ECR TODAY 2018 EUROPEAN CONGRESS OF RADIOLOGY

DAILY NEWS FROM EUROPE’S LEADING IMAGING MEETING | FRIDAY, MARCH 2, 2018

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HIGHLIGHTS CLINICAL CORNER TECHNOLOGY & RESEARCH COMMUNITY NEWS Riklund to unveil the next big MRI holds promise for CT manufacturers step up search European Radiology’s new thing in hybrid imaging immunotherapy but needs for definitive and cost-effective disease Editor-in-Chief to guide the journal more research characterisation into a promising future

BY VIVIENNE RAPER Swiss prepare to unveil connection between chocolate and radiology

several initiatives to improve the quality of Swiss radiology. And chocolate is considered as one of the highest quality products man- ufactured in Switzerland,” he noted. Weishaupt, who is chief physician in the Institute of Radiology and Nuclear Medicine at City Hospital Zurich, explained that Swiss choc- olate needs precision manufactur- ing, and Swiss radiology also prides itself on its attention to detail. He said that the SGR-SSR was the first medical society to introduce board exams, as well as clinical audits for radiology departments in the pri- vate and public sector, which they developed in close collaboration with the Ministry of Health. “Other radiologists outside of Switzerland will probably be very interested in how our board exams are performed,” he pointed out. “We’ve organised them in a very pre- cise and complete way. When we do something in Switzerland, it’s usu- ally very precise and complete.” FreshChocolate with almonds from Läderach chocolatier suisse: the original and the view from a radiological perspective. Provided by Prof. Dominik Weishaupt. The board exams have both a written and an oral component. How to create hand-made choc- Andreas Trumpler, managing 1962, it has established a reputation The connection between Swiss During the oral exam, radiologists olate masterpieces isn’t your usual director marketing and group CMO for chocolate and confectionery chocolate and Swiss radiology is are given a case to discuss and are radiology talk but, in today’s session, at Läderach chocolatier suisse, will specialties. Läderach’s products are one of quality, according to Prof. Dr. asked questions, including some radiologists with a sweet tooth can be giving two short presentations sold throughout Switzerland and Dominik Weishaupt, who has been that go beyond the case itself. In learn all about truffle making and about how Swiss chocolate is trans- Germany, as well as by partners in President of the Swiss Society of board exams, you must get an other confectionery arts from a lead- formed from cacao bean to choc- the Middle East and Asia, and it sup- Radiology (SGR-SSR) since 2016 and impression of how the candidate ing Swiss chocolatier – interspersed olate, and then into a hand-made plies the top end of the gastronomy is chairing today’s session. with more conventional talks about masterpiece. The company employs and hotel industry with semi-fin- “Over the 100 years of the Soci- radiology in Switzerland. more than 800 people and since ished and finished products. ety’s history, we have undertaken continued on page 2 myESR.org #ECR2018 2 HIGHLIGHTS ECR TODAY | FRIDAY, MARCH 2, 2018 ECR TODAY | FRIDAY, MARCH 2, 2018 HIGHLIGHTS 3

continued from page 1 Diffusion-weighted MRI is par- ity images and collaborate closely BY KATRINA MEGGET ticularly helpful for detecting pyelo- with a physicist. ESR meets Session acts as a radiologist in his or her nephritis, differentiating abscess and “To get high-quality choco- daily life, and not just in terms of cystic renal cell carcinoma, detect- late, you need to make an effort,” Friday, March 2, 10:30–12:00, Room B written ability, he added. ing significant prostate cancer, and she said. “Interpreting diffu- ESR meets Switzerland Weishaupt thinks of each of the improving pelvic lymph node stag- sion-weighted MRI also needs effort EM 1 Radiology and Swiss chocolate: a sweet combination Clinical necessity of gadolinium radiology talks in the session as ‘a ing (combined with morphology). by including not only the high truffle’. In the first ‘truffle’, Dr. Har- To get the correct diagnosis, b-value images and the correspond- Presiding: B. Hamm; Berlin/DE riet Thoeny, senior staff member Thoeny said it’s usually sufficient ing ADC map, but also the morpho- D. Weishaupt; Zurich/CH in the radiology department at the to perform qualitative image analy- logical images. You need good ingre- »»Introduction: What Swiss radiology and Swiss University of Bern, will explain why sis by looking at high b-value images dients to make good chocolate, and contrast comes under close scrutiny chocolate have in common diffusion-weighted MRI should be and the corresponding apparent dif- you need good-quality images for D. Weishaupt; Zurich/CH applied to all patients when imag- fusion coefficient (ADC) map. ADC is diffusion-weighted MRI.” ing the urogenital tract. a measure of the magnitude of water In addition to learning about clini- »»Truffle No. 1: MR-diffusion of the urogenital tract: Gadolinium-enhanced MRI scans have been the gold standard in suspected cases of benign “Diffusion-weighted MRI pro- molecule diffusion through tissues, cal practice, Weishaupt hopes radiol- where it really helps vides information on morphol- and is used to look for impediment ogists attending the session will learn H.C. Thoeny; Berne/CH tumour vestibular schwannoma (VS) and multiple sclerosis (MS), but given the growing ogy and function without contrast of water movement within organs in how, despite the fact that Switzer- »»Interlude 1: From cocoa bean to chocolate creations medium administration and with- the body – in this case, the urogen- land is a small country, radiological A. Trümpler; Ennenda/CH evidence that the contrast agent can leave deposits in the brain, debate has ensued about out exposing the patient to radia- ital tract. Radiologists can also per- research carried out there is highly »»Truffle No. 2: hip preservation surgery: tion,” she commented. form quantitative image analysis by visible in Europe and worldwide. a fast evolving field also for imaging how to image wisely. Thoeny explained that gadolini- measuring the ADC value. Further to publishing scientific C.W.A Pfirrmann; Zurich/CH um-based contrast agents have been Although the link between dif- papers, Swiss radiologists belong found to persist in the body after an fusion-weighted MRI and choco- to committees, societies and other »»Interlude 2: From cocoa bean to chocolate creations less and less the rule. Instead, a gad- MRI scan, and although there is no late may seem tenuous, Thoeny bodies of the European Society of A. Trümpler; Ennenda/CH olinium scan is requested in specific evidence that they can harm patients, reiterates that the key points Radiology, he continued. Weishaupt »»Truffle No. 3: multiparametric imaging in cases when its use can potentially it is recommended to avoid these are quality and teamwork. Diffu- will also talk about some of the head and neck oncology answer a clinical question.” examinations in certain patients, par- sion-weighted MRI is relatively activities of the SGR-SSR, such as M. Becker; Geneva/CH While, the use of contrast-en- ticularly those with impaired renal quick, cheap, and avoids poten- the Swiss Congress of Radiology, an »»Panel discussion: The way of maintaining and hanced MRI scans is the only way to function or vulnerable patient groups tial risks from contrast medium annual meeting with scientific and improving quality of Swiss radiology observe blood-brain-barrier disrup- such as pregnant women or children and radiation, and the emphasis educational sections. tion due to an inflammatory lesion, with kidney infections. is on the need to obtain high-qual- Van Hecke said that recent develop- ments of imaging analysis techniques allowed radiologists to evaluate and quantify new and enlarging T2/ fluid attenuated inversion recovery (FLAIR) lesions, which also represent disease activity in patients with MS. As awareness of gadolinium reten- tion grows, he thinks it is important to communicate clearly with neu- rologists, clinicians and patients, on High resolution T2-weighted and enhanced T1 image of large intra and extrameatal vestibular schwannoma. Images provided by Dr. Francesca B. Pizzini. the use of the contrast agents. Ulti- mately, more research is needed to T1-weighted images (T1-WI) con- no need to use gadolinium in firm icometrix, who will be speak- evaluate gadolinium retention in the sidered to be the gold standard for diagnosis, both from a cost and ing today about imaging of MS, brain, he added. tumour assessment. safety perspective. agreed that given the recent discus- Pizzini agrees that more clini- “Gadolinium-based contrast “Several studies propagate screen- sions about gadolinium and its role cal studies are required. “There is a agents increase the relaxation ing by non-contrast enhanced MRI. in disease diagnosis and follow-up, need for wise use of the available rate of water protons in the region Yet, by definition, screening means it was important to evaluate its use gadolinium-based contrast agents where they distribute, thus pro- testing of an asymptomatic pop- and clinical necessity. He thinks fol- and/or of alternative unenhanced viding relevant information on ulation to identify those who are low-up MRI scans in MS using con- sequences until any possible health pathologies, involving changes in susceptible to a given disease,” she trast should be questioned. risks will be completely excluded Post-gadolinium T1-weighted image the vascular density and permea- said, adding that she plans to draw “I believe that for the diagnosis of and until new kinetic/thermody- shows lesion (left: original image; bility and structural differences,” on the scientific literature in today’s MS, the use of a gadolinium-enhanc- namic stable gadolinium complexes right: lesion marked in red). she said. “Unenhanced sequences presentation to help inform radiol- ing scan is still highly recommended will be discovered.” available are not currently provid- ogists’ decision making and enable … For the follow-up MRI scans, it In many cases, wise imaging Gadolinium has already been a sub- ing comparable and alternative them to image wisely. should be a clinically informed deci- will come down to a case-by-case ject of debate with questions about its structural details.” Verbist suggested instead that cli- sion, involving the treating clinician basis, and it is important now to cost-effectiveness, but the news that Her hope is that today’s session nicians should ‘pre-screen’ patients, and the patient,” he noted. “We indeed take more clinical information into gadolinium has been found depos- will also assess the diagnostic accu- selecting only those with symp- observe that the use of gadolinium account before setting an imaging ited in the brain and in other body racy of high-resolution T2-weighted toms, at risk of VS, to have an MRI for the follow-up scans is becoming protocol for patients, she said. tissues – even though there is no evi- scans as an alternative to gadolini- with gadolinium. “That way you dence to suggest it causes any adverse um-enhanced T1-weighted scans in only image selected patients,” she effects – has increased the inten- different clinical settings. said, noting that the sensitivity Pros & Cons Session sity of the discussions. The question Most of the controversies regard- of gadolinium for picking up very many radiologists have been asking ing the use of gadolinium focus on small lesions means any disease can Friday, March 2, 16:00–17:30, Room M 4 is: is it always necessary to use gado- the primary diagnosis – rather than be identified in the early stages in PS 1227 Gadolinium: image wisely linium contrast agents in imaging? In follow-up and post treatment – of these high-risk individuals. While regards to VS and MS, this question VS, which is a benign intracranial efforts are being made to define cri- Moderators: P.M. Parizel; Antwerp/BE will be explored at today’s Pros and tumour of the myelin-forming cells teria of patient selection for imag- A. Rovira-Canellas; Barcelona/ES Cons Session. of the vestibulocochlear nerve, in the ing, it is important to bear in mind »»A. Intracranial gadolinium deposition: update and perspectives “The use of contrast-enhanced internal auditory canal next to the there are presently no reliable H.A. Rowley; Madison, WI/US MRI, during observation of a brain. Patients may present with sen- non-imaging tests to identify high- known VS or surveillance after sur- sorineural hearing loss, tinnitus and risk individuals, she continued. »»B. Do we need gadolinium in imaging MS? Pros and cons gical or radiotherapy treatment, has balance problems, but only a small “If you decide not to use gado- C. Lukas; Bochum/DE become questioned,” said Dr. Fran- percentage of people with these linium then you have to enhance W. Van Hecke; Antwerp/BE cesca B. Pizzini, a neuroradiologist symptoms will have VS, explained awareness of clinicians and coun- »»C. Do we need gadolinium in imaging vestibular schwannomas? at University Hospital Verona, Italy. Dr. Berit Verbist, neuro, and head and sel the patient that small schwan- Pros and cons The problem has arisen because neck radiologist at Leiden University nomas and other diseases may be B. Verbist; Leiden/NL MRI has a central role in evaluat- Medical Centre, the Netherlands. missed,” Verbist said. F.B. Pizzini; Verona/IT ing VS in first diagnosis and fol- As such, this is one of the argu- Dr. Wim Van Hecke, chief exec- »»Discussion on the pros and cons low-up, with contrast-enhanced ments given as to why there is utive of Belgium-based start-up

RTF MEET & GREET SESSIONS

Don’t miss the opportunity to meet Radiology Trainees Forum (RTF) Don’t forget the: representatives from various European countries at the RTF Booth in RTF Meet & Greet with ESR President Prof. Bernd Hamm today, the Rising Stars Lounge (entrance level near Foyer F)! 16:00–16:30 at the Rising Stars Lounge Take this chance to have an informal discussion, present your own ideas and opinions towards radiology training as well as find out more RTF Highlighted Lectures on Saturday, about the RTF and what they do. Who knows, perhaps you will be the March 3, 10:30–12:00 in Room O representative next year!

#ECR2018 myESR.org myESR.org #ECR2018 ECR TODAY | FRIDAY, MARCH 2, 2018 HIGHLIGHTS 5

BY MÉLISANDE ROUGER Riklund to unveil the next DISCOVER big thing in hybrid imaging The Swedish radiologist Prof. Katrine Riklund, the current Chair of the ESR Board of INTERVENTIONAL RADIOLOGY Directors, has dedicated her career to the development of hybrid imaging. During todays’ Marie Curie Honorary Lecture (Room A, 1:00 p.m.) she will look back at the achievements AT THE CUBE made in this emerging field and look forward to future advances.

be making use of the entire hybrid create and label monoclonal anti- also noteworthy, she pointed out. in the system and a situation exists imaging examination for diagnostic bodies to find tumours, and it was The growth in computing power where there is competition between protocols, also for the CT part, she possible to visualise their localisa- has of course been a prerequisite clinical work and science. Teleradio- believes. “This changes workflow tion with scintillation cameras, I for the enormous development of logical collaboration can be used in and gives us more information. PET was hooked. I wrote my PhD the- image data processing. both settings to minimise distances. and CT or MR are not competing sis in 1992, on radioimmunodiagno- Automation and artificial intelli- The financial situation is always a techniques, they are complemen- sis and radioimmunotherapy with gence will change radiologists’ work challenge and can influence contin- tary,” she said. radiolabelled monoclonal antibod- and help us, but it is important that uous development.” Tracer development is key for ies, which was already a transla- we are involved in the work rather This should not discourage med- PET but digital detectors will also tional research project,” she said. than just the computer scientists, ical students from choosing radiol- represent a major step forward. She decided to become a radi- she argued: “I am convinced we ogy as a specialty, however, as it is Currently, the need for a cyclotron ologist after completing a schol- have to start solving clinically rel- fascinating, and of great importance for production of radionuclides arship programme in Saskatoon, evant questions. There are already in most areas of healthcare. “Imag- hinders substantial distribution of Canada, after only three years of many algorithms that can be used ing influences diagnosis, treatment scanners outside large centres. “To medical school. “I was only allowed but we need to identify and focus planning and follow-up. And if you make hybrid imaging really take to choose between radiology and on what we should use them for. choose interventional radiology, you off, we need other forms of tracer pathology. Since I was already an Hopefully we can initially receive will also play a big role in treatment. production. I would like to see the amanuensis in clinical pathology a robust decision support system. There will always be something new Prof. Katrine Riklund from Umeå, tracer production work like a cof- I chose radiology. The specialty There is also a great need for sim- to learn in radiology,” she said. Sweden, will speak about the fee machine – with buttons to select totally caught my interest and I pler systems for organ segmenta- Prof. Riklund also mentioned the growing significance of hybrid tracer and radionuclide,” she said. decided to become a radiologist. tion, and I am awaiting the devel- benefit of travelling abroad and imaging in today’s honorary lecture. In her day-to-day work, Prof. One year later I started my PhD opment of an intelligent system for meeting colleagues from all over Riklund is involved in various studies in radiology in parallel to calculation of total tumour burden the world. “Making friends abroad Riklund, who is a professor, con- research projects, such as COBRA, medical school,” recalled Riklund. or functional tumour burden.” helps to build bridges between sultant in diagnostic radiology and a prospective multimodal imag- Nuclear medicine was already part The next step will be the radiol- countries, which I am convinced pro-vice-chancellor of Umeå Uni- ing study of dopamine, brain struc- of the radiology department at her ogists’ capability to create added can be small steps towards achiev- versity, is one of Sweden’s leading ture and function, and cognition; university hospital. value by integrating imaging data ing better understanding between radiologists. She is also one of the (PEARL-PD), 18F-FE-PE2I PET/CT, During her 30-year career, she has with other clinical data for support us. With regard to imaging, interna- first researchers to have recognised a study of dopamine transporters witnessed the “overpowering devel- in personalised/precision medicine tional cooperation can help to har- the potential of combining PET in early Parkinson’s disease, REC- opment” in radiology and nuclear for treatment planning and prog- monise education, clinical work, with CT and MRI, and has worked TOPET (REctal Cancer Trial On medicine. “The digitalisation of nosis, among other applications, research and equipment standards, to advance the field ever since its PET-MR/CT); and Prostate Cancer imaging completely changed the she added. as well as increase the overall level emergence at the beginning of the – PSMA and Acetate in PET/CT and working process and possibilities Staff shortage is and will remain of competence. This work will, in 21st century. PET/MR. These projects reflect her for remote collaboration. The devel- an issue in many countries includ- the end, also help the patients.” “The combination of structural three major interests in the field; opment of CT and MR has been ing Sweden, she explained. “There What better place to start than and functional/molecular imag- movement disorders and cogni- amazing, and also formed the basis is a lot of pressure on radiologists at ECR? ing is fascinating. The entire field is tion in central nervous system, and for the highly significant introduc- new and extremely interesting, and prostate and colorectal cancer. tion of hybrid imaging, with the it’s the closest to my heart when it Her curiosity has led her to introduction of PET/CT in 2001 and Marie Curie Honorary Lecture comes to imaging,” she said. explore every potential path in PET/MR a few years ago,” she said. During her lecture, Prof. Riklund hybrid imaging from the moment Visualisation and processing of Friday, March 2, 13:00–13:30, Room A will share examples of what hybrid she heard about the exciting pos- image data, which is the basis for Hybrid imaging: the story so far and what to expect next imaging can do and what is going sibilities offered by the new field. the 3D-4D and parametric analyses Katrine Riklund; Umeå /SE to come next. A major trend will “When I learned it was possible to radiologists can perform today, are

Enter the captivating world of interventional radiology (IR) at ECR 2018!

For the fi rst time ever, ECR presents ‘the Cube’, an interactive exhibition dedicated to IR. WELCOME TO ECR

M BUILDING only accessible through ACV Challenges, quizzes, training and much more will SKY HIGH AUSTRIA CENTER STAGE VIENNA take place on daily topics, including peripherals, CITY the aorta, oncology, and stroke. Explore all our U – BAHN locations and get to know STATION

the neighbourhood THE CUBE Wednesday to Saturday Details at ECR EXPO 8:30 – 18:00 at the CUBE myESR.org/cube HALLS

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BY PETER LEANDER Lisbon, Portugal September 22-25 Future radiologists – orchestrators and conductors CIRSE 2018 Orchestrator may be the next buzzword in radiology. If radiologists don’t take the lead, many of the new systems may be conducted directly by the ordering clinicians and they may not wait for radiology to show an interest.

of thousands of neurons/nodes can Peter Leander is Associate Professor About the PIER Subcommittee featuring perform very well, there are still at Lund University and Regional The ESR Professional Issues and often limitations in acquiring anno- Chief Radiology Officer in the Economics in Radiology (PIER) tated training data. Even after more Region Skåne, Sweden. Subcommittee has, amongst other data is available to feed algorithms, tasks, been working on the Digital one cannot yet foresee that radiolo- Imaging Adoption Model (DIAM) gists will be superfluous. that has been initiated by HIMSS With that said, it is not yet time Europe and the ESR to establish to discourage medical students a set of guidelines in Europe to from becoming radiologists, but AI promote the advancement of IT should be embraced in playing a in radiology. helping role. For future radiologists, their job will not look the same as it does today. Even if a total reading is not performed by computers, which Professional Issues and would make AI a complete replace- Economics in Radiology (PIER) Sessions ment for radiologists, various sub- systems will indeed be built in for Friday, March 2, 10:30–12:00, Room M 2 reading. Other changes radiologists PIER 1 Establishing competence in radiology can expect are aggregations of cases to specialised radiologists and even Moderators: J. McNulty; Dublin/IE in certain circumstances the use of P. Valdés Solís; Marbella/ES teleradiology. There are many new »»Achieving homogeneity in radiology education: linking content possibilities and new subsystems to competence through the European training curriculum for the radiologist to be in charge of. L. Oleaga Zufiría; Barcelona/ES The next generation of radiolo- gists will be orchestrators and »»Establishing competence in radiology: a UK perspective conductors C. Rubin; Southampton/UK Bringing together many sys- W. Ramsden; Leeds/UK tems and helping hands is some- »»The value of the European Diploma what like what an orchestrator P.C. Maly Sundgren; Lund/SE does who makes use of different »»Obstacles to establishing competence in radiology instruments to create a full-bod- P. Valdés Solís; Marbella/ES ied sound. Now the radiologist »»How to manage the incompetent professional? may also become that orchestra- J.K. Bell; Manchester/UK tor and in daily work conductor of systems set up for a particular type »»Panel discussion: Overcoming heterogeneity in radiology of examination, e.g. AI with deep competence across Europe: a dream or reality? Artificial intelligence (AI) will soon be naturally integrated into our daily learning, machine learning, anno- work. The images show Lung CAD integrated directly into the reading tation of suspected areas in images, Friday, March 2, 14:00–15:30, Room M 2 workflow in PACS (with permission from Sectra AB, Sweden). automated workflows, or the prepa- PIER 2 Radiology will survive, but will ration of advanced visualisation. the radiologist still be there? Where is radiology heading? ities such as CT, MRI and PET/CT Technical development is provid- Diagnostic imaging is of great this has not changed. Another big ing more opportunities in radiology Moderators: P. Leander; Malmö/SE importance and will become even change in radiology has been digital- than ever before. S. Morozov; Moscow/RU more so with the addition of new isation and making use of RIS and The word orchestrator may be techniques, e.g. functional imaging PACS which enable direct access to the next buzzword in radiology and »»The landscape in radiology is changing: with PET, parametric imaging with images and greater efficiency. But is already seen in some contexts. the radiologists need to adapt Save dynamic contrast enhancement, still, despite the increased use of If radiologists don’t take the lead P. Leander; Malmö/SE DWI in MRI, and texture analy- RIS and PACS, how work is organ- many of the new systems may be »»Big-data, artificial intelligence, machine learning, sis just to mention a few areas. At ised has not really changed and the conducted directly by the ordering deep learning etc.: what radiologists should know the the same time, annual growth- radiologist remains at the end of clinicians and they may not wait for K.J. Dreyer; Boston, MA/US rates of imaging are up to 10% in the chain performing the reading. radiology to show interest. If such »»How to cope with the new IT developments: the western world. Not only is the Do we now stand before an impor- shifts occur away from radiology it the developer’s perspective number of examinations increas- tant paradigm shift? A paradigm will be even harder in hindsight to S. Tolle; Galway/IE ing, but also the studies are more shift is easy to discern when look- take back lost opportunities. date! »»The value of the radiologist in the evolving digital complex requiring highly specific ing back into the past. However, it PIER@ECR is a series of three reports, more quantitative meas- is much harder to grasp when we’re sessions on hot topics in radiology. environment: challenges for leadership urements with detailed parame- in the middle of one. Will new sys- In addition to the session described C.D. Becker; Geneva/CH ters, and reports structured to be tems begin to perform tasks that above, there will be a session fed into databases for follow-up, traditionally have solely been per- called ‘Establishing competence in Friday, March 2, 16:00–17:30, Room M 2 quality control and research. To formed by radiologists? Will such radiology’ and one on ‘Value- PIER 3 Value-based radiology respond to the growing demand, help be implemented in hospi- based radiology’. radiologists try to run faster but tal departments and welcomed The session will have highly Moderators: P. Mildenberger; Mainz/DE may have reached their limit when by radiologists? skilled and experienced speakers G. McGinty; New York, NY/US only working as they always have. AI and other helpers from both the industry as well as If other strategies are not imple- Artificial intelligence (AI) is on distinguished academic institu- »»Basic concepts of value-based radiology: U.S. perspective www.cirse.org mented, the increased workload everyone’s lips in healthcare and tions. The industrial perspective J.A. Brink; Boston, MA/US cannot be coped with and requests in imaging. Many times, AI is dis- will be covered by Steve Tolle from »»Basic concepts of value-based radiology: European perspective for new services from clinical col- cussed in terms of taking over the Galway who is Chief Strategist L. Donoso; Barcelona/ES leagues will be turned down. How- jobs of the radiologists. Computers at IBM Watson Health Imaging. The »»New metrics are required for value-based radiology ever, there may be ways to solve have made tremendous progress in academic perspective will be given G. McGinty; New York, NY/US these problems. the last few years, especially with by Keith J. Dreyer from Boston, Cardiovascular and Interventional Radiological Society of Europe »»Panel discussion: A European-U.S. debate Traditionally all reading has been the help of graphical processor units Chief Science Officer at the Amer- on the value of ‘value-based radiology’ performed by the radiologist (GPU). Once again, the industry for ican College of Radiology Data Sci- J.A. Brink; Boston, MA/US Looking back, traditionally exam- computer games has found its use ence Institute, and Christoph D. L. Donoso; Barcelona/ES inations have been performed by in healthcare. However, even if the Becker, chairman of the Depart- G. McGinty; New York, NY/US technicians and presented to a radi- most impressive deep learning algo- ment of Imaging and Medical L.E. Derchi; Genoa/IT ologist for reading. Throughout the rithms employing convolutional Information Sciences, University E.J. Adam; London/UK development of new potent modal- neuronal networks with hundreds Hospitals of Geneva.

myESR.org #ECR2018 EUROPEAN DIPLOMA IN RADIOLOGY – QUESTION OF THE DAY

-MARCH AY 2 How di cult did you fi nd D I yesterday’s question? R F O 2 N N QUESTIO Today there is a new opportunity to take the EDiR examination for free next year at the ECR 2019.

The European Board of Radiology will ra� e amongst the winners an examination place for the EDiR that will take place at the ECR 2019. The registration for the ECR 2019 is also included! Solve the question Go to the EBR blog at blog.myebr.org posted at the EBR blog in order to look for the EDiR question of the day. You will also fi nd further before 13:30h. interesting resources such as Dr. Pepe’s Diploma Casebook, EDiR Mnemotechnics and other useful tips to prepare for the examination.

The question will be discussed today during the EDiR Teaser at 13:30 The correct at Room Z. answer and the winner will be announced today at 14:00h at the EBR blog.

BLOG.MYEBR.ORG ECR TODAY | FRIDAY, MARCH 2, 2018 CLINICAL CORNER 9

Radiographers: foster the human touch Radiomics pushes treatment response A to Z of radiation dose management 10 in the age of artificial intelligence 11 to a new level 13

BY MÉLISANDE ROUGER MRI holds promise for immunotherapy but needs more research Immunotherapy is a booming field and recent trials have shed light on the effects of these drugs on cancer. A panel of experts will unveil the latest results and discuss the challenges for imaging in triaging patients and assessing treatment response during the dedicated New Horizons session today at ECR.

think about how we can improve treatment effects, as well as detect PET/MR is still in the experi- the assessment of these agents,” adverse effects from treatment. Dif- mental phase and there is no clin- said Goh, who will chair the New fusion-weighted imaging can help ically validated data yet. However, Horizons session. measure cellularity and dynamic it could be an interesting option These drugs have been trialled in contrast-enhanced MRI enables us to investigate in immunotherapy, a number of cancers including renal to assess vascularity. And then we he believes. “PET/MR allows us cell cancer, prostate cancer, colorec- can also look at the complexity of to combine the specificity of PET tal cancer and melanoma. They the tumour environment, i.e. pro- tracers with MRI to visualise dis- have notably improved progres- teins, using magnetisation transfer ease behaviour, but there isn’t a lot sion-free survival in patients with MR,” he said. of output at the moment.” advanced disease, e.g. melanoma. MR’s particular value is that it Radiomics, which generates data Response to treatment has been gives better image definition of the from images that are invisible to the assessed mainly with CT. But assess- tumour in areas such as the brain, human eye, could be an additional ing response remains tricky even on tumours in the extremities of the tool in this setting. “I think radiom- CT, especially since these drugs can body, and sarcoma and soft tissue ics will have a place in the future cause tumours to grow as a second- sarcoma, where CT traditionally has of radiology and would also likely ary effect, when the body’s immune difficulty. contribute in the realm of immuno- system is being stimulated. “This is However the reality is a bit more therapy. However, at the moment, because immune and T-cells are being complicated, especially for new nobody has a very good solution; stimulated in the body. So if you just drug development. “A lot of us who although many imaging biomarker looked at the size change with stand- are doing this find it to be a very trials are in development,” Koh said. ard response criteria, i.e. RECIST, this complicated task. It’s hard to meas- Another specific contribution can be misleading,” Goh said. For this ure drug effect especially when for MRI will be in the surveillance reason, modified response criteria, the effectiveness of a new drug is of adverse effects. “You may not e.g. immune-related response criteria unknown. In malignant melanoma, identify these complications on CT (irRC) or iRECIST, have been devel- we know that immunotherapy or PET. MRI with its exquisite soft oped for assessing treatment response drugs work well in a significant pro- tissue contrast can demonstrate using imaging. portion of patients, so we may be complications that can affect These drugs may be effective, able to identify an MRI signature of patient management.” but they can also have significant treatment response,” Koh said. side effects. Having reliable results A middle aged man with metastatic melanoma commencing on just a few weeks after treatment immunotherapy drugs nivolumab and ipilimumab. Pre-treatment (top row) onset may help to reduce toxic- New Horizons Sessions contrast-enhanced T1-weighted image shows an enhancing metastasis in the ity and improve patient manage- left temporal lobe (arrow), which is associated with low ADC value (791 x 10-6 ment, according to Prof. Dow-Mu Friday, March 2, 08:30–10:00, Room C mm2/s). After eight weeks of treatment, the lesion shows minimal change on Koh, professor in functional can- NH 9 Immunotherapy: a revolution in cancer care? the T1-weighted image (arrow) but demonstrates 20% increase in the ADC cer imaging and consultant radi- value (948 x 10-6 mm2/s). At 16 weeks after treatment (bottom row), the lesion ologist at The Royal Marsden »»Chairperson’s introduction: What the radiologist has regressed and shows no appreciable enhancement on the T1-weighted Hospital, London. needs to know image, although residual post-treatment high ADC value cystic area is visible. “The holy grail is that we want to V.J. Goh; London/UK Image provided by Prof. Dow-Mu Koh. use some other tests and measure- »»CT: looks bigger, but it’s better ments to measure parameters other C. Dromain; Lausanne/CH Immunotherapy drugs enhance of cancer imaging at King’s College than size, to determine tumour »»The MR armoury in follow-up the body’s immune system to get London and honorary consultant response,” said Koh, who will talk D.-M. Koh; Sutton/UK rid of cancer cells. The idea is not radiologist at Guy’s and St Thomas’ during the session. »»Systemic and immunologic effects of image-guided new but is having a rebirth as new Hospital in London. MRI has emerged as an inter- interventions in oncology information emerges. “Immuno- “It is very much a hot topic esting modality, as it can provide S.N. Goldberg; Jerusalem/IL therapy deserves to be the focus right now but also a challenge information on tumour vascularity of a New Horizons session at ECR,” for imaging. This is the right time and cellularity, he explained. “MR »»Panel discussion: How should radiology improve according to Vicky Goh, professor for the imaging community to may enable earlier identification of imaging to support this revolutionary care?

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BY FRANCES RYLANDS-MONK BY MÉLISANDE ROUGER Radiographers: foster the Radiomics pushes treatment human touch in the age of response to a new level Precision medicine is increasingly helping to predict treatment response in a non-invasive artificial intelligence way. But data collected with radiomics and radiogenomics will not fully reveal its power unless it correlates with biology and generates multidisciplinary cooperation, researchers The advent of artificial intelligence (AI) in combination with permanently evolving imaging will argue in a dedicated New Horizons session today at ECR. techniques and machines has created a complex working environment, and there is an ever greater need for radiographers to create strategies to optimise the patient’s clinical pathway Working with radiomics can cannot always do multiple biopsies seem a minefield, but it’s impossible in the same patient, we need to find and be prepared to develop skills to keep their profession alive. At a Special Focus session to resist once you understand the a way to mine the imaging data to mechanisms behind it, according to non-invasively predict response today, ECR delegates will hear about the risk of the machines taking over if radiographers Prof. Laure Fournier, a leading radi- and treatment efficacy.” ologist at Georges Pompidou Euro- Being able to correlate all this infor- don’t fully develop their role and underline the added value of their services. pean Hospital in Paris. mation will help with the booming “Radiomics is a data-driven field of immunotherapy and facili- approach for extracting large sets tate adequate use of chemotherapy, have to make sure we have anxious medically trained staff that these of complex descriptors from clinical Sala believes. “Right now the only patients’ attention and adapt what x-ray patients see in the depart- n % images, without any prior hypothe- way to predict response to immu- we say accordingly. This is one of ment is the radiographer. sis. Data-driven research is a pro- notherapy is to wait and eventually the things that differentiates us Revealing to patients that an Incorrect 59 60 foundly new scientific approach. some of the tumours will respond from the machines.” x-ray is 10 microgray square metre Correct 39 40 Instead of looking at confirming and others will not. Some tumours Paulo also underlined the need (mGy/m²) may not be that helpful or disproving a hypothesis, we first will show pseudo-progression and for proven ‘whole procedure’ met- when communicating risk. look at data and try to extract mean- the response will only be apparent rics to serve as an indicator for how “Effective dose should be trans- ing out of it. It’s a true revolution in on standard imaging after several long examinations should take. It lated into something tangible for Table 1. Correct dose parameters supplied our scientific approach. It’s a smart weeks, which is a rather long time is important to ensure adequate patients to grasp, such as ‘background and agile method, and it brings out in terms of drug toxicity and side time is allocated for explanations radiation’. I tend to explain it in terms n % exciting results,” she said. effects,” she said. and obtaining fully informed con- of days or weeks – or for heavier expo- Radiomics extracts a wide vari- Integration is key to further devel- sent, and studies should be under- sure, months,” O’Hora noted. ety of parameters from features opments and multidisciplinary coop- Missing Kerma at a reference point (Kar) 45 76 taken to measure how many pro- Every facility should provide its of ultrasound, CT, MRI and PET Texture analysis of liver metastases showing tumour heterogeneity. Processing of images allows generating a large eration is an important factor to cedures radiographers can safely own bespoke analogies, depending Missing Kar, Peak ski dose (PSD) supplied 9 15 examinations. Parameters can be number of parameters which can be correlated to outcomes. Image provided by Prof. Laure Fournier. include in the equation and research- perform over a set period of time. on where it falls in terms of the Missing Kerma area product (KAP) 1 2 on tumour geometry, size, contours, ers should collaborate together be The metric tool would also analyse national average. In the Mater, for Missing KAP and Kar 2 3 anfractuosity, irregularity and direc- more precise and subtle,” she said. which will give us the most relevant Traditional risk stratification is they mathematicians, biologists, each patient’s radiation exposure, example, one chest x-ray equals one tionality, but also on pixel composi- Applications of radiomics and prognostic information,” she said. robust, but as medicine is shifting to imagers, oncologists, engineers, etc. Missing fluoroscopic time (FT) and Kar 1 2 as well as time for the radiographer day of background radiation in Ire- tion. The obtained data is then con- radiogenomics have spread mainly A few emergent prospective a more personalised, patient-tailored “Being smart but working in silos The WHO guidance document on to communicate with the radiolo- land, compared to the national fig- Missing FT and KAP 1 2 verted into high-dimensional data. in oncology, but new work is also studies have shown a very good approach, it is necessary to synthe- doesn’t get you anywhere,” she said. communicating radiation risk aims gist or referrer about any post-pro- ure of two days. Once mined, the data may be used emerging in cardiovascular and correlation between the sample sise all histological, genomic, imaging As for radiologists, they should to help radiographers harmonise cedural treatment issues, such as He added that radiographers to detect correlations with genomic other diseases. Prof. Evis Sala, the and imaging findings. Sala herself and clinical information to better invest in appropriate training to communication strategies. for tissue reaction. should opt for scenario comparisons Table 2. Dose parameter omission. Tables provided by Lee O’Hora. patterns; this process is known newly appointed chair of oncolog- has published some of this pio- predict the outcome, provide person- make the most of all these advances These metrics would produce an taken from daily life. “Most patients as radiogenomics. ical imaging at Cambridge Univer- neering work on ovarian cancer, by alised treatment, and use this com- and the fact that data science will Interacting with patients, creat- adequate average time per exami- aren’t worried about the associated The EU Basic Safety Standards he said. “The EU Federation of Tumour heterogeneity parame- sity and former chief of body imag- using 3D printing technology. “We bined information in different drug eventually penetrate many aspects ing a safer environment, and pro- nation that would cover explana- radiation effects of being in an aero- (EU BSS) Directive may also neces- Radiographers has been working ters can be obtained from looking ing services at Memorial Sloan and just completed a study in patients development trials, Sala suggested. of imaging. “It is important to know viding a more effective and objec- tions and also factor in time spent plane 30,000 feet up in the air. If they sitate changes to how risk is com- to rectify the situation. New reg- at pixel intensity and signal-based Kettering Cancer Center in New with advanced ovarian cancer and “Correlation is going to be crucial basic principles and be able to ana- tive service for referrers are key answering patients’ questions after are not worried about the radiation municated and raises the question ulations that will be applied in 20 disposition. Data mining is driving York City, will focus on ovarian can- in whom we inserted the surgical to distinguish what is malignant or lyse results. We must understand to safeguarding the profession’s the procedure, and communicating on a flight from Dublin to London, of who will be responsible for this years time will mention the role research in the field, as it sheds cer during the session. In her talk, tumour specimens into a custom not and which tumours are resist- this language to control how data is future, according to Graciano Paulo, with referrers. then you can let them know that under national legislation. of radiographers more clearly, but light on important aspects of treat- she will explore the correlation made 3D mould and took multiple ant to treatment. Finding a way being used and interpreted, because head of the scientific board of med- Furthermore, whole procedure they probably shouldn’t be worried “In the new Directive radiogra- in the current standards, responsi- ment response, Fournier explained. between radiomics, radiogenom- samples from both primary ovar- to predict resistance to treatment we are the imaging experts,” ical imaging and radiotherapy at metrics can serve as a guidance about a diagnostic procedure.” phers are only mentioned once, bility for communicating risk has “Tumour heterogeneity is an impor- ics and biology, and explain why ian tumours and metastatic disease would be a great step forward. You Fournier concluded. Coimbra Health School, Portugal. tool, incorporating input from A keen proponent of metrics, and then we are largely ignored or been allocated to the practitioner tant piece of information to have in this relationship must be further in the abdomen guided by various Radiographers should prioritise all professionals on the patient O’Hora points to the imaging overlooked. This is a serious omis- and referrer. This is somewhat your diagnosis. The more heteroge- explored to truly benefit healthcare. imaging habitats (microenviron- adapting to today’s reality and pathway, according to Paulo. He department’s motto (“what gets sion of the European legislation,” short-sighted.” neous a tumour, the more aggres- “Most of the published radiomic ments) within each lesion. Using the New Horizons Session focus on communication and team- stressed that ‘point of care’ should measured, gets managed”) as a key sive it is; so treatment may not data is based on retrospective stud- 3D mould, we matched the imaging work, he explained. be the same across the Euro- factor in making the Mater a low- work on all of the tumour cells, and ies, which makes the biological cor- with pathology and genomic sam- Friday, March 2, 16:00–17:30, Room G “If we don’t position ourselves, pean Union (EU), pointing to the dose facility. Evidence from his PhD Special Focus Session surviving cells may go on proliferat- relation rather difficult due to poor ples as much as we could,” she said. NH 12 Radiomics: what is it and how can we use it? then radiographers will become World Health Organization (WHO) research, however, suggests that ing,” she said. annotation of the biopsy site. For But despite efforts on correlat- merely the interface of a technical guidance document on communi- not all hospitals in the EU have the Friday, March 2, 16:00–17:30, Room K All of this information is con- example, when you are performing ing all of the findings, advances »»Chairperson’s introduction service, becoming obsolete as robots cating radiation risk as an excel- same dose parameter awareness SF 12d Radiographers’ challenge: informing patients about tained within an image and can be a biopsy for ovarian cancer, your are relatively slow, she admitted. O. Clément; Paris/FR learn to do the same job. However, lent starting point for the harmo- about the specific parameters used radiation risk extracted using appropriate soft- patient usually has lesions all over “We’re not really there yet. Imaging »»Radiomics: what is it and how does it work? we can bring more than this to the nisation process. to quantify risks associated with ware. Fournier and her team are the abdomen and pelvis, and you might provide different insights L.S. Fournier; Paris/FR profession, assuring the irreplacea- At today’s session, Lee O’Hora, different procedures and this might Moderator: J.N. Vassileva; Vienna/AT currently able to collect about 1,800 cannot biopsy every single one. How- into tumour biology from what »»Radiomics: technical validation ble ‘human touch’ in patient man- radiation safety officer at the Mater pose problems for optimal commu- parameters per image, a capacity ever, we can image all the lesions and pathology or genomics might »»Chairperson’s introduction: The European BSS (Basic Safety R. Leijenaar; Maastricht/NL agement,” Paulo told ECR Today Misericordiae University Hospi- nication to patients (see tables). that tremendously improves the prospectively correlate quantitative reveal and they probably provide Standards) Directive and current legal requirements »»Radiomics: biological correlation ahead of the congress. tal in Dublin, will cover different He sent a questionnaire to Euro- chances of not missing any relevant imaging metrics, i.e. radiomics, with complementary information. The S. Geers-van Gemeren; Utrecht/NL E. Sala; Cambridge/UK In terms of risk communication, strategies for harmonising risk pean interventional physicians and finding. “These techniques are inter- pathology and genomics to unravel key here is to integrate all the data the amount of time spent with each communication to patients within radiographers about using dose »»So whose role is it? What different professionals can and esting to quantify heterogeneity on the biology of the tumour and its using integrated diagnostics which »»Radiomics: clinical challenges patient is the biggest challenge due facilities. Speaking to ECR Today parameters to quantify and qualify should do the pixel scale: they give more infor- heterogeneity. This can help select in turn will lead to personalised T. Penzkofer; Berlin/DE to the increasing volume of proce- ahead of the congress, he said that effects of radiation. In some catego- G. Paulo; Coimbra/PT mation than the human eye. They’re the appropriate lesion to biopsy patient care.” »»Panel discussion: Radiomics, the new holy grail in radiology? dures and the demand for more in his country a large majority of ries of the questionnaire, the major- »»What do patients want to hear and need to be told? rapid access to diagnostic imaging. imaging outpatients are seen by ity of respondents provided incorrect J. Portelli; Msida/MT “We must guarantee not just the radiographers, making these pro- answers. O’Hora believes ongoing »»How to effectively communicate radiation risks most adequate diagnostic and ther- fessionals the most appropriate training is vital, particularly in the L.R. O’Hora; Dublin/IE apeutic procedures but also the people to explain risks and proce- interventional suite, where staff need »»Panel discussion: Speaking a common language: provision of all the necessary infor- dures. Furthermore, around 70% of to be aware of the double risk of sto- how best to work together to inform patients ECR PARTY mation about risk in a harmonised all radiology referrals are for plain castic effects and tissue reactions in way,” he noted. “Furthermore, we film imaging, meaning that the only their exchange with patients. This session is part of the EuroSafe Imaging campaign. Saturday, March 3, 21:30 Buy your ticket for only €50 MarxHalle, Karl-Farkas-Gasse 19, 1030 Vienna at the registration desk

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BY KATHARINA MIEDZINSKA BY REBEKAH MOAN Broken, swollen, bleeding: how to A to Z of radiation dose deal with head and neck emergencies management, courtesy of EuroSafe In a dedicated Special Focus session at ECR 2018 today, three experts will illustrate the difficulties and challenges they face in the management of head and neck emergencies. Imaging campaign and EFOMP

In today’s session entitled ‘Head imaging techniques to use in case It lingers in the back of every radiologist’s mind: radiation dose. How can you lower dose? and neck emergencies’, Dr. Elizabeth of infections and inflammations in Loney, a consultant radiologist at the emergency setting. Specifically How do you track it? What’s the standard and acceptable level for a procedure? Luckily for Darlington Memorial Hospital, U.K., attendees will discover the diversity will discuss the imaging and report- of soft tissue infection patterns and ECR 2018 delegates, today’s presentations on dose management systems and repositories, ing of such cases. Trauma to the pathology that may be present in head and neck is a common reason the emergency setting. organised by the European Federation of Organisations for Medical Physics (EFOMP), will to visit the Emergency Department, Last but not least, Dr. Damien-Ar- ranging from minor facial injuries to thur Varoquaux, from the depart- answer all of those questions and more. life threatening airway compromise. ment of medical imaging at the Mar- As the true extent of the patients’ 3D CT of a Manson Type 1 NOE 3D CT of a ZMC fracture pattern. All seille University Hospital, France, will injuries may not be readily appar- fracture. images provided by Dr. Elizabeth Loney discuss vascular blunt and penetrat- procedure data. The level of com- ent, early diagnosis and appropriate ing traumatic injuries, highlighting in pleteness for patient exposure management is facilitated by accu- the early hours of the morning, it ums in Kensington,” she said. For particular the role of interventional data should take into account the rate imaging assessment. This guides is crucial to have a ‘system’,” Loney further details and to register go radiologists in the treatment of final scope of the data collection, preoperative planning to reconstruct 3D CT of a Le Fort II/pyramidal emphasised. “It is so easy to pro- here: www.eshnr.eu. epistaxis and tumours in the emer- and using them for optimisation of facial buttresses thus restoring form fracture. duce long, complex reports which Also in this session, Prof. Min- gency setting, vascular malforma- clinical protocols or for temporal and function and permitting early are essentially lists of fracture lines, erva Becker, from the division of tions, and endovascular treatments. tracking of changes, or estimation rehabilitation. In her presentation, I fracture the hard palate is detached rather than a concise, helpful report diagnostic and interventional radi- The concluding panel discus- of patient-centric dose/risk quanti- Loney will concentrate on maxillo- from the skull (a ‘floating palate’), which will really change manage- ology at the Geneva University sion will focus on the question ties like organ doses.” facial fractures, touching briefly on whilst in patients with a Le Fort II ment. Hopefully this presentation Hospital, Switzerland, will address of whether the radiologist is an It’s effective to monitor dose in temporal bone and orbital injuries injury, fracture lines include orbital will help radiologists to report such infections of the base of the skull essential component of the emer- such a way, but the effectiveness and finishing with traumatic lesions margins, and in Le Fort III cases examinations, regardless of the and familiarise ECR delegates with gency team. grows exponentially when all of the larynx, with particular focus there is complete dissociation of the mechanism of injury.” systems in a particular hospital on thin slice helical CT using multi- midface from the skull base. Exclu- Dr. Loney is the current President are connected, which allows for planar reconstructions (MPRs) and sion of Le Fort II and III fractures is of the British Society of Head and Special Focus Session inter-system comparison, optimi- 3D reformats. extremely important when evaluat- Neck Imaging, which, on Septem- sation, and standardisation. “There is a lot to consider when ing patients with facial trauma, as ber 27–29, 2018, will hold its annual Friday, March 2, 16:00–17:30, Room N “The next level is to connect sys- evaluating craniofacial injuries,” these patterns are associated with an meeting in collaboration with the SF 12c Head and neck emergencies Prof. Mahadevappa Mahesh, from Jenia Vassileva, PhD, a radiation tems in a group of hospitals in a Loney noted. In this regard she increased risk of cervical spine and European Society of Head and Neck Johns Hopkins University School protection specialist who is region, country, or even different plans to familiarise ECR delegates intracranial injuries. Radiology (ESHNR) and the British »»Chairperson’s introduction of Medicine in Baltimore, U.S., will affiliated with the International countries, which would allow for with a 3-step reporting system for “After excluding a Le Fort fracture, Society of Dental and Maxillofacial R. Kohler; Sion/CH moderate the second of today’s Atomic Energy Agency, will talk establishing DRLs, benchmarking, facial trauma. “The first step is to the next step is to evaluate whether Radiology (BSDMFR) in London, »»What is broken? sessions on dose management about dose monitoring today. and comparison,” she pointed out. Schematic presentation of the exposure-monitoring process. ask yourself the question ‘Are the nasoorbitoethmoid (NOE) or zygoma- at the Royal Geographical Society. E. Loney; Darlington/UK systems. That next-level connection is Image provided by Jenia Vassileva, PhD. pterygoid plates intact?’ If not, you ticomaxillary complex (ZMC) fracture “This promises to be an exciting »»It is red and swollen … precisely what’s occurring in the are looking at some type of Le Fort patterns are present. The final step event attracting prestigious inter- M. Becker; Geneva/CH U.S. with the American College of pattern injury,” she said. involves excluding isolated fractures national speakers with a great Specifically at the congress, the lishing new dose reference levels Radiology (ACR) dose index reg- »»It is bleeding … The Le Fort group of fractures (e.g. orbital and mandibular) and soft social programme at an historic EuroSafe Imaging campaign will based on the clinical indications istry. The registry started in 2011 EFOMP Workshops (European Federation D.-A. Varoquaux; Marseille/FR involves either complete or partial tissue injuries,” explained Loney. venue, adjacent to the Royal Albert unveil a clinical decision support and on the patient’s specific char- and contains more than 42 mil- of Organisations for Medical Physics) detachment of the maxilla from the “When confronted with a com- Hall and close to London’s famous »»Panel discussion: Is the radiologist an essential tool to help radiologists choose the acteristics, driving the actual DRL lion exams/82 million scans from skull base. In patients with a Le Fort plex facial trauma CT scan, often in National History and Science Muse- component of the emergency team? right procedure. It will also pub- based on anatomy toward clinical 2,800 sites across the U.S., accord- Friday, March 2, 08:30–10:00, Room G lish the updated EuroSafe Imaging DRLs,” added Frija, who is a profes- ing to Prof. Mahadevappa EF 1 Dose management systems and repositories: part A Call for Action, which reflects the sor emeritus of radiology and con- Mahesh, from Johns Hopkins group’s goals and activities for the sultant at the Paris Georges Pompi- University School of Medicine in Moderators: J. Damilakis; Iraklion/GR coming years. dou European Hospital. Baltimore, Maryland. A. Trianni; Udine/IT Prof. Guy Frija, chair of the Furthermore, tracking software When facilities use the registry, »»Chairperson’s introduction EuroSafe Imaging steering com- can play an important role in dose they receive a personalised report. J. Damilakis; Iraklion/GR mittee, will provide updates on optimisation, influence behaviour, More importantly, the report also INSIGHTS the campaign, such as the imple- and support quality improvement demonstrates how the facility per- »»The ‘EuroSafe Imaging’ campaign’s point of view mentation of the European Basic initiatives. It allows for the review forms with respect to local hospitals, G. Frija; Paris/FR Safety Standards Directive (2013/59/ of protocol use – both frequency states, and nationally, and that infor- »»Strategies for dose management for achieving optimised INTO IMAGING Euratom), the development and and appropriateness – and optimi- mation may be used to determine if a imaging Your online open access journal for Education piloting of the ESR Audit Tool, the sation of protocols, as well as sup- facility is in the average range. If it is J.N. Vassileva; Vienna/AT revision of the EuroSafe Imaging ports dose awareness in general. not, then a readjustment can be made. »»The benefits of dose management systems in view of the new and Strategies in European Radiology. Stars concept, the development of It’s important to note dose mon- “Recently the ACR published Euratom Directive clinical diagnostic reference levels itoring may be used in two ways, about 10 standard DRLs for CT pro- V. Tsapaki; Athens/GR (DRLs), and education activities. she explained. In the first, data are tocols,” he said. “We’ve been talking “Technological and scientificcollected at the level of a popula- about DRLs for a long time, but it developments have led to a remark- tion of patients undergoing imaging was hard to establish because there Friday, March 2, 10:30–12:00, Room G able increase in radiation exposure,” exams, and patient identification is was no central database.” EF 2 Dose management systems and repositories: part B he told ECR Today. “Dose manage- not needed. The analysis takes on a Because of the central database, ment tools have positive implica- statistical nature, as the data would the ACR was able to publish com- Moderators: M. Brambilla; Novara/IT tions to tackle this issue. However, reflect variability across the popula- mon DRLs and provide a national M. Mahesh; Baltimore, MD/US these tools are relatively new and tion cohort. The second way to use standard. And even though Mahesh the practical impact varies.” dose monitoring is to track individual plans to focus on the U.S. perspec- »»Chairperson’s introduction One of those tools is dose-monitor- patient exposure histories, for which tive, it is relevant to a European M. Brambilla; Novara/IT ing software, which is an electronic, patient identification is needed. audience as well because he will »»Organisation of dose management systems and repositories automatic system that collects and “The dose quantities provided by delve into the practical aspects of for radiation protection and biomedical research: possibilities analyses dose-related data. The soft- the equipment are related to the setting up a dose index and how the and limitations of current implementations and standards ware allows for a precise internal dose received by the patients, but ACR tackled those challenges. B. Gibaud; Rennes/FR audit of dose, but it mainly depends they can’t be indicated as patients’ “If any other countries want to »»Imaging and dose repositories: tools to boost radiation on imaging protocols. Those proto- dose,” Vassileva said. “To proceed set up a similar database, they will protection and research? cols are designed from an anatomi- with further use of these data for face similar challenges,” he said. “I E. Neri; Pisa/IT cal orientation without taking into dose optimisation or estimation also want to encourage facilities to »»The ACR dose index registry: setting a benchmark account the clinical context, he said. of patient-centric dose quanti- sign up for it not only for regulatory M. Mahesh; Baltimore, MD/US “Dose-monitoring systems could ties, more information is needed, purposes. It helps to re-evaluate therefore be a helpful tool for estab- including patient data as well as data on a regular basis.” These sessions are part of the EuroSafe Imaging campaign. www.i3-journal.org FULLY OPEN ACCESS

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BY KATHARINA MIEDZINSKA BY JOÃO SANTOS AND MÁRCIO GARCIA Speakers to look into preclinical Oral cavity cancer staging imaging research and the by CT for the new TNM-8 radiographers’ role within the field Using an extrapolated measurement to evaluate the depth of invasion ical outcome. However, no preopera- ative pathology staging (r=0.693 and Dr. João Santos is a radiology tive imaging staging measurement p<0.001). We also observed a consider- fellow in the Diagnostic Imaging The character of professional activity and daily practice of radiographers are rapidly of the DOI was proposed, a problem able upstaging between the 7th TNM Department at Instituto do Câncer that limited the surgical approach. edition and the TNM-8 classifications do Estado de São Paulo (ICESP) changing. This is as a result of the rapid development of diagnostic and therapeutic In our study, we suggested a CT in the sample of patients evaluated, of the University of Sao Paulo’s DOI measurement method, based on which may be justified by the greater medical school in Brazil. imaging modalities, the continuous emergence of new examination techniques, and an extrapolation of the pathological sensitivity of the values ​​adopted in the Dr. Márcio Garcia is Medical method proposed by the AJCC for new T staging. Coordinator of the Diagnostic the increasing volume and complexity of the services. TNM-8. Pathologically, DOI is meas- Therefore, according to the criteria Imaging Department at Instituto ured from the level of the basement suggested in the present study, com- do Câncer do Estado de São Paulo membrane of the closest adjacent puted tomography may be used to (ICESP) of the University of Sao Radiographers are jointly respon- MRI. The recruitment of a radi- and provides fluent organisation,” insight into small animal imaging inhibitors, and possibly contrast normal mucosa, and then a plumb evaluate the depth of preoperative Paulo’s medical school in Brazil. sible for accurate imaging examina- ographer was an important step Dillenseger emphasised, adding studies and related hurdles. media have to be applied. This line is dropped from this plane to invasion in oral tumours. tions and deal with interventional, forward, according to Dillenseger: that as permanent team-members, Given that mice are approxi- means emphasis must be placed the deepest point of tumour inva- non-invasive, and radiation proce- “The involvement of radiographers radiographers have a close relation- mately 20 times smaller and 1,500 on species differences, technical Anatomopathological slides of an Suggested CT model: to measure sion. The pT category increases with dures, as well as with health sur- into a preclinical laboratory like this ship with researchers, physicians times lighter than humans, there limitations, anaesthesia, physi- oral cavity carcinoma (tongue). the depth of invasion, establish the every interval of 5mm. veillance screening and the emer- seemed obvious to us so we could and engineers. are certain challenges. PET sys- ological constraints, and other Measure suggested by AJCC. horizon that is at the level of the intact The records of 100 patients diag- Scientific Session: Head and Neck gencies which may occur during benefit from their clinical experi- “Their collaboration with the tems for humans are also around issues when tackling small animal mucosa. The deepest point of invasion nosed with oral cavity primary cancer an examination. In summary: radi- ence, practical skills as well as their research team is not only improv- five times larger in diameter than imaging studies. Since its first publication in 1977, is measured by dropping a plumb line and operated on in our institution Friday, March 2, 10:30–12:00, Room L 8 ographers provide essential health- general and in-depth knowledge of ing and facilitating the sequence of preclinical µPET-systems. In During his talk, Zeilinger plans tumour/node/metastasis (TNM) from the horizon. from 2009 to 2015 (with last follow-up SS 1008 Tackling challenges in head and neck cancer imaging care services to patients on a daily medical imaging.” procedures, but also consequently addition, injected activities are to specifically outline these and staging of oral cavity carcinoma in April 2017) were reviewed retro- basis. However, beyond this there is Their field of activity is diverse, increasing the throughput. We increased in small animals to com- other challenges in preclinical has remained essentially the same (DOI) is a better predictive parame- spectively. The study collected data Moderators: M. Lell; Nuremberg/DE also another area in which radiog- ranging from the preparation of the believe that preclinical imaging will pensate for the lack of sensitivity small animal imaging, limitations in the American Joint Committee ter than tumour thickness. for patient demographics, tumour E. Vassallo; Msida/MT in preclinical systems. The sub- raphers play an important role, as subject before any imaging activity offer new opportunities for radiog- in the quantification of preclinical on Cancer (AJCC) manuals. In this At the end of 2016, the AJCC pub- and surgical characteristics, preoper- »»Oral cavity cancer staging by CT for the new TNM-8: using an stance volume that can be admin- th a panel of speakers will illustrate in (ex. care and registration) and radi- raphers in the future,” he said. µPET data, and the radiographer’s time, several studies have shown lished its new 8 edition (TNM-8), ative CT findings, and pathological extrapolated measurement to evaluate the depth of invasion istered is therefore also a limiting today’s course on the objectives and ation safety procedure implemen- Today’s session will be chaired important role in a preclinical envi- that it was insufficient to deter- including the depth of invasion (DOI) specimen evaluation. J.M.M.M. Santos, A. Mourao de Abreu, M.R.T. Garcia, factor, especially when several constraints of preclinical imaging tation (ex. dosimetry management, by Carst Buissink, from Hanze ronment, contrasting this with mine the prognosis of the disease as a pathologic T (pT) parameter. This We demonstrated a strong positive L. Franceschi, L.L. Matos, C.J. Silva, E.M.M. Gebrim, substances like the radiotracer, research and the impact of radiog- laboratory contamination controls, University of Applied Sciences, clinical work. in many cases and it has been rec- criterion was well-defined and vali- correlation between the suggested R.L.E. Gomes; Sao Paulo/BR raphers on this process. management of radioactive waste Groningen, the Netherlands, and ognised that the depth of invasion dated in the postoperative patholog- CT DOI measurement and postoper- Kicking the session off will be Dr. products) to quality controls, the Prof. Dr. Nicolas Grenier from Uni- Jean-Philippe Dillenseger, instruc- preparation and administration versité Bordeaux Ségalen, France. Special Focus Session tor at the radiographers learning of contrast agents and radioac- They will be joined by Markus centre in Strasbourg, France, who tive tracers, and imaging device Zeilinger, MSc, from the University Friday, March 2, 08:30–10:00, Room K BY CLAUDIA GIACONI will discuss the essential skills and operation including positioning, of Applied Sciences Wiener Neus- SF 9b Radiographers in preclinical imaging research knowledge required in preclinical parameter setting, post-processing tadt, Austria, who will address the imaging and the important contri- and data management. All tasks preclinical evaluation of PET trac- »»Chairpersons’ introduction bution radiographers can make in are performed in accordance with ers, and Dr. Sandra Heskamp, from C. Buissink; Groningen/NL this field. To this end, Dillenseger the new French decree 2016-1672 of the Radboud University Medical N. Grenier; Bordeaux/FR plans to familiarise ECR delegates December 5, 2016. Center in Nijmegen, the Nether- »»Radiographers in preclinical research: challenges and chances Patients’ perceptions of radiologists with a preclinical imaging unit led “Practical rigor, in-depth knowl- lands. She will go over the basic J.-P. Dillenseger; Strasbourg/FR by Dr. Philippe Choquet at the Uni- edge of multimodal imaging prin- principles of preclinical SPECT/CT »»Preclinical evaluation of PET tracers versity Hospital of Strasbourg. ciples and protocols, and practical point by point, as well as the dif- M. Zeilinger; Wiener Neustadt/AT Located in the middle of the clinical experience are essential ferences to clinical SPECT/CT, and »»SPECT/CT clinical imaging department, the requirements for working in the discuss relevant practical aspects in an oncologic imaging department S. Heskamp; Nijmengen/NL unit applies translational imaging area of preclinical imaging. Our for preclinical SPECT/CT and how research using the same modalities experience shows that the inte- it can help to answer basic onco- »»Small animal imaging studies that can be found in a clinical imag- gration of a radiographer into a logical research questions. M. Zeilinger; Wiener Neustadt/AT Nowadays, patients are much better informed about their illness and they have the right ing department, including, among preclinical imaging department Zeilinger will give a second lec- »»Panel discussion: Is there a role for radiographers others, SPECT, CT, and clinical field adds value to scientific projects ture, in which he will provide an in preclinical imaging research? to receive as much information as possible. Therefore, a radiologist should have good communicative skills in order to create empathy and a much more personal relationship with the patient.

Radiologists today tend not The first questionnaire contained cation is a fundamental element in cialist, even if a direct relationship but do not appreciate all the work to establish a dialogue with the questions asking about personal this relationship. Patients therefore is not necessarily established. A that it involves, seeing only the final patient, as they are concerned about data, the patient’s perception of the appreciate a radiologist who devotes direct relationship is established report of the exam. CLINICAL TRIALS the accuracy of the diagnosis and waiting room and questions regard- more time to, and shows interest in, even less frequently for this type A good motto for radiologists reporting. The result is the creation ing the procedures and staff. The building a relationship with them as of exam where it is the technician today might be ‘Interact more and of a certain distance in the relation- second questionnaire was aimed at they want to be treated with respect who performs the procedure. In a more meaningfully with patients!’ IN RADIOLOGY ship with the patient in comparison assessing patients’ satisfaction with and not be considered as a num- small percentage of cases, patients to the role of physician, who has the following aspects: waiting time ber, or related to purely in terms of are not able to discern between the Claudia Giaconi, MD, PhD is a the task of explaining the content before the diagnostic exam, the their disease. specialist and the technician, the radiologist at Azienda Ospedaliera of the report. Moreover, oncolog- meeting with the doctor, the level Most patients have a good under- roles of both and the tasks each Universitaria Pisana in Pisa, Italy. ical patients especially require a of interaction between patient and standing of the radiologist’s profes- must carry out. Others are aware significant level of understanding physician, the language used by sion and they are aware that the of the importance of this discipline and empathy from the specialist. the physician and kindness shown radiologist has to interpret imaging We need to examine the aspects of by different members of staff, and studies and make the diagnosis; STRAIGHT FROM THE RESEARCH CENTRE … communication between a patient a general assessment on the radiol- they can distinguish between the Scientific Session: Oncologic Imaging … TO THE WORLD’S MOST INNOVATIVE IMAGING MEETING and the radiologist and technician ogy department. two main professional figures of in a radiology department. Essentially, from a technical view- radiologist and technician. Unfortu- Friday, March 2, 10:30–12:00, Studio 2018 We conducted surveys to obtain point, the patients are worried about nately patients do not always come SS 1016a Improving practice in oncologic imaging data regarding how patients perceive two aspects: the possible side effects into direct contact with the radiolo- their interaction with the specialist. of contrast media and the sense of gist, depending on the type of exam Moderators: T. Pfammatter; Zurich/CH Watch and listen to the results The level of education of the popula- claustrophobia brought about by involved, therefore communication M. Seidensticker; Munich/DE at the SKY HIGH STAGE tion observed was heterogeneous. We the machinery. From a psychological between patient and specialist in »»Patients’ perception of radiologists in an oncologic used two questionnaires: one when viewpoint, patients are understand- radiology is not always guaranteed. Details at imaging department patients arrived at the hospital before ably worried about the results of the Obviously during the ultrasound C. Giaconi, F. Cerimele, A. Bulleri, C. Basile Fasolo, E. Neri; Pisa/IT Wednesday to Friday ipp.myESR.org having the exam, and one after. exam, and for this reason communi- exam the patient meets the spe- 10:30 – 12:00 Type of session CTiR

#ECR2018 myESR.org myESR.org #ECR2018 16 CLINICAL CORNER ECR TODAY | FRIDAY, MARCH 2, 2018

BY YASSER RAGAB Diagnostic performance of QISS non-contrast MRA for diagnosis of acute lower limb ischaemia

confirmatory imaging studies. The many patients with peripheral Quiescent-interval single-shot diagnostic accuracy of vascular artery disease (PAD) suffer from (QISS) MRA is a recently introduced, testing depends on the precision several comorbidities including robust, non-contrast MRA tech- and reproducibility of the measure- renal insufficiency, the administra- nique. It was developed by Edelman ment (e.g. pressure, pulse contour, tion of either iodinated or gadolin- et al as a mean of evaluating PAD blood flow velocity, or volume flow ium-based contrast media may be without using gadolinium-based rate). For example, the measure- of concern given the increased risk agents. QISS is a rapidly acquired, ment of ankle systolic blood pres- of contrast-induced nephropathy unenhanced MRA sequence which sure cannot always be assumed to or nephrogenic systemic fibrosis minimises flow and motion artefact be accurate because the test result (NSF), respectively. using ECG gating. Data is acquired can be affected by a number of fac- Contrast-enhanced MRA also using a modified two-dimensional tors, including biological variabil- occasionally has the disadvantage balanced steady state, free preces- ity, cuff size and placement, exam- of venous contamination hindering sion pulse sequence with fat sup- iner skill, or the presence of tibial proper assessment of leg arteries. pression. A quiescent interval is artery calcification preventing cuff Another limitation of CTA appears incorporated to optimise enhance- occlusion. Interpretation of all vas- in the presence of heavy leg arte- ment of inflowing blood. cular diagnostic testing requires rial calcification, which may lead an appreciation of the limitations, to false negative diagnosis. These Yasser Ragab, MSc, MD, PhD is pitfalls, and artefacts of the testing concerns with the risks of contrast Professor of Radiology at Cairo modality. Interpretation errors can media administration in combina- University in Cairo, Egypt, and result in an incorrect diagnosis and tion with recent technical advances Director of the MRI unit at Dr. faulty subsequent decision-mak- have led to an increased interest in Erfan & Bagedo General Hospital in ing. Let us take a closer look now non-contrast MRA techniques. Jeddah, Saudi Arabia. at some of the more common, typically invasive, tests used on PVD patients. Scientific Session: Emergency Radiology While segmental Doppler pres- sures and pulse volume recording Friday, March 2, 10:30–12:00, Room F2 are the most appropriate tech- SS 1017 Non-traumatic emergencies niques for screening symptomatic patients, more sophisticated non-in- Moderators: R.M.M. Hinzpeter; Zurich/CH QISS non-contrast MRA showing Contrast enhanced MRA, vasive imaging techniques may D.J.M. Tolan; Leeds/UK occlusion of the right external iliac corresponding with QISS image be necessary for further anatomic »»Keynote Lecture artery and distal popliteal one with showing the same findings with evaluation and treatment planning, D.R. Kool; Amsterdam/NL poor distal run off. venous filling in the leg. especially before revascularisation. The American College of Radiology »»Diagnostic performance of quiescent interval single-shot For patients with acute sympto- ing, and for many patients this can (ACR) rates both CT angiography (QISS) non-contrast MRA at 3 Tesla for the diagnosis of acute matic peripheral vascular disease provide sufficient information to (CTA) and MR angiography (MRA) lower limb ischaemia 1 1 2 1 (PVD), clinical evaluation can be proceed with medical treatment as ‘usually appropriate’ diagnos- Y. Ragab , A. Al Marakby , H.M. Hamza , A. Hasanin ; 1 2 performed using non-invasive test- or intervention without additional tic approaches. However, because Cairo/EG, London/UK

ESOR Courses for EDiR 2018 ESOR is continuing to organise preparatory courses for residents and board-certified radiologists, wishing to take the exams of the European Diploma in Radiology (EDiR). A series of courses is organised at the ESR Learning Centre in Vienna/Austria at the end of the year. It is possible to attend either one course only, or several courses of the series.

Neuroradiology Cardiac Imaging Chest Imaging November 5, Vienna/Austria November 8, Vienna/Austria November 12, Vienna/Austria

Head and Neck Radiology Paediatric Radiology Musculoskeletal Radiology November 6, Vienna/Austria November 9, Vienna/Austria November 13, Vienna/Austria

Hybrid Imaging Breast Imaging Abdominal Radiology November 7, Vienna/Austria November 10, Vienna/Austria November 14, Vienna/Austria

ESOR ASKLEPIOS Courses 2018 The established ASKLEPIOS project is tailored toward serving professional development by addressing recognised needs in the context of continuous radiological education. Its programmes include multithematic, organ-oriented, multimodality and multidisciplinary advanced courses, aimed at senior residents, general radiologists, private practitioners in radiology, and allied specialists.

Women‘s Imaging Infectious and Inflammatory Multidisciplinary Approach May 11-12, Bucharest/Romania Disorders to Cancer Imaging September 27-28, Krakow/Poland November 5-6, Rome/Italy Advanced Cardio-Thoracic Imaging June 21-22, Sochi, Cardiac Imaging Cardio-Thoracic Imaging Biomarkers Krasnaya Polyana/Russia October 17-19, Graz/Austria December 10-11, Valencia/Spain

Introduction to Hybrid Imaging Symposium on Imaging Hallmarks in Oncology of Cancer August 30-31, Vienna/Austria October 18-19, Lisbon/Portugal

For further information on the detailed programmes

Education in partnership and registration, please visit myESR.org/esor myESR.org/esor

#ECR2018 myESR.org ECR TODAY | FRIDAY, MARCH 2, 2018 TECHNOLOGY & RESEARCH 17

Two clinical studies in diagnostic EUCLID: a European Commission ESR concept paper on 19 imaging benefit from EIBIR support 21 project on clinical dose reference levels 22 value-based radiology

BY INGA STEVENS CT manufacturers step up search for definitive and cost-effective disease characterisation Technical developments and system improvements are enabling clinicians to utilise CT to make more confident diagnoses in increasingly complex cases. As older scanners struggle to cope with the ever greater demands of a radiology department, exhibitors at the ECR 2018 technical exhibition are eager to show end users how the latest systems can provide clinically valuable and reliable functional information without increasing radiation dose or adding extra expense.

Hypoperfusion of the distal portion wall of the sigmoid loop wall seen on iodine map. GE Healthcare’s Revolution Frontier system with GSI Pro was used. Provided by Dr. Marc Zins, Saint Joseph Hospital, Paris.

A patient with bilateral joint arthroplasty presented with sudden fever and signs of hip inflammation. A CT scan of the abdomen was performed with AIDR (adaptive iterative dose reduction) 3D Enhanced and SEMAR (single SureSubtraction lung image: 0.5mm x 80 detector row chest CT scan was energy metal artefact reduction) technology, using an Aquilion Prime SP performed with and without intravenous iodinated contrast, using the scanner. The coronal comparison images demonstrate the effectiveness of Aquilion One Genesis Edition system. SureExposure and SurekV, automatic SEMAR. An abscess in the right hip is shown, suggesting prosthetic joint mA modulation and kV selection were part of the protocol as well as AIDR infection originally obscured due to the metallic artefacts. Effective dose of (adaptive iterative dose reduction) 3D technology. SureSubtraction images and 4.3 mSv (k=0.015)*. Provided by Canon. iodine maps were generated automatically and demonstrate bilateral wedge shaped defects due to pulmonary emboli. Effective dose of pre-contrast 0.69 users to cover a range of CT appli- is enhanced by a full iterative mSv, effective dose of post-contrast 2.66 mSv (K=0.014)*. Provided by Canon. cations, regardless of the patient reconstruction technique, and or the clinical issue at hand. One further workflow improvements of the fully assisting scanner tech- and increased patient safety are Building on the success of the latest software and applications nology (FAST) applications that are made possible with SUREPosition, Revolution family, GE Healthcare for a hospital or clinic’s CT devices. integrated into the systems is the which accurately centres the Using the Infinix-i 4D CT during is introducing Revolution Frontier, This is said to avoid obsolescence of FAST Integrated Workflow with patient within the isocentre of the ablation procedures provides the a 128-slice scanner with a 0.35-sec a system, ensure the same CT capa- the FAST 3D Camera for automatic gantry, by a single mouse-click, ability to switch rapidly between gantry rotation speed designed to bilities at all sites provide consist- patient positioning. A 3D camera without radiographers having to CT, fluoroscopy and angiography make it easier to undertake spec- ent exams throughout a healthcare fitted above the patient table uses move the patient. to verify the accuracy of needle tral CT examinations. It features enterprise, increase staff efficiency, artificial intelligence and deep Also, Canon’s Infinix-i 4D hybrid positions. Provided by Canon. a new imaging chain, Gemstone reduce the need for training and learning technologies to recognise interventional radiology lab and Clarity detector and Performix HD improve satisfaction by ensuring the patient’s anatomical landmarks CT system can be used to per- form, particularly in emergency Plus x-ray tube, the combination there is one set of capabilities to and the table then automatically form a wide range of procedures, and trauma departments. Given the of which enables the scanner to learn, operate and read. moves into the correct position including tumour therapy, emboli- scanner’s 25% faster reconstruction achieve anatomic detail of 0.23 mm Siemens Healthineers is promot- and adopts the correct height to sation, arterial interventions, dial- speeds, the vendor thinks that end with 25% less electronic noise, the ing its latest scanner portfolio for position the desired body region at ysis, and stent placement. It offers users will be able to perform up to vendor stated. CT, including Somatom go.All and isocentre and achieve an optimal dose management features, includ- 200 scans in a 16-hour workday. The “In today’s healthcare environ- Somatom go.Top, which are suitable examination result, according to ing AIDR (adaptive iterative dose system also includes a novel radia- ment, clinicians need tools that for advanced clinical fields such as the vendor. reduction) 3D. tion therapy planning couch and get to the diagnosis quickly,” said cardiology and CT-guided interven- Canon Medical Systems is Additionally, the firm is highlight- bariatric tabletop to make it possi- Valerie Brissart, molecular imaging tion. With a rotation time of 0.33 introducing Aquilion Precision, an ing Aquilion Prime SP, an upgrade ble for larger patients to be scanned and CT product marketing direc- seconds and the Stellar detector ultra-high resolution CT (UHR-CT) of the Prime platform in an with improved positioning con- tor for Europe for GE Healthcare. technology, the 64-slice Somatom scanner designed to improve 80-detector-row package with 0.35- trols. It can also perform calcium “We believe that CT is that fast and go.All can cover scan ranges of up early detection of disease and sec gantry rotation speed. Newly suppression, estimate electron den- effective tool, and that spectral CT to 100mm in one second. The 128- tumour classification due to its designed PureVision optics and its sity, and provide tissue character- further enhances disease charac- slice Somatom go.Top can perform enhanced image detail that capa- latest PureVision CT detector are isation, which could be good news terisation, reducing the need for whole-body scans of up to 200cm bility to image anatomy as small as said to offer superior image detail for oncology applications. follow-on diagnostic tests.” with a scan speed of up to 175mm 150 microns. and resolution. Hitachi is demonstrating Supria In addition, GE is presenting per second. On display too is the latest ver- Meanwhile, Philips has updated True64, a compact 64-slice CT scan- Smart Subscription, a one-fee-per- The vendor’s Somatom Edge Plus sion of the Aquilion One Genesis its IQon spectral CT platform with device per year subscription that single-source system and Somatom Edition Area Detector CT. Image IQon Elite, which aims to make provides continuous access to the Force dual-source system allow end quality in all anatomical regions spectral CT scanning easier to per- continued on page 18 myESR.org #ECR2018 18 TECHNOLOGY & RESEARCH ECR TODAY | FRIDAY, MARCH 2, 2018 ECR TODAY | FRIDAY, MARCH 2, 2018 TECHNOLOGY & RESEARCH 19

BY PETER GORDEBEKE AND KATHARINA KRISCHAK Staff Box continued from page 17 (CBCT). The software allows radi- It features a number of refine- dose optimisation. Its expanded Editorial Board ologists and orthopaedic surgeons ments compared with the vendor’s use makes it ideal for both mobile ner with 40-mm detector cover- to reach a more accurate diagnosis CereTom CT scanner, including and improved coverage for adult ESR Executive Council age. It is also compliant with the of a patient’s condition and develop improved workflow with omni-di- head and neck, as well as enhanced XR-29 Smart Dose standard and treatment plans, the company rectional wheels and a 16-slice safety via an internal drive system, Paul M. Parizel, Antwerp/BE includes an eco mode that reduces noted. Users can then adjust image (0.625 mm per slice) advanced data making portability less strenuous, Chair of the ESR Board of Directors Two clinical studies in diagnostic power consumption by 55%, stated processing according to the amount acquisition system with effective the manufacturer stated. Bernd Hamm, Berlin/DE the vendor. of metal present. The software uses President Carestream Health is promot- data from the original OnSight Lorenzo E. Derchi, Genoa/IT ing optional metal artefact reduc- scan, eliminating the need for addi- Technical Exhibition Opening Hours 1st Vice-President tion software for its OnSight 3D tional imaging studies. imaging benefit from EIBIR support Boris Brkljačić, Zagreb/HR extremity system that performs Samsung is showing the Omni- Friday, March 2 to Saturday, March 3 10:00–17:00 2nd Vice-President 3D exams using cone beam CT Tom mobile 16-slice CT scanner. Sunday, March 4 10:00–14:00 Katrine Riklund, Umeå/SE The European Institute for Biomedical Imaging Research (EIBIR) provides its Past-President Michael Fuchsjäger, Graz/AT support to two industry-funded multicentre clinical studies, SPECIFIC and MIPA, Communication and External Affairs Committee Chair investigating methods in myocardial perfusion imaging and breast cancer Bernd Hamm, Berlin/DE BY STEVE HOLLOWAY ECR 2018 Congress Committee Chair imaging respectively. Lorenzo E. Derchi, Genoa/IT ECR 2019 Programme Planning Committee Chair Setting up and running multi- EIBIR has over a decade of expe- The objective of the SPECIFIC breast MRI, examining individual sample size of 7,000 patients. Prof. Laura Oleaga, Barcelona/ES centre clinical studies can lead to a rience and success in project prepa- study is to determine the diag- patient data in a multicentre setting Sardanelli will present results of Education Committee Chair Will artificial intelligence great deal of time-consuming and ration and management for bio- nostic accuracy of CT myocardial with the aim of clarifying matters the MIPA study at ECR 2018 in a Deniz Akata, Ankara/TR complex administrative tasks. EIBIR medical imaging research. Over this perfusion imaging for the detec- regarding the ongoing uncertainty refresher course entitled ‘MRI for Finance and Internal Affairs provides support services to clinical period, EIBIR has helped research- tion of haemodynamically rele- in the application of pre-operative early detection, staging and man- Committee Chair studies investigating or evaluating ers secure more than €75 million in vant coronary stenosis, as deter- MRI in breast cancer patients. agement of breast cancer’ today at Christoph D. Becker, Geneva/CH sell more CT systems? diagnostic imaging methods, in funding. mined by invasive fractional flow MIPA collects data on recent 4 p.m. in Room E1. National Societies Committee Chair addition to its regular project prepa- Currently, EIBIR provides its sup- reserve as a reference standard in first-time breast cancer diagnoses EIBIR acts as the contracting Regina Beets-Tan, Amsterdam/NL ration and management services port to two clinical studies: patients with suspected or known and compares surgical outcomes partner for all sites participating Publications Committee Chair It is already becoming clear that artificial intelligence (AI) will have a big for collaborative research projects. •• The SPECIFIC study: Dynamic coronary artery disease who have for those who undergo pre-oper- in the MIPA study, and provides Adrian P. Brady, Cork/IE This includes studies assessing the Stress Perfusion CT for Detec- been clinically referred for invasive ative MRI with those who do not. management and administrative Quality, Safety and Standards technical or diagnostic performance, tion of Inducible Myocardial angiography. Data are being collected from 34 support, in addition to handling all Committee Chair part to play in the future of medical imaging. However, less clear is the clinical usefulness, benefits, effec- Ischemia SPECIFIC is investigating the centres in Europe and beyond. The finances and leading dissemination Olivier Clément, Paris/FR tiveness and cost-effectiveness of •• The MIPA study: Preoperative feasibility of this approach through results will be vital for a better efforts. Research Committee Chair impact of AI on the commercial market for medical imaging hardware. imaging methods. Breast MRI in Clinical Prac- an international multicentre study understanding of the effect pre-op- For more information on clinical Afshin Gangi, Strasbourg/FR The EIBIR Virtual Clinical Trial tice: Multicentre International with recruitment in the Nether- erative breast MRI has on clinical studies supported by EIBIR, please Subspecialties and Allied Sciences If we take the case of CT, a multi-billion-Euro hardware and services Unit (vCTU) offers extensive sup- Prospective Meta-Analysis of lands, Germany, Switzerland, Japan decision-making. visit the website at www.eibir.org. Committee Chair market, will AI drive greater demand for systems, or less? Below, we look port for both the design/prepara- Individual Data and the United States. Approxi- In 2017, MIPA recruited more Nicholas Gourtsoyiannis, Athens/GR tion phase, as well as the execution SPECIFIC mately one third of the subjects than 6,250 patients, which amounts ESOR Scientific/Educational Director at a few of the trends shaping the direction of the CT and discuss if, and phase of clinical studies. By lever- The SPECIFIC study is an inter- have already been examined, and to approximately 90% of the target Peter Baierl, Vienna/AT aging the knowledge from inter- national clinical study investigat- the study aims to finish recruit- Executive Director how, AI will play a role. national experts in radiological ing myocardial perfusion imaging, ment before the end of 2018. subspecialties, image processing, which is funded by Siemens and Within SPECIFIC, EIBIR provides Refresher Course: Breast clinical epidemiology, biostatistics, Bayer with Erasmus University management and administrative Editor tools vary, they are all intended to ative reconstruction in the newest data management, medical ethics, Medical Center (Rotterdam, the support, handles financial matters Friday, March 2, 16:00–17:30, Room E1 Julia Patuzzi, Vienna/AT increase the efficiency and qual- generation of CT solutions. If AI decision modelling and economic Netherlands) as the study sponsor. between the study and partici- RC 1202 MRI for early detection, staging and management Consulting Editor ity of diagnosis based on lung CT can further improve the ‘diagnostic evaluation, EIBIR can help maxim- Cardiac CT provides accurate pating sites, as well as dissemina- of breast cancer Philip Ward, Chester/UK scans. With growing availability richness’ of information from each ise a study’s potential. assessment of the coronary arter- tion of the study results through Sub-Editor and acceptance, AI will no doubt CT scan, the need for re-scans or fol- Furthermore, EIBIR launched its ies and detects significant coronary well-established channels such as »»Chairperson’s introduction Matthew Urmston, Vienna/AT also support the growth in adop- low-up scans could also be reduced. Electronic Data Capture platform last stenosis with high diagnostic accu- the European Society for Radiology. J. Camps Herrero; Valencia/ES Contributing Writers tion of lung screening and with it, While there has been less focus so year. This platform can be used to col- racy. This information is highly Additionally, EIBIR monitors the »»A. Preoperative staging with MRI: did the MIPA trial solve all Michael Crean, Vienna/AT demand for CT systems. far on use of AI in raw signal cap- lect and manage almost any type of relevant, but ignores the haemod- electronic case report forms for the issues? Florian Demuth, Vienna/AT ynamic relevance of such detected study. Peter Gordebeke, Vienna/AT Subtlety matters ture and interpretation, it also looks digital data which is part of a clinical F. Sardanelli; San Donato Milanese/IT Christina Kapusta, Vienna/AT Not all trends point towards a certain to play a role in the next study, including DICOM images. The lesions, which is essential for clinical MIPA »»B. MR imaging biomarkers for the clinical setting Katharina Krischak, Vienna/AT growth in CT use though. There is generation of CT systems. platform uses a secure web appli- decision-making. The recent devel- The MIPA study is funded by Bayer E.A. Morris; New York, NY/US Anthony Lark, Vienna/AT growing evidence towards struc- Walk before you can run cation for building and managing opment of third-generation dual- and is led by EIBIR and Prof. Franc- Ulrike Mayerhofer-Sebera, Vienna/AT tured use of incidental findings The outlook for AI’s influence on study databases with great flexibility source CT allows for the assessment esco Sardanelli (University of Milan, »»C. Screening with abbreviated protocols Becky McCall, London/UK C.K. Kuhl; Aachen/DE Katrina Megget, London/UK from CT scans, reducing the likeli- CT market demand therefore looks and ease-of-use. EIBIR can also assist of myocardial perfusion, and may Italy and past-president of EUSOBI). Katharina Miedzinska, Vienna/AT hood of patients needing multiple positive, though we should also in setting up the data collection tools determine the haemodynamic rele- The study is conducting a sys- »»Panel discussion: Why are some recommendations not adopted Rebekah Moan, San Francisco, CA/US scans. A good recent example of not get ahead of ourselves, espe- for your study. vance of coronary lesions. tematic evaluation of pre-operative and how can we change practice? Lucie Motloch, Vienna/AT this is the creation of the BARCS cially with the initial hype and reg- Vivienne Raper, London/UK scale (Breast Assessment and Rec- ulatory uncertainty surrounding Mélisande Rouger, Madrid/ES Frances Rylands-Monk, St. Meen Le ommendation CT Score) from AI adoption. Grand/FR researchers at the Icahn School of Putting this sharply in context, Yulia Shevchuk, Vienna/AT Medicine, Mount Sinai, New York. more obvious advances in CT tech- Inga Stevens, Dubai/UAE Testing by experienced radiologists nology over the last decade should Jonas van Riet, Brussels/BE on chest CT scans showed that also have a big impact on CT usage using the BARCS scale for inci- and adoption. The CT systems avail- dental invasive cancers resulted in able today allow CT imaging more Design & Layout ‘good to excellent’ results in com- safely and effectively than ever, Nikolaus Schmidt, Vienna/AT parison to standard mammography thanks in part to significant tech- PLANNING A EUROPEAN RESEARCH PROJECT? scans of the same patients. nological development and user Marketing & Advertisements Computer Quantitative Decision Computer Konrad Friedrich Aided Detection Imaging Tools Support Tools Aided Diagnosis The use of incidental findings education. This has borne steady, E-Mail: [email protected] (CADx) from CT scans has not been well low single-digit revenue growth in LET US HELP addressed to date, particularly as the CT market, heavily dependent Contact the Editorial Office 2015 2021 ESR Office time-pressured radiologists may on system replacements. Neutorgasse 9 overlook more subtle incidentals However, given that many users 1010 Vienna, Austria while focusing on establishing the in Western Europe are still using Phone: (+43-1) 533 40 64-0 primary diagnosis. It’s at this stage systems up to ten years old, the E-Mail: [email protected] where AI can play a substantive most likely boost and improvement ECR Today is published 5x Market for Medical Imaging Analysis Software - Lung (Revenues ($M); role; if AI software can be used to market demand and scan volume during ECR 2018. Source: Signify Research to detect subtle incidentals, later will come from a greater push to Circulation: 10,000 scans and radiologist resource replace the ageing installed base of Printed by agensketterl Druckerei Targeted at volume mend EU-wide implementation of could be spared, not to mention the European CT in short to mid-term, GmbH, Vienna 2018 Support for the use of low-dose lung CT screening within the next patient benefits of earlier detection along with system demand gener- Benefit from over a decade of experience in proposal preparation and project management. myESR.org CT for lung screening has been 48 months. and treatment. In terms of CT sys- ated by more widespread adoption gaining momentum, with health Lung screening is also one of the tem demand AI will have a minor of screening programmes. AI will We can support you in making your project idea reality and reduce the administrative burden! legislators in the U.S. and Western areas AI has made significant pro- negative impact, but in comparison also certainly play a part in this Europe calling for wide-reaching gress. AI-based software for Com- to the care outcome improvement, growth, though its impact on the Visit www.eibir.org for more information adoption, especially in high-risk puter Aided Detection (CAD), quan- a negligible one. CT market will more keenly felt populations. While there is little titative imaging tools and decision Wider use of a single-scan, multi- much later. opportunity here to discuss the support for lung CT is already being ple diagnosis approach for CT also detailed arguments and evidence used; examples include ClearRead has some radiation dose benefits Steve Holloway is Analyst & behind these recommendations, CT (Riverain Technologies), QIDS too. Dose-monitoring and manage- Principal Analyst at Signify consensus certainly points towards (HealthMyne), Virtual Resident ment has significantly improved Research, a UK-based independent greater use of low-dose CT for lung (Radlogics) and tools from Veye with CT imaging over the last five supplier of market intelligence screening. In the case of Western Chest (aidence). While the capabili- years, especially given the improve- and consultancy to the global Europe, recent guidelines recom- ties and purpose of these AI-driven ments in tracking software and iter- healthcare technology industry.

#ECR2018 myESR.org myESR.org #ECR2018 20 TECHNOLOGY & RESEARCH ECR TODAY | FRIDAY, MARCH 2, 2018 ECR TODAY | FRIDAY, MARCH 2, 2018 TECHNOLOGY & RESEARCH 21

BY TUGBA AKINCI D’ANTONOLI BY JOHN DAMILAKIS Hidden in plain sight: radiomics helps EUCLID: predict lung cancer prognosis on CT a European Commission project

sun. Fraunhofer had given astron- lem: lung cancer, which is the lead- We retrospectively enrolled 124 the threshold of an era where radi- omy a revolutionary tool, which dis- ing cause of cancer-related deaths. patients with pathologically con- omics promises to help determine on clinical dose reference levels closed the chemical composition of Non-small cell lung cancer (NSCLC) firmed NSCLC at TNM stages I to prognosis from a multitude of data stars by their light but it was only is the most common histologic type IIIA, who were surgically treated. hidden inside the images that until important x-ray imaging tasks in a predefined methodology. WP4 is and the EUCLID project, participate Hospital of Iraklion, Crete, Greece. after another 4 ½ decades of devel- where surgery is the curative treat- We showed that radiomics analysis recently showed to our naked eyes Europe; and (b) to specify up-to-date responsible for specifying up-to- in the EuroSafe Imaging session He is president of EFOMP as well as opment that science was able to ment for the early-stage (stages I of tumour and peritumoural lung lesions but did not necessarily tell DRLs for these clinical tasks. Moreo- date European clinical DRLs for the today at 14:00–15:30 in Room M1. the EURAMED research platform, make sense of the information first and II) and also a palliative treat- parenchyma on CT images helps about their outcomes. ver, a workshop will be organised to protocols/imaging tasks identified chairman of the International acquired by Fraunhofer. ment for the locally advanced (stage predict NSCLC recurrence and disseminate and discuss the results under WP2 and the stakeholder John Damilakis is full professor Organization for Medical Physics Starting from its inception in the IIIA) disease. Despite treatment, stratify patients at risk, thereby Dr. Tugba Akinci D’Antonoli was of this project with Member States consultation/validation of these and chairman at the Department (IOMP) Education and Training early 1970s, CT has been capable of however, 30%–55% of patients enabling a personalised treatment. ESOR Thoracic Radiology Research Different image qualities are and the relevant national, European DRLs. WP5 covers the organisation of Medical Physics, Faculty of Committee and a member of the showing basic tissue characteris- develop a recurrence. Further studies with a larger sam- Fellow at the Catholic University needed for different clinical indi- and international stakeholders. The of the workshop to disseminate and Medicine, University of Crete, and Board of Directors of International Radiomics analysis in this study tics on sectional images. Now, in Conventional use of imaging ple size, prospective in nature, and of the Sacred Heart in Rome, Italy. cations of the same anatomical workshop will also identify the need discuss the results of the project director of the Department of Medical Physics Certification entailed for each patient with NSCLC the same way as Kirchoff and Bun- modalities provides a relevant and with multicentric collaboration are She is a student at Harvard Medical area. A kidney stone evaluation, for for further national and local actions with stakeholders and to identify Medical Physics of the University Board (IMPCB). three 3D regions of interest on CT sen were able to expand on Fraun- valuable contribution to diagno- necessary to optimise radiomics School, Global Clinical Scholars example, can be performed using a on establishing, updating and using the need of further national and images: gross tumoural volume hofer’s technology, the processing sis, staging, and treatment plan- for lung cancer patients before its Research Training Program now. lower radiation dose than it would DRLs. local actions on establishing, updat- (GTV), peritumoural volume (PTV), capacity of computers has reached ning, yet prognostic information routine clinical usage. We are on be required for an evaluation of To fulfil these objectives, this pro- ing and using DRLs. EuroSafe Imaging Session and lobe (LB), where tumour resided. a level where it is now possible to remains mostly unrevealed. Radi- appendicitis. This is because the ject will rely on: The EUCLID project started on glean much more detailed informa- omics features, on the other hand, detection of high-contrast struc- 1. An External Advisory Panel August 1, 2017. During the first few Friday, March 2, 14:00–15:30, Room M 1 When in 1814 German physicist tion about tissues imaged with CT. offer novel information on tumour Scientific Session: Chest tures is less affected by high image that has been set-up to be con- months of the project, a compre- EU 3 Clinical diagnostic reference levels for and optical lens manufacturer A new field of study, named ‘radi- characteristics as well as the noise than low-contrast structures. sulted on the main project activities hensive review was carried out to x-ray medical imaging Joseph von Fraunhofer invented omics’ and aiming to extract large tumour’s environment, which may Friday, March 2, 10:30–12:00, Room O Clinical indications dictate the and outcomes; identify the status of existing clinical the spectroscope, he trained his amounts of quantitative features be related to tumour behaviour SS 1004 Artificial intelligence in chest imaging main parameters that affect patient 2. A Scientific Board that has DRLs for CT, interventional radiol- Chairpersons: J. Damilakis; Iraklion/GR instrument on the sun. He ended from medical images, is now emerg- and response to therapy. In our dose from CT such as scanning been set-up to verify the used data ogy and radiography in Europe and G. Frija; Paris/FR up identifying hundreds of fixed ing. Radiomics has the potential study our aims were two-fold: first, Moderators: F. Doellinger; Berlin/DE length, collimation and number sources; beyond by analysing recent studies, »»Chairpersons’ introduction and update on the project on dark lines in the solar spectrum. It to decipher disease characteristics to design a recurrence prediction J. Jacob; London/UK of phases. Therefore, dose refer- 3. Interaction with the Steering standards and publications. Infor- clinical DRLs for x-ray medical imaging took 45 years and two other Ger- that are impossible to be discerned model by using the radiomics anal- ence levels (DRLs) should be spec- Group established by the European mation about existing clinical DRLs »»Keynote Lecture J. Damilakis; Iraklion/GR man scientists, Gustav Kirchoff and by the naked eye alone. ysis of tumour and peritumoural ified for a given clinical indication. Commission’s Directorate-General was also collected from national J. Jacob; London/UK G. Frija; Paris/FR Robert Wilhelm Eberhard Bunsen, During my 2016–2017 ESOR regions on pre-surgical CT scans in The European Commission (EC) for Energy with other directorates competent authorities and other to explain the significance of the Fellowship year at the radiology NSCLC patients. Second, to estab- »»Radiomics signature for non-small cell lung cancer recurrence launched the ‘European study on concerned to review and approve organisations involved in the project. »»The concept of diagnostic reference levels (DRLs) patterns of these dark lines: they department of Catholic University lish a risk-scoring system with the risk prediction after surgery: quantitative analysis of the tumour clinical diagnostic reference levels the reports and the study; So far only a few national radi- E. Vaño; Madrid/ES and peritumoural lung parenchyma on presurgical MDCT were light absorbed by chemical of the Sacred Heart in Rome, Italy, combination of the patient’s clin- for x-ray medical imaging’ (acro- 4. Α network of EuroSafe Imaging ation protection authorities have »»The concept of clinical diagnostic reference levels (DRLs) elements such as iron, calcium, and I worked as part of a team applying icopathological risk factors and T. Akinci D’Antonoli, A. Farchione, J. Lenkowicz, M. Chiappetta, nym: EUCLID) project to provide Stars hospitals and their experts. defined a limited number of DRLs G. Frija; Paris/FR G. Cicchetti, A.R. Larici, V. Valentini, L. Bonomo, R. Manfredi; Rome/IT sodium in the atmosphere of the radiomics to a major clinical prob- radiomics signature. up-to-date clinical DRLs. The project is divided into five for different clinical indications. »»An update on current European diagnostic reference levels The EUCLID project is led by work packages (WPs). Each of these Although a large number of stud- (DRLs) in adult imaging the European Society of Radiology WPs covers specific tasks leading to ies on doses from x-ray imaging are J. Damilakis; Iraklion/GR (ESR). The ESR experts involved in the common objective to carry out available, there is very limited infor- the project are Prof. John Damilakis a European study on clinical DRLs mation about clinical-indication »»An update on current paediatric diagnostic reference levels (project manager), Prof. Guy Frija for x-ray medical imaging. WP1 cov- specific DRLs. Therefore, the ESR (DRLs) (project co-manager), Prof. Werner ers the management and general developed a survey to collect the C. Granata; Genoa/IT Jaschke, Prof. Graciano Paulo, Dr. coordination of the project, as well data needed to establish DRLs. Data »»The concept of local diagnostic reference levels (DRLs) Jacques Repussard, Dr. Alexander as communication and dissemina- will be collected for the CT clinical N. Saltybaeva; Zurich/CH Schegerer and Dr. Virginia Tsapaki. tion activities. WP2 is responsible indications and fluoroscopically »»Panel discussion This project is also supported by for the identification of procedures guided interventional procedures J. Damilakis; Iraklion/GR the ESR Office. and clinical indications for which identified by WP2. G. Frija; Paris/FR The main objectives of this pro- DLRs will be established, as well as The project has received fund- E. Vaño; Madrid/ES ject are to: (a) conduct a European for review of existing DRLs. WP3 ing from the European Commis- J.N. Vassileva; Vienna/AT survey to collect the data needed to covers the implementation of a sion under Service Contract No° M.R. Perez; Geneva/CH Innovating Healthcare, establish DRLs for the, from the radi- European DRL survey for CT and ENER/2017/NUCL/SI2.759174. ation protection perspective, most interventional radiology (IR) using To learn more about clinical DRLs This session is part of the EuroSafe Imaging campaign. Embracing the Future.

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ND Join our Lunch Symposium on Friday, March 2 , 12.30-13.30, room N TOPICS: and ask us about our Live Sessions at our booth X2/221. Oncologic imaging Musculoskeletal Genitourinary Head and neck Chest Abdominal and gastrointestinal Cardiovascular Breast Neuro Radiographers Details at Interventional radiology Paediatrics ipp.myESR.org Hitachi Medical Systems Europe Holding AG, Switzerland Type of session MyT3

#ECR2018 myESR.org myESR.org #ECR2018 22 TECHNOLOGY & RESEARCH ECR TODAY | FRIDAY, MARCH 2, 2018 ECR TODAY | FRIDAY, MARCH 2, 2018 TECHNOLOGY & RESEARCH 23

BY FLORIAN DEMUTH BY BARRY KELLY, JANE ADAM, ADRIAN BRADY ESR concept paper The European Society of on value-based radiology Radiology’s clinical audit tool

The ESR published a concept questions of value-based radiology processes, cost-effectiveness and sis should be recognised as the 21st century. The ESR, the Radio- paper on value-based radiology on are: What has the greatest impact? healthcare professionals’ perfor- first ‘outcome’. logical Society of North America Audit simply means comparing an element of clinical practice against an agreed August 30, 2017. Prepared by the and How do we develop metrics to mance. What has been lacking so Having established a radiolo- (RSNA), the American College of ESR Value-Based Imaging Working demonstrate this impact? far is the inclusion of the diagnos- gist’s diagnosis as an outcome, the Radiology (ACR), the Canadian upon standard. In radiological practice this might mean what we do, how we do it, Group (VBI WG), led by its chair Value-based healthcare concepts tic process, which constitutes the paper goes on to illustrate radiol- Association of Radiologists (CAR), and current ESR 1st Vice-President focus on ‘outcomes’ as the corner- integral first part of any care cycle. ogy’s multifaceted value, and to and the International Society what equipment we use, or how we interact with our patients, our colleagues and our Prof. Lorenzo Derchi, the paper stone for evaluating healthcare The ESR argues that the diagno- introduce a number of metrics for Strategic Studies in Radiol- sets out the society’s position on that can be developed based on ogy (IS3R) are in discussions to environment. Therefore, the question we answer by conducting audit is: are we safe? value-based trends in healthcare in this premise. draft a joint paper which will general, and radiology in particular. Professional Issues and Economics The discussion on value-based position value-based radiology The VBI WG was established in Radiology (PIER) Sessions radiology is just starting and the within the wider value-based Audit should be Achievable, Local, ments to comply with legislation, to relevance of topics and the audit Session in Room M 1 on Saturday, University Hospital, Cork, Ireland, in August 2016 and tasked by the ESR hopes that radiologists in healthcare concept. Practical, Inexpensive, Non-threat- monitor their own practice and to be tool in general. March 3, at 16:00. a former Dean of the Faculty of ESR’s Board of Directors with lead- Friday, March 2, 16:00–17:30, Room M 2 Europe will actively engage in this ening, and Easy (ALPINE). well prepared for any external audit. “For us as radiologists, the focus Radiologists, Royal College of ing the ESR’s response to trends PIER 3 Value-based radiology debate to keep our profession at Audit uses specific methodology The ESR has both professional on clinically relevant topics such Dr. Jane Adam has a longstanding Surgeons in Ireland, and Chair of within healthcare that increas- the forefront of healthcare in the in which a given performance is and educational perspectives. It as patient safety, internal processes interest in audit and standards the ESR Quality, Safety & Standards ingly emphasise value-based Moderators: P. Mildenberger; Mainz/DE compared with a preselected stand- cooperates with institutions includ- and general radiation protection in radiology, and is former chair Committee. aspects in relation to quality of G. McGinty; New York, NY/US ard. If the standard is not achieved, ing the European Commission aspects is of particular interest and of both the Royal College of Dr. Barry Kelly is the Chairman care, patient safety and reim- »»Basic concepts of value-based radiology: U.S. perspective Coffee & Talk Session the reasons for this are explored, and the Heads of the European significance. This makes the ESR Radiologists Audit and Standards of the ESR Audit and Standards bursement systems. Within radi- J.A. Brink; Boston, MA/US change is implemented and a re-au- Radiation Competent Authorities clinical audit tool clearly different committees, and the ESR Quality, Subcommittee. He is a cross- ology, the issue of volume-based Saturday, March 3, 14:00–15:00, Coffee & Talk dit is carried out to ensure improve- (HERCA) to ensure that clinical from and more valuable than many Safety and Standards Committee. sectional radiologist with a special vs. value-based practice has been »»Basic concepts of value-based radiology: European perspective C 9 From volume-based to value-based radiology ment. This methodology is often audit is applied properly to improve other certification initiatives in Dr. Adrian Brady is a Consultant interest in trauma imaging and debated for a number of years and, L. Donoso; Barcelona/ES described as the audit cycle. quality of patient care in Europe, healthcare,” Mildenberger said. Radiologist in The Mercy imaging of the ICU patient. with this paper, the ESR is making »»New metrics are required for value-based radiology »»Chairperson’s introduction The EU Basic Safety Standards and is in line with the regulators’ The pilot participants were an important contribution to this G. McGinty; New York, NY/US L.E. Derchi; Genoa/IT (BSS) Directive (Council Directive perspective regarding audit. invited to comment on the template discussion. »»Panel discussion: A European-U.S. debate on the value »»What is ‘value’ in radiology and how can it be measured? 2013/59/EURATOM) must be trans- Radiologists’ experience of clin- itself in particular and the ease of Coffee & Talk Session The ESR sees value-based radiol- of ‘value-based radiology’ A. Brady; Cork/IE posed into national law by February ical audit across Europe, however, the process in general. This pilot ogy as an emerging paradigm that J.A. Brink; Boston, MA/US »»What really matters to patients 2018. This has major implications for is variable. In response to this var- study took place during the sum- Friday, March 2, 12:00–12:45, Coffee & Talk complements and enhances its L. Donoso; Barcelona/ES J. Birch; Poole/UK European radiology practice in sev- iability, the ESR Audit and Stand- mer and autumn of 2017. C 6 ESR audit pilot project existing approach to quality and G. McGinty; New York, NY/US eral areas, including documented ards Subcommittee together with The results of the pilot indicated »»What is value from an industry perspective? »»Chairperson’s introduction safety, while focusing on what actu- L.E. Derchi; Genoa/IT justification processes for radiation EuroSafe Imaging undertook a that the process was considered N. Denjoy; Brussels/BE E.J. Adam; London/UK ally matters most to professionals, E.J. Adam; London/UK exposure and dose optimisation. In pilot project in 2017. Concentrating non-time consuming and straight- patients and payers. The central »»Open forum discussion addition, it requires that ‘clinical on the key areas of radiation pro- forward and that the templates »»ESR audit pack audits are carried out in accordance tection and patient safety, 17 key themselves were lucid and easy to B.E. Kelly; Belfast/UK with national procedures’, meaning audit topics were described and use. Dr. Laura Oleaga from the Hos- »»Pilot project among EuroSafe Imaging Stars that clinical audit will be manda- suggested versions of completed pital Clínic Barcelona, Spain, who L. Bonomo; Rome/IT tory (article 58 (e)). templates were produced for each participated in the pilot put it in a »»Open forum discussion The European Commission pub- topic. The ESR Audit and Standards nutshell: “The audit tool proposed lished Guidelines for Clinical Audit Subcommittee and EuroSafe Imag- by the ESR is easily completed. It in 2009, and these were summarised ing are promoting the audit initia- can be utilised to enhance the status ESR Audit and Standards Session in a statement from the ESR in 2011. tive, which also supports the imple- of your department and can help These guidelines and the statement mentation of action no 2 of the to measure the practice’s standards Saturday, March 3, 16:00–17:30, Room M 1 could be considered the basis for ‘EuroSafe Imaging Call for Action’. and improve patient’s care and out- Audit across Europe: directive and perspective internal clinical audit. Although This project was designed, firstly, come. It serves as a quality mainte- there will be variation in how the to increase awareness of clinical nance policy of the department.” »»Chairpersons’ introduction requirements for clinical audit will audit among radiologists and to Subsequently it has been agreed A. Brady; Cork/IE be implemented across Europe, an help them make it part of their rou- that the 17 templates and topics will be D.C. Howlett; Eastbourne/UK internal assessment within units tine departmental work. In addi- made available to all radiology depart- »»The Esperanto Audit Project: or departments that uses standard tion, participation in the project ments in European Union member results from the pilot project and roll out audit methodology is recommended can help demonstrate to external states, along with the explanatory B.E. Kelly; Belfast/UK as a systematic and continuing activ- bodies that radiology departments booklet (Esperanto) which takes the »»Engaging in the pilot: The EuroSafe Imaging Star perspective ity with a significant annual output offer safe, well-documented care. reader step-by-step through the pro- G. Paulo; Coimbra/PT of departmental audit data. Five-star EuroSafe Imaging cess of completing any clinical audit. »»Quality improvement and change management: Internal clinical audit should be departments were invited to partic- We in the ESR Audit and Standards audit in industry in conjunction with external clin- ipate in the pilot. Each participating Subcommittee believe that this audit S. Lee; Guildford/UK ical audit (which may be required department was asked to complete tool will encourage a culture of regu- by national legislation) whereby an five key audits that were consid- lar self-audit and self-improvement. »»HERCA and audit: inspection vs clinical audit. What’s the external auditing body or auditors ered key by the Audit and Stand- Audit in general, and the pilot difference? Brevera® Breast Biopsy S. Ebdon-Jackson; Didcot/UK visit departments every five years. ards Subcommittee. Prof. Peter project in particular, will be dis- Regardless of the national variation Mildenberger from the University cussed in greater detail in the Cof- »»Panel discussion: Does audit make the patient journey safer? within the new legal framework, Medical Center Mainz in Germany, fee & Talk Room on the 1st level System with CorLumina® internal clinical audit will help depart- a pilot participant, highlighted the today at 12:00, and at the ESR Audit These sessions are part of the EuroSafe Imaging campaign Technology is CE marked and ready to be ordered. BE A STAR FOR YOUR PATIENTS! Join the EuroSafe Imaging Stars network of radiology departments committed to best practice in radiation protection.

Find out if your facility has Star potential and apply online at www.eurosafeimaging.com. Experience the difference of usingthe world’s first and only breast biopsy system that integrates tissue collection, imaging, and handling on our booth x2-211 at ECR

eurosafeimaging.org ADS-02142-EUR-EN Rev.001 © 2018 Hologic, Inc. All rights reserved. Hologic, Brevera, The Science of Sure, and associated logos are trademarks and/or registered trademarks of Hologic, Inc. and/or its subsidiaries in the US and/or other countries. All other trademarks, registered trademarks, and product names are the property of their respective owners.

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#ECR2018 myESR.org myESR.org #ECR2018 24 TECHNOLOGY & RESEARCH ECR TODAY | FRIDAY, MARCH 2, 2018

BY REGINA BEETS-TAN, ON BEHALF OF ANDREA LAGHI, EMANUELE NERI AND DANIELE REGGE European Society of Oncologic Imaging reaches out to clinical societies

The European Society of Oncologic afield; in countries both with and shops in collaboration with the Euro- which bases its effect on a molecu- will also prioritise collaboration in Imaging (ESOI) was launched in 2012. without access to high quality onco- pean Organisation for Research and lar biomarker rather than the tradi- membership programmes with clin- In the past five years, the ESOI has logical education. ESOI members Treatment of Cancer (EORTC). tional histological cancer type, we ical cancer societies and organisa- grown from 63 to almost 500 mem- come from 60 different countries, Secondly, the ESOI is aiming to are shifting towards an era of mod- tions such as the European Society bers. The majority of ESOI members and 28 of these are outside Europe. become an oncologic imaging soci- ern oncological treatment where of Surgical Oncology (ESSO), the work in large cancer institutes and To provide education for a broad ety that will attract not only radi- we will no longer refer to cancer European Society for Radiotherapy hospitals and are part of multidis- international forum ESOI partners ologists but also clinical specialists as colorectal, lung, or breast cancer and Oncology (ESTRO) and the Euro- ciplinary management teams. The with the annual Oncologic Imaging and scientists working in the field etc., but only describe the genetic, pean CanCer Organisation (ECCO). members’ subspecialisations reflect Course (OIC) in Dubrovnik and was of oncology. There is no doubt that molecular and imaging biomarker In the case of the ECCO, the ESOI the broad spectrum of oncology involved in the programme of the the input of radiologists in the multi- profile of tumours. is represented via the ESR, which is with a focus on imaging of haemato- inaugural conference of the Society disciplinary approach is crucial for It will be more important than ever part of the ECCO board. logical, gastrointestinal, lung, breast, of Oncologic Imaging India (SOII) an optimal treatment outcome. The to understand the questions posed With these opportunities on the genitourinary, bone, soft tissue, head in Chennai. world of cancer treatment is chang- by our oncological clinical partners, horizon, the ESOI and its board and neck, neurological, and paediat- Another of the society’s focuses ing rapidly. Rapid translation of fun- which are becoming increasingly would like to invite colleagues who ric cancers as well as interventional when it comes to education is damental cancer research goes hand complex. The ESOI recognises this would like to get involved in the oncology. The ESOI is a subspecialty strengthening collaboration with in hand with the quick implementa- need and is striving towards creat- ESOI’s activities and contribute to society of the European Society of other imaging subspecialty societies. tion of innovative cancer treatments. ing an international platform that the exciting new developments in Radiology (ESR) and affiliated with We partnered successfully with the Immunotherapy, only launched in will bring together radiologists with oncologic imaging to become mem- the ESR journals European Radiol- European Society for Hybrid Medical clinics a few years ago, is increas- clinical professionals such as surgi- bers. www.esoi-society.org ogy, Insights into Imaging and Euro- Imaging (ESHI) Educational Course ingly being adopted in cancer care cal oncologists, medical oncologists, pean Radiology Experimental. on ‘Hybrid Imaging in Oncology’ in and requires radiologists to evaluate radiation oncologists and basic sci- Prof. Regina Beets-Tan, MD, The main goal of the ESOI is to 2017, and the EuSoMII Annual Meet- tumour response from a completely entists in fields such as immunol- PhD, chairs the department of raise the scientific level and profes- ing in 2016. These are examples of different perspective. ogy, genetics, molecular pathology radiology at The Netherlands sional knowledge within the field of how integration of the oncological Whilst trying to fully compre- and biotechnology. Cancer Institute, Amsterdam. She is oncologic imaging. imaging education offerings of dif- hend these changes and under- The ESOI successfully organised president of the European Society The ESOI currently has two main ferent imaging societies can mutu- stand our new role as radiologists, joint sessions in the 2016 and 2017 of Oncologic Imaging (ESOI), priority areas. ally benefit their members. The we are already faced with the chal- annual meetings of the European president elect of the European Firstly, the society is striving to ESOI facilitates teaching on the use lenges of the first steps towards a Society of Medical Oncology (ESMO) Society of Gastrointestinal and provide high-quality education in of imaging in research and clinical new paradigm shift in cancer treat- and will organise the very first ESOI/ Abdominal Radiology (ESGAR) and cancer imaging and research not trials by offering live webinars on ment. With the recent launch of ESMO joint course in oncologic a member of the ESR Executive only in Europe, but also further research methodology and work- the first FDA approved cancer drug imaging in August 2018. The ESOI Council.

CONGRESS Friday, March 2 INSIGHT SESSIONSOFFICE

CHECK COAT2

COAT Room 0.16 (Entrance Level) Room 0.14 (Entrance Level) CHECK 1 Room Room BROADCAST ZONE E2 F1 Center Experience 3D Printing Room 10:45 11:45 | MRI 09:30 10:30 | DR Room E1 REGISTRATION F2 Computed MRI - practical application New image processing features of BROADCAST ZONE

REGISTRATION

JARDIN DES with Nova+ the Canon DR control software NE APP & CMEASY PUBLICATIONS JARDIN DES HELP DESK ESR MEETS Dr. I. Parienty, Paris, France C. Deurman, Amstelveen, The Netherlands PUBLICATIONS ESR MEETS

C y MEas Eas y CM ESR 12:00 13:00 | HII 12:00 13:00 | ULTRASOUND CHECK-IN & BAGS WELCOME LOUNGE TAVR planning PRESS OFFICE AND M High-frequency imaging of peripheral BUSINESS CENTRE CHECK-IN & BAGS Bu Dr. S. Niehues, Berlin, Germany ildi nerves in the groin and lower extremities ng Dr. M. Gruber, Innsbruck, Austria 13:15 14:15 | CT CT abdominal oncology - appendicitis 13:15 14:15 | ULTRASOUND FREE 0.14 PUBLICATIONS and challenging contrast injections in State of the art ultrasound imaging 0.16 hepatic CTs of the ankle Dr. A. van der Molen, Leiden, The Netherlands Dr. J. Veryser, Knokke, Belgium INSIGHT SESSIONS MAIN ENTRANCE 14:30 15:30 | CT 15:45 16:45 | ULTRASOUND ROOM 0.14 / 0.16 ENTRANCE LEVEL Ultra-high resolution CT State of the art ultrasound imaging (by invitation only) of the shoulder Dr. E. Smit, Nijmegen, The Netherlands Prof. P. Peetrons, Brussels, Belgium

15:45 16:45 | MRI Practical application of perfusion and di usion analysis in the brain Dr. B. Doche, Bordeaux, France Experience the new Canon | Hall X3

Formerly Toshiba Medical

For a complete overview of our educational program, please visit https://eu.medical.canon/ecr2018

#ECR2018 myESR.org ECR TODAY | FRIDAY, MARCH 2, 2018 COMMUNITY NEWS 25

ETAP all geared up to support Farewell to ESOR founding father The ESNR: promoting the important institutions throughout Europe Nicholas Gourtsoyiannis role of diagnostic and interventional 26 and beyond 27 29 neuroradiology

BY THE ESR SCIENTIFIC PUBLICATIONS DEPARTMENT European Radiology’s new Editor- in-Chief looks forward to guiding the journal into a promising future In January 2018, Prof. Yves Menu from Paris took over as Editor-in-Chief of the ESR’s flagship journal, European Radiology. ECR Today spoke to him about his new assignment and his vision for the future of the journal.

with Prof. Reiser we have organised are rapid, why should publication be YM: The world of artificial intel- addition, I would like to honour our a smooth transition, and I am very slow? Given the necessity of peer-re- ligence, radiomics, radiogenomics three Deputy Editors, Rahel Kubik- grateful for his very elegant man- view, I believe that we cannot do bet- and data sharing is in the main- Huch, José María García Santos and agement of the handover. ter than 30 days on average before stream of science today, in radiology Sujal Desai who do an incredible job The importance of European a first decision is reached without as well as in other specialties. We handling manuscripts within their Radiology? Clearly it’s immense. compromising the quality of the are only at the beginning of this era, field of expertise. I am amazed about the quality comments. My own challenge will but sometimes it seems we have no Interested authors should also and quantity of research which be to remain below the 30 days for idea where we are going. Scientific join the ESR Publications Commit- deserves to be promoted, including 90% of submissions. As this is largely journals play a major role, drawing tee Session on Sunday at 8:30a.m. emerging fields of knowledge, like dependent on the work of reviewers, the reader’s attention to these top- in Room M 1, titled ‘How to write a the world of artificial intelligence, I am very grateful to all those who ics, trying to publish important and scientific paper and how to get it which needs to be explored and volunteer for this anonymous, time understandable advances, briefly published’. explained. consuming and not so rewarding bringing the whole community ECRT: What does the future for ECRT: What is your personal task. They provide incredibly good into this universe, instead of leav- journals like European Radiology vision for European Radiology and advice and comments. ing it to dedicated small groups of look like? how do you think your past expe- A second issue is ethical. We super-specialists. This is clearly an YM: A French humourist, Pierre riences will inform the changes implemented a software analysis adventure: (very) attractive and (a Dac, used to say that “Predic- you plan to implement for the of similarities between submitted little bit) frightening. tions are very difficult, especially Prof. Yves Menu is a Professor of journal or your general vision for manuscripts and existing literature. Another development is the evo- when they are about the future”. Radiology at the Saint Antoine the journal? The goal is to detect verbatim cop- lution of readership behaviour. Let’s try anyway. Increasing elec- Hospital and University Pierre & YM: Obviously, the first role of a ies which breach copyright and, in Most researchers now access the tronic access will continue on as Marie Curie, Paris. He has served scientific journal, especially of a high rare cases, even plagiarism, which journal electronically, through an important trend; interactivity the ESR in many leading positions, ranking one like European Radiol- would then lead to immediate rejec- PubMED or Google Scholar, so we between authors and readers may including as Chairman of the ogy, is to publish, in a timely manner, tion without review. aim to increase searchability by be coming sooner than we think; ESR Professional Organisation research that is recognised as valu- A third initiative is to launch a optimising the presentation of the and changes in the presentation of Committee (POC) from 2011 to 2013, able by peers. This requires a multi- series of ‘Editorial Comments’. We abstract, key words and key points. manuscripts will become necessary. and as ECR 2011 Congress President. step process, as virtually no submis- commonly publish manuscripts At the same time, we are encourag- Social media will be a main part Furthermore, he served as Scientific sion is accepted without revision. We that have important implications ing authors to clarify the message of the journal itself, and not only Director of the European Board of have to ensure at the same time that for clinical practice, or which of manuscript titles, replacing very a side show. We can also imagine Radiology (EBR) from 2013 to 2015. the research is methodologically describe a real scientific advance. In technical and detailed titles with studies being easily updated when valid, clinically relevant, and that the this case, the article in itself might clear clinical messages or questions. needed, and not carved in stone as ECR Today: Professor Menu, final article is understandable. After be a little bit too complicated to be ECRT: Do you have any advice they are now. you slowly started taking over all, we should not forget that our first read by non-specialists. Therefore, for authors? What is the best way Really, I don’t know about the as incoming Editor-in-Chief from goal, when we publish, should nei- we ask an expert to briefly com- for them to present their work? future in detail, but what I antici- Prof. Maximilian Reiser during ther be to see our name on the front ment on this paper, extracting for YM: Yes, we have a lot of advice. pate is that the future of European the transition period last autumn. page nor to add a line to our CV. Actu- the reader the main messages that All those who have submitted an Radiology is brilliant, because this In your opinion, what is the impor- ally, we write for readers, and we hope will prove important for their daily article to European Radiology will joint venture between ESR and tance of European Radiology to the to be cited. practice or general knowledge. notice that they get back not only Springer is an absolute guarantee field of radiology today? ECRT: What specific changes are ECRT: What current develop- comments about their study, but for innovation and professionalism. Yves Menu: Well, slowly is not the you planning to implement in the ments can you identify in the field also advice for improvement. Let me most appropriate term. In the field coming months? of scientific publishing that will take this opportunity to acknowl- of editorial work, speed is probably YM: First of all, we need to speed most likely impact journals such edge our reviewers, and also the the most prominent word! Together up the process. Scientific changes as European Radiology? members of the Editorial Board. In

EUROPE’S NO.1 JOURNAL FOR GENERAL RADIOLOGY

myESR.org #ECR2018 26 COMMUNITY NEWS ECR TODAY | FRIDAY, MARCH 2, 2018 ECR TODAY | FRIDAY, MARCH 2, 2018 COMMUNITY NEWS 27

BY LAURA OLEAGA AND THE EBR OFFICE ETAP all geared up to support Farewell to ESOR founding institutions throughout Europe father Nicholas Gourtsoyiannis For over a decade he has been the face of the European School of Radiology (ESOR). ECR Today pays tribute to Prof. Nicholas Gourtsoyiannis, from Iraklion, Greece, ESOR’s iconic and beyond Scientific and Educational Director, as he hands over command to Prof. Valérie Vilgrain.

and the UEMS agreed on bringing Committee as well as the national facilitate both the application as The final outcome of the certi- the project up to date and establish- delegates to the UEMS Section of well as the assessment and sub- fication of the relevant training ing the ETAP 2.0 by moving from Radiology will perform an essential sequent certification process. For departments is determined using on-site assessment visits to virtual role in this respect. Even though a this purpose, a new software tool is a weighting system for the differ- assessment with a view to achiev- centre is not necessarily representa- being developed, which will be avail- ent areas of evaluation based on ing recognition as certification of tive of a country’s radiology training, able on the EBR website. This new the material provided by the insti- excellence and added value by dif- the representatives of the different platform will enable users – both tution; namely the questionnaires ferent institutions from Europe and national societies in Europe then representatives of the applicant and information provided by the beyond. At the same time, it was become the verifiers on account of institutions and the assessors – to head of training and the residents, decided to move the project under their knowledge and understanding easily and efficiently store, access the video of the institution facili- the umbrella of the European of the training in radiology in their and manage the documents and ties and equipment, and the online Board of Radiology (EBR), meaning respective countries and can there- information provided at any time. interviews. The weighting or scor- the EBR will oversee a new project fore be consulted by the ETAP asses- The phases of the ing in the questionnaire is based in line with its objective of harmo- sors whenever required. ETAP 2.0 process: on the relevance of each one of the nising radiological standards in The working group has been Phase 1: evaluation questions with respect to the skills, education. The ETAP 2.0 aims to: adapting and upgrading the exist- of the documentation knowledge, competences and atti- Prof. Laura Oleaga, MD, PhD, is •• improve and harmonise the ing ETPA documentation and cre- •• Centres interested in being tudes that a trainee must acquire Head of the Radiology Department standards of radiology training ated the necessary new documents assessed submit the application during the training programme. at Hospital Clínic de Barcelona, in Europe and beyond based for each step of the application, form to the ETAP office using the The areas evaluated are: Spain, and serves on the ESR on the ESR European Training assessment and certification pro- ETAP platform •• the structure and management Executive Council as chair of the ESR Curriculum for Radiology (ETC) cess. Radioprotection training and •• The ETAP Scientific Committee of the training programme Education Committee. She is also •• provide institutions that offer knowledge of European regulations verifies compliance with the •• the delivery of training and an editor for the journals European postgraduate radiology educa- are important aspects which must eligibility criteria and the centre education Radiology, Radiologia tion with objective assessment be included in the training pro- receives its access credentials for •• radiology facilities and resources and Neuroradiology. of their training programmes by grammes. In the new ETAP edition the platform •• research facilities nominated external assessors issues related to these have been •• The centre and trainees complete •• outcomes: complementary History of the ETAP (ETAP Scientific Committee incorporated in order to establish their respective questionnaires Institutions will be granted the The European Training Assess- members) an educational standard within the and provide the necessary following levels of certification: ment Programme (ETAP) was estab- •• develop assessment systems and framework of the European Union information Silver: the institution has train- lished as a joint initiative of the guidelines for use by postgrad- in accordance with the ETC to guide Phase 2: video and report ing standards that ensure adequate former European Association of uate education authorities at a and advise training centres. The new •• The centre sends a video of its training in accordance with the Radiology (EAR) and the European national level ETAP aims to provide an objective facilities and equipment. This standards set out in the ETC and Union of Medical Specialists (UEMS) •• become recognised as certifi- and independent assessment of the verifies the information relating covers all aspects of education. Radiology section back in 2001. Over cation of excellence and added training departments of the institu- to the facilities and equipment Gold: the institution provides the last five years the ETAP has value by the different radiologi- tions applying for certification with- required in the questionnaires, a standard of training that is in made assessment visits to ten radiol- cal training institutions out time or geographical constraints. which are filled in by the head of accordance with the ETC, a subspe- ogy training departments at differ- The ETAP Working Group, which The ETAP 2.0 is striving to cover the training (report on equipment, cialisation programme and basic ent European institutions, and 25 in will become the ETAP 2.0 Scientific wide spectrum of European training including manufacturer, model, research training. total between 2005 and 2015. Committee after ECR 2018, com- institutions, and is aware of the het- year, etc.) Platinum: the institution pro- Assessment visits have been prises an equal number of EBR and erogeneity that exists, while at the Phase 3: online interviews vides an advanced subspecialisa- largely positive experiences for UEMS members. Candidates from same time trying to establish com- •• Online interviews with the tion and research training pro- the assessed institutions and visi- the EBR and the UEMS will take the mon ground among the different people who fulfil the following gramme and all imaging modalities tors, although the application and position of scientific director on an training departments in Europe. The functions (adapted to each insti- are available. assessment procedure has proven alternating basis. Three EBR mem- advisory programme is essentially tution according to their training There is variation in terms of leg- somewhat cumbersome. Visits were bers and three UEMS members will based on the content developed by department structure): islation and training programmes relatively resource intensive for the also perform the role of assessor on a the ETC, which establishes the basis •• Head or a deputy head of the across Europe. The harmonisation host institution, the assessors and rotating basis (one lead assessor and for creating an homogeneous train- radiology department of training programmes will sup- the office. Preparing the application co-assessor per assessed institution). ing system throughout all European •• Head of the education port the recognition of common documentation, organising travel A third junior assessor (European centres to facilitate the creation of programme certification and licensing through- (centres were sometimes difficult to junior doctors and ESR Radiology common and interchangeable cer- •• One of the trainees’ tutors out Europe and improve quality of reach) and accommodation, as well Trainees Forum Subcommittee rep- tification and the mobility and real •• One attending physician involved care and patient safety. as the many other necessary prepa- resentatives) will perform an advi- exchange of professionals within in the training programme or a It is important to standardise At last year’s ECR, ESOR celebrated ten years of education in partnership, a success story written by its Director, Nicholas Gourtsoyiannis. rations took a lot of time. sory role as residents or junior doc- the European countries. deputy (involved in the training and facilitate accreditation across Looking ahead: the ETAP 2.0 tors supporting the assessors. The How does it work? programme) borders to promote mobility of pro- ECR Today: Professor Gourtsoy- processes and co-ownership, result- up to the ESR for professional guid- the vehicle for the realisation of the True clinical radiologists will In March 2016, following Prof. new concept and its virtual compo- The ETAP 2.0 has been officially •• Trainee supervisor fessionals, expand horizons, and iannis, after leading the European ing in the ESOR Community – a ance and leadership, in addition to long-cherished ambition of radiolo- always have a primary role in Laura Oleaga’s (ESR Education nent require verification mecha- launched at ECR 2018 and the appli- •• At least two trainees (maximum help to enrich and enhance the School of Radiology right from the community of luminaries, crossing science innovation and structured gists to actually meet their patients; patient management. Their educa- Committee chairperson for the nisms and that is why the national cation process will open after the of five, ideally one junior trainee profession. start throughout its first eleven national borders, speaking the complementary education and c) accept a prime responsibility tion is and should be the primary 2015–2018 term) proposal, the ESR delegates to the ESR Education congress. The new ETAP aims to and one senior trainee) years, what have been the most same radiological language, sharing certification. and role in adding clinical value to aim of the European Society of important achievements of the aspirations and setting the same All six major tasks we outlined radiology, through its many plat- Radiology. school? high-profile standards in radiology; when advocating the creation of forms and fora. ECRT: What would be your Nicholas Gourtsoyiannis: ESOR d) respond to the needs of the our society in March 2005 have ECRT: What would be your advice to your successor? has become an inspiring institution evolving radiological communities been effectively and success- message to new and future NG: The school through these with its own identity and reputation. around the globe, counting for over fully implemented; the European radiologists? years has built a tradition of cre- COFFEE & TALK SESSIONS Beyond numbers, it has managed to: 50% of its programme; Institute for Biomedical Imaging NG: Truth is, it is a wonderful ativity and excellence. The percep- a) create its own recipe, with e) found and develop numerous, Research (EIBIR), ESOR, struc- time to be in radiology and I am tion of tradition, I think, is best Don’t miss this new informal session format taking place teacher-centred lectures, comple- structured, mentored, modular tured public awareness campaigns, sure it will continue to be the same described by the composer Gustav mented/elaborated by interactive scholarship and fellowships every means and teams to influence poli- in the days to come. Driven by con- Mahler, who said “Tradition is not

in the stylish Coffee & Talk Room (EuroSafe Imaging workshops in small groups, embed- year, supported by grants, funded cies favouring radiology within the stant change, radiology is inviting, to preserve the ashes, but to pass Lounge, 1st level). ded into stratified modular courses by the enrolling/receiving institu- EU, the harmonisation of teaching challenging, creative and reward- on the flame”. Therefore, words like of various levels; tions and societies, which encom- programmes around Europe and ing. Radiologists of the present and commitment, perseverance, ‘λογικὴ’ Stop by and contribute to the lively discussions while b) create a long-term educational pass and reflect a new spirit in the increase of individual member- future could be important elements (logic) and change – as a process, sipping your coffee or tea. commitment by developing syn- radiological education. ship and participation in this new of the triage system in healthcare, not as an event – should always be ergies and mobilising resources ECRT: As founding president of society. making it possible for patients to be given a meaning and added value. available for education, including the European Society of Radiology Yet, we have just reached matu- treated earlier, more effectively and Prof. Valérie Vilgrain, the new TOPICS: the mother society, subspecialty you have witnessed the develop- rity, with great challenges ahead less expensively. Director, certainly excels as a scien- and national societies, radiology ment of European radiology. How to anticipate and respond to, such The radiologists’ present and tist in our global community, she is Radiation protection Management tips departments, research institutions, far has the society come? as technical and scientific innova- future is in their own hands. The a committed and experienced edu- Value-based imaging Clinical decision support renowned faculties and valued NG: The ESR is undoubtedly a tions and constant global changes. key role for them is to evolve – by cator and above all she is motivated Details at EuroSafe Imaging Undergraduate radiology teaching industrial partners; major success story. In only twelve I would personally consider constant change – into becoming to lead ESOR in its new era. I have Imaging biobanks Audit ipp.myESR.org c) develop a structured network years, it has evolved into a mature, extremely important for the ESR to: frontline, truly clinical specialists, no doubt that she will succeed. Type of session C between attendees, chartered ref- bold, vibrant and moving soci- a) enhance and build on its lead- working in an integrated multidisci- erence centres, and assigned tutors ety, the largest worldwide in our ing role as an international force in plinary clinical environment, to add and mentors through institutional domain of science. Members look radiological education; b) become value to radiology beyond imaging.

#ECR2018 myESR.org myESR.org #ECR2018 28 COMMUNITY NEWS ECR TODAY | FRIDAY, MARCH 2, 2018 ECR TODAY | FRIDAY, MARCH 2, 2018 COMMUNITY NEWS 29

BY MICHELLE WEISS, CIRSE OFFICE BY ÀLEX ROVIRA The European Conference on The ESNR: promoting the Interventional Oncology (ECIO) important role of diagnostic and and the rise of the fourth pillar interventional neuroradiology

The ESNR is also working to assessment and post-processing. attended by 722 participants, who As well as all the positive news, maintain the important role that The course was well attended and came from 60 different countries I’m sorry to also have to share some of cancer care diagnostic and interventional neu- the ESNR is planning to offer it around the world. Many key diag- sad news with you. Three European roradiology plays as a radiological again in 2018. nostic neuroradiology related topics neuroradiologists who dedicated specialty, and to preserve its lead- The ESNR has extended its edu- were covered during the conference. their entire professional lives to hard to create a high-quality pro- gist colleague along with them at no a second IO registry, called CIREL, ership in education, training, and cational activities to Latin America These included vascular, psychiat- this radiological specialty have gramme with a variety of sessions. extra cost to motivate valuable dis- which aims to collect data on tran- research in these areas. This is a and organises the annual LATAM- ric/neurodegenerative, metabolic/ passed away – Professors Jacque- The full spectrum of IO will be cussions and learning opportunities. scatheter chemoembolisation with critical task, because only neurora- ECNR in Sao Paulo (Brazil) in col- toxic, white matter, infectious, and line Vignaud, Othmar Schubiger, addressed, including such sta- Get involved irinotecan-eluting LifePearl Micro- diologists are in a position to offer laboration with the Paulista Soci- spinal diseases. The programme and Marco Leonardi. I would like ples as hepatocellular carcinoma, If you aren’t able to make it to spheres and is being led by Phil- a service that guarantees optimal ety of Radiology and the Brazilian also offered new insights into pae- to express my deepest gratitude colorectal liver metastases and the the conference, you can always lippe Pereira. outcome on a large scale, while bal- Society of Neuroradiology. It also diatric imaging, the application of for their outstanding contributions clinical management of patients, tune in to view sessions live and on With all this happening, it is clear ancing patient needs and the avail- organises the European Course of advanced imaging techniques and to the development of the ESNR. as well as newer clinical territories demand. This service, begun last to see that this is an exciting time able resources. Ensuring the unity Paediatric Neuroradiology in Cart- reporting standardisation. Professor Schubiger and Marco such as neuroendocrine tumours, year at ECIO, will once again be for interventional oncology, and we of all aspects of neuroradiology is agena (Colombia) in collaboration In 2018, the ESNR Annual Meet- Leonardi also held important posi- immunotherapy and cholangiocar- available at ECIO 2018 and is offered hope you will join us at ECIO 2018 Advanced MRI techniques were the only way to achieve this goal. with the Colombian Association ing and Advanced Course in Diag- tions within the ESNR, fulfilling The 2018 European Conference on Interventional Oncology will be held from cinoma. The popular session Best to all CIRSE Members or those with to experience these advances first discussed during the first Advanced The ESNR is thriving as an organ- of Radiology. nostic and Interventional Neuro- their duties with a strong sense of April 22–25 in Vienna, Austria. IO Papers will showcase several an ESIRonline subscription. A new hand! Course in Brain Tumor Imaging isation, which is clearly reflected by The European Board of Neurora- radiology will take place from 19 responsibility and dedication. The of the most interesting research feature begun this year was a call For more information on our that took place in Milan on 8 to 10 the growing number of individual diology (EBNR) is the only organi- to 23 September in Rotterdam, the ESNR is deeply indebted to these In recent years, interventional interventional world. When ECIO papers in oncology over this past for abstract submissions to be pre- activities in 2018 and beyond, please November 2017. The participants had and institutional members. As of sation in Europe offering diplomas Netherlands, under the presidency professionals, and is greatly sad- oncology (IO) has become a bigger began in 2008, interventional oncol- year. With all these topics planned, sented at ECIO 2018. We are excited consult the CIRSE websites at cirse. the opportunity to gain hands-on the end December 2017, we had a in diagnostic and interventional of Professor Marion Smits. With dened by their passing. player in the field of cancer treat- ogy was still in its early stages and there is bound to be something for to showcase the selected presenta- org, ecio.org, or visit us at our soci- experience in image assessment total of 1,739 individual members neuroradiology, and has continued advanced courses entitled ‘Imaging We encourage all practising neu- ment. Interventional oncology is a the conference occurred only once everyone to learn. tions and give more specialists the ety booth in the exhibition. We look and post-processing. The ESNR is from 79 countries, and 4,100 institu- its work organising examinations techniques in neuroradiology: here roradiologists to join and partic- fast-growing and dynamic field with every other year. Due to the growing Beating cancer together chance to engage with IO topics. forward to meeting you! planning to offer the course again tional members from 27 countries, and awarding certifications and and beyond!’ and ‘Neurovascular ipate in the ESNR to help shape rapidly evolving technologies, and, as popularity of the field of IO and the As interdisciplinary collaboration This feature will continue for ECIO in 2018. which are represented on the Insti- diplomas in this field. In 2017 the lesions: to treat or not to treat?’, the the future of neuroradiology in such, it is vital to provide specialists success of the conference over the is needed from all specialities to 2019 in Amsterdam. CIRSE is a non-profit, educational tutional Members Council. final examination for the European inspiring educational programme Europe. We invite you to visit our with a regular forum for scientific years, ECIO became an annual con- combat cancer and provide optimal CIRSE’s IO registries and scientific association which The European Course of Neu- Diploma in Neuroradiology (EDiNR) will kick off on 20 September website, which includes detailed exchange. As IO continues to stack ference in 2012. As an annual event, patient care, CIRSE has worked to CIRSE takes an active role in the comprises over 7,000 members, The European Society of Neuro- roradiology (ECNR) is the most and the European Diploma in Pedi- and continue throughout the information on all of the ESNR’s up more evidence and pave new ECIO provides an opportunity for give this conference a strong mul- development of research to increase and aims to improve patient radiology (ESNR) has been dedicat- highly recognised and successful atric Neuroradiology (EDiPNR) Annual Meeting. scientific and educational activities roads for the treatment of cancer interventional radiologists and other tidisciplinary focus in order to raise the evidence base within this care through the support of ing considerable effort to activities of ESONR’s programmes. ESONR took place in Malmö, Sweden. In 2017 Professor Gilberto González (www.esnr.org). patients, the European Conference cancer specialists to get updates on awareness of IR techniques among dynamic field, and this is done par- teaching, science, research and in many areas of our field and is also offers courses in paediatric There were 115 applicants for the (Harvard Medical School, USA) and on Interventional Oncology (ECIO), advances in medical technology and other medical specialists. At ECIO tially through registries. The lon- clinical practice in the field of making progress in several projects. neuroradiology, interventional EDiNR and 17 for the EDiPNR from Professor Jan Wilmink (University Prof. Àlex Rovira is Head of the put on by the Cardiovascular and trials, to improve their expertise and 2017, roughly 30% of delegates that gest running CIRSE-led scientific cardiovascular and interventional In some cases, these are long-run- neuroradiology and spine radiol- over 20 countries. of Maastricht, the Netherlands) were Department of Neuroradiology at Interventional Radiological Society of to meet with top specialists from attended were non-radiologists, registry, steered under the expert radiology. CIRSE facilitates learning ning initiatives that are the best ogy. In 2017 the ESNR organised an The 40th ESNR Annual Meeting named Honorary Members of the Vall d’Hebron University Hospital in Europe (CIRSE), has become an essen- around the world. who were encouraged to share their guidance of José Ignacio Bilbao, is throughout the year with state- of their kind in the world. One advanced course on brain tumour was held in Malmö, Sweden from 13 ESNR in recognition and sincere Barcelona, Spain, and President of tial meeting where these innovative In 2018, the conference will take expertise with IRs and vice versa. the CIRSE Registry for SIR-Spheres of-the-art meetings, educational such example is our educational imaging for the first time, on which to 17 September 2017, under the suc- appreciation of their lifelong contri- the European Society developments take centre stage. place in Vienna from April 22–25, With CIRSE’s Collaborating Against Therapy (CIRT), a European-wide workshops and grants, and programme within the European participants had the opportunity to cessful presidency of Professor Pia butions to, and promotion of, neuro- of Neuroradiology. Now in its 9th year, the European with a Scientific Programme Com- Cancer initiative, interventional registry that aims to investigate the scientific, advocacy and patient School of Neuroradiology (ESONR). gain hands-on experience in image Maly Sundgren. The meeting was radiology and science. Conference on Interventional Oncol- mittee headed by Afshin Gangi and radiologists who attend the confer- real-life application of SIR-Spheres safety initiatives. ogy has grown to be a fixture in the Alban Denys, who have worked ence are able to bring a non-radiolo- microspheres. CIRSE is also leading

BY PABLO VALDÉS SOLÍS BY VIERA LEHOTSKÁ AND KAMIL ZELEŇÁK SERAM and new Slovak Radiological Association professional challenges it faces seeks improvement in four key areas

Radiologists from different coun- ological equipment, but also when it that education can be changed in moting radiologists and another congresses and courses truly tries in the European Union face should be updated or replaced. the way it is delivered and that it objective of SERAM’s. In order to become multidisciplinary. In the upcoming year, the Slovak Radiological Association (Slovenská different professional situations. New relationships with the indus- should profit from modern forms meet this objective, we work with SERAM faces new and demand- Incomes, labour conditions, relation- try and its impact on radiologist of communication. Virtualisation, other medical societies and profes- ing challenges. Radiology is rádiologická spoločnosť – SRS) will focus on four major objectives: ships with the industry and other training social networks, video streaming and sional institutions in order to imple- immersed in a revolution: not only factors that can affect radiologists There is a highly demanding ethi- other emerging technologies should ment the most advanced models of technological, but also economic are changing in Spain and the Socie- cal code in Spain that is followed by be at the heart of the design of any competence certification. Our pur- and social. We think that success 1. to provide a strong support ising joint quadrilateral symposia practice should be supported. results of the DAWN and DEFUSE patients, or whether radiologists dad Española de Radiología Med- both sponsors (industry) and radi- educational activity. The SERAM pose is make certification of radi- will come if we face this situation network for young radiologists of young radiologists, which are During 2015, Slovakia began a 3 trials, we are aware that we should also be involved in pro- ica (SERAM) must adapt to these ologists. However, we are facing a National Congress is one of the most ology units and other professional while enhancing professionalism, under the age of 35, held every two years in various host breast cancer screening in high-risk need to use imaging techniques viding intensive post-procedural changes in order to keep on properly new situation with a different way important in the world and possibly units easy. The final result will be applying new technologies, certify- 2. to intensify the cooperation countries. The aim is to educate patients (SCRIMS) project, work- more efficiently when selecting care. We also need to ask ourselves providing services to its members. of managing study aids, especially the biggest in the Spanish-speaking better service for our patients. ing our radiologists and promoting between SRS and the Association and share professional experiences ing in conjunction with the Slovak patient groups, which could bene- what kind of medical division is The economic crisis and its impact because of the fiscal burden that world. We plan to grow and widen its Beyond radiology multidisciplinarity. We are work- of Radiological Assistants of the among the representatives of the Society of Medical Genetics and fit patients who begin endovascu- radiology? Is it diagnostic in nature in our profession could be caused by these aids. This scope in order to enhance radiology Radiology is changing fast and ing hard to adapt to these changes Slovak Republic (Spoločnosť rádi- individual countries, to improve experts in gynaecology and oncol- lar treatment more than six hours or clinical? The economic crisis has been espe- new situation, in addition to the education in Spanish. SERAM knows that. In a few decades, and hope we will be successful. Our ologických asistentov Slovenskej presentation skills in English, and ogy. The aim of the project is to after the onset of their symptoms. cially rough in Mediterranean coun- already low incomes for many radi- Professionalism our profession will have nothing to members deserve it. republiky – SRASR), to build mutual professional and identify and bring together women This treatment is not only ethically Assoc.Prof. Viera Lehotská, MD, tries and in Spain, it has made a deep ologists, threatens the educational All these changes are already hap- do with the way it is now. So, we must 3. to evaluate the preliminary social relations. The symposium with gene mutations and to provide beneficial, but is economically ben- PhD, is Chair of the 2nd Radiology impact not only on the recruitment possibilities for radiologists. SERAM pening and will become fact in the adapt to new technologies: artificial Dr. Pablo Valdés Solís is the Vice outcomes of the pilot study of is supervised by senior radiolo- them with adequate medical man- eficial too thanks to the reduction Dept., Faculty of Medicine, at of radiologists, but also on technology is facing this new situation and act- upcoming months. This is leading intelligence, collaborative network- President of the Spanish Society breast cancer screening with gists from each country who are agement and personalised therapy. of invalidity. the Comenius University and St. acquisition. Technological obsoles- ing as an active partner in the dia- us to redefine our profession. One ing, 3D printing and Industry 4.0 are of Radiology (SERAM), and former MR-mammography in women responsible for motivating and pro- Our third main objective for 2018 In Slovakia, the number of endo- Elizabeth’s Cancer Institute in cence is a topic that concerns radiol- logue between the industry and radi- of the SERAM’s missions is to pro- some of the innovations that will be President of the Spanish Society with proven genetic mutation, fessionally guiding their younger will be to evaluate this project. vascular procedures per 1 million Bratislava, Slovakia, and President ogists in Spain and therefore SERAM. ologists and is also acting to change mote professionalism, so that our a reality in a few years and that will of Management and Quality in and colleagues. Slovakia is preparing to The newfound benefits of treat- people is one of the highest in of the Slovak Radiological A general document has been pub- the way education can be delivered. members can benefit from better challenge us. Radiology. He works as head of 4. to improve the management of host the meeting in 2019. ing ischaemic strokes with endo- Europe. Mobile applications have Association. lished in Spain that describes the New approaches for education management skills, and also so that But this challenge is something the Department of Radiology in hyper acute ischaemic stroke Regarding the second objective, vascular treatment have important been created by the Ministry of Assoc. Prof. Kamil Zeleňák, MD, state of radiology equipment in our In this new and unpredictable set- they can have access to documen- that we cannot and must not do the Hospital Costa del Sol, patients and patients receiving our goal is to organise professional diagnostic implications and radiol- Health to improve the process of PhD, is Head of the Department of country and as a result SERAM has ting, SERAM must change and adapt tation and information that allows alone. We have to establish new Marbella, Spain. endovascular treatment. events for radiologists and radio- ogy plays a vital role in diagnos- transferring patients to stroke cen- Radiology at Comenius University’s been working on the design of a set the way we arrange courses and con- them to reach the highest quality ways of collaborating with other In 2015, Slovakia joined the exist- logical technicians. Technicians are ing patients. In addition, several tres. Despite this, there is still space Jessenius Faculty of Medicine and of rules or recommendations that gresses, making use of new technol- standards in their daily practice. disciplines, and in order to achieve ing activities of Croatia, Hungary, responsible for the quality of imag- recanalisation techniques were for improvement. However, it is University Hospital in Martin, define not only the best technical ogies and so that more people can Professional accreditation and this, SERAM is collaborating with and Slovenia in supporting young ing examinations, which is why designed to recanalise occlusion vital that we discover whether it is Slovakia. characteristics for any piece of radi- take advantage of them. We believe certification is another way of pro- engineers and physicists so our radiologists and residents by organ- their professional growth in daily of the brain arteries. Thanks to enough to provide such service for

#ECR2018 myESR.org myESR.org #ECR2018 30 COMMUNITY NEWS ECR TODAY | FRIDAY, MARCH 2, 2018

BY HENRIETTÆ STÅHLBRANDT ON BEHALF OF THE SWEDISH SOCIETY OF RADIOLOGY News from the Swedish Society of Radiology In the year 2017, the work of the Swedish Society of Radiology has focused more on maintaining previous work than initiating new concepts. As the first pure radiological quality registry in Sweden, we have supported the Peripheral Intervention Quality Registry and enjoyed watching it develop.

argument from some of the county are also discussing which society or started to emerge on a broader level, councils that these patients “would healthcare institution should own and there are now many opportuni- have undergone imaging anyway such systems and make sure they ties for radiologists to work in the and should not increase the work are up-to-date and well maintained. private sector from the comfort of load” does not seem to be correct. Despite being a technologically their own home, from abroad in In addition to these guidelines, advanced healthcare country, the Europe, or even from Sydney, Aus- the Society has been active in sev- radiological exam codes are in dire tralia, taking care of the on-call eral other guideline recommen- need of an update. Most exam codes service for Swedish hospitals. We dations. For example, we have are old and lack the versatility of expect the work of the general participated in several meetings new emerging technologies and radiologist to change as a conse- and arranged subspecialty courses imaging methods, and are unfor- quence of this, but the Society will as well as two major conferences: tunately not universal nationally. continue to work for the quality The Swedish Radiology Week, very Our society is interested in collabo- of Swedish radiology, regardless of nicely arranged by Linköping this rating with the Swedish authorities whether you work in the private or year; and the European Society of on developing new and better func- public sector. Neuroradiology meeting in Malmö, tional exam codes, but are working Within the Society, we are look- where the Swedish Society of slowly in order to make this a very ing to renew ourselves by introduc- Neuroradiology participated in well thought through enterprise. ing two new committees, namely a the programme. Other things being discussed in radiation safety committee, and an The Swedish Society of Radiology Sweden are artificial intelligence/ IT committee. We think more of The new board of the Swedish Society of Radiology met for their annual has also supported iGuide trials in deep learning/machine learning, the work of the Society will revolve conference in Jonköping January 30–31. Sweden, which are now starting and subspecialisation on a larger around those two areas and want to to produce results. In preliminary level. The Society thinks those be able to meet the demands of the Ever since the county councils the quality of cancer care in Den- reports, we’ve seen that iGuide are important to deal with the radiology world. accepted the proposition from the mark and to speed up the diagnos- (referral guidelines for clinicians, nationwide shortage of radiol- In all, this year has been as pro- Swedish government two years tic and clinical work-up for cancer supported and endorsed by the ogists in Sweden, but has yet to ductive as previous years, and we ago to establish the timelines for patients to achieve the earliest pos- ESR) seems to decrease the rate of come up with functional ideas on look forward to 2018! diagnosis and therapy start in can- sible start of therapy. ordered exams with low appropri- how to incorporate them into the cer patients, the various working In Sweden, the implementation ateness scores. However, Sweden daily radiological routine. As for Dr. Henriettæ Stahlbrandt is head groups for the national standards of these timelines has had a high is quite a technologically advanced the shortage of radiologists, Swe- of the Swedish Society of Radiology of care guidelines for management impact on the radiology depart- country, including in the healthcare den has a far-reaching and tightly and works as a consultant Special Exhibition: of cancer have assembled in order ments in Sweden. Because of sector, and yet it has proven more integrated national and regional radiologist and assistant director to set these timelines. This initia- this speeding up of the diagnosis difficult than expected to success- healthcare system, financed by of Radiology in Jönköping county tive was inspired by the work of the work-up, the demands on radiology fully integrate iGuide into other the Swedish state. In recent years, in the south of Sweden. Danish Board of Health to increase departments have increased. The pre-existing healthcare systems. We private healthcare solutions have

BY ADRIAN MIZZI VIENNA 1900! Postgraduate radiology training in Malta proves a major success Klimt – Moser –

The Maltese Association of Radi- to two million tourists visit the minimum of five years in training that encompasses practically all led to an even greater demand for ologists and Nuclear Medicine island every year. The small size of – the first four years in Malta. The aspects of vascular and non-vascu- radiologists and nuclear medicine Physicians is the official body rep- the island state, as well as its geo- curriculum is based on the curric- lar interventional radiology, as well physicians in Malta. Recruitment resenting radiologists and nuclear graphic isolation, pose formidable ula of the Royal College of Radiol- as a 24-hour on call interventional of radiologists from abroad has medicine physicians in Malta. It challenges. ogists (United Kingdom) and the service that includes emergency also increased as a result. The local has 38 members (25 accredited The major challenge that the European Society of Radiology. The stroke thrombectomy. One of the radiology training programme is radiology specialists, two accred- association has encountered over Fellowship of the Royal College locally trained radiologists, who becoming ever more popular with Gerstl – Kokoschka ited nuclear medicine specialists, the past ten years was the pro- of Radiologists (UK) examination underwent subspecialty neuro-in- local junior doctors, and many are as well as one staff grade and 10 vision and implementation of a is mandatory and all trainees are terventional training in Dublin, choosing radiology above other trainee radiologists). 95% of mem- local post-graduate training pro- encouraged to sit the European pioneered a local acute stroke ser- medical and surgical specialties bers practise at Mater Dei Hospital, gramme for radiology. Prior to 2008, Diploma in Radiology exam. Follow- vice in June 2015. In the first eleven when selecting their preferred which is the main public general there was no local postgraduate ing success in these exams, trainees months of 2017, there have been career pathway. hospital for the Maltese Islands. training programme in radiology; must undertake a one or two-year 250 emergency CT stroke protocol The Maltese Association of Radi- The hospital is equipped with mod- any doctors who wanted to pur- fellowship in a subspecialty, at a examinations and 38 consequent ologists and Nuclear Medicine ern imaging facilities including two sue a career in medical imaging centre of excellence outside Malta. acute thrombectomies. Two train- Physicians will strive to continue MRI scanners, two CT scanners, had to move abroad for the dura- The training programme has ees who have completed the local supporting local radiology training LEOPOLD MUSEUM two gamma cameras, one PET/CT tion of their training. This led to a been very successful. Since its training programme are presently and consequently supporting the and two interventional radiology huge brain drain, as most doctors launch, 13 locally trained radiolo- undergoing subspecialty neuro-in- provision of radiology and nuclear suites. The association’s statute has who left the island to train never gists have been awarded certificate terventional training, one in Liver- medicine services in Malta. 1070 Vienna, MuseumsQuartier been recently revised and updated. returned, resulting in a major local of completion of training and there pool and one in Amsterdam. Other The association now endorses both recruitment shortage. Despite the are presently 10 residents in train- new services introduced by locally Dr. Adrian Mizzi, MD, FRCR, www.leopoldmuseum.org radiologists and nuclear medicine shortage of available professionals ing. This has led to a substantial trained radiologists include com- EDiR, is president of the Maltese physicians. The two specialties and limited experience, in October increase in the number of locally bined diagnostic and interventional Association of Radiologists and work in very close collaboration 2008 our specialty association set practising radiologists and to the hepatobiliary radiology and cardiac Nuclear Medicine Physicians. He in Malta. up a radiology training programme introduction of several diagnostic imaging (this subspecialty is shared is also the national post-graduate Malta is one of the smallest Euro- which leads to certification in the and interventional subspecialty with cardiologists). training coordinator for radiology pean states with a population of specialty. The training programme services. These include a thorough The provision of new imaging in Malta. Oskar Kokoschka, Self-Portrait, One Hand Touching the Face, 1918/19 less than half a million people. Up envisages that trainees spend a interventional radiology service and interventional services has © Leopold Museum, Vienna © Fondation Oskar Kokoschka © Bildrecht, Wien, 2017

#ECR2018 myESR.org WHAT’S ON TODAY IN VIENNA? FRIDAY, MARCH 2, 2018

Alain Altinoglu © Marco Borggreve

Ensemble in Eiswind / Hideg szelek by Árpád Schilling and Éva Zabezsinszkij Ensemble in La Traviata by Giuseppe Verdi © Barbara Pálffy / Volksoper Wien © Reinhard Werner / Burgtheater Martin Bermoser and Ensemble in I Am From Austria © VBW Deen Van Meer

THEATRE & DANCE CONCERTS & SOUNDS OPERA & MUSICAL

Eiswind / Hideg szelek Reinhard Mey Pelléas et Mélisande By Árpád Schilling and Éva Zabezsinszkij KONZERTHAUS | 20:00 By Claude Debussy 1030 Vienna, Lothringerstraße 20 AKADEMIETHEATER | 20:00 Conductor Thomas Guggeis www.konzerthaus.at 1030 Vienna, Lisztstraße 1 Directed by Thomas Jonigk Phone: +43 1 51444 4145 www.burgtheater.at Wiener Symphoniker KAMMEROPER | 19:00 Conductor Alain Altinoglu 1010 Vienna, Fleischmarkt 24 www.theater-wien.at Jedermann (stirbt) Renaud Capucon, violin By Ferdinand Schmalz M. Ravel: Pavane pour une infante défunte; La Traviata BURGTHEATER | 19:30 E. Lalo: Symphonie espagnole d minor op.21; Opera by Giuseppe Verdi 1010 Vienna, Universitätsring 2 J. Brahms: Symphonie No. 2 d major op. 73 Phone: +43 1 51444 4145 VOLKSOPER | 19:00 www.burgtheater.at MUSIKVEREIN | 19:30 1090 Vienna, Währingerstraße 78 1010 Vienna, Bösendorferstraße 12 www.volksoper.at All About Eve www.musikverein.at Macbeth By Christopher Hampton Three Wise Men ‘Alive and Cookin’!’ By Giuseppe Verdi KAMMERSPIELE DER JOSEFSTADT | 19:30 (Austria/Netherlands/Italy) 1010 Vienna, Rotenturmstraße 20 Conductor Giampolo Maria Bisanti Phone: +43 1 42 700 300 PORGY & BESS (JAZZ) | 20:30 1010 Vienna, Riemergasse 11 With Zeljko Lučić, Jongmin Park, Tatiana Serjan, www.josefstadt.org www.porgy.at Jinxu Xiahou Ein Körper für jetzt und heute WIENER STAATSOPER | 19:00 Brian Fallon & The Howling Weather (US) By Mehdi Moradpour 1010 Vienna, Opernring 2 + Dave Hause (US) www.wiener-staatsoper.at SCHAUSPIELHAUS | 20:00 ARENA (POP & ALTERNATIVE) | 20:00 1090 Vienna, Porzellangasse 19 1030 Vienna, Baumgasse 80 I Am From Austria Phone: + 43 1 317 01 01 www.arena.co.at Musical with songs by Rainhard Fendrich www.schauspielhaus.at Toto RAIMUNDTHEATER | 19:30 Fremdenzimmer 1060 Vienna, Wallgasse 18–20 By Peter Turrini GASOMETER (POP & ALTERNATIVE) | 20:00 www.musicalvienna.at 1110 Vienna, Guglgasse 8 THEATER IN DER JOSEFSTADT | 19:30 www.planet.tt Tanz der Vampire 1080 Vienna, Josefstädter Straße 26 Musical by Michael Kunze and Phone: +43 1 42 700 300 The Doors Experience www.josefstadt.org Jim Steinman SZENE (POP & ALTERNATIVE) | 20:00 RONACHER | 19:30 Viel Lärm um nichts 1110 Vienna, Hauffgasse 26 www.planet.tt 1010 Vienna, Seilerstätte 9 By William Shakespeare www.musicalvienna.at VOLKSTHEATER | 19:30 1070 Vienna, Arthur-Schnitzler-Platz 1 Phone: 43 1 52111-0 www.volkstheater.at

Please note that all theatre performances are in German. ECR TODAY EUROPEAN CONGRESS OF RADIOLOGY FRIDAY, MARCH 2, 2018

myESR.org ECR FACES

Anna Kulikova (left), a radiologist from Bishkek, Kyrgyzstan, has won the Invest in the Youth grant to attend ECR 2018. She is a big ESR fan, Kulikova revealed in her interview to Mélisande Rouger (right).

Young gun from Kyrgyzstan travels solo to ECR By Mélisande Rouger looking forward to The Beauty of Basic Knowledge Anna Kulikova, a radiologist from Bishkek, Kyrgyz- sessions. “These sessions are easy, interactive and stan, has won the Invest in the Youth grant to attend very interesting. I try to use this type of lecturing ECR 2018. This everyday wonder woman, who style in my work with students,” she said. works three jobs at home, explained why she will Kulikova has been a regular ECR guest since 2014. be the only guest from her country to participate in She first heard about the meeting in 2012, during the the meeting. Russian Radiology Congress, and decided to visit “I’m proud and happy to be part of ECR 2018, even the European School of Radiology (ESOR) Asklepios if I’m the only delegate from Kyrgyzstan. Winning course in Rostov-on-Don a year later. “I was ama- the Invest in the Youth grant is really motivating zed at the high level of organisation of the course and I am very happy,” said Kulikova, who works in and its interesting topics, workshops and great the radiology department at the National Centre of lecturers. Participants and professors were very Oncology and Haematology in Bishkek, Kyrgyzstan. friendly and easy-going. Prof. Paul Parizel and Prof. Tight financial resources prevent more radiologists Valentin Sinitsyn have been my favourite professors from Kyrgyzstan to attend the ECR, she explained. ever since. After this experience, I naturally deci- “I’m a bit sad that our radiologists can’t come. Kyr- ded to visit ECR 2014,” she recalled. That year she gyzstan is a very low-income country and monthly met many new friends from all over the world and income in public hospitals is around €100–120,” particularly enjoyed the FAST US and US-guided she said. biopsy workshop. Although her family helps her out, Kulikova also Kulikova continues to come to Vienna because she is works two other jobs, one as a radiologist at the a big ESR fan. “The society does a lot of good things Neomed private hospital and the other as a lecturer for young radiologists, and it motivates me to attend at Kyrgyz-Russian Slavic University. Combining so the meeting. I really like everything about the ECR. many duties is time-consuming but also a real boost When the train arrives at the Austria Center station

for her career development, she explained. “I really in the morning, I smile and feel very happy. Every Photography © Flora Huebl, Sebastian Kreuzberger, Dominik Walchshofer like to work with patients, clinicians and students. step taken in the Austria Center is special: you are My working day is very interesting and dynamic. walking in a crowd of radiologists. There are beauti- Every day I try to learn something new.” ful installations and, of course, the traditional fresh Kulikova specialises in oncologic imaging and is cur- apples in the main hall every year. There are great rently involved in a research project about mediasti- lectures and professors, books, and an industrial nal tumours. Specialising in radiology was an easy exhibition,” she said. decision for her. In the future, she hopes that the ESR will reduce “I think I didn’t have any other choice. I was always registration fees for countries like Kyrgyzstan. good at differential diagnosis. I have a really good “I’m very appreciative toward ESR and ESOR for visual memory and I like difficult cases. In radiology, all the great opportunities that they provide me and I have ample space for professional growth,” she said. my colleagues. I hope that the ESR can reduce the At ECR 2018, she will attend the European Excel- registration fee for low-income countries one day,” lence in Education programme, and is especially she said.

PEOPLE & PLACES PEOPLE & PLACES FRIDAY, MARCH 2, 2018 FRIDAY, MARCH 2, 2018 LEARNING, TALKING, MEETING & GREETING

Prof. Marc Dewey from Berlin was invited to ECR 2018 to deliver the Wilhelm The ESR and the Indian Radiological and Imaging Association leadership had Conrad Röntgen Honorary Lecture ‘Value-based radiology: the future is now!’ a very fruitful meeting yesterday afternoon, where the ESR-IRIA Memorandum and received his certificate from ESR President Prof. Bernd Hamm. of Understanding was renewed for the second time, strengthening further the great relations and cooperation between the two societies. The MoU was signed by Prof. Paul M. Parizel, Chair of the ESR Board of Directors, and Prof. Kunnumal Mohanan, IRIA President.

Interventional radiology (IR) is a fascinating field, but young physicians get limited opportunities to learn about the tools and procedures that comprise it. To bridge that gap, Prof. Christian Loewe from Vienna and Dr. Maximilian de Bucourt from Berlin (pictured above, fourth from left, surrounded by Prof. Paul M. Parizel, Chair of the ESR Board of Directors, and Dr. Marco participants) imagined the Cube, a new workshop where residents and students Brambilla, President of the European Federation of Organisations for Medical can get hands-on IR experience. Featuring a vast array of simulators and Physics, signed the ESR/EFOMP Memorandum of Understanding, valid for interactive, the Cube has been at maximum capacity so far. Read an interview another two years. with Dr. de Bucourt on the ESR Blog at blog.myESR.org.

The Radiographers Awards were handed over during a formal ceremony by Prof. Paul M. Parizel, Chair of the ESR Board of Directors, and Prof. Paolo ESR President Prof. Bernd Hamm and EFRS President Dr. Jonathan McNulty. Ricci, UEMS Section of Radiology President, signed an agreement on ETAP 2.0 These ESR/EFRS joint awards were bestowed for the first time ever. (European Training Assessment Programme), which is designed as a certificate of excellence for radiology training departments in Europe and beyond.

The ESR, the Royal College of Radiologists of Thailand and the Radiological Society of Thailand had a friendly and productive meeting yesterday afternoon, The leadership of the ESR and the European Federation of Radiographer signing for the first time a trilateral Memorandum of Understanding that Societies (EFRS) met yesterday during the ECR to discuss further ways consolidates and strengthens their future partnership. of cooperation.

PEOPLE & PLACES FRIDAY, MARCH 2, 2018