ECR Today 2011 D aily news from Europe’s leading imaging congress

FRIDAY, MARCH 4, 2011

Inside Imaging of antiquities Dual energy CT PET/MR features among Today and works of art breaks new ground technical exhibits See page 7 See page 9 See page 17 Exploring the brain Reimbursement holds with Opening Lecturer key to CT colonography’s Denis Le Bihan future growth

By Simon Lee By Philip Ward ture. Finally, standards and training are having an impact,” stated Laghi, who will speak about Participants at ECR 2011 yesterday saw Dr. Denis One of Europe’s leading exponents of CT colo- this hot topic at today’s State of the Art Sympo- Le Bihan from Gif-sur-Yvette, France, get the nography (CTC) has called for much greater har- sium. “CTC needs to be reimbursed as a stan- congress programme officially up and running monisation and drastically improved funding for dard CT examination. This is what happens in with the Opening Lecture, ‘Water: radiologists’ the reimbursement of this emerging procedure. the Netherlands and in some Italian regions. It best friend?’ ECR Today took the opportunity will cost money, but at least a programme can be to ask him a few questions about his lecture, his “Reimbursement is a key factor for the deve- started.” recent work at the NeuroSpin institute in France, lopment not only of CTC but also of any ima- as well as the current status of his famous inven- ging method,” said Prof. Andrea Laghi, from As an examination designed for polyp and tion, diffusion MRI. the department of radiological sciences (Polo tumour detection in the colon, CTC has now Pontino), University ‘La Sapienza’, Latina, Italy. reached a sufficient level of competency, making ECR Today: You gave the Opening Lecture at “Considering the current economic situation, the double contrast barium enema an obsolete ECR 2011, entitled ‘Water: radiologists’ best getting reimbursement for a new technique is examination in 2011, according to fellow ECR friend?’ What was the central message of your much more difficult than in the past, especially if presenter Dr. Philippe Lefere, a radiologist at Ste- lecture? there are strongly competing alternatives.” delijk Ziekenhuis in Roeselare, Belgium. As the

Denis Le Bihan: H2O, especially in its liquid implementation of CTC moves ahead, general Opening Ceremony form, the ‘blue gold’, is just indispensable to Denis Le Bihan from Gif-sur-Yvette, France Major differences in reimbursement currently radiologists must become aware that this tech- our lives. Water accounts for 60 to 70% of the exist across Europe, and even within individual nique can play a significant role by scrutinising human body weight and is crucial to the work- countries, as in the case of Italy and Austria. The both symptomatic and asymptomatic patients ing of the biological machinery. The implica- ECRT: What is the primary objective of overall situation is poor, and strong efforts need for polypoid and tumoural lesions in the colon. tion of water in molecular biology, basic cel- NeuroSpin? to be made in the near future to try to solve the lular mechanisms, such as those defining the DLB: The understanding of how the human difficulties, he explained. In general, CTC is not In recent multicentre trials, CTC showed very cells’ shape or volume, or regulating interac- brain works has considerable potential, not only reimbursed for screening in any European coun- good results of polyp detection, and its accuracy tion between cells, cannot be ignored. Radiolo- for healthcare, but also for improving human try, with the recent exception of Spain, where a approaches that of optical colonoscopy, he poin- gists know it well, as water is a source of image cognition in general. The goal of NeuroSpin private insurer decided to cover colorectal can- ted out. CTC is now an indication for patients contrast, whether we use x-rays, ultrasound or is to explore the brain at spatial and temporal cer screening with CTC. In some regions of the after an incomplete optical colonoscopy, patients MRI. A lot of work remains to understand the scales which may give access to the neural code, U.K. and Italy, it forms part of official screening with a contra-indication to optical colonoscopy, mechanisms in detail, although recent studies by pushing the current limits of brain imaging, programmes offered to FOBT (faecal occult and patients unwilling to undergo optical colo- of water mobility in biological structures have from mouse to man, as far as possible with ultra- blood test) positive patients with an incomplete noscopy. CTC is a reliable tool for colorectal highlighted its importance to cellular physiol- high magnetic field (UHF) Magnetic Resonance colonoscopy, but this is not the norm, he added. cancer screening in the patient at average risk for ogy. Recent studies have suggested that water Imaging and Spectroscopy. Results are expected colorectal cancer. (9 out of 10 molecules in the brain are water to impact not only European healthcare, but “Cost is one of the leading factors for both public molecules) may also actively contribute to the also industry, artificial intelligence, social sci- healthcare systems and private insurers. Misin- Moreover, the procedure is patient-friendly and mechanisms underlying brain function. Could ences and the humanities. NeuroSpin is being formation and turf battles with other specialists it can be performed on an outpatient basis. No the ‘molecule of life’ also be the ‘molecule of are additional reasons, together with the hete- the mind’? continued on page 3 rogeneity of the results reported in the litera- continued on page 5

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Renowned thoracic imaging specialist focuses on the value of basics in today’s honorary lecture

By Simon Lee Cook County Hospital in Chicago and com- pleted a residency at the University of Cincin- Professionally, I believe ECR In recognition of his remarkable career and nati from 1966 to 1969, followed by a one-year exceptional contributions to education in radio- fellowship in diagnostic radiology at the same holds its own against any other logy Professor José Cáceres from Barcelona, institution. congress in the world. I believe Spain, has been invited to present the Josef Liss- there is more talent in Europe ner Honorary Lecture, entitled ‘The chest radio- “When I started out in radiology I had the vision graph: a perfect design’ at ECR 2011. that it would become a very important method than in USA or Asia. Personally, for diagnosis, and it turned out that I was right,” I feel surrounded by friends. José Cáceres is Professor Emeritus of Diagnostic explained Cáceres. “I was also very fortunate to Radiology at H.G.U. Vall d’Hebron Universidad be trained by Dr. Benjamin Felson, one of the Autónoma, Barcelona, where he has served since best radiologists of all time. His memory moti- 1996. He is well recognised as an excellent chest vates me every day.” ted radiological journals, and also served as the radiologist and foremost as an outstanding edu- chest imaging section editor for European Jour- cator in the field. After an appointment as Assistant Professor of nal of Radiology. He is a member of many sci- Radiology at the University of Kentucky from entific societies, including the Spanish Society “The central message of my lecture, ‘the chest 1970 to 1971 he returned to Spain and held seve- of Radiology, the Radiological Society of North José Cáceres from Barcelona, Spain radiograph: a perfect design’, is that the chest ral positions as Head of Department and Profes- America, the American Roentgen Ray Society, radiograph is still a valid technique and very use- sor in Madrid, Valladolid and Barcelona. In 1996, and the American Society of Chest Imaging, has ful in the diagnosis and orientation of diseases,” he accepted the post of Professor and Head of served as President of the European Society of said Cáceres. Diagnostic Radiology at the H.G.U. Vall d’Hebron Thoracic Imaging, and the Spanish Society of Autonomous University of Barcelona; a position Thoracic Imaging, and has chaired the chest sub- Josef Lissner Prof. José Cáceres was born in Seville, Spain on he held until his retirement in September 2010. committee of the European Congress of Radio- Honorary Lecture February 9, 1940, and attended medical school logy three times. Friday, March 4, 2011, 12:15–12:45, Room A at the University of Seville from 1957 to 1964. Prof. Cáceres has published throughout his After his graduation in 1965, he moved to the career, including one book, 20 chapters and 91 He is married with three children, and enjoys ‘The chest radiograph: a perfect design’ USA, where he passed his internship at the scientific articles in some of the most respec- running, reading, and movies. José Cáceres; Barcelona/ES

plasticity; Cognitive codes; and Translational MRI diffusion imaging to diagnose strokes and ECRT: What does the ECR mean to you profes- Le Bihan Interview continued from page 1 research for neurological and psychiatric disorders. other injuries to the brain at a very early stage sionally and personally? when the brain is still salvageable. DLB: I have come to the ECR many times over ECRT: What new opportunities have been the last 20 years. I have seen it growing at an equipped with unique MRI systems operating afforded by the centre’s new 17T system? Today, diffusion MRI is also used for the detec- amazing speed to reach a level of quality which at very high magnetic field strengths not yet DLB: Our 17.2T system has been successfully tion of cancer lesions and metastases, as it has makes it now an inescapable reference for our available elsewhere in the world, such as a 17.2T delivered this summer by Bruker. Equipped with been shown that water diffusion slows down in fellow radiologists from the world. Many non small-bore horizontal magnet (installed this a 1000mT/m gradient system, it is really an out- malignant tissues. Our most recent discovery is European colleagues, in particular from Asia, year) and an 11.7T whole-body (90cm) system standing instrument for animal research, unique that water diffusion is decreased in brain activated have told me how much they love this congress to be delivered in 2013. Our objective is to com- in the world. The boost in contrast is obvious, for regions. Diffusion MRI could thus provide a new, which has managed to keep its strong European bine the methodological and neurobiological instance, from vessels which can be visible at an direct approach to detecting and localising brain flavour, while being open to the world, espe- players so that they develop, in synergy, the tools incredible spatial resolution. Our aim is to reach activation. Another huge field for diffusion MRI cially to our young fellows and students who and the models that will enable them to better the ‘mesoscale’, clusters of hundreds or thousands is ‘brain connectivity’. Neurons can connect across find there a very rich and nurturing teaching understand the working of the human brain. of neurons, and to implement MRI microscopy to distant regions of the brain, but the trajectories environment. Clearly, by coming to the ECR, I reach, in vivo, the neuron level. Basically, we are that axons take within the human brain are almost am sure I will meet my best friends and enjoy ECRT: Has NeuroSpin seen any particularly putting together a microscope to look into the brain entirely uncharted. Diffusion MRI, however, has great lectures. notable developments borne of interdiscipli- in vivo in 3 dimensions without opening the skull. raised the possibility of in vivo tract tracing. nary collaborations? Our hope is not only to see better, but to discover ECRT: Your homepage lists Mozart and Schu- DLB: NeuroSpin combines researchers with many new structural or functional features in the brain. ECRT: What was your main motivation for bert among your favourite composers. Will you different backgrounds, creating a broad, strong, choosing your profession, and what keeps you be making the most of Vienna’s cultural back- multidisciplinary environment and working to ECRT: You are well known for developing dif- motivated today? ground during ECR 2011? develop innovative tools and methodologies and fusion MRI. Can you tell us anything about the DLB: Initially, my dream was to become a neurosur- DLB: It is true that Vienna is a musician’s para- to apply them to neurobiology in general, from most recent applications, new developments, geon, which I did during my early residency years. dise! As a pianist I feel very much inspired when neurogenetics and neurophysiology to cognitive or the future of this method? At the same time I was very much attracted by phy- walking in the streets of Vienna, as if the minds neurosciences and clinical neurology. NeuroSpin DLB: A dramatic application of diffusion MRI sics, especially nuclear and elementary particle phy- of those outstanding composers were still wande- scientific programmes rely on the varied expertise has been brain ischaemia, following the disco- sics, so I pursued a PhD in this field in a time-sha- ring out. I am not sure that the busy (but great) within the different laboratories and are interdis- very that water diffusion drops immediately after ring manner with my residency. It was not easy, and programme ahead of us at the ECR meeting will ciplinary by nature. There are currently six inter- the onset of an ischaemic event. This is still the the dilemma remained: physicist or neurosurgeon? leave me much time, but I cannot definitely leave disciplinary programmes: Pushing the limits of main clinical application of diffusion MRI. The Fortunately, MRI came at the right time as the obvi- Vienna without attending a concert or an opera MRI; Multiscale brain functional architecture; MRI market is expected to grow globally bey- ous solution. I realised that as a neuroradiologist- performance. Genetics and phenotypic variability in brain ond $4 billion in 2011 and a key growth factor is physicist I could do much more to understand the anatomy and function; Brain development and expected to be increases in the expanded use of brain than by touching it as a neurosurgeon.

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CT colonography blem can be solved by comparing the lesion radiation exposure and faster and more accurate programme of QA and strong governance, plus continued from page 1 with a tagged stool elsewhere in the colon or by reading, possibly with the help of computer- audit and training.” smoothing the abdominal window. When star- aided diagnosis software. But we should also pur- 1 Lefere P, Gryspeerdt S (2011) CT colonography: avoiding traps and pitfalls. Insights Imaging 2: 57-68. sedation is necessary, the examination time is ting CTC as a novice, a dose of 80 mAs should be sue other goals, including the development of a DOI: 10.1007/s13244-010-0054-3 short, it can be performed the same day as the used to avoid image noise, he advises. optical colonoscopy, it can detect important pathology outside of the colon, and patient pre- Along with his colleague Dr. Stefaan Gryspeerdt, paration is possible without interruption of nor- Lefere has addressed CTC’s potential pitfalls in mal daily activities, Lefere said. The main draw- a comprehensive paper published online on 4 backs are that radiation is used, polypectomy is January 2011 by Insights into Imaging1. Their top not possible, there is the potential for superfluous tips are to perform state-of-the-art CTC (prepa- explorations (iatrogenic pathology), patient pre- ration based on faecal tagging, along with colonic paration is still needed, and it involves a relatively distension with CO2 plus injector, dual positio- steep learning curve and long interpretation ning and smooth muscle relaxation), to remem- times during the initial phase. ber the general principles of interpretation, and to take special care when examining the rectum “Technical advances with the introduction of the and caecum. latest multislice scanners, and improvements in x-ray tubes with the use of tube current modu- It is important to make CTC a really efficient lation and beam-shaping filters, have decreased tool for polyp detection performed reliably by radiation dose,” he stated. “Further improvements a large community of radiologists, and to con- Left: Coronal reformatted view showing a pedunculated polyp of the sigmoid colon. of CT scanners together with iterative reconst- firm the good results obtained in trials, struc- Right: Volume-rendered endoluminal view of the same pedunculated polyp. In both images, the curved arrow ruction techniques will allow more decreases in tured education with ongoing quality assurance indicates the stalk, and the straight arrow indicates the head of the polyp. (Provided by A. Laghi) the radiation dose in general. This will bring radi- (QA) will need to be implemented, Lefere stated. ation doses for CTC to a negligible level.” Recommendations for CTC education need to be further elaborated, and a lot of work is being The use of (ultra-)low dose in CTC is possible done in this area by ESGAR’s CTC committee. because of the high contrast between the luminal Developing good collaboration with gastroen- gas and the colonic structures. A low dose of 120 kV terologists is another vital task because this will and 50 mAs is recommended for CTC in asympto- enable QA through the establishment of patient matic patients. Taking into account this low dose, guidelines and follow-up of patients with a lesion the good performance of CTC, the prevalence of detected by CTC. colorectal adenomas and/or cancer and the patient’s age (usually over 50 years), there is a clear benefit “The future is mainly in the hands of radiologists of CTC versus no screening, with a very low risk active in this field,” Laghi predicted. “We need of radiation-induced cancer (0.05%), Lefere noted. vendors to provide us with the right tools. We should continue working to improve on the pro- Using a low dose may cause excess image noise, cedure from a technical point of view, with more resulting in pseudo-enhancement, but this pro- comfortable bowel preparation, minimisation of Left: Large pedunculated polyp in the sigmoid (white arrow) Right: Corresponding 3D image of this pedunculated polyp with a 2 cm head (white arrow). (Provided by P. Lefere) State of the Art Symposium

Friday, March 4, 08:30–10:00, Room A SA 3 The 3 P’s of CT colonography: polyps, protocols and politics

• Chairman’s introduction S. Halligan; London/UK • CT colonography in 2011: how far has it come P. Lefere; Roeselare/BE • Current status of reimbursement A. Laghi; Latina/IT • Quality, training and accreditation D. Burling; London/UK • CAD: friend or foe? S. Halligan; London/UK • Panel discussion: In 2011, should CTC now be the primary method Left: Small 7 mm polyp in colon, drowned in tagged fluid in supine position (white arrow). of colorectal investigation in my hospital? Right: Corresponding 3D view in prone position shows the same polyp (white arrow). (Provided by P. Lefere)

Mobile Guide

m.myESR.org Get ECR on your smartphone and always stay up to date! The ECR Mobile Guide brings ECR 2011 to the palm of your hand. Find out all about: ▶ Sessions/Lectures ▶ Abstracts ▶ Exhibitors ▶ Floorplans ▶ Places to be

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No individual adverse reaction reached a frequency greater than 1/100QNervous system disorders headache, dizziness, paresthesia, taste disturbance, vertigo, akathisia, tremor, parosmiaQCardiac disorders bundle branch block, palpitationQVascular disorders fl ushing, hypertensionQRespiratory, thoracic and mediastinal disorders dyspnea, respiratory distressQGastrointestinal disorders vomiting, nausea, dry mouth, oral discomfort, salivary hypersecretionQ Skin and subcutaneous tissue disorders rash, pruritus, maculopapular rash, hyperhidrosisQGeneral disorders and administration site conditions chest pain, injection site reactions, feeling hot, chills, discomfort fatigue,malaise, feeling abnormal. 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The patient should refrain from eating for two hours prior to examination to reduce the risk of aspiration, as nausea and vomiting are known possible adverse 07.02.11 10:51 reactions. Whenever possible, the contrast agent should be administered with the patient lying down. After the injection, the patient should be kept under observation for at least 30 minutes, since experience with contrast media shows that the majority of undesirable effects occur within this time. Caution should be exercised in patients with severe renal impairment due to reduced elimination capacity of Gd-EOB-DTPA. Patients with renal impairment: There have been reports of Nephrogenic Systemic Fibrosis (NSF) associated with use of some gadolinium-containing contrast agents in patients with - acute or chronic severe renal impairment (GFR< 30ml/min /1.73 m2) or - acute renal insuffi ciency of any severity due to the hepato-renal syndrome or in the perioperative liver transplantation period. 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Caution should be exercised when Primovist® is administered to patients with severe cardiovascular problems because only limited data are available so far. It cannot be excluded that Gd-EOB-DTPA may cause torsade de points arrhythmias in an individual patient. Hypersensitivity Allergy-like reactions, including shock, are known to be rare events after administration of gadolinium-based MRI c ontrast media. Patients with a history of allergic/allergoid reactions or bronchial asthma might be at higher risk for severe reactions. Most of these reactions occur within half an hour after administration of contrast media. However, as with other contrast media of this class, delayed reactions may occur after hours to days in rare cases. Adequate measures for resuscitation should be made readily available prior to administration of contrast agents. Hypersensitivity reactions can be more intense in patients on beta-blockers, particularly in the presence of bronchial asthma. It should be considered that patients on beta-blockers may be refractory to standard treatment of hypersensitivity reactions with beta-agonists. If hypersensitivity reactions occur, injection of the contrast medium must be discontinued immediately. Local intolerance Intramuscular administration may cause local intolerance reactions including focal necrosis and should therefore be strictly avoided. Date of preparation of the text October 2007. Please note! For current prescribing information refer to the package insert and/or contact your local BSP organisation. Bayer Schering Pharma AG, 13342 Berlin, Germany. 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The Fine Art of Liver Imaging

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From flesh and bone, to wood and stone: Guest Lecturer Marc Ghysels on CT in the art world

By Simon Lee what technical progress had been made with with the play in medical imaging, especially in the introduction of multi-detector CT scanners interventional radiology. Dr. Marc Ghysels is unusual among the speakers and, more importantly, highly sophisticated 3D at ECR 2011, in that he will not be discussing image processing software. In 2002, my friend ECRT: As a practitioner of a non-medical imaging of adults, children, the elderly, or even Dr. Emmanuel Agneessens opened my eyes to application of radiology, what is the signifi- animals. This ex-interventional radiologist plies what was going on and it gave me such a shock cance of the ECR to you? his trade outside healthcare, using his skills to that I left clinical work at the age of 42 and MG: Frankly, as this is my first trip to Vienna, examine antiques and artworks from all over the devoted myself full-time to this field of medico- I am delighted to be here because no one bet- world, and will present the Guest Lecture ‘Slicing cultural activity. ter than my clinical colleagues can appreciate through antiques and works of art’ tomorrow the value and quality of my work and suggest afternoon. ECR Today took the opportunity to ECRT: Have you picked up skills or methods improvements. So, even more than the official find out a little bit about him and his work. during your career that could be applied by programme, the best part for me will be meeting your medical colleagues? and talking with my clinical colleagues during ECR Today: You will give the Guest Lecture at MG: No, it is more a matter of applying the the breaks and evening functions. ECR 2011, entitled ‘Slicing through Antiques knowledge and methods developed by my & Works of Art’. What will be the central mes- medical colleagues to the art field. The method ECRT: As someone familiar with the art world, sage of your lecture? Dr. Marc Ghysels, Brussels/BE used to analyse a scan of a sculpture is basically will you be making the most of Vienna’s rich Marc Ghysels: The main message will probably the same as that used in clinical radiology. In artistic heritage during ECR 2011? be that any radiologist with a bit of curiosity and fact, the biggest difference between my work MG: Of course, starting with a visit to the Kunst- access to a multidetector CT scanner can easily ning in histology and pathology, but in the end it and what my clinical colleagues do every day is historisches Museum! use his radiological skills to further our technical was conventional radiology of the digestive sys- that I have much more time to process and ana- and cultural knowledge about art and antiqui- tem (barium studies) that clinched my decision lyse the images. And although there are unfor- ECRT: Do you know of any of Vienna’s famous ties, and about terracotta, wood and stone sta- to specialise in medical imaging. tunately hardly any reference books to consult, exhibits that have undergone CT scans? tues in particular. This is an atypical application I never have to be on call and there is much less MG: To the best of my knowledge, no … but who for radiology which, although it is not new, has ECRT: What prompted you to make the transi- stress related to the possibility of a mistaken knows, maybe tomorrow, thanks to the ECR’s great potential for development as the number of tion into your current field of work? diagnosis. And, of course, no need to control invitation, I will meet an Austrian colleague who authentic artworks now being found is dwind- MG: “Nuts don’t fall far from the tree!” as the radiation or get into long discussions with insu- has started an activity similar to mine! ling every day and copies or fakes are invading saying goes. My father, Jean-Pierre Ghysels, is rance companies. the art market, whether in Chinese antiquities, a sculptor, my mother, Colette, collects ethnic African art or pre-Columbian terracotta. art, and my brother Eric is an art historian and ECRT: Are there any particular sessions at publisher. For years I had been casting around ECR 2011 that you are looking forward to? Guest Lecture ECRT: What first attracted you to radiology? for an activity which would combine art and MG: It will not come as a surprise that I have MG: The beauty of it. As a medical student, I medical imaging (that’s my boy!). In my clini- a preference for sessions dealing with progress Saturday, March 5, 13:30–14:00, Room A was fascinated by the beauty of the images I saw cal work I mainly specialised in interventional made in computed tomography, but I will be Slicing through Antiques & Works of Art through a microscope during my practical trai- radiology so it was a while before I realised happy to go to other sessions, too, to keep up Marc Ghysels; Brussels/BE

CT of a composite Congo fetish

By Marc Ghysels Museum for Central Africa in Tervuren (RMCA, Thanks to Dr. Anne-Marie Bouttiaux, chief and try to pierce the secrets of its inner life when Inv. no. EO.0.0.32982, H. 26 cm, Crossopteryx curator of the Ethnography Division of the it first came into being. The idea was to write This Yaka figure collected in the region of febrifuga) looks like a carved head sitting on top RMCA, it was recently taken to the Ixelles another page about its ‘social life’, to borrow the Popokabaka, south Bandundu, Democratic of a compact textile ball to which an assortment of Hospital to be scanned. The operation was now famous title of Arjun Appadurai’s book, in Republic of the Congo by colonial administrator small items have been attached: pieces of bamboo, not designed to dissipate doubts about its the sense that objects, like people, can have a A. Verschaffel and given in 1931 to the Royal four Möbius strips made of plaited fibre and shells. authenticity but to shed light on its very structure private and social life.

The CT shows that the head poking out of the bundle is in fact the head of a squatting wooden figure carved in the round. Magical substances are tucked away in a cavity in its belly. There is clear evidence that the object was made in several stages and was perhaps adapted to something other than its original purpose. There would certainly have been no point in carving the figure fully if it were to be bundled up in its charges. Could it first have been used as a small carved squatting figure invested with power by the substances lodged in its body?

Close observation reveals that an inner layer of cloth was wrapped around the statuette, perhaps in an attempt to homogenise the carved surface before adding what was to become the stuffing of its present spherical form.

Soil, lengths of bamboo filled with various powders and blocks of compact substances, particularly fragments of pottery, have been used as stuffing. The assortment of decorative and ritual items (small cloth bags, Möbius strips made of vegetable fibre, bamboo, shells…) attached to the outside of the ball makes the fetish powerful in both appearance and function. While he was adding the ingredients that would endow it with magical powers, the artist clearly took aesthetic pleasure in harmonising the whole figure.

This brief review of a Yaka fetish CT gives once more a glimpse of the many possibilities opened up by the use of CT scanners to probe art works.

CT Images of a Congo fetish reveal how the object was made.

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CIRSE 2011, Europe's most comprehensive forum for minimally invasive image- guided therapy, will offer more than 250 hours of educational and scientific presentations streamlined around seven major topics, hands-on workshops, foundation courses, learning centres, industry symposia, an all-electronic poster exhibition and the largest CIRSE exhibition ever.

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MAIN TOPICS • Vascular Interventions • Transcatheter Embolization • Non-Vascular Interventions • Interventional Oncology • Neuro Interventions • IR Management • Imaging

Cardiovascular and Interventional Radiological Society of Europe C RSE Friday, March 4, 2011 CLINICAL CORNER ECR TODAY 2011 9

Inside ESR meets Oncologic imaging and Molecular medicine Gastroenterologists tumour response enters clinical arena

Today See page 11 See page 14 See page 15

Dual energy capabilities open up spectacular new avenues for CT

By Philip Ward be used to differentiate between bone and iodine contrast, according to session moderator Prof. CT appears to be entering an exciting new phase John Boone, department of radiology, UC Davis in its remarkable development, and it looks Medical Center, Sacramento, California. Today’s poised to spring a fresh set of surprises upon the scanners can produce multidimensional datasets world of clinical radiology. that supply useful clinical information, adding to CT’s diagnostic potential, he said. The fast acquisition capabilities of modern scan- ners has opened the door to the fourth dimension DECT refers to the use of CT data representing (time), where a time-course CT scan can provide two different x-ray energy spectra to increase clinical information about blood flow, perfusion pathology conspicuity and to differentiate and and other physiological measures regarding classify tissue composition. It shows great prom- organ function. The door to the fifth dimension ise in a wide variety of thoracic, abdominal and (energy) has been opened by dual energy acquisi- musculoskeletal applications, and particularly in Illustrative example of the increase in the signal of iodine that occurs when exposed to a lower kilovoltage. The tion techniques, which are made possible by dual the characterisation of renal stones, commented images were obtained in the same acquisition in the pancreatic phase (45 seconds). The image on the left was source systems or rapidly switching x-ray source Dr. Luís Guimarães, a radiologist at Hospital de acquired with 140 kV, while the image on the right was obtained with 80 kV. Notice how the attenuation of pan- scanners. São Teotónio, Viseu, Portugal. creatic parenchyma (arrows) is much higher on the right image. (Provided by L. Guimarães)

“With the technological advances, CT has gone “The principle challenges are to identify patients beyond Hounsfield numbers. Quantification of who would benefit from these examinations iodine, display of iodine distribution maps, and and to reduce image noise. Reducing the image kinetic modelling to derive regional blood flow, noise seen with low-kV imaging will improve blood volume and measures of vascular leakage the quality of dual-kV images and improve such as permeability surface area product are material classification at dual energy,” he noted. changing how we approach the imaging assess- “It must be remembered, however, that the out- ment of cerebrovascular, cardiovascular disease put of the low-energy tube must generate a rela- and cancer,” asserted Dr. Vicky Goh, consultant tively artefact-free image, so there is a patient radiologist at the Paul Strickland Scanner Cen- size limitation.” tre, Mount Vernon Hospital, Northwood, U.K. DECT allows the classification and separation The simplified graphic on the left explains how the three-material decomposition algorithm can distinguish uric At this afternoon’s New Horizons Session, she of different materials because CT numbers at acid renal stones from other types of stones. The red line represents the DE ratio of uric acid, while the blue line will focus on CT perfusion, a quantitative tech- each voxel can be compared between two dif- represents the DE ratio of other common types of stones. If the measurements of the CT number of a stone fall nique that uses rapid sequences of CT images ferent tube energies. By analysing the available below the dissector line, the software classifies it as being composed mainly of uric acid and a specific colour after bolus administration of intravenous con- knowledge of the absorption of materials at dif- code is attributed, as can be seen on the right side. In this image, uric acid is shown in pink (arrow), whereas the trast to measure physiological processes related ferent x-ray energies, materials can be separated, spine, composed mainly of calcium, is shown in blue. (Provided by Dr. Thomas Flohr) to the microvasculature of tissues. The technique explains Guimarães. Routine contrast-enhanced can provide surrogates for tissue hypoxia, as well abdominal CT at 120 or 140 kV exploits the tis- as physiological processes such as vasodilatation sue and perfusional differences between normal that represent vascular responses to hypoxia. anatomy and pathology because the presence of Wider CT detectors, shorter gantry rotation intravenous iodinated contrast increases the con- times, table-toggling, radiation dose reduction spicuity of disease. The signal of iodine at 80 kV and software corrections for image mis-registra- is approximately twice that at 140 kV, so DECT tion have made these innovations possible, noted can highlight pathologies that become more con- Goh, who is due to become chair in cancer imag- spicuous with the use of intravenous iodinated ing at King’s College London during March 2011. contrast.

CT contrast perfusion is most established for The difficulty with the use of low-kV in single- cerebrovascular and cancer assessment, and energy CT is increased image noise, but in consensus guidelines now exist for the acquisi- DECT, the noise of the low-kV data is offset by tion and processing of perfusion studies for the the decreased noise of the higher-kV data, and brain and body. The main applications have been this can be very useful for visualisation of hypo the confirmation of stroke diagnosis and extent, and hypervascular lesions of the pancreas and to identification of penumbra, and selection of increase the identification of hyperenhancement patients for thrombolysis, as well as lesion char- in the small bowel, for instance. Regional bloodflow images (sagittal, coronal and axial) of a vascular renal metastasis located in the right adrenal. acterisation, risk-stratification and assessment of A volume of interest is delineated around the tumour. A marked reduction in bloodflow is seen following two treatment response in oncology. It is also being “Iodine-containing pixels can be identified and cycles of a tyrosine kinase inhibitor. (Provided by V. Goh) considered for cardiovascular assessment, renal then highlighted using colour overlay techniques. assessment, assessment of ischaemia (e.g. bowel, Using single-energy CT, it can be difficult to differ- During his presentation, Guimarães will describe identification of monosodium urate crystals for limb) and inflammatory conditions (e,g. pancre- entiate between a haemorrhagic renal cyst versus a many more examples of the clinical advantages the diagnosis of gout. atitis, diverticulitis). papillary renal cell carcinoma. By classifying pixels of DECT, including bone removal techniques and as containing iodine using DECT, a single contrast- “It is important to ensure your acquisition tech- enhanced pass through a renal mass may be able to niques are optimised for kinetic modelling and clarify the issue of whether a renal lesion has mini- New Horizons Session that the signal-to-noise ratio is adequate. Motion mal contrast enhancement,” he said. Friday, March 4, 16:00–17:30, Room A correction and image registration are essential for sites affected by motion,” she said. “Radiation dose Iodine identification can also be used to create NH 6 Not just Hounsfield numbers: CT aimed at the fifth dimension? remains an issue. Dose should be documented for virtual non-contrast images by removing the • Chairman’s introduction every patient. Dose may be minimised by scan- iodine-containing voxels. Creation of a virtual J.M. Boone; Sacramento, CA/US ning at a lower kV, such as 80 kV versus 120 kV, or non-contrast image set from a contrast-enhanced • Basic principles of dual energy CT reducing temporal interval between acquisitions. nephrographic or pyelographic phase dataset W.A. Kalender; Erlangen/DE Also, try to use the smallest coverage necessary to can lower radiation dose if an unenhanced scan • Clinical examples of dual energy CT encompass the lesion of interest.” can be avoided, and this can be used to identify L. Guimaraes; Viseu/PT renal stones from surrounding iodine-containing • CT contrast perfusion Dual energy CT (DECT) images can be manipu- urine. However, this approach is less efficient in V.J. Goh; Northwood/UK lated to provide quantitative information about obese patients and it fails to detect a small minor- • Panel discussion: the elemental composition of tissues, which can ity of stones less than 3 mm in size. Will CT surprise us again?

myESR.org 10 ECR TODAY 2011 CLINICAL CORNER Friday, March 4, 2011

Uncertainty remains over MRI’s precise clinical role in breast imaging

By Frances Rylands-Monk

MRI can be of value for detecting cancer recurrence in the treated breast, but it con- tinues to arouse controversy when it comes to other indications. Any discussion of the potential applications of MRI for pre-treat- ment and for screening high-risk populations tends to raise more questions than answers.

There is an urgent need for radiologists to be clear about the indications for MRI and to be aware of its advantages and limitations, espe- cially in cases of high-risk, noted Dr. Corinne Balleyguier, a radiological cancer specialist at Institut Gustave Roussy, Villejuif, Paris. Women carrying the BRCA1 or BRCA2 genes have a 70% to 80% chance of developing cancer, and require a yearly examination with mammog- raphy, ultrasound and MRI, and while ultra- sound and mammography can detect around half of cancers in younger women with denser breasts in this population, MRI can detect between 80% and 100%, she added.

“One of the main problems with breast MRI is that its high sensitivity makes for a ‘false positive’ rate of 20–30% in this indication, with the potential of some of these false posi- tives resulting in stressful and expensive MR- guided biopsies. Despite this, the advantages of MRI for these high-risk patients outweigh the danger of false-positives,” said Balley- guier, who will be a speaker at this afternoon’s A 36-year-old woman with palpable nodules at the lower external left quadrant. Mammography (upper panels) shows an extremely dense pattern without any suspicious refresher course on breast MRI. finding on either right or left breast. Ultrasound (not shown) demonstrated three hypoechoic nodules. One of them was biopsied, revealing invasive ductal cancer. MRI (lower panel) showed 22 suspicious enhancing lesions confined in the lower external quadrant of the left breast. Moreover, one enhancing lesion is found in the right breast (arrow), not detectable at targeted second look ultrasound. The patient refused MR-guided biopsy of the contralateral lesion. Left mastectomy was performed, confirming multifocal A gain in survival for BRCA1 mutation car- cancer on the left. At one-year MRI follow-up after chemotherapy, the contralateral lesion was no longer detectable. (Provided by F. Sardanelli) riers due to an earlier diagnosis of highly aggressive triple negative cancers with MRI is probable, but still has to be demonstrated.

“Another issue still open to debate is the “Although we know through a recent five-year ment. The advantages and limitations of 3T possibility that MRI in this indication can study that recurrence is lower in patients who breast imaging will be discussed at the ses- replace mammography, avoiding radiation undergo pre-treatment MRI, we don’t know sion. The role of CAD, in terms of kinetic exposure for high-risk patients. BRCA1 and if these women survive longer than women tasks, lesion-targeting for MR-guided biopsy, BRCA2 mutation carriers who are more sen- who don’t,” said Balleyguier. “However, we and correcting movement artefacts as well as sitive to radiation than the general popula- know that recurrence rate is an element of future developments in the pipeline for CAD tion,” said co-speaker Prof. Francesco Sarda- poor proper prognosis. If we can avoid local morphology tasks, will also be covered. nelli, EuroAIM director, University of Milan recurrence and provide better treatment at School of Medicine and director of radiology the start, then it makes sense that survival To improve image interpretation in breast at the IRCCS Policlinico San Donato, Italy, will improve.” MR, she thinks personal evaluation and who will focus on evidence-based controver- auditing can be useful. Radiologists need to sies at today’s session. Evidence-based medi- At today’s session, she also intends to discuss work on sequences with various protocols on cine (EBM) is a key topic for medical profes- technical aspects for obtaining high qual- different machines to improve quality, and sionalism, including that of radiologists, the ity images, one among several criteria for results should be evaluated. If the radiologist goal of which concerns ethics (i.e. doing the optimal interpretation. Part of her talk will detects additional lesions and the patient has best for patients) and economics (notably deal not only with the use of contrast but to have surgery, then you should be interested avoiding needless examinations and treat- also the importance of T2 imaging to distin- in histological results and treatment in order ments), he elaborated. guish between malignant and benign lesions. to determine if the correct recommendations “Benign and malignant lesions can both were made, she explained. “Radiologists must Perhaps the most controversial indication of enhance. In this case, we look at T2-weighted face the consequences of what they say to breast MRI to date is for staging of breast can- imaging, and if the enhanced lesion is very improve their level.” cer. The discovery of additional cancers by bright, it is usually not a cancer but a benign MRI that were undetected by mammography lesion such as a lymph node or cellular Breast cancer staging in a 42-year-old woman using during staging throws patient management fibroadenoma. Comparison of T2 and T1 plus sagittal 3D sequence with gadolinium chelates injec- into question and so far no studies point to contrast can help to decrease false positives.” tion, subtraction. A bifocal lesion is seen on this view. a clear gold standard, commented Sardanelli. The size of the largest lesion was 50 mm. Mammo- graphy and ultrasound only depicted a unique 40 mm “We see more with preoperative MRI but we The emerging role of diffusion-weighted lesion. Breast MRI can be a valuable imaging tool for do not know if this has a positive impact in imaging (DWI) in diagnosis may also pro- staging lobular infiltrative carcinoma, as in this case. terms of patient outcome. This debate will mote discussion. Sardanelli identifies new (Provided by C. Balleyguier) continue in the next few years and its conclu- non-contrast MRI approaches such as highly sion is not around the corner.” spatially resolved water-selective sequences as the next decade’s major trend. Refine- Additional MRI findings have an impact on ment of current non-contrast approaches, ipsilateral treatment planning in about 11% of especially DWI, may become a substitute for Refresher Course patients, causing wider local excision or shift- contrast-enhanced MRI, as has been demon- Friday, March 4, 16:00–17:30, Room F2 ing from breast-conserving surgery to mastec- strated in studies on the detection of residual tomy, while in about 3–4% of patients, occult tumour after chemotherapy. This has poten- RC 602 Breast MRI today contralateral cancers are detected with MRI. tial implications for screening and for the • Chairman’s introduction “A percentage of these lesions – how many, we general female population, but radiologists W.A. Kaiser; Jena/DE do not know – could be cured with radiation have to prove the high negative predictive A. How to perform and interpret high quality breast MRI therapy or chemotherapy. Thus, there exists a value of these approaches in screening. C.S. Balleyguier; Villejuif/FR real risk of over-diagnosis and over-treatment, B. Evidence-based controversies especially for ipsilateral findings,” he said. Balleyguier pointed to the possibility of clini- F. Sardanelli; Milan/IT cal 3T with spectroscopy and DWI to detect C. How to improve the specificity of breast MRI Balleyguier echoed Sardanelli and pointed to more lesions and better characterise them, J. Veltman; Nijmegen/NL the need for long-term studies of at least ten but she admitted that as yet there was not • Panel discussion: years to follow patient outcomes. enough data to firmly support this develop- Do we find too many cancers with MRI?

myESR.org Friday, March 4, 2011 CLINICAL CORNER ECR TODAY 2011 11

Radiologists and gastroenterologists increase their cooperation for improved efficiency

By Mélisande Rouger

Multidisciplinary work is key to modern medicine and one example of this is the smooth cooperation between radiology and gastroenterology. Imaging has become cen- tral to the detection, staging and follow-up of many diseases, including colorectal can- cer, one of the most widespread carcinomas worldwide. Technical refinements such as the recent introduction of virtual colonoscopy using CT have notably improved its early diagnosis. Experts will discuss how to further improve results during the ‘ESR meets Gas- troenterologists’ session today at ECR.

Optical colonoscopy (OC) is the gold stand- ard for the detection and post-treatment follow-up of colorectal cancer. Its practice enables biopsy and treatment of polyps dur- ing the same session. But virtual colonoscopy Elderly patient presenting with low grade bowel Crohn’s disease involving the transverse colon, with Acute ileal involvement by Crohn’s disease, with wall (VC) offers specific advantages, such as the obstruction. Optical colonoscopy was denied due to wall thickening and hyperhaemia of the colonic vessels. thickening and mucosal enhancement. possibility of reviewing images repeatedly. patient’s condition and a CT with water enema was performed in order to detect a large lesion. This was VC is more comfortable than OC, and it the case because the patient had an almost occlusive enables the imaging of patients who cannot cancer of the sigmoid. undergo a complete examination with colon- (All images provided by Y. Menu) oscopy due to stenotic changes or other tech- nical difficulties. Depending on the specific case, VC can also be a good alternative in the case of low prevalence. a part of Sweden. In other countries, screen- “Everybody agrees that incomplete OC is an ing is available but not actively offered to the excellent indication for VC, as well as indi- whole population. There may be a problem vidual detection in cases of low anticipated with the availability of colonoscopists across prevalence,” said ECR 2011 Congress Presi- the EU, but the main problem I think is poli- dent Professor Yves Menu, Chairman of the ticians’ awareness and willingness to allocate Department of Radiology of Saint Antoine resources for this purpose,” he said. Hospital in Paris. Many other gastroenterological pathologies ColoVirt 2D and 3D show the same image of a small (7 mm) sessile polyp of the descending colon. The modalities appear to be becoming require imaging for detection and evaluation. increasingly complementary. Follow-up pro- Ultrasonography is the first step when liver, grammes can also include VC in association pancreatic or biliary disease is suspected. In with OC. In patients requiring prolonged fol- inflammatory bowel diseases, CT and more “We should recognise that the future of copy, and virtual versus optical colonoscopy, low-up, both methods can be interleaved for recently MRI have proved to be valuable tools medicine is to improve prevention and per- the relationship between gastroenterolo- the detection of polyps or recurrence. for detecting and staging the disease, as well sonalisation. This will not be possible unless gists and radiologists has always been more as for monitoring treatment. all organisations cooperate closely, because it a scientific debate rather than a turf battle. However, areas of doubt remain concern- concerns not only the gastroenterologist and Although the discussions are sometimes pas- ing false positives in the case of faecal occult “Overall, gastroenterology is a specialty the radiologist but also other scientists like sionate, neither the gastroenterologist nor the blood tests. where imaging is dramatically important, biologists, epidemiologists and many more,” radiologist would ever fight against scientific as well as biology, but always in association Professor Menu said. evidence,” Professor Menu said. “In a patient with a positive faecal occult with clinical examination. The number of blood test, knowing the high rate of false patients who require treatment monitoring is Fortunately, things are running smoothly The participation of the UEGF in the ‘ESR positives, we lack evidence today to decide certainly increasing and imaging is a pillar in between gastroenterologists and radiologists. Meets’ initiative this year will certainly provide whether VC is a valuable step or if we should their surveillance,” Professor Menu said. more visibility for this successful cooperation. proceed immediately to OC. Some stud- “Our collaboration is excellent. The basis for all ies are ongoing and might provide us with Recent technical developments in radiology decision making in gastroenterology and many some guidelines in the near future,” Professor have improved both the detection and charac- other clinical specialties is multidisciplinar- Menu said. terisation of diseases. Advances are still ongo- ity, and in this process radiologists are a very ing, for instance with PET/CT in the manage- important part,” Professor Hultcrantz said. Technical advances in MRI have improved the ment of cancer, as imaging gears up towards staging of rectal cancer, especially in the predic- depicting function and metabolism, and “Although we have potential competition tion of local invasion. MRI is crucial when dis- enabling structure analysis. Striking evidence between endoscopy and imaging, for instance cussing a potential indication for neoadjuvant for this is the management of diffuse liver dis- with the development of endosonography, radiochemotherapy, and it also provides useful eases, according to the ECR 2011 President. small bowel imaging versus capsule endos- information when deciding surgical strategy. “In this indication, MRI is very complementary to There are several non-invasive methods, rectal endosonography,” he said. such as ultrasound/MR elastography, dif- fusion weighted MRI, as well as biological ESR meets Session Surgery is still the main treatment option and tests, that provide an excellent view of liver Friday, March 4, 16:00–17:30, Room C surgical techniques have been considerably fibrosis. Fatty liver disease and iron overload ESR meets Gastroenterologists improved. In parallel, the use of radiation and can also be quantified non-invasively. A sig- EM 2 Optical and virtual colonography: friends or enemies? cytostatics has also increased chances of survival. nificant number of liver biopsies can now be Presiding: R. Hultcrantz; Stockholm/SE avoided, to the greatest benefit of patients,” Y. Menu; Paris/FR National screening programmes for the early he explained. • Chairmen’s Introduction detection of colorectal cancer could also R. Hultcrantz; Stockholm/SE improve outcome. But although the European Radiologists are also gathering more and Y. Menu; Paris/FR Union has recommended their launch in all more information from inflammatory bowel • Facts from the statistician (true for once?): incidence, prevalence, rationale countries, most of them still do not have a disease and digestive oncology in general. for screening, standard results of optical colonoscopy well functioning programme, mainly because U. Haug; Heidelberg/DE of a lack of awareness from politicians and The challenge faced by gastroenterologi- • Facts from the statistician (true for once?): how accurate is CT healthcare officers, believes Rolf Hultcrantz, cal imaging today is to determine as fast as colonography Professor of Gastroenterology and Hepatol- possible the optimal strategies for detection, A. Laghi; Latina/IT ogy at Karolinska University Hospital, and characterisation and treatment monitor- • When optical beats virtual President of the United European Gastroen- ing. This goal, along with the financial con- J.F. Riemann; Ludwigshafen/DE terology Foundation (UEGF). straints in many institutions, means immedi- • When virtual beats optical ate improvements in efficiency are necessary, S.A. Taylor; London/UK “There are screening programmes in some as well as increased cooperation with other • Panel discussion: countries, such as England, Finland, Italy and disciplines. Integrated strategy? What about the outsiders (capsule, DNA, PET ...)

myESR.org 12 ECR TODAY 2011 CLINICAL CORNER Friday, March 4, 2011

Imaging children from head to toe

By Mélisande Rouger versity Hospital, Dublin, who will coordinate E3 – European Excellence in Education the course. Paediatric radiology is not recognised as a Foundation Course: Paediatric Radiology subspecialty in many European countries. Covering all body regions, experts will Friday, March 4, 08:30–10:00, Room E2 Training in this field is often very limited present typical scenarios and guidelines on E³ 320b Genitourinary problems: common daily practice or non-existent, leading to major shortages how to image young patients. Moderator: V. Donoghue; Dublin/IE of specialists right across Europe. As a con- A. Imaging strategy in urinary infections sequence, trainees have to gain knowledge In recent years, there has been controversy as M. Riccabona; Graz/AT where they can while general radiologists to the significance of vesicoureteric reflux in B. Urinary tract dilatation: what should be done, to whom and when? must keep up to date with new ways of imag- urinary tract infections in children, and much F.E. Avni; Brussels/BE ing children. Both groups will be given this discussion as to how these children should C. Renal and pararenal masses: basic rules opportunity at ECR, with a dedicated foun- be investigated. Traditionally, vesicoureteric P. Tomà; Rome/IT dation course detailing the most common reflux has been considered the major risk fac- situations encountered in paediatric imaging. tor for urinary tract infection and renal dam- Friday, March 4, 10:30–12:00, Room E2 age. However, it has been shown that infec- E³ 420 Common digestive problems in children: Many conditions encountered in infants and tion and renal scarring occur without reflux the radiologist as a key player young children are not seen in adults, and as and that in some patients reflux with associ- Moderator: A. Paterson; Belfast/UK a result different protocols to those used in ated infection does not cause renal damage. A. Abdominal and pelvic pain: a practical approach the adult population are often required for Besides, the role played by abnormalities of S.G.F. Robben; Maastricht/NL imaging these conditions. Many general radi- bladder function is increasingly recognised. B. Jaundice in children: common causes and imaging strategy ologists have to perform imaging in children D. Pariente; Le Kremlin-Bicêtre/FR at some point in their careers, so it is crucial “The current guidelines for investigation C. Neonatal bowel obstruction: the role of the radiologist that they know and understand the main dif- published by the National Institute for Health S. Ryan; Dublin/IE ferences in this field. and Clinical Excellence (NICE) in the U.K. are much more conservative than heretofore Friday, March 4, 14:00–15:30, Room E2 “More than half of paediatric radiology and are controversial. The European Society E³ 520 Thoracic diseases: common, important and potentially devastating examinations are performed by general radi- of Paediatric Radiology published its own Moderator: C.E. de Lange; Oslo/NO ologists, so it is very important to have a gen- imaging recommendations in 2008. These A. Investigating a child with a ‘cough’: a pragmatic approach will be discussed together with approaches eral overview for people who would not nec- C. Owens; London/UK essarily attend specialised paediatric radiol- to common scenarios in the different age B. Unresolving pneumonia: when and how to image, and clinical consequences groups,” Donoghue said. ogy meetings,” said Dr. Veronica Donoghue, K. Foster; Birmingham/UK paediatric radiologist at the Children’s Uni- C. Common cardiac disorders in children: the basic role of imaging With better equipment and better training C.J. Kellenberger; Zurich/CH in foetal ultrasonography, many congenital abnormalities are now detected early in preg- Friday, March 4, 16:00–17:30, Room E2 nancy. “An increasing number of foetuses with E³ 620b Common musculoskeletal disorders: how to avoid the traps! renal tract dilatation are being detected and it Moderator: A.C. Offiah; Sheffield/UK is important to discuss how to investigate the A. Imaging a child with a limp various grades of foetal hydronephrosis, as it A. Sprigg; Sheffield/UK is essential not only to reduce the number of B. Non-accidental injury: a radiologist’s nightmare unnecessary investigations, but also to avoid P.K. Kleinman; Boston, MA/US invasive procedures and to reduce the radia- C. Bone and joint infection and inflammation: pearls and pitfalls tion burden in children,” she said. G.-H. Sebag; Paris/FR

The use of foetal MRI provides much addi- Saturday, March 5, 08:30–10:00, Room E2 tional information in many instances. It E³ 720 Paediatric neuroimaging: let’s make it simple! allows far more detailed delineation of con- Moderator: J.F. Schneider; Basle/CH genital brain anomalies, which is very help- Chest radiograph on a 3 month old infant. The multip- A. Neurosonography in the neonate: rules of thumb le healing posterior rib fractures on the right side are ful to the obstetrician when counselling the G. Enriquez; Barcelona/ES very suggestive of non-accidental injury. parents and predicting prognosis. It also B. Common congenital cerebral abnormalities provides, for example, information about the A. Rossi; Genoa/IT foetal airway in cases of congenital neck and C. CNS infection and inflammation: signs you should not miss chest tumours, which helps in planning the M.I. Argyropoulou; Ioannina/GR method of delivery of the foetus. Saturday, March 5, 10:30–12:00, Room E2 E³ 820 What should we know about antenatal imaging? CT is commonly used in the adult popula- Moderator: C. Adamsbaum; Paris/FR tion to investigate symptoms relating to the A. Foetal imaging: current practice and evidence base abdomen and pelvis. Because of the increased C. Garel; Paris/FR sensitivity of children to radiation and their B. V entricular enlargement and beyond longer life span, non-ionising methods of E.H. Whitby; Sheffield/UK investigation such as ultrasonography or MRI C. Common chest and abdominal problems are employed where possible. All paediatric A. Darnell; Barcelona/ES CT examinations must be fully justified and the radiation doses should be lowered to be Saturday, March 5, 12:15–13:15, EPOS Area just sufficient to answer the clinical question. Self assessment test Moderator: V. Donoghue; Dublin/IE “This is really important. There is a lot to do Interactive computer evaluation of course learning Abdominal ultrasound examination in a 5 week old in educating radiologists and radiographers infant with vomiting. There is thickening of the pyloric on the importance of adjusting the parame- muscle in keeping with hypertrophic pyloric stenosis. ters on their CT scanners in order to decrease radiation doses in children, even if it means sacrificing the acquisition of ‘pretty images,’” Donoghue said.

Another point the session will explore, among others, is the delicate topic of non- accidental injury or child abuse. In infants, certain lesions, such as the classic metaphy- seal lesion and posterior rib fractures are suf- ficiently characteristic of inflicted trauma. Other fractures are less specific for abuse, but combined with clinical findings they may add support to this diagnosis, and the course will present several scenarios. Visit the

Image from an MR scan of the foetal brain demons- “It is really important for the trainees to be trating an open cleft in the brain bilaterally, which is aware of this condition and to be familiar Arts & Culture Booth lined by cortex. The appearances are compatible with with the specific findings, so that they know bilateral schizencephaly. The abnormality was much when to suspect it,” she added. more clearly delineated on the MR scan than on the in the entrance hall foetal sonogram. (All Images provided by V. Donoghue) Franz Marc, Red and blue horse, 1912 © Städtische Galerie im Lenbachhaus und Kunstbau München

myESR.org Friday, March 4, 2011 CLINICAL CORNER ECR TODAY 2011 13

BI-RADS 3 lesions prove controversial and pose management challenges

By Frances Rylands-Monk “Positive family history for breast cancer, the presence of a lump or a palpable lesion, a nip- Classification of lesions has very relevant con- ple discharge, pregnancy or the intention to sequences, not only in terms of patient out- become pregnant, a recently diagnosed breast come but also for further diagnostic assess- cancer and many other circumstances influ- ment in the context of increasing expendi- ence the final assessment,” Pina said. ture incurred by health systems. For breast lesions, BI-RADS 3 allows the possibility of In screening, BI-RADS 3 should be avoided, a ‘wait and see’ approach instead of imme- particularly because some screening pro- diate biopsy. Given the growing number of grammes do not allow for a three to six incidental benign findings during screening month re-evaluation. In the clinical setting, and clinical breast imaging, this can be a key the low positive predictive value (PPV) of benefit. BI-RADS 3 makes a short interval follow-up possible as an alternative to biopsy. The BI-RADS descriptors and classification system has provided a common formal lan- Oblique mediolateral view of the left breast in a 46-ye- Ultrasound confirms the lesion as a solid homogene- Today most biopsies are performed percuta- guage. Before it was established, confusing ar-old woman. A well delimited lobulated mass can be ous mass, parallel to the skin. These features suggest neously in an outpatient setting, under local terms such as fibrocystic disease or dysplasia seen. Ultrasound is needed to classify the lesion as a a fibroadenoma, but this lesion meets the criteria of anaesthesia, with no scarring and at low cost. were commonly used in reports, and many cyst or a solid mass. (Provided by L. Pina) the BI-RADS 3 category. Follow-up showed no changes This evolution in breast biopsy has resulted general physicians would mistakenly think a over two years. (Provided by L. Pina) in increasing numbers of biopsies, even in patient had a pre-malignant disease when the probably benign lesions. report simply described normal breasts dis- playing high density patterns. “The classification system isn’t an exact science. malignancy will be delayed. Conversely, if a Experts point to the fact that the defini- The main potential pitfall is incorrect classi- BI-RADS 2 lesion is classified as category 3, tion of less than 2% probability of cancer is Another advantage of BI-RADS has been fication,” said Dr. Luis J. Pina, a radiologist at patients may undergo unnecessary anxiety often ignored. A relatively large number of the introduction in the radiology report the University Clinic of Navarra in Spain and and potentially needless intervention. BI-RADS 3 findings tend to be biopsied due of a recommendation, including follow-up a speaker at today’s special focus session. “Spe- to the category being confused with R3, the imaging and interventional procedures. This cifically, the BI-RADS 3 category can become a Incorrect classification may not be just a European category of findings with a rela- increases the radiologist’s responsibility and ‘holding tank’ for problematic lesions which are question of inexperience. Differences in how tively low cancer probability but with a prob- also enhances his or her clinical role. But a so categorised without further diagnostic proce- BI-RADS is adopted as a common language ability that is still higher than BI-RADS 3. limitation of the system pertains predomi- dures. This typically occurs when inexperienced may also lead to problems of classification, nantly to the BI-RADS 3 category, which radiologists feel uncertain about diagnosis.” according to Prof. Francesco Sardanelli, “Prospectively speaking, radiologists should relates to cases of less than 2% probability EuroAIM director at the University of Milan put all the cases they believe to be associated of cancer, a rate which can only be evaluated If a BI-RADS 4 or 5 lesion is erroneously School of Medicine and head of radiology at with a cancer probability from 2% to 95% in retrospectively on a large number of cases. classified as category 3, the diagnosis of the IRCCS Policlinico San Donato, Milan. the category of BI-RADS 4,” Sardanelli said.

“How many radiologists specifically know In an ideal world there would be no BI-RADS that you can give a BI-RADS score to a lesion, 3 classifications, according to Pina. Recog- to a breast, to a woman, for a single examina- nising the impossibility of this, however, he tion or for the series of examinations?” asked suggests that this controversial classification Sardanelli. “After a breast MRI is performed should not exceed 7% of all mammograms. as a third step after mammography and ultrasound, a conclusive BI-RADS must be “Even this figure can be reduced through pre- defined at the end of the report; a suspicious vious imaging comparison and complemen- cluster of microcalcifications, even though tary studies, including non-imaging findings non-enhancing on MRI, remains a BI-RADS such as palpation, clinical symptoms and his- 4 because it may be a ductal carcinoma in situ tory,” he noted. (DCIS) with low angiogenesis.” Delegates at today’s session are likely to be After detection of a possible lesion using a seeking clear ‘golden’ management rules front-line method such as standard two-view on when to biopsy a BI-RADS 3 lesion and mammography, additional techniques should when to watch, particularly if they are keen be used if there is reasonable suspicion of can- to understand how to reduce the risk of legal cer. Superimposed breast tissue can mimic a consequences of delaying cancer diagnosis malignant lesion. If the lesion exists, other because of using this category. For Sardanelli, techniques can help the radiologist to decide the answer is clear: cases of a PPV for can- about the degree of concern and to classify cer of less than 2% should be checked and the lesion correctly. These will be discussed checked again. during today’s session. In addition, speakers will cover the influence of clinical data on “Radiologists should be trained for the classification. responsibility of diagnosis. This is what they are paid for,” he stressed. “If, and only if, your Risk profile is increasingly important in per- BI-RADS 3 categorisation is correct, then sonalised medicine, and this is equally true unless the patient is anxious about waiting, in breast imaging. Carriers of BRCA1 or the logical choice is to watch and follow up at BRCA2, high risk related to a previous cancer, six months. The only alternative is to perform and a high-risk lesion such as lobular neopla- a large number of useless biopsies that would sia, atypical ductal hyperplasia or papilloma- reduce your credibility and that of the centre tosis all change the likelihood of cancer for where you work.” a ‘probably benign’ finding initially thought to be BI-RADS 3 to BI-RADS 4. Management must then be changed accordingly.

Special Focus Session

Friday, March 4, 08:30–10:00, Room F2 SF 3a The BI-RADS 3 controversy • Chairman’s introduction M.G. Wallis; Cambridge/UK • Defining lesions to follow-up P. Skaane; Oslo/NO • Decr easing the number of BI-RADS 3 in clinical settings L.J. Pina Insausti; Pamplona/ES • Management of BI-RADS 3 lesions F. Sardanelli; Milan/IT • Panel discussion: BI-RADS 3: biopsy or watch?

myESR.org 14 ECR TODAY 2011 CLINICAL CORNER Friday, March 4, 2011

Oncologic imaging moves forward in assessing therapy response

By Frances Rylands-Monk

To counter the burden of cancer on healthcare systems and imaging departments, radiolo- gists need to better understand how treatment is changing, as well as novel ways of measuring response, in order to optimise timely patient management. ECR 2011 delegates will disco- ver that PET is proving particularly valuable in assessing how cancer patients respond to FDG-PET image shows an FDG-avid mass of a lymphoma. (Provided by S. Barrington, St. Thomas’ Hospital, London) treatment.

As more targeted treatments for cancer con- tinue to emerge, healthcare professionals’ expectations of response evaluation are chan- ging fast. Previously, oncologists would look at mass dimensions changing after cytotoxic treatment, but newer treatments may produce metabolic changes that are just as important as measures of treatment effect. An understan- ding of functional effect, therefore, is assu- FDG-PET shows a mediastinal lymphoma mass with low level FDG uptake of uncertain clinical significance. (Provided by S. Barrington, St. Thomas’ Hospital, London) ming ever greater importance for oncologists.

Functional imaging to measure cellular and metabolic effects, usually by means of a PET “Pharmacodynamic read-outs provided by in the tumour. In phase II, functional imaging which imaging interpretation is dependent on scan with an FDG (fluorodeoxyglucose) tra- MRI indicate whether or not a drug is acting is being used as a surrogate endpoint to pre- the person reading the examination,” Johnson cer, is commonly used in lung and oesopha- by the mechanism one hopes or expects, pro- dict response to a novel agent. In phase III, the said. “Standardisation is challenging enough geal cancer and malignant lymphoma. Cli- ving a useful tool in drug development,” said role of functional imaging in the treatment as it is and the goalposts keep moving.” nical trials involving newer tracers that can Prof. Peter Johnson, professor of medical algorithm is being tested, using FDG-PET, for produce details about cell proliferation, the oncology at the Cancer Research UK Centre, example, to explore whether radiotherapy can A case in point is FDG-PET, which is a rela- induction of apoptosis and metabolism are Southampton General Hospital, Southamp- be omitted or drug therapy de-escalated in the tively established functional technique, but at an early stage of development, but if they ton, U.K. He will be speaking at today’s special treatment of Hodgkin lymphoma patients. only now is some consensus developing on prove conclusive, these markers look set to focus session entitled ‘Tumour response to how the images should be interpreted. In non- find their way into the clinical setting over the treatment: RECIST, desist or insist?’ Johnson believes there is still a lot of straight- Hodgkin lymphoma, a low level signal on next few years. forward cross-sectional imaging needed in FDG-PET after treatment may still be open In the U.K. cancer research arena, there clinical practice to evaluate tumour response to interpretation and can be deemed ‘negative’ The use of functional MRI to measure meta- are more than 250 ongoing trials at any one to treatment, but it isn’t always appropriate or ‘residual tumour’ depending on the con- bolism and blood flow is also under evalua- time with novel and functional imaging used for newer treatments where gross anatomi- text. This may have serious implications for tion in gauging the response to treatment of throughout. In phase I, for example, pharma- cal changes may take a long time to develop management of the individual patient, and at common solid tumours such as bowel, breast, codynamic readouts are helping determine or where tumour stabilisation is the goal. In present the level of concordance is not high. lung and prostate. whether a drug is hitting the intended target these cases, functional information depicted through imaging is particularly pertinent as Prof. Larry Schwartz, chairman of radiology an early indication of whether the treatments at Columbia University College of Physicians are working in individual patients. and Surgeons, U.S., also stresses the need for standardisation to allow consolidation and At today’s session, Johnson will share his per- further development of techniques for ima- spective as a user of imaging services on the ging response to therapy. He cites an earlier key role of imaging, both conventional CT and and greater recognition in Europe, compared Visit ESOR at ECR 2011: newer functional techniques, and he will exp- to the U.S., of the need to standardise because • Booth in entrance hall lain why imaging is critical in the guidance of of the existence of disease-focused centres. • Info desk in Rising Stars Lounge

• Session on March 4, new treatment development. 14:00–15:30, Room Q “Now we need to improve and propagate the The relationship between the disease, the information we have already. There is a capa- treatment and the imaging modality used to city to standardise what didn’t exist a few years ESOR measure results is complex, and all three vari- ago due to growing recognition of the impor- European School of Radiology ables must be carefully addressed, he explains. tance of this field, leading to better quantita- The usefulness of PET as a measurement of tive imaging,” he noted. response in non-Hodgkin lymphoma will depend on how advanced the disease stage Today Schwartz will focus on functional ima- is, where in the body it is located and the pre- ging and improved quantitative non-functio- cise type of treatment used for the lymphoma. nal CT and MR imaging. These three factors will have a critical influ- ence on how well any imaging modality can “It is clear that these techniques will become perform. routine over the next three to five years. It is now a question of understanding capabilities. “It is vital for oncologists and radiologists to We need to apply imaging techniques properly have a good mutual understanding of what to the therapeutic options available, with spe- oncologists and their patients require. Oncolo- cific biomarkers applied to specific tumour gists sometimes don’t appreciate the degree to type and therapy,” he stated.

GALEN Foundation Courses GALEN Advanced Courses Neuroradiology Cardiac Cross-Sectional Imaging Special Focus Session May 12–14, Iasi/Romania April 14–15, Umea/Sweden Friday, March 4, 08:30–10:00, Room L/M Oncologic Imaging Urogenital Cross-Sectional Imaging May 26–28, Vilnius/Lithuania April 28–29, Barcelona/Spain SF 3c Tumour response to treatment: RECIST, desist or insist? • Chairman’s introduction Paediatric Radiology Abdominal Cross-Sectional Imaging R.H. Reznek; London/UK June 16–18, Sofia/Bulgaria October 13–14, Lisbon/Portugal • Monitoring response to treatment in patients with cancer: why and how. Chest/Cardiovascular Radiology Musculoskeletal Cross-Sectional Imaging The Oncologist’s view October 20–22, Prague/Czech Republic November 17–18, Lille/France P. Johnson; Southampton/UK Breast Imaging • Principles in the use of conventional/anatomic imaging for response November 3–5, Budapest/Hungary assessment L. Schwartz; New York, NY/US • PET in monitoring response W. Weber; Freiburg/DE An ESR initiative, in partnership with GE Healthcare & • Panel discussion: www.myESR.org/esor GE Healthcare Medical Diagnostics South Central Europe Why does the radiologist need to understand the importance of monitoring response and how it is done?

myESR.org Friday, March 4, 2011 CLINICAL CORNER ECR TODAY 2011 15

Molecular imaging starts to deliver on its promises after a slow start

By John Brosky The chairman, Prof. Guy Frija, from the radiology department, l’Hôpital Européen Georges Pompi- The introduction of molecular techniques in dou, Paris, acknowledges that with few applications radiology has so far been fairly underwhelming. approved for clinical use, molecular imaging may Microscopic bubbles and radioactive isotopes seem to be more of a dream than a reality. injected as contrast agents hardly seems the stuff of an advanced science; while the effects can be “Those who believe it is a dream are wrong. The spectacular, as in the case of the sudden illumi- reality is there are 1,500 compounds for molec- nation of vascular networks or a dynamic view ular imaging now under development,” noted of glucose uptake at a cellular level, these images Frija, adding that these new agents will challenge seem only to be enhancements of images from radiology practices on several levels. “Today the well-established modalities of MRI, CT and radiologists are achieving tremendously high lev- ultrasound. els of sensitivity across every modality, yet there is a lack of specificity for characterising tissue For a generation of radiologists accustomed to and disease.” seeing each year further innovations for acquir- ing ever more stunning images, molecular tech- The visualisation of metabolic functions using niques would seem to fit easily into radiology’s biomarkers promises to increase the sensitivity Transverse (left) and sagittal (right) 18F-FDG PET images of a human head fused with an MR image. The MR rapidly expanding toolbox. Taking a closer look, of conventional imaging modalities for diagnos- image was acquired with a dedicated 3D radial ultrashort echo time contrast, allowing the distinction of cortical bone structures and air regions and thus the generation of a correction map for the PET data with high accuracy. however, these modest precursors of molecular ing disease, yet it also demands that radiologists (Provided by V. Schulz, ExMI [RWTH-Aachen] & Philips) imaging may eventually evolve into powerful have a solid understanding of molecular biology techniques that can make inroads into radiol- to interpret results. Other agents under develop- ogy’s well-defined practice areas. ment involve the use of optical imaging technolo- gies, which is a totally new field for radiology, he Additionally, he will explore the challenges for designed for specific modalities and introduc- At this afternoon’s refresher course, ‘Clinical said. Furthermore, some molecular agents may radiology in the newer class of agents using opti- ing new modalities. For me, this is not a battle Potential of Molecular Imaging’, both the threats hold a challenge for interventional radiology, cal imaging techniques. These technologies are with other disciplines, it is a principle of giving to traditional radiology as well as the opportuni- given their ability to ‘see-and-treat’ disease by fast, cheap, and can be used by anybody, but this better patient care,” he said, adding that radiolo- ties posed by this emerging science will be dis- combining a biomarker to target a specific dis- can cause problems. Internal medicine special- gists need to take a more integrated approach to cussed and debated. The session offers a review ease state on a molecule designed as a therapy for ists or surgeons can inject a dye, create an image molecular imaging. of new probes and techniques being tailored for the disease. and then interpret the image any way they wish, clinical use, as well as a look at the value these but some of them do not really understand how Radiologists have already proven with CT, MRI novel visualisations bring in two major fields of Radiologists need to stop seeing themselves the systems work, creating a serious risk for false and ultrasound that they are capable of incorpo- diagnoses, cardiovascular disease and oncology. only as reviewers of images and more as doctors diagnoses, he stated. Conversely, radiologists rating new knowledge and skills and integrating investigating the pathophysiology of a patient have an ability to critically review images, search them into training programmes. “We will need for the diagnosis of disease and the evaluation for artefacts that may be present, and understand to adapt our practice to accommodate this new of therapy response, according to Prof. Fabian the physics behind the imaging technology. field. For future generations, it is clear that back- Kiessling, who leads the department of experi- ground and training will be very different, with mental molecular imaging at the Technical Uni- Frija reckons the convergence of molecular molecular biology being an essential part of their versity of Aachen in Germany. In his presenta- imaging and radiology is essential, if not inevi- working knowledge,” he concluded. tion, he will highlight where molecular imaging table. “Molecular imaging is going to fundamen- has already entered routine clinical use, such as tally change radiology, expanding our practice the family of agents for positron emission tom- into molecular biology, introducing molecules ography and Primovist, a gadolinium-based diethylenetriamine penta-acetic acid (DTPA) agent for liver conditions. Refresher Course

“Nuclear medicine generates ugly images that Friday, March 4, 16:00–17:30, Room N/O seem to be only dark blotches, yet there is a lot RC 606 Clinical potential of molecular imaging: radiologists can learn from the intensity of these between dream and reality spots, such as determining if tissue is prolifer- Moderator: G. Frija; Paris/FR ating,” said Kiessling, noting that the next wave A. Molecular imaging from bench to bedside of molecular imaging to enter the clinic will be F.M.A. Kiessling; Aachen/DE Knowledge of molecular biology will become an contrast-enhancement agents for ultrasound B. Car diovascular disease essential part of radiology training, predicts that target intravascular conditions such as ang- L. Hofstra; Utrecht/NL Prof. Guy Frija from Paris. iogenesis with a powerful potential to assess the C. Oncology effects of therapy on a tumour. M.G. Pomper; Baltimore, MD/US Report from the Slovene Association of Radiology

By Dimitrij Kuhelj, SAR President ventional radiology in Slovenia were actively involved, as well as Slovene interventional radio- This year featured an important anniversary for logists abroad. Presentations were interactive, the Slovene Association of Radiology (SAR), as including movies of the most interesting proce- it celebrated 60 years since its foundation as the dures with comments and questions, resulting in Slovene Section of Roentgenology and Nuclear a fruitful debate and exchange of opinions. Medicine by Prof. Hebain. Since its beginnings it has been the official educational and scientific Our traditionally good cooperation with neigh- organisation of Slovene radiologists, promoting bouring radiological societies, which has resulted and developing radiology in Slovenia through in several meetings, was this year extended with the exchange of information, and scientific and the first Serbo-Slovene radiological meeting. An educational involvement with the goal of impro- invitation from the president of the SAR to the ving patient care. Slovene radiologists gathered at 56th Congress of the Argentinean Radiological the society’s general assembly in Nova Gorica in Society resulted in an educational exchange for Ljubljana is one of Slovenia’s centres of radiology. November for a celebration and members’ elec- our members, and the first Argentinean radio- tions. The scientific and social programme fol- logist was expected in Slovenia for the end of lowed for two days, celebrating another impor- February 2011. the SAR hosted more than 100 Slovenians invol- resident places and attempts to reduce working tant milestone in Slovene radiology – 30 years of ved in radiology at the 2nd Slovenian evening in conditions were noticed. Also, the prices of MR interventional procedures at the General Hospi- Active attendance at ECR 2011 was promoted, Vienna during ECR 2010. and CT examinations were reduced by the Natio- tal Nova Gorica. The assembly was attended by resulting in an increased number of abstracts nal Health Insurance. The SAR aims to be invol- many Slovene radiologists involved in interventi- submitted for the meeting. Members of the SAR For the first time the Slovene Ministry of health ved in future price negotiations, which may be a onal radiology. The presentations included most as well as radiographers, nurses, physicists and has outlined the shortage of Slovene radiolo- tough battle, since it has no formal influence at of the fields that Slovene interventional radiology industry representatives will be invited to the gists, lacking 38 doctors (28%) compared to the present. deals with, and all the centres performing inter- 3rd Slovenian evening during ECR 2011, since European average. Still, only a small number of

myESR.org 16 ECR TODAY 2011 CLINICAL CORNER Friday, March 4, 2011

Consensus grows for switch from fluoroscopy to MRI in pelvic floor imaging

By Edna Astbury-Ward

After many years of using conventional fluoro- scopic evacuation proctography, or defecogra- phy, radiologists at London’s University College Hospital have switched over entirely to MR proctography for imaging of the pelvic floor. Fluoroscopy is only used when a patient has a contraindication to MRI.

“I have been won over to the extent that now I am not too sure that the fluoroscopic technique has any significant advantages over MRI,” said Prof. Steve Halligan, noting that MRI’s lack of ionising radiation is critical in a group of pati- ents comprising mostly young women.

At this afternoon’s special focus session, he Sagittal late evacuation view shows a cystocele in Left: MR image obtained at rest, after rectal filling with gel; normal values of ano-rectal angle and ano-rectal junc- will spell out the clinical rationale behind the the middle and posterior pelvic floor compartment. tion, with respect to the pubo-coccygeal line. Right: MR image obtained during straining and evacuation: a large (Provided by S. Halligan) anterior rectocele develops, associated with descent of the posterior pelvic floor. (Provided by F. Maccioni) change to MR. In a recent prospective study conducted at University College Hospital, researchers compared the clinical utility of both techniques. Results showed that when cli- MRI has emerged as an alternative method of use of MR tractography to detect neural abnor- multidisciplinary approach develops. Pelvic nicians (coloproctologists, urogynaecologists imaging in the evaluation and understanding malities, and the use of MR spectroscopy for a floor clinical units, based on teams of experi- and gastroenterologists) were asked to declare of disorders of the pelvic floor, due to its mul- more detailed analysis of muscular abnormali- enced physicians, surgeons and radiologists, whether they had a preference for either MRI tiplanar capability, high soft tissue contrast and ties underlying some pelvic dysfunctions, are of will become increasingly widespread in the or fluoroscopy, MRI was the clear winner. The adequate temporal resolution. particular interest. future, she predicted. fact that MRI is not performed in the physiolo- gical position (i.e. sitting down) did not appear At today’s session, she will discuss how MRI She expects that historical boundaries between to have a material impact on its clinical value. can demonstrate the main dysfunctions of the different specialists will be broken down, as a posterior pelvic floor, and she will also outline The concept of moving over to MRI might current clinical indications and implications seem daunting, but in reality the change is easy of dynamic MRI of the pelvic floor. A major and radiographic technicians have adopted advantage of MRI is that it provides a unified the MR technique enthusiastically, according view of the pelvic floor, and diseases of the to Halligan. Fluoroscopic methods require a anterior, middle and posterior pelvic floor single cine sequence at rest, and again whilst compartment can be adequately assessed in a voiding, which is obtained in the sagittal plane single examination. It can also help to reduce A premiere at ECR: (steady-state precession gradient echo, e.g. examination time, costs and patient discom- TrueFISP). This provides all required informa- fort, but importantly it provides a highly accu- Medical Students Sessions tion about the position of the pelvic floor and rate and non-invasive evaluation of a unitary pelvic organs at rest and during evacuation, system that is often assessed and treated sepa- At ECR 2011, for the first time ever, medical students will have the chance and it also provides an assessment of the com- rately. Furthermore, because dynamic MRI to present their own abstracts in front of a huge audience. pleteness and difficulty of voiding, if any. offers a complete evaluation of the posterior The submitters of the best 20 student abstracts have been invited to Vienna ano-rectal compartment and of the anterior to present their work, with free accommodation and travel Dynamic pelvic MRI can match the perfor- and middle compartments, urogynaecologists provided by the European Society of Radiology. mance of the fluoroscopic technique, but and proctologists can be assisted with their cli- there are other possibilities. For example, nical diagnosis, she added. the integrity of pelvic floor muscles is well demonstrated by MRI, unlike fluoroscopy, Whilst the examination is neither painful nor Friday, March 4, 12:30–13:30, Room L/M Saturday, March 5, 12:30–13:30, Room L/M and this may provide useful clinical infor- particularly disturbing, Maccioni believes that Session 1 Session 3 mation, although the precise role for MR still possible causes of discomfort may be related Moderator: H. Ringl; Vienna/AT Moderator: A.P. Toms; Norwich/UK needs to be defined. to claustrophobia, the use of a rectal contrast • Fascinating imaging and promising researches of the brain • Changing radiology teaching within the undergraduate medium, and attempting tricky manoeuv- A. Rácz; Budapest/HU curriculum in a single centre within the United • Intuitive updating of post-test probabilities in the light Kingdom While the effects on continence of anal sphinc- res under unfavourable conditions. It can be of new evidence: application and pitfall J.-R. Angus; Dundee/UK ter damage following childbirth are well esta- difficult, in a closed magnet unit and in the M. Benndorf; Jena/DE • Sono4You: ultrasound tutorials for students by students blished, the contribution made by damage to supine position, to attempt functional mano- • Scintigraphy of neuroendocrine tumours A. Sachs; Vienna/AT using 99mTc-Tektrotyde • A medical student’s journey in other pelvic floor muscles is not yet completely euvres, and sometimes this may be unhygienic, M. Stojkovic; Belgrade/RS research and radiology understood. Halligan expects to see clarifica- she added. MRI techniques should be further • Paracingulate sulcus morphology and europsychological S. Oberoi; Charleston, SC/US tion of this area over the next few years. Moreo- developed to reduce possible discomfort, and characteristics in people with a genetic susceptibility to • A day in the life of a radiology resident bipolar disorder: a neuroradiological study emphasising M. Maqbool; Dublin/IE ver, MR can afford the opportunity to make her suggestions for doing this include thorough the potential for prediction of development of psychosis • Problems in undergraduate education in Brazil spectroscopic measurements from the pelvic explanations to patients about the procedure. It by radiological methods D.B.D.Z. Dalke; Curitiba/BR floor musculature, and this may have clinical is critical because the success of dynamic MRI C. Carstairs; Edinburgh/UK • Coronary CTA: input of prospective cardiac gating to benefits, although this is very much work-in- derives from the effectiveness of the manoeuv- reduction of radiation dose Saturday, March 5, 12:30–13:30, Room N/O progress. res performed, she stated. M.A. Glatzkova; Moscow/RU Session 4 Moderators: A.K. Dixon; Cambridge/UK B.J. Hillman; Charlottesville, VA/US Pelvic floor disorders may be difficult to diag- Maccioni would also like to see the wider use Friday, March 4, 12:30–13:30, Room N/O nose, and are usually evaluated by combining of dedicated open magnets to allow the exami- Session 2 • Radiology: prejudices and hidden fascination A. Jost; Sulzbach/DE Moderators: A.K. Dixon; Cambridge/UK different clinical and radiological investiga- nation to be performed in a seated position. In • The x-choice B.J. Hillman; Charlottesville, VA/US tions, explained Dr. Francesca Maccioni of addition, she favours the use of high-field MRI E. Zagvozdkin; Moscow/RU the department of radiological science at the (3 Tesla) to boost understanding of the physio- • To be or not to be a radiologist: radiology through the • Magnetic resonance imaging University ‘La Sapienza’ in Rome. Dynamic pathologic basis underlying these diseases. The eyes of a medical student education ‘down-to-earth’ G. Ungureanu, V. Barbus; Cluj Napoca/RO L.I. Lanczi; Debrecen/HU • Improving the clinical supervision of undergraduate • Foetal ultrasound imaging: form of art students in CT B. Rancane; Riga/LV Special Focus Session E. Zaloni, V. Diakatou; Athens/GR • Radiology: a holistic medicine beyond medicine • Parents’ views of paediatric care concerning their child’s M. Petrini; San Donato Milanese/IT Friday, March 4, 16:00–17:30, Room L/M conventional x-ray examination C. Stanica; Arlöv/SE SF 6 Dynamic MR imaging of the pelvic floor: easy and useful Sunday, March 6, 12:25–13:35, Room E2 • Radiology as a career: what do students and interns Session 5 think • Chairman’s introduction N.M. Hughes; Dublin/IE Moderator: A.K. Dixon; Cambridge/UK D. Weishaupt; Zurich/CH • How radiology is changing: three unavoidable • Final Student Session representing • How I do it challenges for the future the four best student abstracts. C. Messina; Milan/IT C.S. Reiner; Zurich/CH • Students will talk about their experiences • Indications and spectrum of pathological findings and expectations, and give a short review F. Maccioni; Rome/IT of their abstracts. • Dynamic imaging of the pelvic floor: MR imaging or conventional technique? S. Halligan; London/UK • Panel discussion: Does dynamic pelvic MR imaging replace conventional defecography?

myESR.org Friday, March 4, 2011 TECHNOLOGY FOCUS ECR TODAY 2011 17

Inside IMAGINE workshop EIBIR continues to Interventional radiology’s proves popular grow and prosper time to shine

Today See page 18 See page 23 See page 24

PET/MR takes centre stage at technical exhibition in anticipation of European launch

By John Bonner

When the doors of the ECR 2011 technical exhi- bition burst open this morning, a host of surprises and innovations awaits congress attendees. Argua- bly the biggest highlight of all is the first PET/MR system ever displayed at the Austria Center, and it looks certain to attract massive attention and inte- rest over the next four days.

A combination of MRI and PET has long been High-resolution MR image of the hip with spectral considered as the logical next step in the evo- attenuated inversion-recovery (SPAIR) fat suppression lution of imaging modalities, but industry has (Provided by Philips) struggled to deal with the formidable technical challenges of achieving a happy marriage bet- ween the two approaches, notably the difficulties of developing a PET detector capable of coping PET tracer uptake in the liver can be combined with High resolution MR provides a clear image of the the time-varying enhancement of dynamic MR scans to pathology within the pelvic structure, while PET with the powerful static and dynamic magnetic visualise hepatic tumour characteristics. displays the hypermetabolism component of the lesion. fields generated by the MR coils. GE Healthcare (Provided by Siemens) (Provided by Siemens) made the first important move in developing the software needed to integrate data acquired through sequential scans made using the two modalities. Then Philips brought the two main items of hardware alongside each other, linked by a revolving table for easy patient transfer, and the company installed the first European system in a hospital in Geneva in April 2010.

Now Siemens’ engineers have successfully mer- ged the two modalities in a single unit, dubbed the Biograph mMR, which the vendor plans to launch commercially later this year. In the mean- time, radiologists will be able to examine the pro- totype on display in the technical exhibition, and if they are lucky, they will get to talk to Prof. Mar- kus Schwaiger and his colleagues from the Klini- kum rechts der Isar at the Technical University in Munich. The group has been given the privilege of putting the new machine through its paces.

Dr. Alexander Drzezga, from the university’s department of nuclear medicine, has been res- ponsible for setting up the system, which was To improve the precision of spatial registration, the Bio- The benefits of MRI in the study of neurological disea- Two-station torso imaging with multi-transmit. delivered in November 2010. It is currently being graph mMR system collects MR and PET data simulta- ses are well known and established, and it can lead to (Provided by Philips) used to scan up to five patients a day, but that neously from a single frame of reference. The result is a a better understanding of neurological pathologies. number is likely to grow as the Munich team combined MR and PET scan acquired at the same point (Provided by Siemens) explores the limits of the unit’s clinical potential. in time and reflecting the same point in the physiologic “Many neurological conditions are suitable for processes such as respiration. (Provided by Siemens) evaluation with PET/MR, including neurodege- nerative disorders, dementia, epilepsy and brain and its solid-state photodiodes. In getting the The company had to overcome huge challenges in get a better quality image and make more effici- tumours. With regard to evaluation of the cardiac two modalities to work alongside each other, the miniaturising the components to fit inside the coils ent use of the technologist’s time.” system, combined imaging of PET and MR may hybrid molecular MR system can scan the whole and making them tough enough to cope with the also show diagnostic advantages, while inflam- body in as little as 30 minutes, compared with hostile physical environment inside the machine, The main highlight of the company’s offerings at mation and vascular conditions are also areas of an hour or more needed for sequential exami- with its strong magnetic fields, eddy currents and ECR 2011 is a wide-bore 3T MR system, the Dis- interest,” he explains. nations. The machine also incorporates Siemens’ temperature changes. “The result offers a gain of covery MR750w, which incorporates its proprie- TIM (total imaging matrix) technology, which up to 40% in the signal to noise ratio and a 30% tary ART (acoustic reduction technology) system Drzezga believes that combining the two moda- seamlessly integrates multiple coil elements and improvement in throughput and eliminates the for reducing scanner noise. GE is also showing lities offers a number of clinical advantages, not RF channels and can reduce examination times need for coil/channel upgrades as the system is its new Optima MR430s 1.5T device, which is least in eliminating the need for separate diagnostic by up to 50%, according to the vendor. totally channel independent,” he stated. “So it is a designed for examining musculoskeletal injuries examinations. Furthermore, the exact anatomical significant step forward, especially in oncology- of the extremities and can free up places on the registration of structural and functional/molecu- Philips has been working on its latest MR techno- related applications. They become better, faster departmental work list for those patients needing lar information may improve allocation of suspect logy for almost as long as the search for a practical and more robust. We can do a total liver examina- more complex whole body examinations. findings and improve image quality, for example by PET/MR hybrid. After an eight-year development tion, including contrast, in less than eight minutes, motion correction of regions of the body that do not project, the company is promoting its Ingenia 1.5 or a whole body diffusion scan in 15 minutes.” Both these machines are commercially available remain rigid during examination. The Munich team and 3T systems, which it describes as the world’s and come equipped with the GEM suite, a set of will also be exploring how the performance of PET/ first digital broadband MR unit. This incorporates Improving the patient’s experience when he or receive-only RF surface coils. These can be used MR compares with that of PET/CT. There is some dStream architecture, which digitises the signal she is undergoing an MR examination has been individually or combined to provide the desi- evidence that the superior soft tissue contrast achie- directly in the coil. Vendors have been looking the main focus of GE Healthcare’s latest deve- red anatomical coverage, including head to toe vable with the newer system will offer significant for ways to shorten the analogue part of the sig- lopments in this modality. This aspect can have a coverage. Overall, the range covers 98% of examina- benefits, even before physicians consider the safety nal processing pathway because this offers the considerable impact on both the diagnostic accu- tion types. The GEM suite allows for independent issues involved with any radiation-based imaging potential for reducing signal loss and noise. The racy of the procedure and on workflow within selection of 160 coil-mode configurations, and the technology like PET/CT, suggests Drzezga. Philips approach goes further by digitising the the department, noted Marie-Caroline du Réau, system will auto-select the configuration that best signal within the coil itself and transporting it via GE’s European MR marketing manager. “If we fits the selected region of interest, the vendor states. The Biograph mMR is based on the Verio 3 a fibre optic cable to the acquisition electronics can create a stress-free environment, the patient Other key features include a total 205 cm scanning Tesla MR system with a 70cm bore that provides contained in the scanner cabinet, explains Maurits feels more comfortable and is less likely to fidget range, feet-first scanning in many cases and design enough space to position the PET detector ring Wolleswinkel, global lead for MR marketing. inside the machine and spoil the exam. So we can features to embrace patients of all shapes and sizes.

myESR.org 18 ECR TODAY 2011 TECHNOLOGY FOCUS Friday, March 4, 2011

New format for a popular feature: EIBIR presents IMAGINE Workshop

By Prof. Wiro Niessen, Rotterdam/NL neuro image analysis, image analysis in oncology, and image-guided interventions. At ECR 2011, the successful IMAGINE exhibition will return in an entirely new format. The workshop will consist of three lecture If you want to be introduced to novel and exciting sessions, in which the 15 abstracts will be technologies that will influence the future of presented, and interactive workshop sessions. At radiology, it is an event not to be missed. the workshop sessions, visitors will get hands-on experience of the techniques and tools. These The IMAGINE exhibition at the ECR has always sessions are at the heart of the ’EIBIR presents shown the latest developments in medical IMAGINE’ vision: to provide introductions to image analysis and image-guided interventions novel technologies from the researchers that by leading academic and industrial research are creating them. There will be some sessions groups. Starting this year, IMAGINE is being for which participants need to register, and one organised by EIBIR’s biomedical image analysis walk-in session. platform. The mission of this platform is to promote biomedical image analysis research on a European and international level, to foster collaboration, and to establish educational EIBIR presents activities in this field. ‘EIBIR presents IMAGINE’ IMAGINE Workshop is an important activity of the platform, aiming Oral presentations to introduce the radiology community to novel There will be special sessions in the developments that are not yet on the market. workshop area, giving applicants the In this way EIBIR’s IMAGINE functions as an opportunity to present their work. These ‘antenna’ for developments soon to come. Model of the cardiac chambers and coronary arteries, derived from CTA data. (Provided by W. Niessen) sessions are open to all ECR delegates. Friday, March 4 The developments presented at the ‘EIBIR 08:30–10:00 presents IMAGINE Workshop’ largely address processes, which in turn may lead to possibilities enable the integrated analysis of complex, 10:30–12:00 the potential and challenges that have been for drug discovery and development, improved heterogeneous imaging data that have been Saturday, March 5 posed by recent developments in biomedical diagnosis, prevention and early detection of acquired with different imaging modalities 14:00–15:30 image acquisition. Advances in medical imaging disease, improved treatment monitoring, and and at different time points. The overall aim is devices have drastically increased our capabilities improved treatment options, e.g. replacing to fully exploit the information available from Workshop (guided tour) to (non-invasively) study the human body, by conventional open surgery with image-guided, the imaging data for improved diagnosis and Saturday, March 5 providing detailed three or four-dimensional minimally invasive interventions. therapy. 08:30–10:00 morphological information on anatomy, 10:30–12:00 function and physiology. In addition, processes With these advances, the sheer size, complexity, Rather than by invitation, this year’s ‘EIBIR can increasingly be studied at a large range of and heterogeneity of imaging data available for presents IMAGINE’ includes 15 contributions Sunday, March 6 spatial and temporal scales, thanks to – amongst biomedical research and clinical practice have that were selected by peer review. In total, 14:00–15:30 other factors – the availability of a large number increased enormously. Consequently, the lack 58 academic and industrial research groups of custom-made biomarkers that enable the of adequate image processing techniques to submitted abstracts, which were reviewed by Walk-In Session visualisation of specific processes at a cellular and analyse these data has become a main obstacle. members of the biomedical image analysis Saturday, March 5, 12:00-14:00, Room U molecular level. These developments have a large The ‘EIBIR presents IMAGINE’ workshop will platform. Submissions were solicited in the Places will be allocated on a first-come, first- potential to improve our understanding of disease address the urgent need for solutions which following fields: cardiovascular image analysis, served basis.

Proving your skills in an exciting tournament atmosphere The 4th Post Processing Face-Off Session at ECR 2011

By Dr. Anno Graser, Munich/DE University of Munich’s Garmisch MDCT Meet- Francisco? Many of the workstations were ing, might potentially remember the session unable to stand the test and froze or crashed After the great success in the last three years, as one that is fun to attend, and exciting, too! in front of the audience, making both the pre- ECR 2011 will, for the fourth time, feature a Workstations by different vendors are set up senters and the manufacturers break out in a ‘Workstation Face-Off’ session. Continuous on stage side-by-side, and are operated by sweat. rapid technical advances in CT require state- expert radiologists whose task it is to present of-the-art post processing tools and worksta- clinical cases. Nowadays, systems run at a much more stable tions. Increasingly, these solutions are based on pace, and these events happen far less often. a thin client-server architecture which signifi- In order to generate a true tournament or con- Nevertheless, there will be a thrilling atmos- cantly speeds up loading times and workflow. test atmosphere, everyone must show the same phere in the room, which can be felt from the cases in a very limited amount of time, usually very beginning as everyone is setting up their In the 21st century, radiologists have to be 4–5 minutes – definitely in a much shorter systems and the room bustles with industry able to interpret 3D datasets and to handle period of time than would usually be available staff, radiologists, and ECR personnel. Finally, large data volumes. For numerous applica- back home when interpreting a complex case when the lights come down and everyone is tions, dedicated post processing applications that requires dedicated post-processing on a in their seats, you are guaranteed some world are available. All major vendors offer an workstation. To make this a fair game, cases class radiological entertainment and educa- ample variety of hardware and software, and are provided to the companies 3–4 weeks in tion as the leading experts in the field use the it is often difficult to recognise the individual advance, and each vendor can invite an expert latest post-processing technology. strengths and weaknesses of different systems. of their choice to present these cases on the Our 4th annual Post Processing Face-Off Ses- podium. Where else would you find an opportunity to Anno Graser from Munich, Germany, coordinates the sion will allow you to get an impression of the see so much different equipment in so little annual Post Processing Face-Off Session, along with 3D capabilities and large data volume handling I am in the lucky situation to have been on time? As one of the organisers and moderators Prof. Becker from Munich. provided by the latest workstation technology. both sides of the game: moderating this type of the session, together with my co-chairman of session and presenting cases, and I have to Prof. Becker, I would be delighted to have you Many of you might have wondered what the admit that being in the hot seat as a presenter attend our session. This year, it will feature one 4th Post Processing name ‘Face Off Session’ actually means, and is extremely challenging; some would even call tricky abdominal CT angiography case and a Face-Off Session whether this type of session would actually be it nerve-racking. very complex, multi-modality oncology case. worth attending. Well – those of you who have See you in room B at 12:15 on Friday after- Friday, March 4, 12:15–13:30, Room B attended one in the past, be it here at the ECR, And who would forget the first Face-Off Ses- noon! Coordinators: H.-C. Becker; Munich/DE at the ISCT Meeting in San Francisco, or the sion at the Stanford MDCT Meeting in San A. Graser; Munich/DE

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8th Hospital Management Symposium at ECR 2011: the future of radiology Although challenged by turf battles and a lack of young radiologists, the prospects for molecular imaging are bright

Born in Germany in 1961, Symposium, ‘Radiology in Turf Battles’, which hand, further therapeutic implementation and is organised by ECR 2011 in cooperation with care. This will be the case for examinations of Professor Jörg Felix Debatin European Hospital. all types of organs. It will become important for studied at the Université Paris IX, radiologists to define themselves more as diag- ‘Gestion et Economie Appliquee’, Questioned in a European Hospital interview on nosticians and less as image providers. Paris, followed by the University the increasing shift towards medicine as a serv- ice and what such a service will look like, Prof. EH: How is the political world following this of Heidelberg Medical School, Debatin said, “Basically this is about looking at model? and took the executive MBA medicine from the patient’s point of view. The JD: German hospitals are paid for the delivery course at the Hochschule St. patient is not interested in the label on the doc- of a complete service. Admittedly, this is not yet Gallen (HSG) in Switzerland. tor’s coat describing their specialty, but whether linked to the quality of results, but development or not that doctor is competent. At the same is increasingly heading in that direction. Lump- Licensed as a physician in the time, we need to understand that the medicine of sum contracts are entered into that oblige the European Union, Stuttgart, he the future will no longer proceed according to set service providers to care for patients over a cer- became a resident for Diagnostic patterns. This means it will become more indi- tain period of time. Within this model there is vidualised. No course of a disease is ever exactly no room for people who do not provide added Radiology at Duke University the same. The causes for this lie in the hetero- value. Even today, although an oncologist may Medical Center, Durham, N.C., geneity of biology. At the moment we can only read a radiologist’s report on the development of USA, and received an Abdominal guess these differences in cell development by a tumour, he is likely to double check the tumour Imaging Fellowship at Stanford beginning to identify the genetic profiles of dif- size himself because he doesn’t trust the radiolog- ferent tumours. All these aspects taken together ical data. This current approach is a good exam- University Medical Center, mean that, in future, medicine will have to be ple of a scenario where a double effort is made California. organised in a different way.” without achieving double the added value.

Later he became Assistant Professor of Radiology European Hospital: Will payment structures EH: In that case, what skills does a radiologist at Zurich University Hospital, Switzerland; Asso- also have to be adapted? need? ciate Professor of Radiology, Senior Staff Radiol- Jörg Debatin: Yes of course. Whatever creates JD: The actual intellectual challenge for the future ogist and Head of Magnetic Resonance Imaging added value will be paid for. Priorities will change radiologist must be in integrating the volume of at Zurich University Hospital, and Professor and quite significantly. The diagnostic process will no available data and assembling it into an overall Chairman of the Diagnostic and Interventional longer be divided into imaging and non-imaging, diagnostic picture. The radiologist is predestined Radiology Department at University Hospital but there is a growing need and necessity to link for this. More than any other hospital specialist, Essen, Germany. laboratory diagnostics, genetics and imaging the radiologist is used to dealing with different with one another. For the radiologist this means departments. Therefore he is much better trained Since 2003, he has served as Professor, Medi- that he has to deal more with the content, i.e. with in interdisciplinary cooperation than doctors cal Director and CEO at the University Medical the diseases and their individual characteristics, specialising in laboratory work, for example. The Centre in Hamburg-Eppendorf (UKE). As a rec- and with possible therapies. radiologist communicates with doctors as well ognised hospital management expert and strat- as patients. Being able to process large volumes egist, under his leadership the UKE has devel- EH: How does this change affect a radiologist’s of data quickly, working in an interdisciplinary oped several innovative approaches to increas- daily routine? manner and then explaining results to patients ing medical quality, scientific performance, and JD: The former core business of the radiologist, in a comprehensible way - this is where the big profitability. i.e. image diagnosis, loses its relevance. These opportunity for future radiology lies. days, it’s not only image acquisition that’s taken Radiologists are becoming diagnosticians care of by technology but also increasingly the EH: Why is the self-image of radiologists often Hospital Management Rapid advances in medicine and technology have interpretation of images, which is carried out so different? Symposium led to a change in the job description for radi- automatically. However, a comprehensive look at JD: Changes are never easy. But radiologists also ologists. With image acquisition and evaluation all diagnostic data, of which imaging is certainly don’t want a de-intellectualisation of their field. The Future of Radiology increasingly being carried out by machines, there a significant part, is of great relevance. The chal- It’s pointless to train someone to become a doc- presented and organised by ECR 2011 is a need to find new fields of activity. But the lenge will no longer lie in locating a tumour on tor for six years, and then take five years to spe- and European Hospital required re-think is happening far more slowly the image but to integrate the image data with cialise as a radiologist if, in the end, they’re just than the pace of development in science and other data, and then to make an individualised stuck behind two screens. Diagnostic radiologists technology, according to radiologist and health- treatment recommendation. I think, in future, should not, and will not, volunteer to be pushed care management expert Professor Jörg Debatin. there will be a differentiation between diagnos- into such a corner. It is in the interests of sustain- The professor is the first speaker in the open- tics, which ends with an individualised therapy able radiology to achieve a re-think before it is ing session of this year’s Hospital Management recommendation and planning, and, on the other too late.

The Future of Radiology: Challenged by turf battles, too few young radiologists in Europe, but bright prospects in molecular imaging Saturday, March 5, 14:00–18:30, Room Q Moderator: Prof. Michael Forsting, Director of the Institute of Radiology and Neuroradiology; Essen/DE

14:00–14:15 14:15–15:30 Session 1 15:30–16:45 Session 2 17:00–18:30 Session 3 Welcome address and introduction Challenges: Radiology in turf battles Concerns: What can be done about the Prospects: Radiology is on a most Prof. Yves Menu lack of young radiologists in Europe? advanced pathway in molecular imaging Hospital Management ECR 2011 Congress President Prof. Jörg Debatin Hospital Management Radiology Medical Director and CEO, University Clinic Dr. Heinz Brock Prof. Nicolas Grenier Hamburg-Eppendorf; Hamburg/DE Medical Director and Managing Director, Hospital Service Chief at Service d’Imagerie AKH; Linz/AT Diagnostique et Interventionelle de l’Adulte, Radiology Groupe Hospitalien Pellegrin; Bordeaux/FR Prof. Philippe Grenier Radiology Chairman of the Department of Diagnostic Prof. Jarl Jakobsen (MHA) Prof. Osman Ratib Radiology, Hôpital Pitié-Salpêtrière; Paris/FR Consultant Radiologist, Department of Head of the Department of Radiology and Radiology and Nuclear Medicine, Rikshospitalet, Nuclear Medicine, University Hospital; Prof. Moshe Graif Oslo University Hospital; Oslo/NO Geneva/CH Director of the Department of Imaging, Faculty of Medicine Tel-Aviv University; Prof. Małgorzata Szczerbo-Trojanowska Dr. Clemens C. Cyran Tel Aviv/IL Chairman of the Department of Radiology Department of Clinical Radiology; Munich/DE and Head of the Department of Interventional Industry Prof. Fabian Kiessling, Radiology, University Medical School; Lublin/PL Peter Reimer Chair of the Department of Vice President, Global Marketing Imaging Industry Experimental Molecular Imaging, Systems, Philips Healthcare; Andover, MA/US Dr. Michael Friebe University of Aachen (RWTH); Aachen/DE Medical Physicist and Managing Director, Alliance Medical, Northern and Central Europe; Recklinghausen/DE

myESR.org 20 ECR TODAY 2011 TECHNOLOGY FOCUS Friday, March 4, 2011

8th Hospital Management Symposium at ECR 2011: the future of radiology

Philippe A. Grenier is member of leading societies, such as the Euro- 5) As their interests are driven by the market, Professor and Chairman of pean Society of Radiology, and the Interna- equipment companies advocate purchase of tional Society of Strategic Studies in Radiology. imaging equipment for clinicians. Radiology (General Diagnosis) Prof. Grenier has served as President, Chair and heads the Medical Board at and General Secretary of many radiological I recommend taking the following steps: Pitié-Salpêtrière Hospital, at the societies, served on the ECR Executive Com- mittee from 1997 to 2003, and was ECR Con- 1) Th e radiology department must ensure serv- Pierre & Marie Curie University gress President in 2002. Since 2009, he has also ice 24 hours a day for 365 days a year and in Paris, France. chaired the International Advisory Board of demonstrate efficiency, quality insurance and the RSNA. patient safety. An increase in productivity From 1967 to 1972 he trained at the School of may convince the administrative director not Medicine, University of Paris, followed by a His main interests are in chest imaging, lung to fragment and multiply imaging equipment residency in diagnostic radiology at the Assist- cancer, interstitial lung disease, airway disease, in clinical departments. ance Publique - Hôpitaux de Paris. After gain- COPD and asthma, on which he has produced 2) En sure competence of all staff radiologists in ing the French Board of Radiology certification, many notable scientific publications. He serves emergency radiology; develop radiology sub- between 1978 and 1982 he was a Fellow at the on the editorial boards of European Radiology, specialties; and participate in all multidiscipli- Radiology Department in Hôpital Beaujon, Fac- Academic Radiology, and Journal of Thoracic nary conferences. ulté de Médecine Xavier Bichat, Université Paris imaging, is on the Advisory Board of Acta Radi- 3) F orge an alliance with clinicians who have no VII, where he was later appointed Associate ologica, and has also authored numerous peer desire to engage in a battle against radiolo- Professor of Radiology. He then became Profes- reviews, book chapters and books, and presented gists, and keep a strong position on the hospi- sor of Radiology at the Faculté de Médecine de 155 guest lectures. tal’s Executive Board. Bobigny, Université Paris XIII, before taking his 4) R efuse clinicians any training in imaging current role in 1989. How to beat the shortage of young radiologists techniques and promote studies that compare Turf battles for imaging occur for several rea- the performance of radiologists and clinicians He has directed the Training Committee of Resi- sons: 1) Medical imaging has become essential in interpreting imaging examinations. dency in Radiology, been Vice-President of the to diagnosis, treatment planning and patient 5) Produce recommendations in training require- Pierre et Marie Curie University, and is a Mem- follow-up. 2) Interventional radiology provides ments of a high level in specific fields of radiology ber of the Board of the Medical School Pierre et efficient procedures that are credible alterna- to discourage clinicians from getting through. Marie Curie (Paris VI), and Director of the Med- tives to surgery, which offers a challenge to 6) Keep making progress in the science and ical Board at Pitié-Salpêtrière Hospital. surgeons. 3) Radiologists are currently facing knowledge of new emerging imaging tech- an explosion in demand and, paradoxically, niques or modalities. ‘Today’s research is Prof. Grenier was a founding member of the a simultaneous drop in human resources. 4) tomorrow’s clinical practice’. Hospital Management European Society of Thoracic Imaging and Radiologists do not have control of patients. Symposium

The Future of Radiology presented and organised by ECR 2011 and European Hospital

Moshe Graif, Professor of Israel Journal of Medical Science, Harefuah; grant tice supervision and inadequate maintenance of reviewer for the Israel Academy of Science, and skills due to the lack of CME and accreditation Radiology and Medical Imaging Chief Scientist at the Ministry of Health. Interna- processes – not to mention the ethical problems and a Member of the Education tionally, he has been, and is, a notable contribu- resulting from self referral and the frequent Board at the Sackler Medical tor to leading congresses, attending more than 70 abuse it generates. Faculty at Tel Aviv University, international and national meetings as chairman, presenter or co-author. These include the Euro- Allowing non-radiologists to ‘pick the cherries’ Israel, is also Chairman of the pean Congress of Radiology as a member of the off a discipline might cripple it and create a situ- Department of Medical Imaging International Relations Committee. ation where no one will be ready to provide the (Radiology) at the Tel Aviv remaining, less attractive, services. Therefore, Ichilov-Sourasky Medical Centre In education Prof. Graif has served as Adjunct the provision of a satisfactory continuous serv- Associate Professor at the Department of Radi- ice (avoiding a ‘vacuum’) and super-specialised in Tel Aviv, Israel; Chairman ology, Thomas Jefferson University Hospital, training and accreditation programmes are some of the Israel Radiological Philadelphia, USA, and Visiting Professor at of the necessary steps to cope with such trends. Association (ISRA); a Member the Department of Radiology, St Paul’s Hospital, Radiologists should also focus on enhancing the UBC, Vancouver, Canada and at the Depart- personal contact with patients that has been sig- of the Scientific Council of the ment of Radiology in the Italian Hospital in nificantly reduced in the last decade. Yet, radi- Israel Medical Association (IMA) Buenos Aires, Argentina, which is affiliated to ologists should be aware that certain conditions, and Member of the National BA University. such as a professional vacuum and overlap of ter- Council of Medical Imaging for ritorial borders, can also generate turf issues. A Steps to cope with ‘turf war’ convergence approach, consisting of joint teams the Ministry of Health. Turfing is a subversive activity based on a vari- that bridge sub-specialties, may prove construc- ety of economic and prestigious interests. It tive in overlap situations. Finally, the contain- Highly active in research, he has received 21 is opposed to the trend in modern medicine ment of technology and consumption by imple- grants, published 106 medical articles, and been towards harmonisation, ordinate formation menting the regulation of needs and decisions cited in medical literature 1,400 times. His edito- and QA processes. Usually, ‘highjacked’ serv- supporting (pre-authorisation) centres, which is rial activities include being area editor (Muscu- ices are characterised by uncontrolled training becoming more popular, will probably be helpful loskeletal) of the Journal of Clinical Ultrasound, processes, the absence of an official syllabus, no in reducing both inappropriate exams and inap- reviewer for JCU, European Radiology, IMAJ, board exams, a lack of formal (registered) prac- propriate performances.

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8th Hospital Management Symposium at ECR 2011: the future of radiology

In January 2010 Dr. Peter Following three years of sales and marketing a global vendor we face future turf battles with Reimer was appointed Vice assignments from Dröger Medical, the company new market entries, especially from Asia. To win appointed him head of its Business Management those competitive battles we are broadening our President of Global Marketing OR/Anaesthesia division in Lübeck. He then innovation focus to serve the changing needs of of Imaging Systems at Philips joined Philips Healthcare as Vice President of radiologists. Healthcare in Andover, Global Marketing of General X-ray, in Hamburg, Massachusetts (MA), where he covering the entire GXR business at three sites As clinical complexity increases and new appli- (Hamburg, Best, China). Philips then appointed cations for imaging emerge, influence is shifting is responsible for the Imaging him as Vice President of Global Marketing of away from the traditional role of the radiologist. Systems business group Computed Tomography. Based in Cleveland, The key to putting imaging first is to integrate (MRI, CT, Diagnostic X-ray, Ohio, Dr. Reimer was responsible for global innovation in a natural way. We are introducing Interventional X-ray, Ultrasound, upstream and downstream marketing (Product advances in nearly every aspect of radiology to management, Clinical Science, Field Marketing, help do just that. Women’s Health, and Nuclear MarCom, Strategy) for the entire CT business at Medicine). three sites (Cleveland, Haifa and China), before Better collaboration, enabled through advanced taking on his current role. technology, is fuelling a revolution in imaging In 1996, after gaining an engineering diploma science; one that leads to better outcomes and in Biomedical Engineering at the University of Combating industrial competition lower costs. With the launch of ‘Imaging 2.0’ Applied Science in Lübeck, Germany, Dr. Reimer for better patient care Philips serves the new needs of seamless inte- became a research engineer at the Medical Uni- Innovation in imaging in the last few decades was gration of hardware, clinical data and workflow versity Lübeck, until 2000, when he gained his mainly driven by new imaging modalities, better to facilitate new levels of collaboration between doctorate at the Technical University Clausthal image quality and improved workflow tools to radiologists and referring physicians – efficient, in Clausthal Zellerfeld. enhance diagnostic quality and confidence. As personalised care can be realised.

Dr. Heinz Brock was born What can be done about the lack At the level of every single department process, in Bludenz, Austria, in 1953. of young radiologists in Europe? management is the first-line measure to enhance Radiologists play an important part in the productivity without increasing workload. Tel- He studied medicine at the majority of diagnostic and therapeutic pro- eradiology might provide an opportunity for University of Innsbruck, Austria, cedures. For that reason, staff shortages in innovative working environments in the future. where he received his MD in radiology departments severely compromise National societies should assume responsibility 1980. He then took his residency the quality of clinical processes. However, the for the attractiveness of their specialty to young in anaesthesiology and intensive shortage is not evident in absolute terms, as the physicians. Training programmes and career number of radiologists is increasing in most options are the most powerful criteria when care at the General Hospital European countries. On the other hand, the choosing an occupation. Last but not least we (AKH) Linz, Upper Austria, rapid progress of imaging techniques boosts the need a clear strategy in health policy. As long where he became Head of the demand for specialised radiologists to an even as healthcare reforms focus on cutting costs Department of Anaesthesiology greater extent. In order to close the gap between instead of evaluating benefits the medical pro- and Intensive Care in 1989. In the currently available human resources and the fession will lose its fascination. addition, Dr. Brock completed manpower needed for high-quality radiology services, appropriate action has to be taken at academic training as a hospital different management levels. manager at the University of Economics Vienna and is a certified quality manager. Since 2002 he has been Medical Director and Managing Director of the AKH Linz.

Born in Norway in 1949, member of the European Society of Urogenital Positive rumours about the department enhance Jarl Jakobsen qualified as a Radiology. recruitment. Rumours are spread on compul- sory courses, at conferences, in alumni, on medical doctor, specialised in As well as organising and chairing several radio- social media (internet), when residents leave us, radiology and then gained a logical courses and lecturing, with a focus on etc. To us, recruiting good radiologists has been Dr. med. (habil.), Professor of radiological management/IT, ultrasound, con- very easy during the last ten years and we believe trast media and abdominal radiology, Prof. our reputation is a strong contributing factor. Master of Health Administration Jakobsen has authored over 100 scientific papers (MHA). and textbook chapters and produced articles for Many factors may retain young radiologists – popular journals. for example, possibilities to participate in aca- Working as a consultant radiologist since 1989, demic activities, to have some autonomy in from 1998 to 2005 he headed the Department of Improving the job’s attractions organising their working week (e.g. the use of Radiology at Rikshospitalet and, from 2005 to to enhance recruitment teleradiology from home, and on-call structures 2010, served as Chairman of the Division of Medi- The demand for radiology procedures, even on adapted to modern family life) and opportuni- cal Imaging and Intervention at Oslo University a 24/7/365 basis, seems to be increasing faster ties to specialise. The working environment is Hospital. Today, he is Professor of Radiology at the than the number of new radiologists. The short- also important. Leaders might have to choose university as well as Consultant Radiologist and age of radiologists creates a service provider between preserving the status quo and accept- Head of the Department of Radiology and Nuclear gap. Furthermore, quality, safety, education, and ing new structures. However, most adaptations Medicine at the Oslo University Hospital. research are threatened. are cheaper than being a bottleneck in the hos- pital, or having to start new recruitment. In the He has driven significant change in his posi- Generation X is now entering radiology. Their future we will meet new challenges, but compe- tion, organising a new department, overseeing preferences for and requirements from the job tent leadership will still be required when young digitisation, and the merging of imaging depart- may be different than those experienced by radiologists have to be recruited. ments in Oslo into one unit with 700 employees. today’s Heads of Department. Thus, recruiting He holds various board and committee posi- requires an open-minded dialogue and under- tions, is a member of national and international standing of who the applicants are and what radiological societies and a Fellow and founding kind of lives they will live.

myESR.org

Friday, March 4, 2011 TECHNOLOGY FOCUS ECR TODAY 2011 23

Another busy and successful year for the European Institute for Biomedical Imaging Research

By Gabriel Krestin, of the EIBIR guidelines, committed themselves Chair of EIBIR General Meeting, to making a more active contribution to EIBIR PEDDODE.NET Session ESR 2nd Vice President and and to making use of its services by spreading the Jürgen Hennig, word among their members. We look forward to Friday, March 4, 10:30–12:00, Room Z EIBIR Scientific Director their activity reports at the next general meeting, Multimodality Imaging: Do we apply too much radiation? to be held during ECR 2011. Moderator: M. Lassmann; Würzburg/DE During 2010 the European Institute for Biomedi- PEDDOSE.NET, the nuclear medicine project coordinated by EIBIR and endorsed by EANM, cal Imaging Research (EIBIR) underwent a num- We would like to mention just a few highlights of presents its first results. PEDDOSE.NET aims to systematically assess the evaluation of the ber of changes in its structure and operations. EIBIR’s activities during 2010. Detailed informa- impact on patients’ health of small amounts of radioactive substances, as currently used in tion can be found in the EIBIR Annual Report, a diagnostic imaging procedures. The network of scientific institutions has matu- copy of which can be requested from the EIBIR • Radiation Exposure in Nuclear Medicine for Children and Adults red and the services provided have become more Office at [email protected]. U. Eberlein; Würzburg/DE numerous and visible. Three categories of service Basics of NM dosimetry for imaging and presentation of dosimetric data including the role of ICRP103 package fees were introduced for EIBIR’s Net- We are pleased to report that the EIBIR Cancer • CT-Protocols and Radiation Exposure in multimodality imaging C. Vandervoorde; Gent/BE work Members and we are pleased that around Imaging Working Group has formalised this CT protocols, ways of measuring CT doses, exposure scenario 100 institutions have already moved over to year and joined forces with the corresponding • Strategies for optimising patient radiation protection in multimodality imaging the new system. Of course, change always takes ESR group to design a pan-European survey on Nuclear Medicine: time and we still have a lot of work ahead of us oncologic imaging training that will be launched M. Lassmann; Wuerzburg/DE in terms of increasing the service level for our shortly. Members of the working group are con- • Computed Tomography: subscribing Network Members and communica- tributing to the Innovative Medicines Initiative K. Bacher; Gent/BE ting with those who have not yet decided on their project QUIC-CONCEPT, initiated and coordi- EANM dosage card, optimising and standardising PET scans – the role of PEDDOSE.NET; future participation. nated by the EORTC. CT dose reduction scenarios

EIBIR Network Member Session

Saturday, 5 March, 16:00–17:30, Room Z Euro-BioImaging takes shape Moderator: S. Schönberg; Mannheim/DE General and specific aspects of Euro-BioImaging will be presented by the Scientific Coordinator and three work package leaders in order to introduce the project and to define a clear pathway for the involvement of the medical imaging community. Talks will specifically address work package related topics, but also indicate how the respective imaging community is represented in Euro-BioImaging.

• EIBIR Updates J. Hennig; Freiburg/DE • Overview Euro-BioImaging S. Schönberg; Mannheim/DE • Health Technology Assessment L. Sampietro; Barcelona/ES Prof. Jürgen Hennig from Freiburg/DE is the Prof. Gabriel Krestin from Rotterdam/NL is • Access to Innovative Technologies in Medical Imaging Scientific Director of EIBIR. Chairman of the EIBIR General Meeting. J. Hennig; Freiburg/DE • DK Emerging Technologies in Medical Imaging: From Patient to Population EIBIR is currently revising its member database The EuroAIM initiative, under its new leader J. Frokiaer; Aarhus/DK and online members’ area in order to reflect the Prof. Francesco Sardanelli, has established a • Discussion and Reception different categories of service packages. In doing European Working Group on evidence-based so, the functionality of the database will be impro- radiology that is highly active and will present its ved and some additional fields related to site capa- work at a dedicated session during ECR 2011. bilities will be added in order to ensure a compre- EuroAIM Session hensive and up-to-date database to facilitate the In April, the FP7 project PEDDOSE.NET started setting up of new initiatives and the building of under the coordination of EIBIR and has already Sunday, March 6, 10:30–12:00, Room Z consortia for upcoming projects. In fact our analy- made significant progress in evaluating potential Evidence-based radiology: why is evidence-based radiology crucial? sis shows that the database is consulted frequently health impacts of diagnostic imaging agent doses. Moderators: G.P. Krestin; Rotterdam/NL F. Sardanelli; Milan/IT and scientific and industrial partners of the Net- work are using it on a regular basis. Our two FP7 research projects that were started The experts from the European Network for Assessment of Imaging in Medicine (EuroAIM) in 2008, the cell imaging project ENCITE and will reply to this question. A special highlight will be the presentation of results of preliminary The Scientific Advisory Board was newly com- the breast cancer imaging project HAMAM, analysis focusing on the radiologist’s role in the production of secondary evidence, which is the best way to make impact on the whole medical world. posed last year with the aim of generating a pro- progressed well again during this year, with their active body that determines the scientific stra- second annual reports submitted to the European Abstracts of more than 3,000 published articles (1/2000 to 5/2010) were reviewed in tegies of the coming years. The new board has Commission and wide dissemination and trai- order to select systematic reviews and meta-analyses regarding imaging and interventional reviewed a number of Network Member requests ning activities in place. procedures. About 40% of them were submitted for analysis to the members of the Evidence- Based Radiology Working Group promoted by the European Network for Assessment of for support in grant proposal writing, offered Imaging in Medicine (EuroAIM). support to European applicants for the RSNA The COST Action on imaging and theranostics seed grant programme, and has held an electro- submitted by the EIBIR chemistry platform is • Applying EBM to radiology – the EuroAIM project (A-356) nic meeting to discuss priorities and initiatives currently in the final stages of evaluation and we F. Sardanelli; Milan/IT for the coming year. are confident that the networking activities on this • Secondary evidence for diagnostic imaging (A-357) hot topic in biomedical imaging will be fruitful. L.M. Sconfienza; Milan/IT The European Society of Radiology (ESR) has • Secondary evidence for interventional radiology (A-358) again provided significant financial support EIBIR’s experienced project staff have supported D. Vorwerk; Ingolstadt/DE to EIBIR with a contribution of about EUR the European Society of Radiology in success- • The ACRIN experience (A-359) 150,000 to complement the support provided fully applying for an EC Tender on radiation B.J. Hillmann; Charlottesville, VA/US by the EIBIR Industry Panel members, all of protection training. The tender brings together • Discussion and Reception which we gratefully acknowledge. This has allo- the main European stakeholders and professional Details: www.eibir.org wed us to invest in new projects, in particular groups relevant to radiation protection training the planning phase of Euro-BioImaging, which in the medical field. The aim is to provide an has been very intense and only received funding improved implementation of the Medical Expo- from the European Commission at the end of sure Directive provisions relating to radiation EIBIR (Medical Imaging) and EMBL (Biological tion of Europe’s biomedical imaging community. 2010. We are pleased that we were able to wel- protection education and the training of medical Imaging) and its FP7 preparatory phase proposal You are encouraged to visit the project website come a number of new companies as industry professionals in the EU Member States. has been scored by the European Commission www.eurobioimaging.eu to learn about the panel members during the year and very much (EC) as best among all infrastructure projects mission and possibilities for participation and hope that many more will realise the potential However, the focus of EIBIR’s attention and in the biomedical sciences field. The EC-funded contribution. of EIBIR and join forces with our researchers to resources has this year clearly been on Euro- three-year preparatory phase started in Decem- advance Europe’s biomedical imaging research BioImaging, the ESFRI research infrastructure ber 2010 with the aim of developing a plan to You are most welcome to visit the EIBIR booth landscape. project aiming to provide access to imaging construct and operate a set of complementary here at ECR 2011 (located on the entrance level) technologies across the full scale of biological and strongly interlinked infrastructure facilities to learn about EIBIR’s services and activities as And of course we would like to acknowledge our and medical applications, from molecule to pati- distributed throughout Europe. The infrastruc- well as to pick up your personal copy of the EIBIR shareholder organisations who, with the adoption ent. The project is scientifically coordinated by ture project relies on the support and participa- Annual Report 2010!

myESR.org 24 ECR TODAY 2011 TECHNOLOGY FOCUS Friday, March 4, 2011

Interventional Radiology’s time to shine

By Ciara Madden, CIRSE Office hosts Europe’s premier interventional oncology congress, the European Conference on Interven- These challenging times present opportunities tional Oncology (ECIO), a biennial meeting that for those ready to face the challenge, and so the will next take place in spring 2012. ECIO 2010 Cardiovascular and Interventional Radiology was a huge success, as we welcomed delegates Society of Europe (CIRSE) finds itself on the not only from our own IR ranks, but also our threshold of a new era of possibilities. CIRSE colleagues from diagnostic radiology, oncology has been representing the European IR commu- and hepatology. Interventional oncology was nity for 25 years, and is now ready to make an also showcased in our major new PR campaign – even greater mark on the medical community. Interventional Quarter. The discipline has grown steadily over the last decades, developing new techniques and refi- An IR society for IRs ning old ones while building strong cooperative CIRSE has developed significantly in recent partnerships with other medical disciplines, and years from a congress-based organisation to what has been put in motion will continue on its a member-focused one, which is involved in a steady trajectory. Opportunities beckon, and we multitude of different activities. CIRSE’s Euro- look forward to meeting the challenge. pean School of Interventional Radiology (ESIR) offers dedicated training courses, as well as an Vascular Interventions easy-to-navigate website, which offers members The development of vascular interventions laid access to a host of lecture slides, abstracts and the cornerstone for interventional radiology, video lectures. and remains an important area of CIRSE’s work. CIRSE 2010 experienced record-breaking numbers of participants. Below-the-knee interventions in particular are CIRSE supports its members and their interests experiencing increasing demand, in light of the through various research, lobbying and promo- growing number of diabetics who are at high risk economy lost $39.8 billion due to lost work days, many diverse areas, not least of which is the tional activities. Patient information brochures of vascular occlusion in the lower legs. Accor- mortality and permanent disability. recently emerging subspecialty of interventional in several languages have been made available ding to the WHO, the UN and the World Bank, oncology. IR has long been offering cancer pati- to members, and an IR magazine for non-IRs, diabetes is set to reach pandemic levels in the Interventional radiology can help these patients, ents palliative treatments for their conditions, Interventional Quarter, is distributed to a wide near future, mainly due to poor lifestyle choices. as lower limb revascularisation can help avoid or with drainage and tumour-shrinking procedu- readership. Should you wish to pick up a copy of Between 1985 and 2007, the incidence of diabe- minimise the degree of amputation, being better res relieving the pain and discomfort felt by so the latest issue, or find out more about our many tes rose from 30 million to 246 million, and is for patient, health payer and society. In preserving many. Over the last decade, IR’s involvement activities and publications, please call by the estimated to skyrocket to 380 million by 2025. physical integrity, IR offers patients independence has become more active, with techniques and CIRSE Booth here at the ECR, or visit the web- Amongst other dangers, diabetics are at signi- and better quality of life, and CIRSE looks for- therapies being improved and adapted to offer sites listed below. ficantly higher risk of lower limb amputation, ward to supporting this valuable work. curative and adjuvant options such as tumour as vascular damage caused by excessively high ablation, local drug delivery and non-invasive www.cirse.org blood sugar levels commonly affects periphe- Interventional Oncology therapies such as HIFU (High-Intensity Focused www.esir.org ral areas such as the feet. The American Diabe- Interventional radiology has evolved greatly Ultrasound). CIRSE is proud to support and www.interventional-quarter.org tes Association estimated that in 2002, the U.S. since its initial vascular focus, and now covers facilitate this valuable advance in oncology, and

158v1 - ECR Today 4th march 2011.indd 1 13/01/11 15:25 myESR.org Friday, March 4, 2011 Community News ECR TODAY 2011 25

Inside Electronic posters inform ESUR members prepare Find out what’s on and educate delegates to head for Dubrovnik in Vienna today

Today See page 27 See page 30 See page 32

Successful launch for the European Day of Radiology

By Mélisande Rouger ESR staff interviewed experts across Europe, and light the campaign’s issues. In Spain, the Vigo a total of 35 press releases were composed and Hospital in Galicia broadcast the EDoR movie February 10, 2011, saw radiologists throughout sent out to general media to inform them about produced by the ESR (available in 15 languages Europe participate in an unprecedented project. the recent challenges and achievements in every on the ESR website, national societies’ websites Under the coordination of the European Society participating country. Key issues where ima- and YouTube!) all day long to visitors, and in of Radiology (ESR), nineteen national radiologi- ging makes a crucial contribution were tackled, Hungary, various meetings were held all around cal societies took part in the first European Day namely cancer detection and follow-up, emer- the country and a general press conference took of Radiology (EDoR), to raise public awareness gency care, and stroke management. place in the Budapest Intercontinental Hotel. about the role of radiology in modern health- Italy organised a very comprehensive press con- care, with very positive results. The topic of radiation protection was also ference covering not only EDoR topics but also addressed, as the public’s lack of knowledge on other European projects such as the Alliance for With this initiative, the ESR and the participa- this subject often impairs their opinion of radio- MRI and the activities of the Italian Society of ting societies aim to enhance radiology’s image as logy. “Radiation risks are not realistically per- Radiology in Europe. an essential and progressive element of modern ceived. We have made major efforts to reduce healthcare. “Our aim is to raise public awareness radiation exposure, but it remains an emotional Most participating societies invited journalists to of the increasing importance of radiology in every issue, and radiologists should be able to explain press conferences or to visit hospitals, and many field of medicine, from both a diagnostic and a the- radiation protection. The public should also be secured special cooperation with the media. rapeutic point of view,” said ESR Communication educated to realistically assess the risks and the News conferences and/or TV interviews were & International Relations Committee Chairman risk-benefit ratio,” the ESR President explained. given in Ankara, Brussels, Bucharest, Budapest, Professor Luigi Solbiati, from Busto Arsizio, Italy. Paris, Rome, Vienna, Vilnius, and Warsaw. The The national radiological societies of Austria, high attendance at press conferences and large ESR President Professor Maximilian Reiser, from Belgium, Croatia, the Czech Republic, France, presence in the media on or around February 10 Munich, made it clear that public awareness was Georgia, Hungary, Ireland, Italy, Lithuania, the all around Europe might translate into a renewed Wilhelm Conrad Röntgen (1845–1923) a top priority on his agenda when he took office Netherlands, Poland, Portugal, Romania, Spain, action next year. in March 2010. “It is most important that radio- Sweden, Switzerland, Turkey and the U.K. all joi- logy is recognised as a clinical discipline by the ned the initiative. The date February 10 marks the anniversary of of x-rays to benefit mankind to the greatest pos- public. Many patients think that a radiologist is the death of Wilhelm Conrad Röntgen, who first sible extent. He did not even want his discovery a technician who is not really involved in patient Some societies even chose to organise vari- discovered x-rays in 1895. This particular day to bear his name. Long after his passing he is still care,” he said. ous events held on or around February 10. The was chosen for the European Day of Radiology undoubtedly the most important personality in Austrian Röntgen Society organised a very well to draw a link between the beginnings of radio- the history of radiology, having laid the found- The world of radiology is often something of an attended press conference as well as a Day of logy and its current status, so as to highlight the ations for the many and varied advances made unsung hero among the general public. Although Action, with medical institutes offering to carry progress made, as much as to honour the life of in his wake. many procedures are well known by name, and out necessary radiological examinations for the man who made the very first steps in foun- the impact that a single routine examination people without health insurance. In Romania, ding the discipline. Wilhelm Conrad Röntgen Hopefully those advances will now be better can have on a patient’s life can be life-altering, Professor Dragos Negru, the President of the received the Nobel Prize in Physics in 1901 for known to the public. the perception of radiology held by most is often Romanian Society of Radiology and Medical his discovery and, significantly, refused to take confused, outdated and inaccurate. Imaging, made several TV appearances to high- out patents, intending the practical applications

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myESR.org 26 ECR TODAY 2011 C Ommunity NEWS Friday, March 4, 2011

Radiology Trainees Forum again demonstrates its significance for radiology’s youth in Europe

By Peter R. Kornaat, Chairman RTF Starter Kit or the sessions suitable for trai- summer and the link was sent to all RTF nati- nees will be promoted via flat screens. onal delegates with the request to promote it The Radiology Trainees Forum (RTF) was among their fellow residents. Additionally, the established in 1991. Each European country is The RTF General Assembly, which takes place link was sent to over 1,500 ESR members in represented in the RTF by a national delegate annually during the ECR, is attended by the training by the ESR Office. By September the (radiology resident) who is appointed by the national delegates and is open to all interested RTF national delegates were asked to give feed- trainee representative body of the respective trainees wishing to attend. The RTF Gene- back on how the starter kit is being promoted country if existent or the national radiologi- ral Assembly during ECR 2010 was very well and if available to provide the ESR Office with cal society. The main purpose of the RTF is to attended with 32 national delegates present contact details of fellow residents to upload represent the interests of junior radiologists and several ESR Executive Council members: them into the ESR e-Newsletter mailing list. particularly with regard to education, career É. Breatnach (Education Committee Chair- Several national delegates had published the development and research. In close collabo- man), N. Gourtsoyiannis (ESOR Scientific/ presentation on the website of their respective ration with the national societies and the ESR, Educational Director) and L. Solbiati (ESR national society or distributed it via a mailing the RTF’s primary ambition is to provide an Communication & International Relations list or forum for radiology residents. With refe- Peter R Kornaat from Leiden, Netherlands, will equal level of radiological knowledge and skills Committee Chairman) all addressed the RTF rence to the contact details of fellow residents, moderate today's RTF Highlighted Lectures. for radiology trainees all over Europe. General Assembly on specific issues. Other the feedback showed that only 35% of the resi- topics such as the RTF survey results and the dents by whom the contact details had been election of a new board during ECR 2011. A Of course, there will again be particular RTF action to be taken following the survey parti- received were members of the ESR. Hence, further online meeting took place in January activities during ECR 2011. Every year there cularly with reference to raising awareness for the main focus of the RTF has been to put on 2011. is a special session for residents during the ESR/RTF among residents were also discussed. the promotion of ESR among fellow residents ECR, the so-called RTF Highlighted Lectures. The survey, which had been carried out by the to bring as many of them as possible into the I would like to invite all residents, trainees This year’s session, which will be held today ESR Office among the 38 RTF national dele- European radiological community. and students to visit our dedicated RTF Booth from 16:00 to 17:30 in Room Q, the following gates in September 2009, consisted of three in the Rising Stars Lounge on the 2nd level in speakers and topics will be presented: I. Boric sections: ‘General Information on Residency’, The ESR sponsored the RTF Party at ECR Foyer B. Inform yourself and get involved! from Zagreb/HR will speak on musculoskele- ‘Undergraduate Teaching’ and ‘Knowledge of 2010, which was a great success. It was an tal trauma in children, G. Wilms from Leuven/ RTF and ESR’. The response rate was particu- excellent opportunity for trainees from all over BE on basic principles in the interpretation of larly high (92.1%) due to the fact that the sur- the world to meet in an informal atmosphere. I Accompanying Session signal intensities on T1- and T2-weighted ima- vey had been linked to the Invest in the Youth would like to express my gratitude for the ESR’s Friday, March 4, 16:00–17:30, Room Q ges, and H. Bosmans from Leuven/BE on plain Programme, offering all respondents a secure financial support as the party was free for 200 film criteria: quality of the X-rays. D. Bulja place. radiology residents. For 2011, a very popular Radiology Trainees Forum RTF Highlighted Lectures from Sarajevo/BA and P.R. Kornaat from The location in the city centre of Vienna was selec- Hague/NL will serve as moderators. Following the RTF General Assembly at ECR ted and 440 tickets at an entrance fee of EUR Moderators: D. Bulja; Sarajevo/BA 2010, particular importance has been placed to 17 (including a EUR 10 voucher for drinks) P.R. Kornaat; Leiden/NL The RTF booth, a central meeting point for all raising awareness for the RTF, ESR and ESOR will be available. • Musculoskeletal trauma in children interested trainees and national delegates, has among radiology residents in Europe. For this I. Boric; Zagreb/HR become a consistent feature at the ECR. At ECR purpose the RTF Starter Kit, a Power-Point An RTF Board Meeting was held in Septem- • Basic principles in the interpretation 2011 the RTF Booth as well as a staffed ESOR presentation summarising all relevant infor- ber 2010 to evaluate the work of the past year of signal intensities on T1- and Booth will be incorporated into the enlarged mation for trainees on the RTF, ESR, ECR and and plan the activities for the coming year. The T2-weighted images Residents & Students Lounge, now known ESOR was put together by the RTF Board in main issues addressed included the promo- G. Wilms; Leuven/BE under its new name Rising Stars Lounge. All cooperation with the ESR Office. This starter tion of the RTF Starter Kit, the RTF activities • Plain film criteria: quality of the x-rays information relevant to residents, such as the kit was published on the ESR website before during ECR 2011 and the preparation of the H. Bosmans; Leuven/BE French Society of Radiology: a new breath of youth

By Myriam Edjlali-Goujon, major research funding, in collaboration with European and International network at the European level would be the cornerstone French RTF delegate and 2010 President of industry, the SFR offers both M.S. and Ph.D. Collaboration with other radiological societies is to establishing fruitful and durable collabora- the French Junior Society of Radiology grants in radiological sciences. Fifteen young another important undertaking of our organisa- tions. In this context, the SFR Junior is here to researchers have benefited from this offer, and tion. We are working on facilitating cooperation provide you with information on those exchange Founded more than a century ago by Antoine are now working on cutting edge topics such as and exchange programmes in French-speaking possibilities to and from France. Each year, the Béclère and other eminent pioneers of our spe- MRI, magnetic resonance spectroscopy, molec- countries (such as Québec, where a bilateral rec- French Society of Radiology offers a special grant cialty, the French Society of Radiology (SFR) is ular imaging, and image processing as well as ognition of diplomas has been signed by both (Jacques Sauvegrain) for young radiologists to one of the oldest in Europe. Since its inception, other areas of imaging sciences. governments), but not only this! This year, we come and assist the French Congress of Radiol- the SFR has known how to evolve, pursuing and created links with young radiological associa- ogy. We are very pleased each year to welcome heading the crucial technological and medical We all know how difficult it is to add a research tions such as the European RTF, the Canadian the participants to Paris. developments of radiology. Thinking and acting profile to long medical studies and to the devel- association (Pairo) and the American association are the credo of the SFR. opment of a personal life. Support from our (A3CR2). This year, another way to meet the SFR and the peers and mentors, help in the form of fund- SFR Junior is to come and see us in Vienna, here The SFR, which represents more than 8,000 ing, and promotion of good work is the best way The reason for this interest is obvious: shar- at ECR 2011, with Prof. Yves Menu, ECR 2011 members, 10% of whom are residents or fel- to encourage young radiologists to fulfil these ing our poles of excellence would help generate Congress President, where the European Con- lows, took a significant step toward involving expectations. We will continue to work with innovations. Europe, for example, has undeniable gress of Radiology will have a certain French its young population in 2008, thanks to Prof. the industry partnerships to promote research strengths in education and research. Therefore, touch. Jean-Pierre Pruvo, by creating the SFR Junior among radiologists in order to increase the we are one hundred percent behind the ESOR (Junior French Society of Radiology). Hand in number of grants offered. (European School Of Radiology) programmes, hand with our mentors, the SFR Junior intends such as their tutorials and exchange programmes to help young radiologists reach a level of Being involved in our professional debates and for fellowships. Working with different teams knowledge and skill to work as professionals national policy discussions while respecting the Hippocratic Oath. It has a This year in particular has been rich in debates strong commitment to ensuring that residents concerning the demographic evolution of the and fellows acquire knowledge by encouraging number of radiologists in training. An impor- their curiosity, sharpening their research skills, tant modification of the French residency is in and integrating them into the professional com- progress, and we worked within the French del- munity. egation of radiology as well as the French Health Ministry on this subject. Let me summarise three of our main accomplish- ments in 2010. We mainly emphasised the growing need to increase the number of radiologists in training Promoting access to research to reach a correct demographic equilibrium. We Nowadays, research is the new application and promoted the ESR curriculum, known as the 3+2 evolution of our practice. Continually securing years of training for the residency.

myESR.org Friday, March 4, 2011 C Ommunity NEWS ECR TODAY 2011 27

Why to submit, how to become an author, and how to benefit from what EPOS™ offers

By Lisa Loibl JIB: When assessing an abstract, reviewers are authors have to be aware of this responsibility. It ECRT: What are the long-term goals for EPOS™? looking for an interesting or novel answer to a is also important that the authors are aware that How do you envisage its use and contribution EPOS™ is the ESR’s Electronic Presentation specific concern. Thus the content should not they belong to a larger group (hospital, univer- towards common knowledge in radiology? Online System. It was introduced in 2003 to only have scientific quality but also be presen- sity, etc) and, to a certain extent, they represent JIB: EPOS™ should fulfil two objectives. On the replace the traditional paper posters and has ted in a novel way. The title should be carefully their institution. A bad poster does not provide a one hand, it is clear that it is a tool for scienti- since grown into one of the ESR’s largest and evaluated and the authors should make it attrac- good image of the represented institution. fic and educational presentation at the ECR but, most popular online resources. The EPOS™ data- tive, solid and novel. If the author is not a native on the other hand, it is a very large database that base is accessible throughout the year and con- English speaker, proofreading is recommended. ECRT: Are there topics for which you would should be used habitually by radiologists. When tains more than 11,700 electronic presentations. If the writing is poor with frequent errors it will like to specifically encourage submissions? someone is studying, preparing a talk or a class, This year the ESR introduced a new enhance- not make a good impression on reviewers and JIB: In my opinion, it is enriching to present and or simply making a report, he should be able ment by making submissions to EPOS™ possible may even obscure good research. show specific professional matters that affect dif- to have all the ESR e-tools available. By using all year round. The new submission system has ferent centres or nations. Scientific societies look a single tool – EPOS™ – the radiologist could been designed to offer authors a platform where Abstracts are sent to reviewers who are chosen for homogeneity among educational program- have access to all the required information. This their work can be made available to the scientific according to their areas of expertise and the mes, titles and protocols. In order to learn more reflects the great service that the ESR is offering community quickly and efficiently – the shortest ESR keywords representing each abstract. It is and understand where to pay attention, one has in the diffusion of knowledge. possible time between abstract submission and important that the authors take care to choose to be informed. poster publication amounting to about 20 days. the categories that best represent their work, as the assignment of appropriate reviewers depends ECR Today spoke to Professor José I. Bilbao, on these choices. EPOSTM Area & Lounge / EPOSTM Discussions chairman of the scientific exhibition, about EPOS™, the idea behind it, and recommenda- An abstract is much more than the summarised EPOSTM (the Electronic Presentation Online Friday, March 4, 10:00–10:30 tions for submitters. presentation of a scientific paper. The reviewers System) will again – as for ECR 2010 – feature a Imaging perfusion for the have to give an opinion on a brief text, so the dedicated lounge, up on the second floor of the prediction of treatment outcome ECR Today: What is the special focus of EPOS™ authors should carefully analyse and choose the congress venue, in Foyer A. The idea is to cre- Moderator: A. Trojanowska; Lublin/PL compared to other publications? When should an best way to present their work. ate a more suitable atmosphere for studying its Friday, March 4, 13:30–14:00 author’s work be presented as an EPOS™ poster? nearly 3,000 posters in peace, with a more open José I. Bilbao: The main goal of EPOS™ is to offer a ECRT: What are important considerations for library ambience, but still allowing ample space Whole body MRI wide variety of quality proven work in our field in preparing a good poster? for discussion and exchange. Moderator: E. de Kerviler; Paris/FR an attractive format. EPOS™ presentations, which JIB: A good poster should be prepared with atten- Friday, March 4, 15:30–16:00 are much shorter than scientific articles and there- tion and effort. Mistakes or poor references should Opening Hours New MR Biomarkers fore more easily accessible, provide a vast base of not be accepted. The figures and quotations Thursday, March 3: 14:00–18:00 Moderator: L. Martí-Bonmatí; Valencia/ES knowledge that is available all year long. Because should be adequate, containing the necessary Friday, March 4 to Sunday, March 6: 08:00–18:00 of these characteristics, EPOS™ also functions as a legends (arrows, etc). The material and methods Monday, March 7: 13:30–18:00 Saturday, March 5, 13:30–14:00 great learning tool and is of specific value to our section should be presented in detail since the aim Liver Intervention young researchers. If the author believes that he/ is to help others do the same in order to obtain the To enhance interaction, discussions on hot Moderator: J.I. Bilbao; Pamplona/ES she has something to share with others and would same results. The discussion, and comparison with topics in radiology have been arranged, where like to reach a wider audience and have the work other series, should be done carefully. authors of the highest-scored posters in each Saturday, March 5, 15:30–16:00 published quickly, EPOS™ is an excellent platform. field will discuss them with a moderator. ECR Dose in CT Journal articles are evaluated in their final form delegates are welcome to join, listen, and dis- Moderator: K. Nikolaou; Munich/DE ECRT: What are important considerations for while EPOS™ posters do not receive such a cuss with the experts. The five discussion a good poster abstract? revision – it is the abstract that is accepted. The rounds will be: Please visit www.myESR.org/EPOS! Share your scientific work with the radiological world. New and unique – submit your work, all year long!

EPOS Abstract Submission is open all year!

Abstract submission for EPOS™ (Electronic Presentation Online System) has been re-structured to include the following new features:

 All-year-round submission & poster upload  Quicker review process  Your publication citable and available online throughout the year

Find more information at myESR.org/epos_all_year

myESR.org 28 ECR TODAY 2011 C Ommunity NEWS Friday, March 4, 2011 ESOR – European School of Radiology

The European School of Radiology (ESOR) Jaanika Kumm Nina Shishinka Rana Mehsen is an established and growing initiative of the Tartu University Clinics, Tartu/Estonia N.N. Blokhin Russian Cancer Research Centre, Medical College/Babylon University, European Society of Radiology (ESR) in the Topic: Abdominal Radiology Moscow/Russian Federation Babil/Iraq field of education. One of its main goals isto Training centre: Skane University Hospital, Topic: Oncologic Imaging Topic: Abdominal Imaging assist in harmonising radiological education in Malmö/Sweden Training centre: Medical University of Training centre: University Hospital Maastricht, Europe. With its wide range of activities ESOR Innsbruck, Innsbruck/Austria Maastricht/Netherlands aims to raise standards in the field of scientific Irene Kyratzi radiology, to extend and coordinate teaching Evangelismos Hospital, Athens/Greece Muthyala Sreenivas Leyla Musayeva resources worldwide and to help young radiolo- Topic: Abdominal Radiology Hull Royal Infirmary, 2JZ/United Kingdom National Oncology Centre of Azerbaijan, gists to achieve the knowledge and skills to fulfil Training centre: Hôpital Erasme, Topic: Breast Imaging Baku/Azerbaijan tomorrow’s requirements. The activities of ESOR Brussels/Belgium Training centre: Medical University of Vienna, Topic: Cardiac Imaging encompass, at present, visiting schools, visiting Vienna/Austria Training centre: University of Leipzig – Andrei Lebovici Heart Centre, Leipzig/Germany seminars, visiting scholarships, exchange pro- Emergency Clinical County Hospital, Ramanivas Sundareyan grammes for fellowships, and tutorials. Cluj/Romania Sree Mookambigai Medical College, Dimitra Ntoula Topic: Urogenital Radiology Coimbatore/India Theageneio Hospital of Thessaloniki, At its third session held on the occasion of ECR, Training centre: Emergency Radiology Thessaloniki/Greece ESOR will give an insight into the variety of Medical University of Innsbruck, Training centre: Hôpital Calmette – University Topic: Breast Imaging educational programmes established for young Innsbruck/Austria Centre of Lille, Lille/France Training centre: IRCCS Policlinico San Donato / radiologists during their training. University of Milan School of Medicine, Gergely Léránt Marianna Telesca Milan/Italy ESOR Awards National Institute of Oncology, Sapienza Università di Roma, Rome/Italy On the occasion of the session, scholars and fellows Budapest/Hungary Topic: Breast Imaging Sladjana Petrovic will be awarded certificates for successfully com- Topic: Head and Neck Radiology Training centre: Barts and The Royal London Clinical Centre Nis, Nis/Serbia pleting the 2010 Visiting Scholarship Programmes Training centre: Catholic University Leuven, Hospital NHS Trust, London/United Kingdom Topic: Head and Neck Imaging and Exchange Programmes for Fellowships. Leuven/Belgium Training centre: University Hospital of Geneva, Wouter Veldhuis Geneva/Switzerland Marius Mayerhöfer University Medical Centre Utrecht, Visiting Scholarship Programme 2010 Medical University of Vienna, Utrecht/The Netherlands Anca Raluca Popovici The Visiting Scholarship Programme is one of Vienna/Austria Topic: Oncologic Imaging Academic Hospital ‘Sfantul Spiridon’, the most popular programmes among residents Topic: Oncologic Imaging Training centre: Memorial Sloan-Kettering Iasi, Iasi/Romania in radiology, offering the chance to stimulate Training centre: Addenbrooke’s Hospital, Cancer Center, New York/USA Topic: Neuroradiology interest in a chosen field of radiology. In 2010, Cambridge/United Kingdom Training centre: CHU de Nancy Hôpital Cen- thirty scholars completed three months of trai- Exchange Programmes for Fellowships tral, Nancy/France ning at highly esteemed reference centres across Maria Carla Mingote In partnership with the European subspecialty Europe, supported by grants from Bracco and Hospital Italiano de la Ciudad de Buenos Aires, societies, ESOR has organised several subspe- Jeremy Rabouhans the ESR. Two scholars were given the unique Buenos Aires/Argentina cialty Exchange Programmes for Fellowships, University Hospital, opportunity to do their training at the Memo- Topic: Urogenital Radiology which are aimed at rounding off educational Mitcham/United Kingdom rial Sloan-Kettering Cancer Centre in New York. Training centre: Policlinico Gemelli-Catholic requirements for subspecialty fellowships. In Topic: Abdominal Imaging Congratulations! University, Rome/Italy 2010, 23 trainees successfully completed their Training centre: Saint-Antoine Hospital, Paris/France Paraskevi Mintzopoulou training. Congratulations! Asim Afaq University Hospital of Alexandropoulos, Luis Riera The Royal Marsden NHS Foundation Trust, Alexandropoulos/Greece Ahmed Abdelwahed Corporació Sanitària del Parc Taulí, London/United Kingdom Topic: Chest Imaging Ain Shams University Hospital/Egypt UDIAT-SDI, Barcelona/Spain Topic: Oncologic Imaging Training centre: Hospital Vall d’Hebron, Topic: Neuroradiology Topic: Paediatric Imaging Training centre: Memorial Sloan-Kettering Barcelona/Spain Training centre: Royal Hallamshire Hospital, Training centre: Medical University of Graz, Cancer Center, New York/USA Sheffield Teaching Hospitals NHS Trust, Graz/Austria Hanief Moosa Sheffield/United Kingdom Georgios Barmpalios Chris Hani Baragwanath Hospital, Benjamin Rock Hippokration General Hospital, Johannesburg/South Africa Babatunde Aremu Derriford Hospital, Plymouth/United Kingdom Thessaloniki Greece Topic: Musculoskeletal Radiology University of Ilorin Teaching Hospital, Topic: Head and Neck Imaging Topic: Paediatric Imaging Training centre: University Hospital of Ilorin/Nigeria Training centre: Hôpital de Hautepierre, Training centre: Erasmus University Medical Strasbourg, Strasbourg/France Topic: Neuroradiology Strasbourg/France Centre, Rotterdam/The Netherlands Training centre: Université catholique de Ricardo Moutinho Louvain, Brussels/Belgium Riste Saat Livia Bernardin Faro Hospital, Faro/Potugal Meilahti Hospital, Helsinki/Finland University Hospital G.B. Rossi, Verona/ITALY Topic: Chest Imaging Ben Ariff Topic: Head and Neck Imaging Topic: Oncologic Imaging Training centre: Hôpital Pitié-Salpêtrière, Hammersmith Hospital, Training centre: Medical University of Vienna, Training centre: Barts and The Royal London Paris/France London/United Kingdom Vienna/Austria Hospital NHS Trust, London/United Kingdom Topic: Cardiac Imaging Christine Ojango Training centre: Leiden University Medical Gerwin Schmidt Deniz Bulja North Estonian Medical Center (PERH), Centre, Leiden/The Netherlands Ludwig-Maximilians-Universität München, Clinical Centre of Sarajevo University, Tallinn/Estonia Munich/Germany Sarajevo/Bosnia and Herzegovina Topic: Neuroradiology Despine Bibileishvili Topic: Paediatric Imaging Topic: Neuroradiology Training centre: Second University of Naples, Research Institute of Clinical Medicine, Training centre: Hôpital Timone-Enfants, Training centre: Catholic University Leuven, Naples/Italy Tbilisi/Georgia Marseille/France Leuven/Belgium Topic: Breast Imaging Adam Perenyi Training centre: Addenbrooke’s Hospital, Kristof de Smet Bella Chamokova University of Szeged, Albert Szent-Györgyi Cambridge/United Kingdom Universitair Ziekenhuis Brussel, Federal Centre of Medicine and Rehabilitation, Medical and Pharmaceutical Center, Brussels/Belgium Moscow/Russian Federation Szeged/Hungary Radoslav Bielik Topic: Cardiac Imaging Topic: Neuroradiology Topic: Abdominal Radiology University Hospital, Banska Bystrica/Slovakia Training centre: University Medical Centre Training centre: Antwerp University Hospital, Training centre: University Hospitals of Leices- Topic: Abdominal Imaging Groningen, Groningen/The Netherlands Antwerp/Belgium ter NHS Trust – Leicester General Hospital, Training centre: Derriford Hospital, Leicester/United Kingdom Plymouth/United Kingdom Maie Uusväli Pim de Jong West-Tallinn Central Hospital, Tallinn/Estonia University Medical Centre Utrecht, Paweł Poluha Patricia Carreno Moran Topic: Neuroradiology Utrecht/Netherlands Medical University in Lublin, Lublin/Poland Complejo Universitario Salamanca/Spain Training centre: Bologna University, Bellaria Topic: Chest Imaging Topic: Neuroradiology Topic: Cardiac Imaging Hospital, Bologna/Italy Training centre: University Hospitals Leuven, Training centre: Hospital Barcelona, Training centre: University of Bangor, Leuven/Belgium Barcelona/Spain Gwynedd/United Kingdom Efstathios Detorakis Rodrigo Raurich Scheuch Luigia D’Errico ESOR Session University Hospital of Iraklion, Iraklion/Greece Clínica Alemana, Santiago/Chile Università di Pisa, Pisa/Italy Topic: Cardiac Imaging Topic: Abdominal Radiology Topic: Cardiac Imaging Friday, March 4, 14:00–15:30, Room Q Training centre: Hôpital Lariboisière, Training centre: Hospital Barcelona, Training centre: University of Basel, Experiencing variety in education Barcelona/Spain Basel/Switzerland Paris/France Moderators: N. Gourtsoyiannis; Iraklion/GR Hassan Douis Saša Rudolf Kyriakos Iliadis M.F. Reiser; Munich/DE Birmingham Heartlands Hospital, UKC Maribor, Maribor/Slovenia University Hospital, Plovdiv/Bulgaria Birmingham/United Kingdom Topic: Abdominal Radiology Topic: Paediatric Imaging During this session, the European School of Topic: Musculoskeletal Radiology Training centre: Medical University of Vienna, Training centre: Great Ormond Street Radiology (ESOR), will give an insight into Training centre: Vienna/Austria Hospital for Children NHS Trust, the variety of its educational programmes and Ludwig-Maximilians-University, London/United Kingdom opportunities for education in radiology. Munich/Germany Berta Ruiz Morín Hospital de Basurto, Bilbao/Spain Giedre Kavaliauskiene • Introduction Slavco Ivanoski Topic: Neuroradiology Kaunas Medical University Hospital, M.F. Reiser; Munich/DE Special Hospital for Orthopaedic Surgery and Training centre: Policlinico Gemelli-Catholic Kaunas/Lithuania Traumatology St. Erasmo, Ohrid/Macedonia University, Rome/Italy Topic: Abdominal Imaging • ESOR in action Topic: Musculoskeletal Radiology Training centre: Academic Medical Centre, N. Gourtsoyiannis; Iraklion/GR Jesica Savluk Amsterdam/Netherlands Training centre: Saint-Antoine Hospital, • Teach the teachers Paris/France Hospital Italiano de Buenos Aires, Buenos Aires/Argentina Jasmina Kovacevic H. Cameron; Edinburgh/UK Zdravstveni centar Valjevo, Valjevo/Serbia Ivana Kopecka Topic: Abdominal Radiology • Widening the vision of teaching University Hospital Sv. Cyrila a Metoda, Training centre: Addenbrooke’s Hospital, Topic: Abdominal Imaging Training centre: Ospedale Ca’ Foncello, in radilogy Bratislava/SLOVAKIA Cambridge/United Kingdom S. Golding; Oxford/UK Topic: Musculoskeletal Radiology Treviso/Italy Valeria Schonstedt Geldres Training centre: Imperial College NHS Trust - • Tutoring in radiology Hospital Clínico de la Universidad de Chile, Ana Casado Lopez St. Mary’s Hospital Campus, Clínico San Carlos, Madrid/Spain C. Loewe; Vienna/AT London/United Kingdom Santiago/Chile Topic: Neuroradiology Topic: Neuroradiology Training centre: Hospital Vall d’Hebron, Training centre: Western General Hospital, Barcelona/Spain Edinburgh/United Kingdom

myESR.org Friday, March 4, 2011 C Ommunity NEWS ECR TODAY 2011 29

ESR’s stakeholder engagement at European level gains importance

By Monika Hierath and the Council support the proposal and that including the extension of the competences of sortium. The project started in late December, the national radiological societies support the the European Medicines Agency (EMA), which 2010, and will last for 27 months. You will find The ESR’s EU Taskforce, established in 2009, campaign. is considered highly controversial. an article on this challenging project in Monday’s monitors and analyses a wide range of EU policy edition of ECR Today. and legislative developments that have impli- You will find a dedicated article on the latest deve- The ESR has been involved as a stakeholder in the cations for the radiology profession. The EU lopments regarding the revision of the Directive exploratory process on the future of the medical The European endeavours to develop European Taskforce is headed by the ESR Past President in Saturday’s edition of ECR Today. devices sector that discussed the challenges to medical imaging referral guidelines have so far and is supported by the Department of EU and medical devices posed by health spend, demo- not come to fruition, as a previous call for tenders Public Affairs at the ESR Office in Vienna. The European Commission proposal for a Direc- graphic changes and health system restructuring. of the European Commission was significantly tive on patients’ rights in cross-border healthcare Following this process, a high-level EU confe- underfunded, and ESR has decided not to file an A dedicated section of the ESR website keeps has been a key focus of the ESR EU Taskforce rence will be held at the end of March to debate application. The ESR has been in constant dia- ESR members up to date on European affairs and over the past months in order to ensure that tele- innovation in medical technology. The ESR will logue with the European Commission to empha- offers a range of opportunities to engage with EU radiology and eHealth issues are properly regu- be represented at this important meeting. sise the dimension and challenges of developing affairs and to get involved in the ESR’s work. lated in the Directive. An extensive campaign European referral guidelines and the importance has been led to inform Commission officers and The ESR is represented in the European Medici- of also considering the concept of clinical deci- The Taskforce aims to secure a European policy MEPs about the importance of considering tele- nes Agency’s Healthcare Professionals Working sion support in such a project. The European environment that supports the ESR’s mission to radiology to be a medical act and of maintaining Group – a stakeholder forum that is currently Commission is now aware of the complexity of serve the healthcare needs of the general pub- responsibility with the country where the patient being formalised in order to provide expert opi- such a project and the importance of cooperation lic through the support of science, teaching, accesses healthcare. After a promising parlia- nions and advice to the Agency. between several directorates general and is plan- research, and quality service in the field of radio- mentary committee report that considered some ning a meeting in this regard together with ESR logy. The Taskforce is therefore engaged in con- of the key requests put forward by the ESR, many In close cooperation with the ESR Education representatives. stant dialogue with the European institutions as of these beneficial provisions were excluded in and Professional Organisations Committees, the well as policymakers at the national level, and the adopted version of the Directive. The direc- Taskforce is preparing a response to the European In February the European Commission pub- is dedicated to pushing forward the European tive is primarily focused on ensuring that pati- Commission consultation on the professional lished a Green Paper on a Common Strategic agenda for radiology-related issues in the fields ents from one country within the EU may obtain qualifications Directive. The public consultation Framework for future EU Research and Inno- of research, regulatory affairs and education. healthcare within another EU country without is aimed at gathering stakeholders’ views on a vation Funding and has opened a stakeholder hindrance. The main emphasis of the directive is modernisation of the Professional Qualifications consultation. The Green Paper proposes major Below you will find an overview of the most to make it easier for patients to obtain approval Directive (Directive 2005/36/EC) and remains changes to EU research and innovation funding important policy areas the ESR is currently invol- and for an organised financial framework to be open until mid-March. This Directive, adopted to make participation easier, increase scientific ved in, or planning to engage in, to ensure a favo- put in place to pay for the healthcare. in 2005, sets the rules for mutual recognition of and economic impact and provide better value urable development of medical imaging in the professional qualifications between Member Sta- for money. The changes, to be introduced in the best interest of Europe’s patients. Sunday’s edition of ECR Today will feature an article tes and is considered highly relevant to the radio- next EU budget after 2013, would bring together on eHealth in the European legislative context. logy profession. the current Framework Programme for research, A European campaign that has required a very the Competitiveness and Innovation Programme, high level of commitment and stamina over the The ESR is also closely monitoring the recast The ESR has successfully applied for an EC Ten- and the European Institute of Innovation and past few years has been the Alliance for MRI, process of European medical devices legisla- der on radiation protection training. The ten- Technology. As this will also considerably impact established in 2007 to avert the threat posed tion, initiated by the European Commission in der brings together the main European stakehol- future funding for imaging research, the ESR and to MRI by the EU Physical Agents 2004/40/ 2008, as the current Medical Devices Directives ders and professional groups relevant to radiation the European Institute for Biomedical Imaging EC (EMF) Directive. Although the European do not always offer a uniform level of protection protection training in the medical field. The aim Research (EIBIR) will prepare a response to the Commission’s decision to propose an exemp- of public health. In particular, new and emerging is to provide an improved implementation of the consultation. tion for MRI from the numerical limit values in technologies present new challenges that are not Medical Exposure Directive provisions relating the Directive represents a huge step in the right accounted for in the current legal documents. to radiation protection education and the trai- For extensive information on all European direction, the battle for the future of research and In the course of that process, different scenarios ning of medical professionals in the EU Mem- topics the ESR is engaged in, please visit clinical applications of MRI is far from won. It for a European regulatory body for the authori- ber States. The European Commission assigned www.myESR.org ▶ EU Affairs or e-mail is now important that the European Parliament sation of medical devices have been discussed, a budget of approximately €330,000 to the con- [email protected].

ECR’s Interactive Programme Planner Browse ECR 2011 Abstracts with the new Interactive Programme Planner

The ESR is proud to present a new interactive tool for ECR 2011. The brand new IPP provides a convenient way to explore and customise the whole ECR programme online, with a traditional browser or on your mobile device.

Featuring various search and browse functions for sessions as well as posters, the IPP also includes a new ‘basket’ option, so you can collate items from the programme to create a personal calendar and even print your own personalised Book of Abstracts.

@ Visit ipp.myESR.org (or m.myESR.org with your mobile device) and start creating your personal schedule for ECR 2011!

myESR.org 30 ECR TODAY 2011 C Ommunity NEWS Friday, March 4, 2011

ESUR promotes new standards in genitourinary imaging

By Gertraud Heinz-Peer, Vienna, of our websites with more than 3,000 hits per ESUR President month.

‘Panta rhei’, meaning ‘everything flows’, is a Translations of the English CMS guidelines are famous phrase from Simplicius, and often misat- now available in 9 languages; German, Greek, tributed to Heraclitus (544–483BC) since it French, Hungarian, Italian, Japanese, Polish, characterises his concept. Certainly this quota- Russian and Turkish; and translations into tion remains true today for the subspecialty of Serbo-Croatian, Chinese, Hindi, and Arabic are genitourinary imaging, which like all areas of in preparation. diagnostic and interventional radiology has seen relentless technological innovation herald new ESUR believes that strong clinical-radiological developments and raise new imaging-related cooperation is of vital importance in modern challenges. medical practice and has established a Paediatric Working Group that has built strong scientific From a diagnostic perspective, most recent chal- links with the ESPR (European Society of Pae- lenging topical issues for ESUR relate to female diatric Radiology). Recently, the ESPR uroradi- pelvic imaging, CT and MR urography (CTU, ology task force and ESUR Paediatric Working MRU), as well as prostate imaging. Group published ‘Imaging and procedural rec- ommendations in paediatric uroradiology, part The ESUR Female Pelvic Imaging Group pub- III’. Further publications of the Paediatric Work- lished guidelines entitled ‘Characterisation of ing Group include ‘Imaging recommendations Ovarian Masses’ in 2009 and guidelines on ‘MR in paediatric uroradiology’ and ‘Imaging recom- imaging of the sonographically indeterminate mendations in paediatric uroradiology: minutes In October 2011 ESUR will hold a joint meeting with SUR in Dubrovnik, Croatia. adnexal masses: an algorithmic approach’ as well of the ESPR workgroup session on urinary tract as on staging of endometrial carcinoma in 2010. infection, fetal hydronephrosis, urinary tract Additional guidelines on cervical cancer and ultrasonography and voiding cystourethrogra- ovarian cancer are being finalised and will be phy’. All these recommendations are freely avail- teacher) is to provide ESUR-approved work- Annual ESUR symposium in 2011 published this year. able on our website. shops on state-of-the-art use of contrast media The annual ESUR meeting will be held in in different countries and thus promote the safe Dubrovnik, on October 13–16. The main topic The CTU and MRU techniques have now been Joint meeting with SUR and their merger use of these agents and avoid adverse effects. will be ‘Female and renal imaging’. It will be a introduced widely throughout Europe and are with SGR Leading radiologists from Turkey, Kazakhstan, joint meeting with the SUR. Additionally, a joint currently used for various clinical indications. ESUR has always closely cooperated with the Russia, Poland, and Romania participated at our session with our colleagues from ESGAR will The ESUR CTU and MRU working group pub- Society of Uroradiology (SUR). We are fortu- first global education meeting on the safe use of cover abdominal and pelvic emergency topics. lished guidelines on ‘CT urography: definition, nate to experience excellent scientific exchange contrast media in Istanbul on May 1, 2010. indications and techniques. A guideline for and enjoy a good friendship with SUR col- Prostate course in Ghent clinical practice’ in 2010. The role of CTU in the leagues at our biannual joint meetings. Next Since then, education on the safe use of con- This teaching course, scheduled for June 3–5, evaluation of hematuria continues to be debated time we will meet in Dubrovnik, Croatia, on trast media has been further promoted under 2011, in Ghent, Belgium, aims to provide prac- between urologists and radiologists. However October 13–16, 2011. Recently, the SUR has ESUR patrimony at local radiological meetings tical information for radiologists who want to our clinical colleagues increasingly appreciate merged with the Society of Gastrointestinal in those countries. Recently, another very suc- start or promote prostate MRI at their own insti- these techniques. Radiology (SGR). SAR, the Society of Abdomi- cessful ESUR global education meeting with tution. It will include formal state-of-the-art lec- nal Radiology, will be the new identification of participants from Hungary, the Czech Republic, tures presented by experts in the field, but also Imaging of prostate cancer remains a great chal- the merged society. Slovakia, Serbia, Republica Srpska and the Fed- practical case studies and ample time for open lenge. ESUR has established a new working eration of Bosnia & Herzegovina took place in discussions among participants and experts. group on Prostate Cancer Imaging. A guideline Supported by ESUR, the European School of Vienna on December 11, 2010. Knowledge on for MR imaging of the prostate will be finalised Radiology (ESOR) organised a Galen course contrast media will be spread at local meetings For further information, full programme and in 2011. focusing on urogenital radiology, held on June in 2011 under the patrimony of ESUR. In 2011, registration, visit www.prostatemricourse.com 17–19, 2010 in Tallinn, Estonia. Another one will further contrast media educational programmes Special attention has always been given to con- be held in Barcelona, Spain, April 28–30, 2011. will be organised in Malaysia, Taiwan, Thailand The European Society of Urogenital Radiology trast media research and the safety aspects of and Indonesia. wishes all readers a successful and invigorating these agents. The Society’s Contrast Media Safety Global Education Programme on Contrast ECR 2011. Long live the dictum ‘Panta rhei’! Committee has published more than 20 impor- Media The Scientific Committee of the ESUR global tant guidelines; all of these, including the latest In 2010, ESUR launched a global education pro- education programme consists of S. Morcos For further information, please visit the ESUR version 7.0, are freely available on our website. gramme on the safe use of contrast media. The (Chair, UK), G. Heinz-Peer (Austria), M.F. Bel- website at www.esur.org These guidelines are the most popular feature idea of this educational programme (teach the lin (France), H. Thomsen (Denmark).

Staff Box

Editorial Board Editors Art Direction ESR Executive Council Julia Patuzzi, Vienna/AT Robert Punz, Vienna/AT

Philip Ward, Chester/UK Maximilian F. Reiser, Munich/DE Luis Martí-Bonmatí, Valencia/ES Layout ESR President Research Committee Chairman Sub-Editor Robert Punz, Vienna/AT Simon Lee, Vienna/AT Tine Ulbing, Vienna/AT András Palkó, Szeged/HU Éamann Breatnach, Dublin/IE ESR 1st Vice-President Education Committee Chairman Contributing Writers Marketing & Advertisements Edna Astbury-Ward, Chester/UK Betty Wilk Gabriel P. Krestin, Rotterdam/NL Luís Donoso, Sabadell/ES John Bonner, London/UK E-mail: [email protected] ESR 2nd Vice-President Professional Organisation Committee Chairman John Brosky, Paris/FR Contact the Editorial Office Christian J. Herold, Vienna/AT Fred E. Avni, Brussels/BE Sarah Edwards, Vienna/AT ESR Office Past-President Subspecialties Committee Chairman Sonja Guttenbrunner, Vienna/AT Neutorgasse 9 Eva Haas, Vienna/AT Yves Menu, Paris/FR Guy Frija, Paris/FR 1010 Vienna, Austria Monika Hierath, Vienna/AT Congress Committee Chairman National Societies Committee Chairman Phone: (+43-1) 533 40 64-0 Simon Lee, Vienna/AT Fax: (+43-1) 533 40 64-441 Lorenzo Bonomo, Rome/IT Luigi Solbiati, Busto Arsizio/IT Lisa Loibl, Vienna/AT E-mail: [email protected] 1st Vice-Chairman of the Congress Committee Communication & International Relations Lucie Motloch, Vienna/AT Committee Chairman Stefanie Muzik, Vienna/AT ECR Today is published 5x during ECR 2011. José I. Bilbao, Pamplona/ES Mélisande Rouger, Vienna/AT Circulation: 20,000 2nd Vice-Chairman of the Congress Committee Katrine Åhlström-Riklund, Umeå/SE Frances Rylands-Monk, St. Meen Le Grand/France Printed by Angerer & Göschl, Vienna 2011 Finance Committee Chairman Adrian K. Dixon, Cambridge/UK Philip Ward, Chester/UK myESR.org Publications Committee Chairman Peter Baierl, Vienna/AT Executive Director

The Editorial Board, Editors and Contributing Writers make every effort to ensure that no inaccurate or misleading data, opinion or statement appears in this publication. All data and opinions appearing in the articles and advertisements herein are the sole responsibility of the contributor or advertiser concerned. Therefore the Editorial Board, Editors and Contributing Writers and their respective employees accept no liability whatsoever for the consequences of any such inaccurate or misleading data, opinion or statement. Advertising rates valid as per January 2011. Unless otherwise indicated all pictures © ESR – European Society of Radiology

myESR.org Paul Klee, Foehn in Marc’s Garden, 1915, Städtische Galerie im Lenbachhaus und Kunstbau München © VBK Wien, 2011 www.albertina.at 10am–9pm Wednesday hours: Opening 1 Albertinaplatz Vienna, 1010 Rider Blue The Exhibition: Special Albertina daily 10am–6pm daily 32 ECR TODAY 2011 AR TS & CULTURE Friday, March 4, 2011

What’s on today in Vienna?

Theatre & Dance Please note that all performances, except at Vienna’s English Theatre, are in German! Rabenhof 20:00 A ustrofred – You can shove your magic 1030 Vienna, Rabengasse 3 flute up your a…A correspondence carried phone: + 43 1 712 82 82 on between Austrofred and W.A. Mozart www.rabenhof.at

Schauspielhaus 20:30 K reisky – wer sonst? Folge 8 1090 Vienna, Porzellangasse 19 by Bastian Kraft and Daniela Kranz phone: + 43 1 317 01 01 www.schauspielhaus.at

stadtTheater walfischgasse 20:00 K arriere 1010 Vienna, Walfischgasse 4 by Verena Kurth based on the novel phone: + 43 1 512 42 00 by Robert Neumann www.stadttheater.org

Tanzquartier Wien 20:30 Ond e de choc 1070 Vienna, Museumsplatz 1 O Vertigo (Canada), choreography by phone: + 43 1 581 35 91 Ginette Laurin, music by Michael Nyman www.tqw.at

Theater in der Josefstadt 19:30 Dr ei Schwestern 1080 Vienna, Josefstädter Straße 26 by Anton Tschechow phone: +43 1 42 700 300 www.josefstadt.org

Vienna’s English Theatre 19:30 C at on a Hot Tin Roof 1080 Vienna, Josefsgasse 12 by Tennessee Williams phone: +43 1 402 12 60 0 www.englishtheatre.at

Volkstheater 19:30 A ntigone Vertigo © Ginette Laurin Vertigo

O 1070 Vienna, Neustiftgasse 1 by Sophokles phone: 43 1 52111 400 www.volkstheater.at nde de choc by O

Concerts & Sounds

Musikverein (Classical Music) 19:30 O RF Radio Symphonie Orchester Wien, 1010 Vienna, Bösendorferstraße 12 conductor Peter Eötvös www.musikverein.at Natalia Zagorinskaya, soprano, Carolin Widmann, violin Z. Kodály, P. Eötvös, G. Kurtág, B. Bartók

Porgy & Bess (Jazz) 20:00 A rmen Donelian Quartet 1010 Vienna, Riemergasse 11 www.porgy.at

Arena (Alternative Music) 20:00 ‘Paganfest 2011’ 1030 Vienna, Baumgasse 80 www.arena.co.at

Gasometer (Alternative Music) 20:00 Beatsteaks BA-CA Halle Gasometer 1110 Vienna, Guglgasse 8 www.gasometer.at

Szene Wien (Alternative Music) 20:00 V ienna Prog Rock Night feat. 1110 Vienna, Hauffgasse 26 Captagon / Inspirational Corner / Terratoma www.szenewien.com Peter Eötvös © Klaus Rudolph

Opera & Musical Theatre

Volksoper 19:00 Di e Blume von Hawaii 1090 Vienna, Währingerstraße 78 Operetta by Paul Abraham www.volksoper.at / Rolf Bock

W Wiener Staatsoper – 14:30 & 17:00 Die Zauberflöte (The Magic Flute) for Children Vienna State Opera by Wolfgang Amadeus Mozart, 1010 Vienna, Opernring 2 conducted by Franz Welser-Möst www.wiener-staatsoper.at do Jürgens © VB U

by Raimundtheater 19:30 I ch war noch niemals in New York ork Y 1060 Vienna, Wallgasse 18–20 by Udo Jürgens & Gabriel Barylli ew

N www.musicalvienna.at

Ronacher 19:30 T anz der Vampire 1010 Vienna, Seilerstätte 9 by Jim Steinman & Michael Kunze www.musicalvienna.at Ich war noch niemals in

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