ECR TODAY 2007 Daily news from Europe’s leading imaging congress

MONDAY/TUESDAY, MARCH 12/13, 2007

Published by the European Society of Radiology

Breast screening PET-CT aids Get your progresses in lung cancer tickets for the Czech Republic diagnosis ECR 2007 Party on Monday

See page 2 See page 3 See page 7 Systems-based healthcare hinges on imaging research Inside Today By Paula Gould One of the greatest weaknesses in rally resolved relevant biological “Science advances so fast that any medical research is the inability to information. Th at’s what we do.” barriers between scientists wher- Imaging is poised to play a key role study complexity, Zerhouni said. ever they are – within an institution in the advancement of 21st century Th is looks set to change as science Imaging will be relevant to every or between institutions in diff erent science and healthcare, but this will moves towards systems biology. measurement length-scale – ang- countries – are an impediment to • Training only happen if the radiology com- Investigators in the future will look stroms, microns, and metres. Exist- progress,” he said. “In the future, harmonisation munity changes its view of imag- at disease pathways, not single dis- ing imaging technologies currently imaging sciences will have to have p. 3 ing sciences, according to Prof. eases, and multiple drug targets. struggle to resolve structures in an international collaborative Elias Zerhouni, director of the US Th ey will study fundamental disease the 100 to 500 nm range, such as framework that is easy to travel.” • Technical exhibition National Institutes of Health. If that mechanisms, such as infl ammation complex macromolecular systems. p. 5 means researchers adopting uncon- or apoptosis, rather than specifi c Researchers are working to plug this Dr. Liselotte Højgaard, chair of the ventional or innovative approaches, conditions, like arthritis or cancer. gap through the development of European Medical Research Councils • EPOS prize winners so be it. innovative imaging technologies. (EMRC), reiterated the importance of p. 7 Th is change in approach will mean international collaboration in imag- “Th e greatest risk in science is to a move away from qualitative, uni- Zerhouni predicts that over the next ing research. Th e EMRC is looking • Radiographers’ stop taking risks. Let radiologists dimensional, non-specifi c informa- 20 years, imaging researchers will at ways to reciprocate the generos- sessions become what they were before tion. “We are talking about quan- continue in their eff orts to detect ity that the NIH shows to European p. 7 – great risk-takers,” he said, dur- titative, non-destructive, spatially subclinical disease. He would also researchers. At the moment, however, ing Sunday’s plenary session on the resolved, temporally resolved data, like radiologists to develop imaging- Europe lags behind the US in terms future of biomedical imaging and all of these words say ‘imaging’ to based in vivo biomarkers that could of R&D investment. In the US, 2.6% medical Imaging Research. She imaging research. me,” he said. “Imaging is the science assist in the study of treatments for of GDP is channelled towards R&D, advised radiologists not to become of extracting spatially and tempo- long-term chronic diseases. Image- compared with 1.9% in the European ‘method racists’, but to consider all guided interventions and micro- Union. Sources for funding are also available tools and techniques that sampling for disease characterisa- fragmented, and just 7% to 8% of could assist in answering their clini- tion is another large area ripe for EU R&D investment comes from the cal questions. radiology research. centralised framework funding pro- gramme. Th e remainder is provided “Some radiologists are very much He envisages this research endeav- by national agencies, industry, and in love with their own methodology our as being truly global and is charities. and don’t look at the methodology keen to foster international col- next door. Th ey are either a CT per- laboration. Th e NIH will this year Højgaard encouraged ECR delegates son, a PET person, or an MRI per- invest approximately $1 billion in to take advantage of funding oppor- son,” she said. “Perhaps we should scientifi c research outside the US, tunities for research. She also wel- instead be organ experts, so we and collaborative projects involv- comed initiatives designed to unite know, for example, about all the dif- ing non-US partners. Over 50% of imaging researchers from diff erent ferent modalities that could be used NIH’s partnership projects involve backgrounds, such as the newly for brain imaging.” Prof. Elias Zerhouni Dr. Liselotte Højgaard European countries. formed European Institute for Bio-

would like to ensure it is the best action. But dermatologists and plastic ECR 2008 ever radiological meeting in Europe, Intervention moves into surgeons might choke over their por- in terms of the quality of the science ridge when they hear the terms inter- ECR 2007 has not yet closed, but one presented, in terms of attendance ventional radiology and cosmetic person who is already turning his – I would like to see even more Ger- cosmetic medicine medicine being linked,” he said. thoughts fi rmly towards next year’s man radiologists attend the meeting congress is Prof. Maximilian Reiser, – and in terms of its character as a By Paula Gould “Of course we are used to interacting Prof. Ziv J. Haskal, director of vas- President of ECR 2008. multidisciplinary meeting.” with vascular surgeons, so our inter- cular and interventional radiology Interventional radiologists are well est in treating varicose veins will only “My ambitions for the next ECR ECR 2008 will take place from 7 to known for carving their own niche in further stimulate that pleasant inter- continued on page 2 meeting are very high,” he said. “I 11 March, and will put a particular uncharted territory. Plans to conquer focus on women’s imaging, including the beauty business, however, may be breast imaging and uterine fi broid their biggest challenge to date. embolisation. Women in the radio- logical profession will be another Th e fi eld of interventional radiol- key topic. Th ere will be a new foun- ogy is continually evolving, oft en Costs down – quality up. dation course on interventional in unpredictable directions, ECR Proven Excellence. radiology, and the traditional ‘ECR 2006 President Prof. Andy Adam Leading edge refurbished systems. meets’ concept will continue, with told attendees at Sunday’s hot topics India, Israel, and Germany being the in interventional radiology session. Proven Outcomes in Refurbished Systems. guest countries. Also, industry will New ventures require practition- Healthcare budgets are tight, but the demand for latest be off ered a new platform within the ers to master additional techniques, technology equipment is growing. We offer tailor-made so-called face-off sessions. and also to interact with diff erent, solutions world wide, with outstanding price/performance ratios and new equipment warranties. perhaps unfamiliar, disciplines. Th e We are there for you at ECR, EXPO D. Turn to page 19 of this issue of ECR emergence of cosmetic interven- Today for an extended interview tional radiology will certainly be no www.siemens.com/proven-excellence Prof. Maximilian Reiser from Munich with Prof. Reiser. diff erent.

myESR.org

Siemens_ECR_Ad_2_FINAL.indd 1 08.02.2007 17:36:37 Uhr ECR TODAY 2 MONDAY/TUESDAY, MARCH 12/13, 2007 HIGHLIGHTS

continued from page 1

at Columbia University, New York, is confi dent that interventional Breast cancer screening gathers radiologists could put their existing skills to good use in the cosmetic medicine marketplace. He foresees momentum in Czech Republic a time when practitioners trained in minimally invasive image-guided By Philip Ward and is covered every two years by the All units are obliged to provide the procedures may be rectifying wrin- Kateřina Tomková health insurance scheme. central board reviewers with their kles, spider veins, and sun-spots in annual data using the appropriate outpatient clinics. Czech radiology continues to make “Th ere is one breast-screening cen- soft ware. Radiologists performing rapid progress, as shown by the tre per 200,000 inhabitants,” she screening have to be fully qualifi ed “Ten years ago I never would have varied selection of presentations said. “Centres archive mammo- in mammography, breast ultra- imagined that I would be doing at Sunday’s ECR meets the Czech grams for at least fi ve years, and sound, and core biopsy. Double pro- fi broid embolisation,” he said. “In the Dr. Sanjoy Kundu from Toronto Republic session. must take part in an annual data jection and double reading are used. same way that we perhaps wouldn’t collection seminar and perform For more details on the project, she have imagined doing endovenous tices set up to perform these proce- Introducing the session, ECR 2007 at least 5,000 screening mammo- urged ECR attendees to visit the web ablation and sclerotherapy, we need dures should not look like regular President Prof. Christian J. Herold grams.” site: www.mamo.cz to keep looking towards the next diagnostic imaging centres. “You revealed his strong personal links things that we may go on to.” have to have an attractive, welcom- with the Czech Republic. He grew Th ere are 59 certifi ed screening General radiological training is also ing situation, and what we describe up only 30 km from the border town units in the country. Th ese units are moving ahead. Th e Czech Radio- Th e market for cosmetic interven- as a ‘bright, brass and glass’ setting,” of Mikulov, and his grandmother accredited for two years only, and logical Society (CRS) is organis- tion is undoubtedly buoyant, at least he said. “You have to have furniture was Czech. He said he has followed re-accreditation involves a site visit. ing a trilateral refresher course, to in the US. Between 1997 and 2005 that fi ts the cosmetic environment.” the progress made by his colleagues Each unit cooperates closely with be held in Prague between 4 and 6 there was a 444% increase in all cos- across the border with keen interest the regional breast-cancer treatment October 2007. In 1968, the second metic procedures. Within this, the Th e market for minimally invasive over the years. group. At the unit, each woman fi lls national congress was cancelled in rise in non-surgical cosmetic pro- treatment of varicose veins is also out a questionnaire, giving her per- protest over Soviet occupation, but cedures soared by 726%. US inter- looking like a healthy place to be. A prime example of the develop- sonal and medical details and family otherwise conferences have been ventional radiologists seem keen to Approximately 25% of all women ment of radiology in the Czech history. All suspicious cases are veri- held on a regular basis, according to get a piece of the action. A one-day and 15% of all men in North America Republic is the national breast fi ed immediately by a core biopsy. In Prof. Marek Mechl, President of the symposium in February devoted to have some type of lower extremity screening programme. Th ere were 10-15% of cases, mammography is CRS. Next year’s 36th radiological cosmetic interventional radiology venous insuffi ciency. Patients with 5,378 new breast cancer cases and supplemented with ultrasound due congress will focus on emergency attracted over 350 attendees. bulging, painful veins were previously 1,965 deaths from breast cancer in to dense breasts. radiology. referred for surgical stripping, but 2002. Of the 5 million women in the Haskal sees no reason why interven- this invasive procedure is no longer Czech Republic, 1.6 million women “Mammography must fulfi l all the Th e sub-committees of the CRS are tional radiologists practising out- the gold standard, Kundu said. are aged between 45 and 69 years safety regulations required by the ultrasound, CT, MR, musculoskel- side of the US should not venture and thereby qualify for screening, State Institute for Nuclear Safety,” etal, abdominal, thoracic, mam- into cosmetic medicine as well. For Endothermal treatment, either using according to Dr. Miroslava Skova- said Skovajsova. “For ultrasound of mography, paediatric, and PACS this to happen, interventional radi- radio-frequency (RF) waves or laser jsova from the Mamma Center in the breast, linear probes of no less and telemedicine. For more infor- ology must evolve as a specialty that therapies, has now emerged as a Prague. Screening mammography than 7.5 MHz must be used.” mation, visit www.crs.cz accepts patients directly. viable alternative. Kundu showed data from a multi-centre prospec- Th e journal, Acta Radiologica et “If you walk down any main street, tive clinical trial demonstrating that Cancerologica Bohemoslovenica, anywhere, you can see the adver- 92% of limbs that were refl ux-free 12 was established in 1938, but was tisements for cosmetics and medi- months aft er intervention remained closed during the Second World cations that mimic Botox,” he said. so aft er fi ve years. Centres partici- War. Czech Radiology is now pub- “We already know how to make our pating in an ongoing trial of endo- lished four times a year. patients feel good. Now we can also thermal laser treatment are report- learn how to make them look good.” ing 93% to 99% closure rates. “Th e legacy of all the pioneers of Czech radiology is still alive: to Interventional radiologists remov- Th e use of tumescent anaesthesia maintain radiology as an independ- ing varicose veins with endovascu- is critical to the effi cacy of both RF ent medical specialty and to co- lar techniques should consider what ablation and endovenous laser vein operate with colleagues all over the they are doing as a form of cosmetic treatments. He advises patients to world,” said Mechl, who is based at medicine, said Dr. Sanjoy Kundu, wear compression stockings for at the department of radiology at Brno medical director of the Vein Insti- least two weeks aft erwards to ensure University Hospital. tute of Toronto. Outpatient prac- that treated veins remain closed. Prof. Marek Mechl from Brno Dr. Miroslava Skovajsova from Prague

Electronic lessons to boost ranks of imaging’s next generation

By Frances Rylands-Monk R-ITI’s development in conjunction where they don’t have the same kind with the creation of three radiology of structured training and where Located on the entrance level academies has proved to project nobody’s seen any materials like between rooms F1 and F2, the Radi- architects and joint project leads Dr. this!” Fowler said. ology-Integrated Training Initiative Richard Fowler and Dr. Phil Cook (R-ITI), currently the largest struc- that this material does allow training Th e interaction is as much mental tured e-learning radiology resource schemes to increase their capacity. as physical and doesn’t just entail in the world, is bringing its message In addition, the trainees are making page-turning or mouse-clicking, to ECR: the future is here. faster progress through the normal Fowler continued. Plus R-ITI con- milestones than their predecessors. tains immediate feedback on the A collaboration between the UK accuracy of trainee answers. You can fi nd the helpful R-ITI staff between rooms F1 and F2. Royal College of Radiologists and R-ITI’s fi rst component, the e- the Department of Health in Eng- Learning Database (eLD), com- R-ITI’s second element is a Vali- land, R-ITI’s primary aim was to prises a vast library of tutorials, or dated Case Archive (VCA). In- tool for self assessment, question to move beyond the academies to be increase capacity in radiology train- ‘sessions’, between 600 and 1000 depth information from each case setting, validation of radiologists, web-based by 2008. ing aft er workforce analysis by the hours of learning, based on a struc- about the modality used, imaging continuous professional develop- College in 2001 indicated a shortfall tured curriculum, and in scope the fi ndings, diagnosis and pathology is ment and as a desktop help with “Th is is not to replace conventional in trained consultant radiologists fi rst three years of a UK fi ve-year twinned with detailed search engine other cases.” traditional workplace training in the in the UK, resulting in the ratio of training programme. capabilities. clinical radiology department. Th is trainees to trainers being two to Free to all UK-based radiologists is to support it and to accelerate the three times higher than it was in the “Th at’s one of the things that’s prov- “Th e VCA will reinforce knowledge with non-UK residents able to learning process,” Fowler said. “We rest of Europe. ing popular. We’ve had a lot of inter- acquired during sessions,” Cook access the resource through licence fi rmly believe that this is the future est from other countries in Europe said. “In addition it will a be useful from next year, R-ITI is scheduled of medical education.”

myESR.org ECR TODAY HIGHLIGHTS MONDAY/TUESDAY, MARCH 12/13, 2007 3

CT to measure response to anti-ang- perfusion CT, will show additional Experts pinpoint benefits of hybrid iogenic therapy. Because therapy information to morphology. is expensive, clinicians want early and reliable answers as to whether “Perfusion multidetector CT can systems in cancer management growth-inhibiting drugs are work- easily be integrated into routine ing or not. New imaging strategies staging protocols and will be much By Frances Rylands-Monk score of 1, had a 96% incidence of scan, said Barrington, noting that are needed to complement advances faster in determining which patients malignancy. PET yielded a high negative predic- in anti-angiogenics and the new will respond to therapy and who will Correct diagnosis of tumour char- tive value in N-staging. Importantly, molecular approach to therapy, not,” Graser said. acter and stage is fundamental to Lesions can be investigated with negative node fi ndings in PET obvi- according to Dr. Anno Graser, radi- lung-cancer therapy planning, but fl exible bronchoscopy, CT-guided ated the need for mediastinoscopy ologist at the University Hospital of Stimulated by increasing prevalence evaluating small indeterminate pul- biopsy, or using PET in those with or endoscopic ultrasound. Munich. of hybrid systems, the European monary nodules (SPNs) continues poor lung function when the risk of Society of Nuclear Medicine and to challenge radiologists. In addi- pneumothorax needs to be avoided. In positive nodes, sampling tech- Traditionally, treatment response ESR have formed a draft policy doc- tion, it is vital to determine as soon niques vary with node location. A has been assessed through visualis- ument to develop closer arrange- as possible whether patients are PET’s sensitivity helps in the con- nodule next to the left pulmonary ing tumour size and volume, but in ments for the training of radiolo- likely to respond to treatment. servative management of SPN by artery might be reported as a T2N1, anti-angiogenics these parameters gists in nuclear medicine and that detecting small well-diff erentiated but uptake in an adjacent lymph may remain unchanged for weeks of nuclear medicine doctors in radi- SPNs are common, and a small cancers that are missed initially in node visualised in PET/CT and a aft er the start of treatment. Moreo- ology. Hopes that the two organi- percentage are malignant. PET/ radiological follow-up at a treat- lesion in the vertebrae may reveal ver, tumour size might not refl ect sations look set to form a closer CT is a sensitive detector of malig- able stage, Barrington told attend- that the stage is really T2N2M1. accurate response to treatment, relationship in future lie partly in a nancy due to FDG uptake. Missed ees at Sunday’s ESR Session on whereby a tumour may shrink series of joint meetings, culminating lesions are rare and mainly occur monitoring therapy and follow-up Because PET/CT is a useful tool to but metabolic activity remains the in the shared chairing of yesterday’s due to small size of the lesion or in cancer. detect and stage metastasis in other same. Functional imaging, such as session. because the lesion is a well-differ- areas of the body, it can also reduce entiated cancer, which has a low “For pulmonary nodules that require futile thoracotomy, whereby during avidity for FDG. False positives tissue diagnosis where the uptake is surgery, benign disease is discov- may result from FDG uptake due very high, it is reasonable to proceed ered to be inoperable. to other reasons such as infec- direct to surgery. Using this approach, tion and inflammation, though a few patients will go to the operating “I think that [4D PET/CT] respiratory the higher the uptake, the greater theatre with benign disease, but the gating will be very important to help the risk of cancer, according to rate is very low,” she said. us improve detection and targeted Dr. Sally Barrington, consultant in radiotherapy. New tracers targeting nuclear medicine at the PET Imag- T-staging may sometimes require other aspects of tumour biology will ing Centre, St Thomas’ Hospital, CT with intravenous contrast for be useful for guiding treatment in London. In a study at the hospi- central tumours or those adjacent to individual patients,” she said. tal of 285 patients, patients with the chest wall, otherwise prognostic a standardised uptake value of 4, information can be obtained from Such new drug development plays a compared to the average uptake the primary tumour in the PET major role in the future of perfusion Dr. Sally Barrington from London Dr. Anno Graser from Munich

-??#2PDF   ESR masterminds initiative to harmonise training

By Frances Rylands-Monk ing entity to be reviewed by the ESR and updated on an ongoing basis, As medical migration increases in refl ecting changes in radiology an expanded Europe, radiologists practice. continue their work of harmonis- ing training standards to improve “Its ultimate aim is to improve train- patient care. Th e European Society ing and to harmonise it, which is of Radiology aims to build on the particularly important in the con- L^i]jchjgeVhhZY^bV\ZfjVa^in[dgVaandjgcZZYh! foundations that have already been text of medical migration,” he said. YdcÉiWZZbWVggVhhZYidaZindjg[ZZa^c\hdji/ laid by the EAR and ECR, particu- “We have an issue of teleradiology larly in the context of education, where images go from one country according to Dr. Éamann Breatnach, to another where maybe the labour current Chairman of the Society’s costs are less. Th is is another reason >adkZbn8G Education Committee. to standardise the situation.”

“An existing document outlining To measure the document’s impact, the European Training Charter and radiologists are invited to access the detailed curriculum for clinical document available at www.myESR. radiology is a great achievement. It’s org and at the ESR booth and e-mail a consensus document to identify their comments to the ESR offi ce. what the society would be happy with in the education of a clinical “We’re looking for response to see radiologist,” Breatnach told ECR how the manual has aff ected the Today. “It incorporates the concept training that is available through- of radiology as being a clinical spe- out Europe,” Breatnach said. “We cialty, and the idea is that people would like to know: Has it aff ected training to this level will give the their national curriculum? Has it best patient care available in diag- benefi ted their training? Has it been L]dldjaYc¼iadkZ8GHnhiZbh[gdb6\[V=ZVai]8VgZ46cZl!^cij^i^kZCMldg`hiVi^dc#BJH>86'ž^ciZaa^\Zci nostic radiology.” of use to them in their negotiations ^bV\ZegdXZhh^c\[dg^begdkZYegdYjXi^k^in#6cY!Wdi]VgZVkV^aVWaZdcZkZgn8G[dgegZX^h^dc^bV\Z fjVa^inl^i]djiXdbegdb^hZ#>cYZZY!6\[V=ZVai]8VgZ\^kZhndjbdgZi]VcndjZmeZXi#I]Z8G(%"MiVWaZide with government bodies and state egdk^YZhVcV[[dgYVWaZY^\^iVahdaji^dc[dgZkZci]Zi^\]iZhiZck^gdcbZcih#I]Z8G(*"Md[[ZghWgdVYbjai^" Published in November 2005, the agencies, etc.?” Veea^XVi^dcjhZl]^aZi]Z8G-*"McZkZg`ZZehndjlV^i^c\l^i]^ihjc^fjZ&%"XVhhZiiZYgde"VcY"\dWj[[Zg¸ document was intended to be a liv- eZg[ZXi[dgZkZci]ZWjh^ZhigVY^dad\nYZeVgibZcih#D[XdjghZ!Ydc¼i[dg\Zii]Z9M"H!l]^X]gZYZ[^cZh8Gl^i] WgZV`i]gdj\]iZX]cdad\^Zha^`Z9^gZXig^MVcYHXVc]ZVY!YZa^kZg^c\bdgZheZZY![aZm^W^a^inVcY^bV\ZfjVa^in i]VcndjeZg]Vehi]dj\]iedhh^WaZ#Hdi]ZdcanfjZhi^dc^h!l]^X]dcZl^aandjadkZbdgZ4 lll#V\[V#Xdb$]ZVai]XVgZ Job vacancy in Austria Staff on the ECR Today newspaper have a steady stream of visitors each day in our offi ces on AZVgcbdgZVWdjidjgXdbeaZiZ8Gedgi[da^d#K^h^i6\[V=ZVai]8VgZVi:8G!:med7!Wddi]'&' the ground fl oor. Perhaps the most resourceful visitor so far has been Dr. Gerd Powischer from Burgenland, AT, who pleaded with us to announce that he is urgently seeking to recruit a radiologist. We always try to help a delegate in need, so anybody who is interested in the job vacancy should contact Dr. Powischer at +43 664 101 4682 or gerd.powischer@krages.

myESR.org ECR TODAY 4 MONDAY/TUESDAY, MARCH 12/13, 2007 European Society of Radiology

Become a member for € 10.-

e better we can serve you! e are, th igger w The b

Nicholas Gourtsoyiannis ESR President

Visit the ESR booth in the entrance hall myESR.org myESR.org

ESR_membership_300x440.indd 1 22.02.2007 11:17:44 ECR TODAY HIGHLIGHTS MONDAY/TUESDAY, MARCH 12/13, 2007 5

Harry’s highlights from third day of ECR 2007 Once again, ECR Today’s intrepid photographer, Harry Schiffer, mingled with the masses on Sunday to unearth some novel images from day three of the congress. Below is a selection of what he came across on his travels through the Austria Center.

Th is delegate clearly appreciated the blaze of colour during a break from sessions.

Large numbers of Chinese delegates have played an active and essential role at ECR 2007. Mandarin-speaking staff have been kept busy at the special China welcome desk in the entrance hall. Leading researchers from China will give lectures during Monday’s ECR meets China session, called China and Europe: Tradition and future, to be held in Room A from 14:00 to 15:30. Th is will be followed by a special session (Room B, 16:00 to 17:30) on how to make a successful presentation, for which there will be simultaneous translations Dr. Annemie Snoeckx from Edegem, BE, was the from English to Chinese. winner of the interpretation course. In the photo, she is congratulated by Prof. Adrian Dixon, Deputy Editor of European Radiology. Dr. Tobias Jakobs from Munich, DE, was awarded the prize for the most cited paper in European Radiology between 2002 and 2006. He receives his certifi cate from Prof. Albert L. Baert, ER Editor-in-Chief.

Prof. Marek Mechl receives a commemorative plaque from Prof. Christian J. Herold during the ECR meets the Czech Republic session.

Th e hands-on workshop, Experience Vascular Procedures Using Simulators, received rave reviews during the fi rst three days of ECR. Th e workshop was supported by the Cardiovascular and Intervention- al Radiological Society of Europe (CIRSE) and allowed delegates to use computerised medical simulators to brush up on their inter- ventional techniques. Th e fi ve sessions focused on the carotids and renals/peripherals.

Th ere is something for everyone in the hugely popular technical exhibition, and Monday will be your fi nal opportunity to visit this important area. Th e exhibition booths will remain open from 10:00 to 18:00 on Monday, and they are located in the lower level in Expo B, C, D, and E.

Some new alliances and friendships were formed at Sunday aft ernoon’s well-attended image interpretation quiz when teams from France/ U.K., Greece/Turkey, Germany/Austria, and Italy/Hungary were pitted against each other. To ensure fair play, the action was supervised by referees Prof. Helen Carty from Liverpool and Prof. José Cáceres from Barcelona. Th e winners of the quiz will be announced on the ESR web site within the next week.

Prof. Albert L. Baert (right) receives a certifi cate of appreciation from ESR President Prof. Nicholas Gourtsoyiannis for his services to the Eurorad project.

Yesterday’s children’s radiology congress attracted over 800 kids to the Minopolis theme park, where radiolo- gists from the Vienna General Hospital explained about the various imaging modalities to the youngsters.

myESR.org we can see your heart beat

your radiologist

an initiative of the European Society of Radiology patient information at myESR.org

the ECR Kids Day is supported by SIEMENS ECR TODAY HIGHLIGHTS MONDAY/TUESDAY, MARCH 12/13, 2007 7

Chinese golfer tastes Popular sessions for radio gra phers success in Singapore continue on Monday and Tuesday

Th e emerging Chinese golfer, Liang the second player from China to An ever popular feature of the sci- All the sessions for radiographers Wen-Chong, parred the fi rst extra win an event on the European Tour, entifi c programme at ECR is the are held in Room L/M. Radiologists hole of a play-off to defeat Iain Steel following in the footsteps of Zhang sessions for radiographers, which are also very welcome to attend. of Malaysia at Laguna National Golf Lian-Wei, who won the same event began on Sunday with an in-depth and Country Club on Sunday to win on the same course in 2003. discussion about training and edu- the Singapore Masters. cation. Elsewhere in the sporting world, Th e 28-year-old player claimed the England pulled off an unexpected Th e radiographers’ lectures on title in the European and Asian- 26-18 victory in the Six Nations Monday will concentrate on CT sanctioned event. He became only rugby championship, setting up a applications, 64-slice CT of the thrilling fi nale to the competition. heart, old problems and new solu- On Saturday, Ireland secured the tions in MRI and CT, informa- narrowest of victories (19-18) in tion and care policy in the pae- the big rugby match with Scotland. diatric radiology department, Having already beaten Wales and MRI of congenital heart disease, England, the Irish have now won the and radiation protection (part 1). Triple Crown. Th e hero was fl y-half Th e presentations on Tuesday will Ronan O’Gara, who scored all of address quality assurance/manage- Ireland’s points with a converted try ment, radiation protection (part 2), and four penalties. Chris Paterson and effi ciency in radiography and Moderators of Sunday’s radiographers session: Dr. Joseph Stines from the Centre scored all of Scotland’s points with fl uoroscopy. Alexis Vautrin in Vandoeuvre-les-Nancy, France, and Gunvor Robertsen from Trondheim, Norway. six penalties. Liang Wen-Chong Peripheral CTA postprocessing Scientific exhibition award winners arrives at ECR 2007 Magna Cum Laude AngioVis is one of the IMAGINE Th e new soft ware, AngioVis-Tool- exhibits, and it is dedicated to basic Box, has been developed as an Dr. Eva Castaner, Sabadell, Spain and translational research in the interdisciplinary research eff ort to Chest fi eld of vascular imaging and visu- improve clinical visualisation of alisation. Th e clinical part of the lower-extremity CT angiograms Dr. Satoru Takahashi, Nijmegen, The Netherlands exhibit demonstrates the AngioVis- in patients with peripheral arterial Contrast Media ToolBox, a soft ware platform spe- occlusive disease. Observe the entire cifi cally developed to process lower- peripheral CTA post-processing Prof. Yongsoo Kim, Kuri, Republic of Korea extremity CT angiograms in a busy workfl ow, and witness how hundreds GI Tract clinical environment. Current clini- of CT images become MultiPath and cal AngioVis users from Vienna, AT, Single-Path CPR images. Dr. Mana Ishibashi, Yonago, Japan and Stanford, US, illustrate the pos- Head and Neck sibilities of the ToolBox on a variety Th e organizers can print your of cases with peripheral occlusive high-resolution images on a high- Dr. Alejandro Rovira-Cañellas, Barcelona, Spain disease. Cases can be submitted resolution Codonics Horizon (R) Neuro directly on CD/DVD at the Angio- Multi-media Dry Imager, or burn a Vis booth in the IMAGINE exhibi- DICOM CD on a Codonics Virtua Dr. Hector Perez-Ponce, Vandoeuvre-lès-Nancy, France tion area and at the Bracco booth in Medical Disc Publisher, which can Prof. Dominik Fleischmann from Stanford Physics in Radiology the technical exhibition. be viewed with any DICOM-viewer, University (right) explains about new devel- and even sent to PACS. opments in vascular imaging.

LET’S PARTY!

Want to see the sun rise above your host city? Join the ECR Party, Vienna’s top event during ECR 2007!

This most popular and traditional festivity will leave nothing to be desired …

… delicious food for every taste Check out the ECR 2007 web gallery! … exquisite drinks galore Browse through hundreds of photos covering everything from the … fascinating entertainment scientifi c and educational programme to the technical exhibition to … intoxicating music to make you dance till you drop beautiful impressions of the congress. … beautiful people to meet

The ECR Party – an unforgettable evening, a worthy fi nale of our congress!

Monday, March 12, 19:30 BA/CA Halle (Gasometer), one of the city’s trendiest party locations

Get your tickets ONSITE at the TICKET COUNTER in the entrance hall!

myESR.org ECR TODAY MONDAY/TUESDAY, MARCH 12/13, 2007 GE Healthcare Ultrasound Re-think. Re-discover. Re-invent. Re-imagine.

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GE imagination at work

© 2007 General Electric Company GE Medical Systems, a General Electric company, doing business as GE Healthcare. ECR TODAY 2007 LOWER/ENTRANCE LEVEL 9

Daily news from Europe’s leading imaging congress MONDAY/TUESDAY, MARCH 12/13, 2007 PACS vendors rise to challenges from well- Inside Today informed customers and demanding technology

By Brenda Tilke “It was only a few years ago that business and product strategy of part of Fuji’s plan to expand its glo- • Subspecialty and vendors still had to convince cus- the Health Care Information Solu- bal image and health data manage- National Societies Even a casual glance at the ECR tomers of the general value of buy- tion at Kodak Health Group. ment business. p. 10, 12 technical exhibit hall shows the ing PACS. Today your focus is on ascendancy of PACS/RIS. Th is year’s your own solutions and how they Customers are looking closely at Among the features high on cus- • Optimisation of exhibit space features more PACS meet much more detailed require- how PACS/RIS products handle tomers’ wish lists are integrated MDCT examinations vendors than ever before and major ments from highly knowledge- high volumes of data associated systems that can handle the ever- p. 11 exhibitors are allocating more space able customers,” said Patrick Koch, with multislice CT, MRI, and fusion increasing image volume and 3D to their PACS/RIS off erings. director of worldwide marketing, imaging. In response, companies displays. GE Healthcare is display- • Whole-body imaging are off ering a variety of general and ing its upgraded Centricity Advan- p. 13 application-specifi c products. Barco tage Workstation (AW) with mul- is showing its new 3D Colon Matrix timodality 3D tools for computers • List of exhibitors for CT colonography. Th is applica- networked into Centricity PACS. p. 14 tion integrates into the Voxar 3D platform and allows radiologists “Th ere is so much data with 64-slice to interpret a study and generate a CT that your PACS must be able to report in as little as 10 minutes. handle easily,” said Jürgen Reyinger, Despite the shift toward high-end general manager of Integrated PACS/RIS, there is still a niche for Digital mammography also is IT Solutions for GE Healthcare, entry level PACS, particularly from emerging as an important consid- Europe, Middle East and Africa. institutions in Central and Eastern eration in PACS/RIS. Agfa Health- “You also have to be able to include Europe. care is showing its digital mam- CAD.” mography solutions, including a “Th ere are basically two kinds of dedicated workstation. Th e work- Swedish company Sectra is display- PACS activities in Eastern Europe,” station is currently marketed in ing its new family of workstations Koch said. “One group is moving France and will soon be marketed designed to handle high image vol- into PACS from older technology in other European countries, said umes independent of network capa- and these customers are very price Marcus Ostländer, global market- bilities. Th e company recently made sensitive. On the other hand, there ing manager for RIS/PACS at Agfa its fi rst sale to a Belgian public hos- are EU initiatives with funding to Digital mammography is emerging as an important consideration in PACS/RIS. Healthcare. pital and signed a €2.4 million con- advance the healthcare infrastruc- (Provided by Agfa Healthcare) tract with Leiden University Medi- ture in Eastern Europe. As this goes In the European PACS/RIS market, cal Centre in the Netherlands. Th e forward, we may even see institu- the focus is on speed of display and Leiden hospital project represents tions in the new EU countries leap- integration beyond the radiology the company’s fi rst major Dutch frogging over some in the ‘old’ EU department. Philips Medical Sys- installation of its fully integrated in terms of advanced technology.” tems has integrated its ViewForum RIS/PACS solution. clinical workstation within the iSite Radiology workstation.

In addition, PACS vendors are Technical Exhibition keenly aware of national eff orts to implement electronic medical records (EMR) for all patients. For instance, Agfa has just completed the fi rst phase of a large-scale multi- centre IT project with Vivantes, Monday is your final opportunity to Germany’s largest municipal hospi- tal group. Th e aim is to replace the visit the technical exhibits. group’s heterogeneous IT systems with a centralised HIS, PACS, and RIS from a single source. As more countries take steps to develop Opening hours: 10:00–18:00 national EMR databases, competi- tion among PACS/RIS/HIS vendors GE Healthcare is displaying its upgraded Centricity Advantage workstation with multi- will become stiff for potentially modality 3D tools for computers networked into Centricity PACS. lucrative contracts.

Kodak is showcasing new additions to its Carestream platform, encom- passing both works in progress and new features commercially avail- able. Works in progress enhance- ments include support for workfl ow Stand #332 - Expo C grid computing, with synchronised US: (800) 544-4624 global worklist and reporting fea- UK: +44 1869-366-900 tures. Th e company is also develop- www.ezem.com ing a new user-friendly ‘dashboard’ to allow PACS administrators and A New Concept in MR Injectors users at any location to monitor and While preserving the same award winning design modify workload status. as our EmpowerCT® injector; EmpowerMR® is the  rst MR injector to deploy hydraulic contrast In addition to displaying its next delivery technology. Consequently, true  ow rate generation Synapse medical imag- and pressure performance can be continuously ing and information management achieved, resulting in optimal image quality. system, FujiFilm has information EmpowerMR is the only injector that is MR- available regarding its January 2007 compatible up to 7T environments. Eliminating acquisition of Problem Solving the need for batteries also helps improve produc- Concepts, Inc. (ProSolv), which has tivity with reduced maintenance. CE pending Philips Medical Systems has integrated its ViewForum clinical workstation within the iSite cardiology PACS installed at 350 Radiology workstation. sites worldwide. Th e acquisition is

1304449 [EmpowerMR New Prod Inse1 1 1/30/2007 4:54:34 PM myESR.org ECR TODAY 10 MONDAY/TUESDAY, MARCH 12/13, 2007 SOCIETIES

Norwegian Society Portuguese Society Staff box Editorial Board of Radiology of Radiology ESR Executive Board Editors Michael J. Lee, Dublin/IE Th e Norwegian Society of Radiol- research among our members. Th e Clare Roche, Galway/IE ogy has about 650 members, 460 of institute will organise networks for and Nuclear Medicine whom are active. For 20 years the researchers and academics and con- Managing Editors Monika Hierath, Vienna/AT Society has been associated with tacts with project advisors, as well Th e Portuguese Society of Radiology Beginning in 1992, the society has Julia Patuzzi, Vienna/AT the Norwegian Medical Association as providing the services of medical and Nuclear Medicine (SPRMN) organised the National Congress of Philip Ward, Chester/UK (which has 23,000 members) but it writers for assistance with appli- was founded in 1931 in Lisbon. It is Radiology, which takes place every Contributing Writers is now in the process of becoming cations, fund raising, etc. Th ere is the most important scientifi c radio- two years. Th e last was in 2006, in John Bonner, London/UK an offi cial part of it. Th is is primarily now a growing interest in research logical society in Portugal and the Vilamoura, Algarve. Th e society Paula Gould, Holmfi rth/UK due to the desire of the Association amongst young radiologists in Nor- vast majority of Portuguese radiolo- also organises thematic meetings Monika Hierath, Vienna/AT Julia Patuzzi, Vienna/AT to strengthen medical professional- way and we will try to contribute to gists are members. A large number every other year, which are entirely Frances Rylands-Monk, ism, rather than a wish of the Radio- the strengthening of this wave. At the of the most distinguished Portu- devoted to a particular imaging St. Meen Le Grand/France logical Society. last Annual Meeting of the Society, guese radiologists have served on technique or body region. Th e last Karen Sandrick, Chicago, IL/US Brenda Tilke, Maidenhead/UK all of the chairpeople of academic the board of the society. one took place in Porto last Janu- We feel that this new mix of a labour radiology departments in Norway ary and was devoted to cardiac and Layout union – the Medical Association were called upon to give a public Th e goal of the society is to enhance vascular imaging. In collaboration Nina Ober, ESR Graphic Department

– and a professional/scientifi c soci- report on the research strategies and promote the highest standards with the Armed Forces Institute Marketing & Advertisements ety, like ours in radiology, may not and activities of their departments, of radiology through education of of Pathology from Washington, Erik Barczik, E-mail: [email protected] always be a benefi t. Roles may be regarding resource allocation, etc. its members. Th e society tries to USA, the society organises a yearly Contact the Editorial Offi ce confused; what is good for radiology Th is reporting will become a regu- provide radiologists with educa- 3-day course on radiologic-pathol- ESR Offi ce may not always be good for radiolo- lar routine from now on, in order tional programmes and courses of ogy correlation. Th e next one, the Neutorgasse 9 gists and vice versa, but the fusion to give R&D a durable increase in the highest quality. Internationally XIIth AFIP Course, will take place in AT – 1010 Vienna, Austria

will probably take place in 2007. Th e attention and prestige. renowned radiologists are regularly Funchal, Madeira Island, from June Phone: (+43-1) 533 40 64-16 Norwegian Society of Radiology invited to lecture at its courses. 23–25, 2007. Fax: (+43-1) 533 40 64-448 will continue as the special branch Recently, the fi rst of several PET/CT E-mail: [email protected]

for our medical discipline, with its installations came into operation in Th e society has always worked with Th e Society off ers all of its logistical ECR Today is published 4x during ECR current name, its own board, meet- our country. Th e Society of Radiol- international radiology societies, support to the organisation of inter- 2007. Circulation: 8,000 ings, publications, courses and other ogy established a cross-disciplinary namely the EAR and ECR, and most national meetings in Portugal, such national and international activities, commission to advise us how we recently the ESR. One major col- as the forthcoming ESGAR 2007 in Printed by Angerer & Göschl, Vienna 2007 within the new structure. could contribute to reaching a good laboration with a European organi- Lisbon, and ESCR 2008 in Porto. myESR.org th European level in molecular imag- sation was ECR ’87 (VI European Th e Editorial Board, Editors and Contributing Writ- ers make every eff ort to ensure that no inaccurate Last year, the Norwegian Society ing during the coming years. Th e Congress of Radiology), which took Our purpose is to constantly or misleading data, opinion or statement appears in this publication. All data and opinions appearing of Radiology established its own commission gave its recommenda- place in Lisbon in June 1987 and was improve the knowledge of Portu- in the articles and advertisements herein are the research institute. Th is is an ‘insti- tions last autumn and we will now presided over by Dr. Maria Emília guese radiologists and thus contrib- sole responsibility of the contributor or advertiser concerned. Th erefore the Editorial Board, Editors tute without walls’ for stimulating try to follow up and implement Silvestre, who at the time was also ute to the better care of patients. and Contributing Writers and their respective employees accept no liability whatsoever for the increased quality and quantity of some of the actions. the president of the SPRMN. consequences of any such inaccurate or misleading data, opinion or statement. Th e Board of the SPRMN Advertising rates valid as per January 2007. Unless otherwise indicated all pictures © ESR Offi ce

myESR.org ECR TODAY LOWER LEVEL MONDAY/TUESDAY, MARCH 12/13, 2007 C 11

Researchers seek novel ways of minimising radiation risks of multidetector CT

By Brenda Tilke At Monday’s course, he will discuss MDCT optimisation and justifi ca- more detector rows, shorter and these techniques in Monday’s ses- his model for achieving justifi ca- tion working in tandem should give more eff ective scan times, higher sion, and will address the need to For the best results, radiologists tion that is founded on evidence- the modality a strong future, noted resolution, and more tissue param- balance image quality and dose. need to pay attention to both justifi - based medicine. Th e model can be Prof. Willi Kalender, from the Med- eters. cation and optimisation of multide- used to develop real-world practical ical Physical Institute at Friedrich- Th e fi nal speaker at the course, Dr. tector CT. Th at will be the overrid- guidelines integrating all aspects of Alexander University in Erlangen, His research has also focused on Stefan Puig from the department of ing message at Monday’s refresher MDCT. Th e model is created with Germany. CT accounts for 25% specifi c techniques to optimise radiology at the Medical University course. infl uence diagrams, which show the of all radiation exposure in medi- MDCT, such as referring to patient of Vienna, will focus on the optimi- interaction between variables, deci- cal imaging, and clinical justifi ca- size to provide optimal organ doses, sation of paediatric MDCT exami- Th e International Committee on sions, and outcomes. One example tion must be particularly strong for particularly liver doses. Relatively nations. Radiological Protection (ICRP) illustrates the eff ects of general tests serial, repeat whole-body scans. He small changes in patient size can provides the global framework for (such as scoring systems and labo- thinks the trends that will optimise result in large changes of exposure justifi cation of medical imaging ratory analyses) and medical imag- MDCT beyond lower dose include levels. Kalender will discuss some of procedures using ionising radiation, including MDCT. For a procedure to be justifi ed, the patient should be exposed to radiation only if it ben- efi ts the individual patient or society at large.

Determining the benefi ts of MDCT depends on the appropriate selec- tion of patients for the procedure. Th ese benefi ts are based on the accurate detection or exclusion of disease balanced against the proce- dure’s risk factors.

Radiation dose should not be the only risk factor radiologists con- sider. MDCT vendors oft en are quick to claim their systems off er the lowest dose solution for MDCT, but generally, all late generation Dr. Jacob Geleijns (left ) and his colleagues at Leiden are trying to develop decision trees that Although complex at fi rst glance, infl uence diagrams can help simplify decisions regarding equipment has good standards for can be used in clinical practice by both radiologists and referring physicians. the justifi cation for MDCT. (Provided by Dr. J. Geleijns) using minimal dose, observed Dr. Jacob Geleijns, medical physicist at ing (MR, ultrasound, and MDCT) Leiden University, the Netherlands. on the treatment of acute abdomi- nal pain. ABCD “Decisions on proper indications for springer.com MDCT are even more relevant when “Th is is a work in progress based on considering the radiation risk fac- patient statistics and does look rather tor, but there are other risk factors,” complicated,” Geleijns said. “But it’s he said. Because diagnostic tests are a very handy tool for modelling. Th e Headline morebooks onecolor not perfect, clinicians need to con- next challenge is to derive decision sider the secondary risk of an erro- trees that can be used in clinical neous treatment decision derived practice, not just by radiologists but from faulty test results. Th e third also by referring physicians.” Springer – type of risk involves direct compli- cations of the test itself. In MDCT, Th ese diagrams and models can help this third risk is usually related to radiologists quantify their primary contrast agents. goal of doing more good than harm. Covering the entire At present, many radiologists are Across Europe, there is substantial aware of radiation risks with MDCT variability in the factors that are and believe the benefi ts outweigh used to determine the appropriate- the risks, but they tend to base their spectrum of radiology ness of MDCT, and there is ample conclusions on qualitative criteria. room for improvement, Geleijns noted. Both the American College “We are trying to provide a method of Radiology and the UK Royal Col- for justifi cation that goes beyond Visit our booth # 549 / Expo E lege of Radiologists have published what has been more or less a feel- NEW guidelines that can be used by radi- ing,” he said. ologists in other countries. in the publishers’ row

Refresher Course

Monday, March 12, 08:30–10:00, Room I

RC 1313 Justifi cation and optimisation of multidetector CT (MDCT) examinations

Moderators: J. Damilakis; Iraklion/GR D. Fleischmann; Stanford, CA/US • A. Justifi cation of MDCT examinations J. Geleijns; Leiden/NL • B. MDCT: Balancing image quality and dose W.A. Kalender; Erlangen/DE • C. Optimisation of pediatric MDCT examinations S. Puig; Vienna/AT 012922x

myESR.org ECR TODAY 12 MONDAY/TUESDAY, MARCH 12/13, 2007 ENTRANCE LEVEL

European Society of Radiology Section of Kazakhstan Urogenital Radiology Academy of Medical Sciences

In the mid 1980s, Henrik Th omsen Th e guidelines have been published Th e public non-commercial medical tions working in the sphere of In 2002 Prof. Mukhtar A. Ali- recognised the lack of a European in peer-reviewed journals, printed organisation, Kazakhstan Academy radiology, both nationally and yev, Academician of the National uroradiological forum that could in a series of booklets and are posted of Medical Sciences, was formed internationally (EAR and AOSR) Academy of Sciences, Head of the provide teaching and allow for on the ESUR website. for the purpose of promoting pro- • Cooperation with other national Scientifi c Center of Surgery of presentation of research. In the fol- fessional and educational activi- radiology societies Kazakhstan, was elected as the fi rst lowing years, he organised several More recently, a committee on ties in the fi eld of medical scientifi c • Participation in postgraduate president of the Academy of Medi- symposiums on uroradiology until Female Pelvic Imaging has been research in Kazakhstan. Th e Acad- training and continuous medical cal Sciences. Th e vice-president of fi nally, on August 26, 1990, twelve established, which is currently work- emy consists of 30 branches, bring- education of radiologists, bringing the academy and head of the radiol- uroradiologists met in the garden of ing on the production of technical ing together scientists from all fi elds standards closer to the recommen- ogy section is Dr. Yermek Akhme- Sven Dorph in Copenhagen, where guidelines for the study of uterine of medicine. Th e activities of the dations of the European Associa- tov, who is also a member of the this informal meeting turned into the tumours with MR. Members with Section of Radiology are concerned tion of Radiology (EAR) International Relations Committee fi rst General Assembly of the ESUR. special clinical and research inter- with the improvement of radiologi- • Legislation and radiation protection of ECR (2005, 2006 and 2007). ests, such as paediatric uroradiology cal practice in Kazakhstan, including • Propagation of eff ective and Initially, the ESUR met every second and CT- and MR-urography, have teaching and training activities in the rational use of radiological Th e academy carries out its activities year, but since 2000 the Society has also created working groups. fi eld of diagnostic imaging, support screening modalities in close cooperation with the Minis- met annually. Meetings have been of the implementation of modern • Support of young researchers and try of Healthcare of Kazakhstan and held in diff erent cities throughout Th e Society is a member of the Euro- radiological equipment and rational scientists in the sphere of radiology the Chief Regional Radiologists of Europe (Copenhagen, Florence, pean Association of Radiology and usage of imaging equipment. • Exchange of young scientists Kazakhstan, as well as other profes- Zurich, Strasbourg, London, Rot- has worked closely with the Educa- between local and foreign medical sional societies, associations, jour- terdam, Genoa, Uppsala, Santiago, tional Committee to produce both Th e main activities of the section are centres nals, faculties and companies (man- Ljubljana) and even beyond (Cairo, the curriculum for the programme concentrated in the following fi elds: • Periodic publication of various ufacturers of imaging equipment), Florida) and have always included a of general radiological training • Development and improvement materials, providing discussions and other organisations working in scientifi c session for members, fol- in Europe and the detailed cur- of radiology services and recommendations concerning the fi eld of diagnostic imaging. lowed by a postgraduate course and riculum for subspecialty training in • Education and teaching of its problems of national radiological open scientifi c sessions and exhib- urogenital radiology (on the ESUR members and young radiologists service Th e academy constantly aspires to its. Th e activities of ESUR are not and EAR websites). ESUR has also • Creation of a network of regional improve its professional and social limited to organising meetings. cooperated with ECR, to plan the branches Any new member should accept the links with colleagues from diff erent urogenital part of the programme of • Optimisation of radiological Charter and Principles of the Acad- countries and aims to share experi- To promote research on and the European Congress of Radiol- practice to match modern emy. Th e activity of the academy is ence in the application of new mod- improve knowledge about contrast ogy, and also maintains close links standards directed by the Executive Commit- ern radiological methods, hoping media, in 1994 the Board of the with the American Society of Uro- • Support of research activities in tee, consisting of 25–35 persons, that broad international cooperation ESUR established a Contrast Media radiology. radiology the composition of which should be will aid the further development and Safety Committee, chaired by Hen- • Organisation of national renewed every 5 years. Th e president, improvement of radiological prac- rik Th omsen, with Sameh Morcos as ESUR’s next meeting will be held symposiums, seminars and vice-president and treasurer will be tice and education in Kazakhstan. Secretary. Since then, the Commit- April 15–20, 2007 in Florida, in con- teaching schools chosen from members of the Execu- tee has issued a series of guidelines junction with SUR and SGR. • Constant coordination of the tive Committee, and heads of each on the safe use of contrast media. activity of societies and organisa- section are chosen by its members. Internet: www.surgery.med.kz

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myESR.org ECR TODAY ENTRANCE LEVEL MONDAY/TUESDAY, MARCH 12/13, 2007 C 13

Whole-body imaging survives era of undirected screening to emerge as tool for specific indications

Few controversies in radiology have False-positive test results and inci- Preliminary studies looking at cross- Evidence of MRI’s superior sensi- generated as much interest as that dental fi ndings, which are oft en bed correlation show that certain vas- tivity in detecting bone metastases of whole-body imaging. Monday underestimated, carry an increased cular beds correlate well with some has been available for over a decade. aft ernoon’s special focus session on risk to the patient stemming from vascular beds, while others do not. Researchers held back from recom- the issue promises to enlighten and further workup and anxiety. Addi- Many outcome studies need to be mending that scintigraphy surveys educate ECR attendees. tionally, they could put a strain on conducted to determine the path of be discontinued, however, until healthcare fi nances. preclinical lesions. Until then, clini- head-to-toe MRI examinations “It’s a perfect topic for the meet- cians run the risk of putting in stents became clinically viable. ing as it has been so controversial, “In Europe, where we have many or performing surgery when it’s not with people advocating whole-body countries with socialised medicine, really needed, according to Rubin. Whole-body MRI can identify scle- imaging and others with very strong we are concerned about the eff ect rotic metastases, which are common feelings against it,” said session whole-body imaging will have on He favours using whole-body imag- to prostate and breast cancer, and moderator Prof. Gabriel P. Krestin, the fi nances of the healthcare sys- ing to investigate atherosclerosis as the bone marrow disease multiple radiology chair at Erasmus Univer- tem,” Krestin said. a disease, to better understand the myeloma. Eustace will also argue in sity Medical Center in Rotterdam, diversity of its manifestations. He favor of MRI over PET for staging the Netherlands. Many people will come to the focus does not advocate screening asymp- skeletal metastases. Regarding soft - session expecting to hear about tomatic vascular territories with the tissue metastatic disease, PET-CT Prof. Gabriel P. Krestin from Rotterdam Th ere is no question that whole- undirected screening of asympto- intent to treat them upon fi nding currently holds an edge, but diff u- body imaging is more feasible than matic people, he explained. What lesions. “Th ere is very little evidence sion-weighted MRI techniques hold ever, given technological advances they will get instead are two very to support doing so,” he said. promise. Additionally, whole-body in both CT and MRI. Th e ques- strong advocates of whole-body MRI staging of cancer will only tion then becomes in which patient imaging, but for clearly specifi ed Th ere are a few preliminary reports grow with the development of tar- population does it make the most indications. for whole-body MRI, but no out- geted contrast agents. sense to apply the technique. Exam- come studies comparing treatment ining the topic from an epidemio- Prof. Geoff rey Rubin, chief of car- based upon 64-slice CT to the refer- Whether these lectures put an end logical point of view, Prof. Myriam diovascular imaging at Stanford ence standard of catheter angiogra- to the swirling controversy remains G. Hunink from the department of University, California, will describe phy. Th is is a recognised defi ciency, to be seen. In the end, however, it epidemiology and biostatistics and the current evidence for and against and some outcome studies are in the should stimulate healthy dialogue. the department of radiology at Eras- whole-body imaging for vascular works, particularly looking at the mus University Medical Center will disease. It is known that atheroscle- acute chest pain patient, said Rubin. “Participants should have questions focus on whether whole-body imag- rosis is a systemic disease. If it is aft erwards. Th is is the intention of ing is benefi cial and whether those found in one vessel area, it is most Th e fi nal presenter, Prof. Stephen J. the session,” Krestin said. “Physi- benefi ts are cost-eff ective. likely to be in other vessel areas. But Eustace, professor of musculoskel- cians, radiologists, entrepreneurs, there is scant peer-reviewed evi- etal radiology at Cappagh National and a large portion of the popula- “Th e decision to perform whole- dence that treating asymptomatic Orthopaedic and Mater Misericor- tion were, and still are, attracted to Prof. Myriam G. Hunink from Rotterdam body imaging depends on the lesions results in better survival, he diae Hospitals in Dublin, advocates the idea of whole-body imaging. probability of disease, the trade- said. using whole-body MRI for staging Yes, there is a place for whole-body off between the expected net gain cancer patients. He says it is a much imaging, but only for very clear indi- of correctly identifying patients “Technologically, we have the capa- more effi cient approach than a bone cations. In this setting, it is feasible.” with disease versus the expected bility to scan the entire arterial sys- scan for proving or ruling out meta- net harm of incorrectly labelling a tem with CT and MRI. Clinically, we static disease. Whole-body MRI healthy individual as diseased, and haven’t proven it has a real benefi t in also provides additional diagnostic the associated costs,” she noted. whole populations,” he noted. information. Special Focus Session

Monday, March 12, 14:00–15:30, Room E2

SF 15b Whole body imaging: Panacea or fallacy

• Chairman’s Introduction G.P. Krestin; Rotterdam/NL • Whole body imaging: Who does and who does not benefi t? M.G.M. Hunink; Rotterdam/NL • Current evidence for and against whole body imaging for vascular disease G.D. Rubin; Stanford, CA/US • Exploiting cancer phobia? S.J. Eustace; Dublin/IE

Whole-body CT showing mainly the skel- A 47-year-old woman with metastatic breast carcinoma to lungs, liver and bone. (Provided etal system. (Provided by Prof. G. Krestin) by Prof. S. Eustace and reprinted from the Journal of Magnetic Resonance Imaging)

Visit the Free Publications booth on the 1st level

Pick up your free copies of radiology journals and magazines ... Get free access to online radiology journals ...

33 publishers joined this new initiative and present more than 40 print media and almost 30 online journals.

Free bags will be provided, so pick up as many magazines as you can carry.

myESR.org ECR TODAY 14 MONDAY/TUESDAY, MARCH 12/13, 2007 LIST OF EXHIBITORS

List of exhibitors Society booths Company Booth Location Company Booth Location All Society booths are located on the entrance level.

3Mensio Medical Imaging, NL 11 Ext. Expo A Linos Photonics, DE 121 Expo A American Association for Women in Radiology 3W-Informed, NL 542 Expo E Lodox Systems, BE 304 Expo C Armed Forces Institute of Pathology Adani, BY 323 Expo C MCI Optonix, US 40 Ext. Expo A Asian Oceanian Congress of Radiology 2008 Seoul Agfa HealthCare, BE 214 Expo B Mecall, IT 403 Expo Foyer D Association of Radiologists of Ukraine Albatross Projects, DE 120 Expo A Med.e.Com, FR 109 Expo A Cardiovascular and Interventional Radiological Society of Europe Alliance Medical, UK 4 Ext. Expo A Medcomp Interventional, US 501 Expo E Chinese Society of Radiology Aloka Holding Europe, CH 333 Expo C MedConSol, DE 41 Ext. Expo A College of Radiographers UK Aloka Holding Europe, CH 336 Expo C Medelkom, LT 37 Ext. Expo A Computer Assisted Radiology and Surgery, Germany American College of Radiology, US 545 Expo E Median Technologies, FR 342 Expo C Croatian Society of Radiology American Medical Sales, US 41 Ext. Expo A Medical Imaging International, US 553 Expo E Czech Radiological Society American Roentgen Ray Society, US 552 Expo E Medicor Medical Supplies, BE 348 Expo C Deutsche Röntgengesellschaft Anzai Medical, JP 506 Expo E Medicsight , UK 34 Ext. Expo A Deutsches Röntgenmuseum Apelem, FR 341 Expo C Medis medical imaging systems, NL 3 Ext. Expo A European Congress of Interventional Oncology 2008 Arcoma, SE 106 Expo A Medison, KR 522 Expo E European Coordination Committee of the Radiological, Electromedical Array Corporation Europe, NL 15 Ext. Expo A Medisys, FR 349 Expo C and Healthcare IT Industry ATS, IT 404 Expo Foyer D Medos, DE 6 Ext. Expo A European Federation of Organisations in Medical Physics aycan Digitalsysteme, DE 24 Ext. Expo A Medrad Europe, NL 329 Expo C European Project FP6 Az Corporation, RU 114 Expo A Medtron, DE 16 Ext. Expo A European School of Interventional Radiology Barco, BE 201 Expo B Mercury Computer Systems, DE 343 Expo C European Society for Magnetic Resonance in Medicine and Biology Bayer Schering Pharma, DE 317 Expo C Merge Healthcare / Cedara Software, NL 23 Ext. Expo A European Society of Breast Imaging Bayer Schering Pharma, DE 318 Expo C Metaltronica, IT 211 Expo B European Society of Cardiac Radiology Beijing Choice Electronic Technology, CN 530 Expo E Mindray, CN 515 Expo E European Society of Gastrointestinal and Abdominal Radiology Beijing Wandong Medical Equipment, CN 514 Expo E Mindways Software, US 504 Expo E European Society of Head and Neck Radiology Biodex Medical Systems, US 1 Ext. Expo A MR-Schutztechnik Kabinenbau, DE 215 Expo B European Society of Musculoskeletal Radiology Biospace med, FR 304a Expo C National Display Systems, NL 339 Expo C European Society of Neuroradiology Blue X Imaging, IT 108 Expo A NEC Display Solutions Europe, DE 42 Ext. Expo A European Society of Paediatric Radiology BMI Biomedical International SRL, IT 523 Expo E NeoRad, NO 122 Expo A European Society of Thoracic Imaging BoneSupport, SE 30 Ext. Expo A Neusoft Medical Systems, CN 517 Expo E European Society of Urogenital Radiology Bracco, CH 101 Expo A Ningbo Xingaoyi Magnetism, CN 535 Expo E Faculty of Radiologists, Royal College of Surgeons in Ireland BrainLAB, DE 321 Expo C Noras Roentgen- und Medizintechnik, DE 125 Expo A Hellenic Radiological Society CAD Sciences, US 110 Expo A NordicNeuroLab, NO 528 Expo E Hellenic Society for Ultrasound in Medicine and Biology Campden Publishing, UK 537 Expo E Olympus Winter & Ibe, DE 13 Ext. Expo A Integrating the Healthcare Enterprise Europe Canon Europa, NL 104 Expo A Orthocrat, IL 505 Expo E International Cancer Imaging Society - Cancer Imaging Celon medical instruments, DE 13 Ext. Expo A Parker Laboratories, US 17 Ext. Expo A International Congress of Radiology 2008 Morocco Cerner Deutschland, DE 310 Expo C Pausch technologies, DE 340 Expo C International Diagnostic Course in Davos Chison Medical Imaging, CN 532 Expo E PEHA Med. Geraete , DE 308 Expo C International Society for Magnetic Resonance in Medicine Civco Medical Solutions, US 503 Expo E Philips Medical Systems, NL 102 Expo A International Society of Radiographers & Radiological Technologists Codonics, US 520 Expo E Philips Medical Systems, NL 119 Expo A Japan Radiological Society Confirma Europe, DE 19 Ext. Expo A Planar Systems, FI 208 Expo B Korean Radiological Society ContextVision, SE 527 Expo E Planilux-Gerätebau Felix Schulte, DE 41 Ext. Expo A Management in Radiology Control-X Medical, HU 320 Expo C Planmed , FI 344 Expo C Österreichische Röntgengesellschaft CPI International, CH 326 Expo C PrimaX International, FR 404 Expo Foyer D Polish Medical Society of Radiology D.A.T.A. Corporation - Automed, AT 21 Ext. Expo A Protec, DE 27 Ext. Expo A Radiological Society of Saudi Arabia Dastor, IT 36 Ext. Expo A PTW-Freiburg, DE 26 Ext. Expo A Radiology Trainees Forum DatCard Systems, US 29 Ext. Expo A Quantum Medical Imaging, US 512 Expo E RadiotechnologInnen Österreichs Del Medical Imaging, US 315 Expo C Radcal, US 302 Expo C Romanian Society of Radiology and Medical Imaging Diagnostic Imaging Europe, US 547 Expo E Radiological Society of North America, US 544 Expo E Royal Belgian Radiological Society DigiMed-mcs / Esinomed , DE 127 Expo A Radiology OneSource Europe, BE 304 Expo C Royal College of Radiologists DIRA, RU 526 Expo E Raymed, CH 314 Expo C Russian Association of Radiology DMS Apelem, FR 341 Expo C Reichert, DE 543 Expo E School of MRI Dr. Goos-Suprema, DE 5 Ext. Expo A Rein EDV - MeDiSol, DE 14 Ext. Expo A Sociedad Española de Radiologia Medica Dr. Sennewald Medizintechnik, DE 12 Ext. Expo A REM , IT 405 Expo Foyer D Societa Italiana di Radiologia Medica DRTech Corporation, KR 524 Expo E Rendoscopy, DE 408 Expo Foyer D Société Française de Radiologie Dunlee Medical Components, DE 324 Expo C Rimage Europe, DE 347 Expo C Society of Hungarian Radiologists Dynamic Imaging, US 22 Ext. Expo A Rogan-Delft, NL 325 Expo C Society of Specialists in Radiology Russia Ebit AET, IT 123 Expo A RTI Electronics, SE 322 Expo C Turkish Society of Radiology Echonet, the Ultrasound Network, GR 550 Expo E Sanochemia Diagnostics International, CH UK Radiological Congress Edge Medical Devices, IL 33 Ext. Expo A 205 Expo B WFUMB 2009 Sydney hosted by ASUM Eizo Nanao , JP 521 Expo E Scanditronix Wellhöfer, DE 309 Expo C Ella Legros, FR 113 Expo A Schiller, CH 305 Expo C Elsevier, NL 536 Expo E Schulte Felix Gerätebau, DE 41 Ext. Expo A EMC , US 508 Expo E Sectra, SE 525 Expo E EMD Technologies, CA 38 Ext. Expo A Sectra, SE 407 Expo Foyer D Esaote, IT 518 Expo E Sedecal, ES 212 Expo B Etiam, FR 112 Expo A Shantou Institute of Ultrasonic Instruments, CN ETS-Lindgren, UK 25 Ext. Expo A 533 Expo E European Hospital, DE 539 Expo E Shenzhen Emperor Electronic Technology, CN European Hospital, DE 551 Expo E 531 Expo E EZEM, US 332 Expo C Shimadzu Europa , DE 328 Expo C Fluke Biomedical, US 346 Expo C Sidam , IT 111 Expo A Fogale nanotech, FR 511 Expo E Siemens Medical Solutions, DE 409 Expo D Fujifilm Europe , DE 103 Expo A Siemens, Display Technologies and OEM Business, DE Gammex-RMI , DE 307 Expo C 210 Expo B GE Healthcare, UK 202 Expo B SonoScape , CN 516 Expo E GE Healthcare, UK 209 Expo B Sony Europe, UK 18 Ext. Expo A GE Healthcare, UK 213 Expo B Soyee, KR 401 Expo Foyer D General Medical Merate, IT 312 Expo C Springer , DE 549 Expo E Georg Thieme Verlag, DE 548 Expo E Suinsa Medical Systems, ES 327 Expo C Gilardoni, IT 204 Expo B Swiss Medical Care, CH 35 Ext. Expo A GIT Verlag , DE 546 Expo E Swissray Medical , CH 513 Expo E Gruppo Soluzioni Tecnologiche , IT 502 Expo E systema, DE 44 Ext. Expo A Guerbet, FR 331 Expo C Taramed Distribution , IE 14 Ext. Expo A Healthcare IT Management, BE 554 Expo E Technix, IT 337 Expo C Healthcare IT Management, BE 555 Expo E Tecnologie Avanzate , IT 14 Ext. Expo A Hitachi Medical Systems Europe , CH 519 Expo E Teknova Medical Systems , CN 534 Expo E Hologic, US 311 Expo C Telemed, LT 116 Expo A Hoorn Holland, NL 126 Expo A TeraRecon, US 20 Ext. Expo A Hospital, BE 554 Expo E Thales Electron Devices, FR 406 Expo Foyer D Hospital , BE 555 Expo E The Medipattern Corporation, CA 45 Ext. Expo A I.A.E., IT 402 Expo Foyer D Thieme & Frohberg , DE 541 Expo E iCAD, US 117 Expo A Toshiba Electronics Europe , UK 350 Expo C iCRco, US 128 Expo A Toshiba Medical Systems Europe, NL 316 Expo C im3D , IT 107 Expo A Totoku Electric, DE 14 Ext. Expo A Image Diagnost International , DE 28 Ext. Expo A Trixell, FR 406 Expo Foyer D Imaging Diagnostic Systems, US 115 Expo A Tyco Healthcare / Mallinckrodt, DE 105 Expo A Imaging Management, BE 554 Expo E ulrich medical, DE 330 Expo C Imaging Management, BE 555 Expo E Ultrasonix Medical Corporation, CA 352 Expo C Imedco, CH 217 Expo B Unfors Instruments, SE 345 Expo C IMIX ADR, FI 2 Ext. Expo A VacuTec Meßtechnik, DE 301 Expo C Innomed Medical, HU 216 Expo B Varian Medical Systems, DE 313 Expo C Instrumentarium Dental, FI 303 Expo C VDL Konings Medical Systems, NL 529 Expo E Intelligence in Medical Technologies, FR 510 Expo E VIDAR Systems Corporation, US 338 Expo C Intermedical Italia, IT 306 Expo C Villa Sistemi Medicali, IT 315 Expo C International Hospital Equipment & Solutions, BE Visus Technology Transfer, DE 206 Expo B 538 Expo E Vital Images, NL 335 Expo C Invivo, US 124 Expo A VuCOMP, US 41 Ext. Expo A Italray, IT 334 Expo C Wide EU Office, NL 32 Ext. Expo A J B Damgaard, DK 43 Ext. Expo A Wiroma, CH 39 Ext. Expo A Kiran Medical Systems, IN 118 Expo A Wisepress Online Bookshop, UK 540 Expo E Kodak [Eastman Kodak Company], UK 203 Expo B X-Parts France, FR 31 Ext. Expo A Konica Minolta Medical & Graphic Imaging, DE Ziehm Imaging, DE 319 Expo C 207 Expo B Zonare Medical Systems, US 351 Expo C Kyphon, BE 509 Expo E Maertens Medical, DE 539 a Expo E Companies and societies are listed in alphabetical order. Leidel & Kracht Schaumstoff-Technik, DE 507 Expo E

myESR.org ECR TODAY LOWER LEVEL MONDAY/TUESDAY, MARCH 12/13, 2007 C 15

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myESR.org ECR TODAY 2007 1st LEVEL 17

Daily news from Europe’s leading imaging congress MONDAY/TUESDAY, MARCH 12/13, 2007 EuroAIM charts ambitious new Inside Today direction for clinical trials

By Brenda Tilke technical or diagnostic aspects of a Institute. ACRIN supports wide- trial manages patient accrual, data • Angiogenesis imaging modality or technique. Other stud- scale studies and collaboration with collection, and data monitoring, and p. 18 In the not too distant past, a small ies focus on a specifi c therapeutic other groups, the healthcare indus- oversees the work of the team’s bio- study conducted at a single centre aspect. Clinical trials should move try, and healthcare funding sources stasticians. Protocol managers coor- • Subspecialty and could still generate signifi cant inter- beyond these limits, noted Prof. such as insurance companies. dinate communications between National Societies est and have an impact on clinical Adrian Dixon, honorary consultant ACRIN’s primary aim is to coor- researchers and establish the trial’s p. 18, 20, 21 practice. But those days are end- radiologist at Addenbrooke’s Hospi- dinate clinical trials of diagnostic guidelines. imaging and image-guided thera- • Interview with the peutic technologies that ultimately Before the trial starts, data manag- incoming ECR President can lengthen lives and improve the ers must review and help shape the p. 19 quality of life for cancer patients. developing protocol and oversee Although it may follow the ACRIN the procedure for maintaining the • BI-RADS TM Training model, EuroAIM’s reach will extend integrity and accuracy of computer in breast imaging beyond cancer. data fi les. Th e imaging technology p. 21 specialist works with the principal At Tuesday’s session, Prof. Bruce investigators to develop the specifi c • 2006 Nobel Prize Hillman, the Th eodore E. Keats pro- imaging needs of the study and, in medicine fessor of radiology at the University aft er the trial has started, oversees p. 22 of Virginia and ACRIN’s network how images are collected, stored, chair, will share his insights into cre- and read. Other personnel needed • Radiologists from a ating and running large-scale trials. include protocol associates, regu- different perspective latory specialists, auditors, patient p. 23 Prof. Bruce Hillman from Charlottesville Prof. Adrian Dixon from Cambridge “Th e most important thing is to be advocates, recruitment specialists, practical,” he said. “You can have and quality assurance committee ing. Th e push for evidence-based tal and professor of radiology at the absolutely terrifi c science, but if the liaisons. pean researchers believe these bod- medicine is shift ing the emphasis University of Cambridge, UK. doctors won’t or can’t adhere to the ies may post serious roadblocks to to larger multi-centre, and prefer- protocol or the patients are not will- Collaboration and cooperation are developing and conducting wide- ably multi-national, studies that can “Whether it makes patients bet- ing to sign on, you’re going to have a needed between not only the trial scale trials. Others are more opti- yield generalisable results. ter or not, that’s the ultimate ques- failure on your hands.” investigators but also the regula- mistic that common goals will over- tion. Or perhaps it doesn’t, but new tory/ethics boards of the countries shadow national diff erences. To help facilitate this evolving radiological techniques may allow Moreover, he cautioned that any included in the trial. Some Euro- approach to clinical trial develop- us to image patients in a more com- large-scale multi-national, multi- ment and management, the Euro- fortable fashion with less risk or at centre study would demand a sig- pean Institute for Biomedical Imag- less cost. Or perhaps the use of an nifi cant amount of funding and ing Research (EIBIR) established expensive test early on may make personnel. One of ACRIN’s larg- EuroAIM the European Network for the the entire course of hospital treat- est studies, a national lung cancer Assessment of Imaging in Medicine ment cheaper,” he explained. “It’s screening trial involving 50,000 Tuesday, March 13, 08:30–10:00, Room N/O (EuroAIM). At Tuesday’s session, increasingly important to come up subjects, has costs totalling nearly presenters will explain EuroAIM’s with strategies to manage patients $200 million (€155 million). Th e EA 1725 EuroAIM: European network for the Assessment goals and objectives and how it with a smaller hospital bed base, organisation’s annual core budget is of Imaging in Medicine intends to put these into action. which is good for patients as there is $7 million (€5.4 million). • Introduction to EuroAIM Radiologists with an interest in run- then less chance of secondary infec- M.G. Myriam Hunink; Rotterdam/NL ning or participating in a clinical tion.” Th e personnel demands of a large- • The relationship between EIBIR and EuroAIM trial should attend to learn more scale, multi-centre, multi-national G.P. Krestin; Rotterdam/NL about the new trends in research. EuroAIM has fi ve key objectives, trial should not be underestimated, • Lessons learned from ACRIN which are based largely on the Hillman said. In ACRIN trials, a B.J. Hillman; Charlottesville, VA/US Imaging assessment in many stud- activities of the American College comprehensive protocol team is • Discussion ies hinges on whether the imaging of Radiology Imaging Network required. Key team members must • Conclusions: Multicentre assessment studies in the future technique delivers anatomically (ACRIN), a cooperative group include a statistician who helps A.K. Dixon; Cambridge/UK reproducible information or on the funded by the (US) National Cancer design the protocol and during the

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myESR.org ECR TODAY st 18 MONDAY/TUESDAY, MARCH 12/13, 2007 1 LEVEL

STOP BY OUR BOOTH AT ECR ESSR European Society of Musculoskeletal Radiology Visit the 14th Annual Meeting June 1–2, 2007 Izmir/Turkey

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Angiogenesis imaging matures rapidly into ‘must-do’ technique

By Paula Gould to attend a refresher course with the Th e session’s presenters are keen always necessary. Even a visual, qual- telling title: Angiogenesis imaging to dispel the widely held view that itative impression of enhancement It’s offi cial: angiogenesis imaging in clinical practice today. angiogenesis imaging is only of aca- can indicate important diagnostic is no longer just a worthy research demic interest and is diffi cult to per- information about a lesion’s status. tool. Evaluation of tumour vascu- “I gave my fi rst talk on this topic at form. Far from it, they say. Another Radiologists may already be using lature has been recognised as a key ECR in 2003. In those days, it was misconception is that FDG-PET can this information – without calling it part of oncology work-up and ther- in the ‘New Horizons’ arena,” said provide the exact same diagnostic angiogenesis imaging – when they apy monitoring, and clinical radi- Dr. Anwar Padhani, radiologist and and prognostic information. So why perform dynamic examinations. ologists are getting on board. head of imaging research at the Paul bother with the quantitative studies? For evidence of this shift , look no Strickland Scanner Centre, Mount “Much of what radiologists do actu- further than this year’s ECR pro- Vernon Hospital, London. “Now “Th e information you get from look- ally captures information about ang- gramme. Angiogenesis imaging there are more radiologists out there ing at angiogenesis is diff erent,” said iogenesis. Th e idea is to show these would once have been fl agged up who are familiar with the basic con- Prof. Ken Miles, professor of imag- clinical practitioners that it isn’t as a novel technique. Not this time. cepts, know a little bit about the tech- ing at Brighton and Sussex Medical such an erudite area as they might Delegates are instead being invited niques, and want to learn more.” School. “An important message will imagine, and it is something they be: ‘Don’t write this off because you are doing anyway,” Miles said. think FDG-PET can do everything in oncology, because it can’t.’” Both CT and MRI can be used for angiogenesis imaging. Certain indi- Angiogenesis is the process by cations, however, may favour one which tumours develop their own modality over the other. Tumours vascular supply. Determining the in the upper retroperitoneum or level of angiogenic activity can indi- the central mediastinum are oft en cate more about a lesion’s future obscured by artefacts on MRI, and behaviour. For instance, aggressive may be better assessed by CT. Con- cancers that are likely to spread cerns about ionising radiation, on will demonstrate quite intense ang- the other hand, could rule out CT for Conventional CT (A), perfusion CT (B), and iogenesis. Spotting this behaviour imaging brain tumours and paedi- FDG-PET (C) of the liver demonstrate mis- can help indicate which treatment atric applications. MRI may be pre- match between tumour angiogenesis and option to pursue. ferred for evaluating bone tumours, metabolism in metastatic breast cancer. Th e necrotic centre of the tumour demonstrates given the high chance of calcium low perfusion and metabolism (arrow), Th e extent of angiogenesis can artefacts on CT, and for visualising whilst high perfusion and metabolism are Radiologists working in oncology should Prof. Ken Miles will demystify the be gauged by analysing contrast prostate and breast tumours. seen in the tumour periphery. Th e interme- get up to speed with angiogenesis imaging, principles of angiogenesis imaging at diate zone demonstrates mismatch between or risk being sidelined in the future, accord- Monday aft ernoon’s refresher course. enhancement patterns quantita- perfusion (low values) and metabolism ing to Dr. Anwar Padhani. tively. But dedicated soft ware is not continued on next page (high values). (Provided by Prof. K. Miles)

myESR.org ECR TODAY st 1 LEVEL MONDAY/TUESDAY, MARCH 12/13, 2007 C 19

in implementing economically viable Incoming ECR President sets the stage strategies. Th ere are clear indications that powerful and eff ective radiol- ogy greatly contributes to the suc- for state-of-the art 2008 meeting cess of hospitals and the healthcare system. Precise and fast diagnosis By Monika Hierath, ESR Offi ce Radiology also has to be aware of its therapy, and high tech medicine allows one to start adequate therapy social responsibility. ECR 2008 will which continued to thrill me, and at an early stage, so that hospital stays Another successful ECR draws to a put a particular focus on women’s its fascination never ended. can be considerably reduced, which close and the incoming ECR Presi- imaging, including current hot top- is a major factor in the success of a dent, Prof. Maximilian Reiser, who ics, such as breast imaging, uterine ECRT: What is your message to the hospital. Radiologists have to make will preside over ECR in 2008, gears fi broid embolisation, etc. However, younger generation of radiologists? their practice as eff ective as possi- up for the preparations for next women in the radiological profes- MR: First, I would like to tell young ble, improve the workfl ow and save year’s meeting. We would like to sion will also be a key topic, dis- radiologists that they have chosen resources. Th is also includes imple- present a brief portrait of the incom- cussed in a session chaired by Prof. the right discipline. Th ere is an ever mentation of modern equipment ing President to our readers. Helen Carty, who presided over increasing demand for advanced and technologies. ECR in 2004 and who will explore medical imaging and minimally Years ago, for example, I caused a stir ECR Today: What are your ambi- how the input of women can be invasive, image-guided therapy. Th e when I presented the then futuristic Prof. Maximilian Reiser tions and expectations for your term maximised. We will also introduce a opportunities for qualifi ed radi- concept of teleradiology. Today, this ECR 2008 President as President of ECR? new foundation course on interven- ologists are excellent, not only in valuable service is not only a reality, Prof. Maximilian Reiser: My tional radiology. Europe, but also worldwide. Many but also a fairly widespread practice. the fi rst European institutions to ambitions for the next ECR meet- Th e traditional ‘ECR meets …’ concept young M.D.s are aware of this, so In general, the task of the radiologist successfully apply selective inter- ing are very high. I would like to will be continued, with India, Israel radiology attracts many bright and is to convince hospital managers that nal radiation therapy, using micro- ensure it is the best ever radiological and Germany as guest countries. committed people, while various investments in radiology services scopic radioactive spheres to treat meeting in Europe, in terms of the Our industry partners will be other disciplines have problems will lead to immediate returns, e.g. malign liver tumours. What’s going quality of the science presented, in off ered a new platform within the recruiting the next generation. by reducing the duration of hospital to come next? terms of attendance – I would like to so-called ‘Face Off ’ sessions. Five Young radiologists should fi ght for stays, by increasing patient fl ow in MR: (laughing) … First of all, our see even more German radiologists companies will be invited to present their rights and join forces under the radiology units, etc. current investments and advances attend the meeting – and in terms their soft ware products, which are the umbrella of ESR, in order not have to become fi nancially viable of its character as a multi-discipli- demonstrated by using a dataset to get lost in fragmented organisa- ECRT: What does molecular imag- and have to be made available at nary meeting. I plan to increasingly provided by ECR. Within a limited tional structures, and in order to ing hold for the ‘man on the street’? other hospitals throughout Europe, involve other professionals in the period of time, the functionality and stay at the forefront of the advances MR: As with all state-of-the-art so that these become accessible to a annual meeting of ECR, under the performance will be demonstrated. made in medical imaging. One medical developments, molecular large number of patients. motto ‘ESR meets partner disci- Th e goal of the ‘Face Off ’ session is undisputed key to the next genera- imaging today is still far from ben- plines’. Next year we will have a par- to give attendees an opportunity to tion’s success is connecting people in efi ting the man on the street. How- ECRT: Does your busy professional ticular focus on general practition- compare the capabilities of the dif- their early years of professional life, ever, this can change from one day to life leave time for hobbies and activ- ers and we are already working on a ferent workstations. at the European level. Th is forms the next, as we have recently seen in ities outside the hospital? What are concept of how to enhance interac- the basis for exchanging knowledge other fi elds, for example, the freez- your personal remedies to counter tions between general practitioners ECRT: Since 1993 you have been and ideas, liaising with peers, and ing of stem cells as a potential cure stress and burnout? and radiologists, and how to defi ne professor of radiology and chair- presenting one’s work to others for later in life, a service that is already MR: I love to play tennis and golf common strategies and interests. man of the Department of Clinical critical and competitive appraisal. widely used. in my spare time. One of my favour- Radiology at the Ludwig Maximil- Face-to-face encounters and pres- Provided there is decent support ite partners was Professor Lissner, ECRT: What are going to be the ian University of Munich. What entations at international meetings from society and politicians, molec- although you can imagine that this highlights of ECR 2008, scientifi - were your reasons and your motiva- are conducive to these processes. ular imaging will soon be avail- was not always as relaxing as it cally, as well as regarding new tech- tion to become a radiologist? ECR is an ideal platform for that. able to all patients, since it brings should have been, since it was dif- nology presented? MR: As a student in medical school about a great potential for savings fi cult for both of us to escape from MR: Radiology is such a rapidly I was most interested in surgery. As ECRT: Innovations always walk the on treatment costs, by allowing an professional discussions. Skiing is evolving discipline. Both in tech- an intern I found it worthwhile to tightrope between high-tech and early detection of diseases and a also among my favourite sports and nology and clinical application we spend a year in radiology in order economic viability. What role does more targeted therapy, adapted to I prefer Austrian ski resorts. Apart have a huge number of fantastic to become familiar with accurate radiology play? the genetic disposition of the par- from that, I love art. Th is is where innovations. Th ink of advances in diagnostics. As a resident in neu- MR: We all have to face the chal- ticular patient. I fi nd my inner balance and can MDCT, MRI, ultrasound and inter- roradiology I was so enthused that lenges posed by the 21st century. As in really get away from daily routine. I ventional radiology, as well as I decided to stay in the fi eld of radi- every fi eld where technology plays a ECRT: Your institution was the fi rst am very proud of my collection of molecular imaging. ECR 2008 will ology. It was the combination of key role, the structure of hospitals has in the whole world to install a dual- both contemporary and old paint- present the latest developments in image analysis and interpretation, also changed. Th e task of the radiolo- source CT scanner for clinical use, ings, which will hopefully continue our discipline. image-guided minimally invasive gist is to support hospital managers in April 2006. Also, it was among to grow in the future!

account for this variability come market for these agents will eventu- treatment monitoring once these into play. ally be worth billions of euros. agents become more widespread in oncology. Th e translation of angiogenesis Drug developers have been using imaging from research to clini- quantitative imaging techniques to “Every single one of us who does cal practice is only just beginning, assess how well their novel therapies cancer imaging will be faced with according to Miles. But the shift has are working. Dynamic CT or MRI the challenge of assessing these started, and uptake will increase. can determine extremely quickly novel therapies,” he said. “Radi- One area where this may happen whether an anti-angiogenic agent ologists who aren’t familiar with soon is CT-based characterisation is working or not, Padhani said. these techniques will be doing their of lung nodules. He recommends that clinical radi- patients a disservice and will lose ologists use the same approach for work from referring clinicians.” “Given that low-dose CT screening for lung cancer is coming along, the issue of how you manage a detected lung nodule is increasing in impor- Refresher Course tance,” he said. Monday, March 12, 16:00–17:30, Room N/O Angiogenesis imaging with MRI. T1-weighted morphological images and quantitative Gd- Th e development of drugs that target DTPA concentration images before, and four hours aft er, injection of a vascular disruptive tumours’ blood supply is providing a RC 1606 Angiogenesis imaging in clinical practice today drug. Note acute blood fl ow is shut down in some lesions. Intra- and inter-tumour heteroge- neity in response to therapy is very evident. (Provided by Dr. A. Padhani) major impetus for clinical radiolo- gists to become familiar with angio- Moderator: C.A. Cuénod; Paris/FR genesis imaging, according to Pad- • A. Principles continued from previous page explain these diff erences more fully hani. Anti-angiogenic agents have K.A. Miles; Brighton/UK in his ECR presentation. Patient been approved for use in three sepa- • B. How to do it Practitioners just need to be aware weight and the amount of contrast rate cancers. Numerous other anti- A.R. Padhani; Northwood/UK that angiogenesis alters contrast medium can also aff ect enhance- angiogenic drugs aimed at treating • C. Information you can get enhancement diff erently for CT ment. Th is is where more sophis- other cancers are undergoing clini- A.R. Padhani; Northwood/UK and MRI, Miles said. He plans to ticated quantifi cation tools that cal trials. He predicts that the annual

myESR.org ECR TODAY 20 MONDAY/TUESDAY, MARCH 12/13, 2007 SOCIETIES

As a fi rst step, all of them have been and with manuscripts also translated Spanish Society of Medical Radiology asked to recommend a radiologist into English. Th e fi nal objective is from their society to act as editors to place RADIOLOGÍA at the level Th e Spanish Society of Medical visibility of its articles. On the other pursues the following objectives: or journal reviewers. of the best international radiology Radiology (SERAM) is currently hand, this is excellent news for the 1. Achieve entry of the journal into 3. Increase collaboration with the journals and, taking into account one of the fastest growing and most extremely large market of Spanish- the registry that issues the Impact Spanish-American radiologists and the dynamism and strength of the infl uential scientifi c societies in American radiologists, given that Factor. In order to do so, a new edi- off er the possibility for the journal Spanish-speaking radiology com- Spain. Th e journal RADIOLOGÍA RADIOLOGÍA is the only scien- torial board has been named, formed to be their communication media. munity, project its growth further, is its offi cial communication media. tifi c journal written in Spanish and by radiologists of renowned prestige. 4. Change the design and content without establishing any limits. dedicated to the publication of arti- Th e international editorial board will of the editorial sections of the jour- RADIOLOGÍA has been accepted cles on image-guided diagnosis and be renewed and the relevance of the nal to make it more attractive and Dr. Salvador Pedraza by Medline recently, and this fact therapy. manuscripts will be improved. functional. Director of Publications marks a great event in the history of 2. Increase involvement and par- 5. Initiate an electronic version Dr. José María García Santos the journal. On one hand, it means SERAM has recently initiated a stra- ticipation in the journal of the dif- of the journal with more extensive Editor-in-Chief of the journal a radical change towards greater tegic plan for RADIOLOGÍA, which ferent Spanish radiology societies. contents than the printed version RADIOLOGÍA

EAR Membership inspires GeoAR to enhance the prestige of Georgian radiology

Th e Georgian Association of Radiol- carried out at the Institute, it is the relationships are being developed increased signifi cantly. Th e unifi ca- its foundation, many international ogy (GeoAR) was the fi rst among the university clinic that is of utmost as far as possible. Th eir professional tion of radiology diagnostics and congresses, annual meetings and former Soviet Republics to become importance to young radiologists, skills are being improved through radiotherapy has contributed to the symposia have been held in Georgia, a member of the EAR in 1996. Since postgraduates and residents. Th e short and long-term courses in lead- promotion of radiology as a whole, with the participation of prominent then, a new era has begun in Geor- newly created continuous educa- ing European radiology clinics and thus giving priority to this sphere of radiologists from many European gian radiology. Th e fi rst steps have tion system, which involves many training centres, with joint research medicine. countries. been taken in the development of Georgian radiologists studying in being carried out and published in the European model in Georgia and Georgia or abroad, enables them to journals. Th e ‘Georgian Journal of Radiology’ Th e integration of the GeoAR with this process is still progressing. improve their knowledge and intro- founded by GeoAR deals with the the EAR and the regular collabora- duce new achievements into the Due to the integration of the GeoAR achievements of Georgian radiolo- tion of Georgian radiologists with Professor Fridon Todua, Head of sphere of radiology in Georgia. into the EAR, new technologies have gists, as well as those of other Euro- specialists from European clinics, the Research Institute of Medi- been introduced on a large scale, pean countries. can contribute to the rise in prestige cal Radiology, is the President of Georgian radiologists enjoy very not only in the capital of Georgia, of radiology in Georgia. the GeoAR, which was founded in close connections with outstanding but also in its regions. Th e amount International and national scien- 1995 on the initiative of the Insti- world specialists, European medi- of CT, MRI, ultrasound and other tifi c meetings have already become tute. Along with scientifi c research cal centres and clinics, and these digital equipment being used has traditional for the GeoAR. Since

L INTERNATIONAL A N ACADEMY OF O I T MEDICAL A N R ULTRASOUND E T N I

Advanced Course in Musculoskeletal 1 Ultrasound TEACHERS: LOCATION: Prof. Stefano BIANCHI Hotels van Oranje, University of Geneva, CH Noordwijk -NETHERLANDS

Prof. Carlo MARTINOLI TIME: University of Genova, I May 4th - 5th, 2007

Final details available at the educational site www.sonoportal.net

Contrast-Enhanced Ultrasound: "current" applications and 2 future challenges TIME: September 2007, 2 days

Final details available soon at the educational site www.sonoportal.net

myESR.org ECR TODAY st 1 LEVEL MONDAY/TUESDAY, MARCH 12/13, 2007 C 21

Clarity and brevity prove essential for meaningful breast imaging reports

By Brenda Tilke ing to Prof. Dr. Ingrid Schreer, pro- Th e zero category is used only for but not always clear, choice of terms was created by Dr. Georg Pfarl and fessor of medicine at the University screening mammograms where in their reports. BI-RADS™ uses 22 Prof. Dr. Th omas Helbich from ECR attendees can test their skills at of Kiel, Germany. Young radiolo- the fi ndings are inconclusive and terms to characterise calcifi cations, the department of radiology at the diagnosing breast disease and learn gists need to develop an ability to another imaging modality is rec- whereas radiologists not adhering University of Vienna. Prof. Helbich how to create clear, concise breast provide clear, concise reports. ommended. In reports classifi ed as to the system may use at least 50 dif- will be the moderator of the ECR imaging reports at Tuesday morn- zero, the radiologist should recom- ferent terms. Some of the descrip- session on BI-RADS™. Th e other ing’s BI-RADS™ training in breast At ECR 2007, she will give a presen- mend which adjunct imaging study tive terms used frequently in the UK two presenters will be Dr. Roberta imaging session. tation on how to use the BI-RADS™ should be used. system do not appear in BI-RADS™, Chersevani from the General Hos- breast image classifi cation system. and not all of these non BI-RADS™ pital, Gorizia, Italy, and Dr. Karen Mammography reports throughout Developed by the American College Th e BI-RADS™ lexicon is succinct, descriptors have diagnostic value. Kinkel from the University Hospital much of Europe have simply too of Radiology (ACR), BI-RADS™ with a strictly limited choice of words of Geneva, Switzerland. much variety in the choice of words (Breast Imaging Reporting and Data used to describe fi ndings in mam- Although radiologists may have used, which can lead to confusion System) is steadily gaining accept- mography, ultrasound, and MRI. valid reasons for not wanting to and even medical mistakes, accord- ance in Europe. embrace BI-RADS™, proponents like Th ose at the session will be pre- Dr. Schreer believe that radiologists “We should have a uniform way to sented with 10 cases (none with pal- need to rely on a reporting lexicon describe, to categorise what we see pable lesions) and asked to evaluate that can be easily understood across on mammograms,” Schreer said. and classify each case using remote Europe. She thinks that putting control panels on their seats. To give an emphasis on the needs of clear Th e BI-RADS™ system classifi es the challenge a ‘real world’ feel, they communication in breast imaging images on a 0–6 scale: 1 = abso- will have less than a minute to reach diagnosis and reports can help to lutely normal; 2 = clearly benign their decision for each case. Schreer avoid unnecessary surgery. In 1997, lesion; 3 = probably benign lesion, and her fellow speakers will then a medical scandal shocked the Ger- risk of malignancy less than 2%; 4 = discuss the delegates’ responses. man medical community when it questionable lesion needing imme- A computer will track individual was found that 300 unnecessary diate histological examination; 5 = answers, and the participant with mastectomies had been performed highly suspicious, with a high risk the best score will win a prize; at on patients in the cities of Essen and of malignancy; and 6 = malignancy the 2006 congress, a young Polish Bochum. In the follow-up aft er the confi rmed with percutaneous radiologist won two bottles of fi ne scandal, contradictions and lack of biopsy. Austrian wine. information were given as the main Prof. Ingrid Schreer from Kiel factors that led to the disaster. Mammography of both breasts shows a “It was fun for everyone last year BI-RADS 5 lesion of the right breast. and quite eye-opening,” she said. Further information is available on (Provided by Prof. I. Schreer) “We had radiologists in training the website, www.birads.at, which 3 E – European with very little experience in breast imaging and those who were spe- Excellence in Education cialising in this fi eld. And people both over- and under-diagnosed the Breast Imaging cases we showed.”

Tuesday, March 13, 10:30–12:00, Room R2 Last year’s BI-RADS™ course drew a standing-room only crowd and had E3 1820 BI-RADS™ – Training in breast imaging: to be repeated, so attendees should What every radiologist needs to know plan on arriving in plenty of time to fi nd a seat and be able to participate • Chairman’s Introduction in the image evaluation part of the T.H. Helbich; Vienna/AT course. • Mammography I. Schreer; Kiel/DE Not everyone is willing and eager to • Ultrasound switch to BI-RADS™, however. Th e R. Chersevani; Gorizia/IT UK has its own reporting system, • MRI as do many institutions in Scandi- K. Kinkel; Chêne-Bougeries/CH navian countries. Without a strict lexicon, radiologists may use a rich, Star-like lesion with highly suspicious microcalcifi cations. (Provided by Prof. I. Schreer)

Faculty of Radiologists, Royal College of Surgeons in Ireland

Th e Faculty of Radiologists at the a Fellow of the Faculty of Radiolo- Th rough its research committee, gramme was established under the For further information on the Royal College of Surgeons in Ire- gists. Th e fi ft h year is spent on the the faculty fosters and promotes auspices of the faculty. Under this Faculty of Radiologists, Royal Col- land was established in 1961. It is Higher Training Programme for the initiation and integration of programme, a scholar from a devel- lege of Surgeons in Ireland please the professional and academic body subspecialty/fellowship experience research activity in Ireland. Its activ- oping country is appointed to view our website www.radiology.ie for clinical radiologists and radia- or on an accredited fellowship pro- ities include awarding grants and undergo complete radiology training or contact us at [email protected]. tion oncologists in Ireland. Its pri- gramme abroad. Th e fi ft h year of the development of education in in Ireland. Th ese scholars are com- mary activity is postgraduate edu- training is required for CCST certi- research skills. Th rough its higher mitted to return to their country of cation, which is conducted under fi cation. training committee, the faculty has origin aft er training and it is hoped the auspices of the National Train- developed a close relationship with that these graduates will have a sig- ing Programmes in both Radiology Apart from its role in postgraduate the academic radiology depart- nifi cant and long-term impact on the and Radiation Oncology. Th e Irish training, the Faculty of Radiolo- ments of universities in Ireland. Th is standard of services in their home Training Programme in Radiology gists is also involved in professional allows the faculty to promote the countries. Th e faculty continues to was established in 1966 and was certifi cation; accreditation of par- role of radiology within the under- represent itself abroad and to interact in fact the fi rst structured medical ticipating hospitals on the training graduate medical curriculum. with European and North American postgraduate training programme in programme; the organisation and radiological societies. Th e develop- Ireland. Since then, the programme running of continuing medical edu- Th e Faculty of Radiologists, R.C.S.I. ment and conferring of Honorary has evolved and strengthened, and cation meetings; the organisation is also involved in a number of inter- Fellowships of the Faculty has also is now a comprehensive fi ve-year of examinations; radiation protec- national activities. Th e faculty runs strengthened our overseas associa- training programme. Th e initial tion; and interaction with various a successful radiology training pro- tions and the faculty is proud of the four years consist of the Basic Radi- national bodies, including the Med- gramme in Kuwait, which was estab- list of distinguished radiologists from ology Training Programme, leading ical Council and the Department of lished in 1984. In 2004 the O’Halpin/ Europe and North America who have to the examination for admission as Health and Children. Linders outreach scholarship pro- been conferred with this honour.

myESR.org ECR TODAY 22 MONDAY/TUESDAY, MARCH 12/13, 2007 RELATED SCIENCE

2006 Nobel Prize in Medicine awarded to eminent American physicians

In December last year, the Nobel ied to mRNA and subsequently used Th e American scientists had been ference (now commonly abbreviated cause damage if they end up in the Assembly at Karolinska Institutet to synthesise proteins. Th is fl ow of investigating how gene expression to RNAi) is a catalytic process. wrong place. Many transposons awarded the 2006 Nobel Prize in genetic information from DNA via is regulated in the nematode worm operate by copying their DNA to Physiology or Medicine jointly to mRNA to protein has been termed Caenorhabditis elegans. Injecting Fire and Mello published their fi nd- RNA, which is then reverse-tran- Prof. Andrew Z. Fire and Prof. Craig the central dogma of molecular biol- mRNA molecules encoding a mus- ings in Nature on February 19, 1998. scribed back to DNA and inserted C. Mello for their discovery of ‘RNA ogy by the British Nobel Laureate cle protein led to no changes in the Th eir discovery clarifi ed many con- at another site in the genome. Part interference – gene silencing by dou- Francis Crick. Proteins are involved behaviour of the worms. Th e genetic fusing and contradictory experi- of this RNA molecule is oft en dou- ble-stranded RNA’. in all processes of life, for instance as code in mRNA is described as being mental observations and revealed a ble-stranded and can be targeted by enzymes digesting our food, recep- the ‘sense’ sequence, and injecting natural mechanism for controlling RNA interference. Th e new Nobel Laureates have dis- tors receiving signals in the brain, ‘antisense’ RNA, which can pair with the fl ow of genetic information. Th is covered a fundamental mechanism and as antibodies defending us the mRNA, also had no eff ect. But heralded the start of a new research RNA interference is used to regulate for controlling the fl ow of genetic against bacteria. when Fire and Mello injected sense fi eld. gene expression in the cells of humans as well as worms. Hundreds of genes in our genome encode small RNA molecules, called microRNAs, which contain pieces of the code of other genes. Such a microRNA molecule can form a double-stranded structure and activate the RNA interference machinery to block protein synthesis. Th e expression of that particular gene is silenced. Genetic regulation by microRNAs plays an important role in the development of the organism and the control of cellular functions.

RNA interference opens up exciting possibilities for use in gene technol- ogy. Double-stranded RNA mol- ecules have been designed to acti- vate the silencing of specifi c genes in humans, animals or plants. Such silencing RNA molecules are intro- duced into the cell and activate the RNA interference machinery to break down mRNA with an identi- cal code.

Th is method has already become an important research tool in biol- ogy and biomedicine. In the future, it is hoped that it will be used in many disciplines including clini- Craig Mello, Nobel Laureate 2006 Andrew Fire, Nobel Laureate 2006 cal medicine and agriculture. Plans are underway to develop silencing information. Our genome operates Our genome consists of approxi- and antisense RNA together, they Th e components of the RNAi RNA as a treatment for virus infec- by sending instructions for the man- mately 30,000 genes. However, only observed that the worms displayed machinery were identifi ed during tions, cardiovascular diseases, can- ufacture of proteins from DNA in a fraction of them are used in each peculiar, twitching movements. Sim- the following years. Double-stranded cer, endocrine disorders and several the nucleus of the cell to the protein cell. Which genes are expressed (i.e. ilar movements were seen in worms RNA binds to a protein complex, other conditions. synthesising machinery in the cyto- govern the synthesis of new pro- that completely lacked a functioning Dicer, which cleaves it into frag- plasm. Th ese instructions are con- teins) is controlled by the machin- gene for the muscle protein. What ments. Another protein complex, In many diseases, certain genes are veyed by messenger RNA (mRNA). ery that copies DNA to mRNA in had happened? RISC, binds these fragments. One over-expressed (that is, overactive). In 1998, Andrew Fire and Craig a process called transcription. Th e of the RNA strands is eliminated but It might be possible to alleviate these Mello published their discovery of a fundamental principles for the regu- When sense and antisense RNA the other remains bound to the RISC disorders by suppressing the activity mechanism that can degrade mRNA lation of gene expression were iden- molecules meet, they bind to each complex and serves as a probe to of specifi c genes. It is conceptually from a specifi c gene. Th is mecha- tifi ed more than 40 years ago by the other and form double-stranded detect mRNA molecules. When an attractive to use RNA interference nism, RNA interference, is acti- French Nobel Laureates François RNA. Could it be that such a dou- mRNA molecule can pair with the to treat diseases: RNA interfer- vated when RNA molecules occur Jacob and Jacques Monod. Today, we ble-stranded RNA molecule silences RNA fragment on RISC, it is bound ence is a natural mechanism and as double-stranded pairs in the cell. know that similar principles operate the gene carrying the same code as to the RISC complex, cleaved and double-stranded RNA is an endog- Double-stranded RNA activates bio- throughout evolution, from bacteria this particular RNA? Fire and Mello degraded. Th e gene served by this enous substance. RNA interference chemical machinery which degrades to humans. Th ey also form the basis tested this hypothesis by injecting particular mRNA has been silenced. – unlike antisense techniques – has those mRNA molecules that carry a for gene technology, in which a DNA double-stranded RNA molecules also been shown to give reproduc- genetic code identical to that of the sequence is introduced into a cell to containing the genetic codes for sev- RNA interference is important in the ible results. In addition, double- double-stranded RNA. When such produce new protein. eral other worm proteins. In every defence against viruses, particularly stranded RNA molecules can easily mRNA molecules disappear, the cor- experiment, injection of double- in lower organisms. Many viruses be synthesised. responding gene is silenced and no Around 1990, molecular biologists stranded RNA carrying a genetic have a genetic code that contains protein of the encoded type is made. obtained a number of unexpected code silenced the gene containing double-stranded RNA. When such So far no drugs based on RNA inter- results that were diffi cult to explain. that particular code. Th e protein a virus infects a cell, it injects its ference have been approved, but RNA interference occurs in plants, Th e most striking eff ects were encoded by that gene was no longer RNA molecule, which immediately successful animal experiments have animals, and humans. It is of great observed by plant biologists who formed. binds to Dicer. Th e RISC complex been performed and several sub- importance for the regulation of were trying to increase the colour is activated, viral RNA is degraded, stances are being tested in clinical gene expression, participates in intensity of the petals in petunias Aft er a series of simple but elegant and the cell survives the infection. trials. For example, double-stranded defence against viral infections, and by introducing a gene inducing the experiments, Fire and Mello deduced In addition to this defence, higher RNA is being tested as a means to keeps so-called jumping genes under formation of red pigment in the that double-stranded RNA can silence organisms such as man have devel- treat age related degeneration of the control. RNA interference is already fl owers. But instead of intensifying genes, that this RNA interference oped an effi cient immune defence fovea (neovascular or ‘wet’ macu- being widely used in basic science the colour, this treatment led to a is specifi c for the gene whose code involving antibodies, killer cells, and lar degeneration). Th is condition is as a method to study the function of complete loss of colour and the pet- matches that of the injected RNA interferons. common among elderly people and genes and it may lead to novel thera- als turned white! Th e mechanism molecule, and that RNA interference can severely reduce the eyesight. pies in the future. causing these eff ects remained enig- can spread between cells and even be RNA interference can also provide Blood vessels grow into and dam- matic until Fire and Mello made the inherited. It was enough to inject tiny protection against DNA sequences age the fovea, the part of the retina Th e genetic code in DNA determines discovery for which they received amounts of double-stranded RNA that can move around in the genome. that gives the sharpest image. One how proteins are built. Th e instruc- last year’s Nobel Prize. to achieve an eff ect. Fire and Mello Th ese transposons, or jumping genes, tions contained in the DNA are cop- therefore proposed that RNA inter- are present in all organisms and can continued on next page

myESR.org ECR TODAY LEISURE MONDAY/TUESDAY, MARCH 12/13, 2007 C 23

Radiology, a piano and all that jazz …

By Julia Patuzzi, ESR Offi ce ECRT: Today, are you always playing with the same group? AA: Th e actual group ‘L’AZARINE 6’ was founded in 1999. It is what Don Cherry would call Today, our series on radiologists seen from a diff erent perspective introduces a young French a ‘multi kulti’ group! Th e musicians have origins in Bulgaria, the Caribbean Islands, Argentina, radiologist from Hôpital Européen Georges Pompidou in Paris, namely Dr. Arshid Alexandre France, Turkish Safarad, and Iran, and our music mixes our native pulses coming from what Azarine. In his spare time Dr. Azarine pursues something like a second career as a jazz pianist, we’ve heard during our childhood. Jazz and rock music is the common culture we have together. not only playing privately with friends, but even performing regularly in some of Paris’s better So we play some kind of ‘world fusion’ music! For some performances we also have dancers with known jazz clubs. us, a sufi dancer, Shahrokh Moshkin Ghalam – quite famous in his scene, and a fl amenco dancer, namely Karine Gonzales. Dr. Azarine was born in Tehran, Iran in 1968 and came to France as a child. When asked about the beginnings of his piano ‘career’, he started to elaborate on his childhood and thus provided ECRT: How oft en do you practise as a group and how do you and they cope with your work- us with a touching story. load? AA: We try to practise once a week. And we usually have one performance per month. Th is ECR Today: When did you start learning to play the piano? forces you to get organised and then you suddenly realise you’ve got plenty of time. 3 hours of Dr. Arshid Azarine: I started when I was 8 or 9 years old, because my older sister was playing practice is about the same amount of time as for watching a movie or playing a tennis match. I … and I was hanging around the piano … It was in Iran before the revolution and I had a very guess we sacrifi ce some sport time or something … but still it’s not such a big deal. Th e thing is serious Armenian piano teacher (a Chopinist), he was physically huge and very strong, so I was that the three doctors in the group have got used to living this way; I know for myself that when really impressed! He took the lessons very seriously, and he wanted to prepare me for classical I was younger it wasn’t always so easy to get organised! You learn it! piano contests, especially for one regularly scheduled at the Conservatoire de Versailles. But then the revolution happened when I was 10 and for a while everything stopped. I was secretly happy as I was fed up with always having to refuse to play football or whatever with my pals and instead had to practise on the piano … However, once the revolution fi nished and my teacher hadn’t left Tehran, we started the courses again!

When I was almost 12, I went to see my sis- ter in Paris for a short September holiday, and that’s exactly when Iraq attacked Iran and the 10-year war started in that September 1980. My parents, who were in Iran, couldn’t exit the country and they asked me to stay in Paris with my sister, who was herself only 18. So the ‘exile’ years started, and of course playing piano in those days wasn’t even mentionable. My mother and then my father fi nally succeeded in Dr. Azarine & friends jamming ... joining us in Paris. I was 14 then and aft er these 2 years of privation I showed again the desire to play piano. Maybe these 2 years of infl icted privation have progressively increased the desire inside of me to play piano again, because like many other kids, I was about to ask my parents to Lost in the realms of music. stop playing piano, but some other event forced me to stop it before!

So, thanks to the insistance of my mother, I was accepted at the Conservatoire d’Ivry-sur-Seine, ECRT: Have you ever played with someone ‘famous’? where I was supported just enough fi nancially to be able to go on playing piano, and then aft er AA: We have played for Johnny Hallyday, who is very famous in France. Years ago I played in a things were going better, we rented a piano and I started to take private courses with Miss Poor- jam session with Mathieu Chedid (‘M’) who is a popular pop singer in France. torab, an award-winning pianist from Budapest. She was a real guru for me; I had 4 hours of courses per week and 6 hours of practice every day! When I started the fi rst year of medicine, ECRT: Would you tell the readers about any dreams regarding your career as a pianist? I stopped taking courses with her. I went on playing alone, some Chopin or Bach, but aft er a AA: I guess you always want to fi nd a way to touch more people, and indeed I would like to share while I started building my own group (‘chimère’ was the fi rst one) with musician friends I had my compositions and arrangements with more and more people … met through ads in student music studios. At the beginning, I was the singer and pianist and we played mostly my own compositions … Th en, aft er a while we started to become jazzy! ECRT: Do you have a favourite piece of music, to listen to and/or to play? AA: Th ere are many pieces I love to play. When playing with the group, it depends on the direc- ECRT: When did you fi rst develop an interest in jazz piano? tions you take in unison. Sometimes you are not playing one of your favourite songs, but it AA: At medical university we started building a jazz fusion band with medical and dentistry happens that the improvisation takes unexpected turns and then together you reach new spaces students. And that was when we began to play funk fusion and fi rst became familiar with jazz. and fi elds you didn’t really expect, but it still sounds good and you go on in this unexpected and Little by little we discovered jazz bands and fi nally we played in famous jazz bars like ‘Sunset’ mysterious manner. To go forward together is very exciting and can make you discover summits and ‘Baiser Salé’ in Paris. Th e bass player I’m playing with now is from this fi rst group, and that of inspiration and ‘procreation’ with your band. You can of course also create a big catastrophe makes 17 years that we have been playing together! He is now the chief of the E.N.T. (ear, nose and then try to resolve it. Th is eventuality makes it even more exciting! … Playing alone, there’s a and throat) department of a Parisian hospital. Our saxophonist is a psychiatrist we met during Persian song I have rearranged and which I like to play … I also notice that ‘Dark eyes’, the Rus- a jam session we once played at a club (not via medical links!). Th e other members of our band sian gipsy song, is a piece I like to play and ‘recook’ with diff erent fl avours every now and then! are professional musicians. Dr. Arshid Azarine is senior radiologist at the Hôpital Européen Georges Pompidou and an ECRT: Who would you call your most important infl uence and/or inspiration? instructor at the School of Radiologic Technology (IFINEM) in Paris. He is also one of the vol- AA: In classical piano I’m inspired by Bach and Prokoviev, both together! In jazz, by many. unteer doctors, medical coordinator and instructor for the French Medical Institute for Children, Let’s say that Chick Corea, Abdullah Ibrahim and the Austrian native Joe Zawinul are my most which is part of the Enfants Afghan programme of La Chaîne de l’Espoir, a French humanitarian important infl uences. organisation fi ghting birth-place injustice and providing necessary surgical care and education for disadvantaged children. continued from previous page important cause of vessel growth is healthy human volunteers and the lems remain to be solved to make Andrew Fire, born in 1959, is a US Craig Mello, born in 1960, is a US a substance called VEGF (vascular treatment did not have any serious this treatment work optimally. For citizen. Since 2003 he has been pro- citizen and a professor of Molecular endothelial growth factor). If dou- side-eff ects. example, we have to be able to get fessor of Pathology and Genetics at Medicine. Since 1994 he has worked ble-stranded RNA corresponding to the double-stranded RNA molecules Stanford University School of Medi- within the Program in Molecular the mRNA for VEGF is injected into Many RNA interference studies on into the right type of cell and the cine, Stanford, California, USA. Medicine, University of Massachu- the eye, this can decrease the amount animals and in cell cultures are also right number of those cells. It must setts Medical School, Worcester, of the growth factor and prevent new underway. In a recent study on ani- also be possible to control treatment In 1983 he took his PhD in Biology at Massachusetts, USA. He is also a vessels from invading the fovea. mals (rodents and monkeys), dou- so the double-stranded RNA is active the Massachusetts Institute of Tech- Howard Hughes Medical Institute ble-stranded RNA was successfully for the appropriate length of time. nology, Cambridge, Massachusetts, Investigator. RNA interference is also being tested used to silence a gene that leads to USA. He began his research on the as a method to combat the RS virus, high cholesterol levels. Experiments Fire and Mello have been awarded nematode C. elegans during his time In 1990 he took his PhD in Cellular which can cause severe respiratory in human cells have also shown that the Nobel Prize for their discovery of as visiting scientist in Cambridge, and Developmental Biology at Har- infections in small children. Th e RNA interference has been found to a central mechanism of gene regula- England, at the laboratory of Syd- vard University, Boston, Massachu- principle behind the treatment is reduce the activity of the AIDS virus tion. Th e future will show whether ney Brenner (Nobel Laureate 2002). setts. Before he moved to the Univer- that when the child inhales double- HIV. their fi nding will contribute to the When Fire and Mello made their key sity of Massachusetts Medical School stranded RNA, viruses in the lung development of new treatment strate- discoveries about RNA interference, in Worcester, he worked at the Fred will be inactivated and the infec- Although many experiments with gies – it looks promising. Fire was working at the Carnegie Hutchinson Cancer Research Center. tion will be terminated. To date, RNA interference have yielded Institution of Washington. one study has been carried out on promising results, quite a few prob-

myESR.org ECR TODAY st 24 MONDAY/TUESDAY, MARCH 12/13, 2007 1 LEVEL

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myESR.org ECR TODAY 2007 2nd LEVEL 25

Daily news from Europe’s leading imaging congress MONDAY/TUESDAY, MARCH 12/13, 2007 Hybrid imaging makes headway in cardiac and Inside Today oncologic imaging, but not without caveats

Th e combined functional and mor- staging and response assessment in Th ere are limitations in using PET Prof. Dr. Philipp A. Kaufmann, • Felix Fleischner phological approach to imaging diff erent types of lymphoma, accord- imaging for lymphoma, including director of nuclear cardiology at Uni- Honorary Lecture aff orded by PET/CT and SPECT/CT ing to Dr. Sally F. Barrington, head of false negative uptake in some low- versity Hospital Zurich, will present p. 26 has several far-reaching technical, the PET Imaging Centre at London’s grade lymphomas and minimal a talk on PET/CT and SPECT/CT in diagnostic, and economic advan- St. Th omas’ Hospital and a presenter residual disease as well as false posi- cardiac imaging. Kaufmann was the • ECR meets China tages, according to Prof. Dr. Gerald at Monday’s session. tive uptake in infection and infl am- senior investigator in a study that p. 27 Antoch, from the department of mation. produced the US Society of Nuclear diagnostic and interventional radiol- Accurate staging and response Medicine’s 2006 Image of the Year. • IMAGINE ogy and neuroradiology at the Uni- assessment are essential in lym- Th e four most common cancers Th e image illustrated perfusion p. 28 versity Hospital Essen, Germany, phoma to avoid toxic treatment in imaged with PET/CT at St. Vincent’s SPECT/CT’s importance for assess- and moderator of Monday’s state- patients with good prognosis and to University Hospital in Dublin are: ing low-risk patients with suspected • MR imaging of of-the-art symposium on the use of enable dose escalation for poor prog- myocardial infarction. Th e addition the abdomen PET/CT and SPECT/CT for cardiac nosis patients in order to increase • lymphoma – staging, treatment of SPECT to CTA data increases spe- p. 29 and oncologic purposes. cure rates. FDG-PET has the ability evaluation, and assessment of cifi city, mainly the ability to identify to detect metabolically active lym- recurrence the vessel responsible for causing • Arts & Culture in Vienna Regarding PET/CT, he noted that phoma independent of nodal size • non-small cell lung cancer – pre- ischemia. p. 30 the PET imaging no longer requires and has better sensitivity for extra- operative staging and assessment transmission sources because atten- nodal disease compared with CT. In of recurrence

A B C

Male patient with non-small cell lung cancer of the right lower pulmonary lobe. Infracarinal lymph node not pathologically enlarged on CT (arrow in A). FDG-PET (B) demonstrates increased glucose metabolism within the mediastinum, suggesting N2 disease. FDG-PET/CT (C) localises the area of increased tracer uptake within the infracarinal lymph node. Th us, CT falsely characterised the lymph node stage as N0, while FDG-PET and FDG-PET/CT correctly determined N2 disease. (Provided by Prof. G. Antoch) uation correction can be based on fact, PET staging alters management • colorectal cancer – preoperative SPECT/CT and PET/CT certainly developments may make cardiac MRI previously acquired CT images. In in up to 30% of adult and paediatric staging in patients with hepatic present the opportunity for a ‘one a strong competitor when imaging addition to better PET image qual- patients, she said. metastases and assessment of story shopping approach’ for cardiac morphology and function in a sin- ity, the PET examination time can possible recurrence, and imaging, Antoch said. But he added gle session, research into PET/MRI be reduced by 30% to 40%. Conse- Data are accumulating to confi rm • oesophageal cancer – preopera- that these hybrid imaging modalities hybrid scanners could round out the quently, patient throughput increases PET/CT’s effi cacy in assessing early tive staging, evaluation of treat- are not the last word. While future playing fi eld. and examination costs decrease. response to treatment. PET performed ment response, and assessment aft er two or three cycles of induction of recurrence. From a diagnostic point of view, the chemotherapy is a strong predictor of combination proves invaluable. Sup- disease free and overall survival, inde- Th ere is also increasing utilisation Junior plementing morphological images by pendent of clinical stage and other of PET/CT in patients with can- functional data vastly increases the pre-treatment prognostic indicators in cers of extracranial head and neck, Image diagnostic yield. By the same token, Hodgkin’s disease and non-Hodgkin’s breast, testes, cervix, and melanoma, because a clear anatomical correla- lymphoma. PET also has a high nega- according to Prof. Conor Collins, Interpretation tion is possible, functional PET data tive predictive value in the assessment from the department of radiology at become far more valuable. of residual masses in Hodgkin’s dis- St. Vincent’s, who will present a lec- Quiz ease at completion of chemotherapy, ture defi ning the tumours for which Th e advantages of PET, and now and reduces the number of patients PET/CT has become the reference PET/CT, mean that it has become with complete response unconfi rmed, standard. The Image Interpretation sessions, two traditional highlights of every ECR, the standard in many institutions for Barrington observed. provide both education and entertainment. He noted that there are still impor- tant underlying questions about The ‘juniors’ slogan is: ‘Emergency Room’. The panellists will be confronted PET/CT, despite its accuracy. What is with their cases just a few hours before the session, which will raise the State-of-the-Art its impact on patient management? Is suspense even more, and the moderator will guarantee a scientifically chal- it cost-eff ective? And are there other lenging and entertaining session. Symposium less expensive imaging alternatives that would provide the same infor- Monday, March 12, 08:30–10:00, Room C mation? Tuesday, March 13, 12:15–13:15, Room A

SA 13 PET/CT and SPECT/CT: Indications and limitations One area where FDG-PET has no Junior Image Interpretation Quiz in cardiology and oncology role is prostate cancer, he said. How- ‘Emergency Room’ ever, other radiotracers such as 18F- • Chairman’s Introduction choline and 18F-ethylcholine show G. Antoch; Essen/DE promise in the prostate. Research Moderator: R.A. Novelline; Boston, MA/US • PET/CT and SPECT/CT in cardiac imaging also is ongoing into new tracers for P.A. Kaufmann; Zurich/CH specifi c organs or cellular signatures. Panellists: C. Cronin; Galway/IE • PET/CT: For which tumors is it the reference standard? Th ese include 18F-ethyltyrosine for A. Dimopoulou; Uppsala/SE C. Collins; Dublin/IE brain tumours, 18F-thymidine for S. Pans; Leuven/BE • PET/CT in staging and follow-up of lymphoma cellular proliferation, 18F-DOPA O. Persiva Morenza; Barcelona/ES S.F. Barrington; London/UK for endocrine tumours, and 60Cu- K. Sklinda; Warsaw/PL ATSM for cellular hypoxia.

myESR.org ECR TODAY nd 26 MONDAY/TUESDAY, MARCH 12/13, 2007 2 LEVEL

Why thoracic imaging must evolve toward cardiothoracic imaging

By Monika Hierath, ESR Offi ce MRJ: Th e recent introduction of tinent information provided by the ECRT: How did you decide to longstanding and fruitful partnership dual-source CT and its increased numerous diagnostic tests which become a radiologist? with the group of Research & Devel- Prof. Martine Rémy-Jardin will temporal resolution opens the fi eld can be indicated for the manage- MRJ: When I started my residency, opment from Siemens, initiated 17 present Monday’s Felix Fleischner of larger applications of ECG-gated ment of respiratory disorders. In radiology was not as popular as it years ago by Prof. Jacques Rémy, is Honorary Lecture. ECR Today had MDCT examinations of the entire our specialty, we have seen not is right now among residents. My the second important aspect of this the pleasure to speak with her about thorax in respiratory patients. Initial only technological developments decision to become a radiologist motivation which has allowed us to her career and why thoracic imaging experiences have already shown that in thoracic imaging, but also in was the direct consequence of a fi rst participate in numerous investiga- must evolve toward cardiothoracic dual-source CT permits improved biological markers and pulmonary semester in this specialty, where I tions of chest disorders. imaging. morphological evaluation of tho- function tests. In such conditions, discovered its technological aspects racic organs. Coronary artery imag- it has become mandatory for each and their benefi ts for the patients. ECRT: Are you a regular visitor to ECR Today: Can you briefl y explain ing is now accessible from routine specialist to share their conclusions Having previously developed some the congress? why such an evolution is necessary? chest CT scans without the need for with the other participants of multi- interest toward pulmonology, I MRJ: Th e answer is undoubtedly Prof. Martine Rémy-Jardin: routine administration of an oral became very rapidly and logically ‘yes’, since its very fi rst meeting. Th is Before the advent of multidetec- beta-blocker. Moreover, functional interested in chest imaging. is an important meeting for Euro- tor-row CT (MDCT) technology, information is no longer restricted pean radiologists, during which thoracic CT studies were exclusively to cardiac function. New areas are ECRT: Who or what are your we can share our experiences with used for morphological assess- currently under investigation and sources of inspiration? colleagues of the same specialty ment of thoracic organs. However, promising results are expected from MRJ: I don’t know if I have ‘inspi- throughout Europe, but also with because of the low temporal reso- MDCT in the depiction of pulmo- ration’ in my professional activity. radiologists coming from all the con- lution of previous MDCT scanner nary hypertension as well as in the What I can confi rm is that I have tinents. Its evolution over years has generations, the heart and coronary investigation of lung ventilation and never seen any decline in my inter- led to its current format, appreciated arteries were excluded from chest perfusion. est for chest imaging over the last by all the attendees. Th e dynamism imaging. With 64-slice MDCT and 20 years. Th e most likely explana- of those involved in its organisation more effi ciently with dual-source ECRT: How do you see CT evolving tion is that this intellectual interest is should be acknowledged! CT, it is now possible to provide in the future? regularly stimulated by technological more morphologic information, MRJ: Developments in CT technol- developments in CT, which open new including cardiac and coronary ogy have already triggered numer- fi elds of clinical applications. Th is artery imaging, into standard chest ous changes in chest imaging, with Prof. Martine Rémy-Jardin constantly evolving link between an Monday, March 12, 12:15–12:45 CT scans, but also to include car- insights into functional imaging. imaging tool and patient manage- diac functional information from Th e future of cardiothoracic imaging disciplinary groups when the objec- ment is a great clinical stimulation. Room B the same data set. From a practical will probably see considerable devel- tive is to reach a diagnosis with the It would not have been possible to standpoint, this evolution is going opments in this direction, thanks to lowest invasive test for the patient, maintain this level of interest over Felix Fleischner – to have an important impact on further improvement in temporal especially for diffi cult cases. In our the years without strong links with Honorary Lecture clinicians’ daily practice as MDCT resolution and postprocessing tech- hospital dedicated to chest disor- all the radiologists and technologists ‘Why thoracic imaging has the potential to replace several niques, the sine-qua-non conditions ders, chest radiologists are involved working in our department, who must evolve toward additional investigations, previously for widespread clinical applications in three categories of multidiscipli- should be congratulated for the qual- cardiothoracic imaging’ necessary for their patients’ man- of functional imaging. Molecular nary meetings, focusing on thoracic ity of their daily activity and personal Dr. Martine Rémy-Jardin, Lille/FR agement. For radiologists, when- imaging, currently far from our oncology, chest surgery and inter- involvement in clinical research. Th e ever CT technology allows it, it is clinical practice, is also in the fi eld stitial lung diseases. Th ese weekly important to provide all these pieces of future developments. meetings gather chest physicians, of information from the same CT chest surgeons, specialists of pulmo- examination. ECRT: What specialty do you think nary function test, chest pathologists Curriculum vitae will eventually surpass the other in and/or radiotherapists according to ECRT: Why is it relevant to have terms of technical achievements: the category of cases considered. Martine Rémy-Jardin, M.D., Ph.D. special areas of interest make up the both morphological and functional CT or MR? was born in 1956 in Meknès, core of her published works, which assessment in the same diagnosis? MRJ: For chest disorders, until now, ECRT: How many radiologists are Morocco. She received her M.D. in comprise 166 peer-reviewed pub- What else could be achieved thanks there was a double option, namely working at the Hospital Calmette in 1981 from the Montpellier School lications, 68 postgraduate publica- to MDCT technology? precise morphological assessment Lille? How does that number com- of Medicine. From 1981 to 1986 tions, 245 scientifi c papers, 28 book MRJ: Th ere are numerous inter- of chest organs with CT and func- pare with other French University she completed her radiologic and chapters, and 4 books, of which ‘CT actions between lung and cardiac tional information with MR. Th e Center hospitals? pneumologic residency at the Uni- Angiography of the Chest’ is most function (i.e. physiological, lesional dramatic and rapid technological MRJ: In the University Center of versity Centers of Toulouse and likely the best-known. and mechanical interactions) which improvement observed with CT Lille, there are seven departments of Lille before she obtained her Spe- are important to recognise in clini- over the last few years has modifi ed radiology, each oriented in a specifi c cialty Board Certifi cation in Radi- Prof. Rémy-Jardin was on the edi- cal practice at least for three main this balance as functional imaging is subspecialty (neuroradiology; mus- ology in 1986. In the same year torial boards of Radiology (1995– reasons. Firstly, numerous acute now accessible to CT. If the industry culoskeletal radiology; paediatric, Prof. Rémy-Jardin moved on to 2000) and European Radiology and chronic respiratory diseases is able to go on with such a trend in obstetric and gynaecology; cardio- the Hôpital Calmette of the Uni- (1995–2002). She acts currently and their specifi c treatments can the coming years, there is no doubt vascular imaging; thoracic imaging; versity Center of Lille, as a fellow as journal reviewer for European lead to cardiac dysfunction, espe- that CT is going to maintain and abdominal imaging; uroradiology). in radiology until 1989, when she Radiology, European Respiratory cially at the level of the pulmonary even increase its current superiority One site of this Center is the Hospi- became associate professor of radi- Journal, Revue Française des Mala- vessels and right heart. Secondly, over MR in thoracic applications. tal Calmette, exclusively dedicated ology, and fi nally in 1991 professor dies Respiratoires, Journal de Radi- respiratory symptoms are non-spe- to the management of chest diseases, of radiology. In 1998 she was pro- ologie, American Journal of Respi- cifi c and, whereas they can reveal ECRT: Why did you choose CT as where we work. In our department of moted to her current position as ratory and Critical Care Medicine, an underlying respiratory disease, your specialty? thoracic imaging, we investigate all head of the Department of Radiol- Th orax, and Radiology. For her sig- they may also reveal the presence MRJ: Th e main reason for a chest respiratory cases referred from the ogy and Chairman of the Depart- nifi cant contributions to Radiology of an unknown cardiovascular dis- radiologist to choose CT for clini- University Hospital Center as well as ment of Th oracic Imaging at the she received the Editor’s Recogni- order. Lastly, there are numerous cal developments is that CT off ers from regional chest specialists. Th is Hôpital Calmette of the University tion Award with Special Distinc- co-morbidities, well illustrated in a more precise understanding of organisation with specifi c specialities Center of Lille. In addition Prof. tion for Manuscript Reviewing in chronic obstructive pulmonary dis- the underlying changes than MR. on diff erent (but close) geographical Rémy-Jardin received her Ph.D. in 1993. ease (COPD), now recognised as In our specialty, MR has several sites of our University Center is quite 1993 from the University of Lille. a cardiovascular disorder. In this limitations in lung imaging and it unique in France, installed more than Prof. Rémy-Jardin is a member of group of patients, chest radiologists cannot be considered as a fi rst-line 30 years ago. Prof. Rémy-Jardin names her main the Fleischner Society, the Ameri- can now provide clinicians with a examination of thoracic disorders. In the Hospital Calmette, seven senior fi elds of interest as HRCT of diff use can Th oracic Society, the Society greater deal of diagnostic informa- Th is choice for CT is undoubtedly radiologists (including 2 fellows) and infi ltrative lung diseases, interven- of Th oracic Radiology, the Euro- tion, no longer limited to the evalu- reinforced by the current evolution six residents work in the Department tional vascular procedures, cardiac pean Society of Th oracic Imaging, ation of the bronchopulmonary of CT technology. of Chest Imaging. Our team of sen- and pulmonary functional imaging, the European Respiratory Society, consequences of tobacco smoke, but ior radiologists is partly composed of and reduction in radiation dose. the Radiological Society of North currently including the detection ECRT: Th ere tends to be a growing European or American radiologists, However, the major focus of her America, the European Congress of right and/or left ventricular dys- need in radiology for a multidisci- working with us for one year of clini- research lies probably in spiral CT of Radiology, the French Society of function as well as coronary artery plinary approach. How do you cope cal research. Each academic year, this imaging, where she covers techni- Th oracic Imaging, and the French disease. with this phenomenon at the Hospi- programme allows us to work with cal developments, postprocessing Society of Radiology, for which she tal Calmette in Lille? very motivated chest radiologists techniques, and CT angiography served as President of the Scientifi c ECRT: What other developments in MRJ: Th is trend is a necessity for from diff erent countries, a very fruit- as well as multidetector CT. Th ose Committee from 1995 to 2006. CT are important? an optimal integration of the per- ful experience for all of us.

myESR.org ECR TODAY ECR MEETS CHINA MONDAY/TUESDAY, MARCH 12/13, 2007 C 27

Radiology in China continues to thrive

Besides the Czech Republic and Aus- JQ: Th e range of new equipment such logical services – what do you do to SPECT, PET and other methods such age of eligible professional radiolo- tria, the ‘ECR meets …’ programme as CT and MRI has been growing promote junior staff as well as post- as optical imaging. gists in rural areas. introduces a still more or less fast in recent years. In big hospitals, graduate education and training in Other problems are: the language ‘great unknown’ as a guest country the equipment of radiology depart- modern imaging methods? ECRT: Where do you locate future barrier in contact with western coun- – China. For European radiologists ments is taking over 35–40% of the JQ: Th e Chinese Society of Radiology trends and challenges in Chinese tries and the distortion of the salary and the ECR this provides a perfect assets of the whole hospital. Radiol- will hold 15 to 20 academic confer- radiology? system in hospitals, the actual salary opportunity to improve the under- ogy departments now play a major ences in each specialised area such as JQ: At the university hospitals of big is very low. standing and further the esteem for role in the diagnosis and treatment neuro, chest, abdomen, skeletal and Chinese cities, the range of imaging the work of the Chinese radiological of diseases, like hospitals in equipment is the same or ECRT: Groundbreaking new tech- community. Th rough this exchange, western countries. similar to hospitals in west- nologies such as molecular imaging the communication and coopera- ern countries. What they are pushing the boundaries of radi- tion between European and Chinese ECRT: Can you name need most is to reform the ology – how do you judge the impact colleagues will certainly experience some key fi gures on radio- organisation of radiology of these techniques on healthcare in major progress. logical equipment and dis- departments and commu- China? tribution in China? nicate with international JQ: Indeed, the CSR is promoting A diverse group of Chinese experts JQ: Th ere are about 5,000 colleagues, so that a new the start up of molecular imaging will highlight the talents and collec- CT and 1,000 MRI sys- generation of specialists now, and promoting international tive experience in their country and tems in China now. Most can evolve, who will be cooperation. But it can only be present a fascinating programme CT and MRI or other more suitable to develop done in a few hospitals for there is a under the heading ‘China and advanced imaging equip- the radiology department shortage of funds. Anyway, Chinese Europe: Tradition and future’. Radi- ments are in big cities. But into the next stage. radiologists will try to keep up with ology has greatly advanced in China CT and MRI scanners have But in other small hos- the development of international over the past two decades and plays become more and more pitals, especially in rural colleagues in this area despite the an increasingly important role in popular in small cities over areas, we should put our great diffi culties. medical healthcare. Th e vast cultural the last years. energy into introducing and political diversity of the Asia- current techniques and ECRT: In conclusion, please allow Pacifi c region poses many challenges ECRT: Th e amount of training the professional a personal question: What was your though, such as supplying China’s expenditure allocated to radiologists. main stimulus for choosing your 1.2 billion population with suffi cient health can be interpreted profession? medical staff . as an indicator of the gov- ECRT: Can you outline in JQ: Generally said, it is the devo- ernment’s commitment to brief the diffi culties in set- tion, responsibility and dedication. However, fi gures and statistics never healthcare – so, what rat- ting standards across such However, the environment facing tell the whole story. In an interview ing has radiology attained a heterogeneous area such Chinese radiologists is very diff erent with ECR Today, Prof. Ji Qi, Presi- in China? Prof. Ji Qi presides over today’s session ‘ECR meets China’ together as the Asia-Pacifi c region from that faced by our international dent of the Chinese Society of Radi- JQ: Th e expenditure of the with the Congress President. with its fi nancial, cultural, colleagues. ology, from Tianjing, outlines the Chinese government on and political diversity? accomplishments in setting stand- healthcare was low until now. It was interventional radiology, or some JQ: One big problem is the health- ECRT: If a good fairy were to grant ards across such a heterogeneous about 2.76 billion RMB Yuans (0.35 local regions. Th ere are 28 radiologi- care system in China. Only about you a wish for your department region – and takes a few, quite per- billion US dollars) in the last year. If cal magazines in China now. Each 10% of the people in cities could be – what would you ask for? sonal sidesteps. one has an illness, most people have province has its own CME commit- covered by the medical insurance JQ: Let us get the same conditions to pay for the treatment themselves. tee. Th e CME committee chooses the system. For farmers in poor areas it is as other international colleagues! We ECR Today: Th e beginning of radi- training courses. Each radiologist impossible to aff ord these ‘expensive’ could do it better. ology as a science has induced many ECRT: Our readers will also be must get corresponding CME credit examinations. Also there is a short- pioneers – can you give a short sur- interested in what kind of equipment hours every year. Th ey must also pass vey of outstanding Chinese pioneers Chinese clinicians tend to use: west- several exams to be senior doctors. such as Professor Zhi-Guang Xie, ern or home devices? Probably you Th e CSR will probably also hold 10 Prof. Du-Shan Rong or Zhao-Xuan can name a ratio? symposiums each year with equip- ECR meets China Wang and their contributions to the JQ: Th e biggest names in the Chinese ment companies. development of Chinese radiology? market are now GE and Siemens, Monday, March 12, 14:00–15:30, Room A Prof. Ji Qi: Th e Chinese Society of which account for more than half of ECRT: Is standardisation of national Radiology (CSR) was founded in the entire market. Other companies training still an important issue? EM 3 China and Europe: Tradition and future April 1937. Professor Zhi-Guang such as Philips, Toshiba and several JQ: Yes. But it is still the government’s Presiding: C.J. Herold; Vienna/AT Xie was the fi rst President of CSR. Chinese equipment makers, which business in China. Th at means the J. Qi; Tianjin/CN He was the fi rst Chinese Director of can produce CT and MRI equip- training system is managed by the Peking Union Hospital; before him it ment, share the rest of the market. government, not by the Radiology • Advanced MRI of prostate cancer was Professor Paul Hodges. A lot of Several joint-stock companies with Society. Of course the government M. Chen; Beijing/CN Chinese pioneers in radiology were Siemens, GE and others can export has to invite senior radiologists to • fMRI study for reorganisation of brain motor educated in his department, such as nearly 500 CT and 100 MRI systems perform the training courses. X.-Y. Feng; Shanghai/CN Jing Wu, Du-shan Rong, Qing-yang per year. • Reorganisation of speech production of Wu, Zhao-xun Wang and so on. Th at ECRT: Are there any turf battles postoperative laryngeal carcinoma patients: was the beginning of CSR’s history. ECRT: In general, the mode of with other specialties? And if so, how A follow-up fMRI study But it was stopped aft er the Japanese departments of radiology in Chinese are Chinese radiologists developing J.-Z. Yin; Tianjin/CN invasion during the Second World hospitals is quite diff erent from those a pragmatic, collaborative model to • Characterisation of psychiatric disorders War, and the inner war of China. in western countries. Can you pin- improve the situation? Q.-Y. Gong; Chengdu, Sichuan/CN At the time of war, Du-shan Rong point the deviations? JQ: Yes, there are. Th e biggest prob- trained lots of radiologists in Gui- JQ: Because of the special economic lem is in the interventional radiology yang, in the southwest of China. background aft er the ‘open’ policy, area. More and more neurological, Monday, March 12, 16:00–17:30, Room B Aft er the war, he went back to Shang- Chinese radiology departments were cardiac and other departments’ doc- hai. He was the only supervisor of usually composed of general x-ray, tors are given preference to enter 1620a How to do a successful presentation: doctors’ degrees in radiology in the CT, MRI, ultrasound, nuclear medi- this area. Th e radiologist usually From abstract to slide show south of China at that time. Th e CSR cine and other units in past years. doesn’t have much advantage in such Simultaneous translation: English ´ Chinese was rebuilt in 1951. Professor Zhao- Each unit was separated from oth- turf battles. Th is situation may be Xuan Wang was elected to be the ers. But more and more radiologists improved by exploiting new fi elds 2nd to the 4th President of CSR. He realised it was not suitable for the and integrating new medical modes, Monday, March 12, 17:30, Foyer B was the only supervisor of doctors’ training of young radiologists and such as molecular imaging. degrees in radiology in the north of the development of the department. Special Welcome Buffet for Chinese delegates China at that time. Th ere was a say- Based on the encouragement by ECRT: How is China’s radiology ing, ‘South Rong and North Xie’ to CSR, more and more hospitals have encountering the growing need for a show the situation at the time of the changed their way of working in multidisciplinary approach in radiol- 1950s to 1960s. neuro, chest, abdomen, skeletal and ogy? interventional radiology and so on, JQ: Th e radiology department has ECRT: Chinese radiology has made but still not all of them. become a major part in every hospi- great advances since its founding. tal. Some big hospitals even changed Can you explain what role medi- ECRT: Skilled staff are a main its name to ‘Imaging Department’, cal imaging plays in healthcare and premise for the implementation and and it includes all the modalities and treatment nowadays in China? maintenance of high-quality radio- staff of x-ray, CT, MRI, Ultrasound,

myESR.org ECR TODAY 28 MONDAY/TUESDAY, MARCH 12/13, 2007 IMAGINE

Biomedical Image Analysis Eindhoven University of Technology, the Netherlands

Th e Biomedical Image Analysis Cardiac Image Analysis (BMIA) group at Eindhoven Uni- Here it is all about quantitative versity of Technology is part of the image analysis: study of the detailed Department of Biomedical Engi- local deformation of the left atrium neering (BME), which is the largest wall, with high-resolution optic in the Netherlands with 500 stu- fl ow fi eld analysis from tagged MRI dents. Th e group, headed by Prof. (CSPAMM); left atrium segmen- Bart ter Haar Romeny, was estab- tation of the heart facilitated with lished in 2001, as a response to the ‘Active Shape Models’ (ASMs, sta- growing need for qualifi ed research tistical shape models extended with and education in the fi eld of medical a matching component), and the image analysis. Now 7 staff mem- heart’s microvessel analysis from bers and 17 PhD students form the cryomicrotomy (collaboration with scientifi c core, with some 20 MSc the University of Amsterdam). students spending the last year of their BME study in the group. Fundamental research to new computer vision algorithms BMIA’s research and education Th is is core business, with high-level focuses on the development of diag- mathematics. We pay great eff ort nostic workstation applications for to study human visual perception diagnostic radiology, image-guided physiology, in order to mimic its surgery and life-sciences, and is exceptionally precise layout with divided into fi ve areas: mathematical algorithms. We found new methods for feature extraction, Computer-aided Diagnosis denoising, motion quantifi cation We develop CAD methods for and enhancement. We managed, dynamic contrast-enhanced MR in collaboration with Philips, e.g. images of the breast. Static and to extract EP catheters in low-dose dynamic MR images are acquired fl uoroscopy and surfaces in low- Visualisation of muscle fi bres going through a slice of Diff usion Tensor Imaging data of a mouse heart. Note the clear helical orientation during diff usion of a contrast dose CT virtual endoscopy. Th e change. Courtesy: T. Peeters, A. Vilanova. agent in the breast tissue, expos- so-called ‘toppoints’ (prestigious ing cancerous disorders by means Dutch VICI grant to Dr. Florack) of characteristic spatial and tem- form a revolutionary and promising poral enhancement patterns. We approach to image-guided retrieval exploit pharmacokinetic multi- (PACS) and recognition (CAD). compartment modelling and pat- tern recognition techniques. Other Image-guided Surgery projects include automated detec- Neurosurgery is a complex surgical tion of pulmonary emboli, and discipline, requiring accurate plan- polyp detection in low-dose virtual ning and intra-operative navigation. endoscopy. All in collaboration Maastricht University Hospital, our with Philips Medical Systems. clinical partner, acquired a 0.15T interoperative MRI in 2005. In col- Multivalued Image Analysis and laboration with Medtronic, we focus Visualisation on the optimal pre-operative path We tackle the diffi cult problem of planning, registration of pre- to automated setting of the transfer intra-operative MR images, and the function for volume rendering, and development of (GPU based) multi- how to view complex multi-valued modal (mix of MR, CT, fMRI, DTI) data. MR Diff usion Tensor Imag- 3D visualisation. ing (DTI) measures the diff usion of water molecules in tissue, and ena- We hope to meet you at the bles the imaging of fi bre tracts in IMAGINE exhibit. All the research brain and muscle tissue. We special- topics described above (and more) ise in interactive and photo-realistic are demonstrated and carefully 3D visualisation of the fi bre fi eld, explained. And quite special: all staff bundle extraction and fi bre fi eld members and PhD students, and a segmentation. We also explore new range of MSc students have come to illustrative volume rendering tech- ECR to meet you there. niques, wondering about the eff ec- Lessons from the brain: images can also be represented by ‘toppoints’ instead of pixels, revolutionising new ways of image analysis. tivity of drawings in anatomy books. Courtesy: L. Florack, B. Platel, F. Kanters.

IMAGINE – the high-tech specialty exhibit

Aft er being absent at last year’s con- standing conferences regarding high- Th e focus is on CAD, interactive gress – and bitterly missed by many tech in radiology. visualisation, image-guided interven- delegates – a most popular feature of tions & robotics, and computer-based former meetings is reinstalled at ECR Th e main aim of IMAGINE in 2007, training. IMAGINE 2007 – IMAGINE, the high-tech spe- as well as in the following years, is cialty exhibit. to provide a platform at ECR to Th e location on the second fl oor of the Opening Hours: show new technological develop- congress venue in Foyer A is ideally Th e former IT committee of ECR, ments in the fi eld of diagnostic and suited for the presentation of IMAG- Prof. Davide Caramella, Prof. Wiro interventional radiology. In contrast INE, as it provides suffi cient space Monday, March 12 08:00–18:00 Niessen (as successor of Prof. Bart to the technical exhibition which for all groups and for discussions in Tuesday, March 13 08:00–12:00 ter Haar Romeny) and Prof. Joachim shows already available products, front of the booths. It will therefore Kettenbach, together with the ECR IMAGINE focuses on research and help to intensify cooperation and Executive Committee, decided to re- gives a preview of future evolution further contact between individuals, establish IMAGINE in 2007, since and trends. IMAGINE aspires to institutes and universities, thus add- 2nd level, Foyer A an exhibit of such quality would function as an ‘antenna’ for devel- ing to ECR’s status as a perfect meet- certainly further contribute to ECR’s opments soon to come, but not yet ing place for all those who want to be reputation as one of the world’s out- commercially available. part of the future of imaging.

myESR.org ECR TODAY nd 2 LEVEL MONDAY/TUESDAY, MARCH 12/13, 2007 C 29

Patient care in abdominal cases can improve from wider use of functional MR imaging

By Frances Rylands-Monk which can quantitate abnormalities, they can be now because treatment for the exploration of abdominal ance using an interventional system doctors will be able to establish the depended on scoring other features pathologies. for an improved prognosis. Technical advances in MRI have paved severity of a disease, its prognosis, such as number of lymph nodes and the way for functional imaging of the and treatment response. bowel wall thickness to decide on its Improved depiction of lesions not “In thermal ablation therapy, too abdomen, moving beyond simple progress. Th is cumbersome proc- seen by ultrasound or CT can now much heat kills good liver paren- morphological evaluation of disease Diff use diseases of the liver such as ess has now been replaced by a very lead to treatment by image-guided chyma around the tumour, while and in some cases proving superior steatosis, fi brosis, and iron overload easy T2-weighted sequence,” said Dr. therapy that would not be possible too little leaves some of the tumour. to multi-detector CT. With ‘quantita- that could not be staged before, can Th omas Lauenstein, assistant profes- otherwise. For example, patients With MRI, one can now monitor in tion imaging’ tools at their disposal, now be subject to accurate evalua- sor of radiology at Emory University who cannot be treated by surgery real time the heat deposition using radiologists are rethinking what they tion with functional and quantita- Hospital, Atlanta, US, who will be can still have metastases removed by the temperature dependency of the need to visualise with MR in order to tive MRI. Abdominal tumours can speaking about MRI of the GI tract. thermal ablation under MRI guid- MR signal phase,” Vallée said. answer new clinical questions. be assessed more precisely with perfusion and diff usion MRI, and Infl ammatory, metabolic, and tu m- their response to chemotherapy, our ous diseases of the abdomen can radiotherapy, and new antivascular appear on a functional, microstruc- and antiangiogenic treatments can tural, or molecular basis, and not be evaluated with increased sensi- just anatomically. Th erefore, infor- tivity. mation acquired through new MR approaches such as perfusion, diff u- Th e functional and quantitative sion, spectroscopy, or elastography capabilities of MRI in the diagnosis (which relate to vascular permeabil- of diff use liver diseases and abdomi- ity, thermal motion, chemical com- nal tumours will be demonstrated by position of lesions, and microstruc- Prof. Bernard Van Beers, professor ture of parenchymas) will become of radiology and head of the medical increasingly important in clinical imaging department at the Univer- A B practice. sité Catholique de Louvain in Brus- Biopsy of a liver mass under MRI guidance Non-invasiveness, lack of radiation exposure, and outstanding soft -tissue contrast in combina- sels, during Tuesday’s special focus (Provided by Prof. C. Becker, Geneva) tion with diff erent information provided by T1-weighted data (Figure A) and T2-weighted data Th is also means MRI can detect session. (Figure B) make MRI an ideal tool for bowel imaging. (Provided by Dr. T. Lauenstein) vascular, structural, or molecular changes, which may not have asso- “Approaches such as perfusion, diff u- ciated symptomatic changes in the sion, spectroscopy, and elastography patient to allow for earlier detection complement the assessment of dif- and follow-up. With new MR tools, fuse and focal diseases with anatomi- cal MR images, and can obviate the need for invasive procedures such as biopsy,” he said.

Th e session moderator, Prof. Luis Martí-Bonmatí, head of the MRI- Unit at Dr Peset Hospital from Valencia in Spain, thinks a greater number of patients will benefi t from these new techniques. Pharmacokinetic images resulting from the extravascular extracellular space and the plasma volume space calculations aft er contrast admin- istration in MR examination of the upper abdomen. (Provided by Prof. L. Martí-Bonmatí) “We can approach diff erent diseases from the ones we were used to with new MR tools. Liver diseases aff ect 5- Th e session aims to provide up-to- Dr. Th omas Lauenstein from Atlanta 10% of Europe’s population. 20–30% date knowledge of not only per- of these patients will benefi t, and formance and techniques, but also 25% of abdominal examinations will indications of MRI. Crohn’s disease be improved with these new tech- aff ects a large number of otherwise niques,” he noted. healthy young adults of between 15 and 35 years of age, and doc- Techniques covered in the session will tors manage the disease on a day- include T2-weighted fat-suppressed to-day basis. However, with centres imaging, which is a key sequence for still performing CT to visualise the assessment of infl ammation activ- infl ammation process, some radi- ity. In a patient with infl ammatory ologists are concerned about the A B bowel disease, the gastroenterologist accumulation of radiation exposure needs to know whether it is active in a young person who is most likely MR elastography images in patient with liver fi brosis. A: Magnitude image shows sagittal view or chronic, given that active disease to undergo long-term therapeutic of liver and right kidney. B: Corresponding elasticity map shows hepatic elasticity values of is treated with immuno-suppressive monitoring. about 5 kPa and corresponding to advanced fi brosis (F3). (Provided by Prof. B. Van Beers) medication such as cortisol, while chronic disease is treated mainly “MR is a good indication in such Prof. Bernard Van Beers from Brussels with surgery. patients. CT should not be the fi rst choice modality, especially in young Aft er a T1-weighted sequence to people with infl ammatory bowel dis- detect the presence of disease, T2- ease,” he said. Special Focus Session weighted fat-suppressed imaging sequences allow depiction of oedema Many of these new functional Tuesday, March 13, 08:30–10:00, Room C adjacent to the bowel wall. Oedema imaging techniques would not be in this location is considered to be as eff ective or productive without SF 17 Imaging of the abdomen: Where MR hits back nearly always an indication of active the latest generation of MRI scan- disease, while absence of oedema ners for real time intervention • Chairman’s Introduction means that the disease can be diag- under imaging guidance, according L. Martí-Bonmatí; Valencia/ES nosed in most cases as chronic. to Prof. Jean-Paul Vallée, professor • Technical advances and improvements of radiology at Geneva University J.-P. Vallée; Geneva/CH “Before this two-step technique, the Hospital. He will be talking about • Functional imaging decision to choose the right treat- improvements in hardware and B. van Beers; Brussels/BE ment was more diffi cult. Even three soft ware, as well as contrast agents, • MRI of the GI tract years ago, it was possible that patients particularly hepatospecifi c media, T.C. Lauenstein; Atlanta, GA/US Prof. Jean-Paul Vallée from Geneva were not followed up as eff ectively as all creating new opportunities

myESR.org ECR TODAY 30 MONDAY/TUESDAY, MARCH 12/13, 2007 ARTS & CULTURE

Cultural rendezvous Pay a visit to a founder of ‘New Music’ What’s on today OPERA By Julia Patuzzi, ESR Offi ce Schönberg’s reputation as a com- and found a job as a music teacher at Staatsoper poser striding away from tradition. the Malkin Conservatory in Boston. March 12 19:30 Moses und Aron by Arnold Schönberg, conductor Daniele Today we would like to introduce Th e triumphal première of this work From 1936 to 1944 he held a profes- Gatti, with Franz Grundheber and Thomas Moser a lesser known institution, which in 1913 brought to a temporary sorship in music at the University March 13 19:30 Manon by Jules Massenet, conductor Bertrand de Billy nevertheless is well worth a visit to silence all those critics who had for of California in Los Angeles and with Anna Netrebko, Roberto Alagna, Adrian Eröd meet one of the 20th century’s fore- the past few years rejected his steps in 1941 he was granted American Volksoper most composers. toward an expressionist New Music, citizenship. In 1947 he became an March 12 19:00 Das Nachtlager in Granada by Konradin Kreutzer calling it a result of compositional elected member of the American March 13 19:00 They will rock you – an homage to Queen (Dance) Arnold Schönberg was born in incompetence or even impotence. Academy of Arts and Letters and Vienna in 1874. As early as 1882 With the works composed between in 1951 honorary president of the CLASSICAL MUSIC he took his fi rst violin lessons and 1907 and 1913, Schönberg entered Israeli Academy of Music in Jerusa- Konzerthaus made his fi rst attempts at compos- music history. Th ey are the source lem. Schönberg died in Los Angeles March 12 19:30 Gidon Kremer, violin & Oleg Maisenberg, piano ing. Aft er fi nishing school in 1890, documents of what has since been on July 13, 1951. F. Schubert, A. Webern, V. Silvestrov he started to train as a clerk in a bank called ‘New Music’. March 13 19:30 Orchestre National de Lyon, conductor Jun Märkl J.-Y. Thibaudet, piano O. Messiaen, G. Gershwin, M. Ravel Musikverein March 12 19:30 Thomas Quasthoff & Band featuring Till Brönner, A Jazz Dream March 13 18:30 Ensemble Wien F. Schubert, C.M. Ziehrer, J. Strauß

JAZZ Porgy & Bess March 12 20:00 Pat Martino Quartet (USA)

THEATRE Akademietheater March 12 20:00 Effi Briest by Theodor Fontane March 13 20:00 Die Unvernünftigen sterben aus by Peter Handke Burgtheater March 13 20:00 Kleinbürger by Maxim Gorki Odeon March 12/13 20:00 Com di com com by U. Kaufmann and E. Piplits Rabenhof March 13 20:00 Galanacht by Werner Schneyder Schauspielhaus March 12/13 20:00 Der Ubu-Komplex by D. Maayan inspired by A. Jarry Theater in der Josefstadt March 12/13 19:30 Das Fest by Thomas Vinterberg Volkstheater March 12 19:30 Liebelei by Arthur Schnitzler March 13 19:30 Cabaret by Masteroff / Kander / Ebb / Walker

A place of inspiration: the study of Arnold Schönberg, master of dodecaphony. Culinary treats and worked for a private bank until In music history his name is associ- In 1997, in memory of this true gen- 1895. In 1894, being a member of the ated with two epic inventions: the ius of modern music, the Arnold Dip into the Austrian literary classic reviewed on the right and you may find out amateur orchestra ‘Polyhymnia’, he renunciation of tonal composition, Schönberg Center was founded for yourself about the secret of today’s culinary recommendation. It was the met his future teacher and brother- in the wake of the ‘emancipation by the City of Vienna, together eponymous Auntie Jolesch’s specialty, coveted and dearly loved by her friends in-law Alexander Zemlinsky. In the of the dissonance’ in expression- with the Internationale Schönberg and relatives. following years, Schönberg devoted ist atonality around 1910 and, a Gesellschaft . Aft er the collection was himself mainly to composing and dozen years later, the development moved from Los Angeles, the archive directing workers’ choirs. In 1901, of ‘composition with twelve notes was made available to researchers, upon the recommendation of Rich- related only to each other’ (i.e. not composers, musicians and the gen- Krautfleckerln ard Strauss, he got a job as musical based on a common tonic note), 12- eral public. Th e collection contains director at the Berlin cabaret ‘Über- tone music or dodecaphony. Th ese approximately 9,000 pages of musi- (Pasta Squares with Cabbage) brettl’ and in 1902 taught composi- compositional innovations are cer- cal manuscripts, 6,000 pages of text tion at the Stern Conservatoire. In tifi ed by works of the highest rank, manuscripts and 3,500 historical Ingredients 1903 he returned to Vienna, where their possibilities having been artis- photos, as well as personal docu- for 4 servings he set up as a composer and teacher tically proven beyond all theory and ments, diaries, concert programmes, 7 oz. pasta squares of composition. explicit poetics. his entire library (music, books and 21 oz. white cabbage, without stem and outer leaves recordings) and a replica of Schön- 5 ¼ oz. onions Among the pupils he taught at the In 1933, the year the National Social- berg’s study in Los Angeles. 2 oz. granular sugar progressive ‘Schwarzwald-Schule’ in ists took over power, Schönberg was 8 tablespoons oil or fat Vienna were Alban Berg and Anton excluded from the Berlin Academy. For a close encounter with Schön- salt Webern. Schönberg drew upon his He emigrated to the USA via Paris berg’s music visit the State Opera black pepper, ground experience of teaching to produce which tonight presents ‘Moses a little broth or water his ‘Harmonielehre’ of 1911. Apart und Aron’. from working as a composer, he also turned to painting from 1907 and Cook the pasta squares in plenty of salted water until al dente, sieve, refresh in contributed to the almanac ‘Der blaue Palais Fanto ! cold water, leave to drain. Reiter’ published by Wassily Kand- 1030 Vienna Heat the oil or fat, add the sugar and caramelise until quite brown, add the insky and Franz Marc. Around this Schwarzenbergplatz 6 fi nely sliced onions, fry well. time he published the fi rst of a string www.schoenberg.at Cut the cabbage into squares of approx. 1/2”, add and fry, pour some broth of epoch-making compositions. or water underneath, season with salt and pepper, stew until tender but still Opening hours: crunchy (approx. 30 minutes), take care to keep dry. Th e ‘Gurre-Lieder’, a masterwork Monday – Friday Reheat the pasta squares, salt and pepper, and mix with the cabbage. lyrically founded in a turn-of-the- Genius at work: 10:00–17:00 Best served with: lettuce

century musical world view, secured Arnold Schönberg composing. © Arnold Schönberg Center Vienna (2)

myESR.org ECR TODAY ARTS & CULTURE MONDAY/TUESDAY, MARCH 12/13, 2007 C 31

Places to see A place for remembering – the Jewish Museum of Vienna

By Julia Patuzzi, ESR Offi ce for remembering’, thus enabling the international breakthrough. Th e as of ‘Josephine Mutzenbacher’, the A memorial by the English sculptress visitor to view Austrian history from Jewish Museum Vienna is devoting only German-language ‘classic por- Rachel Whiteread marks a second In line with today’s literary recom- the angle of a specifi cally Jewish his- an exhibition to the works of these nographic novel’, is one of the most place of remembrance on Juden- mendation, a portrait of the pre- tory. ‘Memory’ is present on all four three artists. It focuses for the fi rst successful Austrian writers in the platz, a few minutes walk from the dominantly Jewish artistic scene of fl oors of the Jewish Museum Vienna. time on the Jewish themes in their world. As a theatre and cinema critic museum. It is a reinforced concrete fi n-de-siècle Vienna, we introduce It is a key to Jewish culture and per- paintings. Th ey reference the art- and as screenwriter, cabaret enter- cube with a base of 10 by 7 metres to you today a very special place of meates the museum right down to ists’ own Jewish roots and the indi- tainer, operetta librettist, travel writer, and a height of 3.8 metres, the outer interest. the smallest detail. But remember- vidual and collective experiences author of children’s books, president sides of which are in the form of ing also means active confrontation, aft er 1938 and in the early years of of the Austrian PEN Club, art critic library shelves. Around the bottom In 1993 the Jewish Museum of and the museum is therefore a place the Second Republic. Th e exhibition and translator, he was instrumental of the monument are engraved the Vienna opened its doors at Pal- to meet, communicate and discuss. is an attempt to confront the works in shaping the culture of his time. Th e names of the places in which Aus- ais Eskeles, close to St. Stephen’s Apart from the exhibitions, it off ers of Brauer, Fuchs und Hundert- life and works of Felix Salten provide trian Jews were put to death during Cathedral. Th e museum houses a a wide range of symposia, lectures, wasser in a new way that disregards an exceptional and typical refl ection the Nazi regime. Situated below are permanent historic exhibition on panel discussions, concerts and old rivalries. It includes around 60 of the major themes of Austrian and three exhibition rooms on medieval Austrian-Jewish history and a per- many other events. outstanding early paintings, while Jewish history, including the question Jewish life in Vienna and the exca- manent exhibition on Jewish reli- documents on the survival of Brauer of Jewish identity in an era of liberal vations of the medieval synagogue, gion. Th e museum’s comprehensive A special exhibition entitled ‘FAN- and Hundertwasser in Vienna and assimilation, cultural modernisation which show the religious, cultural inventory is on display continually TASTIC. Jewish Elements in Early on the emigration of Ernst Fuchs’ and Zionism. Th e exhibition takes and social life of the Viennese Jews and accessible to the public. On Masterpieces by Arik Brauer, Ernst father to Shanghai shed light on the a biographical approach showing of the Middle Ages until their expul- the second fl oor of the museum Fuchs, and Friedensreich Hun- biographical background and its Salten, his works and his era, while sion and death in 1420/21 during the special exhibitions on diff erent top- dertwasser’ is now on show in the vital infl uence on the work of these cross-referencing themes such as First Viennese Gesera, as it is called. ics from Jewish cultural and intel- museum. Arik Brauer and Ernst exceptional artists. eroticism, urban culture, Zionism lectual life, literature, architecture, Fuchs are two central fi gures in an and physiognomy. Th e documenta- Jewish Museum of Vienna photography, and art are shown. Th e art movement known as the ‘Vienna Another special exhibition is dedi- tion is illustrated by private photos, 1010 Vienna, Dorotheergasse 11 museum defi nes itself as an ‘Austrian School of Fantastic Realism’. In the cated to ‘Felix Salten. Writer – Jour- stills from Salten fi lms, Salten’s letters www.jmw.at memory’. Accordingly, the historical 1960s, together with Friedensreich nalist – Émigré’. Felix Salten (1869– to Hofmannsthal and Schnitzler, and Opening hours: exhibition will function as a ‘place Hundertwasser, they achieved an 1945), the author of ‘Bambi’ as well paintings, costumes, posters, etc. Sunday – Friday 10:00–18:00

Literary encounters On the traces of a Viennese original

By Nils Jensen, Viennese author, merfrische’. Th e eponymous Auntie haus runs like a thread through all Besides portraying Sommerfrische, Buchkultur Jolesch was one of an omnipresent these stories, described in details grumpy eccentrics, close and less kind in those days, as were the many and in anecdotes, as background to close male and female relatives, Kaf- Not too long ago, Viennese citizens real people portrayed; days when a story, as a very particular institu- feehaus, card games, and culinary did not go on holidays but on ‘Som- one of the hot topics discussed was tion, which belonged to the Vien- trips, Torberg resolves the old dis- merfrische’, a term which seems where ‘better German’ was spoken nese (and Prague and Budapest) way pute about the Sachertorte – who impossible to translate and which and written, in Prague or Vienna. of life in those days like the air they owns and produces the ‘original’ means something like ‘a refresh- Aft er all, some of the most emi- breathed. Torberg stated that it is the one and who the ‘genuine’ one: the ing sojourn in the country’. Author nent German-language authors of ‘functioning legends’ that determine world-famous Hotel Sacher or the Friedrich Torberg, a ‘born Viennese that time came from Prague, such the character of Vienna, and the legendary imperial bakery Demel? and trained Austrian’, elaborates on as Franz Kafk a, Anton Kuh, Franz most complicated legend is the Vien- An arbitral award made with a twin- this sojourn and what it conveys Werfel and Egon Erwin Kisch. nese Kaff eehaus. Th e author expa- kle in the author’s eye, a reader’s in his book ‘Auntie Jolesch or Th e tiates on this topic on many, many delight, satisfying for gourmets as decline of the occident in anecdotes’. Torberg presents these famous men pages as you read smiling, with a well as for gourmands. Th e term ‘decline’ must not be taken as well as the legendary summer frown, amused and thoughtful, only Friedrich Torberg ! too seriously, though. In a nostalgic resort Bad Ischl, where Emperor to fi nally reach the conclusion that Translation by Julia Patuzzi, ESR Die Tante Jolesch way, Torberg tells about the ‘decline’ Franz Joseph traditionally spent his exquisitely defi nes the spirit of the Offi ce Langen Müller of circumstances, ways of living, summer holidays – if you could call Kaff eehaus as slovenly, impregnable The book is available in English, oddballs and eccentrics, and certain it holidays, for an Emperor. And, of and inimitable. German, Italian and Czech.

© Jüdisches Museum Wien experiences like the fabulous ‘Som- course, the typical Viennese Kaff ee-

myESR.org ECR TODAY ND 32 MONDAY/TUESDAY, MARCH 12/13, 2007 2 LEVEL

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IMAGINE ePACS WORKSHOP “DANCING WITH WORKSTATIONS”

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