceedings of CARS 2003, Elsevier Publisher, Amsterdam.

Heinz U. Lemke, August 2009

a commentary by Leonard Berliner, MD, Department of Radiology, New York Methodist Hospital, Brooklyn, USA

CARS: Bridging the gap, worldwide, between engineering and medicine

Under the increasingly broad umbrella of computer applications in medicine, the International Congress and Exhibition of Computer Assisted Radiology and Surgery (CARS), each year, covers a wider range of topics, attracts a more varied group of contributors and reaches a growing audience.

1. CARS is an International Meeting:
The international nature of the CARS Meeting is a very important feature. Any and all countries that are involved in the advancements in computers in medicine are represented among the organizers, presenters, and attendees of the CARS meetings, promoting both a national and international sense of accomplishment. As attendees of CARS, we can look forward to experiencing different countries and cultures each year, in a manner that enhances international communication, cooperation, and education.

2. CARS has a Comprehensive and Unique Syllabus:
The CARS meeting is the only meeting worldwide which addresses all facets of computer applications in medicine under a single roof. Each year the agenda of the meeting expands to encompass the ever growing list of topics that are of relevance to those on the engineering side as well as the practitioner’s side of computer applications in medicine.

The list of topics, all of which are covered in depth, includes:

• Medical Imaging, e.g. CT, MR, US, SPECT, PET, DR, Molecular Imaging, and Virtual Endoscopy
• Image Processing and Display
• 3D, 4D and 5D Imaging
• Hospital-wide PACS and Telemedicine
• Computer Applications for e.g. Neurosurgery, Head and Neck, Orthopaedics, Ear Nose and Throat, Cardiovascular and Thoracoabdominal Surgery, and Plastic/Reconstructive Surgery
• Image Guided Therapy
• Surgical Robotics and Instrumentation
• Surgical Navigation
• 3D Modelling and Rapid Prototyping
• Postoperative Result Assessment
• Surgical Education and Training
• Haptics and Multimodal Devices in Medical Applications
• Methods of Validation and Verification
• CAD for Breast, Prostate, Chest, Colon, Liver, Brain, Skeletal and Vascular Imaging
• Cranial and Maxillofacial Image Guided Surgery
• Surgical Workflow
• Surgical DICOM and IHE
• Digital Operating Room
• Personalized, Predicitive, and Preventative Healthcare
• Patient-Specific Modeling and Model-Based Surgery
  

One would have to attend selected lectures at numerous international meetings in the US, Europe and Japan, such as RSNA, ECR, SPIE, and SIIM, as well as various Surgical, Radiology, Dental, ENT and Orthopedic Meetings, in order to be exposed to the material presented at CARS.

3. CARS is a Personalized, Academic Meeting:
CARS is an academic program, in which researchers and practitioners can present their most up-to-date research and interact on a personal level. All presenters are accessible to all attendees, not only during the scientific sessions, but during organized social events.

In addition, an attendee can modify his or her schedule at the CARS meeting, to meet their own personal needs. If one wishes to focus on particular medical disciplines, such as Cardiovascular Surgery, Neurosurgery or Maxillofacial Surgery, the standard daily schedule may be followed. If one wishes to focus on a particular technology, such as robotics or imaging technologies, one may scan across the daily schedules and achieve a more focused, personalized schedule from among the various disciplines.

4. CARS is at the crossroads of Research and Application:
By attending the CARS meeting each year, one has the unique perspective in which the gradual transformation of theory into practical reality can be observed first hand. One is given the opportunity to see advancements in medical technology develop gradually and incrementally. And, since many of these advancements are first seen at CARS, participants have the unique opportunity to influence the manner and direction in which they develop.

For example, consider Cone Beam CT. We have seen the gradual development of this technology from prototypes, theoretical proposals, and a series of isolated technical papers into the beginnings of commercially available, practical, and medically useful equipment. The initial clinical applications were in dental imaging, and now Cone Beam CT is finding its way into Angiography Suites, providing cross-sectional imaging and interventional navigation.

5. CARS is a blend of the Academic and the Commercial:
Vendors have several forums and opportunities to present their products fairly at CARS: in the scientific sessions; in sessions for vendors; and at the exhibition booths. The interactions between vendors and attendees seem less commercial than at many other meetings, and more like an opportunity for academic and commercial development.

The CARS meeting provides manufacturers the opportunity, at a single meeting, to meet with researchers, practitioners and leaders, from 5 continents, who are on forefront of medical technology.

6. International Journal of CARS (IJCARS)
The International Journal for CARS is a peer-reviewed journal that aims to provide a forum to bridge the gap between the medical and technical disciplines and to encourage interdisciplinary research and development activities in an international environment. The International Journal of CARS presents results from the many fields of interest, listed above, in selected proffered papers, review articles, short communications and commentaries.

To improve health care for patients world-wide, the focus of the International Journal of CARS is on providing balanced and in-depth information on new diagnostic and therapeutic processes. These include results from multidisciplinary R&D efforts, providers' experiences, patient outcomes, economic considerations and scientific/medical validation results.

In Summary:

CARS may be thought of as an international, academic society, guided by a sense of ethics, dedicated to bridging the gap between the disciplines of biomedical engineering and clinical medicine (including surgery, informatics, and diagnostic and interventional imaging), through the organization of scientific meetings and symposia to promote education and the exchange of new ideas, and to provide for the presentation and publication of original research.

Leonard Berliner, MD
October 2009