Under Stress: Radiologists Embrace Novel Ways to Tackle Burnout When Dr

ECR TODAY 2017 EUROPEAN CONGRESS OF RADIOLOGY

DAILY NEWS FROM EUROPE’S LEADING IMAGING MEETING | SATURDAY, MARCH 4, 2017

3 9 17 25

HIGHLIGHTS CLINICAL CORNER TECHNOLOGY & RESEARCH COMMUNITY NEWS Refocusing radiologists’ Pitfalls in PET/CT and FDG ECR 2017 exhibitors demonstrate Editor looks back on practice around indications in focus how to realise full potential seven years of patient’s needs of healthcare IT Insights into Imaging

BY VIVIENNE RAPER Under stress: radiologists embrace novel ways to tackle burnout When Dr. Markus Berger set off to work on a Monday morning, he had no idea that his drive would eventually lead him to Buddhist teachings and to become a more thoughtful and complete radiologist. He plans to describe his experiences during today’s session on burnout.

“I was driving out of the garage After some thought, he realised he’d reorganisation and 12-hour work towards the motorway when sud- felt stressed and overworked for days. According to Hunink, increa- denly I felt I couldn’t control the car a couple of years and had found it sing workloads are among the fac- anymore,” he told ECR Today in a difficult to sleep through the night. tors leading to a rise in burnout. pre-congress interview. “I was swea- Insomnia is among the first sym- Radiologists are tackling more ting, I couldn’t carry on. I drove back ptoms of burnout, according to Prof. cases, interpreting more images, about a kilometre and put the car Myriam Hunink, professor of radio- and under increased pressure not back in the garage, but – being a faith- logy and clinical epidemiology at the to make mistakes. ful employee – took the train to the Erasmus University Medical Cen- “Previously everything was done hospital. I arrived an hour or two late.” tre in Rotterdam, the Netherlands. by interacting with the patient Berger, who is chief of radiology at Other physical symptoms include and referring physician, and there the Swiss Paraplegic Centre in Nott- headache, stiff neck, lower back was time to talk. Now there’s a wil, Switzerland, talked to his super- pain, and gastrointestinal upsets. long worklist to take care of, which visor and team. They agreed he could Hunink came up with the idea for seems to grow each day and – if you work half time for three to six weeks today’s session after realising – from don’t do it – all hell breaks loose,” while he identified the problem. colleagues and the media – that she said. “The first thing I did was to scan burnout was becoming more pre- Moreover, there’s an expectation myself to look for anything organic. valent. She estimates that 50% of that everything is done digitally, Of course, everything was normal. radiologists have at least one sym- which means radiologists can feel I went to see an ophthalmologist, a ptom of burnout, of which the most they spend most of their day looking general internist … They prescribed important for diagnosis are emoti- at pixels and clicking on their mouse. me therapies, medications. They onal, such as feeling overwhelmed, This potential problem is worse in even prescribed me a pacemaker, detached, or disillusioned. radiology than other clinical speci- which is hard for a radiologist who “It’s important on two levels: at alties where there is naturally more works with MRI machines,” he the level of the individual, and at patient-clinician interaction. said. “But the only thing I got was the level of the department. It has a new glasses.” huge effect on people and the qua- Berger turned to the internet lity of care they can give,” she noted. where he read about people having Berger attributes his burnout to Prof. Myriam Hunink meditates in her aikido clothes in the dojo. panic attacks while driving a car. – among other things – a hospital continued on page 2 myESR.org #ECR2017 2 HIGHLIGHTS ECR TODAY | SATURDAY, MARCH 4, 2017

“There were mats on the floor and to destress by increasing aware- He gives the example of the funny candles. I’m a radiologist, a techno- ness and focusing on the present internet video of a group of people logy person, and felt totally in the moment. with blue and red balls, where vie- wrong place. Then we started these Since his experience of burnout, wers are asked to count the number exercises, and the first I did, I felt an Berger has taken a sabbatical for a of throws. Only after viewing the immense pressure in my head. I was summer course in mindfulness, read video again do they notice the huge intrigued. I started to do daily exer- Buddhist teachings on the mind- gorilla walking among the crowd. cises and, after two weeks, I started body connection, and attended a Mindfulness has helped him to sleep through again.” Zen meditation week. Although not focus on what the images show There are many practical things a Buddhist, he believes mindfulness, rather than his preconceptions, so radiologists can do to avoid bur- along with Buddha’s ideas, have he misses less. Meanwhile, his expe- nout, says Beate Trück, managing made him a better radiologist. rience of burnout has made him partner of the Brussels Mind- One Buddhist teaching is that the a more caring physician. He’s less fulness Institute. These include mind clings to certain ideas, he said. fixated on the power of high-tech taking a walk in the park at As a radiologist, this means seeing medicine and sees patients as peo- lunchtime, leaving your mobile the first finding, entering autopilot ple, not just cases, he added. phone in the office, and using all and ignoring other pertinent featu- your senses to appreciate your sur- res of the image. roundings. “It’s important to pause. Our Professional Challenges Session Mindfulness training at the Brussels Mindfulness Institute. Provided mind is a tricky thing – it can tell by Beate Trück. you that you can’t take a break Saturday, March 4, 08:30–10:00, Room K and, when you’re stressed, you’ve PC 13b Burnout of radiologists continued from page 1 He met an old friend who had quit a tendency to believe it,” she said. his job as the chief executive of a large At today’s session, Trück intends »»Chairman’s introduction Berger took out his bicycle around Dutch multinational company when to do a simple group meditation M.G.M. Hunink; Rotterdam/NL three weeks after he cut his wor- in his fifties to buy a farm. The friend exercise as part of her talk. She »»A personal story king hours, and found he could tra- recommended mindfulness-based will also explain basic principles of M.F. Berger; Nottwil/CH vel again. After six weeks, he went stress reduction, which is an eight- mindfulness, such as how to step »»Mindfulness-based interventions for burnout of physicians on vacation with his family and week structured course of guided out of autopilot. This is where your A. Speckens; Nijmegen/NL then returned to work. However, meditations, simple yoga exercises, mind wanders onto work while »»Interventions to prevent and treat burnout although he could resume his duties, and body awareness training. you’re doing other activities, such B. Trück; Brussels/BE he had to wait another two months “I went there for the first time as showering or driving. Mindful- to tackle his underlying burnout. on a Tuesday evening,” Berger said. ness training encourages people »»Panel discussion and discussion with the audience

BY MÉLISANDE ROUGER Distinguished breast radiologist to present honorary lecture today In recognition of her contribution to cancer imaging and passionate work in education and research, Professor Fiona J. Gilbert from Cambridge, UK, has been invited to deliver the Arthur de Schepper Honorary Lecture ‘From features to function: breakthroughs in breast imaging’ at ECR 2017.

Radiology first piqued her inte- “I am very involved in research. volumes of images and free us to do in order to maximise the fantastic rest while doing a residency in My particular interests here are in more interventional procedures, and opportunities that imaging provides oncology in Glasgow. “CT scanning assessing new imaging technology more multidisciplinary team mee- cost-effective patient care,” she said. had just been introduced and I and finding out whether it is impro- tings to allow us to influence patient Prof. Gilbert has tackled all these found it much easier to manage ving diagnostic confidence, impro- management,” she said. issues in various talks around the patients with cancer when I could ving decision making, and whether She also foresees an increase in world. She is a regular speaker at see the amount of disease that was or not it impacts on patient care using imaging for screening pati- international radiology conferences there. I then undertook my training and is cost effective. I love taking ents and patient stratification including the European Congress in medicine and went into radio- a multimodal approach to better for more optimal treatment and of Radiology, the annual meeting logy as it allowed me to keep my understand tumour physiology and earlier diagnosis. “But I hope this of the European Society of Breast interests in general medicine and am thrilled as we have just acquired will be guided by a more thought- Imaging and the Radiological Soci- surgery. I love being able to influ- a PET/MR machine to do just that,” ful approach, using all available ety of North America meeting. ence management of our patients she said. technology such as blood tests She has regularly attended the through imaging and I find the Prof. Gilbert has authored more and genetic analysis. Cost cont- ECR after a first presentation on CT Professor Fiona J. Gilbert from level of certainty that we can bring than 180 peer-reviewed publica- ainment is critical and imaging and MRI in the management of low Cambridge, UK, will speak about to a diagnostic dilemma rewarding. tions, six book chapters and many needs to be undertaken only when back pain, years ago. breakthroughs in breast ima- I find it much easier to understand conference abstracts. this impacts positively on patient “The meeting was much smal- ging in today’s honorary lecture. the pathophysiology when I can see She has worked to advance the management,” she added. ler then but still had a wonderful the images, so my absolute delight discipline at the national level and Prof. Gilbert is also concerned European feel to it. The size of the Fiona J. Gilbert is professor of is CT and MRI images, which is the immediate past chair of the about the current shortage of radio- meeting meant it was much easier radiology and head of the depart- reveal the answers. I particularly academic committee of the Royal logists in Europe, as the profession to navigate compared to RSNA ment of radiology at Cambridge like taking multidisciplinary team College of Radiologists. She has also is ageing and the demand for ima- and easier to meet colleagues from University. She is also an honorary meetings where we can give our served in leadership roles for vari- ging studies is rising sharply. other departments and countries. consultant radiologist at Adden- expert opinion and discuss patient ous organisations, including the UK “In the UK there is a critical shor- The meeting was very high quality brooke’s Hospital in Cambridge and management,” she said. National Cancer Research Institute tage of trained radiologists – the with superb presentations and lec- previously served as head of the Over the last ten years, Prof. Gil- Imaging Advisory Group. problem is being exacerbated by the tures and I am thrilled to see it gro- Aberdeen Biomedical Imaging cen- bert has been awarded grants in In the future, she expects more IT inexorable increase in the demand wing. I loved being in Vienna and tre at the University of Aberdeen. excess of £33m from the Medical support to help radiologists avoid for cross sectional imaging. The took the opportunity to go to the Prof. Gilbert is primarily inte- Research Council, the Engineering missing disease and making mistakes, situation is being mirrored in some Opera, which I try to do every year,” rested in imaging breast cancer, & Physics Research Council, the Bri- and improve their diagnostic acumen. other countries in Europe. We need she said. and more specifically multimodal tish National Institute for Health “I hope we will see a dramatic to ensure we train more radiologists functional imaging of the tumour Research (NIHR) Health Techno- reduction in the amount of radia- microenvironment in breast cancer logy Assessment Board, and Cancer tion we use to image patients and Arthur de Schepper Honorary Lecture to map the tumour genetic profile. Research UK. more judicious use of contrast She is also very interested in asses- She is responsible for radiology agents. I hope that there will be tools Saturday, March 4, 12:15–12:45, Room A sing new imaging technologies, research and radiological under- that will allow us to pre-read images From features to function: breakthroughs in breast imaging especially related to breast cancer graduate teaching at Cambridge with computer aided detection algo- Fiona J. Gilbert; Cambridge/UK and in oncology generally. University. rithms, to allow us to report greater

#ECR2017 myESR.org ECR TODAY | SATURDAY, MARCH 4, 2017 HIGHLIGHTS 3

BY KATHARINA MIEDZINSKA Refocusing radiologists’ practice around patients’ needs The traditional view of the radiologist as a physician who adds value to the healthcare system solely by interpreting diagnostic images and generating reports is obsolete – the role has drastically expanded, today encompassing a broad spectrum of different competences. In today’s ‘ESR meets’ session, experts from the United States will discuss how radiologists can stay in control and keep pace with changes that healthcare delivery models are currently facing.

selves available as expert consul- tants to referring physicians and healthcare systems. “Imaging 3.0 makes the clear sta- Efficient Registration, tement that radiologists are the Timely Scheduling stewards of appropriate imaging. It calls for culture change to connect more effectively with the patient and the care team and it establis- Transparent Quality Service / hes a focus on developing tools Billing Cycle Compassionate Staff and advocating for alignment of incentives to support that change,” McGinty noted. Today’s session will be chaired by Ehman, Prof. James Brink, from the Department of Radiology at the Massachusetts General Hospi- tal, Boston, and the ESR President, Radiologist / PATIENT-CENTERED Safe, Comfortable Prof. Paul Parizel, from the Depart- Patient Consultation Examinations EXPERIENCE ment of Radiology at the Antwerp University Hospital, Belgium. They will be joined by Prof. Keith Dreyer, from the Department of Radiology at Harvard Medical School, Boston, who, among others, plans to discuss the role of decision Radiologist / Radiologist Expertise, support systems in improving the Referring Physician Visibility Consultation appropriate utilisation of medical imaging, and Prof. Edward Jackson, from the Department of Medical Physics at the University of Wis- Accurate, consin School of Medicine and Timely Reports Public Health. Jackson intends to explain the need for quantitative imaging biomarkers in clinical trials and practice and to address the key challenges and some current approaches in regard to the implementa- Radiology Cares campaign: patient-centred radiology model (Provided by Prof. Richard L. Ehman, with permission of the RSNA) tion of standardised quantitative imaging techniques. Over the last decades, radiolo- meeting the patients’ needs and these new models by delivering of the care delivery team, requiring gists have not only been critical to transitioning from a focus on the high quality high value patient-cen- radiologists to go beyond image the technological developments volume of scans read to the value of tred care,” said Ehman. interpretation and to make them- in imaging, but they have more the patient experience. With this in Launched at RSNA 2012, the recently developed guidelines for mind, professional radiology orga- Radiology Cares campaign attempts the appropriate imaging algorithms nisations in the United States have to promote the alignment of radio- ESR meets Session to maximise clinical effectiveness. created campaigns to promote pati- logy practice with patients’ needs These ‘appropriate use criteria’ are ent-centred practice and a thought- and best interests; the meaningful Saturday, March 4, 10:30–12:00, Room B now being implemented into clini- ful understanding of the radiolo- engagement of radiologists in their ESR meets the United States of America cal workflows. The radiologist’s role gist’s role in shaping care delivery patients’ experiences throughout EM 2 Precision imaging and patient experience now includes public health delivery, and improving the health of the the continuum of their radiologi- Presiding: J.A. Brink; Boston, MA/US quality of care improvement, infor- patients they serve. cal care; effective communication R.L. Ehman; Rochester, MN/US mation technology, cost effective- Two of them, the Radiology Cares between radiologists, patients and P.M. Parizel; Antwerp/BE ness and, most importantly, patient campaign, developed by the Radio- other healthcare providers; and, safety, among various other facets logical Society of North America last but not least, patients’ ability to »»Introduction and competences. Radiology’s realm (RSNA), and the Imaging 3.0 cam- make informed decisions regarding P.M. Parizel; Antwerp/BE of technical possibilities is conti- paign of the American College of their medical care. J.A. Brink; Boston, MA/US nuously expanding and its place in Radiology (ACR), and in particular “The Radiology Cares campaign R.L. Ehman; Rochester, MN/US healthcare continues to evolve. their principles, will be discussed focuses on optimising the experi- »»Clinical decision support However, it has also become more today by Prof. Richard L. Ehman, ence of patients during their radio- K.J. Dreyer; Boston, MA/US vulnerable to financial pressures from the Department of Radio- logical care. Through online resour- and subject to the profound ongo- logy at the Mayo Clinic, Rochester, ces and educational materials the »»Interlude/Commentary: Future directions in decision support ing changes that seek to transition Minnesota, and Prof. Geraldine initiative helps radiologists to take ESR/ACR/RSNA Leaders healthcare delivery to a value-ba- McGinty, from the Department of patient-centred radiology from con- »»Quantitative Imaging Biomarkers Alliance sed system. Radiologists need to Radiology at Weill Cornell Medicine cept to practice,” explained Ehman. E.F. Jackson; Madison, WI/US develop new strategies to claim a in New York. A similar approach is followed by »»Interlude/Commentary: Future directions in quantitative central role in healthcare reform. “Radiology societies in the US the Imaging 3.0 initiative, a mul- imaging It is not an exaggeration to say that are supporting radiologists as they tiphase programme consisting of ser- ESR/ACR/RSNA Leaders the future of the profession will reengineer and put patients at the vices, processes and technology tools »»Imaging 3.0/Radiology Cares depend on how radiologists decide centre of care delivery. Practice that enable radiologists to adapt how G. McGinty; New York, NY/US to act and how they manage exter- and reimbursement policies are they manage their practices, patient R.L. Ehman; Rochester, MN/US nal disruptions and trends. aligning to incentivise this change. care and their own futures. To ensure radiology’s future, gre- Tools are being developed that will The initiative aims to position the »»Interlude/Commentary: Future directions in patient experience ater emphasis should be placed on help radiologists to succeed under radiologist as an integral member ESR/ACR/RSNA Leaders myESR.org #ECR2017

HOT SHOTS FROM DAY 3

Photography: S. Kreuzberger, F. Hübl, A. Rinkhy September 16-20 Copenhagen, Denmark CIRSE 2017

featuring

Save the date!

www.cirse.org

Cardiovascular and Interventional Radiological Society of Europe ECR TODAY | SATURDAY, MARCH 4, 2017 HIGHLIGHTS 7

BY VIVIENNE RAPER How radiology can find new roles in post-PACS, networked world An unexpected consequence of PACS is that radiologists are increasingly sidelined by referring physicians to the extent that if a patient comes into the emergency room with a suspected fracture, the physician can look at the images to make a diagnosis and may not even read the radiologist’s report, according to Prof. Johan Van Goethem from the Department of Neuroradiology at Antwerp University Hospital in Belgium.

This problem is confounded as diagnoses and prescribes, therapy need to understand more about the physicians grow more specialised. In costs rise exponentially. In spine molecular basis of diseases, under- their areas of special interest, they imaging, for example, radiologists stand the power of computers and can increasingly read images with recommend no imaging for acute artificial intelligence, and deal with equivalent skills to a radiologist. lower back pain without leg pain big data, and data analytics,” he “Many radiologists don’t see it for the first eight weeks because said. “This is something we need to coming yet, but our profession is in it doesn’t aid therapy, and this introduce as fast as possible into real danger if we don’t act swiftly in reduces both costs and patient our education.” the coming years to change the way exposure to ionising radiation. Deep machine learning will make we work,” he said. Additionally, he recommends some aspects of the job easier, but Moreover, although radiologists that radiologists focus on examina- also raises some philosophical ques- have an active role in many mul- tions, such as MRI today and spect- tions. For example, if computers can tidisciplinary teams, some referral imaging in CT in the future, that analyse the raw data underlying ring physicians don’t appreciate the referring physicians find too com- MRI and CT images, do radiologists work they do. Also, the public and plex to report or interpret. need images at all? media are often unaware of the Radiologists should also Krestin suggests that the future The fully automated segmentation and quantification of different work of radiologists, believing that super-specialise in order to gain role of radiologists will be more brain regions based on a machine learning algorithm. Software radiologists are mere technicians the respect of referring physici- about consulting with clinicians enables the identification of patients at risk of developing dementia who take images to be interpreted ans, Van Goethem believes. They in a multidisciplinary team, hand- long before symptoms of cognitive impairment are apparent. by a referring physician. should be aware, for example, of ling data, and answering their Provided by Prof. Gabriel Krestin. “We need to interact with the the techniques used by orthopaedic questions. To perform this role, public and press to highlight our surgeons, the complications that radiologists would need to change function,” urged Van Goethem. are possible, and what both nor- their daily practice, moving from “We’re weakening our position if we mal and abnormal post-operative describing images to interpreting don’t have them on our side.” imaging look like. “Otherwise you’re and integrating information from Radiologists must interact more placing yourself out of the game blood tests, imaging, and genetic Professional Challenges Session with patients rather than sitting and radiologists aren’t necessary sequencing. in a darkened room, and must also anymore,” he warned. Other speakers in the session Saturday, March 4, 16:00–17:30, Room D place themselves inside the clinical During today’s session, ECR dele- will talk about turf battles resulting PC 16 Ensuring the future role of radiologists loop by discussing more cases with gates will hear about other challen- from more cardiologists, neurolo- referring physicians and becoming ges to the profession and how they gists, and other physicians repor- »»Chairman’s introduction more active members of multidisci- can respond. ting CT or MRI examinations. Who J. Van Goethem; Antwerp/BE plinary teams, he continued. Prof. Gabriel Krestin, chairman should report examinations pre- »»SWOT analysis of the radiologic profession An important future role of of radiology and nuclear medicine sents a different type of challenge J.-Y. Meuwly; Lausanne/CH radiologists might be as a gate- at the Erasmus Medical Centre, to the profession. »»Turf battles: how to respond to the challenges keeper. This may include screening Rotterdam, the Netherlands, thinks There will also be a talk about C. Loewe; Vienna/AT referrals for the appropriateness of the training of radiologists needs to how SWOT (strengths, weaknesses, »»Always on the forefront: ensuring the future of radiology the technique and limiting access adapt to prepare the next generation opportunities, and threats) analysis G.P. Krestin; Rotterdam/NL to examinations. Here the bene- for future changes in the profession. can help radiologists understand fit is financial, and Van Goethem “The radiologists who will be their strengths as a profession and »»Panel discussion: The real challenge for radiologists is explains that if the same physician practising in 20 to 30 years time will how to focus on these. “how to change ourselves”

Don’t miss today’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

myESR.org #ECR2017

ECR TODAY | SATURDAY, MARCH 4, 2017 CLINICAL CORNER 9

The time is now: breast cancer Unforgettable cases come under Communication with radiologists screening with tomosynthesis close scrutiny in special focus on proves vital to high level of care 10 edges closer to implementation 11 chest radiology 12 and safety

BY MÉLISANDE ROUGER Pitfalls in PET/CT and FDG indications in focus Hybrid imaging provides unique insight into tumours but the potential pitfalls make it a challenging tool only to be used after appropriate training. However, many strategies exist to read PET/CT scans properly and research is increasingly pushing the new modality further into areas other than oncology, as a panel of experts will highlight at ECR 2017.

nations have a high spatial resolution. By using the combined information from PET and CT, you will have both functional and structural information which both add to the interpretation of the patients’ disease,” Riklund said. Defining common indications for PET/CT beyond oncology diagnosis remains a little challenging because more clinical studies are needed. “For diagnoses where the indi- A B cations can be based on scientific results it is not a problem, but for other diseases clinical studies are needed to decide whether the examination will add substantial information to the common work-up. This is a challenge that goes with all imaging and is not unique to PET/CT. Besides, new tracers are under development and it takes a long time for them to progress from preclinical studies to clinical use,” she said. Nevertheless PET/CT is spreading to neurology, cardiology and infecti- C D ous diseases, especially in patients with fever of unknown origin. Images demonstrating a contrast-associated PET-artefact. CT (A) demonstrates highly concentrated contrast material in the subclavian vein. “Not only tumours but also infec- On PET (B) and fused PET/CT (C) there is apparently increased FDG-uptake. Non-attenuation corrected PET image (D) does not show uptake tions present with an increased glu- in the area of the subclavian vein, identifying this as an artefact. Images provided by Prof. Antoch. cose metabolism, so if you use FDG radionucleide for PET glucose, it CT and PET already come with One strategy to reduce the num- rial injectors that have 2 lumen – a tracer for prostate cancer even if will also work in this context,” Prof. their own pitfalls before they are ber of contrast material associated dual lumen injector. aggressive types can show increa- Antoch explained. combined into PET/CT, according artefacts is to adapt the scanning One bolus is the contrast material; sed FDG uptake,” she said. As for cardiology and neurology, to Prof. Gerald Antoch, chairman of protocols to the examination. as soon as it has flushed into the vein Riklund will also focus on specific these two indications will further the department of diagnostic and Typically, physicians inject CT a saline flush helps to flush the cont- findings in PET/CT imaging, depen- evolve with PET/MRI scanners interventional radiology at Düssel- contrast material through a vein rast material to the heart very quickly. ding on which tracer is being used. becoming more popular, he belie- dorf University Hospital, Germany. in the arm so that the material “It’s really important to know FDG helps to visualise energy ves. “MRI is very good for the heart “You have to deal with already flushes into the thorax and is then all potential artefacts arising from metabolism and FLT helps to image and brain, so it may be well sui- known pitfalls and now that these distributed throughout the entire bringing together PET and CT. proliferation. Dotatoc or Raclo- ted. These are two major fields on modalities have been brought body. While a CT scan would be Otherwise you are at risk of misin- pride enable examination of the the move.” together there are additional pit- acquired by scanning from the terpreting the images,” said Antoch. quantity of somatostatin or dopa- falls that PET/CT imaging may head all the way down to the thigh, Appropriate training remains a mine receptors. Both PET and CT come along with,” he said. in PET/CT imaging things are typi- cornerstone to use hybrid imaging, are useful for obtaining structural Misinterpreting CT contrast cally done the other way around. he added. and functional information. material uptake is one of the most Physicians start with the thigh Also taking part in the session is “A PET study shows the distri- common difficulties encountered and scan upwards to the head. By the founding President of the Euro- bution and amount of an active by radiologists and nuclear physici- the time they reach the thorax, the pean Society for Hybrid Imaging biomarker while CT shows the ans in charge of reading PET/CT. contrast material has already been (ESHI), Prof. Katrine Riklund, who structural appearance in the body. “In PET/CT one uses the CT distributed throughout the body is a radiologist and nuclear medi- PET studies have an extremely high images for attenuation correction and there is no high amount of cine specialist at Umeå University molar sensitivity while CT exami- of the PET data. If you use CT con- contrast material left in the veins, Hospital, Sweden. She will explain trast material, this CT-based PET which helps to reduce the number when to and when not to use FDG, ESHI Session (European Society for Hybrid Medical Imaging) attenuation correction may cause of artefacts. the most commonly used tracer in artefacts in the PET image. These “It’s important to know that, PET/CT examinations, in oncology. Saturday, March 4, 08:30–10:00, Room M 2 artefacts may show as areas of compared to a classic CT scan or a “FDG is best used to image many Hybrid imaging: case-based diagnosis in PET/CT apparently increased tracer uptake classic PET scan you have to adapt of the solid cancers and also for Moderator: K. Nikolaou; Tubingen/DE on PET where there is actually no both your CT and PET protocols in lymphomas. Slow growing tumours tracer uptake. So if you don’t look order to adapt to as many potential might have only a minor increase »»FDG indications in oncology: case-based closely enough and if you’re not pitfalls as possible,” said Antoch. in the energy metabolism and will K. Riklund; Umeå/SE aware of this artefact, you may Another option is to flush the therefore not present an increa- »»Non-FDG indications in oncology: case-based misinterpret these areas of tra- contrast material from the vein to sed FDG uptake. Carcinoids, some O. Ratib; Geneva/CH cer uptake as real areas of tracer avoid these artefacts. mucinous tumours and bronchi »»Pitfalls in PET/CT: case-based uptake caused, for example, by a Radiologists and nuclear physi- alveolar cancer are examples of G. Antoch; Düsseldorf/DE tumour,” said Antoch. cians typically use contrast mate- such tumours. FDG is not a good myESR.org #ECR2017 10 CLINICAL CORNER ECR TODAY | SATURDAY, MARCH 4, 2017

BY REBEKAH MOAN Staff Box Editorial Board

ESR Executive Council Katrine Riklund, Umeå/SE The time is now: Chairperson of the ESR Board of Directors Paul M. Parizel, Antwerp/BE President Bernd Hamm, Berlin/DE breast cancer screening with 1st Vice-President Lorenzo E. Derchi, Genoa/IT 2nd Vice-President Luis Donoso, Barcelona/ES tomosynthesis edges closer Past-President

Boris Brkljačić, Zagreb/HR Communication and External Affairs Committee Chairperson Paul M. Parizel, Antwerp/BE to implementation ECR 2017 Congress Committee Chairperson Bernd Hamm, Berlin/DE ECR 2018 Programme Planning Digital breast tomosynthesis (DBT) has taken its first tentative steps into Committee Chairperson Laura Oleaga, Barcelona/ES the clinical arena. It’s already in use in some places, but adoption is not Education Committee Chairperson Michael Fuchsjäger, Graz/AT yet widespread for a variety of reasons. DBT advocates are convinced its Finance and Internal Affairs Committee Chairperson time has come, but others are not so sure. In a Special Focus session Christoph D. Becker, Geneva/CH National Societies Committee today, the big names of DBT cover all the bases of the modality and Chairperson Regina Beets-Tan, Amsterdam/NL discuss its future. Publications Committee Chairperson E. Jane Adam, London/UK Quality, Safety and Standards Management Review, Veneto Insti- huge amount of data implies an Committee Chairperson tute of Oncology (IOV) – Istituto di increase in review time and some Olivier Clément, Paris/FR Ricovero e Cura a Carattere Scienti- complications in image transfer and Research Committee Chairperson fico (IRCCS) in Padua, Italy. image handling, making DBT more Catherine M. Owens, London/UK In her talk, she intends to discuss challenging, according to Gennaro. Subspecialties and Allied Sciences radiation dose, number of DBT pro- “You need to think about your Committee Chairperson jections, and the need for conven- infrastructure (network speci- Nicholas Gourtsoyiannis, Athens/GR tional or synthetic 2D images in fications), about your review Director of the European School combination with DBT. During the hardware, about your storage capa- of Radiology (ESOR) session, attendees will also learn bility [when adopting DBT],” she Peter Baierl, Vienna/AT about hanging protocols, reading continued. Executive Director time, and potential solutions for Also, there is no standard for DBT reducing the interpretation time, in images that is accepted and applied addition to IT issues. by all manufacturers. The lack of a Editors Anyone familiar with DBT reco- standard for DBT images is not the Julia Patuzzi, Vienna/AT gnises it produces a lot more data only issue because there is also the Philip Ward, Chester/UK than standard mammography. In question of synthetic images. Gil- standard mammography screening, bert foresees developments in syn- Associate Editors there are four images (between 10 thetic imaging, leading to the repla- Michael Crean, Vienna/AT and 50 MB each) plus four prior cement of conventional 2D images Simon Lee, Vienna/AT mammograms of the same size. that are used when reading DBT. In DBT screening, the number of “These are of higher quality than Contributing Writers images can be between 20 (for 2cm the original versions and they also Stefanie Bolldorf, Vienna/AT compressed-breast thickness) and have certain enhancement charac- Michael Crean, Vienna/AT more than 60 images (for 6cm or teristics, which makes it easier to Florian Demuth, Vienna/AT A 63-year-old woman with bilateral breast pain for two months. Both more compressed-breast thickness), spot the microcalcifications and Peter Gordebeke, Vienna/AT Katharina Krischak, Vienna/AT breasts were normal on clinical evaluation. In the outer quadrant assuming 1mm slice thickness. subtle lesions,” she said. “The syn- Becky McCall, London/UK of the left breast, there is a subtle spiculated mass, measuring 16mm, “Those numbers double for some thetic image means that the radia- Katrina Megget, London/UK seen on craniocaudal view. This is not well visualised on the manufacturers using 0.5mm slice tion dose used in DBT can be held at Katharina Miedzinska, Vienna/AT mediolateral oblique view, but is better demonstrated on tomosyn- thickness,” she said. “And tomo- just about the same level as a con- Rebekah Moan, San Francisco, CA/US Lucie Motloch, Vienna/AT thesis. Images provided by Prof. Fiona Gilbert. synthesis is not only about slices: ventional 2D mammogram.” Vivienne Raper, London/UK there are slabs and synthetic Also, it’s likely that computer-ai- Mélisande Rouger, Madrid/ES Prof. Fiona Gilbert, head of the economic evaluation is necessary images, making twice the data ded detection (CAD) will improve Frances Rylands-Monk, radiology department at the Uni- before some policymakers will give amount if you consider the prior reading sensitivity and specificity St. Meen Le Grand/FR versity of Cambridge in the U.K., the go ahead, she said. examinations.” and shorten the reading time. Inga Stevens, Dubai/UAE Kathrin Tauer, Vienna/AT is keen for ECR 2017 attendees to “This is because the technology Mammography screening review So how soon will DBT be ready to Pamela Zolda, Vienna/AT appreciate the state-of-play of DBT is more expensive, potentially has is a relatively fast process, but the run? Only time will tell. and why they might wish to use it in a higher radiation dose (therefore their practice. One reason to adopt potential cost to the woman), and Design & Layout Nikolaus Schmidt, Vienna/AT DBT is it’s been shown to increase also takes longer to read, so is more Special Focus Session the number of screen-detected can- costly in terms of the radiologist’s cers, and this is likely because the time,” she said. “The policymakers Saturday, March 4, 14:00–15:30, Room E1 Marketing & Advertisements technique tends to find cancers ear- will also want to ensure there is a SF 15b Breast cancer screening with tomosynthesis: Konrad Friedrich lier and also diagnoses cancers that sustained increase in cancer detec- E-Mail: [email protected] the time is now would have otherwise presented in tion before adoption of DBT. They the interval between screens. wish to see a reduction in interval »»Chairman’s introduction She plans to discuss not only cancers and a sustained increase P. Skaane; Oslo/NO Contact the Editorial Office the potential influence of DBT in cancer detection in subsequent »»Screening with digital breast tomosynthesis in the USA: ESR Office Neutorgasse 9 screening on the interval cancer screening rounds.” performance indicators and breast density 1010 Vienna, Austria rate and next-round cancers but Also, they need to be sure the E.A. Morris; New York, NY/US Phone: (+43-1) 533 40 64-0 also to share the tumour characteri- additional cancers found are can- »»Screening with digital breast tomosynthesis in Europe: tumour E-Mail: [email protected] stics of cancers detected with tomo- cers that might have caused death characteristics and potential harms including overdiagnosis synthesis and the potential harms if not found at the time DBT detec- F.J. Gilbert; Cambridge/UK of using it for screening, with a spe- ted them, which is more difficult to ECR Today is published 5x »»Which challenges should we consider prior to tomosynthesis during ECR 2017. cial focus on overdiagnosis. prove, Gilbert added. Circulation: 15,000 So why hasn’t DBT been adopted Another speaker who studied screening implementation? Printed by agensketterl Druckerei widely yet? In order for it to become this topic closely is Dr. Gisella G. Gennaro; Padua/IT GmbH, Vienna 2017 more accepted as a breast cancer Gennaro, a medical physicist at »»Panel discussion: Is tomosynthesis ready for replacing 2D myESR.org screening tool, a robust health the Department of Radiology and mammography in organised breast cancer screening?

#ECR2017 myESR.org ECR TODAY | SATURDAY, MARCH 4, 2017 CLINICAL CORNER 11

BY FRANCES RYLANDS-MONK Unforgettable cases come under close scrutiny in special focus on chest radiology When histology is known for the left side in bilateral chest lesions then, depending on the risk and whether a local treatment is considered, radiologists should clarify the other side, not wait, recommends Dr. Claus Peter Heussel, diagnostic and interventional radiologist at the Thorax clinic, University Hospital of Heidelberg, Germany.

which should always be considered during interpretation in order to tailor therapy as swiftly as possible. “The clinician relies on our esti- mate. An oncologist might be swayed by an initial ‘malignant’ diagnosis and start systemic treatment. This might prevent a possibly curative resection,” he said. “Benign lesions such as tubercu- losis (TB) and cryptogenic organising pneumonia (COP) may appear as malignancy but in reality aren’t, and these lesions require different treatment,” he added, pointing to a case of a 62-year-old female who underwent a CT-guided biopsy for In this case the lesion obscuring the lateral view in the lower vertebral spine is a bronchial carcinoma. (Provided by Dr. Claus Peter Heussel) suspected bronchial carcinoma that in fact turned out to be COP. His third tip, therefore, is always to check the benign differential and then prove the histology in the week-long window before therapy starts. This means scheduling a bronchoscopy and confirming diagnosis with histological proof. The same strategy should be applied for other types of suspicious lesions, particularly given the increase in TB cases in Europe. Fourth, radiologists should consider a longitudinal assessment, whe- never possible. “When pre-scans are available, such as non-radiology-sourced chest x-rays, or previous historical COP was diagnosed in a 62-year-old patient after CT-guided Cartilage wall thickening limited to the anterior and lateral tracheal images and reports, ask yourself: is bronchoscopy and biopsy for suspected carcinoma. (Provided by walls in a patient with relapsing polychondritis. this lesion under a few weeks old? Dr. Claus Peter Heussel) If so, it may be an infection, but if it grows over several weeks then it is In a 45-year-old patient, a pulmo- Heussel will also reveal tips for probably a tumour.” nary adenocarcinoma on the left improving mass or consolidation Speaking about airway abnor- side can possibly be cured if the interpretation. malities in the same session, Dr. right side is not affected. With this “In the lateral view, understand Eva Castañer, a chest radiologist histology, FDG-PET may not work the density distribution of the verte- from Parc Taulí University Hospi- as a diagnostic test due to low meta- bral spine by the shoulder muscles. tal, Sabadell, Spain, will reveal how bolism, and the patient will need Visualisation is less solid towards findings of tracheal involvement in CT-guided biopsy, he explained to the lower vertebral spine, and also some systemic diseases such as gra- ECR Today ahead of the congress. in the lower part there is less supe- nulomatosis or polyangiitis may be In today’s special focus session on rimposition by shoulder muscula- the key to a diagnosis. However, she unforgettable chest cases, he plans ture,” he said. “You can check if the warns that some findings may point to illustrate how localisation of large finding is normal in the lateral view. to a disease that later turns out to be masses, often challenging on a chest If something in the lung or chest a different pathology. For example, x-ray, can be made easier by careful wall is blocking the view, this should in patients with haemoptysis, blood analysis and comparison with CT, be deemed suspicious.” on the tracheal walls that will even- when available. Identifying lesions Also, with large lesions visuali- tually be spontaneously absorbed by chest x-ray can be difficult, even sed in the lateral view, radiologists might be mistaken for tracheal wall in the case of larger lesions of more must also check for blackness in thickening, wrongly pointing to tra- than 2 or 3cm and which sometimes the retrosternal and retrocardial cheal disease. Specific knowledge present as large as 7cm in diameter. space. One case to be presented of the anatomical and pathological For subsequent characterisation, will demonstrate how retroster- basis of airway abnormalities and radiologists must know the diffe- nal space, normally black, may be also the typical diagnoses and differential diagnoses that depend on obscured by a thymoma. With this rentials is crucial when interpreting the spaces in which they are found, visualisation, differential diagno- trachea images, she noted. according to Heussel. ses include goiter, which does not Due to its composition of cartila- Radiologists need to be aware of require surgery, or cancer metas- ginous and membranous areas, the the signs of chest x-ray that can be tases. CT will strongly indicate the trachea can be affected by a range less easily understood in certain underlying pathology and possibly of diseases like relapsing poly- anatomical spaces. In the medias- reveal other manifestations, such chondritis and osteochondropla- Circumferential thickening of the trachea and a focal thickening of tinum, hidden regions behind the as lymphoma in the lymph nodes, stic tracheopathy that affect only the aortic wall were visible. The aortic finding suggested vasculitis, liver and heart require some rea- stated Heussel. However, the diffe- the cartilaginous part. Others but the patient had granulomatosis and polyangiitis. (Provided by ding ‘tricks’ that he will demons- rentials are not just malignant, and Dr. Eva Castañer). trate in cases to be presented today. they also include benign lesions, continued on page 12 myESR.org #ECR2017 12 CLINICAL CORNER ECR TODAY | SATURDAY, MARCH 4, 2017

continued from page 11 stemmed from failing to look at it,” in diameter, with a reported malig- she concluded. nancy rate of 1–12%. Special Focus Session have a circumferential pattern, Another diagnostic challenge in “These nodules may be missed on such as amyloidosis. the chest is identification by x-ray x-ray, particularly when they show Saturday, March 4, 08:30–10:00, Room C “Differential diagnosis can be of pulmonary nodules that range ill-defined margins or ground-glass SF 13a Cases I’ll never forget in chest imaging narrowed by paying attention to from 4mm to 2cm, and this topic density, if they are masked by supe- these facts,” she said. will be presented today by Dr. Anna rimposed chest bone structures or »»Chairman’s introduction In suspected airway abnormality, Rita Larici, chest radiologist at the have an endobronchial location,” A.P. Parkar; Bergen/NO the trachea must be investigated, A. Gemelli Foundation Polyclinic, she noted. »»Nodules (0.4–2 cm) continued Castañer, who flagged Catholic University of the Sacred During Larici’s presentation on A.R. Larici; Rome/IT the fact that although pathologies Heart, Rome. Observer error lies how to systematically review chest »»Masses and consolidation (> 2 cm) are normally easy to see, they are behind most misdiagnoses and this x-ray and improve interpretation, C.P. Heussel; Heidelberg/DE relatively rare, so radiologists often usually stems from a lack of scan- ECR delegates will have the chance »»Ground glass opacity investigate the parenchyma and ning method, failure to recognise to refresh their expertise in this dif- M.-P. Revel; Paris/FR neglect to look at the trachea itself. the signs, or satisfaction of search. ficult area through a side-by-side “The trachea is right in the middle Nodule size is strongly related to comparison of x-ray and CT scans. »»Reticular pattern of the images we interpret, but the the risk of malignancy, but up to J. Coolen; Leuven/BE worst mistakes I have ever made, 96% of nodules are less than 10mm »»Cystic pattern S.R. Desai; London/UK »»Airway abnormalities E. Castañer; Sabadell/ES »»Vascular abnormalities M. Das; Maastricht/NL »»Pleural disease C. Beigelman; Lausanne/CH »»Panel discussion: How to avoid common mistakes in the interpretation of chest imaging?

BY MÉLISANDE ROUGER Communication with radiologists proves vital to high level of care and safety of patients Radiology sits at the crossroads of many medical specialties. This peculiar position and the fact that technology has enabled images to travel faster than ever and to guide interventions mean that radiologists must increasingly communicate with a variety of partners, including referring physicians, patients and people outside the hospital. This new order does not come without challenges, which a panel of experts will tackle in a dedicated Professional Challenges session today at the ECR.

much more precise in your written hires different radiologists for “Teleradiology business simply report and in the information you outsourcing. ignores the fact that radiologists may give over the phone. Don’t just “In this case you don’t even know are clinicians interacting with write ‘fluid collection’, write a speci- the name of the radiologist and patients and other physicians to fic diagnosis such as abscess or bili- usually you don’t communicate analyse complex conditions of oma or clearly indicate that specifi- with the same person more than patients. Direct communication cation is not possible,” Jaschke said. once,” Jaschke said. improves patient care because new Outsourcing is time consuming The underlying problem in his ideas and information contribute and does not bring a feeling of effi- opinion is that there is no interest significantly to establishing a cor- ciency as does in-house radiology. in evaluating quality in outsourcing. rect diagnosis. We pretend we can “When you enter teleradiology, “Usually the hospitals that export supplement this communication it is our experience that it is not nightshift services are not interes- process with smartphones and so satisfying for both parties. The ted in finding out how insufficient tablets. I think this assumption is one who is doing the report usually communication is. For outsiders, it wrong,” he explained. doesn’t get feedback and the person is very difficult to evaluate the effi- Teleradiology should therefore at the end of the line usually has ciency of the service. Usually they only be used when no specialist the impression that service is not as only report that it is less expensive is available in-house, he believes. Prof. Werner Jaschke from Erik Briers, PhD, will good as having a radiologist onsite,” and that the response cycle is as “Without communication, you turn Innsbruck, Austria, will focus emphasise the importance he said. long as or perhaps shorter than it is radiology into a commodity. Phy- on the pros and cons of of sharing information with The request response cycle is not in-house. But you don’t hear much sicians need communication with teleradiology in his talk. the patient in today’s session. so transparent to the person who is about quality or satisfaction from radiologists, just like patients.” working offsite, he added. people working in such a system.” Patients have a lot of different Communicating imaging fin- municate with somebody, interac- “If somebody in-house hands in Communication technologies needs when they arrive at the radio- dings has never been easier than tion beyond language has terrific a request and the hospital is very have improved workflow inside the logy department, according to Dr. now. However, radiologists must do importance. But in teleradiology, we busy, he or she usually gets the fee- hospital, much more than outside. Erik Briers, a volunteer at Europa so in new and sometimes challen- are only focusing on images and a ling that the radiology department “People were very much con- Uomo, the European Prostate Cancer ging settings. written report, there is no room for is also very busy and that one has to cerned that tools like PACS would Coalition of patient support groups A prime example of such a com- unspoken communication,” he said. be patient. But for the professionals incite physicians to ignore radio- for prostate cancer across Europe. plex scenario is teleradiology, which The only way radiologists can offsite, the request response cycle is logy because they could already Briers has a PhD in chemistry does not allow face-to-face commu- communicate their findings appro- in obscured. They don’t know what access images and reports; but in and a career in laboratory medicine nication and may lead to loopholes priately in teleradiology is in a clear, is going on and they are waiting on our hospital, that is not the case. and as a science writer. He is also a in the information being trans- unambiguous manner. the phone for a call back or a writ- PACS actually made communica- cancer survivor and a member of mitted, according to Prof. Werner “Fluid collection can be an abscess ten electronic report, which generation easier,” he said. the ESR Patient Advisory Group Jaschke, Head of the Radiology or pleural effusion. So you have to tes frustration.” Teleradiology is an excellent (ESR-PAG). He will speak of his Department at Innsbruck Medical inform the person you are talking The distance between the refer- tool when a radiologist is unavai- experience with radiology during University, Austria. to in a much different way than ring physician and the radiologist lable, but technology alone will the session. “In communication, approxima- you would do in-house, where peo- creates anonymity, especially if not replace direct communica- “Patients first need to know why tely 90% of what we perceive is ple use the same phrases every day. teleradiology services are being tion and its benefits, according they are being referred for an exa- based on sentiments. If you com- When outsourcing, you need to be provided through a company who to Jaschke. mination, so clinicians should really

#ECR2017 myESR.org ECR TODAY | SATURDAY, MARCH 4, 2017 CLINICAL CORNER 13

explain their decisions. Patients need ments should be available in the have shown that literacy is linked to know what type of imaging test department; for example, a bro- with life expectancy. “The least Professional Challenges Session they will undergo and why,” he said. chure or on-screen information on intelligent and least educated Patients should also receive a PET, CT or MRI scan. rarely present themselves. They Saturday, March 4, 14:00–15:30, Room E2 practical details, for instance how A very important aspect is that miss out on a lot of information PC 15a Radiology at the core of interdisciplinary they should prepare for the exa- information must be communica- and the difference in life expec- communication mination. “Will the examination ted in broad terms so that everyone tancy between high and low liter- last four hours, and if so, is there a can understand it. acy is twelve years. Treatment »»Chairman’s introduction parking lot nearby? Should patients “Communication is not simple. It adherence is not different. Some E.J. Adam; London/UK eat or not eat before the test? This depends on the literacy of the pati- people don’t understand that they »»Sharing information within the hospital is the kind of practical information ent. If you have a baker or profes- need to take their pills in the mor- D. Regge; Turin/IT patients should know before ente- sor of philosophy, you will probably ning and evening. You can also see »»Sharing information beyond the hospital ring the department,” he said. give your answers in different ways that those who are highly trained W.R. Jaschke; Innsbruck/AT It is the responsibility of the but both patients deserve the same smoke less,” Briers said. radiology department to explain quality answers and information. Patients rarely have direct con- »»Sharing information with the patient everything about the procedure to Literacy is an important aspect to tact with their radiologist but this E. Briers; Hasselt/BE the patient and information should take into account.” could sometimes help, especially »»Panel discussion: Conveying information clearly. be given as the examination pro- Knowing this is crucial to impro- when patients have doubts about Do we still need to ‘speak’ to each other? gresses. Common information ele- ving patient prognosis, as studies their examination, he concluded.

BY REBEKAH MOAN Gastrointestinal specialists provide top tips for tackling common problems in abdominal imaging There is a lot to consider when imaging the abdomen. Luckily, in a session today, ECR 2017 delegates will get practical and timely advice from a myriad of speakers, including former ECR President Prof. Yves Menu.

His third tip is to apply the rele- depends upon the reader’s experi- vant evaluation standard for the ence, but one of the new weapons tumour and for the treatment. in the hands of radiologists has Looking to the future, develop- been represented by the introduc- ments of standards, and therefore tion and use of computer-aided new guidelines for radiological detection software that can help reports, will be crafted to increase radiologists in showing automati- the personalisation of manage- cally some possible finding that the ment, he said. reader must decide if it’s important Menu is not the only person pro- or not,” he explained. viding guidance. Other radiologists There is some debate about inter- will share their suggestions, inclu- mediate polyps – those ranging in dingA Dr. Franco Iafrate, director of sizeB from 6mm to 9mm. Cancer A B the CT Colonography Unit, Depart- frequency is very low (approxima- Dr. Franco Iafrate from Rome ment of Radiological, Oncological tely 0.07%), but these polyps can A: 3D image of an intermediate 9mm polyp arising from a fold. will discuss colonic polyps in and Pathological Sciences at ‘Sapi- become larger and may develop B: 2D axial image obtained on supine position, of the same polyp today’s session on abdominal enza Università di Roma’ in Rome. into advanced adenomas, so detec- (arrow) that is not tagged by the oral contrast agent. (Provided imaging. He will discuss colonic polyps. ting these polyps with an accurate by Dr. Franco Iafrate) Colorectal cancer is the second exam that has a good level of spe- Menu, from the Department of deadliest tumour in both men and cificity and sensitivity is important Radiology at Saint Antoine Hospi- women, and it has been constantly because these intermediate polyps tal in Paris, will address patients increasing for the last 20 years, can turn into cancer, he said. It is with liver metastases, for whom even though it is preventable, important to keep track of them. follow-up is ‘dramatically’ import- he said. “Radiologists are now playing Special Focus Session ant with systemic chemotherapy. “Conventional colonoscopy is not a crucial role in colorectal cancer “Follow-up of metastases to the well accepted by the patient and it screening,” Iafrate continued. “All Saturday, March 4, 14:00–15:30, Room B liver is an extremely common cli- seems that CT colonography has radiologists, even if they are not SF 15a My three top tips for abdominal imaging nical problem and every general approximately the same accuracy well trained in gastrointestinal ima- radiologist has to face this situa- for detecting lesions > 5mm,” Iaf- ging, need to be aware that next to »»Chairman’s introduction tion daily,” he said. rate said. “We hope for a dramatic a more invasive exam for colorectal M. Zins; Paris/FR His first tip is to identify if the increase of CT colonography exami- cancer prevention, such as conventi- »»Postoperative abdomen treatment is adjuvant, neoadju- nations because colorectal cancer onal colonoscopy, there is nowadays D.J.M. Tolan; Leeds/UK vant, or palliative because the goals is defeatable and we must try to virtual colonoscopy. This is a mini- »»Appendicitis and evaluation methods will be defeat as much as we can.” mally invasive, safe, well-accepted, J.B.C.M. Puylaert; The Hague/NL completely different. For adjuvant Colon cancer has a slow progres- and efficient method for detecting »»Bile duct stones therapy, it’s important to detect sion (an average of ten years) and polyps that has been endorsed by J.A. Guthrie; Leeds/UK new lesions. For neoadjuvant the- usually originates from a benign scientific societies and associations rapy, you must select the optimal lesion, a polyp. Consequently, early for colorectal cancer screening.” »»Dilated pancreatic duct schedule for curative treatment if detection and identification of a CT colonography software is R. Manfredi; Rome/IT relevant. For palliative treatment, polyp can cause a drastic reduction effective and the technique is stan- »»Liver biopsy it’s essential to evaluate treatment of colorectal cancer cases. The only dardised so not much will change V. Vilgrain; Clichy/FR efficacy. two exams that have been conside- there, according to Iafrate. Plus, CT »»Bowel ischaemia Menu’s second tip is to under- red to be able to detect colorectal colonography has the added benefit A. Filippone; Chieti/IT stand if the treatment is cytoto- polyps with accuracy are conven- of being accepted by patients. »»Colon polyp xic, targeted, or immune, because tional colonoscopy and CT colono- “Radiologists must play the first F. Iafrate; Rome/IT again, evaluation criteria and com- graphy, according to the American actor in this fight,” he said. “We just plications are different for each Cancer Society and the U.S. Preven- need to train more radiologists dedi- »»Acute pancreatitis category. For cytotoxic CT, only size tive Services Task Force. Meanwhile, cated to colorectal cancer screening.” W. Schima; Vienna/AT matters. For targeted treatment, the faecal occult blood test usually During the session delegates »»Crohn’s disease structure, and vascularisation mat- finds cancer when it is already in will also pick up tips on imaging J. Rimola; Barcelona/ES existence. appendicitis, bile duct stones, bowel ter. For immune therapy, the radio- »»Liver metastases follow-up ischaemia, acute pancreatitis, logist should be aware of the possi- “CT colonography sensitivity in Y. Menu; Paris/FR bility of pseudoprogression. detecting colorectal polyps strictly and more. myESR.org #ECR2017 14 CLINICAL CORNER ECR TODAY | SATURDAY, MARCH 4, 2017

BY KATHARINA MIEDZINSKA Experts to look into quality of care in clinical radiology In recent years, the need for quality assessment and quality assurance in radiology has moved to the forefront. In today’s ESR Patient Advisory Group session, experts and representatives of patient organisations will assess the situation and discuss different strategies to improve patient safety and quality of care in clinical radiology.

of such technological, sterile and quantitative assessments, continu- spective by using examples of good busy environments?” ity and communication. and bad radiology practice from In particular, three tools, which “It is important to present the relevant disease areas, and more have been designed to promote a results regularly to the whole importantly, by dealing with the compassionate, comprehensible team and to draw clear conclusi- issue of information transfer. and personal experience for pati- ons from the feedback received. It ECR delegates will learn that a ents will be discussed, including the might be difficult to take account fair knowledge of an upcoming pro- patient satisfaction questionnaire; of all patients’ needs and expecta- cedure is an important part of fee- a driver diagram, which is being tions with a simple questionnaire, ling safe for the patient and that an used to conceptualise an issue and but it is a way of letting patients overload of information is equally determine its system components, express themselves and improving detrimental to a safe feeling as no thus creating a pathway to achie- the patient-physician relationship. information. In their presentations, ving the goal of patient-centred Radiologists should not be afraid Briers and Walsh plan to illustrate care; and audit, which, according to to evaluate what patients think that implementing the driver dia- Kelly, measures something against about their work. Dialogue and gram in a department is a step-by- an agreed standard. communication with our patients step process that can be monitored “As radiological healthcare pro- will improve our sense of work well by patients, and analyse the poten- fessionals, we tend to think of this done and help us to assure higher tial phases of patient involvement, as being process-driven. This is an quality service,” he concluded. including ways to identify the most important component, but audit To illuminate the topic from every relevant patient-reported measures Nicola Bedlington, Executive Dr. Barry Kelly is Consultant can and should also be used to particular angle, Europa Uomo Ex and possibilities to collect and ana- Director of the European Radiologist at the Royal Victoria measure our interaction with each Officio Board Member Erik Briers, lyse patient-generated evidence. Patients’ Forum, will co-chair Hospital, Belfast, UK, and Chair other and with our patients. By PhD, and Executive Director of the The session will close with a panel today’s ESR-PAG session. of the ESR Subcommittee on doing this, we ensure that a pati- European Federation of Neurologi- discussion on the central question: Audit and Standards. ent-centred approach leads to a cal Associations, Ms. Donna Walsh, “Does your department perform safe, professional and harmonious will discuss patient safety and qua- well in patient-centred care?” Medical imaging saves lives every hin the context of the situation, institution,” he said. lity of care from the patient’s per- day and is indispensable in pati- they can have a positive influence In this session, Kelly will be ent-centred care. During the past on the patient’s experience in vari- joined by Dr. Dominique-Gérard two decades, the use of medical ous ways. Carrié, from the department of ESR Patient Advisory Group Session imaging to visualise and help dia- Considering a patient’s journey radiology and medical imaging at gnose illness and injuries and to through different medical depart- Polyclinique du Parc, Toulouse, Saturday, March 4, 10:30–12:00, Room L 8 guide complex therapeutic inter- ments is going to be one of the main France, who will specifically discuss ESR-PAG 1 Improving patient safety and quality of care ventions has expanded greatly, so focuses of today’s ESR-PAG session, how to implement a patient satis- in clinical radiology that nowadays, patients with a which will be chaired by Ms. Nicola faction questionnaire in radiology wide spectrum of physical comp- Bedlington, Executive Director of departments. »»Chairpersons’ introduction laints benefit from different ima- the European Patient’s Forum, and “In order to better respond and to N. Bedlington; Vienna/AT ging procedures. Dr. Barry Kelly, Consultant Radiolo- optimise our practices, we must try B.E. Kelly; Belfast/UK Radiology is very much seen as gist at the Royal Victoria Hospital, harder to understand the expecta- »»The work of the ESR Audit & Standards Subcommittee a service provider, and as such, its Belfast, UK. tions of our patients. It is necessary in collaboration with ESR-PAG practitioners need to understand “Many of us as doctors suddenly and not that complicated to imple- B.E. Kelly; Belfast/UK quality and delivery of service, become aware when we are pati- ment this kind of questionnaire in »»Patients’ perspective including knowledge of customer ents, that the once familiar terri- all medical imaging departments,” D. Walsh; Dublin/IE service and satisfaction, quality tory of our hospitals can suddenly he emphasised, adding that, in this E. Briers; Hasselt/BE assurance and improvement issues. seem forbidding, stressful, offici- context, collaboration with patient In this context, radiologists ous or even uncaring,” noted Kelly. organisations might be especially »»Example of good practice: implementing a patient should bear in mind that they do “If this is how it can seem to profes- helpful and constructive. satisfaction questionnaire in your radiology department not sell images, but essential dia- sionals who find themselves on the “The questions should be simple, D.-G. Carrié; Toulouse/FR gnostic information and advice, other side of the white coats, how so that they can easily be under- »»Panel discussion: Does your department perform well in and that by getting involved with much more profound and intimi- stood by all patients,” noted Carrié. patient-centred care? the patient and by providing an dating must it be for our fellow To get the most from these mea- This session is part of the EuroSafe Imaging campaign. interpretation of their images wit- citizens, who have no experience sures, emphasis must be put on

ESOR Courses for EDiR 2017 ESOR is continuing to organise preparatory courses for residents and board-certified radiologists, wishing to take the exams of the European Diploma in Radiology (EDiR). A series of courses is organised at the ESR Learning Centre in Vienna/Austria at the end of the year. It is possible to attend either one course only, or several courses of the series.

Chest Imaging Neuroradiology Abdominal Imaging November 6 November 9 November 13

Cardiac Imaging Head and Neck Radiology Hybrid Imaging November 7 November 10 November 14

Breast Imaging Musculoskeletal Radiology Paediatric Radiology November 8 November 11 November 15

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 | SATURDAY, MARCH 4, 2017 CLINICAL CORNER 15

BY VESNA GERSHAN AND DAVID LURIE How low can iterative reconstruction really help us go? Recent years have seen dramatic improvements in CT technology, and this has brought with it a steady improvement in clinical utility, in turn resulting in an increased number of scans conducted worldwide.

A B noise can be reduced even further, There is no doubt that iterative potentially enabling 80–90% pati- reconstruction has an enormous ent dose reduction compared to amount to offer in clinical CT and FBP1, 2. The noise reduction afforded it has already been taken up by by IR can be exploited as improved the major manufacturers, each of image quality at constant dose, as which offers their own variant of a reduction of dose with no loss in the technology. IR most certainly image quality (see Figure), or as a leads to substantial reductions in combination of these. patient dose from CT, which can Despite the real benefits of IR in only be a good thing. Nevertheless, CT, the method has to be used with optimum use of IR requires further care since it can introduce its own discussion among the community, effects on images. Some studies and international guidance about have found over-smoothing in cases the implementation of IR in clinical Abdominopelvic 2mm-slice CT images from a 26-year-old patient (follow-up of post-traumatic hepatic when higher strengths of IR were practice would be very beneficial. fracture). (A) Full-dose CT with FBP reconstruction (529 mGy.cm); (B) Half-dose CT with iterative applied. This has been associated reconstruction (267 mGy.cm). Note the comparable image noise. From reference 2. with aggressive noise reduction and Vesna Gershan is Associate Profes- is reported as a distinctive image sor of Physics of Medical Imaging Unfortunately, an unwanted interest in state-of-the-art CT and improving the spatial and tempo- texture of ‘waxiness’ or ‘pixilation’. Techniques at the Ss. Cyril and consequence of the increased use dose reduction. ral resolution, without sacrificing Hence, it is vital that the approp- Methodius University in Skopje, of CT is an overall increase in radi- For many years, Filtered Back image quality; IR goes a long way riate radiation dose level as well as Macedonia. ation dose to the patient popula- Projection (FBP) was the primary towards satisfying these goals. Ins- the strength of the IR techniques is David Lurie is Professor of Biome- tion. Therefore, major efforts have method used for reconstructing CT tead of the ‘brute-force’ reconstruc- selected; CT dose reduction with IR dical Physics at the University of gone into promoting methods to images. FBP takes the raw CT data tion used in FBP, which uses only techniques should be achieved in a Aberdeen, UK; he is Chair of the reduce patient dose while main- (1000–4000 projections) and pro- the raw data, IR methods involve gradual stepwise approach. Physics in Radiology Subcommittee taining image quality. jects it back into the image space, modelling the physical processes Finally, it is important to note of ECR 2017. Probably the most dramatic to determine an attenuation value involved in the generation of pro- that images reconstructed by IR effect on dose reduction has come for each voxel. Despite its robust- jection data. The resulting simula- techniques can have a different References from the use of Iterative Reconst- ness and generally acceptable per- ted projections are compared with appearance compared to FBP, 1 Geyer et al., ‘State of the Art: ruction (IR), which is now available formance, CT images reconstructed the raw data, and reconstruction mainly due to a decrease in over- Iterative CT Reconstruction on most latest-generation CT scan- by FBP can suffer from image noise, proceeds in a cyclical manner until all noise and different depiction Techniques’, Radiology, 276, 339-357 ners. Today’s Refresher Course on poor low-contrast detectability and there is a good match (according of tissues. Therefore, radiologists (2015). CT dose reduction using IR will image artefacts, and these prob- to a pre-defined criterion) between need a period of adaptation to the 2 European Society of Radiology, Ask provide attendees with vital infor- lems (especially noise) are amplified the measured and simulated data1. new image appearance. Over time, EuroSafe Imaging, Tips & Tricks, mation about the background, when the radiation dose is lowered. In fact, IR was proposed as long ago as they become accustomed to the ‘Iterative reconstructions in CT’, methods, pitfalls and practical There is a need for an improved as the 1970s and has already found look of the images, the iterative http://www.eurosafeimaging.org/ use of IR; it is ‘essential viewing’ reconstruction method to allow a extensive use in methods such as strength level may be altered, in wp/wp-content/uploads/2016/06/ for all ECR attendees who have an reduction of radiation dose while SPECT. However, the much larger order to reduce the patient dose CT-WG_TipsTricks3.pdf data sets (higher spatial resolution) even further. in CT have precluded the use of IR with CT until relatively recently, when it has become feasible due Refresher Course to improvements in computing hardware. Saturday, March 4, 14:00–15:30, Room G The power of IR algorithms is RC 1513 Dose reduction using iterative image that they can model many of the reconstruction in CT physical parameters that FBP does not (and cannot) take account of, »»Chairman’s introduction such as the x-ray spectrum and the V. Gershan; Skopje/MK blurring of the focal spot. A number »»A. Basics of iterative image reconstruction in CT of approaches and algorithms exist M. Kortesniemi; Helsinki/FI for IR, with their own strengths and »»B. Iterative image reconstruction in clinical practice weaknesses. The most basic IR algo- (dos and don’ts) rithm goes through a series of ite- H. Alkadhi; Zurich/CH rations applied on a first-pass FBP raw dataset. Recently, more com- »»C. Image quality assessment of iterative reconstruction: plex IR, termed fully-model based pitfalls and future directions Vesna Gershan from Skopje, David Lurie from Aberdeen, algorithms, have become available, C. Ghetti; Parma/IT Macedonia, will chair today’s UK, is Chair of the Physics in which use both backward and for- »»Panel discussion: How low can we go? refresher course on iterative Radiology Subcommittee of ward projection datasets. By com- This session is part of the EuroSafe Imaging campaign. reconstruction in CT. ECR 2017. bining many more iterations, image

Visit the Arts & Culture booth in the entrance hall Tina Blau, View on Vienna from the Upper Belvedere, 1894/1895 © Legat Peter Parzer, Vienna myESR.org #ECR2017 16 CLINICAL CORNER ECR TODAY | SATURDAY, MARCH 4, 2017

BY FRANCESCO GENTILI Feasibility of high-resolution MR lymphangiography in planning lymphaticovenous anastomosis treatment

Lymphoedema is a prevalent disease that affects 90 million people all over the world, primarily due to parasitic infections but due to malignancy or its therapy (lymph node removal during cancer surgery or radiotherapy). Though there are many conservative treatment options, their efficacy is highly variable and they are not curative.

gram represents added value in distinguishing lymphatics from veins (Figure 1). Furthermore, we show that in some cases, by comparing heavily T2-weigthed sequences with gradient-echo T1-weighted MR lymphangiography (though many authors have found the former reliable for identifying lymphatic vessels), it is very difficult to distinguish lymphatics from a diffuse oedematous subcutaneous infiltration. All our patients (n=16) underwent LVA treatment within 72 hours after MR examination, and 34 out of 38 specimens of presumed lymphatic vessels at MR lymphangiography, collected during surgery, resulted positive at the immunois- tochemical marker d2-40, demonstrating a significant association (Chi-square=40.421, DF=1, p< 0.05, contingency coefficient 0.644). From this study, despite the reduced sample size, MR lymphan- A B giography seems to be a promising imaging technique that combi- Recently, operative approaches, tral fat saturation, in order to pro- nes morphological and functional such as lymphaticovenous anas- vide a map of the venous system information into a single exam. It is tomosis (LVA) treatment, have and visualisation of lymphedema easy to perform and can be useful proved their worth as a radical and a post-contrast 3D spoiled gra- in planning LVA in patients with cure for lymphedema, bypassing dient-recalled echo T1-weighted lymphedema and in evaluating pos- lymphatic obstruction by shunting sequence with SPECtral inversion sible LVA treatment complications. lymph flow into the venous system. at lipid (FSPGR with SPECIAL, GE). This procedure, where collecting The contrast agent (Gd-BOPTA, Francesco Gentili, MD, is a resident lymphatics are anastomosed to sub- 0.1 mmol/kg body weight) was injec- fellow in diagnostic imaging at the dermal veins, requires microsurgi- ted subcutaneously with a low dose department of medical, surgical cal techniques and high-resolution of lidocaine in the region of the four and neuro sciences at the Universi- imaging to depict these vessels interdigital web spaces (generally ty of Siena, Italy. because of their small size (2–3mm). 1ml for each interdigital web space), Imaging lymphatic vessels has and post-contrast sequences were always been a challenge for diagno- repeated with different timings for stics. While lymphoscintigraphy is a dynamic visualisation of both still considered the main technique lymphatics and veins, with a total in diagnosing lymphedema, it average examination time of about lacks spatial resolution. Similarly, one hour. indocyanine green (ICG) fluore- We show the possibility of dis- scence lymphography, which is used tinguishing lymphatic vessels intraoperatively, has several disad- from veins not only by their mor- vantages, such as limited anatomical phology but also by their different coverage, lack of spatial information, enhancement kinetics (p<0.05). limited penetration depth (< 2cm to Moreover, the pre-contrast veno- the skin) and inability to characte- rise subcutaneous soft tissues. C In our study, we propose the use Scientific Session of magnetic resonance lymphan- Figure 1: A 52-year-old woman with unilateral lymphoedema giography (MR lymphangiography) Saturday, March 4, 10:30-12:00, Room X secondary to lymphadenectomy for breast cancer. 3D SSFP in patients with lymphedema for SS 1415 Assessing venous and lymphatic diseases balanced ECG-triggered sequence provides a map of the venous imaging lymphatic vessels and system (open arrows, A); post-contrast 3D coronal spoiled distinguishing them from veins in Moderators: M.A. Aschauer; Graz/AT gradient-echo T1-weighted sequences after five (B) and 35 (C) planning LVA treatment. All MR C. Floridi; Varese/IT minutes show a progressive delineation and enhancement of examinations were performed with »»Feasibility of high-resolution MR lymphangiography in lymphatic vessels (white solid arrows); it is clear the beaded a 1.5T MR unit with the following planning lymphaticovenous anastomosis treatment: appearance of lymphatics comparing to veins (open arrows) sequences: a 3D steady-state free a single-centre experience and their different enhancement kinetics; furthermore pre-contrast precession (SSFP) balanced elec- F. Gentili, F.G. Mazzei, P. Gennaro, D. Notaro, A. Fausto, venogram makes the subsequent distinction of the different trocardiography (ECG)-triggered M.A. Mazzei, L. Volterrani; Siena/IT structures easier. Provided by Dr. Francesco Gentili. sequence (FIESTA, GE) with spec-

#ECR2017 myESR.org ECR TODAY | SATURDAY, MARCH 4, 2017 TECHNOLOGY & RESEARCH 17

Innovative solutions for diagnosis Change in paradigm – why medical Digital Imaging Adoption Model helps and treatment for GIST patients radiation protection has become a to assess imaging capabilities within 19 21 fundamental clinical challenge 23 your organisation

BY INGA STEVENS In post-PACS world, ECR 2017 exhibitors demonstrate how to realise full potential of healthcare IT Since the first mumblings of the term ‘picture archiving and communications system’ were heard in the late 1970s, PACS has become mainstream in the practice of radiology.

In the early days of digitalisation, GE Healthcare is announcing European hospitals and healthcare several innovations in the enter- suppliers played a central role in prise imaging and cloud radiology the development of the technology. sectors. The company is revealing Today, many of the world’s leading the availability of the Centricity manufacturers are at ECR 2017 to dis- 360 Suite, which is designed to help play their latest PACS and healthcare distributed care teams collaborate IT offerings. The emphasis is on fas- efficiently on patient cases in a ter network connections, increased secure on-premise platform to opti- storage, 3D capabilities and monitors mise and simplify patient informa- with higher resolution. tion exchange with primary care to Sectra is demonstrating enhan- improve care management. ced PACS capabilities designed for Centricity 360 Case Exchange, high-production environments with Centricity 360 Physician Access and usability and availability in focus. Centricity 360 Patient Access are the Highlights include functions to speed first applications in the firm’s Centri- up oncology workflows, such as lesion city 360 suite of private/public cloud tracking and anatomical linking. Addi- or data centre-based solutions. tionally, Sectra Breast Imaging PACS “At ECR 2017, we will be showca- can support fully integrated breast sing analytics solutions across the tomosynthesis reading as well as MRI GE Healthcare booth highligh- integrated within the mammogra- ting actionable insights for x-ray, phy workflow. It also features strong ultrasound, CT, MR, enterprise workflow management tools, allowing imaging and cardiology,” explained efficient hosting of tumour boards Bryan McGuinn, marketing director and workflows being based on breast for GE Healthcare Digital. “Custo- density. New enhancements include mers can place orders for custom The Clinical Collaboration Platform from Carestream assists with the acquisition, management, and breast implant masking, further stre- analytics solution engagements consolidation of islands of systems and presents a single point of access to patients’ clinical records. amlined hanging protocols, and an and we are pursuing pilot oppor- integrated peer review package. tunities for analytics applications.” Carestream is showing several Meanwhile, Siemens Healthineers work-in-progress modules of its Cli- is presenting a new version of the nical Collaboration Platform. The Syngo.via diagnostic software – the enterprise image data management Syngo.via VB20 software assistant product is designed to make criti- – which manages diagnostic fin- cal patient images and data easily dings to make all relevant data accessible to all stakeholders who immediately available. The Cine- collaborate in the continuum of matic Volume Rendering Technique care, including referring physicians, (Cinematic VRT) available on Syngo. specialists, IT and business admi- via VB20, also known as ‘Cinematic nistrators, payers, and patients. Rendering’, uses raw data from CT “Some of the work-in-progress and MRI scans to create hyper-rea- modules that enable all stakehol- listic anatomical images taking 3D ders to collaborate include the imaging to a whole new level. While expansion of Analytics Solution, Cinematic VRT has been available to which leverages natural language a small scientific group for the past processing and semantic search few years, this is the first time the technology to data-mine multi-me- technology has been available as an dia interactive diagnostic reports application to all Syngo.via users. to detect discrepancies and reduce The partnership and collabora- errors,” said Massimo Angileri, tion between TeraRecon and Agfa EMEA regional business manager HealthCare is also on show at ECR at Carestream. “In addition, the new 2017, as the companies present deconstructed patient management their release of an application pro- workflow can be applicable beyond gramming interface (API) between radiology for applications such as iNtuition and Enterprise Imaging telemedicine, enabling zero-foot- 8.1. This combined solution seeks print deployment that can simplify to deliver a workflow that provi- system administration and improve des a complete clinical and imaging access by remote users for wound experience. The potential bene- care, tele-triaging and dermatology.” fits include a single user interface Also in progress is the introduc- for accessing 2D and advanced 3D tion of new worklists for radio- applications, the ability to launch logists that can orchestrate daily into TeraRecon workflow from wit- Cinematic volume-rendering technique: high-resolution diffusion tensor imaging shows very reading workloads, enable real-time hin Agfa hanging protocol work- detailed white matter fibre track. Copyright: Max Planck Institute, Leipzig, Germany. Provided by communication with peers and Siemens Healthineers. improve productivity, he added. continued on page 18 myESR.org #ECR2017 18 TECHNOLOGY & RESEARCH ECR TODAY | SATURDAY, MARCH 4, 2017

continued from page 17 DICOM to a 3D printed model, in a matter of minutes. What you see is flow, verification of patient infor- truly what you get.” mation to ensure data integrity In other healthcare IT news, between Agfa and TeraRecon, and the evolving IntelliSpace Portal other benefits such as multi-series 9.0 analysis platform from Philips data loading for 3D analysis. now incorporates applications to TeraRecon is also presenting its track and compare brain images to technological and workflow advan- more accurately determine patient ces, resulting in the ability to print progression. In addition to enhan- models of incredible detail direc- cements in areas such as CT Brain tly from TeraRecon software. The Perfusion and MR T2 Perfusion, new 3D Print Packs make online, the analysis platform will offer lon- cloud-based 3D reconstruction and gitudinal brain imaging (LoBI), an printing simple, fast, and affordable, application for neuro reading to according to president and CEO Jeff support the evaluation of neurologi- Sorenson, who explains that the cal disorders over time so clinicians company has looked at the econo- can monitor disease progression. mics of 3D printing and concluded Another feature is the inclusion that there has to be a better way. of the NeuroQuant measurement “Current in-house 3D medical application (CorTech Labs), which printing programmes are too costly enables clinicians to quantify brain and complex,” he said. “TeraRecon, volume loss. together with WhiteClouds, is now offering a 3D printing online service Technical Exhibition with its new 3D Print Packs. Ever- Opening Hours yone knows that TeraRecon can make beautiful 3D renderings but Thursday, March 2 to Saturday, now we can take those beautiful March 4 10:00–17:00 Cloud-based 3D reconstruction using TeraRecon’s 3D Print Packs. 3D renderings and go directly from Sunday, March 5 10:00–14:00

BY STEPHEN HOLLOWAY The great enabler: artificial intelligence in radiology Much has already been debated over the impact of artificial intelligence (AI) for radiology, and now we start to see the first products enter the market.

like science-fiction? It will happen reading radiologist. However, there sooner than you think. Our recent can be far too much information research with an extensive field to review, leaving this potentially of medical imaging AI companies critical information unused. Here is predicts that close to one-third of where AI can again aid the radiolo- image analysis software will be gist: decision support tools. built on deep-learning algorithms These advanced machine lear- by 2021. ning tools can source, collate and Evidence pool all relevant clinical informa- Quantification tools have been tion together, in combination with part of imaging IT software for quantitative imaging markers, to some time, from coronary calcium offer a more complete diagnostic Sales scoring to lung density analysis. In picture to the reader. Furthermore, offering quantification of imaging these systems will also be able to biomarkers, more accurate measu- quickly pool evidence from simi- rement of disease characteristics larly presenting past studies and can be made. However, often these outcome data, thereby providing tools are manual, a time-consu- guidance on likely outcomes of ming and inaccurate process. each diagnostic scenario based What’s more, the development of on prior outcome reporting. It is the algorithms supporting these still early in market adoption for tools is manual. decision support tools, but some By using deep-learning, the products are already approved for process can increasingly be auto- use in very specific study types, mated, while the development of while a multitude of others are algorithms can be developed faster. in development. The accuracy of this development Of course, there are many barri- process has yet to be tested in large ers to overcome for widespread AI scale clinical trials compared to adoption in radiology. How to regu- today’s manual solutions admit- late continually learning systems? Current maturity of image analysis solutions; AI is already penetrating CADe and quantitative tools; tedly, but the range of quantitative What are the legal and ethical decision support tools just entering the market, while CADx remains some way from being implemented. tools in development is rapidly implications? How will AI systems increasing. Therefore, expect to see access patient data that is disparate Most discussion has targeted technology has helped speed the ning and continuing to learn from a growing number of more auto- and unstructured? the role of ‘holy grail’, automated imaging process, but this has not how they work. This means soon mated, more accurate quantitative Despite these, the signs are clear differential diagnosis (or CADx), been enough to counter the ramp imaging software will allow auto- imaging tools coming to the market that AI will have a transformative prompting a mix of scepticism, in demand and the complexity of matic, customised hanging proto- in the next five years. role in radiology. But rather than division and uncertainty from the imaging studies. Furthermore, com- cols, smart reporting preferences, Excellence replacing the radiologist, it’s more radiologist community. Yet when plicated protocol management and prior study recall and tool selec- Quality of diagnosis is a continu- likely AI will be an enabler to more we dig into the investment and changing structured reporting are tion, based on the unique working ing challenge for the modern radio- efficient, quality and evidence-ba- development being made in AI for putting radiologists under even gre- practices of each individual user. logy professional. While pains are sed diagnosis. And sooner than radiology, it becomes clear that AI ater pressure. Radiologists will be more autono- taken to safeguard against adverse you’d think. will not replace radiologists, but This is where AI can help. Work mous, with fewer ‘clicks’ and far reporting, the volume of images to enable them. is already underway utilising AI fewer workflow headaches. be read and limited radiologist capa- Stephen Holloway is principal Efficiency to improve the back-end workflow What’s more, with systems based city makes upholding quality stan- analyst and company director There is no getting away from it, issues that slow radiologist reading on deep learning algorithms (rather dards a challenge. Due to digitalisa- at Signify Research radiologist physician numbers are and reporting. It will over time than manually writing algorithms), tion of health information over the (www.signifyresearch.net), a dwindling and scan volumes rising, ‘individualise’ the working plat- vendors can make improvements last two decades, a raft of new clini- health tech, market-intelligence driving focus on efficiency. Digital form for each radiologist, by lear- and upgrades more quickly. Sound cal evidence is now available to the firm based in Cranfield, U.K.

#ECR2017 myESR.org ECR TODAY | SATURDAY, MARCH 4, 2017 TECHNOLOGY & RESEARCH 19

BY PAMELA ZOLDA Innovative solutions for diagnosis and treatment for GIST patients A multidisciplinary consortium has made significant steps towards an improved diagnosis of metastatic gastrointestinal stromal tumours (GIST) and has further developed therapy concepts for patients that are resistant to the current types of medication.

with high affinity/specificity to the improved treatment concepts for atment options that were further gastrin-releasing peptide receptor the individual patient. Together developed by the project will be expressed in GIST. MITIGATE’s in this will result in a personalised introduced. Finally, a representa- vitro studies confirmed this in spe- and combined multimodal treat- tive from GIST Support Austria cially developed tumour models, ment approach in patients with will report on the impact of the and NEOBOMB1 was chosen for advanced disease. MITIGATE project on European the first-in-human application in a Today at ECR 2017, EIBIR will GIST patients. MITIGATE is an EU clinical trial at the Medical Univer- host a special session presenting an (FP7) co-funded project that aims at sity Innsbruck, Austria. overview of the MITIGATE project’s developing new protocols and gui- This phase I/IIa study started in innovative results. Members of the delines to effectively diagnose and December 2016 and will evaluate project consortium will introduce treat patients with metastatic GIST safety, biodistribution, dosimetry current therapy methods and the resistant to current treatment. and preliminary diagnostic per- advances made by the MITIGATE Learn more about MITIGATE Tumour to muscle ratio for PET imaging of GIST-882-bearing mice at formance of 68Ga-NeoBOMB1 in partners. The clinical trial for pati- and visit the project website: different times after tumour inoculation. The same animal received patients with advanced TKI-treated ents with metastatic GIST who are www.mitigate-project.eu an injection of 68Ga-NeoBOMB1 and 18F-FDG at different times on GIST using PET/CT. Based on the experiencing tumour progression the same day. results of the trial, GIST patients while under treatment with Ima- may derive real benefits from the tinib (Glivec®, Gleevec™) will be Gastrointestinal stromal tumour ging technologies (PET and MRI) imaging procedure, such as impro- presented. Minimally invasive tre- (GIST) is a rare disease frequently and companion radiopharmaceuti- ved tumour volume definition and affecting young patients. Its high cals. This is followed by assessment better detection of disease in the EIBIR Session potential for metastasising often of biodistribution, dose calculation near future. leaves patients with a life expec- and measurement of therapeutic In its final year, the project will Saturday, March 4, 14:00–15:30, Room L 8 tancy of less than three years. effectiveness. In addition, synergi- focus on the following: EIBIR Session 3 Currently, there is only one class stic concepts of minimally invasive •• Evaluation of the results of the Innovative solutions for diagnosis and treatment concepts of effective medication – tyrosi- treatment will be applied. clinical trial for GIST patients from the MITIGATE project ne-kinase inhibitors – but tumours The project consortium, which is •• Further development of new frequently develop drug resistance coordinated by the Ruprecht Karl Uni- GIST-specific radiotracers Moderator: S.O. Schönberg; Mannheim/DE after a few years. versity of Heidelberg and the Euro- •• Minimally-invasive percutaneous »»Introduction to the state-of-the-art therapy in GIST The objective of the four-year pean Institute for Biomedical Imaging thermal ablation and irradia- P. Hohenberger; Mannheim/DE EU-funded project MITIGATE is to Research (EIBIR), comprises three tion, guided by molecular PET develop and validate a targeted, per- European universities, three research imaging and a robotic assistance »»Improving the diagnostic imaging approach in GIST patients sonalised and integrated closed-loop organisations and four SMEs. system C. Decristoforo; Innsbruck/AT process to effectively treat patients In the third year of the project, a •• Assessment of new functional »»Minimally invasive treatment of GIST patients in a with metastatic GIST resistant to number of radiopharmaceuticals, and metabolic MR imaging compassionate use programme current medication. The innovative all with a potential for GIST-spe- methods for GIST tumours. S. Diehl; Mannheim/DE treatment concept combines new cific imaging, were tested with The MITIGATE consortium is »»Impact of the MITIGATE project on European GIST patients strategies for biopsy, inline tissue respect to specificity and patient looking to continue its success A. Bruno-Lindner; Vienna/AT analysis, molecular tumour charac- safety. NeoBOMB1 is a new genera- and ultimately ensure an accelera- terisation, theranostics with ima- tion bombesin analogue that binds ted decision-making process and »»Discussion

RTF MEET & GREET SESSIONS Visit the RTF Booth in the ESOR & Rising Stars Lounge (M Building) to meet Professor Laura Oleaga, Chairperson of the ESR Education Committee, today, from 16:30 to 17:30.

Join your European colleagues and Radiology Trainees Forum Saturday, March 4, 10:30–12:00, Room O (RTF) representatives from different European countries in an infor- TF Highlighted Lectures mal and relaxed discussion, exchange opinions and points of view with them and present your ideas. Take advantage of this great Moderators: A. Svare; Riga/LV opportunity! L. Andrade; Coimbra/PT

Don’t miss the RTF Highlighted Lectures moderated by RTF Board » Ovarian cancer staging: where and what to look for? members Atis Svare and Luisa Andrade today, 10:30–12:00 in Room O. M.M. Otero-García; Santiago de Compostela/ES » Update in breast ultrasound For more detailed information please visit the RTF Meeting Point in B. Brkljačić; Zagreb/HR the ESOR & Rising Stars Lounge. » Multiparametric MRI evaluation in brain tumours A. Santa; Sibiu/RO

myESR.org #ECR2017 20 TECHNOLOGY & RESEARCH ECR TODAY | SATURDAY, MARCH 4, 2017

BY FLORIAN SAGMEISTER, HORST BRUNNER AND MEINRAD BEER The non-invasive determination of ‘pressure recovery’ using MRI for the correction of aortic stenosis severity classification

pressure recovery by MRI will be presented. In this session, you can learn more about the following issues: how large is the absolute extent of pressure recovery in a patient cohort with moderate and severe calcific degenerative aortic stenosis? Do MRI results correlate with echocardiographic results? What impact does the measurement position (Figure 2) in the ascending aorta have on calculated pressure recovery? How clinically important is pressure recovery?

Dr. Florian Sagmeister is resident Figure 1: Schematic drawing of the course of blood stream during left Figure 2: Anatomic positions as typical measurement locations of physician at University Hospital ventricular systolic ejection from left ventricular outflow tract to aortic annulus and ascending aorta. Ulm, department of diagnostic tubular ascending aorta. and interventional radiology, Ulm, Germany. In patients with severe aortic Behind this position, the blood ters are called pressure recovery Until now, there has been no Dr. Horst Brunner is senior physi- stenosis, the moment for surgi- stream expands again and kinetic (mmHg), indexed pressure reco- study using MRI-based aortic mea- cian at University Hospital Ulm, cal intervention depends on the energy is reconverted into potential very (pressure recovery related to surements for the non-invasive department of diagnostic and inter- severity of aortic stenosis (AS) and energy in the ascending aorta – a maximal valve gradient across the estimation of pressure recovery. ventional radiology, Ulm, Germany. the symptoms of the patient. In the phenomenon called ‘pressure reco- stenosis, %), energy loss coefficient In the oral presentation ‘Pressure Prof. Meinrad Beer is chief physici- last decades, several new parame- very’ (Figure 1). Invasive studies sug- (ELCO, cm2) and energy loss index recovery determination by cine an and head of department at the ters for stenosis severity have been gest that this haemodynamic phen- (ELCO indexed to body surface MRI is feasible and leads to sig- University Hospital Ulm, depart- developed in order to improve the omenon probably takes place along area, cm2/m2). nificant re-classification of aortic ment of diagnostic and interventio- correlation of parameters with the a longer distance of the ascending Echocardiography is the first and stenosis severity’, initial results in nal radiology, Ulm, Germany. haemodynamic physiology across aorta. Unfortunately, the extent of most prevalent imaging modality in the non-invasive determination of and behind the valve and with cli- pressure recovery is diminished by patients with severe AS. However, in nical symptoms and outcome of the loss and dissipation of energy in the several studies discrepancies have Scientific Session patient (e.g. left ventricular stroke form of heat and flow turbulence. been found between non-invasively work loss, valvulo-arterial impe- In order to evaluate the ‘real’ estimated echocardiographic gra- Saturday, March 4, 10:30-12:00, Room M 3 dance, aortic valve resistance). energy reduction across the valve, dients using the Bernoulli equation SS 1403b Transcatheter aortic valve implantation (TAVI), In every systole, the intracardiac these ‘energy losses’ should be and invasively measured gradients valves and stents blood is ejected through the left quantified. Based on the fluid across the aortic valve before and Moderators: E. Blondiaux; Paris/FR ventricular outflow tract and cros- mechanical principles first descri- after surgical valve replacement. O. Duvernoy; Uppsala/SE ses the more or less stenotic aortic bed by Clark et al. in 1976, formulas The phenomenon of pressure reco- valve. A short distance after the aor- for the non-invasive determination very has been applied to explain »»Pressure recovery determination by cine MRI is feasible and tic valve, the blood stream conver- of the extent of pressure recovery the often observed overestimation leads to significant re-classification of aortic stenosis severity ges to the narrowest diameter and have been developed and have been of echocardiographic pressure F. Sagmeister1, S. Herrmann2, M. Weininger3, T. Bley2, H. Köstler2, achieves its maximal kinetic energy, applied in several echocardiogra- gradients compared to invasively D. Hahn2, F. Weidemann4, M. Beer1; 1Ulm/DE, 2Würzburg/DE, which is called ‘vena contracta’. phic studies. The relevant parame- determined pressure gradients. 3Mutlangen/DE, 4Unna/DE

BY HAZEL I. ZONNEVELD The neural substrate of cognition

Cognitive ability varies between prefrontal cortex), even though individuals and throughout life. It considerable functional speciali- is determined by both genetic and sation typically exists within such environmental factors, which are regions. Hypothesis-free approa- partly reflected in the structure of ches that study brain structure at the brain. Over the past few deca- the highest resolution, i.e. the voxel des, brain imaging has enabled on brain scans, in relation to cog- us to study the relation between nitive ability have been typically brain structure and cognition. For lacking or underpowered. example, the hippocampus has These analyses could yield crucial been studied extensively in relation new insight into the exact neural to memory. Many of the investiga- substrate for cognition. Therefore, ted links between brain structure we investigated the neural subst- and cognition have arisen from cli- rate of cognition in a large popula- nical observations of patients with tion-based sample of nearly 5,000 localised brain lesions or following middle-aged and elderly subjects surgical interventions. who were free of dementia and Neuroimaging studies have used without clinical stroke. these observations in hypothe- All participants underwent brain sis-driven approaches to study the MRI, including high-resolution 3D Medial (left) and lateral (right) view of the left hemisphere showing associations of grey matter density with neural substrate of human cogni- T1-weighting imaging. Cognitive the Stroop interference test. Colours correspond to values indicated in the scale and represent t scores from tion. These studies have primarily function was assessed using an regression models. Positive and negative t scores correspond to worse and better performance on the Stroop focused on aggregate measures extensive neuropsychological test test respectively. over entire brain regions (e.g. the battery, including the Mini-Mental

#ECR2017 myESR.org ECR TODAY | SATURDAY, MARCH 4, 2017 TECHNOLOGY & RESEARCH 21

State Examination, Stroop test, a with better performance on the ver- In conclusion, in this study we 15-word verbal learning test (WLT), bal fluency test. Better performance showed that the detection of more Scientific Session the letter-digit substitution task on WLT, a task to test memory, was localised differences in brain struc- (LDST), the verbal fluency test and associated with higher grey matter ture provides relevant information Saturday, March 4, 10:30-12:00, Room E2 the Perdue Pegboard test. Voxel-ba- density in the left hippocampus. Bet- in addition to aggregate measures. SS 1411 The ageing brain: cognition and dementia sed morphometry was performed ter performance on the Stroop test, a Subsequently, this study may pro- Moderators: L. Hermoye; Brussels/BE to investigate the association bet- reading/colour naming interference vide insight into the pathways of A. Negaard; Lørenskog/NO ween local grey matter density and task to test executive function, was cognitive decline. cognitive function. related to higher grey matter density »»The neural substrate of cognition: the Rotterdam study When looking into the verbal flu- in both hippocampi, and lower grey Dr. Hazel I. Zonneveld works at the H.I. Zonneveld, G.V. Roshchupkin, H.H.H. Adams, W.J. Niessen, ency test, we found that higher grey matter density in the left and right department of epidemiology and M.A. Ikram, M.W. Vernooij; Rotterdam/NL matter density in the left parietal thalamus (Figure). Furthermore, we the department of radiology and lobe and posterior temporal lobe was observed that lower grey matter nuclear medicine at Erasmus MC associated with better performance. density in the left insula was asso- University Medical Center, Rotter- Lower grey matter density in the ciated with worse performance on dam, the Netherlands. right insular cortex was associated the LDST.

Change in paradigm – why medical radiation protection has become a fundamental clinical challenge An interview with EuroSafe Imaging Chair, Professor Guy Frija

an example. An ESR survey showed than on technical and/or anatomi- under way. Paediatric imaging is by that in most cases they are not used cal protocols. The development of definition included in the concept. in clinical practice, even in countries automatic dose-recording systems ECRT: What would be the where such guidelines are available. would facilitate the establishment potential impact of this propo- Diagnostic reference levels of local diagnostic reference levels sed change in paradigm towards (DRLs), for example, were establis- (LDRLs), which have the advantage clinically oriented radiation hed for common protocols on the of better reflecting the distribution protection? basis of national surveys. However, of the patient’s body characteristics, GF: If implemented properly and they were rarely updated and did as well as the disease’s prevalence, in a collaborative teamwork setting not follow the pace of technological and the performance of the modali- with all stakeholders involved, alig- progress. In addition, current DRLs ties used. It has already been shown ning radiation protection with clini- Prof. Guy Frija is Chair of the do not take into account the dis- that LDRLs could be an effective cal concerns could have a significant EuroSafe Imaging Steering tribution of patients’ body charac- tool for improving the clinical impact on the quality of daily clini- Committee and Co-Chair of teristics nor a disease’s prevalence. practice, as one can only improve cal practice and hence patient out- the new International Society Optimisation is generally seen what one can measure. comes. In summary, radiation proof Radiology Quality and as a dose reduction process, even In addition, using indication-re- tection would become much more belonging to a community strongly Safety Alliance. though image quality in relation to lated rather than protocol-based appealing if it were clinically based, involved in the development of radi- clinical need would be much more DRLs would sound much better for focused on a patient-centric appro- ation protection should facilitate ECR Today: Radiation protec- relevant. This is perhaps why the patients and also for physicians, ach, especially if it were to involve a new era of networking between tion in medicine has historically DRL concept currently in use fulfils and could be helpful for external the use of modern equipment. European institutions in order to been driven by national regulators the requirements of regulators but communication. ECRT: Radiation protection, bring big data to our specialty. from the nuclear sector who have not the clinical needs of an optimi- ECRT: Europe has a very hetero- however, is not considered a ‘sexy’ ECRT: EuroSafe Imaging has established regulations for the sation process. geneous equipment base, isn’t this topic by the vast majority of radio- served as role model for radia- safe use of medical imaging. What ECRT: Do you have a remedy? a hindrance to your plans? logists. EuroSafe Imaging has see- tion protection campaigns across will be the implications of the new GF: Radiation protection can GF: In fact, equipment per- mingly improved the visibility the globe. You have recently been Council Directive 2013/59/Eura- be viewed as a process of several formance is another extremely and attention radiation protection appointed Co-Chair of the new tom (Basic Safety Standards – BSS inter-related and interdependent important aspect. Modern CT receives both within the clinical International Society of Radio- Directive)? steps. The starting point is the justi- technology has enabled a signifi- environment and at political level. logy Quality and Safety Alliance. Guy Frija: The European Union fication process; making sure that cant decrease in patient exposure. How are you going to ‘sell’ the What is your motivation and mis- has a leading role in medical radi- the requested examination is clini- However, COCIR market surveys topic to the younger generation of sion for this new challenging role? ation protection, having updated cally relevant. show a strong heterogeneity of CT radiologists? GF: The aim will be to ‘profile’ and consolidated five applicable In the United States, using an scanners across Europe, which is a GF: Through EuroSafe Imaging, each regional organisation in order directives into a single legislation integrated clinical decision support huge concern. It is the radiologist’s we will convince them to think dif- to better know and understand entitled Council Directive 2013/59/ tool to perform and document this responsibility to highlight this criti- ferently! First, by propagating that local and regional priorities. We Euratom (Basic Safety Standards process will be mandatory from cal aspect to national governments radiation protection become one will pool experiences and resour- Directive). Issued in December 2013, 2018. In the EU, there are a variety and the European Commission and of the pillars of their daily clinical ces into a single website, which the Directive must be transposed of co-existing approaches, as res- to encourage the development of practice, even though the delivered will allow us to share experience, into national law by EU member ponsibility for health systems resi- equipment upgrade plans. dose per examination has signifi- knowledge and relevant material. states by February 2018. des with member states. ECRT: Another big buzzword cantly decreased in the past years. Also we plan to launch a call for It is essential to understand that However, it is the radiologists’ surrounded by numerous ques- Making it mandatory that an exa- action, which will reflect the regi- the implementation of the previ- responsibility and interest to lobby tion marks is clinical audit, which mination is clinically warranted and onal priorities. In other words, the ous European legislation for medi- national governments to develop was already made mandatory in that the relevant protocol is appro- Alliance’s activities will be entirely cal radiation protection has been a a strong policy on justification in the previous Directive but badly priately set up, as well as that the bottom-up. failure. It is now important in the order to ensure better and safer use implemented … image quality assessment is a part The contribution of EuroSafe transposition phase of the new of medical imaging based on clini- GF: The audit process should of the report, will certainly improve Imaging to this global endeavour BSS Directive that all stakeholders cal considerations. focus primarily on the four cli- the patient outcomes thanks to a cli- will be very important, as we have collaborate in order to ensure that When CT is performed, it is clear nical steps of clinically oriented nically driven process optimisation. a lot of material to provide from the the proposed safety measures and that the technical protocol is dri- radiation protection: justification, Radiation protection should no lon- European side. We could also pro- requirements will be applicable in ven by the clinical indication. The clinically-guided protocols, clini- ger be a regulatory constraint, but a pose educational workshops, which daily clinical routine. resultant image quality needed for cally-evaluated image quality, and way to improve the total quality of would cover the whole spectrum of ECRT: In how far has the imple- a reliable interpretation is conse- disease/symptom-oriented DRLs. daily clinical practice. In addition, radiation protection. It is clear that mentation of European radiation quently also directly linked to the Fluoroscopy-guided interventions modern tools allow us to establish an active cooperation with IAEA protection legislation in the medi- clinical indication. Therefore, it is were not considered in this legal our own practice profiles and to activities will be sought. cal field been a failure until now? very important for a given facility requirement, but the clinical appro- compare it to equivalent facilities. ECRT: Congratulations to Euro- GF: Let’s take imaging referral to record the dose exposure on the ach to patient radiation protection This benchmarking endeavour Safe Imaging and thank you for guidelines for medical imaging as basis of the clinical indication rather for such procedures is already should be very stimulating. Finally, the interview.

myESR.org #ECR2017 22 TECHNOLOGY & RESEARCH ECR TODAY | SATURDAY, MARCH 4, 2017

BY KONSTANTIN NIKOLAOU ESMOFIR: research and education on the latest translational imaging modalities and applications

The European Society for Mole- In the era of ‘personalised medi- medicine techniques and therefore, 2016, ESMOFIR joined again with allow radiologists, nuclear medicine cular and Functional Imaging in cine’, a precise, structured and a close and constructive strategy ESMI (European Society of Molecu- physicians and basic researchers Radiology (ESMOFIR) started its quantitative evaluation of disea- between radiology and nuclear lar Imaging) to organise a workshop interested in translating these new activities in 2013, and since then has ses and their therapies is needed. medicine is mandatory, not only on ‘Imaging of Tumour Heterogene- techniques into clinical practice an pursued a variety of educational To assist with this, a close collabo- in the field of hybrid imaging, but ity’, which was held on March 11, 2016, opportunity to learn more about this and strategic activities in transla- ration is being fostered between also in advanced post-processing in Utrecht, and was a major success. area and to attend both meetings. tional research in radiology. The the ESR Research Committee, methods such as texture analysis. It featured excellent talks on various Overall, there is a clear need for primary purpose of ESMOFIR is ESMOFIR and EIBALL, the Euro- Finally, physiological models and aspects of tumour genetics, radio- systematic and structured education to promote molecular and functio- pean Imaging Biomarker Alliance, mathematical modelling of develo- mics, tumour metabolism, texture in the complex and rapidly develo- nal imaging in radiology, as well as to create a clear structure of aims ping imaging biomarkers have to analysis and imaging biomarkers, ping field of translational research in educating young radiologists in this and goals between these groups. be repeatable and reproducible, and was attended by more than 60 radiology, to understand the unmet field. The broader scope of ESMO- There are several major challenges introducing dedicated and speci- participants. In 2016, ESMOFIR also clinical needs, the underlying phy- FIR’s activities focuses on educa- in trying to develop and introduce fic post-processing tools to clinical started a series of ‘webinars’ on the siological basis of the models used, tion and training in various advan- specific imaging tracers and valida- routine, independent of specific ESR Education on Demand plat- the value and benefits of competing ced fields of research, including the ted imaging biomarkers into clini- scanning equipment. form, introducing topics such as modalities and techniques, and the integration of multimodal and mul- cal routine. First, most functional As for educational and coordina- ‘Therapy monitoring in oncology – limits and limitations of the para- tiparametric image information, as and molecular imaging techniques ting activities, in June 2016, ESMO- RECIST and beyond’ and ‘Functional meters obtained. ESMOFIR will con- well as advances in data analysis for are evolving constantly, and stan- FIR held a workshop on Breast Renal Imaging’. This webinar series tinue its educational and strategic molecular and functional imaging dardisation and harmonisation of Imaging in Vienna (Multimodality will be continued in 2017. activities in close collaboration with datasets. In these areas, there is an acquisition is extremely challen- hands-on workshop in breast ima- In 2017, ESMOFIR will continue its the ESR and the ESR subspecialty obvious and very close relations- ging, e.g., in diffusion-weighted MR ging: from morphology to function successful collaboration with ESMI, societies, as well as with the ESR hip between radiology and nuclear or perfusion MR. Second, the num- and molecules), with a broad educa- organising a workshop as a satel- Research Committee and EIBALL. medicine, between basic and clini- ber and diversity of functional and tional spectrum from fundamental lite workshop to the annual mee- cal research, and between medical quantitative imaging techniques in lectures to practical case sessions. ting in Cologne, on Saturday, April Prof. Konstantin Nikolaou is doctors and scientific researchers radiology are increasing rapidly and Acquisition techniques along with 8. This workshop is a joint initiative medical director of the department involved in the field. This aspect of may overlap, e.g., volume-perfusion image reading and processing were of ESMOFIR and ESHI (European of diagnostic and interventional interdisciplinary translational rese- CT and Dual-Energy CT/spectral CT covered by a selection of European Society for Hybrid Medical Imaging) radiology at the University Clinic arch is emphasised strongly in all techniques. Third, clinical molecu- radiologists who are opinion leaders and is titled ‘Evolving hybrid ima- Tübingen, Germany, and ESMOFIR ESMOFIR endeavours. lar imaging also includes nuclear in this field. Furthermore, in March ging into clinical practice’. This will President.

Visit us at the Bayer booth, X5/13 Boost your image As a radiologist, you are a true partner in the care continuum. Medrad® Stellant CT Injection System offers technology and reliability that drives performance in patient-centered care in CT imaging. Precisely timed contrast delivery Individually optimizes contrast protocols* Designed for efficiency from routine to complex protocols Scalable platform can meet your changing CT imaging needs Backed by reliable on-site field service team and VirtualCare® Remote Support. Find out more: www.radiology.bayer.com/stellant G.MKT.RI.01.2017.0855 L.AT.MKT.01.2017.5278

* At the point of care with Certegra® P3T® software

170126_02_ad_radiologist_260x195.indd 1 26.01.17 16:38

#ECR2017 myESR.org ECR TODAY | SATURDAY, MARCH 4, 2017 TECHNOLOGY & RESEARCH 23

BY JÖRG STUDZINSKI Digital Imaging Adoption Model helps to assess imaging capabilities within your organisation Is your imaging service ready for the digital age?

DIAM stage has specific require- Within an organisation, the ments drawn from the ten focus results of the DIAM assessment can areas. A stage is achieved when 70% be used for initiating or updating or more of the requirement is met. an imaging IT strategy. If a strategy In Stages 0–4 the model has already exists, DIAM results will sequential compliance goals, i.e. the be useful to add an external per- organisation must meet the requi- spective, i.e. as a proof of being on rements of the lower stages before the right track or to indicate to the moving to the higher stages. The management board that new inves- early stages (0–4) are concerned tments, workflow improvements or with the planning and implementa- strategic changes are needed. Ano- tion of imaging IT. ther internally valuable benefit is Stages 5–7 are non-hierarchical to use the results for benchmarking and allow for different approaches purposes and to show relevant sta- when making best use of advanced keholders how mature the imaging For organisations who want to software-related features. To reach IT environment is compared to receive more in-depth support, sub- Stage 5, an organisation is required other organisations from the same ject matter experts from HIMSS to achieve at least one of the three region, country or abroad. Analytics and the ESR will be avai- possible options: 1) Advanced ana- If repeated over time, the assess- lable to help organisations with lytics and personalised medicine ment will help an organisation to their imaging IT strategy develop- capabilities, 2) clinical decision monitor progress, e.g. moving from ment or educational matters support and value-based imaging, an inward-looking, volume-driven, related to imaging IT maturity. or 3) advanced health information imaging-silo service to an orga- Experience so far exchange and patient engage- nisation that exchanges relevant The DIAM was officially laun- ment. Stage 6 requires two out of information with other care provi- ched during ECR 2016 and has since the three options to be fulfilled, ders, provides value-based imaging, been piloted with more than 20 while all three must be achieved to engages patients in their care and organisations in countries across reach Stage 7. correlates findings from imaging the globe. How it works exams with other data sources for The feedback so far from parti- The DIAM assessment is a three- the benefit of the patient. cipants is extremely positive. The step process. Externally, i.e. between an indi- assessment form is easy to com- 1. Organisations who participate vidual imaging service and other plete and contains relevant com- must first fill in an online organisations, the results of the pliance goals. The gap report has assessment form, called the DIAM assessment can be used in been used in discussions and nego- DIAM survey. This process can discussions and negotiations with tiations with hospital manage- take up to three hours and should potential suppliers of imaging IT. It ment teams to support strategy be completed by a radiologist can, for example, be used to agree development, focus on key objec- and the CIO or someone with on certain goals (like achieving tives and to prioritise next steps. delegated authority. DIAM Stage 6 within two years) in Some respondents have already 2. Once completed each online discussions and negotiations with requested a second score following DIAM survey undergoes a regional health authorities or other the introduction of a new PACS or Background king opportunity is designed to thorough quality assurance payer organisations. It can also be EMR system. While it is common practice for identify those organisations that assessment. used to receive additional funding At the time of writing, several radiology service providers to make have already made sophisticated 3. The DIAM score is calculated and access to certain imaging plat- organisations had been scored bet- use of radiology information sys- and valuable use of imaging tech- and a gap report is produced. forms, standards, etc. ween DIAM Stages 1 and 5, with the tems and imaging archives such nology in order to highlight them The score is only shared with Public recognition at Stage 6 or 7 average DIAM Score being 3.4. A as PACS, this is just the start of as best practice cases at HIMSS and the organisation who provided will often help organisations attract few organisations are on the edge the journey in an environment of ESR-hosted events. the data. high-calibre staff, assist with rec- of DIAM Stage 6 and are likely to ever-increasing data generation, The DIAM has been developed as For organisations who initially ruitment and retention issues and achieve this standard in 2017. technical innovation, complex data a worldwide model predominantly achieve DIAM Stage 6 or 7, an addi- provide assurance to patients and How to take part exchange and the need to satisfy for use in hospitals with imaging tional validation process is requi- members of the public that the orga- The DIAM is now ready for full multiple stakeholders across the departments or external imaging red. This is because those organi- nisation is compliant with indepen- roll-out and can be fully supported continuum of care. centres that collaborate with hos- sations (with their consent) will dent imaging standards designed by the joint efforts of HIMSS and In order to address the challenges pitals. It can also be used by and be publically recognised. At DIAM to improve patient safety and the the ESR. within digital imaging and the sub- tested with out-patient-oriented Stage 6, subject matter experts from overall quality of clinical care. Stage If you are interested in parti- sequent requirement to improve imaging networks. HIMSS and the ESR seek assurance 6/7 organisations also demonstrate cipating please send an email to patient outcomes, HIMSS Ana- The model is specific to medical that participating organisations are externally that they have a commit- [email protected] and lytics and senior colleagues within imaging and uses over 100 indi- actually able to demonstrate the ment to develop technology in their you will receive access to the online the European Society of Radiology cators from ten different focus collective capabilities described in imaging services and that they view DIAM survey form. The standard have worked together to jointly areas to assess imaging IT matu- the survey. This would normally investment of this kind as a stra- assessment, including DIAM score develop the Digital Imaging Adop- rity. These areas include software be achieved during a phone or web tegic priority. DIAM also enables and gap report, is completely free of tion Model (DIAM). infrastructure, health information conference. For DIAM Stage 7, an different stakeholders within the charge. What is DIAM? exchange, workflow and process onsite visit is required. same organisation, but also across The DIAM supports clinical and security, quality and safety manage- Benefits of DIAM participation different organisations, to use a Jörg Studzinski is director for managerial users of medical ima- ment, patient engagement, (structu- There are a number of benefits common terminology, i.e. to talk Research and Advisory Services at ging technology with their strate- red) clinical documentation, clinical that participating organisations and discuss challenges based on the HIMSS Analytics in Europe. He is gic, operational and procurement decision support, pervasiveness of will realise from a DIAM assess- same framework. responsible for product develop- decisions. The model is designed use, advanced analytics and perso- ment. All participants will receive Last but not least, participating ment, the creation of market to identify potential gaps in inf- nalised medicine. their individual DIAM score, as well organisations will also benefit reports and consulting services rastructure and workflow, moni- The DIAM associates participa- as a report highlighting current from getting access to a network around HIMSS IT Maturity Models, tor technological progress, enable ting organisations with one of eight gaps, future investment opportuni- of peers who have similar challen- such as the Digital Imaging benchmarking with peer organi- stages. Stage 0 indicates a low level ties and metrics for benchmarking. ges and the ability to share smart Adoption Model, the EMR Adoption sations and provide a roadmap for of imaging IT maturity and Stage 7 These insights can be used for solutions for their common issues/ Model, and the Continuity of Care future investment. The benchmar- represents advanced maturity. Each internal and external purposes. challenges. Maturity Model.

myESR.org #ECR2017 24 TECHNOLOGY & RESEARCH ECR TODAY | SATURDAY, MARCH 4, 2017

BY GIUSEPPE GUGLIELMI ESSR 2017: Emergency and trauma

The European Society of Musculoskeletal Radiology (ESSR) is the main organisation in Europe dedicated to promoting the development of musculoskeletal radiology and, consequently, to advancing the knowledge, diagnosis and treatment of musculoskeletal diseases by means of imaging.

the common purpose of promoting physiotherapists and radiographers China’ with the aim of deepening the interests of musculoskeletal with an interest in musculoskeletal understanding and fostering coope- radiology. In particular, the ESSR and sports radiology are invited. ration with our new partners. cooperates with international bodies The main topic of ESSR 2017 Finally, on the last day, the main such as the Australasian Musculos- is emergency & trauma. Howe- topics will be trauma of the spine keletal Imaging Group (AMSIG), the ver, other important themes will and pelvis, sport, spine diagnostics Chinese MSK society and the Rus- be discussed, such as sport ima- and interventional and tumour. sian Radiological Society. ging, osteoporosis, rheumatology, In addition to these, there will be The ESSR coordinates research tumours and interventional proce- two new sessions. The first is ‘Medi- activities, develops educational and dures covered by internationally co-legal and forensic issues’, which multidisciplinary research activi- acclaimed specialists in their res- focuses on bone age assessment by ties and encourages the presenta- pective fields. MRI, spectrum of missed fractures tion of the results of these endea- The scientific programme inclu- in the ER and imaging analysis. The vours at its annual meeting. These des oral presentations, scientific other one is ‘Publish or perish’ in meetings represent the major Euro- and educational poster’s exhibi- which we’ll talk about how to write pean forum for sharing advances tions, lectures, video presentations scientific manuscripts, ethics in in musculoskeletal radiology and and ultrasound demonstrations. publishing, the peer-review process offers excellence in education. The On June 15, there will be the and how to get published. annual meeting is regulated by ultrasound workshop, focused on More information can be found internal guidelines. Every year since the upper and lower limbs. In the at www.essr.org The ESSR Scientific Meeting 2017 will be held in Bari, Italy, 1994, the meetings have taken place afternoon, in addition to lectures from June 15–17. in a different European city. and video presentation, there is Giuseppe Guglielmi, MD is professor The ESSR Scientific Meeting the session ‘Hands-on teaching’. of radiology at the University of The ESSR aims to produce solu- onals who are actively working with 2017 will be held in Bari, Italy, from On June 16, the meeting gets to the Foggia, Italy, head of the depart- tions for current and imminent the specific aim of benefiting their June 15–17. heart of the topic, when we will talk ment of radiology of the Scientific issues by supporting research, as patients. It also works in cooperation The meeting is open to both ESSR about musculoskeletal trauma. Institute Hospital ‘Casa Sollievo well as education and training. with other European radiological members and non-members. Radio- The important features for this della Sofferenza’ in San Giovanni The Society, based in Vienna, relies societies, the European Commission logists, clinicians and members year are the plenary sessions ‘ESSR Rotondo, Italy, and Past President on medical and non-medical professi- and other European authorities with of associated professions such as meets Russia’ and ‘ESSR meets of the ESSR.

HANDS ON HII / CT SATELLITE ULTRASOUND WORKSHOP MARCH 4 LUNCH SYMPOSIUM MARCH 4

10:00 – 16:00 | ROOM 0.14 ENTRANCE LEVEL 12:30 – 13:30 | ROOM F2 ENTRANCE LEVEL

10:00 – 11:00 | HII See more. Earlier. Faster. Lung tumor volumetry Dr. Stefan Niehues (Charité Universitätsmedizin, Berlin, Chair: Germany) Prof. Valerie Vilgrain (Beaujon University Hospital, Paris, France)

11:15 – 12:15 | CT – Cardiology Speakers: Dedicated work ow for CT TAVI planning The expanded toolbox for ultrasound diagnostics Dr. Jim Stirrup (Royal Brompton Hospital, London, United Prof. Thomas Fischer (Charité Universitätsmedizin, Berlin, Kingdom) Germany)

12:30 – 13:30 | CT – Pulmonary Angio 2D shear wave elastography of the liver – correlation with Diagnosis of pulmonary embolism transient elastography Dr. Russell Bull (Royal Bournemouth Hospital, Bournemouth, Dr. Maxime Ronot (Beaujon University Hospital, Paris, France) United Kindom) Ultrasound-guided biopsies and interventions – Intuitive. 13:45 – 14:45 | CT – Cardiology Intelligent. Innovative. Dedicated work ow for CT TAVI planning Dr. Julien Garnon (Strasbourg University Hospitals, Strasbourg, Dr. Jim Stirrup (Royal Brompton Hospital, London, United France) Kingdom)

15:00 – 16:00 | HII 3D Printing Prof. Jean-Paul Vallée (Hôpitaux Universitaires de Genève, Geneva, Switzerland)

Visit our booth #16 (Hall X2) and get your free Cartoon

©ANDREAS FLORIS For a complete overview of our educational program please visit within 2 minutes! www.toshiba-medical.eu/ecr2017 #GYCartoon @toshiba_med #ECR2017

#ECR2017 myESR.org ECR TODAY | SATURDAY, MARCH 4, 2017 COMMUNITY NEWS 25

Accreditation Council in Imaging sets ESR Patient Advisory Group to EuroSafe Imaging Stars: Affidea 26 out to harmonise CME accreditation 28 focus on patient safety and big data 30 Diagnostic Center in Budapest

BY KATHRIN TAUER Editor looks back on seven years of Insights into Imaging ECR Today spoke with Insights into Imaging’s Editor-in-Chief, Professor Robert Hermans from Leuven, about the challenges he has faced in his seven years as head of the ESR’s open access educational journal.

ECR Today: You have been the sions to the journal has increased, think this will impact the journal? that it represents a journal metric editor of Insights into Imaging and in my opinion the overall qua- Do you think this will increase and should not be used to judge the since the journal’s launch in 2010. lity of the submitted manuscripts submissions? quality of individual articles. During this time, have you noticed has also improved. I also noted RH: The impact factor reflects The journal has been under any major developments? more submissions coming from how many times articles published evaluation since 2015, and indeed Robert Hermans: The most outside Europe: Insights into Ima- in a journal over the last two years we will hopefully receive an Impact important development so far was ging is read worldwide. were cited, relative to the number Factor this year. As calculated by the change to an open access jour- ECRT: The Impact Factor (IF) is of articles published in that jour- our publisher, Springer, the theo- nal. This boosted the visibility of still a major force in the publishing nal. Although there is criticism of retical Impact Factor for 2015 was the journal and led to a substantial world, and still very important the actual value of the Impact Fac- nearly 1.5, virtually ranking Insights increase in the number of article to authors. Insights into Imaging tor, it is believed by many to reflect into Imaging in the upper two downloads. Over the years, the is set to receive an Impact Factor, the diffusion and scientific level of thirds of radiological journals. number of spontaneous submis- hopefully this year. How do you a journal. It is important to realise I anticipate, once an IF is acquired, the journal will become even more attractive to authors, and the number of submissions will likely increase significantly. ECRT: Do you have any advice for aspiring authors? What is the best way for them to present their work? Robert Hermans is professor RH: Case reports are a good way of radiology at UZ Leuven, to start scientific writing for young specialising in head and neck radiologists. The ESR has been pub- radiology. He has served as lishing peer-reviewed case reports Editor-in-Chief of Insights for several years on its online plat- into Imaging since 2010. form EURORAD. A more labour-intensive alternative is to write a review article. Such ECRT: This year will be your last a review article should provide a syn- as editor of Insights into Imaging. thesis of the best published research How do you feel about leaving this on an important topic or question. position? Do you feel relieved or It may, for example, discuss the use will you miss it? of imaging in a specific pathological RH: I am still very grateful for condition. Insights into Imaging is the opportunity I got from the the ideal platform for such articles. ESR to help start up this journal. An article on original research I am confident it will continue should be structured according to to grow and settle among the the acronym ‘IMRaD’, which stands important journals in the field of for Introduction, Material and radiology. The time has come for methods, Results and Discussion; a new editor-in-chief, bringing in each of these sections has specific new ideas to further nourish our content. A common problem obser- journal. During the past seven ved in manuscripts from novice years, I have got to know many authors is mixing up the different enthusiastic colleagues, whom I sections. Incomplete information is otherwise would never have met. I also a common problem. will certainly miss the regular and When preparing a manuscript for friendly contacts with the crew in submission, it is important that the the Vienna Editorial Office, all of guidelines for authors are followed, them very devoted to their work, so that the manuscript is format- and always ready to help and ted in the correct way. It is equally solve problems. important to also read the additio- ECRT: What are your plans for nal important documents that have the future? to be signed, such as the copyright RH: As a head and neck radiolo- transfer agreement and the disclo- gist, most of my time goes toward sure of conflict of interests. caring for patients, training our Also, I would like to stress that residents and teaching medi- citation rules should be rigorously cal students. Implementing new followed. Ask permission from the techniques, and trying to develop copyright holder to use images or new approaches in head and neck text passages that have already imaging, together with the team in been published elsewhere; provide Leuven, will continue to be part of evidence that permission was gran- my job. Obviously, I will stay availa- ted; and include proper references ble for the ESR, to help foster educa- in your manuscript. Material freely tion and science in radiology. distributed in the public domain (e.g. from websites) is also often protected by copyright and cannot be used without prior permission. myESR.org #ECR2017 26 COMMUNITY NEWS ECR TODAY | SATURDAY, MARCH 4, 2017

BY VIOLETA IRANZO AND MÒNICA GIL Accreditation Council in Imaging sets out to harmonise CME accreditation The Accreditation Council in Imaging (ACI), operating under the umbrella of the European Board of Radiology (EBR), was launched successfully in January 2016, in cooperation with the European Union of Medical Specialists (UEMS), its Accreditation Council (EACCME®) and its Radiology Section. Thanks to this fruitful collaboration, more than 125 events in radiology have been accredited during the first year.

committees there are UEMS repre- recognise all kinds of educational sation of continuing medical educa- Through EACCME®, the UEMS sentatives and we work in close activities and to contribute to the tion (CME). This was to be achieved has also significantly contribu- cooperation with the UEMS Radio- standardisation and homogenisa- through the international accredita- ted to the harmonisation of CME/ logy Section. The specialist review tion of CME in Europe for our pati- tion of CME events, and the establis- CPD activities in Europe, building is carried out by the ACI Reviewing ents’ safety and quality of care. hment of a system for the internatio- a bridge between European and Committee and the administra- nal acceptance of CME points. overseas colleagues by giving access tive part is done by the EACCME®. The UEMS-EACCME® sets its- to international CME and, at the Review of applications by the ACI elf as the central link between the same time, safeguarded the role of is done using the UEMS EACCME® National Accreditation Authorities national authorities. Harmonisa- criteria. The ACI already offers a (NAAs), the UEMS Specialist Sec- tion of procedures and fees is ano- larger number of specialist revie- tions and Boards (S&Bs), the Euro- ther important key aspect that has wers as well as a larger number of pean Specialty Accreditation Boards recently been discussed in Amster- administrative staff, which adds (ESABs) and the Providers of CME dam, at the 3rd UEMS Conference Prof. Dragoş Negru is Professor quality to the process and will lead activities. The UEMS-EACCME® on CME-CPD, on November 12. of Radiology at the Faculty of to the whole process being faster has mutual recognition agreements The European Board of Radio- Medicine at the University in the future. Can we enhance our with the American Medical Associ- logy (EBR) and the UEMS have been of Medicine and Pharmacy work with the EACCME®? The ans- ation (AMA) for live events and e-le- cooperating since 2015 to organise Gr. T. Popa Iasi, Romania, and wer is yes, by providing even more arning materials and with the Royal the accreditation of international Chairman of the Department feedback and know-how from spe- Dr. Paolo Ricci is Associate College of Physicians and Surgeons live educational events (LEEs) and of Radiology at the University cialists in the radiology field. Professor of Radiology at the of Canada for live events only. e-learning materials (ELM) in ima- Hospital Sf. Spiridon Iasi. He is ECRT: Does the larger number of Department of Radiological Among the ESABs the ACI (Accre- ging. The specialist body of the EBR, the current Scientific Director reviewers and staff taking care of Sciences, University of Rome ‘La ditation Council in Imaging) is a which is carrying out the procedure of the Accreditation Council the accreditation process in ima- Sapienza’, Policlinico Umberto specialty accreditation board, esta- of the accreditation in collaboration on Imaging. ging benefit the control of quality? I, Rome. He is President of the blished through a cooperation bet- with the EACCME®, is the Accredit- Dragoş Negru: Yes, accreditation UEMS Section of Radiology ween the European Board of Radio- ation Council in Imaging. The ACI ECR Today spoke with the ACI guarantees high quality and unbia- and member of the ACI Policy logy (EBR) and the UEMS Section is operating under the umbrella of leadership to learn more about this sed educational events. I am extre- Committee. of Radiology, which is working for the European Board of Radiology initiative. Our first interview part- mely grateful to our staff and our CME in Radiology, according to the (EBR). Within the framework of this ner was Prof. Dragoş Negru, ACI reviewers for their dedication, pas- Next, ECR Today spoke with Prof. EACCME® guidelines. collaboration, during the Content Scientific Director. sion and knowledge. Paolo Ricci from Rome, President ECRT: Are CME and CPD moral and Review Process of Application, the ECR Today: What is the connec- ECRT: In the past, you have clai- of the UEMS Section Radiology and ethical obligations for all doctors? EBR will assume the role of revie- tion between the EBR/ACI and the med credits as a radiologist. What member of the ACI Policy Committee. Paolo Ricci: In the Basel Decla- wing all contents and documents UEMS/EACCME® and what is the is your view of accreditation in ECRT: Is CME practiced widely ration of 2001, CME and CPD them- provided by the applicant, through EBR/ACI’s role in the cooperation? general now, as Scientific Director in Europe and what is the current selves have been defined as moral its specialist body and the EAC- Dragoş Negru: On March 7, 2015, of the ACI? CME status in Europe? and ethical obligations for doctors, CME® will ensure that the applica- Prof. Lorenzo Bonomo, President of Dragoş Negru: Within the next Paolo Ricci: CME is now widely as they help to maintain the level tion is duly reviewed by the Natio- the European Board of Radiology few years, CME will become increa- practiced in Europe and, in most EU of academic training and raise nal Accreditation Authority (NAA) (EBR) Shareholders’ Board for the singly sought after in Europe and Member States it has even become personal quality factors, including of the country in which the LEE term 2014–2015, and Prof. Romuald on a global scale. In addition, educa- mandatory (e.g. in Italy and Ger- respect for patients and colleagues, will be held, or the e-learning mate- Krajewski, President of the Euro- tion and the way it is provided will many up to 50 CME credits should integrity and thirst for excellence. rial used, for national approval. pean Union of Medical Specialists develop in the direction of world- be collected annually). National or In the Declaration, doctors are seen ECRT: After the implementation (UEMS) signed an agreement to wide collaboration and harmonisa- regional chambers of physicians as life-long learners wishing to res- of the revised application criteria cooperate in the accreditation tion. The EBR/ACI wants to be part are usually responsible for issuing pond to the legitimate interests of (EACCME 2.0) what are the main of international live educational of that process by putting itself at CME ID cards, which hold individu- different groups of stakeholders changes that should be highlighted? events and accreditation of e-lear- the forefront of a new era of CME; a als’ records of electronic credits and (society, patients, and healthcare Paolo Ricci: With EACCME 2.0, ning material in imaging. The EBR development which will ultimately final certifications. Some work still funding institutions) in ensuring the entire application, review and carries out the accreditation proce- benefit all patients. needs to be done in terms of har- that the highest standards of medi- accreditation process has been dure via the Accreditation Council ECRT: After the implementation monisation, reciprocity and mutual cal care are achieved. made more flexible and efficient, in Imaging (ACI). of EACCME 2.0, the revised EAC- recognition of CME credits. Furthermore, article 27 of the Prin- in particular through the introduc- The ACI is a one-step guide to CME criteria for accreditation, In the EMOs’ consensus statem- ciples of European medical ethics, tion of a fast lane for ‘trusted pro- CME accreditation, which supports what are the new challenges for ent (Luxembourg 2015), the main adopted in 1987, states that “within viders’ whose quality level has been the European Accreditation Coun- accreditation in the imaging field? European medical organisations the limits of their skills and the pos- assured. A brand-new IT platform cil for Continuing Medical Educa- Dragoş Negru: I am confident confirmed how important CME sibilities available, [doctors] must par- has been designed to better support tion (EACCME®) in delivering and that the new challenges for accre- should be on the EU Health Agenda ticipate in the continuous progress the application process and assist harmonising the highest level of ditation in imaging are to continue in order to cope with the pressing of healthcare quality through rese- users and providers remotely. CME in imaging. The ACI’s purpose working on the assurance of qua- needs of our continent: health sys- arch and continuous improvement Concerning the recognition of is to make managing CME quick lity of CME/CPD in Europe, to cover tems should become more inter- in order to offer patients care that CME activities beyond live events, and easy for all applicants and to and adapt ourselves to all forms of connected and interdependent, complies with scientific data”. new innovative contents will be work together with providers to e-learning materials and to recog- free movement of patients and ECRT: What are the benefits of reviewed, such as e-learning modu- offer imaging specialists the cont- nise the work of all professionals professionals should be assured, the UEMS-EBR collaboration for les, educational e-platforms, educati- inuing medical education they are involved in a specialty examination and the new issues raised by an the radiological community? onal apps and educational e-libraries. seeking so they may offer the care (e.g. the EDIR examination). The ageing European population must Paolo Ricci: This joint collabora- Also the recognition of CME-CPD patients need. same applies for the ‘learning by be addressed. tion could be considered particu- activities will be provided by EAC- ECRT: How does the collabora- teaching’ approach, which could The European Union of Medical larly fruitful for what may concern CME 2.0, including publications in tion between the EBR and UEMS also be granted in the future for Specialists (UEMS) established the both live and distance learning journals, reviewing of papers, par- benefit accreditation in the ima- professionals giving ESOR courses, European Accreditation Council for education. It may help to shape a ticipation in UEMS-recognised exa- ging field? for example. Continuing Medical Education (EAC- new class of medical doctors where minations (like EDiR) and learning Dragoş Negru: ACI has two com- We also have a clear aspiration to CME®) in January 2000, with the aim the importance of professional by teaching activities. Finally, EAC- mittees: the Reviewing Committee speed up the accreditation process of encouraging high standards in the development merges with quality CME 2.0 will embrace a much broa- and the Policy Committee. In both in order to shorten deadlines, to development, delivery and harmoni- and innovation in health services. der spectrum of healthcare profes-

#ECR2017 myESR.org ECR TODAY | SATURDAY, MARCH 4, 2017 COMMUNITY NEWS 27

sionals other than doctors, such as many new and constructive appro- EACCME®, ensures that there is no pharmacists, nurses and midwives. aches were presented, such as the commercial influence or bias in the This is already a reality, at least revised criteria for the accreditation events accredited, as independence to some extent, in basic medical of live events as well as new forms of the events or e-learning mate- education and in specialist training. of CME-CPD: the EACCME 2.0. rials is essential for achieving the ECRT: E-learning materials are The ACI Policy and Reviewing necessary quality in education. a growing educational tool. Are committees, in coordination with Many important developments the future challenges in radiology the EACCME®, work together to that come with the implementa- education covered? ensure a smooth implementation tion of the EACCME 2.0 are being Paolo Ricci: To provide high-qua- of the revised and new criteria. The applied. The review process has lity e-learning strategies has been accreditation process presents some been reduced to 12–14 weeks and one of the major goals of the latest developments that allow a faster will hopefully be even further European CME Forum and of the and more efficient review process, reduced in the future, provided that 3rd UEMS Conference on CME/CPD preserving the quality of the accre- the quality control can be ensured. in Amsterdam. Although e-learning dited events and materials. Some of Furthermore, as underlined by Prof. already started in 2009, we now the most remarkable development Lucic, the enhancement of the ‘trus- particularly envisage people see- for that end is the enhancement ted provider’ status will benefit fre- king out medical education online of the ‘trusted provider’ concept, quent providers without affecting to stay up to date on latest practice which enables a fast lane for fre- Prof. Christian Loewe is the quality of the events accredited. improvement guidelines. Among Prof. Milos A. Lucic is quent providers. In addition, other Chairman of the Department Additionally, the accreditation for the elements of effective education Professor of Radiology and forms of accreditation are conside- of Cardiovascular and e-learning materials, as a growing we need to assess, there is certainly Neuroradiology at the Faculty red, such as the accreditation of e-li- Interventional Radiology, educational tool, has been revised space for interactive, practical of Medicine, University of Novi braries or apps and the recognition Department of Bioimaging and and enhanced to cover the needs of and needs-based online materials, Sad, working at Diagnostic of CME-CPD activities such as the Image-Guided Therapy at the a constantly changing and growing which could be more attractive for Imaging Center, Oncology publishing of scientific and educati- Medical University of Vienna. form of education provision. Our the younger generation. Institute of Vojvodina, Sremska onal material, among others. He is Chairman of the ACI duty as expert reviewers is also to In the future, we will probably Kamenica, Serbia. He is the The ACI Policy committee is com- Reviewing Committee, of the identify these needs and changes to progress from a CME improving current Chair of the ACI posed of five members who work to Educational Committee of meet demand in future reviews of what you know scheme to a CPD Policy Committee. implement policies, define strate- the European Society of the EACCME® criteria. apply your knowledge programme. gies and develop new procedures, Cardiovascular Radiology The role of the ACI and the that the highest level of CME accre- among other tasks, and will cont- (ESCR) and of the European EACCME® as experts in assessing Prof. Milos Lucic, chairperson of the ditation available today is delivered. inue doing so in order to stream- Board in Cardiovascular events is important for achie- ACI Policy Committee explains some The committees of the ACI, which line and enhance the accreditation Radiology (EBCR). ving standardisation in radiology of the main developments achieved are composed of members of the process and ensure the quality nee- education. The CME-CPD system during the first year of the Accredita- EBR and the UEMS, maximise syn- ded to harmonise educational stan- same is done in parallel by the Nati- in Europe is heterogeneous for tion Council in Imaging (ACI). ergies in order to provide an added dards in radiology in Europe. onal Accreditation Authority (NAA) various reasons. In some European Milos Lucic: The ACI was esta- value in the accreditation of ima- of the country hosting the event. countries CME is mandatory, in blished under the umbrella of the ging events. The combination of Prof. Christian Loewe, chairper- Finally, the credits proposed by both other countries CME is not subject European Board of Radiology (EBR) resources of both organisations son of the ACI Reviewing Commit- are validated and awarded by the to regulations. In some countries, to collaborate with the accreditation benefits providers, as additional tee, explains the work methodology EACCME®, which works closely with CME is managed at a regional level, council of the UEMS, the European support is offered, which ultimately of the committee and the EACCME® the ACI Reviewing Committee. in others at a national level. Reco- Accreditation Council for Continu- benefits event attendees. and the future challenges that The work of the committee is gnition of EACCME® at European ing Medical Education (EACCME®). With the purpose of continuing accreditation in imaging is facing. of utmost importance in order to level is a fundamental element for During its first year live, the ACI, to improve the service provided Christian Loewe: The ACI Revie- ensure and preserve the quality of the homogenisation and standardi- launched in January 2016, has recei- to applicants and contributing to wing Committee is composed of six the events. The specialist reviewers sation of radiology education. The ved more than 170 applications for the quality assurance needed, the members and is in charge of per- ensure that the criteria for each role of the EBR/ACI is to constantly the accreditation of live events. UEMS held the 3rd Conference on forming the specialist review and event or e-learning material are work to achieve such development The Accreditation Council in CME-CPD on November 12, 2016 in assessment of each application. The fulfilled as well as the quality and in order to build a robust basis to Imaging aims to ensure, through Amsterdam. The ACI actively par- ACI reviewers recommend a num- adequacy of its content. Moreover, that end and to provide a good ser- an accurate accreditation process, ticipated at the conference where ber of credits (ECMECs), and the the committee, together with the vice to the educational providers. 28 COMMUNITY NEWS ECR TODAY | SATURDAY, MARCH 4, 2017

BY NICOLA BEDLINGTON, BARRY KELLY, PETER MILDENBERGER ESR Patient Advisory Group to focus on patient safety and big data The ESR Patient Advisory Group (ESR-PAG) is holding two sessions dedicated to patient safety issues during this year’s ECR. One of ESR-PAG’s core goals is improving communication between patients and the healthcare professionals working in radiology departments. The ESR-PAG has therefore developed a patient satisfaction questionnaire to enable radiology departments to ask their patients for feedback on services, waiting time, experiences and feelings, as well as the information provided before and afterwards.

Today, a session related to the onals, we tend to think of this as generate a lot of different data, Improved data management Nicola Bedlington is secretary patient satisfaction questionnaire equipment and process-driven. which require more sophisticated will also allow optimised quality general of the European Patients’ will take place: ‘Improving pati- Whilst this is, of course, an import- work-up than conventional x-ray or management, e.g. for benchmar- Forum, co-founder of the Patient ent safety and quality of care in ant component, audit can and CT imaging. Therefore, for research king in radiation protection or Access Partnership, and clinical radiology’ (see article on should also be used to measure our or analysis, multi-site collaboration image quality. Therefore, it is worth chairperson of the ESR Patient page 14). The focus of this joint interaction with each other and will very often be necessary. For engaging in this domain. However, Advisory Group. session is on exploring the inter- with our patients. By doing this, we individual treatment, patients will the patient’s point of view also has Prof. Barry Kelly is chairperson section of the ESR Audit & Stan- can ensure that a patient-centred try to find a second opinion outside to be considered and will thus be of the ESR Audit and Standards dards Subcommittee and the ESR approach leads to a safe, professio- their primary care-centre, seeking presented in the session. Subcommittee and an examiner Patient Advisory Group regarding nal and harmonious institution. experts throughout their country Background in the EDiR. our common purpose: considering The session will conclude with a or even on international level. The ESR Patient Advisory Group Prof. Peter Mildenberger is chair- a patient’s journey through our panel discussion and an exchange The EU directive on cross-bor- (ESR-PAG), launched in 2013, consists person of the ESR Subcommittee departments. Many of us as doc- of views with the audience on the der healthcare and the new regu- of representatives of pan-European on Professional Issues and tors suddenly become aware when key question: ‘Does your depart- lation on data protection support patient organisations, the European Economics in Radiology (PIER) we are patients, that the once ment perform well in patient-cent- such applications. Several countries Federation of Radiographers Socie- and user co-chair of IHE-Europe. familiar territory of our hospitals red care?’ already have regional or national ties (EFRS) and ESR experts. The can suddenly seem forbidding, Also today, the second ESR-PAG eHealth strategies, which help to aim of the group is to bring together stressful, officious or even unca- session chaired by Dr. Nicola Bed- communicate information between patients, the public and imaging ring. If this is how it can seem to lington together with Prof. Boris different care providers or patients professionals to positively influence professionals who find themsel- Brkljačić, chair of the ESR Commu- themselves. One internationally advances in the field of medical ima- ves on the other side of the white nications and External Affairs Com- accepted way of standardised com- ging and to foster a patient-centred coats, how much more profound mittee, will be held:‘Big data – data munication in healthcare is the approach in the work of ESR. and intimidating must it be for management, standardisation, application of IHE profiles. Many of our fellow citizens who have no access and protection: the way these profiles are already recommen- ESR Patient Advisory Group Session experience of such technological, forward in developing personali- ded for procurement by the Euro- sterile and busy environments? sed/precision medicine’. pean Commission. Building such Saturday, March 4, 16:00–17:30, Room L 8 So, this session looks at three This is a follow-up session from networks could enable access for ESR-PAG 2 Big data – data management, standardisation, tools that are designed to promote ECR 2016, as the ESR’s collabora- patients to experts, or pseudonomi- access and protection: the way forward in developing a patient-centred, compassionate, tion with patient groups on Euro- sed/anonymised imaging data could personalised/precision medicine comprehensible and personal expe- pean political topics is one of the be used to feed national or interna- rience for those patients under our key objectives of the ESR-PAG. The tional registers for benchmarking »»Chairmen’s introduction care. These are audit, a driver dia- session will focus on the current quality parameters, e.g. for radiation N. Bedlington; Vienna/AT gram and the patient satisfaction developments in Europe and the exposure optimisation. B. Brkljačić; Zagreb/HR questionnaire. The third is exactly US, as development in imaging stra- Some more work has to be orga- »»European developments within data management, that, and is impressively power- tegies is clearly providing new and nised to build such registers and to standardisation, access and protection ful at implementing change. The exciting opportunities in functional have consensus on coding systems P. Mildenberger; Mainz/DE second, a driver diagram is used to or molecular imaging, image proces- to be used in such environments. »»Patients’ point of view conceptualise an issue and to deter- sing, for example, and many others. Actually, coding is very inhomoge- N. Bedlington; Vienna/AT mine its system components, thus The terms ‘artificial intelligence’ neous across Europe today. Impro- E. Briers; Hasselt/BE creating a pathway to achieve the or ‘deep-learning’ are of strong inte- vement in these fields is relevant to goal of patient-centred care. rest in radiological research, because reaching interoperability beyond »»Current US status pros and cons and issues Audit measures something it seems that such image processing a technical level and to enable J.A. Brink; Boston, MA/US against an agreed standard. As can support image interpretation interoperability of data (semantic »»Panel discussion: Importance of data management in modern radiological healthcare professi- in many cases. These techniques interoperability). medicine – what are the main issues to be addressed? ESMRMB proves its commitment to education

“Nothing to add, absolutely days. These courses have an inter- ning on scanners and workstations, 19 to 21, 2017. There is still time to excellent!” What could be nicer active character with 50% of the with a maximum of 30 participants contribute to the congress by sub- than such positive feedback? total teaching time used for repeti- per course. mitting your abstract. Join other Over the last 15 years, quality tion and case discussions in small Lectures on MR clinicians, physicists, engineers, bio- and expertise have proven to groups. 65 participants are the MR physicists and other basic or chemists and radiographers from be the guarantor of a highly maximum per course. clinical scientists are warmly wel- around the world for the premier satisfied audience. The European Learn wherever you are: after its come to seven courses in 2017, with meeting in the MR global commu- Society for Magnetic Resonance in successful introduction in 2016, our a duration of 2 – 2.5 days. 40% of the nity in mid-October in the beautiful Medicine and Biology (ESMRMB) is eLearning course on Basic MR Phy- total teaching time will be used for city of Barcelona. Submit your abs- very proud to offer highly regarded sics will again be held in 2017. repetition, exercises, and practical tract by May 18, 2017! education for professionals wor- Hands-On MRI demonstrations. The maximum is Find out more at www.esmrmb. king in the field of MR. We would like to inform MR 50 participants per course. org and join us on Facebook and School of MRI radiographers, technologists and ESMRMB Annual Scientific Mee- Twitter! The 34th Annual Scientific Mee- Physicians and MR radiogra- interested physicians that three ting 2017 ting of the ESMRMB will take phers/technologists are cordially courses are planned for 2017, with a The 34th Annual Scientific Mee- place in Barcelona, Spain, from invited to 11 advanced clinical cour- duration of 2.5 days each. They offer ting of the ESMRMB will take place October 19 to 21, 2017. ses with a course duration of 2 – 2.5 50% vendor specific hands-on trai- in Barcelona, Spain, from October

#ECR2017 myESR.org ECR TODAY | SATURDAY, MARCH 4, 2017 COMMUNITY NEWS 29

BY ANDRZEJ URBANIK, ROBERT CHRZAN Polish Society promotes education of medical students in imaging Undergraduate radiological education is becoming one of the priorities of the European Society of Radiology. The Polish Medical Society of Radiology is also involved in similar pursuits, and we would like to use this opportunity and share some of our experiences.

of lectures, but also, or indeed most central server and client computers, it is possible to present diagnostic importantly, by means of practi- and perform the following functions: images related to rare diseases for cal classes. In its optimal version, 1. Loading anonymised imaging example. the programme involves arranging data from the server and viewing Both the client computers and separate ultrasound rooms desi- them on client computers. Sets of the server are managed by Windows gned only for students, and equip- cases for study are selected and 7 Professional 64-bit. The client ped with simple ultrasonography arranged in groups to match the computers have full HD 1920x1080 equipment (two probes, Doppler topic of classes. monitors, and the station used by function). The training is conducted Assessment of the images is per- the instructor is additionally equip- in groups of two to four students, formed in a way which is as close ped with an option to display large who examine each other under as possible to typical radiological images by means of a digital projec- supervision of a doctor. At this ele- assessment based on PACS, so avai- tor installed in the laboratory. mentary stage students acquire the lable options include change of A modular structure allows for skills to operate an ultrasound unit window (grayscale), enlargement, expanding the system by including and perform ultrasound examina- linear measurements, surface areas, new functionalities, as the need tions to improve their knowledge shading rate, etc. rather than only arises. RAID 1 is used to ensure the of the normal appearance of spe- an analysis of static bitmap image security of data stored in the server, cific organs and structures of the carried out during traditional clas- and a BlueRay drive is available for body. Of great help for this pur- ses. This ensures significantly better periodical archiving. Such laborato- Front facade of Collegium Novum, one of the oldest academic pose are video materials used as training for performing assessment ries are gradually opening in more buildings of the Jagiellonian University in Krakow, Poland. teaching aids to show examination of diagnostic images in daily clinical and more medical universities. techniques and interpretation of practice. Transmission is carried out According to the Polish Medical The earliest documents about with the use of methods available images. Such ultrasound rooms at with the use of a DICOM protocol. Society of Radiology, implementation classes in radiology for medical at that time. This is also true today this point operate at some Polish 2. Loading Power Point presen- of these two programmes will signifi- students at the Jagiellonian Uni- when medical students in Poland schools of medicine. The next stage tations and Adobe Reader docu- cantly improve the quality of educa- versity in Krakow date from 1897. are trained at 16 universities of involves examinations with the ments and viewing them on client tion provided to medical students in The first Polish textbook on radio- medicine. use of simulators. As a result of a computers. The presentations and the field of diagnostic imaging. logy was published in 1900, in Kra- Given the progress in diagnostic nationwide programme designed documents are related to the topic kow as well, and the first radiology imaging, methods of teaching radio- to equip schools of medicine with currently discussed in class and can Prof. Andrzej Urbanik is head of department providing systematic logy to students must be based on simulators, this option will soon be be viewed simultaneously with or the radiology department at education to students opened in tools equivalent to those used in cli- available in all locations providing independently from the instructor. Krakow University Hospital and 1921 in Poznań. Later, other newly nical practice. To this end the Polish education to medical students. Transmission is carried out with President of the Polish Medical established faculties of medicine Medical Society of Radiology focu- The second programme involves the use of an SMB protocol. Society of Radiology. opened radiology departments. The ses on two basic schemes. Its main launching computer radiology labo- 3. Viewing radiology-related web- Dr. Robert Chrzan is assistant courses which they provided to uni- endeavour is designed to promote ratories for students. sites (Radiopedia, AuntMinnie, etc.) professor at the radiology versity students presented the cur- the knowledge of ultrasonography Such laboratories are made up of on client computers, depending on department at Krakow University rent state of radiological knowledge among students, not only by means a local area network consisting of a the topic of the classes. This way Hospital.

BY MICHELLE WEISS, CIRSE OFFICE The EBIR examination: certifying expertise in interventional radiology

In order to provide interventional the clinical skillset and knowledge layered structure made up of con- and the EBIR provides doctors with riculum. Through this collabora- radiologists with the opportunity of candidates through an oral and tributors, examiners and council proof of their specialist skills. Cur- tion, the EBIR has seen significant to demonstrate the competency written component, thus providing members not only distributes the rently, the EBIR acts as a supple- growth in the last six years, with and knowledge they have attained the chance for them to demonstrate task of creating comprehensive ment to the national certification three examinations taking place in their studies, training and work, their expertise in IR and to establish questions, but also ensures quality in many countries, but work has each year and nearly 500 interven- the Cardiovascular and Interventi- themselves in their practice. questions across the broad range already begun to make the EBIR the tional radiologists now holding the onal Radiological Society of Europe Examination material is provided of interventional radiology themes. official IR examination in certain certification and many more expec- (CIRSE) developed the European by dedicated interventional radio- Over 100 interventional radiologists European countries, meaning that ted in the near future. Board of Interventional Radiology logists through a sophisticated sys- have participated as contributors passing the EBIR would be a requi- By certifying the knowledge (EBIR) examination in 2010. The tem of examiner acquisition: the thus far, and their invaluable input rement before beginning a career of interventional radiologists in EBIR is designed to serve as a certi- EBIR Contributors’ Pathway. The makes the examination possible. in IR. Besides impacting the orga- Europe and around the world, the fication of competence in interven- Contributors’ Pathway reinforces The drive for creating the Euro- nisation of training programmes EBIR has become a well-establis- tional radiology (IR) with the addi- the EBIR’s quality and robust struc- pean IR Syllabus and Curriculum, in European countries, the EBIR hed and powerful tool, which will tional aim of eventually acting as ture by ensuring those specialists from which the EBIR examination has also started to expand across strengthen the field of IR. With an entrance exam for younger, ful- who have already taken and pas- is built on, came from a desire to the globe, with its adoption by the continued collaboration between ly-trained and licensed radiologists sed the EBIR examination attend produce an international accredit- Interventional Radiology Society CIRSE, the ESR, the UEMS Radio- to demonstrate that they have acqui- training workshops to learn how ation that could verify the exper- of Australasia (IRSA). As even more logy Section and IR Division, as red suitable IR knowledge to start to create written or oral exami- tise of interventional radiologists societies collaborate in this endea- well as the national IR societies, their career in this specialist field. nation questions. Through active from any nation, despite differen- vour, the EBIR is gaining momen- this professional examination will Built on the pillars of scientifi- involvement, the Contributors’ ces which exist in the training pro- tum and can only grow stronger. be able to ensure excellence while cally proven assessment techniques, Pathway also offers the chance for grammes between countries. The CIRSE gratefully acknowledges positively promoting and strengt- high-quality material and a dedica- EBIR certificate holders to train to EBIR also sought to fill a gap which endorsement of the EBIR by the hening the subspecialty of inter- ted steering committee, this exami- become examiners. Upon invita- desperately needed to be filled. European Society of Radiology ventional radiology. nation has been run successfully tion, this can then lead to a position Several European countries did not (ESR) and contributes to the IR For more information please go for the last six years. The EBIR tests on the Examination Council. This have a national certification for IR, chapters of the ESR Training Cur- to www.cirse.org/ebir myESR.org #ECR2017 30 COMMUNITY NEWS ECR TODAY | SATURDAY, MARCH 4, 2017 EuroSafe Imaging Stars: Affidea Diagnostic Center in Budapest 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.

international collaboration, we have granularity in the way the data are unified our practice together with presented. centres across 12 countries, and so ECRT: What are your sugge- are in an excellent position to both stions for improving the EuroSafe optimise our practice and dose Imaging Stars initiative? levels and undertake collaborative EP: The EuroSafe Imaging Stars research in this field. The EuroSafe initiative is an excellent project, and Imaging Stars initiative is a fan- taking part is both a privilege and a tastic way for those centres enga- pleasure. Interviews such as this are ging in CT dose optimisation to be a very important way to increase recognised by their peers and also the exposure of the wider radiologi- to demonstrate to patients that we cal community to this project. The take exposure to radiation seriously more the initiative can be promoted by embedding a culture of dose through the official channels of the awareness into everything we do. ESR the better. these together, the faster we can ECRT: One important contribu- ECRT: Which future cooperation reach meaningful answers. The team of the Affidea Diagnostic Center within the Péterfy tion EuroSafe Imaging Stars are and activities within the network ECRT: Would you recommend Hospital and Trauma Center in Budapest was proud to receive expected to make is to participate of Stars would you like to see? other facilities to become Euro- the EuroSafe Imaging Stars certificate. in the data collection initiatives EP: International cooperation Safe Imaging Stars? If so, what through the ‘Is your Imaging Euro- is tremendously important. We arguments would you use to con- One of the EuroSafe Imaging Please read below an interview Safe?’ surveys on CT dose. What is are fortunate enough to be part of vince them? Stars institutions is the Affidea with Dr. Eva Papp, chief radiologist your opinion on these surveys and a dose optimisation project that EP: We would definitely recom- Diagnostic Center within the at the Affidea Diagnostic Center, how useful do you think the Euro- includes 67 centres, and it is clear mend other facilities to become Euro- Péterfy Hospital and Trauma Cen- which is a five-star facility. Safe Imaging survey findings will that by comparing the way we all Safe Imaging Stars! It is a challen- ter, which is the biggest public-pri- ECR Today: Your radiology be for your daily clinical activity? operate allows development of ging process to obtain the necessary vate partnership in Budapest, department joined the EuroSafe EP: Data collection is the neces- best practice. There are many areas evidence to support the application, Hungary. The centre has two CT Imaging Stars network. Why sary first step to benchmarking a around dose optimisation that but it highlights strengths and weak- scanners and performs more than did you apply and what are your department’s own practice against require further work – for instance nesses that are key drivers for service 40, 000 examinations annually. thoughts on this initiative? a group of peers. Such surveys are the integration of clinical decision improvement. It allows everyone to Affidea has operated in Hungary Eva Papp: We joined the EuroSafe vital, but they can only provide a support and the correct method of come together to focus on quality. for 25 years and currently directly Imaging Stars initiative, as we are snapshot view of clinical practice. image quality analysis. These are The final result is a huge badge of employs around 10% of the Hunga- part of the Affidea Dose Excellence How useful the findings are is questions that we are looking into, honour, and one that patients can rian radiology workforce. Programme (DEP). Through this dependent upon the amount of and the more sites that work on recognise as being important to them.

BY HENRIETTÆ STÅHLBRANDT Swedish Society to improve standards for protocols and reports

it gives us an opportunity to gain and we hope our efforts will be of bers in our work. Our quarterly insight into our current situation of national value. members’ journal is well appreci- insufficient levels of equipment and The Swedish Society of Radio- ated, as is our website, but these personnel. We could now obtain logy also facilitates the spread of ways of communication do not the means to drastically improve knowledge by endorsing the Swe- sufficiently promote dialogue with our response time from referral to dish iGuide pilots, as well as suppor- our members. In 2017, we will pay examination to finished evaluation, ting a newly founded Quality Regis- more attention to creating a more but perhaps with the risk of increa- ter in Interventional Radiology. We diverse communications plat- sing waiting times in radiology for are also discussing an update to the form, possibly embracing Twitter, patients not included in the pre-de- Swedish radiology textbook and Facebook and a radiology Wiki fined cancer pathways. Imaging creating a Swedish radiology Wiki to further support and facilitate diagnostics are an important step website. We continue to give cour- seamless interaction with our in most of the cancer pathways, and ses in radiology, which are appre- members, as well as the public. thus we are struggling to adequa- ciated throughout the country, as However, we continue to make tely meet the demands. The cancer well as organise the annual nati- sure that the different regions in pathways are specifically designed onal radiology meeting, including Sweden and the different levels of not to take current lack of resour- the European Diploma in Radiology healthcare are represented on the The new board of the Swedish Society of Radiology met in Gränna, ces into consideration, and are not (EDiR) examination, and to award board of our Society, and we know Sweden, in January 2017. always designed with the latest research stipends each year. from local discussions that the knowledge in mind. The Swedish We are proud to announce that in Society is highly thought of and The Swedish Society of Radio- A current issue includes easing Society of Radiology works to facili- December 2016 we received appro- appreciated. As always, we continue logy continues to be the main the implementation of the Standar- tate the introduction of the Cancer val of our first subspecialty certifi- our work with enthusiasm! society for radiologists in Sweden, dised Cancer Pathways Directive, Pathways Directive to the nation’s cation in interventional radiology. representing a vast majority of as directed by the Swedish govern- radiology departments by offering Sweden previously had only one Prof. Henriettæ Ståhlbrandt is Swedish radiologists. The Society ment. The Directive aims to shorten standardised recommendations of other official subspecialty (neurora- assistant head of the department handles matters of significance to the timeframe from when clinical protocols, standardised reporting diology). This certification follows of radiology in Jönköping County, Swedish radiology, aiming to faci- suspicion of cancer arises to confir- structure and other forms of sup- our determination to offer more Sweden, and President of the litate, develop and improve the mation or exclusion of cancer. The port. The Swedish Society of Gast- official subspecialties. Swedish Society of Radiology. field of Swedish radiology through Directive offers certain benefits for rointestinal and Abdominal Radio- Challenges include finding ways knowledge and research. the Swedish diagnostic system as logy has taken the lead in this field, to inform and involve our mem-

#ECR2017 myESR.org Special Exhibition: The Klewan Collection. Portrait(s) of Modernism

BELVEDERE 1030 Vienna, Prinz Eugen-Str. 27 www.belvedere.at

Jean Dubuffet, Passe furtif et décor, 1955, Collection Klewan, Jean Dubuffet © VGBild-Kunst, Bonn 2016 WHAT’S ON TODAY IN VIENNA?

SATURDAY, MARCH 4, 2017

August Diehl and Nicholas Ofczarek in Philippe Jordan © JF Leclercq Diese Geschichte von Ihnen by John Hopkins © Bernd Uhlig Mathias Habjan and his puppets in Kottan ermittelt © Rita Newman / Rabenhof

THEATRE & DANCE OPERA & MUSICAL

Diese Geschichte von Ihnen (Ein) Käthchen.Traum Die lustige Witwe by John Hopkins by Gernot Plass, based on ‘Das Käthchen Operetta by Franz Lehár AKADEMIETHEATER | 19:30 von Heilbronn’ by Heinrich von Kleist VOLKSOPER | 18:30 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 Onegin Kunst www.dastag.at Ballet by Pyotr Ilyich Tchaikovsky by Yasmina Reza Choreography by John Cranko Das Mädl aus der Vorstadt BURGTHEATER | 20:00 WIENER STAATSOPER | 19:30 1010 Vienna, Universitätsring 2 by Johann N. Nestroy 1010 Vienna, Opernring 2 Phone: +43 1 51444 4145 THEATER IN DER JOSEFSTADT | 19:30 www.wiener-staatsoper.at www.burgtheater.at 1080 Vienna, Josefstädter Straße 26 Phone: +43 1 42 700 300 Schikaneder Die Kehrseite der Medaille www.josefstadt.org Musical by Stephen Schwartz by Florian Zeller Klein Zaches – Operation Zinnober & Christian Struppeck KAMMERSPIELE DER JOSEFSTADT | 19:30 1010 Vienna, Rotenturmstraße 20 based on a story by E.T.A. Hoffmann RAIMUNDTHEATER | 19:30 Phone: +43 1 42 700 300 1060 Vienna, Wallgasse 18–20 VOLKSTHEATER | 19:30 www.josefstadt.org www.musicalvienna.at 1070 Vienna, Neustiftgasse 1 Phone: 43 1 52111 400 Don Camillo & Peppone Kottan ermittelt www.volkstheater.at Austrian cult TV show from the 1970s Musical by Michael Kunze & Dario Farina brought to life on stage RONACHER | 19:30 1010 Vienna, Seilerstätte 9 RABENHOF | 20:00 www.musicalvienna.at 1030 Vienna, Rabengasse 3 Phone: + 43 1 712 82 82 www.rabenhoftheater.com

CONCERTS & SOUNDS

Wiener Symphoniker Concentus Musicus Wien La Bandada Mancini Conductor Philippe Jordan María Hinojosa Montenegro, soprano Accordion Festival J.S. Bach: Johannespassion (St. John Passion) U. van Wassenaer; A. Vivaldi; L. Boccherini PORGY & BESS (JAZZ) | 20:30 BMV 245 1010 Vienna, Riemergasse 11 MUSIKVEREIN | 19:30 www.porgy.at KONZERTHAUS | 19:30 1010 Vienna, Bösendorferstraße 12 1030 Vienna, Lothringerstraße 20 www.musikverein.at Kalkbrenner Fritz www.konzerthaus.at GASOMETER (POP & ALTERNATIVE) | 20:00 1110 Vienna, Guglgasse 8 www.planet.tt

Please note that all theatre performances are in German.