To Be Alarmed Or Not Be Alarmed Over Gadolinium Contrast Agent Revelations? That Is the Question

ECR TODAY 2017 EUROPEAN CONGRESS OF RADIOLOGY

DAILY NEWS FROM EUROPE’S LEADING IMAGING MEETING | FRIDAY, MARCH 3, 2017

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HIGHLIGHTS CLINICAL CORNER TECHNOLOGY & RESEARCH COMMUNITY NEWS Facial genetics and forensics Radiation dose concerns in Manufacturers provide glimpse European Radiology: take centre stage paediatric cases propel PET/ into CT’s bright and 25 years of excellence at ECR MRI into more widespread dynamic future clinical use

BY KATRINA MEGGET To be alarmed or not be alarmed over gadolinium contrast agent revelations? That is the question. The medical imaging community should not develop a gadolinium phobia while waiting for guidance from regulators over controversial gadolinium contrast agents. This is the opinion of Dr. Howard Rowley, Joseph Sackett Professor of Radiology at the University of Wisconsin, U.S., who will speak at today’s key session on MRI contrast agents.

“There is understandable concern community was drawing parallels around the recent discovery that but gadolinium is, and should be, between gadolinium deposition gadolinium deposits in the body – a expected to deposit in various tissues and nephrogenic systemic fibrosis finding that has rattled radiologists. in the body and, based on what we (NSF), which is unrelated. Such par- Gadolinium is a toxic heavy metal know about other metals, it’s not a allels are unfounded, he continued. not normally found in the body, but case for alarm. It doesn’t necessarily “The important point is this is diffe- when chelated to reduce toxicity, it imply a toxic effect,” he told ECR Today rent to NSF, which can cause tissue becomes a powerful contrast agent in advance of the congress. injury and harm. But we shouldn’t for MRI scans and has vastly impro- Other metals critical for normal infer similar mechanisms in the ved the imaging of body organs and physiology have also been found body between the two.” tissues. It has been used success- to deposit in the body, and this can The debate has become heated fully for years, with eight agents provide insight into the ‘imaging as unanswered questions abound approved for use. However, the ele- A B curiosity’ seen with gadolinium, and confusion reigns, with pressure ment has found itself in the middle he explained. Animal and human on regulators to decide a position of a scientific controversy after it Two images of a patient prior to (A) and after (B) nine injections autopsies have shown, to date, no on contrast agents. Overall, the was discovered that patients with of the linear gadolinium-based contrast agent Magnevist. The tissue injury at the sites where risk/benefit ratio was still largely renal failure who had been admi- image prior to injection shows no hyperintensities displayed in gadolinium deposits, he added. “At in favour of using gadolinium, but nistered gadolinium for scans were the dentate nucleus, while a clear signal intensity increase in the the levels of tissue deposition we’re Rowley acknowledged more rese- at increased risk of developing the dentate nucleus becomes visible after nine injections of Magnevist. seeing, it’s not toxic and there are no arch and observation were requi- condition NSF, which involves the (Provided by Dr. Alexander Radbruch, head of neuro-oncologic symptoms associated with them.” red, adding there is cause for cau- thickening and scarring of the skin imaging, University Hospital Heidelberg, Germany) Rowley, who is president of the tion but not alarm. and internal organs. American Society or Neuroradio- At today’s session, he intends to logy, is concerned the radiology speak about the preclinical data continued on page 3 myESR.org #ECR2017 Hitachi Medical Systems Europe Holding AG, Switzerland ECR TODAY | FRIDAY, MARCH 3, 2017 HIGHLIGHTS 3

continued from page 1 definitive, proven associated sym- tain agents. Or they could remove groups based on the strength of Regulators are faced with a tough ptoms”, despite several papers sug- some agents from the market. In chelation. Instead, he suggested that decision. In the meantime, radiolo- Further research has since revea- gesting symptoms associated with Europe, the EMA is likely to pursue radiologists view all agents as sour- gists will be waiting. Today’s session led that some of the agents can gadolinium deposition. Secondly, one of the two latter courses.” ces of deposition and consider all should provide clarity on the current undergo dechelation in patients with the radiology community is arguing The problem is there is no easy variables and specific applications landscape and thinking on gadolini- normal renal function, resulting in over which of the approved agents answer, he said. For example, where when choosing which agent to use. um-based contrast agents with an gadolinium deposits in the brain are implicated in gadolinium depo- do the regulators draw the line bet- “It would be premature to con- overview of the research to date, as and other body tissue. The findings sition and how they should be trea- ween agents if they were to place clude one agent is better or safer well as a discussion on dealing with have shocked the imaging commu- ted by the regulators. restrictions, and were they to go for over another. I don’t think the data the challenges facing radiologists nity – what had been go-to contrast The agents can be classified into the third option, how would they are there yet,” he said. using these contrast agents. agents are now being viewed with three general groups, Runge explained: decide which agents to remove and some caution. With studies thin on the non-ionic linear agents (Omniscan in what time frame? Furthermore, the ground and numerous unanswe- and OptiMARK), which are more likely could the manufacturers of the Special Focus Session red questions, radiologists have been to undergo dechelation and have been remaining agents increase supply left confused over how to approach implicated in gadolinium deposition; to meet the shortfall in the market? Friday, March 3, 16:00–17:30, Room M 4 the eight approved agents. Both the the ionic linear agents with medium “These are not insignificant pro- SF 12c Gadolinium contrast agents: a Yin and Yang story European Medicines Agency (EMA) stability (Magnevist, MultiHance, Pri- blems,” said Runge, who will review and the U.S. Food and Drug Adminis- movist); and the macrocyclic agents the published clinical papers in »»Chairman’s introduction tration (FDA) are expected to clarify (Dotarem, Gadavist, ProHance), which today’s session. “The question most B. Hamm; Berlin/DE the situation and provide guidelines are the most stable and least likely to likely comes back to the agents »»Latest preclinical data on gadolinium deposition for use in 2017. dechelate. in the middle – should they be H.A. Rowley; Madison, WI/US The issue has become contro- “The regulators could do one of withdrawn or be limited? This is »»Current clinical situation based on published data versial for two main reasons, said three things,” he explained. “They an ongoing discussion by medical V. Runge; Berne/CH Prof. Val Runge, professor of radio- could do nothing – say it’s too early authorities across the world.” »»What is the position of the regulatory authorities? logy and physician at Bern Univer- and recommend more studies. They Rowley, however, is of a different O. Clément; Paris/FR sity Hospital, Switzerland. Firstly, could take an intermediate position mindset, believing it is unhelpful to he said, “at this time, there are no where they put restrictions on cer- segregate the different agents into »»Panel discussion: After all that, what are you doing?

BY MÉLISANDE ROUGER Specialist in new imaging technologies to deliver honorary lecture today

In recognition of his achie- of radiology at UMC Utrecht, the Prof. Prokop has authored more multislice CT of the body. He has vements in new imaging Netherlands. than 250 articles in peer-reviewed served on several industry advisory technologies, particularly in He received his bachelor of scientific journals, 50 book chap- boards and scientific committees, cardiovascular and thoracic science in physics from Phil- ters, 300 scientific abstracts, and and has served as vice chairman of applications, Professor Math- ipps-Universität Marburg and 300 invited lectures. He has also the Dutch Radiological Society. ias Prokop from Nijmegen, the trained as a radiologist at Hanover published a textbook on spiral and Netherlands, has been invi- Medical School in Germany. In 1998 ted to deliver the Josef Lissner he was appointed associate profes- Honorary Lecture ‘The future sor of radiology at the University Honoraray Lecture of CT: from hardware to software’ of Vienna Medical School, Austria. Professor Mathias Prokop from today at the ECR. His main research interests are Friday, March 3, 13:00–13:30, Room A Nijmegen, the Netherlands, Mathias Prokop is head of the body imaging with a special focus Josef Lissner Honorary Lecture will deliver the Josef Lissner department of radiology and nuc- on multislice CT and new imaging Honorary Lecture today at lear medicine at Radboud Uni- technologies in cardiovascular and »»The future of CT: from hardware to software 13:00 in Room A. versity Nijmegen and professor thoracic applications. Mathias Prokop; Nijmegen/NL

DON’T MISS TOMORROW’S JOINT ESR AND CIRSE SESSION ON INTERVENTIONAL PROCEDURES!

Saturday, March 4, 08:30–10:00, Room Z

Joint Session of the ESR and the CIRSE (Cardiovascular and Interventional Radiological Society of Europe) Interventional procedures: clinical patient management

Moderators: E. Brountzos; Athens/GR L. Donoso; Barcelona/ES »»Chairmen’s introduction E. Brountzos; Athens/GR L. Donoso; Barcelona/ES »»BEFORE: pre-intervention procedures and protocols C. Binkert; Winterthur/CH »»DURING: patient management, communication, time out procedure ... J.I. Bilbao; Pamplona/ES »»AFTER: patient follow up and discharge procedures O.M. van Delden; Amsterdam/NL »»The role of radiographers and nurses in the interventional radiology suite: tasks and duties C. McLaren; London/UK »»Discussion

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Cardiovascular and Interventional Radiological Society of Europe ECR TODAY | FRIDAY, MARCH 3, 2017 HIGHLIGHTS 7

BY MÉLISANDE ROUGER Facial genetics and forensics take centre stage at ECR Forensics and facial genetics will be in the spotlight at ECR 2017 as the ‘ESR meets Belgium’ session offer a look at medical imaging’s most original contributions to healthcare and crime investigation.

tical twins, who share the same (DVI), a field in which he has gained CT also helps to find relevant DNA profile and almost the same experience ever since he worked in information for the ongoing medi- face. Physical features also influ- the aftermath of the Tsunami in colegal investigation; the modality is ence your brain, the way you think. Thailand in 2004. used to help identify traces from the A lot of facial characteristics are CT is important in DVI and its blast such as objects from the explo- shared, for example in Down’s syn- use depends on the on-going disas- sives. The injury pattern helps to drome patients, who present with ter, he said. determine the cause and manner of the same features whether they are “During the MH17 Ukraine plane death. When pathologists and radio- European or Asian,” he explained. crash in 2014, CT was very useful for logists can provide this information The link between genetic disor- victim identification. After the terror it can help police with the inquiry. ders and facial genes has been of attacks in Brussels airport in Zaven- Protocols can change according to interest to scientists for a while, but tem in March 2016, CT helped us not the situation and the forensic team research is slow and tedious. only with the identification but also must adapt to local circumstances. Claes became interested in facial later with the enquiry,” he said. “In Thailand I could choose between genetics after working in cranio- Develter and his colleagues were ventilation or lighting. It was more facial morphometrics to help cor- responsible for the triage after the than 36 degrees in the morgue; I had rect morphological abnormalities MH17 plane crash. They opened the some air or light but no electricity and anomalies, and in craniofacial coffins that came from Ukraine, for both,” Develter said. reconstruction to identify victims. inventoried the contents and selec- In Europe, DVI teams can con- To help decipher facial genetics, ted which bodies would go to a spe- tract mobile CT scans anywhere Claes uses the computer-based cific identification chain (full ‘classic’ and receive the material within craniofacial reconstruction pro- identification or body fragments for 24 to 36 hours. These services are gramme he developed for victim anthropology and DNA sampling), typically used for clinical purposes identification, and combines 3D in order to optimise and accelerate in hospitals that need CT examina- surface processing, statistical the identification process. Before tions once or twice a week but have modelling, analysis, mapping and this triage, a CT examination was no budget to purchase a scanner. prediction techniques. He has also performed to facilitate the opera- Regarding DVI and terror attacks created an array of algorithms and tion and identify important objects Develter is also responsible for the software for investigators who such as personal belongings, pro- education of the forensic patho- plan to use 3D facial datasets. Last stheses, shrapnel, or explosives. logists in his department and is year, he also co-organised the first “Despite the advantage of CT involved with the national Crisis international workshop on facial the coffins had to be opened and Centre of Internal Affairs. genetics in London. soon the biohazard risk appeared. In his lecture, he will insist on the The challenge in using images During the amateurish recovery of necessity for pathologists within for the study of facial genetics is to the bodies in Ukraine, chemicals DVI teams to be properly trained, focus on and measure the right ele- were used for body preservation through standard exercise and ments, for instance the space bet- (a toxic and lethal dose of formal- simulation, to extract the maxi- ween the nose and upper lip. Claes dehyde was measured) and appa- mum information from the crime or analyses the nearly 10,000 faces in rently some bodies had remnants disaster scene and the subsequent his database in combination with of toxic rocket carburant. After the investigation of the victims. “If your imaging of brain genetics and blood necessary safety measures, our job pathologist is not trained well, cru- vessel structures in the brain, such continued,” he said. cial information can be lost,” he said. as the circle of Willis. Instead of analysing voxels, which “would take forever”, he ESR meets Session relies on powerful software to map voxel images spatially, as shown in Friday, March 3, 10:30–12:00, Room B the images illustrating this article. ESR meets Belgium “Facial genetics can be useful EM 1 Emergency radiology in both genetics and forensics, by predicting genes from the face and Presiding: G. Villeirs; Ghent/BE faces from the genes, and more glo- P.M. Parizel; Antwerp/BE bally the link between the face and »»Introduction DNA points to the whole area of per- G. Villeirs; Ghent/BE sonalised medicine,” Claes added. “We try to find genes associated »»Additional value of dual-energy CT in abdominal emergencies with brain morphology and faces. E. Danse; Brussels/BE Advanced decomposition of brain MRI or facial 3D surface images And for faces, we try to predict the »»High-end CT imaging in forensic medicine: experience after into modules, tailored for associations with underlying genetic vari- face from genetics, which is use- recent Brussels terror attacks ations. Images provided by Dr. Peter Claes. ful for identification in relation to W. Develter; Leuven/BE crime scenes, in forensics and DNA »»Interlude: Imaging Belgian food Dr. Peter Claes from Leuven, Bel- Electrical Engineering department matches,” he said. K. Verstraete; Ghent/BE gium, will present his work in facial at Leuven Catholic University. Victim identification will also be genetics in a session titled ‘Imaging He uses CT, MRI and 3D surface the focus of Dr. Wim Develter’s talk »»Imaging genetics and beyond: facial reconstruction and genetics and beyond: facial reconst- imaging modalities to grasp the link on high-end CT imaging in forensic identification ruction and identification’. between people’s appearance and pathology. P. Claes; Leuven/BE Claes is a senior research expert underlying genetic variations. A forensic pathologist at the »»Interlude: The Belgian Museum of Radiology in the Medical Image Computing “Your appearance is genetically University Hospitals of Leuven, Dr. R. Van Tiggelen; Brussels/BE research group of the Processing of driven. In families there’s a strong Develter will highlight the role of »»Panel discussion: Acute pathology: emergency radiologists Speech and Images division of the link, even more so between iden- CT in Disaster Victim Identification or organ subspecialists?

myESR.org #ECR2017 Hitachi Medical Systems Europe Holding AG, Switzerland ECR TODAY | FRIDAY, MARCH 3, 2017 CLINICAL CORNER 9

Patient safety: how to manage Clinical decision support can help Experts to provide insights into new radiation incidents and accidents improve patient outcomes procedures to diagnose and treat 11 12 13 lymphatic disease

BY BECKY MCCALL Radiation dose concerns in paediatric cases propel PET/MRI into more widespread clinical use As research on PET/MRI gathers momentum, stakeholders eagerly await news on outcomes and solid evidence of the benefits. Today’s New Horizons session promises to offer insight into how the latest evidence stacks up and what developments can be expected in the future.

during cancer therapy is all the more residual tumour or post-operative I think there is an impact but this important because they are more change – trauma or bleeding, for has not been shown, which is why radiosensitive and have a longer life example. Choline PET is being used PET/MR is not being used in the cli- expectancy than adults. If young to study the rim of the tumour site nical setting yet,” he said. “Also, with patients are being cured, then the to see if there is metabolic activity; the exception of Japan, there are no chance of getting a secondary effect if there is increased choline uptake, guidelines worldwide to push this of the treatment is much higher. then this suggests residual tumour. technique into routine use.” “If we can find an alternative Clearly, an ongoing challenge is Turning to the research that he means of reducing exposure to radi- to convince hospital managers to had been involved in, Andreisek ation during diagnosis or staging purchase a PET/MR machine, given said that his group had used PET/ then that’s a sensible thing to do,” its high price compared to a stand- MRI to help delineate the borders of he emphasised. alone MRI scanner, he noted. the soft tissue tumours much more Most paediatric radiologists work Prof. Dr. Gustav Andreisek, precisely and to define which part on the principle that even a small head of radiology at Canton Hos- of the tumour has the highest cell amount of radiation exposure puts pital, Munsterlingen, and profes- turnover. This helps to direct biopsy a child at increased risk, and there- sor of radiology at the University and/or radiotherapy appropriately fore they use the lowest reasonably of Zurich, Switzerland, shared at the most aggressive tumour cells. achievable exposure. Because PET/ his thoughts with ECR Today on All in all, he thinks radiology has MRI reduces radioactive exposure the value of PET/MRI in musculo- a strong tool with PET/CT and MRI considerably, it is an attractive skeletal imaging. alone and that it was necessary to option for imaging in children. “This is a promising technique, ask what additional benefits were From a research perspective, but we need to better define its offered by PET/MR. Humphries uses PET/CT for many of application and provide evidence “It’s an interesting technique, fast the haematological malignancies that of outcomes,” he noted. “Most developing with great potential and come his way, but much of his current countries are likely to experience application, but as yet, radiological work is on lymphoma, with the aim reimbursement issues with PET/ societies have not been in a position of determining whether PET/MRI MR because providers will not be to declare PET/MRI as a state of the is equivalent or non-inferior to PET/ prepared to pay more for new tech- art technique,” he said. CT. He said he would prefer to avoid nology unless it improves patient using CT for anatomical and attenua- outcomes.” tion correction for the PET scan. Reflecting on the evidence base for At today’s session, he intends to PET/MRI, Andreisek said much of the discuss some of the preliminary research to date was technical, and as findings of the study he is leading yet removed from the clinical setting. on PET/MRI in children with lym- “The main question is whether phoma. Previous research on PET/ we enhance patient care with it. MRI in lymphoma has yielded encouraging results, but Humphries’ Coronal whole body PET/MR image shows a patient with team is assessing PET/MRI perfor- New Horizons Session mediastinal lymphoma. (Provided by Dr. Paul Humphries) mance for both staging/restaging and assessment of response to the- Friday, March 3, 16:00–17:30, Room B “We are using PET/MR hybrid medical needs in paediatric onco- rapy in order to investigate whether NH 12 The increasing clinical impact of MR/PET imaging as part of our clinical trial logy. Historically, a child with can- it is as good as PET/CT. protocol and from an a priori stand- cer very often had a devastating “If patients don’t respond well to »»Chairman’s introduction point it makes sense to say that it terminal illness, but over the past chemotherapy they will need radi- L. Umutlu; Essen/DE works, but we need to prove that 20 years survival of children with otherapy so it is an important point »»MR/PET in paediatric oncology? before we dive in and start using it cancer has changed dramatically. in their management,” Humphries P.D. Humphries; London/UK routinely,” said Dr. Paul Humphries, “With lymphoma there is an over said. “Our current impression is »»MR/PET in cardiac imaging? paediatric radiologist at Great 90% cure rate, so it is no longer the that staging will be as good as PET/ M. Dewey; Berlin/DE Ormond Street Hospital and Uni- automatic death sentence it once CT, but the real question relates »»MR/PET in head and neck imaging? versity College Hospital, London, was. Even for the more aggressive to how the response assessment M. Becker; Geneva/CH adding that the technology’s main tumours in smaller children, like stacks up.” appeal in paediatrics is the lower Wilm’s tumour, survival has really Another benefit of PET/MRI is »»MR/PET in musculoskeletal imaging? radiation dose required. improved,” Humphries said. in delineating whether abnormal G. Andreisek; Munsterlingen/CH In his ECR talk, he plans to high- Under these conditions, the radi- signal around operated sites in the »»Panel discussion: Are we ready to fully integrate MR/PET light why PET/MRI meets unmet oactive dose that children receive central nervous system represents into clinical diagnostic work-up?

myESR.org #ECR2017 10 CLINICAL CORNER ECR TODAY | FRIDAY, MARCH 3, 2017

BY VIVIENNE RAPER Staff Box Editorial Board

ESR Executive Council

Katrine Riklund, Umeå/SE Skill shortages prompt Chairperson of the ESR Board of Directors Paul M. Parizel, Antwerp/BE President Bernd Hamm, Berlin/DE U.K. to push ahead with 1st Vice-President Lorenzo E. Derchi, Genoa/IT 2nd Vice-President Luis Donoso, Barcelona/ES sonographer-led services Past-President

Boris Brkljačić, Zagreb/HR Communication and External Affairs Committee Chairperson Judged on the composition of today’s eagerly awaited professional Paul M. Parizel, Antwerp/BE challenges session, more healthcare professionals are looking to the ECR 2017 Congress Committee Chairperson U.K. for an alternative model for ultrasound services, yet that model Bernd Hamm, Berlin/DE ECR 2018 Programme Planning Committee Chairperson is evolving largely due to a shortage of appropriately trained staff. Laura Oleaga, Barcelona/ES Education Committee Chairperson Michael Fuchsjäger, Graz/AT Finance and Internal Affairs Committee Chairperson Christoph D. Becker, Geneva/CH National Societies Committee Chairperson Regina Beets-Tan, Amsterdam/NL Publications Committee Chairperson E. Jane Adam, London/UK Quality, Safety and Standards Committee Chairperson Olivier Clément, Paris/FR Research Committee Chairperson Catherine M. Owens, London/UK Subspecialties and Allied Sciences Committee Chairperson Nicholas Gourtsoyiannis, Athens/GR Director of the European School of Radiology (ESOR) Peter Baierl, Vienna/AT Executive Director The emphasis is on hands-on, interactive training in the ultrasound skills suite at City, University of London. (Provided by Gill Harrison)

Editors Most ultrasound examinations in procedures, has led to them handing The ultrasound examination is fessionals, and extending the role Julia Patuzzi, Vienna/AT the U.K. are performed and reported their general ultrasound workload a dynamic investigation where the of radiographers, already exist in Philip Ward, Chester/UK by sonographers and radiographers to specially trained radiographers. sonographer relies on patient feed- other countries. with postgraduate training, unlike Traditionally sonographers work back on, for example, the location of Edwards predicts that in future Associate Editors in much of mainland Europe and closely alongside radiologists and pain. The images produced are open sonographers will train directly in Michael Crean, Vienna/AT in Australia, Canada, and the U.S., are quick to adopt roles that radio- to misinterpretation. It seems rea- ultrasound rather than becoming Simon Lee, Vienna/AT where sonographers tend to per- logists, for one reason or another, sonable that the person doing the a radiographer or midwife first. “We form examinations but rely on an might choose to delegate, she noted. scan should also write the report. are living in very exciting times Contributing Writers overseeing physician to interpret Also, studies show detection rates Harrison says the traditional when it comes to U.K. ultrasound Stefanie Bolldorf, Vienna/AT the examination and write a report. and accuracy for ultrasound exa- route for supplying the U.K’s sono- education, the likes of which have Michael Crean, Vienna/AT However, now attention is focu- minations are similar for sonogra- graphers is training radiographers, not been seen in over 20 years,” Florian Demuth, Vienna/AT sing on the U.K. model due to an phers and radiologists. but a shortage of sonographers and she said. Peter Gordebeke, Vienna/AT escalating need for ultrasound ser- Looking to the future, she belie- radiographers means education Finally, Edwards has some advice Katharina Krischak, Vienna/AT Becky McCall, London/UK vices, said Hazel Edwards, senior ves U.K. sonographers may give up providers are turning to innovative to sonographers in mainland Katrina Megget, London/UK sonographer in the Department of simpler tasks to technicians, while new models to bring more profes- Europe who are novices at inde- Katharina Miedzinska, Vienna/AT Radiology at East and North Hert- continuing to further develop their sionals into the field. For instance, pendent reporting: they will need Rebekah Moan, San Francisco, CA/US fordshire National Health Service own skills. “As for mainland Europe, the U.K. is starting to offer direct to forge good working relationships Lucie Motloch, Vienna/AT Vivienne Raper, London/UK (NHS) Trust. This rising demand I anticipate that more sonogra- entry programmes that can lead with medical colleagues, including Mélisande Rouger, Madrid/ES has resulted from the growing pher-led ultrasound departments to training placements of students, radiologists, to discuss results and Frances Rylands-Monk, number of elderly patients, the will emerge and independent repor- and students come from a variety gain in confidence. St. Meen Le Grand/FR increasing population overall, and ting will become common practice of backgrounds. Such programmes Inga Stevens, Dubai/UAE the greater incidence of liver and for sonographers,” she said. for training non-healthcare pro- Kathrin Tauer, Vienna/AT Pamela Zolda, Vienna/AT vascular disease often linked to At the same session, a compari- lifestyle choices, she explained. son of the training and education of At ECR 2017, Edwards plans to sonographers between the U.K. and Pros & Cons Session Design & Layout outline the three main models of other countries will be covered in a Nikolaus Schmidt, Vienna/AT ultrasound scanning in the U.K. lecture by Gill Harrison, ultrasound Friday, March 3, 16:00–17:30, Room K She will also discuss the history programme director in the Division PS 1227 Providing an effective ultrasound service: how and by Marketing & Advertisements of the country’s sonographer-led of Midwifery and Radiography at whom? Konrad Friedrich model for ultrasound services and City, University of London. E-Mail: [email protected] Moderators: L.E. Derchi; Genoa/IT give recommendations to support U.K. sonographers complete one V. Gibbs; Bristol/UK sonographers outside the U.K. who to three years of postgraduate trai- are starting to report examinations. ning to gain a certificate, diploma, »»A. Who provides US services? The situation in Europe Contact the Editorial Office “We have a service model that or MSc degree in ultrasound. This H. Edwards; Stevenage/UK ESR Office works very well in the U.K., but it includes an assessment both of Neutorgasse 9 »»B. Should US services be provided by radiologists? 1010 Vienna, Austria took a long while to build up,” she clinical competency in their work- (performed and reported on) Phone: (+43-1) 533 40 64-0 said, adding that most scans are place and report writing. M. Claudon; Vandoeuvre-les-Nancy/FR E-Mail: [email protected] performed and reported by sono- “The interpretation of »»C. Can or should US services be provided by graphy specialists. ultrasound findings is a cru- radiographers/sonographers? Educational needs Edwards attributes the U.K’s reli- cial part of ultrasound educa- ECR Today is published 5x G. Harrison; London/UK during ECR 2017. ance on sonographers to several fac- tion and is integrated into the Circulation: 15,000 tors, including the financial model curriculum,” she said, adding »»D. Is it possible to standardise a ‘real-time’ examination? Printed by agensketterl Druckerei of the NHS, which prioritises safe, that guidelines from the British Sometimes it is possible, but not always GmbH, Vienna 2017 reliable, timely, accurate but also Medical Ultrasound Society and C. Nyhsen; Sunderland/UK myESR.org affordable care. Furthermore, a shor- the Society and College of Radio- »»Discussion on the pros and cons tage of radiologists since the 1970s, graphers both recommend that L.E. Derchi; Genoa/IT combined with the development of reporting findings is an integral V. Gibbs; Bristol/UK increasingly complex radiological part of the examination.

#ECR2017 myESR.org ECR TODAY | FRIDAY, MARCH 3, 2017 CLINICAL CORNER 11

BY FRANCES RYLANDS-MONK Patient safety: how to manage radiation incidents and accidents Accidents during imaging are rare, but nevertheless when they do happen the results can be devastating. Ongoing education and safety awareness, whether relating to radiation exposure or other incidents, remain vital.

Incidents caused by the so-called missile effect are extremely rare these days, mainly due to better management of controlled areas in MRI facilities, he noted. More common are the effects of the static magnetic field on small, treatment-related objects such as endot- racheal tube components and on non MR-safe implants including pacemakers, stents, and aneurysm clips. “Any implanted device should be fully documented in a patient’s notes. But these notes may not always be available, particularly in an emergency situation, and the Imaging can provide life-saving patient is not always able to provide information about a pregnant accurate information,” Lurie said. patient’s condition. This CT Action plans depend on the type image shows a pregnant trauma of accident in question, but at the patient admitted to the facility in Aberdeen, all incidents University Hospital of Iraklion. The first two of ‘10 Pearls: Radiation protection of patients in fluoroscopy.’ For more details, and near misses, including pati- The conceptus dose from this go to http://rpop.iaea.org. (Provided by Dr. Madan Rehani, PhD) ent referrals with pacemakers, are examination calculated using registered onto an online incident CODE software was 32.5 mGy. Interventional radiologists must “While the threshold levels for cies in patients undergoing irra- reporting system run by the local (Provided by Prof. John try to display not only the dose-area national reporting of overexpo- diating imaging tests, and inci- health authority and are reviewed Damilakis, PhD) product (DAP) on the fluoroscopy sure accidents under the European dental pregnancy diagnosed in by radiology management, inclu- screen but also the entrance skin Directive 2013/59/Euratom (EU-BSS) emergency trauma. ding the MR safety officer. dose (ESD), and they should change are currently under discussion, all As part of the project that led to Lurie pointed to reports in the the radiation entrance field if the incidents should go to a local criti- the development of CODE, Greek literature indicating that adverse ESD exceeds 2 Gy, according to Prof. cal incident reporting system, and obstetricians were asked how many events during MRI are increasing. Dr. Dr. Reinhard Loose, emeritus pro- this includes near misses without pregnant patients exposed acci- “This may be because hospi- fessor of radiology at the University radiation. Communication between dentally to diagnostic x-rays visited tals are getting better at reporting of Erlangen and former chair of the the staff members involved, the them over 12 months to seek advice such incidents, or it could be that Department of Diagnostic & Inter- referrer, and in some cases with the about the biological effects of radia- pressure for higher throughput ventional Radiology and Nuclear patient is essential,” he pointed out. tion on the embryo. Around 63% of of patients is leading to less time Medicine at Nuremberg Hospital. Pregnant patients respondents stated that one to five being spent on preventative mea- “For high dose procedures, inclu- The sense of safeguarding future pregnant patients who had been sures; even a simple thing such as ding both interventional radiology life prospects is heightened when exposed accidentally to radiation instructing a patient on the correct and CT, dose parameters should be pregnant patients present for ima- asked for information, underlining use of foam earplugs takes time and stored electronically, preferably as a ging. But what should happen the rate of accidental exposure of effort,” he concluded. DICOM Radiation Dose Structured when pregnancies are discovered pregnant patients in the country, Report (RDSR),” he noted. only after a medical imaging proce- according to Damilakis. The doses of different modalities dure has taken place? During the first two weeks after EFOMP Workshops and in interventional procedures, Abortion due to x-ray examina- conception, only high-dose radia- (European Federation of Organisations for Medical Physics) between different operators, should tions is not justified in the vast tion exposure can terminate preg- then be compared. Furthermore, majority of cases, according to nancy via miscarriage, but not diag- Friday, March 3, 08:30–10:00, Room G radiologists should ask referrers Prof. John Damilakis, PhD, direc- nostic x-ray, he added. Furthermore, EF 1 Radiation incidents and accidents in medical imaging to check patients for injuries two tor of the medical physics depart- radiation risks are more significant and their management (part I) to four weeks following high-dose ment of the University Hospital of during organogenesis and the early Moderators: J. Damilakis; Iraklion/GR examinations. Iraklion, Crete. foetal period. A. Torresin; Milan/IT Skin and soft tissue injuries, such “Referring physicians and radio- Damilakis fears that some refer- as erythema and necrosis, often graphers must investigate the ring physicians and radiologists »»Chairman’s introduction affect the body area closest to the reproductive status of all female who lack knowledge in this area J. Damilakis; Iraklion/GR x-ray tube, usually the back. While patients of childbearing age prior recommend termination of preg- »»Radiation incidents and accidents in CT the threshold for reactions is an to x-ray imaging, and a screening nancy following any x-ray exami- M. Mahesh; Baltimore, MD/US ESD dose of about 2 Gy, severe reac- policy for pregnant patients nation. Meanwhile, others avoid all »»Radiation incidents and accidents in interventional suites tions develop above 5 Gy. must be defined prospectively,” x-ray examinations for pregnant R.W.R. Loose; Nurnberg/DE Loose cited one incident in he explained. patients, despite the fact that the which the obesity of a cardiac valve This translates into a need for radiation risk for the conceptus is »»Accidental exposure during pregnancy replacement patient meant that clear guidelines on pre-imaging negligible, and this practice results J. Damilakis; Iraklion/GR the typical diagnostic reference protocols for determining preg- in underdiagnosis for these preg- levels of a prior diagnostic coron- nancy status. Posters in waiting nant patients. Friday, March 3, 10:30–12:00, Room G ary angiogram were exceeded by areas constituted one key strategy. In the second part of this double EF 2 Radiation incidents and accidents in medical imaging a factor of three. Then, during Risk assessment tools session, EF2, Prof. David Lurie, PhD, and their management (part II) the valve repair, the fluoroscopic Management of pregnant pati- head of an MRI research group and Moderators: M. Brambilla; Novara/IT image quality was so poor that the ents depends mainly on concep- professor of biomedical physics at D.J. Lurie; Aberdeen/UK operator changed to cine images. tus dose and stage of pregnancy, the University of Aberdeen, U.K., Tens of thousands of images were according to Damilakis. His depart- plans to advocate ongoing MRI saf- »»Chairman’s introduction generated and the patient received ment has recently developed a free ety education for all staff at every M. Brambilla; Novara/IT an ESD of more than 30 Gy. Several web-based tool (COnceptus Dose level, not just on initial appoint- »»Incidents and accidents in MRI skin transplantations followed a Estimation, CODE http://embryo- ment to a post. D.J. Lurie; Aberdeen/UK few months later. dose.med.uoc.gr/index.php/en/) for “The number of MR scanners and »»Radiation incidents and accidents in nuclear medicine While very complex interven- estimating dose and risk. scans conducted are steadily increa- M. Brambilla; Novara/IT tions, and therefore doses, are The frequency of accidental sing. So it is very likely all radiology increasing, angiography detectors exposure of pregnant patients is staff will have some involvement »»Management of incidents and accidents in imaging depart- are becoming more dose-efficient unknown, but in today’s presen- with MRI at some time during their ments: the role and responsibilities of medical physicists and ESD tracking helps the radio- tation he will draw on various career. Awareness of MR safety V. Tsapaki; Athens/GR logist to change the radiation studies that point to a significant issues is paramount,” Lurie told ECR These sessions are part of the EuroSafe Imaging campaign. entrance field as needed. number of unidentified pregnan- Today ahead of the congress. myESR.org #ECR2017 12 CLINICAL CORNER ECR TODAY | FRIDAY, MARCH 3, 2017

BY VIVIENNE RAPER Clinical decision support can help improve patient outcomes Clinical decision support (CDS) systems might enable radiologists to move from a healthcare service based on measuring success by means of the volume of examinations to one focused on improving patient outcomes.

The result of the CDS system was faster and earlier decision-making, and the patients that need complex treatment are now diagnosed and referred to the specialist soo- ner, noted Oleaga Zufiría. The ESR’s iGuide will now be used routinely by the primary care physicians and the future plan is to roll it out across the hospital. In conclusion, speaking about the potential difficulties of CDS, she said that care needs to be taken Prof. Dr. Hans-Ulrich Kauczor Prof. Laura Oleaga Zufiría The home page of the ESR’s iGuide shows how the application in the implementation process to from Heidelberg will from Barcelona will chair is displayed when the physician selects a clinical situation and avoid any negative impacts. One speak about the role of CDS today’s session on clinical prepares to order an imaging study. aspect is helping physicians to see in value-centred radiology. decision support. the technology as a tool for continuous medical education, rather In an interview with ECR Today CDS wouldn’t only select the cor- and insurance,” he said. “We want Physicians at her hospital were than as a threat to their autonomy. before today’s session, Prof. Dr. rect modality – e.g., a CT scan for to be reimbursed, not by the sim- unable to order their own MRI or “CDS systems should not be used Hans-Ulrich Kauczor, medical direc- a physician referring a bedridden ple number of exams, but by their CT studies, but had to refer patients as a substitute for the clinician,” she tor at the University Clinic Heidel- older male patient with suspected value, and we need to define how to a specialist. After the CDS sys- commented. berg, Germany, outlined some pro- pulmonary embolism – but it could we measure that. This is still part of tem was implemented, the number blems with the volume-centred automatically check for prerequi- the discussion.” of CT and MRI studies increased, reporting of imaging results. site lab results, schedule the scan, There are few studies evaluating but the number of referrals to the In most countries, if a knee MRI load the right protocol in the CT the effect of CDS on patient outco- specialist decreased. examination is performed, there suite, and prepare the injector. mes, according to Prof. Laura Ole- are some basic requirements that Kauczor added that focusing on aga Zufiría, chair of the Radiology you must follow. For example, you complex cases will help radiolo- Department at the Hospital Clinic Professional Challenges Session might perform three sequences gists adapt to the future challenges in Barcelona. Although studies have on two different planes, taking 13 facing the profession. The easy calls been published, most have focused Friday, March 3, 08:30–10:00, Studio 2017 minutes of examination time. The will be done by machines within the on how CDS affects the process of PC 9 Implementing and evaluating clinical decision radiologist has little freedom to near future so radiologists will only care and clinical decision-making. support (CDS) for imaging referral guidelines devote 15 minutes to an easy case, have the task of signing them off. Comparatively few are randomised and 90 minutes to a difficult one. Trends pointing in that direction control trials. »»Chairman’s introduction “Regardless of how long and include big data, IBM’s Watson medi- Introducing the session, she L. Oleaga Zufiría; Barcelona/ES detailed a report is, regardless of the cal supercomputer, and the develop- intends to discuss the impact of »»The role of basic and advanced CDS in value-centred radiology complexity of the case, you get the ment of structured reporting. CDS on patient outcomes. Her own H.-U. Kauczor; Heidelberg/DE same reimbursement,” he noted. One future challenge will be hospital began a pilot study in 2013 »»Evaluating CDS implementation and measuring outcomes With an advanced CDS system, making clear that radiologists play with primary care physicians, to see M.G.M. Hunink; Rotterdam/NL patients could be stratified into their part in making a diagnosis and how a basic CDS system affected the two or three different categories doing the preparatory work for treat- number of CT and MRI studies orde- »»Using CDS: referring physicians’ perspective: GPs dependent on their complexity. The ment decisions. Another is evaluating red. The study began using the Ame- J.F.M. Metsemakers; Maastricht/NL stratification would rely on the cli- the success of the new value-centred rican College of Radiology (ACR) »»CDS implementation in the classroom: ESR eGuide nical information used to request pay-for-performance radiology. Select CDS, but moved to the iGuide L. Donoso; Barcelona/ES an examination and the protocols “We need to develop metrics that from European Society of Radiology »»Panel discussion: Introducing CDS for medical imaging pre-set into the system. Advanced will be accepted by clinical partners (ESR) when it became available. referrals: what to do and how to measure

ESOR Ten-Year Anniversary Session Friday, March 3, 12:15–13:00 Room A

Introduction Paul M. Parizel, Antwerp/BE ESR President

Ten years of ESOR Nicholas Gourtsoyiannis, Athens/GR ESOR Scientific/Educational Director

How did ESOR influence my professional development Oshaani Abeyakoon, Cambridge/UK Teaching for ESOR: Tutoring scholars and fellows Christian Loewe, Vienna/AT Celebration

For further information on the detailed programmes

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

#ECR2017 myESR.org ECR TODAY | FRIDAY, MARCH 3, 2017 CLINICAL CORNER 13

BY KATHARINA MIEDZINSKA Experts to provide insights into new procedures to diagnose and treat lymphatic disease The term ‘lymphatic vascular disease’ covers a broad category of conditions, including a very large number of diseases with various subjective complaints, which can accompany the lymphatic malfunction. In addition to physical examination, imaging is an important diagnostic tool; particularly when the diagnosis remains in question, the presence of lymphatic vascular insufficiency can be ascertained through different imaging methods.

It is a unique and non-invasive imaging modality that can be used in different fields, including, but not limited to, evaluation of lym- phoedema patterns and diagnosis of upper and lower limb lymphoe- dema, cystic lymphangioma, various lymphatic disorders such as lymphatic injuries resulting in chylous collections, chylous ascites and chylothorax, and lymphatic pathologies of the liver, the spleen, the kidneys and the chest. Figure 1: Intranodal lymphangiogram. Ultrasound guided puncture Being a relatively new imaging of a groin lymph node. The tip of the 25 gauge needle is located technique, non-contrast MR lym- within the medulla of the lymph node. phography is still in a honeymoon period and certain limitations such In today’s Special Focus session material over a period of hours, in Figure 2: Intranodal lymphangiogram and thoracic duct as suboptimal spatial resolution titled ‘The revival of lymphangio- recent years, it has not been done embolisation. Left: Fluoroscopic image of the right pelvis and groin remain. However, due to ongoing graphy’, three experts will discuss frequently. Thus, not many doctors with good filling of the lymphatic system after intranodal access of advances in software and hard- different radiological diagnostic are able to perform this procedure a groin lymph node. Centre and right: Transabdominal cannulation ware, in the near future it could tools and therapy options for today,” he explained. of the thoracic duct with a 22 gauge needle and a 0.018 wire for become the imaging modality of lymphatic disease. Starting the ses- The leading cause of chylotho- thoracic duct embolisation. (All images provided by Dr. Ernesto reference for the investigation of sion off will be Dr. Ernesto Santos rax is the iatrogenic disruption of Santos Martín) lymphatic pathology, as Arrivé will Martín, from the Interventional the thoracic duct or its tributary illustrate today. Radiology Division at the Memorial lymphatics. An undiagnosed six patients undergoing thoracic Department of Radiology at Hôpital Last but not least, Prof. Hans Sloan Kettering Cancer Center in postoperative chylothorax may duct embolisation. Saint Antoine, Paris, plans to exp- Schild, Director of the Department New York, who plans to familiarise result in malnutrition, sepsis or “Compared to the bipedal appro- lain the indication, technique and of Radiology at the University ECR delegates with the indications death. Therefore, rapid diagno- ach, INL is less technically difficult; success of non-contrast magnetic Clinic Bonn, Germany, will, dis- for and the technique of intranodal sis and early intervention are of furthermore it diminishes pro- resonance lymphography, a moda- cuss the indication and technique lymphangiography (INL). Accor- paramount importance. Difficul- cedure time,” Santos Martín said, lity which uses heavily T2-weighted of thoracic duct embolisation as ding to Santos Martín, INL is a reli- ties associated with bilateral pedal adding that the development of fast spin echo sequences with 3D well as available therapeutic alter- able, reproducible and less techni- lymphangiography are a significant INL has enabled confirmation of acquisition and very thin section natives for patients who cannot cally challenging alternative to limitation of percutaneous thoracic two different virtues. source images obtaining a specific undergo this procedure, among pedal lymphangiography. duct embolisation and present a “First of all, INL has diagnostic display of lymphatic vessels. other topics. “In patients with chylothorax, barrier to its widespread use, mea- properties which allow the study percutaneous thoracic duct emboli- ning alternative techniques needed of lymphatic abnormalities such as sation is an established alternative to be implemented. leakage, malformations and others. Special Focus Session to the surgical ligation of the thora- “Intranodal lymphangiography Furthermore, due to the embolic cic duct. It is a minimally invasive was first described in 1967, with no properties of the iodinated oil, it Friday, March 3, 08:30–10:00, Room F2 procedure, requiring an opacifica- need of incisions. Due to the diffi- has therapeutic capabilities and can SF 9 The revival of lymphangiography tion of the lymphatic system prior culty of lymph node puncture, it help to seal off lymphatic leaks. The to the transabdominal catheterisa- was not widespread. However, this simplicity of the intranodal appro- »»Chairman’s introduction tion of the thoracic duct. Classically, problem has been solved by using ach under ultrasound guidance is B.A. Radeleff; Heidelberg/DE bipedal lymphangiography was ultrasound guidance, which has enabling the development of new »»‘Theranostic’ lymphangiography required to opacify the lymphatic enabled to puncture impalpable applications of INL such as novel E. Santos Martín; New York, NY/US system, but as it is a technically lymph nodes,” said Santos Martín. lymphatic therapies via intranodal »»MR lymphangiography demanding and time-consuming In 2012, Nadolski and Itkin access and MR lymphangiography,” L. Arrivé; Paris/FR procedure, involving the cannula- described the feasibility of he added. »»Thoracic duct embolisation tion of a small lymphatic duct on ultrasound-guided intranodal The latter will be the key topic of H.H. Schild; Bonn/DE the dorsal aspect of the feet follo- lymphangiography as an alterna- the second presentation of today’s wed by an infusion of oily contrast tive to pedal lymphangiography in session. Prof. Lionel Arrivé, from the »»Panel discussion: Lymphangiography, are you convinced?

myESR.org #ECR2017 14 CLINICAL CORNER ECR TODAY | FRIDAY, MARCH 3, 2017

BY KATHARINA MIEDZINSKA How to deal with primary bone tumours: the radiologist’s, pathologist’s and surgeon’s perspective

Due to their widely varied nature, primary bone tumours may pose unique diagnostic challenges. Thus, their management often requires a multidisciplinary approach, as will be shown by three experts in today’s Multidisciplinary Session on the subject.

tumour-like lesions such as simple at the Royal Orthopaedic Hospital ding on the oncological or surgi- diagnosis and to allow communica- bone cysts and giant cell tumours – in Birmingham, UK. cal management of the patient; tion with oncology surgeons, patho- to name just a few examples. Age is considered to be the most moreover, by accurate staging of logists and oncologists. Imaging plays a key role in esta- important piece of clinical informa- the tumour, disease prognosis can In today’s session, chaired by blishing the initial diagnosis and tion when assessing a bone tumour, be determined. Distant staging will Dr. Mark Davies from the Royal subsequently affects the initial as most bone tumours have a predi- include a CT of the chest to exclude Orthopaedic Hospital in Birming- management. Undiagnosed lesi- lection for a specific age group. For pulmonary metastases and a bone ham, James will be joined by Prof. ons are best divided into biologi- example, giant cell tumours occur scintigraphy or a whole body MRI Lars-Gunnar Kindblom, from the cally nonaggressive and aggressive in skeletally mature people, while to examine for osseous metastasis. Department of Pathology at the categories. If the lesion is aggres- the Ewing sarcoma typically occurs Also, PET/CT can be a problem sol- Sahlgrenska Academy in Gothen- sive, biopsy is indicated; otherwise, in patients aged 10–20, and conven- ving tool,” explained James. burg, Sweden, who will discuss watchful waiting with follow-up tional osteosarcoma has two age In regard to local staging, MRI the pathologist’s perspective in imaging is the norm. peaks: one, arising de novo, in teen- is usually the modality of choice, the diagnosis of bone tumours Radiographs are the primary agers, and the other, arising in pre- he added. and how to correlate imaging screening technique used for bone viously irradiated or pagetic bone, MRI can extend the diagnostic features of malignancy with tumours and tumour-like lesi- in adults older than 50 years. evaluation by demonstrating com- histological findings. ons. They are recommended as Regarding the location, many ponents such as cartilage, vascular Prof. Lee Jeys, a consultant the initial imaging modality for bone tumours, independent of tissue, fat and liquid. Even when a orthopaedic oncology surgeon the evaluation of bone pain, and whether they are malignant or specific diagnosis cannot be made, from the Royal Orthopaedic Hos- standard radiographic techniques benign, often occur in a charac- MRI can help by narrowing the dif- pital, besides giving the surgeon’s are typically adequate for tumour teristic location in the skeleton. ferential diagnosis, thus, it has chan- perspective, will point out imaging imaging. Aggressive features are Some tumours tend to follow the ged from a single study-based diag- requirements for robotic surgery detected on radiographs by the distribution of red marrow, while nosis (solely based on radiographs) and especially illustrate the need evaluation of different imaging others such as osteosarcoma have a to a multimodal imaging approach, for a multidisciplinary approach in characteristics, including perios- predilection for sites of rapid bone which, according to James, is often the management of patients with teal reaction, cortical reaction and, growth like the metaphyseal region. required to reach a correct imaging primary bone tumours. AP radiograph of the knee above all, the margin of the lesion “Moreover, a lesion in a long bone demonstrating a distal femoral and the zone of transition between can be characterised by its longitu- osteosarcoma. (Provided by lesion and adjacent bone; two of dinal and its transverse location. Multidisciplinary Session Dr. Steven James) the key factors in determining if a So when considering the location, lesion is aggressive or not. Lesions both, the longitudinal position in Friday, March 3, 08:30–10:00, Room D The term ‘bone tumour’ is a broad with sharp margins and a narrow the bone and the transverse ori- MS 9 Primary bone tumours category, including a bewildering transition zone are radiographi- entation need to be taken into number of bone tumours with a cally considered to be nonaggres- account, as this aspect alters the »»Chairman’s introduction wide variety of radiological appea- sive, especially when the margins differential diagnosis,” James said. A.M. Davies; Birmingham/UK rances. The spectrum ranges from have a sclerotic border. In this session, he plans to go over »»Fundamental imaging bone-forming tumours such as “In order to reach a diagnosis, the fundamental requirements S.L.J. James; Birmingham/UK osteoblastoma and osteosarcoma, to the age of the patient, the location for bone tumour imaging point by »»Why I need the radiologist: the pathologist’s perspective fibrous bone lesions such as fibrous of the lesion, any pre-existing con- point and to discuss local and dis- L.-G. Kindblom; Gothenburg/SE dysplasia and ossifying fibroma, ditions and the radiological appe- tant imaging strategies for staging. »»The surgeon’s perspective and bone marrow tumours, to carti- arance need to be considered in “Staging always needs to be con- L. Jeys; Birmingham/UK lage-forming tumours, bony metas- turn,” explained Dr. Steven James sidered in two ways. Local staging tases and other bone tumours or from the Department of Radiology plays an important role in deci- »»Multidisciplinary case presentation and discussion

RTF MEET & GREET SESSIONS Visit the RTF Booth in the ESOR & Rising Stars Lounge (M Building) to meet Radiology Trainees Forum (RTF) representatives from different European countries!

Join your European colleagues and representatives in an informal and relaxed discussion, exchange opinions and points of view with them and present your ideas. Take advantage of this great opportunity!

Don’t miss the RTF Highlighted Lectures, moderated by RTF Board members Atis Svare and Luisa Andrade (tomorrow, Saturday, March 3, 10:30–12:00) in Room O.

For more detailed information please visit the RTF Meeting Point in the ESOR & Rising Stars Lounge.

#ECR2017 myESR.org ECR TODAY | FRIDAY, MARCH 3, 2017 CLINICAL CORNER 15

BY KATHARINA MIEDZINSKA Optimising the management of acute appendicitis Appendicitis can be a tough diagnosis to make, especially in ‘difficult’ cases such as elderly, obese and pregnant patients. In today’s session, ECR delegates will get the chance to familiarise themselves with challenges in the diagnosis of acute appendicitis and to learn about optimal diagnostic strategies and the important role of imaging in the management of acute appendicitis in specific populations.

after an indeterminate ultrasound. However, this technique is not always immediately available in every centre, and delaying the diagnosis due to the fear of perform CT may have disastrous consequences for the mother and the foetus. In this setting, ultra low-dose CT (<2mSv) may be an interesting alternative to standard CT,” said Poletti. Also in this session, Dr. Marc Zins, from the Department of Radiology at Hôpital Saint Joseph in Paris, will discuss the cost-effectiveness of different imaging modalities of high-end ultrasound, ultra-low dose CT and MRI in acute uncomplicated and complicated appen- Figure 1: 36-year-old woman, in the second trimester of pregnancy, Figure 3: 45-year-old woman, four weeks pregnant, with right lower dicitis, also with special regard to with right lower quadrant pain. Ultrasound clearly shows an quadrant pain. Ultrasound was indeterminate. T2 MRI sequence difficult patients, while Prof. Marja enlarged and uncompressible appendix, surrounded by an intense with fat suppression shows a thickened appendix surrounded by Boermeester, from the Department inflammation (between crosshairs), typical for appendicitis. an intense inflammation (arrowhead), and centred by a hypodense of Surgery at the Academic Medical The diagnosis was confirmed by surgery. appendicolith (arrow). The diagnosis of appendicitis was confirmed Center in Amsterdam, Netherlands, by surgery. (All images provided by Dr. Pierre-Alexandre Poletti) will speak about the evidence based treatment of acute appendicitis. Many surgeons use an aggressive rian torsion and cholecystitis. Diffi- Herbert Fitz was the first author approach, accepting a certain num- culties in rendering a definitive dia- to publish on the importance of ber of negative appendectomies gnosis of appendicitis may result early diagnosis and surgery for – approximately 25% of appendec- in delayed treatment and compli- acute appendicitis, and for more tomies are unnecessary, while a cations from delayed diagnosis of than a century, appendectomy, significant surgical delay occurs in appendicitis. which today can generally be per- 20% of patients with appendicitis. During his talk, Dr. Pierre- formed with low morbidity and The use of advanced abdominal Alexandre Poletti, from the Depart- very low mortality, has been the imaging such as ultrasound, CT and ment of Radiology at the University treatment of choice, remaining the MRI have reduced these numbers Hospital of Geneva, Switzerland, standard of care for most patients. to 3% and 5% respectively, by enab- will provide an insight into the dia- An alternative strategy is antibiotic ling accurate diagnosis of acute gnosis of acute appendicitis in preg- therapy, with appendectomy reser- appendicitis, as well as many of its nant patients and highlight the role ved for those who do not respond clinical masquerades. of high-end ultrasound, ultra-low to this treatment or those who However, certain conditions dose CT and unenhanced MRI in develop complicated appendicitis. make the diagnosis of acute appen- this clinical setting. Although many controver- A dicitis even more difficult, as Prof. “Due to its availability and lack of sies exist over the non-operative Julien Puylaert, from the Depart- ionising radiation, ultrasound with management of acute appendicitis, ment of Radiology at Westeinde a graded compression technique antibiotics have an important role Hospital, The Hague, Netherlands, is usually the imaging modality of in the treatment of patients with will illustrate in today’s presenta- choice to be performed at admis- this condition. Thus, Prof. Boermee- tion, Imaging algorithms for acute sion of pregnant patients with right ster plans to specifically address the appendicitis in difficult patients. lower quadrant pain. However, it role of clinical history, physical exa- Puylaert will go over point by is often indeterminate, especially mination and laboratory findings point the pros and cons of high-end during the last trimester of preg- and to emphasise the role of ima- ultrasound, ultra-low dose CT and nancy. Concerns about dose in the ging in the management of acute MRI in diagnosing appendicitis in use of CT make unenhanced MRI uncomplicated and complicated obese and elderly patients, highligh- a good second choice to be used appendicitis. ting their roles in relation to clinical findings to differentiate between Special Focus Session uncomplicated and complicated appendicitis in difficult patients, as Friday, March 3, 16:00–17:30, Room E1 B well as the pros and cons of diffe- SF 12b Challenges in the diagnosis of acute appendicitis rent imaging strategies. Figure 2: 22-year-old woman, ten weeks pregnant, with right lower However, the obese and the »»Chairman’s introduction quadrant pain. Admission ultrasound was indeterminate and MRI elderly are not the only ‘special’ J. Stoker; Amsterdam/NL was not available. A low-dose CT was performed, which shows a cases – there are also pregnant pati- »»Acute appendicitis during pregnancy: high-end normal thin appendix, filled with oral contrast media (A, arrow) and ents to consider. Anatomical and ultrasonography, ultra-low dose CT or unenhanced MRI? multiple lymph nodes close to the cecum (B, arrow), consistent with physiological alterations associated P.-A. Poletti; Geneva/CH a mesenteric adenitis. The clinical outcome was uneventful. with pregnancy make it difficult to »»Imaging algorithms for acute appendicitis in difficult patients reach the correct diagnosis in these (obese, elderly, other) Appendicitis is the most common The main goals of acute appendi- patients, as, for example, pregnancy J.B.C.M. Puylaert; The Hague/NL urgent cause of acute abdominal citis management are an early dia- can result in upward displacement »»What is the cost-effectiveness of different imaging modalities pain seen in emergency depart- gnosis and prompt surgical or con- of the appendix and nonspecific in acute appendicitis? ments. Approximately one in every servative intervention. However, a leucocytosis. The range of differen- M. Zins; Paris/FR ten individuals will have acute correct diagnosis is often delayed, tial diagnoses of right-sided pain appendicitis during their lifetime. because on the one hand, many in pregnancy is broad, including »»Evidence-based treatment of acute appendicitis: The cause is unknown, but is proba- patients do not seek medical atten- benign causes such as haemorrha- conservative vs surgical management? bly multifactorial, including lumi- tion in a timely manner, and on the gic corpus luteum cyst and renal M.A. Boermeester; Amsterdam/NL nal obstruction as well as dietary other, appendicitis can be an overall colic as well as conditions requiring »»Panel discussion: Optimised imaging algorithms in the and familial factors. difficult clinical diagnosis to make. surgical intervention, such as ova- diagnosis of acute appendicitis myESR.org #ECR2017 16 CLINICAL CORNER ECR TODAY | FRIDAY, MARCH 3, 2017

BY GIUSEPPE LO RE The role of radiology in body identification and in determining cause of death in refugee casualties In recent years, Europe has been witnessing large-scale migration from African countries and the Middle East, leading to problems with regard to safety, funding and, above all, ethical issues.

autopsy through a mobile eight- channel CT machine assigned to NATO’s Melilli base in Sicily, placed next to the tents where forensic studies were being performed. Images were studied according to the guidelines provided by the Ministry of the Interior. The study of number, type, con- gruency, calluses, fractures and anthropometric measurements of bones, teeth, growth-plate cartila- ges and genitals helped in sex and age assessment. Foreign objects MIP reconstruction of mandibular bone and tooth. were encountered and reported in many cases, and some of them were a European database where diffe- to give back names and surnames potentially dangerous for the coro- rent features can be catalogued, to these people, a gesture of respect ners, while others were useful for Mobile CT scanner in Melilli’s ‘pontile NATO’, Siracuse, Sicily. allowing relatives in other EU coun- for human dignity. body identification. tries or family members back home Remains were recovered and This experience clearly demons- to find their deceased relatives. kept inside body bags in refrige- trates the pivotal role of radiology “It’s a gesture of respect for rated trucks. The bodies of these in mass disasters and that radiolo- human dignity and it has been poor victims arrived in indescriba- gical assessment in mass disasters shown that not knowing, leaving ble conditions, partially skeletoni- is feasible. Pre-autopsy diagnostic relatives of people probably dead sed and often unrecognisable with imaging proved its utility in the in limbo, is comparable to torture,” faces disfigured due to having been identification of human remains said Prof. Cristina Cattaneo, head underwater for about a year. while leaving all clothing and per- of the Labanof Forensic Pathology Forensic pathologists and anth- sonal effects in place, preserving Laboratory, which specialises in ropologists from several Italian uni- evidence in an undisturbed state. It identifying decomposed, burned or versities were recruited, along with was also used for ‘safety screening’ mutilated remains. the police forces for this activity. prior to forensic assessment of the Deceased migrants are very often Radiologists from the University remains, preventing danger to the identified thanks to the last phone Hospital of Palermo were asked to workers who handled the remains. numbers they called or numbers assist by performing pre-autopsy written on paper or even inside CT scans in order to facilitate iden- Giuseppe Lo Re, PhD, MD is their clothing. tification and give a proper burial to professor of radiology at the In April 2015, an overcrowded boat these migrants. Section of Radiology, DiBiMed, with an estimated 700 migrants on In July 2016, 149 body bags University of Palermo, Italy. board headed for Italy sank off the were scanned before conventional Libyan coasts. It was the deadliest Gantry of mobile CT scanner. migrant disaster in the Mediterra- nean in recent decades. Scientific Session Moreover, during these years, deep wounds in their families, as The Italian navy recovered the there have been numerous acci- well as administrative problems. boat and thanks to a memorandum Friday, March 3, 10:30-12:00, Room F2 dents during attempts to cross the Just think of the impossibility of of understanding between the Minis- SS 1017 CT virtopsy and other ‘hot’ topics Mediterranean, which resulted reuniting families in the event that try of the Interior, the Ministry of Moderators: F.H. Berger; Toronto, ON/CA in more than 3,500 deaths in 2016 a relative is declared missing. Education and the Commissioner’s F. Macri; Nimes/FR alone from a population of 65 mil- Since the first large-scale sinking Office for Missing Persons, post-mor- lion forced to leave their country. off Lampedusa in 2013, Italy has tem activities aimed at the identifica- »»The role of radiology in body identification and in determinati- The bodies of these ‘victims of hope’ been trying to find the names of tion of the victims were performed. on of the cause of death in shipwrecked refugee casualties are often not recovered, inhibiting all those who have perished along The main purpose of this opera- G. Lo Re1, A. Argo1, S. Zerbo1, S. Salerno1, D. Mazzarelli2, M. Midiri1, proper identification and causing its Mediterranean borders, creating tion was to do everything possible C. Cattaneo2, R. Lagalla1; 1Palermo/IT, 2Milano/IT

Visit the Arts & Culture booth in the entrance hall Peter Dressler, Mit großem Interesse, Naturhistorisches Museum 1989 © Fotohof Archiv

#ECR2017 myESR.org ECR TODAY | FRIDAY, MARCH 3, 2017 TECHNOLOGY & RESEARCH 17

Three EU-funded cancer projects ESR establishes Working Group on EuroSafe Imaging Stars: be a star for 19 underway with support from EIBIR 21 Value-Based Imaging 23 your patients

BY INGA STEVENS Manufacturers provide glimpse into CT’s bright and dynamic future in ECR 2017 exhibition halls

Toshiba Medical is celebrating the 10th anniversary of Area Detec- tor CT technology after its introduction in 2007. At this year’s ECR, the company is highlighting its latest feature that seeks to improve resolution while further lowering radiation levels. “Our forward projected model-based iterative reconstruction solution, called FIRST, is a fully automated and integrated reconstruction technique that, in clinical practice, can be used for all scanning procedures including cardiac and 4D studies,” said Henk Zomer, the senior manager of the CT business unit. “FIRST lowers the radiation dose and improves image quality to unseen levels while the reconstruction of a 16 cm volume takes only three minutes.” Combining premium CT technology with the economic advantage

The low-dose performance enabled by a tin filter makes it suitable for lung screening purposes. In these images, TDIvol = 0.44 mGy, of an entry-level system, Toshiba dose length product = 16.4 mGy-cm. Provided by University Hospital of Erlangen, Germany and Siemens Healthineers. is unveiling the 80 row Aquilion Lightning SP. The system is ideal According to Valérie Brissart, the Since the scanners can be controlled for routine scanning and combi- company’s molecular imaging and via a tablet, medical staff no longer nes the PUREViSION detector tech- CT product marketing director for have to keep moving between the nology with 0.5mm elements, and Europe, Revolution ACT is engineered CT scanner and the control room, the 78cm-wide bore, small foot- to lower operating costs and to help enabling radiographers to stay with print, and short installation time with a better return-on-investment patients while carrying out the scan. makes it a patient friendly and cost and a quicker break-even position. Sectra is highlighting its CT liver effective scanner, Zomer said. With “It also features smart techno- surgery planning application that features usually found only in pre- logies designed to help improve facilitates segmentation, measure- mium scanners, including AIDR 3D productivity by streamlining user ments, and visualisation of import- Enhanced dose reduction techno- workflow and access to informa- ant and relevant information such logy and metal artefact reduction, tion. In particular, inspired by our as the entire hepatic vascular sys- the system ensures there is no need CT angiography of the aorta at most premium product, Revolution tems, including portal and hepatic to compromise quality to meet low kV and high mAs with High CT, the console for Revolution ACT veins, healthy parenchyma, and lesi- business goals and reduce the total Power 80 for iodine contrast and has been designed to make it easy ons. The volume of each target can cost of ownership, he added. potential reduction of required to learn and use,” she explained. be measured with high precision In other news in the CT world, Phi- contrast media dosage (tube Siemens Healthineers is another and if needed, displayed in 3D. For lips recently announced that it has current = 80 kV/375 mAs, vendor focused on providing an excel- planning of partial liver resection launched the detector-based spectral

CTDIvol = 3.45 mGy, dose length lent return on investment for radio- and pre-planning of radiofrequency CT scanner. The Philips IQon Spec- product = 147 mGy-cm). logy customers, and it has developed ablation, cutting the plane on the 3D tral CT delivers on-demand colour Provided by University an entirely new platform for CT view or portal vein and hepatic vein quantification and the ability to Whole-body aorta assessment Hospital of Erlangen, Germany that it is showcasing at this year’s vascular territories calculations can characterise structures simply and with GE’s Revolution ACT. and Siemens Healthineers. congress. Based on the Somatom go. be performed. The result can easily at a low dose, the vendor noted. The platform, the vendor offers two scan- be saved as a 3D pdf file, facilitating scanner reportedly adds spectral With trends such as preventa- GE Healthcare continues to ner variants: the 32-slice Somatom communication with referring phy- resolution to traditional CT scanning tive screening continuing to make invest in the Revolution family of go.Now, which is particularly suited sicians, the company points out. through a new dual-layer spectral progress throughout the world, CT CT systems with the ultimate aim to radiology providers who want to Carestream is keen to demons- detector, and it identifies photons of scanners are continuing to evolve of helping clinicians redefine what’s establish a new CT department; and trate the benefits of cone beam high energy and low energy simul- to handle more complex cases, and possible with CT. At ECR 2017, GE the Somatom go.Up, which is equip- technology with its OnSight 3D taneously, allowing not only anato- manufacturers are increasingly loo- is demonstrating the Revolution ped with a wider detector providing Extremity system, which can cap- mical views but also uses colour to king at ways to extract more value ACT, which is designed to help up to 64 slices and offers faster scan- ture images of patient extremities, characterise the material content of from the information provided by users who are relatively new to CT ning and is therefore suited to users including knees, legs, and feet. The critical structures. existing capabilities. Against this or using aging systems to feel more who want to expand an already system uses less radiation than background, suppliers of systems confident about moving to the next successful portfolio. traditional CT, is compact and Technical Exhibition are going head to head with their level, both clinically and economi- This approach facilitates more affordable, and can be used in a Opening Hours latest equipment and software cally. Visitors to the GE booth can comprehensive patient care, and wide range of facilities, according advancements, and delegates at learn about the four key benefits: also gives radiology providers the to the manufacturer. The device Thursday, March 2 to Saturday, ECR 2017 are guaranteed to have diagnostic confidence, patient care, option of using a highly cost-effi- has received FDA 510(k) Clearance March 4: 10:00–17:00 front-row seats to explore the latest financial performance, and clinical cient single-room concept for the and is approved for sale in the U.S. innovations on offer. excellence. first time, according to Siemens. and Europe. Sunday, March 5: 10:00–14:00

myESR.org #ECR2017 18 TECHNOLOGY & RESEARCH ECR TODAY | FRIDAY, MARCH 3, 2017

BY STEPHEN HOLLOWAY Gap widening between CT innovation and installation Of all major imaging modalities on show in the exhibition halls, it’s arguable that none have undergone such transformation over the last decade as CT. Following a rapid rise to prominence as a workhorse tool for radiology in the early 21st century, safety concerns and the increasing use of MRI and ultrasound in a wider array of applications, CT has had to reinvent itself.

forging into quantitative imaging and for Europe does not suggest this ventional CT and handle a significant radiomics with Spectral Dual Energy will change anytime soon. In addi- proportion of CT procedures soon. CT. While these advances point to an tion, radiologist numbers in Europe The business model for procu- assured role for CT in the future of also continue to slowly decline, rement is also evolving. Capital radiology and have allowed greater further limiting the momentum expenditure models are predicted to access efficiency and safety of CT use, for a significant push to renew the slowly transition towards a mixture the lag between the exhibition floor ageing installed base. of managed services and risk-sha- and everyday use in European hospi- That said, there are some ring partnerships between vendors tals appears to be widening. developments that can help ease and providers. This will certainly A recent COCIR survey1 of Euro- the situation. Firstly, a wider choice not happen overnight, as this requi- pean countries has shown that in of competent but lower-cost CT res a major overhaul of current pub- the past five years the age profile of is now available. These systems lic and private healthcare funding. CT system installed base has worse- boast many technical, efficiency However, with a greater focus on ned, while other advanced imaging and safety benefits over systems a efficiency, cost control and operati- modalities such as MRI and cath- decade old. Moreover, with health- onal analytics, we should expect to labs have remained stable. More care analytics more commonplace, see more focus on the longer-term than half of currently installed CT the ability to calculate return on benefits of newer CT technology, systems are six years old or older investment versus legacy systems rather than the short-term focus on 2015 Source: COCIR ‘Medical Imaging and, more alarmingly, the number is getting easier for providers. Alter- up-front system cost. 2013 Equipment: Age Profile & Density of countries with 10% of their CT natively, the major CT vendors are 2011 Report – 2016’ systems older than ten years has also wiser to the potential value to 1 COCIR Report: ‘Medical Imaging trebled in the last seven years. customers of refurbished systems Equipment: Age Profile & Density Percentage of CT systems installed aged ten years or older; If we consider many impro- and now offer certified, high-quality Report – 2016’ http://www.cocir.org/ select European countries. vements in CT dose modulation refurbished systems with attractive uploads/media/16052_COC_AGE_ and monitoring have come to mar- warranty and service options. PROFILE_web_01.pdf The latest CT offerings provide many of the clinical symposia being ket in the last decade, then a sig- Other options are coming to the greatly improved imaging capabi- held this week. CT is diversifying, nificant proportion of currently fore. Cone-beam CT (CBCT) for ext- lity, but also automatic dose-moni- with use in radiotherapy planning installed systems still in use today remity imaging has been recently Stephen Holloway is principal toring with smart dose protocols, and tracking treatment response, CT are a long way from the safety and unveiled and use of CBCT for head- analyst and company director much quicker scan speeds and a colonography and lung cancer detec- clinical standard on show today. trauma for emergency medicine is at Signify Research wider range of systems to cater for tion (with low-dose scanning proto- So what can be done? expected to follow soon. While cur- (www.signifyresearch.net), a all provider types. cols). It continues also to be merged There is no easy fix. Health bud- rently priced equivalent to conven- health tech, market-intelligence Additionally, the application of CT with other modalities (PET/CT, CT-in- gets are under scrutiny and control tional mid-range CT systems, CBCT firm based in Cranfield, U.K. continues to expand as is evident in terventional x-ray labs) and is even and the current economic picture may offer a lower cost option to con-

BY CHRISTIAN CZERNY Research to gain increasing significance in head and neck imaging

During the last decade there has Since its foundation in 1987, the together clinicians (head and neck The 30th Annual Meeting and outstanding oral and poster presen- been growing interest in head and European Society of Head and Neck surgeons, radiation therapists Refresher Course will welcome its tations will be offered by the ESHNR. neck imaging. It is partially due to Radiology (ESHNR) has been highly and medical oncologists), patholo- participants in Portugal from Sep- At the congress in 2017, there advances in modern imaging (fun- successful in accomplishing its mis- gists, other health professionals, tember 28–30, 2017. will also be a chance to take the ctional imaging techniques, hybrid sion of teaching the state-of-the-art basic scientists and patient orga- As in previous years, the ESHNR European Board in Head and Neck imaging, MR imaging of previously practice of head and neck radiology. nisations involved in any aspect will gather renowned specialists Radiology Diploma (EBiHNR) exa- difficult areas), but it is also greatly At the end of 2016, the ESHNR had of head and neck radiology and and enthusiastic speakers with ses- mination. The EBiHNR Diploma influenced by evolving surgical more than 390 active members treatment. sions focused on: is a document certifying in-depth techniques and growing popularity from 34 countries. Its main goal – in The ESHNR also seeks close col- •• new MR imaging and US knowledge of the pertinent ana- of non-surgical treatment options. common with other societies – is laboration with allied radiological applications tomy, pathology, clinical-radiolo- Therefore, head and neck radiology to support and stimulate exchange societies – both European and Ame- •• quantitative multiparametric gical and imaging-related issues is in constant change. The demands of knowledge in all aspects of head rican – such as the Society of Neuro- imaging in the field of head and neck and for improved healthcare are and neck imaging and diseases, and radiology, Society of Head and Neck •• standardisation of imaging maxillofacial radiology. The Dip- greater than ever and diagnostic to promote the highest standards of Cancer and the European Society for protocols loma is also endorsed by the Euro- capabilities have greatly improved research, education and training. Radiotherapy and Oncology. During •• structured radiologic reports pean Society of Radiology (ESR). in response. Currently, the ESHNR is happy to its little less than three decades of •• acute head and neck trauma If you are a member of the Subspecialty radiology, including have the Head and Neck Section of existence, the ESHNR has enjoyed •• foetal and postnatal imaging ESHNR, please join us during these the subspecialty of head and neck the NVvR (Radiological Society of a friendly and collegial relationship •• MR neurography sessions and courses. If you are not imaging, is slowly becoming an the Netherlands), the British Society with a number of these professio- •• the role of imaging in swallowing a member, please stop by our booth obvious necessity in busy academic of Head & Neck Imaging (BSHNI, UK) nal medical societies. Together with and sleep disorders to learn more about our warm, fri- hospitals and other types of clinic. and the Arbeitsgruppe Kopf-Hals of these societies, it has hosted joint •• and much more. endly and dynamic society. The special knowledge required the DRG (German Radiological Soci- annual meetings, symposia, lectures The whole meeting will consist of for the interpretation of head and ety) as institutional members. and courses. We believe such relati- formal lectures, practical workshops Prof. Christian Czerny is professor neck diseases is now unquestioned. The ESHNR, besides organising onships are mutually beneficial to and interactive clinical-radiological of radiology at the department of Furthermore, research, either basic conferences, courses and scholars- our various member constituencies sessions. Do not miss the opportunity radiology, General Hospital Vienna or clinical, is vital to the advance- hips, is evolving to become a truly and will continue to pursue such a to be a part of this exciting scientific and President of the European Soci- ment of this specialty. multidisciplinary body bringing policy in the future. event. As usual, prizes for the most ety of Head and Neck Radiology.

#ECR2017 myESR.org ECR TODAY | FRIDAY, MARCH 3, 2017 TECHNOLOGY & RESEARCH 19

BY KATHARINA KRISCHAK AND MICHAEL CREAN Three EU-funded cancer projects underway with support from EIBIR The European Institute for Biomedical Imaging Research (EIBIR) was founded in 2006 by the European Society of Radiology (ESR) to support researchers in applying for funding and in managing collaborative research projects.

of non-diagnostic and false positive aims to design, build and test a The impact of this technology on results leads to numerous unneces- ground-breaking PET radiofre- breast cancer diagnosis, prediction, sary cost-intensive surgeries. The quency (RF) insert that will vastly monitoring and assessment of tre- project Laser and Ultrasound improve breast cancer imaging. This atment response will be evaluated This image shows a patient model on the patient rest (white). Co-analyzer for Thyroid Nodules new device will also facilitate guided by a clinical study that will test The HYPMED PET detector sensors (green) are adjustable in the (LUCA) is working on a new solu- biopsy through a combination of established and novel PET tracers feet-head direction in order to immobilise the breast for the tion for thyroid nodule screening high-resolution/ultra-high sensiti- in patients. Imaging data will be examination. The biopsy device (brown) allows for minimally and an improved and more accurate vity PET and structural and functio- correlated with established and invasive biopsy of suspicious tissue. diagnosis of thyroid nodules. nal MR. With the molecular and fun- novel molecular biomarkers, the By combining traditional ctional PET-RF imaging developed results will be compared to those Over the last ten years, EIBIR Currently, clinicians use fluoro- ultrasound with an optical sys- by the HYPMED project, physici- obtained from whole-body PET/ has helped researchers secure more deoxyglucose (FDG) PET to detect tem based on diffuse correlation ans will have more information for MRI and PET/CT. than €67 million in funding, going glucose uptake and metabolism in spectroscopy (DCS) and an opti- selecting appropriate and individu- The project is made of ten part- on to become part of more than a tumours and determine whether cal system based on time resolved alised treatment, which will lead to ners which include leading uni- dozen research projects. Many of cancer treatment is working. The near-infrared spectroscopy (TRS), improved survival and quality of life versities, research organisations these projects have been aimed at GLINT method will avoid the use of the LUCA partners aim to develop for women with breast cancer. and industry from across Europe. improving the diagnosis or treat- expensive radiolabelled compounds a portable and low-cost device for With the new insert, any regular EIBIR serves as project coordina- ment of various types of cancer. A and develop an innovative radia- simultaneous multiparametric clinical MR machine can be turned tor and leads project management special session, today at ECR 2017, tion-free MRI technique. This will ultrasound imaging with optical into a hybrid system when requi- and dissemination activities. The will cover the work of the most significantly reduce patient expo- measurement of tissue haemodyna- red. The insert will be created by project’s proposal earned the top recent EIBIR-supported projects sure to radiation and allow for closer mics and composition of the thyroid integrating an innovative and fully score from the European Commis- related to cancer. monitoring of tumour progression nodules. This new device will help to digital MRI-transparent PET detec- sion evaluators and received pro- The project GlucoCEST Ima- and treatment, leading to improved reduce the number of invasive dia- tor into a multichannel PET-trans- posal preparation support from the ging in Neoplastic Tumours clinical decisions and outcomes. By gnostic and therapeutic procedures parent MRI surface coil. EIBIR Team. (GLINT) is expected to have a offering a less expensive comple- and provide enhanced information major impact on European clini- mentary method to FDG-PET, the for clinical decision making. cal oncology practice and beyond. GLINT project will also contribute The LUCA project is expected to It aims to develop an innovative to the sustainability of healthcare have a major impact on the effec- EIBIR Session image-based metabolic evaluation systems throughout Europe. tiveness, cost and speed of medical technique which will allow for less The GLINT method will also diagnosis in the field of thyroid Friday, March 3, 08:30–10:00, Room M 2 invasive, more reliable and earlier open the field of metabolic ima- cancer and beyond. The device has EIBIR Session 2 cancer diagnosis. This ground-bre- ging to a multitude of non-can- the potential to represent a very EU Research on cancer imaging aking novel MRI method builds cer diseases. It is anticipated that innovative tool for the diagnosis, Moderator: Y. Liu; Brussels/BE on recent research revealing the the project’s results will facilitate screening and therapy monitoring sensitivity of a technique named the development of other MRI of other types of cancer in areas »»Introduction glucose-based chemical exchange techniques, increasing the potential of the body accessible to both Y. Liu; Brussels/BE saturation transfer (glucoCEST) to applications of this important diag- ultrasound and near-infrared dif- »»Multimodal imaging with diffuse optics for cancer theranostics detect native (D-glucose) glucose nostic tool. fuse optical technologies and is T. Durduran; Barcelona/ES uptake in tumours and that glucose Another EIBIR-supported project expected to have a major impact on »»Hybrid PET/MRI for breast cancer detection analogues, such as 3-oxy-methyl- addresses the current lack of sen- society. C.K. Kuhl; Aachen/DE D-glucose (3OMG), can be used as sitivity and specificity of current The EU-funded project Digital potential non-metabolisable tracers screening methods in thyroid can- Hybrid PET/MRI for Enhanced Dia- »»Using GlucoCEST MRI to visualise cancer using the same technique. cer diagnosis, where a large number gnosis of Breast Cancer (HYPMED) X. Golay; London/UK

TOGETHER FOR PATIENT SAFETY! VISIT THE EUROSAFE IMAGING CAFÉ and booth (Austria Center Vienna - 1st floor)

To learn more about radiation protection and safety in medical imaging while enjoying a cup of coffee or tea and networking with your colleagues.

www.eurosafeimaging.org

myESR.org #ECR2017 20 TECHNOLOGY & RESEARCH ECR TODAY | FRIDAY, MARCH 3, 2017

BY EMANUELE NERI The CT Dose Repository working group The European CT Dose Repository Subgroup is one of the four EuroSafe Imaging subgroups.

ric trend, which mainly depends on based on anatomy toward clinical The session will conclude with a over 1,600 participating institutions, the adopted imaging protocols. indication reference levels. presentation on the American Col- both domestically and internatio- Such imaging protocols are fre- ECR 2017 will feature a dedica- lege of Radiology (ACR) Dose Index nally, and over 33 million exams are quently designed from an anatomi- ted session on the European CT Registry (DIR), which was concei- currently in the DIR. cal orientation with few concerns Dose Repository. It will focus on ved in 2004 and launched in 2011 to about the specific clinical context the current adoption and impact address the uncertainty of doses in Dr. Emanuele Neri from Pisa, Italy, in which the exam is performed. In of dose-tracking tools in the daily various imaging examinations. It is is chair of the EuroSafe Imaging parallel, the attention to dose refe- practice of radiological depart- designed to assist practices and ins- subgroup on European CT Dose rence levels (DRL) is oriented by the ments, and provide an overview of titutions in comparing dose indices Repository. anatomical segments, and not by the work carried out by the Euro- with national values. The DIR has the clinical context. Safe Imaging Subgroup. One example is that lung CT for Technological and scientific EuroSafe Imaging Session The Subgroup was created in screening has the same scan length developments have led to a remar- March 2016 to explore the clinical of a lung CT for nodule characteri- kable increase in radiation expo- Friday, March 3, 14:00–15:30, Room M 1 impact of tools for automatic dose sation, as well for pulmonary embo- sure. Thus, the technical implemen- EU 4 European CT dose repository monitoring and to provide recom- lism, but these three exams are tation and benefits of dose-tracking Moderators: J.A. Brink; Boston, MA/US mendations and best practice in CT, highly different by indication, and tools will be presented in the first J. Damilakis; Iraklion/GR as well as to reassure radiologists as a consequence by imaging proto- talk. The implementation of radia- about the reliability of statistics cols that influence the dose levels. tion dose index monitoring (RDIM) »»The technical implementation of dose tracking tools obtained from such systems. To Therefore, it is clear that the actual systems, which passively or acti- A. Torresin; Milan/IT reach these goals the Subgroup has dose reference levels, based on the vely collect all the radiation dose »»How do dose tracking tools change the practice of drafted a questionnaire that will anatomical focus, do not reflect the index (RDI) from ionising radiation radiographers? be distributed to European Society standard of dose anymore. Further- modalities, will be introduced and S.J. Foley; Dublin/IE of Radiology (ESR) members. The more, in the same clinical context, open issues related to integration, »»How do dose tracking tools change the practice of radiologists? results of the questionnaire could there is potential variability in pati- e.g. standards, protocols, etc. will F. Zanca; Leuven/BE be helpful in preparing recommen- ent anatomy, physiology and target be discussed. dations on how to improve the CT disease, which influences the CT The session will also present how »»European CT Dose repository working group: summary of dosimetric behaviour in radiologi- imaging protocols. dose-tracking tools change the daily activities cal departments (with the help of Dose monitoring systems could practice of radiographers and radio- E. Neri; Pisa/IT such tools). therefore be a helpful tool for esta- logists. Radiographers and radio- »»The ACR Dose Index Registry The dose monitoring tools allow a blishing new dose reference levels logists play a crucial role in dose R.L. Morin; Jacksonville, FL/US precise internal audit of dose beha- based on the clinical indications optimisation and thus their respon- »»Questions and answers viour in the radiology department, and on the patient’s specific cha- sibility and behaviour towards CT while tracking the general dosimet- racteristics, driving the actual DRL protocols will be reviewed. This session is part of the EuroSafe Imaging campaign.

BY RAYMOND OYEN ESUR takes stock of strengths, threats and opportunities

Although the European Society Early in 2016, ESUR members a large audience of mainly young lines for testicular microlithiasis Abdominal and Urogenital Radio- of Urogenital Radiology (ESUR) is participated in a satellite sym- radiologists. This proves that there (Eur Radiol 2015;25(2):323-330), and on logy (SAR) and ESUR to contribute rather small in numbers, it is great posium on the state-of-the-art is awareness within the commu- incidental testicular lesions/tumours to their respective symposia. The in achievements. Indeed, ESUR practice of urogenital imaging nity of general radiologists that (Eur Radiol 2016;26(7):2268-2278). perspective of urogenital imaging has built a tradition of organising in Muscat, hosted by the Oman mpMRI is rapidly evolving and con- A paper on guidelines for pelvic on both sides of the ocean is wide- high-level symposia and work- Radiology and Molecular Imaging tinuous education is required to endometriosis has been published ning, albeit at times from slightly shops, as well as participation in Society (ORMIS), which was atten- improve competence in performing in European Radiology on the initi- different angles, but always aimed international meetings. It also pro- ded by an enthusiastic audience of high-quality mpMRI examinations ative of the Female Pelvis Imaging at improving radiologists’ compe- duces numerous papers for highly predominately young radiologists and to improve reporting based Working Group (Eur Radiol 2016 tences and patient care. M-F. Bellin ranked journals. These activities and clinicians. on the PI-RADS vs. 2 classification. ESUR guidelines: MR imaging of presented the honorary ESUR Lec- largely contribute to the visibility From the early days of the Con- This PI-RADS vs. 2 is the result of a pelvic endometriosis). ture on ‘New paradigms in renal of ESUR and urogenital radiology. trast Media Safety Committee joint effort by the American College The Paediatric Imaging Working tumour imaging’ at the 2016 SAR This success is due to the initiative (CMSC), ESUR has taken the lead of Radiology (ACR), ESUR, and the Group published imaging recom- Annual Meeting in Hawaii (contri- of the subcommittees and working in producing guidelines on the AdMetech Foundation, and is based mendations on specific topics in the butions by J. Barentsz, J. Futterer, groups and the inspiring enthusi- safe use of contrast media (ver- on the ESUR guidelines on prostate recent past (M. Riccabona; on behalf and G. Masselli). Likewise, there is asm of local organisers of annual sion 9.0), in collaboration with the MR by the Prostate Imaging Wor- of the ESPR Uroradiology Task- strong collaboration with the Asian symposia and workshops. A fri- main companies. The guidelines king Group (Eur Radiol 2012;22:746- force. Pediatr Radiol 2015;45(13)2023- Society of Abdominal Radiology endly and familiar atmosphere has are widely accepted, translated 757). This acceptance by the urologi- 2028). (ASAR) through exchanging cont- become a typical characteristic of into several languages, and locally cal community has been confirmed ESUR is looking forward to its ributions to the annual meetings. ESUR meetings. adapted by many national societies. with the publication in European 24th annual symposium in 2017, Sep- The collaboration with both SAR The Society is particularly proud Recent meetings include a session Urology (Eur Urol 2016;69(1):16-40). In tember 14–17, in Gdansk, Poland, and ASAR must be strengthened that ESUR members will become during the International Congress June 2017, the workshop on mpMRI hosted by M. Studniarek and the to enhance the visibility of the sub- Presidents of the European Society of Radiology in Buenos Aires, Sep- will be held in Copenhagen (V. Loga- 2018 ESUR symposium in Barcelona specialty of urogenital imaging and of Radiology (ESR): Bernd Hamm tember 2016 (H. Thomson) and a ger), building on the wave of ent- hosted by C. Nicolau. ESUR in particular. from Berlin (2017/18) and Lorenzo workshop in Jakarta, Indonesia in husiasm of previous meetings. The ESUR: Strengths, visibility and The cooperation with the Euro- Derchi from Genoa (2018/19). Many November 2016 (S. Morcos). In early 2018 workshop is most likely to be scientific output in collaboration pean Society of Gastrointestinal other ESUR members are involved 2017, a workshop will be held in Peru held in Lille, France (P. Puech). with other societies and Abdominal Imaging (ESGAR) in the ESR at an institutional level. with the contribution of G. Heinz- In November 2016, Michele Berto- The active involvement of ESUR has been further formalised with Strengths: visibility and scienti- Peer. Twenty eight countries have lotto organised a workshop on the in the ESR and ECR guarantees bilateral active participation. This fic output participated so far in the ESUR Glo- multimodality imaging approach to input from experts in urogeni- widens the range of topics for gene- The 23rd ESUR Annual Sympo- bal Educational Programme on Safe penile and scrotal pathologies (Flo- tal imaging in future policies and ral radiologists offered at the res- sium (chair: Nicolas Grenier) took Use of Contrast Media. rence). The ESUR Working Group on further improvement on the scien- pective meetings. A joint paper on place in Bordeaux in 2016 and The workshop on multiparame- Scrotal and Penile Imaging (chair: J. tific level. recommendations for MRI of pelvic was very successful from all points tric prostate MRI (mpMRI) in June Richenberg) is extremely productive It is of mutual interest to mem- floor dysfunction has been accep- of view. 2016 (Berlin; B. Hamm) attracted with recent publications on guide- bers of the American Society of ted by European Radiology (R.E. El

#ECR2017 myESR.org ECR TODAY | FRIDAY, MARCH 3, 2017 TECHNOLOGY & RESEARCH 21

Sayed et al; Eur Radiol 2016), proving cations, advantages and limitations. certificates for specific pathologies veillance, targeted imaging-guided specialties. The term ‘diagnostic the true willingness to collaborate Similar ‘pressure’ on radiologi- and/or modalities. biopsies, improved visualisation platform’ is gaining popularity. and ultimately improve patient cal imaging is generated by other There is a tsunami of meetings for focal therapy (radiotherapy, ESUR has developed a specific care. Future workshops organised societies, and the above reflections focusing on similar topics, yet from brachytherapy, thermal therapy, and highly detailed training char- by ESGAR will involve ESUR when should be incorporated into the a different perspective and with etc.) and FU-imaging strategies ter for uroradiologists. The aim of appropriate (Acute Abdomen work- cooperation with these societies considerable overlap (International for tumour response during and subspecialised training is to pre- shop – Rome, October 2017). and become fully integrated into Cancer Imaging Society, European after therapy. pare radiologists for a career in Threats: competing interests future ESUR strategies. Radiolo- Society for Oncologic Imaging, New approaches have to be which a substantial proportion of in urogenital imaging with other gists must therefore move from European Meeting on Urological explored, such as DTI-MRI. Other their professional work is dedica- clinicians and societies being merely report generators to Cancers, Cardiovascular and Inter- IT evolutions have to be embra- ted to uroradiology. These radiolo- Workshops by ESUR are open for real consultants, preferably in mul- ventional Radiological Society of ced, like computer-aided detection gists not only provide routine cli- urologists and other clinicians. Par- tidisciplinary teams of specialists. Europe and many others). Choices and diagnosis (CAD and CADx), nical services, but also adopt and ticipation by urologists is not neces- In this context, collaboration have to be made on if, how, when, 3D visualisation, artificial intel- develop new imaging and interven- sarily a potential threat as this holds with the European Association of and whom should participate. ligence, deep learning, radiomics tional methods and disseminate opportunities with mutual benefit Urology (EAU) and ESGAR deserves Opportunities: improving com- and radiogenomics. the expertise to their colleagues in to both disciplines. Input from uro- particular attention, assuring active petence and leadership Strong collaboration with other general radiology. logists is essential to optimising MRI participation at the annual mee- Imaging data have a substantial diagnostic specialties, including procedures and reporting on the tings and in projects on guidelines, impact on diagnostic and thera- nuclear medicine, pathology and Prof. Raymond Oyen is head of the continuously evolving diagnostic indications and reporting. Active peutic management. The contribu- genetics is required in order to department of radiology at Uni- and therapeutic needs. On the other involvement in the European Soci- tion of skilled radiologists is neces- provide a cost-effective diagnostic versity Hospitals Gasthuisberg in hand, urologists must fully realise ety of Urological Imaging (ESUI) sary in order to take the lead and pathway and an ‘integrated’ perso- Leuven, Belgium, and President of that the radiologist is in the driver’s must be formalised to avoid unila- remain involved in the follow-up nalised diagnosis, with full respect the European Society of Urogenital seat and clearly understand the indi- teral initiatives in granting imaging of suspicious lesions, active sur- to the expertise of the contributing Radiology (ESUR).

BY FLORIAN DEMUTH ESR establishes Working Group on Value-Based Imaging Responding to trends within healthcare – and particularly in radiology – that are already prevalent in the United States and increasingly also in Europe, the European Society of Radiology established a working group (WG) on value-based imaging (VBI) in 2016.

scheduling, communication before tion of reimbursement of imaging and after the examination, and of services, effectively and accurately course performing the procedure measuring radiologists’ contri- itself, to achieve the optimal medical butions in countless patient-care outcome as quickly as possible. cycles is a prerequisite for demons- A paradigm for the future? trating their value. A significant A radiological practice that is amount of literature on quanti- organised according to value-based tative radiology metrics already principles takes into consideration exists, and some value-based met- a number of trends in healthcare. rics such as impact on the length Financial constraints on healthcare of patients’ hospital stay, impact on systems mean that the pressure for treatment decisions, changes in dia- justification is increasing, positio- gnoses, etc. But more work is nee- ning radiology as a value-contribu- ded to develop metrics that assess tor instead of a cost-factor will be radiologists’ contribution to health- essential to functioning effectively care outcomes. And while no metric in this environment. Evidence-ba- or equation can ever reflect the true sed medicine reduces variations in complexity of healthcare delivery, practice and focuses on medical ser- quantitative metrics are essential vices with proven clinical utility. For and should be completed by the medical imaging, this means that development qualitative indicators. appropriate referrals, justified radi- The ESR’s journey: from quality ation exposures and optimised exa- and safety areas to value-based, minations will become a necessity. patient-centred radiology Many aspects of embedding A first glimpse of the WG’s work value-based imaging in clinical and future plans was provided practice require the support of during the ESR Annual Leadership Steps in the imaging chain (Ammar Sarwar, Giles Boland, et.al., Metrics for Radiologists in the Era of IT tools. Radiology has long been Meeting 2016. The WG is working Value-based Health Care Delivery, RadioGraphics Volume 35, Number 3, p. 866ff.) among the medical specialties most on an ESR concept for VBI as well advanced in their adoption of IT as a working plan for the coming This working group, under the fic expenditures – but it captures patients. For example, a value-ba- applications. The rapid develop- year, enhancing relevant initiatives umbrella of the ESR Board of Direc- the difference with volume-driven sed approach would assess radio- ment of new technologies and the with a value-based dimension. Even tors, is charged with assessing the approaches that ‘reward’ healthcare logy reports in terms of actionable expected ‘big data revolution’ will though VBI is a relatively new con- status of value-based approaches professionals for services provided recommendations, clarity and intel- reinforce these trends. In addition cept, for the ESR it is very much a in Europe, developing a definition with limited or no regard to their ligibility, perhaps even tracking and to linking referrers, radiologists and continuation of its focus on patient and concept of VBI for the ESR, and appropriateness or clinical utility. evaluating the treatment decisions patients more closely, this will cre- safety and quality of care, increa- positioning the ESR strategically to The imaging value chain expands that are made based on radiology ate a more even playing field with singly emphasising patient-cent- shape this emerging paradigm. the healthcare value-equation to recommendations. regard to information access, not to red service and outcome-focused The imaging value-chain encompass a variety of factors Value-based imaging also emphasi- mention the possibilities for quan- practice supported by IT tools, Value in healthcare is commonly that contribute to the added value ses a more patient-centric approach, titative analysis to understand and knowledge dissemination and tailo- defined as the achieved health out- provided by medical imaging and focusing on health outcomes and the improve practice patterns. red metrics to support radiologists come per unit of currency spent. the different services radiologists patient experience from their per- Measure for measure in enhancing healthcare delivery This equation has obvious limita- provide. Importantly, it places the spective. A premium is put on patient Metrics occupy a central role wit- for their patients. tions – outcomes can be difficult to radiologist in context with refer- satisfaction throughout the entire hin value-based imaging. For a vari- measure and directly link to speci- ring and treating physicians and patient experience, from referral to ety of reasons, not least the ques-

myESR.org #ECR2017 22 TECHNOLOGY & RESEARCH ECR TODAY | FRIDAY, MARCH 3, 2017

BY CELSO MATOS ESGAR uses past success to fine-tune annual meeting for 2017

from the attendees, it will most probably be renewed to give talented young ESGAR members the unique opportunity to invest in research and understand how to translate it into patient care. The continuous innovations in medical imaging capabilities and the progressive development of new ways of studying biological tissues present challenges for ESGAR in identifying opportunities for change in the forthcoming years. Looking forward in such a challenging environment will most probably require the Society to invest further in uniting the biomedical and physical sciences and in develo- ESGAR’s next Annual Meeting will be held in Athens, Greece, June 20–23, 2017. ping an infrastructure to support well-designed research. This would The European Society of Abdomi- well-recognised and well-attended meeting delegates. Among many room-based courses, all those inte- allow us to document the effects of nal and Gastrointestinal Radiology forum that meets the educational other topics, abdominal oncologic rested in abdominal imaging have new imaging modalities and new (ESGAR) is a leading educational and scientific needs of all, and provi- imaging will be highlighted during an opportunity to master techno- clinical applications on patient and scientific society composed of des opportunities for younger radio- workshops and joint sessions with logical advances, learn abdominal outcomes. ESGAR’s next Annual a highly diverse group of members logists to present their research. An our partner societies. The very suc- imaging from an organ and disea- Meeting will be held in Athens, an that has now spread all over exciting new programme for 2017’s cessful ESR-ESGAR leadership ses- se-based perspective and under- ideal destination, and will certainly the world, being represen- ESGAR Annual Meeting, to be held sion that took place in Prague will stand how to incorporate diagno- provide useful insights into these ted at a national level in both in Athens, has been put together. be repeated, serving as a platform to stic and imaging-guided therapy challenges. We do hope you will be hemispheres – from Sweden to Aus- The postgraduate course will debate the organisation of abdomi- into the multidisciplinary manage- part of it and contribute to the con- tralia. address everyday clinical challenges nal radiology in Europe. ment of patients. New initiatives tinued success of ESGAR. ESGAR aims to enhance subspe- through ‘Imaging of the post-ope- The Society also provides an have been proposed for 2017, such cialisation training and the eviden- rative abdomen’. Some fine-tuning extensive array of educational pro- as the first ESGAR workshop focu- Prof. Celso Matos is chair of the ce-based practice skills of all those of successful concepts from previ- gramming for professionals with sing on clinical research methods imaging department at the Cham- interested in abdominal imaging. ous years has been carried out in different profiles and backgrounds and grantsmanship. Thanks to the palimaud Clinical Centre in Lisbon, The ESGAR annual meeting is a order to fulfil the requirements of all year round. Throughout class- positive and enthusiastic feedback Portugal, and ESGAR President.

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#ECR2017 myESR.org ECR TODAY | FRIDAY, MARCH 3, 2017 TECHNOLOGY & RESEARCH 23

BY GUY FRIJA AND LORENZO BONOMO EuroSafe Imaging Stars: be a star for your patients

The EuroSafe Imaging Stars ini- they fulfil. However, some criteria applications currently in the www.eurosafeimaging.org tiative was launched under the are mandatory, for example parti- process of evaluation. [email protected] umbrella of EuroSafe Imaging in cipation in the survey series to col- If your department is not a Euro- early 2016 to support the Call for lect CT dose data entitled ‘Is your Safe Imaging Star yet, don’t miss Prof. Guy Frija from Paris, France, Action. It has been designed to Imaging EuroSafe?’. In addition, the the chance to apply online or at the is a member of the ESR Radiation identify and recognise imaging faci- self-assessment also includes ques- EuroSafe Imaging booth, located in Protection Subcommittee and chair lities that embody best practice in tions on the use of CT protocols and the EuroSafe Imaging Café. of the EuroSafe Imaging Steering radiation protection and that are automatic dose recording, dose opti- You can also attend the dedicated Committee. committed to putting the principles misation, justification, equipment session on the EuroSafe Imaging Lorenzo Bonomo from Rome, Italy, advocated and concepts developed quality, clinical audit, or the use of a Stars today, 16:00-17:30, Room is professor of radiology at the by the European Society of Radio- clinical decision support for imaging M1. This session will present the Radiology Catholic University logy into practice. referral guidelines. After successful EuroSafe Imaging Stars initiative Rome. He is the chair of the The Stars initiative enables the evaluation, the participating ima- in detail while also focusing on EuroSafe Imaging Stars initiative. EuroSafe Imaging is the European Society of Radiology to ging departments are awarded the limitations and how to improve European Society of Radiolo- collect dose data for analysing trends respective number of stars from one the concept. gy’s (ESR) flagship initiative to in medical imaging. In addition, the to five and listed on the ‘Wall of Stars’ promote quality and safety in Stars network can use the data for according to the level attained. Par- EuroSafe Imaging Session medical imaging for the benefit of benchmarking and comparing their ticipating facilities have to undergo patients by strengthening medical results with those of their peers. the self-assessment biannually to Friday, March 3, 16:00–17:30, Room M 1 radiation protection across Europe The EuroSafe Imaging Stars initi- renew their star status. EU 5 EuroSafe imaging stars following a holistic and inclusive ative provides imaging departments EuroSafe Imaging aims to promote Moderators: L. Bonomo; Rome/IT approach. with an incentive to embrace a holi- quality and safety in medical imaging S. Ebdon-Jackson; Didcot/UK EuroSafe Imaging is committed stic approach to quality and safety well beyond Europe and to encourage to supporting the Bonn Call for in radiology, and thus the Stars net- other regions to follow suit. Thus, »»Value and limitations of the ‘Is your Imaging EuroSafe’ surveys Action published by the Internati- work takes efforts to give radiation imaging departments worldwide can L. Bonomo; Rome/IT onal Atomic Energy Agency (IAEA) protection greater visibility while apply to become a EuroSafe Imaging »»Integration of the ‘EuroSafe Imaging Clinical Audit Pack’ and co-sponsored by the World having a positive impact on clinical Star, provided that the department’s in imaging departments Health Organisation (WHO). Based practice at the same time. head is an ESR member in good B.E. Kelly; Belfast/UK on this it has issued the ‘EuroSafe To participate in the EuroSafe standing. EuroSafe Imaging serves »»Benchmarking: why, how and when? Imaging Call for Action’, a 12-point Imaging Stars initiative, imaging as a role model for radiation protec- J. Hakumaki; Kuopio/FI action plan to achieve EuroSafe departments have to perform a tion campaigns on other continents, Imaging’s objectives of promoting self-assessment on their level of where initiatives like Latin Safe (LAC »»The value of achieving star status appropriateness in radiological ima- radiation protection. Therefore, an countries), the pan-African AFRO- D. Akata; Ankara/TR ging, maintaining radiation doses applicant department has to com- SAFE initiative, Canada Safe Ima- »»How to improve the EuroSafe imaging stars concept? within diagnostic reference levels, plete an online application form. ging and Japan Safe Imaging have L. Donoso; Barcelona/ES encouraging the use of the ALARA The list of criteria of the self-assess- recently been established. »»Improving the integration of radiation protection in principle, promoting the use of ment is divided into five sections As of January 2017, 44 facili- the clinical setting up-to-date equipment, empowering and imaging facilities will be awar- ties from 17 countries worldwide G. Frija; Paris/FR patients and joining forces with ded up to five stars depending on have joined the EuroSafe Imaging various stakeholders. how many criteria of a certain level Stars network, with another 25 This session is part of the EuroSafe Imaging campaign.

EuroSafe Imaging Stars: Innsbruck Medical University in Austria EuroSafe Imaging Stars is EuroSafe Imaging’s latest initiative to promote quality and safety in medical imaging. By recruiting a network of imaging departments committed to best practice in radiation protection, the Stars initiative will give radiation protection efforts greater visibility, have a direct impact on clinical practice and enable the European Society of Radiology to collect data for analysis and benchmarking.

One of the EuroSafe Imaging ning the campaign would enhance ECRT: What are your sugge- ECRT: Would you recommend Stars institutions is the department our own mission to be a leader in stions for improving the EuroSafe other facilities to become Euro- of radiology at Innsbruck Medical the field of dose management and Imaging Stars initiative? Safe Imaging Stars? If so, what University, Austria. The depart- radiation safety. WJ: The programme will proba- arguments would you use to con- ment of radiology has approxima- ECRT: One important contribu- bly require clinical audits at some vince them? tely 300,000 patient visits per year, tion EuroSafe Imaging Stars are point. This is, however, expensive WJ: I would encourage in particu- operates fully digital and provides expected to make is to participate and a lot of work for everybody lar every high-volume centre to join imaging services and interventional in the data collection initiatives involved. Mentoring of institutions the initiative. The EuroSafe Imaging procedures for the Austrian federal through the ‘Is your Imaging Euro- which have problems establishing Stars initiative can stimulate new state of Tyrol, with approximately 48 Safe?’ surveys on CT dose. What is an effective radiation safety culture activities and improvements that million overnight tourists per year. your opinion on these surveys and also has to be considered. reach beyond the requirements of Please read below an interview how useful do you think the Euro- ECRT: Which future cooperation national radiation protection laws. with Prof. Werner Jaschke, direc- Safe Imaging survey findings will and activities within the network tor of the department of radiology be for your daily clinical activity? of Stars would you like to see? at Innsbruck Medical University, WJ: Benchmarks in CT dose are WJ: Hot topics in radiation safety Prof. Werner Jaschke is director which is a five-star facility. very important for optimisation. are paediatric radiology, CT and inter- of the department of radiology ECR Today: Your radiology We can meet diagnostic reference ventional radiology. I think interventi- at Innsbruck Medical University, department joined the EuroSafe levels in Austria without problems. onal radiology should be in the focus Austria. He is a certified inter- Imaging Stars network. Why But, of course, we want to reach of future activities. Interventional ventional radiologist and chairs did you apply and what are your CT dose levels which compare radiology is probably the only field of a department with more than thoughts on this initiative? favourably with other European radiology in which you can encounter 60 radiologists. Werner Jaschke: We felt that joi- leaders in radiation safety. deterministic effects of radiation. myESR.org #ECR2017 24 TECHNOLOGY & RESEARCH ECR TODAY | FRIDAY, MARCH 3, 2017

BY VIKTOR BÉRCZI, GÁBOR FORRAI, PETER BOGNER Hungarian Society of Radiologists in 2016

The Hungarian Society of Radio- Giles Maskell, who presented five equipment, which does not use purposes. In the same year, a small research of different neurologic dis- logists (HSR), founded in 1922, had lectures on modern MR techniques compression or radiation. MR research group was established orders in which the structural alte- yet another fruitful year in 2016. We and MR diagnosis on liver, breast, The Hungarian IDoR press including an information technolo- rations of the central nervous sys- had our biennial national radiology gynaecological and rectal tumours. release referred to EUSOBI’s five gist, a physicist, a biologist and seve- tem plays a prominent role during meeting in June in Budapest, with It was also our honour to enjoy two points against breast cancer, which ral physicians from the neighbou- their pathomechanisms (epilepsy, more than 400 participants and lectures by Professor Paul M. Pari- included statements like “mammo- ring neurology and neurosurgery TBI, multiple sclerosis, migraine, more than 180 lectures. The main zel, President of the ESR. graphy saves lives and life quality – clinics. This research group, named etc.). Besides being part of the Hun- topics included emergency radio- In addition, two more activities it can decrease breast cancer death MTA-PTE Clinical Neuroscience MR garian Brain Research Programme, logy, quality control and modern related to breast imaging and the by up to 40%” and “if a woman has Research Group, became an offi- our research group also participates MR techniques. We had numerous International Day of Radiology breast symptoms, the breast radio- cial Hungarian Academy of Scien- in EU Seventh Framework projects clinical-radiological symposiums (IDoR) and neuroradiology research logist is the doctor to meet”. (See ces-funded research group in 2012, (Center-TBI, I. Family). where the importance of coope- in Pécs may be of interest for our also https://healthmanagement. and this successful structure has ration and consultation between readers. The Section of Breast Ima- org/c/healthmanagement/issuear- not changed since. In the past five Prof. Viktor Bérczi is professor and radiologists and clinicians was ging of the Hungarian Society of ticle/mammography-is-the-most- years, the research group has pub- chairman of the department of emphasised. The topics included Radiologists held a successful pro- proven-screening-method) lished around 80 articles in peer-re- radiology at the Semmelweis MSK, stroke, emergency medicine, fessional meeting and public press Hungary introduced an organi- viewed international journals with a University in Budapest, Hungary, gynaecology, pulmonology, uroge- appearance for IDoR. sed screening programme with free cumulative impact factor of around and President of the Hungarian nital radiology, liver diagnostics This year’s ‘breast imaging’ sub- participation very early on (2001), 180. These publications have already Society of Radiologists (HSR). and interventional radiology. We ject was a good opportunity to have which invites all women between received over 300 independent cita- Prof. Gabor Forrai is head of the also had joint symposiums with a roundtable conference among 45 and 65 years of age for a bien- tions. The research group, due to department of radiology at Duna the Hungarian Society of Nuclear national screening centres and nial mammography examination. the widely different background of Medical Center in Budapest, Medicine as well as the Hungarian authorities about subjects such as Even after completing the th7 cycle, its members, has diverse research Hungary, head of the breast Society of Emergency Medicine. differences in screening protocols, the average participation is quite topics inherently connected by the screening centres in Vác and Eger Moreover, there were 19 invited transition to digital mammogra- low (45–60%). Our focus is to moti- utilisation of cutting-edge MR ima- County Hospitals, board member foreign speakers from countries phy, the steps towards tomosyn- vate the public to be more health ging and evaluation methods. These of the HSR, and President of the like Austria, Belgium, Croatia, Ger- thesis and how to prevent medical conscious, to raise breast cancer topics focus on two main aspects. European Society of Breast Imaging many, Turkey and the UK on vari- fraud. This is an important issue in awareness and to achieve 70–75% The first is basic research on human (EUSOBI). ous topics of diagnostic and inter- our country because the authori- participation in the nationwide ‘higher-level’ cognitive brain func- Prof. Peter Bogner is clinic director ventional radiology. We were very ties are not effectively protecting breast-screening programme. tions that cannot be assessed using of the department of radiology proud to welcome the official dele- the public from medical frauds In 2007, a 3 Tesla Siemens MR scan- animal models (language organi- at the University of Pécs Medical gation from the Royal College of who offer patients screening and ner was installed at the Pécs Diag- sation, addictions, schizophrenia, School and board member of Radiologists, led by then-president, diagnostics with non-approved nostic Center, mainly for research etc.). The second is basic and clinical the HSR.

HANDSON CT / HII / ULTRASOUND / MRI SATELLITE MRI WORKSHOP MARCH 3 LUNCH SYMPOSIUM MARCH 3

10:00 – 17:15 | ROOM 0.14 ENTRANCE LEVEL 12:30 – 13:30 | ROOM F2 ENTRANCE LEVEL

10:00 – 11:00 | CT – Urography Advances in musculoskeletal MR imaging Ultra-low dose CT urogram protocols Dr. Mark Kon (Bradford Royal In rmary, Bradford, United Chair: Kindom) Prof. Martin Zwaan (Ammerland Klinik, Westerstede, Germany)

11:15 – 12:15 | CT – Metal artifact reduction Speakers: Minimizing artifacts in metal implants imaging MR-Ultrasound fusion in clinical practice Dr. Pedro Gondim Teixeira (Nancy University Hospital, Nancy, Dr. Lluís Til (First team physician at FC Barcelona, Barcelona, France) Spain)

12:30 – 13:30 | HII Functional imaging of striated muscle: perfusion 3D Printing and di usion weighted imaging Prof. Jean-Paul Vallée (Hôpitaux Universitaires de Genève, Dr. Pedro Gondim Teixeira (Nancy University Hospital, Nancy, Geneva, Switzerland) France)

13:45 – 14:45 | MRI and Ultrasound Computed MRI in a nutshell MR-Ultrasound fusion in clinical practice Mr. Bruno Triaire (Olea Medical, La Ciotat, France) Dr. Lluís Til (First team physician at FC Barcelona, Barcelona, Spain)

15:00 – 16:00 | Ultrasound Ultra-high frequency approach to small peripheral nerves Dr. Alexander Loizides (Medical University Innsbruck, Innsbruck, Austria)

16:15 – 17:15 | Ultrasound Advances in prostate ultrasound diagnostics and treatment guidance Prof. Thomas Fischer (Charité Universitätsmedizin, Berlin, Germany) Visit our booth #16 (Hall X2) and get your free Cartoon within 2 minutes! For a complete overview of our educational program please visit #GYCartoon @toshiba_med #ECR2017 www.toshiba-medical.eu/ecr2017 ©ANDREAS FLORIS

#ECR2017 myESR.org ECR TODAY | FRIDAY, MARCH 3, 2017 COMMUNITY NEWS 25

European Diploma in Radiology ESCR expands activities in Russian Society of Radiology continues to thrive cardiovascular imaging education celebrates its centenary 27 28 and research 29

BY KATHRIN TAUER European Radiology: 25 years of excellence The ESR’s flagship journal, European Radiology, celebrated 25 years of publication in 2016. We spoke to Prof. Albert L. Baert, the journal’s Editor-in-Chief from 1995 to 2007, Prof. Adrian K. Dixon, who headed European Radiology from 2008 until 2013, and our current Editor-in-Chief, Prof. Maximilian F. Reiser. Together, they gave us a comprehensive account of the journal’s development during the last quarter of a century.

fully thanks to the enthusiastic col- of our published articles meets the laboration of the editorial staff, the highest scientific standards and authors and the reviewers, but also that our readers can rely on the due to the outstanding technical fact that all published manuscripts expertise of the Springer staff, hea- have undergone a strict indepen- ded by Dr. Ute Heilmann. dent and anonymous peer review Adrian K. Dixon: Helping with process. the rise in the Impact Factor and We should try to expand our inter- speeding up the turnaround time active elements to further intensify for decisions and subsequent the discussion with authors, revie- publication. wers and readers and increase our Maximilian F. Reiser: Over the social media presence. last three years, the number of sub- Adrian K. Dixon: Publication of missions has increased dramatically. research material will become even While we are extremely happy that more immediate with open access so many authors are interested for all. Indeed some journals may in publishing in European Radio- even make the review process itself logy, it also means an increased ‘open’, thereby making it possible workload for the Editorial Office for experts to offer their opinion and the editors. This has presented while the paper is still under review. us with many difficulties, but we Of course that would mean that have undertaken enormous efforts submission would have to count and managed to tackle this growing as the start date for that research number of manuscripts. We were article in order to prevent others lucky enough to be able to recruit from ‘stealing’ the idea! two excellent new Deputy Editors to Albert L. Baert: As my colleagues our team, Dr. Sujal Desai from Lon- mention, it is quite remarkable don, UK, and Prof. Jean-François to notice that the end of printing Geschwind from New Haven, US. scientific material on paper may be 25 years of success for the three editors-in-chief of European Radiology: Albert L. Baert, Prof. Rahel Kubik from Baden, Swit- in sight due to electronic publica- Maximilian F. Reiser, Adrian K. Dixon. zerland, Prof. José María García San- tion, which is now widely accepted tos from Murcia, Spain, und Prof. by the scientific community. The ECR Today: How have you seen to know the editorial team, the one selected candidate the chance Peter Vock from Berne, Switzerland, increasing trend to ‘open access’ the journal develop during the authors and the reviewers. There to look ‘behind the scenes’ of scien- continue to support me with their will certainly be another challenge past 25 years? has been an increasing need to gua- tific publishing, has also proved competence and expertise, which I for the future years! Albert L. Baert: During this time rantee the authenticity/originality very successful in my opinion. For am very grateful for. period the number of published of articles and insisting on a named 2017, we look forward to welcoming ECRT: Which direction do you Prof. Albert L. Baert is Emeritus articles has increased spectacularly senior ‘guarantor’ for each paper. a radiologist from China. think the journal, and publishing Professor of Radiology at the from 60 articles per year in the first Maximilian F. Reiser: Under the ECRT: What were your greatest in general, will take in the future? Katholieke Universiteit (KU) Leuven, issues to more than 400 per year visionary leadership of Prof. Albert personal achievements during Maximilian F. Reiser: With the Belgium, and was Editor-in-Chief now. For example, no less than 4,674 Baert and Prof. Adrian Dixon, Euro- your time as Editor-in-Chief? introduction of European Radio- of European Radiology from 1995 pages were published in 2016! Euro- pean Radiology has made remar- Albert L. Baert: When I took over logy Experimental, our family of to 2007. pean Radiology is now one of the kable progress. It has claimed a as Editor-in-Chief in 1995, the jour- ESR journals has been supplemen- Prof. Adrian K. Dixon is Emeritus most widely distributed and read position among the highest ran- nal had no Impact Factor. European ted in a very logical way. Insights Professor of Radiology at scientific journals in the world. ked journals in general radiology Radiology was accepted onto the into Imaging has developed won- Cambridge University and an Simultaneously, the scientific level of and has managed to considerably ranking list by the ISI institute in derfully under the guidance of honorary consultant radiologist at the contents has improved steadily increase its attraction to imaging Washington in 1996 and the first IF Prof. Robert Hermans, so that in Addenbrooke’s Hospital, over the years as proven by the cur- and interventional scientists all was attributed for the year 1997. It the future, all three journals can Cambridge. He was Editor-in-Chief rent excellent Impact Factor ranking. over the world. was a modest 0.5601 but had increa- best meet the individual demands of European Radiology from 2008 Adrian K. Dixon: I was very The journal now represents the sed to 3.651 by the end of my term of radiological scientists. to 2013. lucky to take over when the diffi- diverse and impressive range of our in 2008. The proliferation of open access Prof. Maximilian F. Reiser is the cult task of making it all electronic specialty, with all its sub-sections Another decisive achievement for journals presents established scien- outgoing chair of the Ludwig had already been achieved by Prof. and areas, and has truly become glo- the development of the journal was tific journals with a challenge; Maximilians University’s depart- Baert’s team in Leuven. Thereaf- bal, in terms of papers submitted as the radical switch to electronic pub- something that also concerns Euro- ment of radiology in Munich, and ter it was a case of personalising well as people involved. Our Albert lication during the years 2004–2005. pean Radiology. Our top priorities has been the Editor-in-Chief of the electronic letters and getting L. Baert Editorial Fellowship, giving This mutation was realised success- are to make sure that the quality European Radiology since 2014.

myESR.org #ECR2017 26 COMMUNITY NEWS ECR TODAY | FRIDAY, MARCH 3, 2017

BY GEERT M. VILLEIRS Belgian Society of Radiology to promote appropriate use of medical imaging In Belgium, about 1,400 radiologists assume the important daily task of providing high- quality imaging in the diagnosis, staging and follow-up of women, men and children seeking medical care. With about 11 million inhabitants, each radiologist in Belgium serves an average population of about 8,000.

The Belgian Society of Radiology, to additional medical concerns. For is often an obvious solution to reas- opt for a ‘quicker’ CT scan instead vities. The Annual Symposium is founded in 2013 according to Bel- example, the increasing number of sure their anxious patients or ‘to be of an MRI, despite the fact that held every year in November, and gian law on professional organisa- cancer cases leads to an increasing on the safe side’ even though the CT for some patients, or for some Section Meetings are held throug- tions, is an effective merger of three demand for repetitive oncological indication is not in accordance with symptoms, is not the most appro- hout the year in every radiological pre-existing radiological societies, imaging (monitoring of size, loca- the guidelines. Nevertheless, it is a priate exam. This adds to the total sub-discipline. It is of great interest including a scientific and a profes- tion, multiplicity and extent of very legitimate question whether population radiation dose, but also that two new Sections have been sional wing. Its goals are to defend, tumour burden). Medical imaging national health insurance providers inflates the total amount of exams founded recently. The first one is the study, protect and foster both the technology is constantly evolving, should be financially responsible (first a quick CT and then an MRI Young Radiologist Section, gathe- scientific and professional interests and while radiology was almost for such investigations. anyway). After long negotiations, ring all Belgian residents-in-trai- of all Belgian radiologists. The mer- synonymous with anatomical For that reason, the Belgian Soci- the Belgian Society of Radiology ning and radiologists within five ger of the three societies has had evaluation in the past, functional ety of Radiology has been positively came to an agreement with the years of their graduation. This is a several advantages: it has allowed imaging such as diffusion, perfu- collaborating with the government Federal Government to extend very active section that succeeds in better integration of scientific and sion and spectroscopy have now for many years to promote the the national programme with 12 attracting many young radiologists professional interests, increased gained widespread acceptance and appropriate use of medical imaging additional MR scanners (seven to its dedicated meetings, as well as visibility and accessibility of radio- generated new indications. through initiatives such as the pub- in Flanders and five in Wallonia), to the Annual Symposium, during logical executives for all stakehol- Secondly, the Belgian medical lication and electronic distribution now totalling 121 machines throug- which it organises an extremely ders, and has facilitated more effi- imaging budget is a closed budget. of the Belgian Medical Imaging hout the country (1.1 machines well attended parallel programme cient and influential representation That means that any budget over- Guidelines (www.health.belgium. per 100,000 inhabitants) but their dedicated to the young. The most at the governmental level. run in the past has been compensa- be/richtlijnen-medische-beeldvor- effect on the substitution rate still recent section is the Leadership, Professional defence ted repeatedly through depreciation ming); an annual media campaign needs to be established. Management and Quality Section, Such representation is very in reimbursement. The entrenched ‘Medical images are no holiday Although adherence to the gui- aiming at increasing the engage- important. It is a recurring problem idea that Belgian radiologists, wor- snaps, use them wisely’ aiming delines can be expected to improve ment of radiologists in leadership that radiological work is not apprai- king in a fee-for-service system, at informing the general popu- through information campaigns, and encouraging them to take part sed on its merits, but rather on its greedily encourage their referring lation through radio spots about this process is a passive one. Solu- in ongoing managerial education budget that is invariably perceived clinicians to order as many radio- the disadvantages of unnecessary tions such as an active decision and attend leadership development as incessantly increasing and exces- logical examinations as possible to x-rays; and a quarterly magazine support system (e.g. ESR iGuide), programmes. sive. Both policymakers, opinion raise their income is a total myth Focus on Medical Imaging (www. embedded in an electronic ordering Scientific reporting and publis- leaders, the (popular) press and the and awfully naïve. In a closed bud- focusonmedicalimaging.be), tar- system, provide referring physici- hing is also encouraged through general population tend to associate get system, only the workload is geted at referring physicians in an ans with pertinent evidence-based the Journal of the Belgian Society of growing medical imaging expen- increased, not the profits. attempt to improve the efficient use imaging guidelines tailored to the Radiology (www.jbsr.be), formerly ses with the greediness of radiolo- Thirdly, the volume of medical of imaging in selected clinical cases. clinical context of their patient published as the Journal Belge de gists, especially in a fee-for-service imaging in Belgium is exclusively Such initiatives seek to promote the at the time of ordering an exam. Radiologie – Belgisch Tijdschrift system (the more exams, the more determined by the number of use of non-irradiating techniques Hence, patients will be referred for voor Radiologie (JBR-BTR). It is an income). For example, a recent Bel- exams ordered by referring phy- such as magnetic resonance ima- unjustified exams less often, allevi- open-access online journal indexed gian magazine article referring to sicians (general practitioners and ging (MRI) instead of CT scans, and ating the pressure on the medical by several services, such as Cross- the medical imaging budget claimed specialists) as radiologists have no to avoid unnecessary examinations, imaging budget through volume Ref, DOAJ, EBSCOHost and Google that “hundreds of millions of euros ‘auto-prescription right’, i.e. they enabling budget control through control rather than tariff deprecia- Scholar. are squandered each year without are not allowed to order radiologi- volume-reduction rather than repe- tion. Therefore, the Belgian Society Conclusion better quality of care, but with an cal examinations. Not all ordered titive tariff reductions. of Radiology is currently collabo- The Belgian Society or Radio- unnecessary exposure of the popu- exams, however, turn out to be justi- The positive effects of these ini- rating with the government for logy is a recently unified society lation to harmful radiation …” fied (i.e. consistent with guidelines tiatives have been limited by two the nationwide implementation of that manages both the professio- The Belgian Society of Radiology for appropriate use of medical ima- major problems so far. such an active decision support sys- nal and scientific interests of the puts a lot of effort into drawing atten- ging), but add to the total volume of Substituting MRI for CT requi- tem in Belgium. very active Belgian radiological tion to a number of important facts. medical imaging and put additional res sufficient access to MRI, and Scientific activities community. Through the integra- First of all, the increasing pressure on the medical imaging this poses a particular problem in The Belgian Society of Radio- tion of both interests, a more effi- demand for medical imaging can budget. Although it is tempting to Belgium because the use of an MRI logy has an independent Scientific cient and influential representa- largely be explained on the basis label such exams as ‘a useless waste machine is subject to a national Counsel, fostering and promoting tion at the governmental level has of demographic and technological of time and money’, they can be policy, a constraint that has never all kinds of scientific activities. been achieved, promising a more grounds. Indeed, the Belgian popu- understandable to some extent, as existed for the use of CT scanners. It publishes scientific news and confident approach towards future lation is growing, with 11,267,910 physicians (especially in emergency Therefore, CT scanners are suf- information on major issues on the challenges. inhabitants in 2016, a growth of no departments) are constantly expec- ficiently available and accessible BSR website (bsr-web.be), provides less than 428,000 since 2010 (source: ted to make the right diagnosis and throughout the country, in cont- a scientific meeting database and Prof. Geert M. Villeirs is professor stabel.fgov.be), part of whom will initiate the right treatment in all rast to MRI scanners, which suffer an online database of educational of radiology at Ghent University need medical imaging. The Belgian circumstances, even for trivial com- from long waiting lists. Referring resources and supports PhD the- Hospital and President of the population is also ageing, leading plaints. For them, medical imaging physicians therefore frequently ses, along with many other acti- Belgian Society of Radiology.

Visit the Arts & Culture booth in the entrance hall

#ECR2017 myESR.org ECR TODAY | FRIDAY, MARCH 3, 2017 COMMUNITY NEWS 27

BY JOSÉ VILAR European Diploma in Radiology continues to thrive As EDiR Scientific Director I am very happy to announce that 300 candidates have sat the EDiR examination at ECR 2017. This beats the previous record number of candidates at a single examination, increasing the number who sat for the ECR 2016 examination by more than 140%.

TOP: 25% of candidates Highest score with highest scores

50% of candidates in the middle

BOTTOM: Lowest score

25% of candidates OUTLIER: with lowest scores Prof. José Vilar is former Head Individual that is distant from other observations of Department of the Hospital

Dr. Peset in Valencia. He is the examination current EDiR Scientific Director (since ECR 2015), and an EDiR examination examiner.

This important step forward has radiologist at work. This way, more (ETC) Levels I and II from those lity in the scores for the oral part true for any examination. Actually, been possible thanks to the new candidates are able to take the exa- who do not have them. than for the CORE part. This could for any examination we can fore- examination structure which was mination simultaneously, and their Now the scores of candidates be due to several reasons, such as see that a candidate that fails the implemented at ECR 2016. Due skills, attitudes and knowledge can taking the CORE section are more that now the same examiner marks CORE part will have around 63.99% to the exponential growth in the be easily evaluated. Additionally, homogeneous than those of candi- the same case for all the candida- and a candidate that passes the number of candidates at the EDiR the new platform enables the pos- dates who previously took the oral tes and therefore applies the same CORE part will have around 83.44%. examinations, new approaches sibility of taking the examination section. This means that the exa- criteria for all of them. The scoring Given its high scientific stan- to the oral part of the EDiR were online such as the first online EDiR miners are more consistent when is more objective in the CORE part dards, the EBR aims to extend necessary with the aim of reaching that was successfully conducted in marking the cases. and the examiners assign the same access to the examination, and the maximum number of poten- Istanbul last October. The box plots below depict the scores to similar qualities of exams. I would like to highly recom- tial candidates. While candidates Furthermore, the evaluation and variation in the scores (y-axis) of This fact guarantees the quality of mend all heads of department used to be tested in the old oral scoring process has been improved the candidates per examination the examination and makes EDiR a to encourage their residents and examination one by one, they now by the CORE section and it has pro- (x-axis). The spacing between the very objective and reliable test for younger colleagues to take the take the Clinically Oriented Reaso- ved to be better at discriminating top and the bottom of the boxes of the knowledge in radiology. EDiR. This would be a breakth- ning Evaluation (CORE), which is a the candidates who have the com- the oral examinations is larger than Based on the results obtained rough towards European harmo- computer-based examination that petences according to the European in the CORE examinations. This after the statistical analysis, we can nisation of educational standards simulates the daily routine of a Training Curriculum for Radiology means that there is more variabi- confirm that these results will be in radiology.

myESR.org #ECR2017 28 COMMUNITY NEWS ECR TODAY | FRIDAY, MARCH 3, 2017

BY MATTHIAS GUTBERLET ESCR expands activities in cardiovascular imaging education and research The former European Society of Cardiac Radiology is now the European Society of Cardiovascular Radiology (ESCR) with a record number of members of more than 1,500. The name change was unanimously voted upon during the General Assembly in Krakow in October 2016. From now on the ESCR will continue its work under this new name. This modification reflects the evolving interest and demand from Society members to also cover topics in the field of vascular imaging.

Clinical consequences Cardiac MR (n=78,036) Cardiac CT (n=58,849)

No further invasive diagnostics 32.5 % (n=25,361) 36.6 % (n=21,546)

Impact on interventional procedure 6 % (n=4,650) 21.7 % (n=12,754)

Direct referral to catheter laboratory 2.5 % (n=1,925) 4.9 % (n=2,910)

Patient discharge 4.4 % (n=3,434) 3.3 % (n=1,937)

Change of drug regime 5.6 % (n=4,409) 2.4 % (n=1,422)

Multiple clinical consequences for one imaging study possible. ESCR MR/CT Registry Data analysis as per October 2016. Courtesy: Dr. Johannes Uhlig (University Göttingen)

Table 1: Data on the clinical consequences of MR and CT studies, generated from the ESCR Cardiac MR/ CT-Registry

Webinars 2017 March 15, 2017 Approaching dilated hearts: is it only a matter of tissue characterization? April 12, 2017 Imaging of pulmonary hypertension – what you need to know May 17, 2017 MR in cardiovascular implants recipients June 14, 2017 Tips and Tricks for performing and analysing CT in congenital heart disease September 13, 2016 Hide and seek – screening for cardiovascular diseases October 18, 2017 MR in athletes and those, who aims to be November 15, 2017 T1-, T2-, T2* – MR mapping and beyond December 13, 2017 The 10 most important cardiac imaging trials of 2016/17

A: ESCR MR/CT Registry: participating institutes in Europe 2016. Annual Scientific Meeting in Milan, Committee Chairman, Marco Fran- ESCR President, Matthias Gut- B: Participating institutes and number of submitted Cardiac CTs. Italy, from October 12–14, 2017. It will cone from Rome, Italy) is a joint ven- berlet from Leipzig, Germany, on C: Submitted Cardiac MRs to the ESCR MR/CT Registry. again be a full three-day meeting ture between the ESCR and Smart the ESHI Executive Committee. with two scientific and educational Radiology, a Munich-based company. International cooperation with Educational and scientific cont- 135 diploma holders. The MR/CT tracks and the workshop track will Additionally, this helps to generate the Asian Society of Cardiovascu- ent will be continuously provided to Registry also continued to grow. In be reintroduced. Registration will important data about the use of these lar Imaging (ASCI) and the North the members, including webinars, 2016, it had more than 143,000 sub- open after the European Congress important techniques throughout American Society for Cardiovas- which were successfully introduced mitted cases – an annual increase of of Radiology in March 2017. Europe (Figure) and their impact on cular Imaging (NASCI) will be con- in 2016; the fellowships programme, almost 50 percent. Structured reporting now integ- clinical decision-making (Table 1). tinued and a new memorandum in cooperation with the European The ESCR Executive Committee rated in ESCR Cardiac MR/CT-Re- Cooperation with other ESR of understanding with the Euro- School of Radiology (ESOR); the has recently decided on guidelines for gistry: Impact on clinical decisi- subspecialty societies and inter- pean Society of Cardiology (ESC) EBCR Diploma; and of course the the endorsement of local and natio- on-making national societies: and its imaging subgroup EACVI Annual Scientific Meeting. In 2017, nal meetings as well as workshops The Society’s major tasks are to Within the European Society and the European Association the board members will continue to on cardiovascular imaging. The docu- support education and research in of Radiology (ESR) the coopera- of Nuclear Medicine (EANM) is work on consensus documents on ment is available on the ESCR web- the field of cardiovascular imaging tion with the European Society of being planned. transcatheter aortic valve implan- site. In future, applications for ESCR and to make the daily routine of its Thoracic Imaging (ESTI) will be tation (TAVI), big data, myocarditis endorsement should be submitted members much easier. strengthened with additional joint Prof. Matthias Gutberlet, and cardiac CT. o the ESCR office in Vienna at least Therefore, the first template of sessions during the annual mee- MD, PhD, EBCR, is head of the Last year was a very success- six months in advance to allow the structured reporting for coronary tings, and for the first time a joint department of radiology at the ful year for the ESCR, with the scientific and educational chair as CTA was launched in October 2016, ESCR-ESTI meeting will be held in University of Leipzig Heart Centre, Annual Scientific Meeting in Kra- well as the ESCR Executive Commit- which is integrated into the MR/CT 2018 in Geneva. Cooperation with Helios Kliniken, in Leipzig, kow, Poland with over 450 registe- tee to make a decision. Registry and automatically fills in the recently established Euro- Germany, and President of the red participants. In the same year, The Congress Programme Com- the required de-identified data, no pean Society for Hybrid Medical European Society of Cardiovascular 13 members earned the EBCR dip- mittee has finalised the Prelimi- additional typing is necessary. This Imaging (ESHI) will be improved Radiology (ESCR). loma, leading to a total number of nary Programme of the ESCR ESCR initiative (led by the New Media with an Ex-officio position for the

#ECR2017 myESR.org ECR TODAY | FRIDAY, MARCH 3, 2017 COMMUNITY NEWS 29

BY VALENTIN SINITSYN Russian Society of Radiology celebrates its centenary The Russian Society of Radiology (RSR) was founded in 1916. Its founding father was the famous Russian radiologist Prof. Mikhail Nemenov (1890–1950). After the disintegration of the Soviet Union in 1991, the Society was re-organised into the Russian Association of Radiologists (RAR). In 2016, the Russian radiological community decided to change the name of the Society back to the original one – the Russian Society of Radiology.

The RSR has been involved in The European School of Radio- ESR activities since 1992 when it logy (ESOR), directed by Prof. joined the European Association Nicholas Gourtsoyiannis, has of Radiology (EAR) upon invitation provided a great contribution to from Prof. Guy Delorme, then-pre- the education of our radiologists. sident of the EAR. Every year 500 Since 2009, ESOR has held two to to 600 Russian radiologists attend three courses per year in various the annual congress of the ESR, the Russian cities and each time they European Congress of Radiology have been fully booked. Actually (ECR), and our country is always in ESOR has set up a new standard the top ten ECR countries by atten- for organisation, content and qua- dance. It is important to note that lity of education, and our domestic since 2011 the number of oral pre- educational activities now follow sentations and abstracts from Rus- the example of ESOR. Many of our sia has been steadily increasing. young radiologists have been gran- The presence of Russian radiolo- ted ESOR fellowships, and some gists in different committees and ESOR fellows select leading Rus- subcommittees is more and more sian hospitals for their teaching Prof. Mikhail Nemenov RSR President Prof. Valentin Sinitsyn together with ESR President visible, and one can mention the sites. For example, in 2016 Dr. Mer (1890–1950), the founder of Paul M. Parizel, at ECR 2014 when Prof. Sinitsyn was ECR President names of I. Turin, I. Pronin, E. Mahmood Shah Hoshang Merzad the RSR. and Prof. Parizel delivered an honorary lecture. Mershina, S. Morozov, I. Arkhipova, from Afghanistan chose the V. Sinitsyn, G. Karmazanovsky, all Federal Centre of Treatment and The RSR unifies not only radio- nal and professional organisations and supports multiple teaching and of whom have served for quite a Rehabilitation as a training centre logists but also nuclear medicine committees of the ESR. scientific meetings in different for- long time in the different structu- for his abdominal fellowship. and ultrasound specialists, onco- Prof. Pavel Vlasov was the first mats all over Russia. The country res of the ESR. In addition to this, After 100 years of successful logy radiation specialists, medical President of the RAR (since 1991). has a new system of CME and parti- more and more younger doctors development, the Russian Society physicists and radiographers. In He was followed by Prof. Vladimir cipants in these courses can collect from Russia have been involved in of Radiology has ambitious plans November 2016, we started the Kharchenko, who for many years CME credits. ESR activities. We are happy to see to expand its activities in all sphe- re-registration of individual mem- directed and improved our profes- In 2016, the RSR Jubilee Con- that more and more Russian radio- res of modern radiology and nuc- bers, and by the end of 2016 the sional organisation. He still plays gress had a record attendance logists pay their ESR membership lear medicine. Our future would Society had more than 1,200 active an important role in the Executive with 2,598 participants from 226 fees through their national society be unthinkable without close members. This is a moderate figure Board of the Society. Prof. Alexan- Russian cities and towns and 14 (RSR). In 2016, 600 Russian radiolo- cooperation with the ESR and for such a large country like Rus- der Zubarev, a well-known Russian foreign countries. The ESR was a gists became ESR members with other European and international sia, which has more than 14,000 specialist in ultrasound, served as guest of the congress with a nice the help of the RSR. radiological societies. radiologists and over 1,500 nuc- President of the RAR in 2007–2011. booth to promote ECR 2017. Among Russia was guest country at the Russian radiologists and the RSR lear medicine specialists, but we From 2011 to 2016, Prof. Nadejda our special guests and honourable ECR in 2006 and 2014. In fact, ECR would like to congratulate ECR 2017 are expecting rapid growth in the Rojkova served as President of speakers were Prof. Boris Brkl- 2014 was a landmark for further attendees from all over the world Society in 2017. the RAR. Under her guidance the jačić (Croatia), member of ESR development and progress of and wish them a great congress! The RSR sees its main task as Society expanded its activities and Executive Council; Prof. Gusieppe the society. In 2014, the congress More information on the generally improving radiology in launched some new initiatives. In Gugliemi (Italy), President of the in Vienna had, for the first time, Society can be found at Russia and bringing it closer to 2016, Prof. Valentin Sinitsyn was European Society of Musculos- a President from our country. www.russian-radiology.ru international standards. It pays elected as the new Society’s presi- keletal Radiology; Prof. Mansoor During the session ‘ESR Meets special attention to problems in dent, and the RAR was renamed Fatehi (Iran); Prof. Christoforos Russia’, chaired by Prof. Guy Frija Prof. Valentin Sinitsyn is head training and education of radio- the RSR with some changes in the Stoupis (Switzerland); Prof. Raus- (2014 ESR President), along with of radiology at Moscow State logists, and to the creation of pro- Society’s statutes. han Rakhimzhanova; Tairkhan Prof. Valentin Sinitsyn (ECR 2014 University, head of radiology at fessional guidelines and standards. The RSR annual meetings take Dautov (Kazakhstan); and Prof. President) and Prof. Nadejda Roz- the Federal Centre of Medicine RSR representatives regularly take place in the second week of Novem- Marat Khodjibekov (Uzbekistan). hkova, both leading Russian radio- and Rehabilitation in Moscow and part in ESR Annual Leadership ber, around the date of the Inter- For the first time a delegation from logists, presented state-of-the-art President of the Russian Society of Meetings, and the Society delegates national Day of Radiology (IDoR, the Armenian Society of Radiology lectures on the modern aspects of Radiology (RSR). its members to scientific, educatio- November 8). The RSR organises took part in the Congress. diagnostic imaging.

Visit the Arts & Culture booth in the entrance hall Július Koller. One Man Anti Show, mumok Wien, Exhibition view, Photo: mumok / Stephan Wyckoff myESR.org #ECR2017 30 COMMUNITY NEWS ECR TODAY | FRIDAY, MARCH 3, 2017

BY ÀNGEL GAYETE CARA AND PABLO VALDÉS SOLÍS Spanish radiological society tackles new professional challenges

Radiologists from different coun- New relationships with the training activities should change moting radiologists and another and physicists so our conferences tries in the European Union face a industry and its impact on radiolo- both formats and ways of delivery objective of SERAM. Thus, we are and courses become really variety of professional issues. Income, gical education and benefit from the new ways working with other medical socie- multidisciplinary. labour conditions, relationship There is a demanding ethical code of communication. Virtualisation, ties and professional institutions Conclusion with the industry and other factors in Spain that has to be followed by social networks, video streaming in order to implement the most SERAM is facing new and affecting radiologists are changing both sponsors (industry) and radio- and other emerging ways of commu- advanced models of competence demanding challenges. Radiology in Spain, and the Spanish Society of logists. However, the national trans- nicating should be at the core of any certification. Our purpose is to is immersed in a revolution that Radiology (Sociedad Española de position of new European regula- training activity. The SERAM Nati- make certification of professionals is not only technological, but also Radiología Médica – SERAM) must tions of the sector forces us to face a onal Conference is one of the most and radiology units more acces- economic and social. We think that adapt to these new circumstances in new situation with a different way important events of its kind and possible. The final result will be a better we will succeed if we face this situa- order to continue providing a good of managing sponsorship funds sibly the biggest in the Spanish-spe- service for our patients. tion by enhancing professionalism, service to its members. for training, especially concerning aking world. We intend to expand Beyond radiology applying new technologies, cer- The economic crisis and its fiscal uncertainty due to tax arran- in future meetings and widen their Radiology is changing fast and this tifying our radiologists and promo- impact on our profession gements. This new situation, added scope in order to enhance radiology is a reality of which SERAM is very ting multidisciplinarity. We are wor- The economic crisis has been espe- to the low income of many radiolo- training in Spanish. keenly aware. In a few decades’ time, king hard to adapt to these changes cially rough in the Mediterranean gists, might threaten many training Professionalism our profession will have nothing and hope we will be successful countries, and in Spain it has had a activities aimed at these professi- All these changes mentioned so in common with the way we see it because our members deserve a deep impact not only on the recru- onals. SERAM is facing this new far are already taking place or will now. Therefore, we must adapt to bright future. itment of radiologists, but also on situation by playing an active role be a fact in the coming months, the new technologies: artificial intel- technology acquisition. Technological in the dialogue between industry, which is leading us to redefine ligence, collaborative networking, 3D Prof. Àngel Gayete Cara is Clinical obsolescence is a concern for radio- radiologists and professional orga- our profession. printing, 4.0 industry, which are just Chief of Radiology at Parc de logists in Spain, and also for SERAM. nisations and institutions. Other- One important goal of SERAM some of the innovations that will be Salut MAR (Hospital del Mar) in Although a general document explai- wise, it might be difficult to conti- is to promote professionalism so a reality in a few years, and which Barcelona, Spain, associate ning the state of radiology equipment nue arranging this specific training. that our members can benefit will be a challenge for us. professor at the Autonomous in our country has been published New ways of training from better management skills and But this challenge is something University of Barcelona, and in Spain, SERAM is working on the In this new and predictable scene, access documentation and infor- that we cannot and must not take President of the SERAM. specification of rules or recommen- SERAM must change and adapt the mation that will allow them to on alone. We have to establish Prof. Pablo Valdés Solís is Head of dations that define not only the best way we arrange courses and confe- reach the highest standard in their new ways of collaborating with Department at Agencia Sanitaria technical characteristics of all radio- rences so that they become more daily practice. other disciplines, and in order to Costa del Sol in Marbella, Spain, logical equipment, but also when it available and can benefit from the Professional accreditation and achieve this, SERAM is participa- and Vice-President of the SERAM. needs to be updated or replaced. new technologies. We believe that certification is another way of pro- ting in projects with engineers

BY IOANA LUPESCU Novelties and perspectives in 2017 for radiologists in Romania: education, subspecialisation, research

specialty societies. These societies European Society of Cardiovascular will organise the following radio- include the European Society of Gast- Radiology (ESCR), the European logy events for the year 2017: rointestinal and Abdominal Radio- Society of Emergency Radiology We hope that 2017 will be an logy (ESGAR), the European Society (ESER) and other subspecialty and excellent and fruitful year for of Neuroradiology (ESNR), the Euro- professional societies, will also con- all radiologists and their teams, pean Society of Oncologic Imaging tinue to be one of SRIM’s main acti- with new opportunities and new (ESOI), the European Society of Pae- vities in 2017. horizons in radiology and medical diatric Radiology (ESPR), the Euro- In addition, advising and follo- imaging. pean Society of Thoracic Imaging wing up on the training of resident (ESTI) and the European Society of doctors and young specialists to Prof. Ioana Lupescu is professor Urogenital Radiology (ESUR). encourage research, publishing, and of radiology at the University of The Society will also work to subspecialisation will continue. Medicine and Pharmacy ‘Carol structure the final specialty exam The Ministry of Health has also Davila’, Faculty of Medicine, The next SRIM Congress of Radiology will take place in Bucharest, in line with the European Society of decided to return to a five-year Bucharest, Romania; head of the Romania, October 6–8, 2017. Radiology (ESR) model and standar- duration for residency training in radiology, medical imaging and dise this model across all training radiology starting on January 1, 2017. interventional radiology depart- The main priorities in 2017 for the ding of the best practice guide in centres in Romania. The main objective of SRIM is to ment of Fundeni Clinical Institute, Romanian Society of Radiology and medical imaging, and strengthening Disseminating information recei- raise the scientific level and profes- Bucharest; and President of the Medical Imaging (SRIM) will be com- professional relationships with other ved from affiliated ESR professio- sional knowledge within different Romanian Society of Radiology pleting the restructuring and upgra- imaging professional European sub- nal subspecialties societies, like the imaging fields. To this end, SRIM and Medical Imaging.

The main objective of SRIM is to raise the scientific level and professional knowledge within different imaging fields. To this end, SRIM will organise the following radiology events for the year 2017:

• Asklepios Course, Emergency Radiology, Bucharest, May 4–5 • Imaging Role in Hand and Hip Pathologies, Bucharest/Iasi, May 19–21 • The National Conference of Ultrasound in Medicine, Cluj-Napoca, June 1–3 • Course on Imaging Aspects in Clinical Demyelinating Diseases, Constanta, June 2–3, with the support of the German Society of Radiology • The Second Head and Neck Imaging Symposium, Bucharest, June 2–3 • Course and Workshop on Essentials in Paediatric Imaging, Bucharest, June 20–23, with the support of ESPR • Summer School for Residents and Young Specialists, Brasov, June 29 – July 2 • The pre-congress Course on Novelties in Multiparametric Imaging, with the support of the French Society of Radiology, Bucharest, October 5 • SRIM Congress of Radiology, Bucharest, October 6–8 • Annual Conference of Breast Imaging, Sibiu, November 24–26 • Winter School on Neuroradiology and Interventional Radiology, Poiana Brasov, November 24–26

#ECR2017 myESR.org Special Exhibition: The Better Half: Jewish Women Artists Before 1938

JÜDISCHES MUSEUM WIEN 1010 Vienna, Dorotheergasse 11 www.jmw.at

Bettina Ehrlich-Bauer, Self-portrait, 1928 © Belvedere Archives, Vienna, Photo: Bruno Reiffenstein WHAT’S ON TODAY IN VIENNA? FRIDAY, MARCH 3, 2017

Kristiane Kaiser in Don Giovanni by W.A. Mozart © Barbara Pálffy / Volksoper Wien Wolfgang Muthspiel © Oliver Jiszda / www.ojp.at

THEATRE & DANCE OPERA & MUSICAL

Die Welt im Rücken (Ein) Käthchen.Traum Don Giovanni based on the novel by Thomas Melle by Gernot Plass, based on ‘Das Käthchen by Wolfgang Amadeus Mozart AKADEMIETHEATER | 19:30 von Heilbronn’ by Heinrich von Kleist VOLKSOPER | 19:00 1030 Vienna, Lisztstraße 1 1090 Vienna, Währingerstraße 78 TAG – THEATER AN DER Phone: +43 1 51444 4145 www.volksoper.at GUMPENDORFER STRASSE | 20:00 www.burgtheater.at 1060 Vienna, Gumpendorfer Straße 67 Phone: + 43 1 5865222 Turandot Kunst www.dastag.at by Giacomo Puccini by Yasmina Reza Das Mädl aus der Vorstadt Conducted by Paolo Carignani BURGTHEATER | 20:00 With Elena Pankratova, Heinz Zednik, Ryan 1010 Vienna, Universitätsring 2 by Johann N. Nestroy Speedo Green, Stefano La Colla, Anita Hartig Phone: +43 1 51444 4145 THEATER IN DER JOSEFSTADT | 19:30 www.burgtheater.at WIENER STAATSOPER | 19:30 1080 Vienna, Josefstädter Straße 26 1010 Vienna, Opernring 2 Phone: +43 1 42 700 300 Harold und Maude www.wiener-staatsoper.at www.josefstadt.org by Colin Higgins Schikaneder KAMMERSPIELE DER JOSEFSTADT | 19:30 Alles Walzer, alles brennt 1010 Vienna, Rotenturmstraße 20 by Christine Eder Musical by Stephen Schwartz & Phone: +43 1 42 700 300 Christian Struppeck VOLKSTHEATER | 19:30 www.josefstadt.org 1070 Vienna, Neustiftgasse 1 RAIMUNDTHEATER | 19:30 Grünmandl Phone: 43 1 52111 400 1060 Vienna, Wallgasse 18–20 www.volkstheater.at www.musicalvienna.at Famous Austrian actor and comedian Andreas Vitásek revives the life and Don Camillo & Peppone career of a well-known predecessor Musical by Michael Kunze & Dario Farina RABENHOF | 20:00 RONACHER | 19:30 1030 Vienna, Rabengasse 3 1010 Vienna, Seilerstätte 9 Phone: + 43 1 712 82 82 www.musicalvienna.at www.rabenhoftheater.com

CONCERTS & SOUNDS

Wolfgang Muthspiel Quintet OZMA ‘Welcome Home’ (France) State Champs (US) Jazz PORGY & BESS (JAZZ) | 20:30 ARENA (POP & ALTERNATIVE) | 20:00 1010 Vienna, Riemergasse 11 1030 Vienna, Baumgasse 80 KONZERTHAUS | 19:30 www.porgy.at www.arena.co.at 1030 Vienna, Lothringerstraße 20 www.konzerthaus.at

Please note that all theatre performances are in German.