ECRODAY T 2017 EUROPEAN CONGRESS OF

DAILY NEWS FROM EUROPE’S LEADING IMAGING MEETING | WEDNESDAY, MARCH 1, 2017

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HIGHLIGHTS CLINICAL CORNER TECHNOLOGY & RESEARCH COMMUNITY NEWS London team shows how Age assessments based on ECR 2017 exhibitors display Maximilian F. Reiser steps imaging contributes to bone maturation raise complex ultrasound’s 3D capabilities down as Editor-in-Chief patient outcome in mental scientific and ethical issues of European Radiology health disorders

BY PAUL M. PARIZEL, ESR PRESIDENT Welcome to Vienna. Welcome to the flower gardens of radiology. Welcome to ECR 2017. ESR President Prof. Paul M. Parizel is chairman of Antwerp University Welcome to the European Congress of Radiology (ECR), the flagship Hospital’s department of radiology and full professor of radiology at the scientific meeting of the European Society of Radiology (ESR). University of Antwerp’s faculty of .

With your help, we shall make lence has earned us a reputation But there is more … ECR 2017 active sessions, a more prominent mission for ECR 2017 closed with a this ECR 2017 a memorable and for quality and innovation. At ECR, will have a unique twist compared role for social media, and we shall record 6,757 abstracts submitted, unparalleled event, a supreme we continue to explore the world with previous editions, because our have topics that are of interest to representing a 22.8% increase on achievement in the annals of Euro- of radiology with determination, meeting is specifically dedicated young people, because they are the the previous year’s figure. The new pean radiology, with the support of confidence and ambition, and we to YOUTH, die Jugend, de jeugd, la future of our profession. The broad record includes abstracts submitted all national, and allied do so with style and elegance, in a jeunesse, la giovinezza, la juventud, consensus among the members for both scientific papers and oral sciences societies. uniquely European tradition. молодежь. During ECR 2017, I extend of the Programme Planning Com- presentations (+18%), and electronic For the organisation of ECR As President of this meeting, it is an open invitation to all and sundry mittee demonstrates our shared posters for the ECR’s EPOS™ exhi- 2017, I was lucky to get off to a fly- my pleasure to announce that ECR to take a stroll in ‘the flower gardens ambition for ECR 2017 to bring this bition (+27%). The boost in submis- ing start, surfing on a wave of posi- 2017 offers a very ambitious and of radiology’. Radiology is a beauti- message of hope to a new genera- sions for EPOS™ reflects the over- tive energy, generated by a string of challenging agenda. I invite you ful, fragrant, sweet-smelling flower tion of radiologists. whelming success of the Voice of successful meetings. Our congress to explore the fascinating world garden, and this is the message I As President of ECR 2017, I am EPOS sessions, introduced at ECR boasts a long tradition of deliver- of medical imaging and image- want to bring to young radiologists, extremely happy and proud that 2016, which give poster authors the ing scientific and educational excel- guided interventions, and to dis- throughout Europe and across the this new generation in radiology opportunity to present their work lence. ECR can be truly proud of an cover the exciting opportunities globe. Our scientific programme has heeded my call. We received in person at the congress. unmatched track record and look that lie ahead. The ECR attracts for ECR 2017 reflects this focus on a an all-time record of submitted to the future with confidence. The the best and the brightest, from new generation of radiologists, who abstracts, which proves that this growing impact of our society (ESR) students to professors, and offers demand high-quality education, army of young, smart, ambitious, and our congress (ECR) is interna- them the ultimate in education delivered in an efficient, under- driven young professionals have tionally recognised, in Europe and and science, as well as the opportu- standable, and customer-friendly entered our garden, ready and will- around the globe, and our strong nity to build a network of profes- way. To accommodate these young ing to plant new seeds and pre- commitment to delivering excel- sional relationships. colleagues, there will be more inter- pare new flowerbeds. Abstract sub- continued on page 2 myESR.org #ECR2017 2 HIGHLIGHTS ECR TODAY | WEDNESDAY, MARCH 1, 2017

continued from page 1 Mauricio Castillo – Wilhelm Conrad at all stages of professional devel- ties, with the purpose of fostering the programme. Unfortunately, for Röntgen Honorary Lecture), from opment, from students to those at collaboration across boundaries a huge meeting such as ECR 2017, the Netherlands (Prof. Mathias a very advanced level. The E³ pro- and disciplines. scheduling conflicts are inevitable, In addition to abstracts from Prokop – Josef Lissner Honorary gramme is divided into the Ris- As President, I am very happy to because there are so many parallel the traditional European coun- Lecture), and from the United King- ing Stars Programme, The Beauty see that, increasingly, the ECR has sessions, and it is physically impos- tries, it is of note that we received dom (Prof. Fiona J. Gilbert – Arthur of Basic Knowledge, European also become the flagship meeting sible to see everything. But fortu- huge increases in submissions from de Schepper Honorary Lecture). In Diploma Prep Sessions, ECR Acad- of the European Federation of Radi- nately, through ECR Online, you can Latin America (Argentina, Brazil, addition, we shall have a special emies, and ECR Master Classes, in ographer Societies (EFRS). A grow- still catch up with those sessions Mexico, Chile, and Colombia) and guest lecturer from Brazil, who will order of increasing complexity. All ing number of educational sessions you missed. Asia (China, India). This great suc- provide us with insider informa- sessions are labelled as level 1, 2 or and workshops have been planned I take this opportunity to express cess is living proof that the out- tion about the Zika virus infection 3, according the ESR’s European especially for radiographers. In par- my thanks to all my colleagues on reach of our society is now truly (Dr. Maria de Fátima Vasco Aragão – Training Curriculum for Radiology. ticular, I would like to draw your the ECR 2017 Programme Planning global. Moreover, it demonstrates Breaking news from Latin America). Moreover, we are proud to offer del- attention to the EFRS Workshop Committee, as well as to the chairs that the appeal of playing a part Traditionally, the ECR offers a egates a Joint Course of the ESR and to the ‘EFRS meets Belgium’ and members of the Scientific Sub- in one of the world’s biggest medi- platform for the ESR to take an and RSNA (Radiological Society of session, which provides an insight committees. It is thanks to their cal imaging events is as high as ever international perspective, and to North America) on Hybrid Imag- into the clinical and research work inspiration, commitment and hard and that the future of radiology, have joint sessions with member ing. And, not to forget, there will be performed by radiographers. In a work, that ECR 2017 will be a suc- and of the ECR, is secure. countries. These are the so-called a Pros & Cons Session on Provid- significant new step, all of the ses- cess. Moreover, I would like to give Radiology is currently undergo- ‘ESR meets …’ sessions. It is my ing an effective ultrasound service: sions for radiographers taking place special thanks to the entire staff of ing a metamorphosis, and there is pleasure, therefore, to invite you how and by whom?. Finally, I would in Room K at ECR 2017 will also be the ESR Office in Vienna, under the a growing focus on functional, bio- to discover the radiological flower like to remind all delegates that the simultaneously translated into Ger- inspired leadership of Peter Baierl logical, and genetics-related imag- gardens of Belgium, Peru and the ECR also offers Satellite Symposia man, Italian, Polish and Spanish. and Andrea Cermak. ing. Even though the mainstay of United States of America. The top- and Industry Workshops. Very close to my heart is the ECR 2017 will be more than just a radiology is still ‘anatomical imag- ics will be Emergency radiology Please make sure you also stop by European Diploma in Radiology congress. It will be a happening; an ing’, we must provide information (Belgium), Peru in the radiological the EPOS™ Arena to catch some of (EDiR). Examinations for the EDiR experience; an event to be enjoyed about cutting edge techniques to world (Peru), and Precision imaging the Voice of EPOS™ sessions, which have been taking place at the ECR and remembered. With all my heart, our colleagues, and help them to and patient experience (USA). proved so popular during their first for several years, as well as at var- I invite you to be a part of ECR 2017, understand that they should not The ECR offers a very rich vari- run at ECR 2016. The authors of ious other venues. It is reassuring to feel the joy and the energy. I be afraid of innovations, but rather ety of high quality scientific ses- electronic posters will give live pres- to notice that EDiR continues to invite you to share ECR 2017 with find a way to adopt these tech- sions, and educational activities, entations about their work, which grow in popularity and has become old and new friends, with profes- niques to explore new diagnos- including New Horizons Sessions, will also be broadcast online via the a standard of excellence for radiolo- sional contacts, with industry part- tic pathways and improve existing State of the Art Symposia, Profes- ECR Online streaming service. You gists. I am very happy to announce ners, with everyone. I look forward workflows. Radiology is not only sional Challenges Sessions, Multi- can watch these presentations each that EDiR will have a prominent to seeing you in Vienna, and please about detecting lesions and offer- disciplinary Sessions, Special Focus day during the conference, grouped place during ECR 2017, as we will remember … ing a differential diagnosis, but Sessions, Refresher Courses, Sci- into topical sessions, and sessions host a fully booked diploma exami- also about understanding how the entific Sessions, and Clinical Tri- dedicated to various countries and nation. Candidates accepted to take When you’re going to Vienna human body works, how lesions als in Radiology Sessions. We have languages. This initiative is primar- the EDiR examination who applied for ECR 2017, arise and behave, and how we can worked hard to carefully select the ily intended to offer young radiolo- before December 15 also receive free Join us for a walk through the monitor and influence disease pro- topics, many of which are new and gists, radiographers, residents and congress registration. flower gardens of radiology. cesses using radiological techniques challenging, offering information students, a forum to present their Many of you are already familiar When you’re going to Vienna and image-guided interventions. to a new generation in radiology. A work to their peers, in a high-en- with ECR Online. This portal is used for ECR 2017 The scientific programme for ECR very important element of the edu- ergy, low-threshold setting. by thousands of viewers to follow Be sure to wear some flowers in 2017 will address these issues. cational programme is the variety There are many more joint the ECR remotely. However, I would your hair Our Honorary Lectures will be of sessions grouped under the ban- sessions which the ESR will co-host also like to invite you to use ECR When you’re going to Vienna presented by an all-star interna- ner of E³ – European Excellence in together with other organisa- Online in Vienna, for example to for ECR 2017 tional cast of top speakers from Education. These sessions include tions. ECR 2017 offers a platform to catch up with sessions you cannot You’re gonna meet some gentle the United States of America (Prof. attractive lectures for participants our partner disciplines and socie- visit due to schedule conflicts within people there …

BY MÉLISANDE ROUGER Prominent Brazilian radiologist to shed light on Zika virus imaging in

Professor Maria de Fátima Vasco Aragão from Recife, Brazil, will today’s guest lecture present the Guest Lecture on ‘Breaking News from Latin America’ today at 12:15 in Room B. In recognition of her major achievements in neuroimaging and advancement of the field, Professor Maria de Fátima Vasco Aragão from Recife, Pernambuco, Brazil, will present the Guest Lecture ‘Breaking News from Latin America: How to recognise Zika virus infections on imaging studies’ at ECR 2017.

Maria de Fátima Vasco Aragão lowship at Mount Sinai Hospital As an intern student of medicine, not a doctor. Shortly after gradua- buco Federal University in Recife in is professor of radiology at the Center in New York, US. I was very impressed when I took tion, I sat for a test and won a place 2010. She is a founding member of Maurício de Nassau University and She always knew she would my patients to be examined by CT in radiology at the first attempt, the Brazilian Society of Neuroradi- Scientific Director of the Multim- become a doctor and chose radiol- and US. Even though there was and radiology has been my passion ology and a member of many radi- agem Diagnostic Centre in Recife, ogy because she recognised early only one CT scanner in my city, I ever since. I would like to say that ology societies, including the Amer- Brazil. She is also financial director on the field’s value in diagnosis succeeded in having all my intern I am grateful for having had great ican Society of Neuroradiology. of the Diagnostika Endoscopy and and treatment. patients examined, when indicated. mentors, including the neuroradi- Recently most of her research Radiology Clinic in Recife. “My mother is a retired biolo- My tutors were impressed by the ologist Dr. Sérgio Santos Lima, who has focused on the use of radiol- Prof. Vasco Aragão received her gist and teacher. I have swiftness with which cases were was my director during my fellow- ogy techniques to help diagnose medical degree from Pernambuco never forgotten the moment she resolved. Thus I learned that radiol- ship in the Med Imagem Beneficen- microcephaly, caused by Zika virus Federal University in 1987 and com- taught me what a cell was. In my ogy not only helps to quickly define cia Portuguesa, and the head and infection. “I have always had a spe- pleted her residency in radiology at family, educators predominated diagnosis in most patients, but also neck radiologist, Dr. Peter Som, who cial interest in advanced techniques Ribeirão Preto Faculty of Medicine, and my great aunt was the first provides a clear prognosis for the was one of my directors during my such as spectroscopy, diffusion, per- University of São Paulo. She did fel- woman in Pernambuco, my home most adequate treatment. At the research fellowship at Mount Sinai fusion, permeability and functional lowships in CT and MRI and in neu- state, to graduate from medical end of the course I began consider- Hospital Center New York,” she said. resonance. My master’s degree roradiology at the Med Imagem school, in 1935. Perhaps on account ing the possibility of specialising in Prof. Vasco Aragão’s main interest and doctorate studies focused on Beneficencia Portuguesa, São Paulo, of this family background I made radiology, even though 29 years ago, is neuroimaging and she completed researching these techniques in and later completed a research fel- up my mind to become a doctor. for most people, a radiologist was her PhD in neuroscience at Pernam- magnetic resonance on patients

#ECR2017 myESR.org ECR TODAY | WEDNESDAY, MARCH 1, 2017 HIGHLIGHTS 3

with cerebral tumours (astrocyto- but there are dangers looming for the imaging studies have become Prof. Vasco Aragão hopes to cines and medication will be devel- mas). I feel obliged to participate the profession. much cheaper and the machines tackle these issues and share her oped soon. The world has already and contribute to the development “Since the discovery of x-rays much more expensive. Over and experience with her colleagues dur- gone through so many epidem- of knowledge for the further under- by Wilhelm Conrad Röntgen in above this, there is the necessity ing ECR 2017, which will be her sec- ics and problems that I have confi- standing of microcephaly, this new 1895, radiology has become essen- for doctors to constantly update ond visit to the Vienna meeting. dence in the future and that all the tragic sickness that has appeared tial for medical practice. In spite their knowledge and at times “I am very honoured at having current challenges to health, ethics, in Brazil, with the greatest number of this progress, the doctor-pa- assume administrative functions. our work acknowledged by the ESR. politics, diplomacy, culture, econom- of cases being reported in my state. tient relationship is more distant All these factors lead doctors to Unfortunately we are talking about ics, and education will one day be So I have made time to describe the than in other clinical and surgi- distance themselves from their this tragic sickness that is spreading overcome. I hope that we are alive findings jointly with other doctors. cal specialties; and this distancing patients; reducing the time they throughout the world. I sincerely to witness this change. May the ECR We are currently concentrating our is increasing. The radiologist has need to study a specific case at hope that specific and efficient vac- be a solid step in that direction.” efforts to help to describe the con- less time to give attention to or greater depth and review previous genital syndrome of the Zika virus talk to patients, since the number examinations. Worst of all, this spectrum,” she said. of examinations has risen sharply way of working is being passed on Prof. Vasco Aragão served as with the advent of increasingly to students and residents as some- Guest Lecture president of the Pernambuco Radi- rapid machines. There is tremen- thing normal and correct in our ology Society from 2014 to 2016, dous pressure on radiologists to specialty, which it is not. The time Wednesday, March 1, 12:15–12:45, Room B being recently re-elected for the perform further examinations has come to review and reflect on Breaking News from Latin America 2016–18 term. so as to get an adequate finan- the true meaning and values of How to recognise Zika virus infections on imaging studies In her opinion, radiology is cial return for the institutions what it is to be a doctor and a radi- Maria de Fátima Vasco Aragão; Recife, PE/BR increasingly central to healthcare and doctors themselves, since ologist,” she said.

BY MÉLISANDE ROUGER Distinguished gastrointestinal expert to receive Honorary Membership during today’s Opening Ceremony In recognition of his contribution to the advancement of liver imaging and his commitment to research and education, Professor Richard L. Baron from Chicago, United States, will receive ESR Honorary Membership at ECR 2017.

Richard L. Baron is professor and radiologists achieve with so many on to the next generation of radiol- ring clinicians to maintain impor- chair emeritus of radiology at the of our referring .” ogists,” said Baron. tant informal education, and to keep University of Chicago, where he also His research interests are liver He identifies the challenges of the workday vibrant,” he said. previously served as dean for clin- and biliary imaging, and he has the profession in finding the bal- Prof. Baron has received the ical practice. He is the immediate authored more than 150 publica- ance between value and qual- Walter Cannon Medal from the past president of the Radiological tions, 28 book chapters and one ity, and in the efforts radiologists Society of Abdominal Radiology, Society of North America (RSNA). book. He has served as a visiting will have to make to communicate the Gold Medal of the Asian Oce- Prof. Baron completed his under- professor at more than 50 institu- in real-time with each other and anian Society of Radiology, and graduate education at Yale Univer- tions, and has delivered numerous other specialists. honorary fellowship of the Euro- sity with a cum laude award and named lectures, including the Wil- “In the United States our gov- pean Society of Abdominal and graduated from Washington Univer- helm Conrad Röntgen Lecture at ernental health agencies are Gastrointestinal Radiology. sity (WU), St. Louis School of Med- ECR 2011. increasingly measuring our out- He has become a regular guest at icine. He completed his training in Prof. Baron has also served as puts and reimbursable activities on the ECR since 1995, a first visit he at Yale University associate editor for Radiology and a value-provided basis rather than vividly remembers. and his residency in radiology at the Liver Transplantation, and served a volume activity basis. This will be “The airline had lost my luggage Mallinckrodt Institute of Radiology in leadership roles for many radiol- very challenging for radiologists to and I never received it throughout at WU. He later served as chairman ogy societies. adapt to. A large part of this chal- the entire meeting, requiring me to of the department of radiology at He and his generation were lenge will be how ‘value’ and ‘qual- become quite familiar with cloth- the University of Pittsburgh. the first physicians to work with Professor Richard L. Baron from Chi- ity’ are defined and measured as ing shops in Vienna! But the best “I always enjoyed solving puz- modalities like CT, which at the cago, United States, will receive ESR these will be in light of the experi- memory is of some international zles as a child and adult, and radi- time required extensive research. Honorary Membership today during ences of patients, third party pay- friendships I made then that have ology is perhaps the medical field Later on he also took roles in educa- the Opening Ceremony. ers, and referring clinicians. grown over the past two decades. that most resembles puzzle solv- tion, and has now focused his atten- While technological advance- The best aspects of the ECR are ing activities,” explained Baron. “I tion on patient care and teaching interests. As the years passed I ments have been a boon to the radi- the international interactions and enjoy all the aspects of radiology the new generation of radiologists. enjoyed opportunities to engage in ology community, they have also collegial relationships that can be and healthcare delivery, but best of “The exciting advances in the field leadership activities and help shape created barriers and problems for us built. In our home countries we all all to me are the personal relation- of radiology have afforded me many healthcare locally and nationally, as in isolating radiologists from each hear wonderful scientific and edu- ships. Interacting with patients opportunities to move into differ- well as bring international radiolo- other and from the general medical cational lectures, but to share infor- and seeing how I can impact their ent directions in medical imaging. gists together to advance the field. community. It will take creativity mation and learn new approaches healthcare would hit the top of In my early years, when body CT At the current time I remain active and effort for radiologists to recreate with very different cultural experi- the list, but close behind would was just beginning, clinical research in patient care and education but meaningful real-time discussions ences is truly the best opportunity,” be enjoying the daily interactions was a large part of my professional have passed the torch on research among each other and with refer- Prof. Baron said.

Opening Ceremony Presentation of ESR Honorary Membership Wednesday, March 1, 17:45–19:00, Room A Richard L. Baron; Chicago, IL/US James A. Brink; Boston, MA/US Welcome Address Gloria Soto Giordani; Santiago/CL Paul M. Parizel; Antwerp/BE ESR President Presentation of ESR Gold Medals Jose Ignacio Bilbao; Pamplona/ES Guy Frija; Paris/FR Stephen J. Golding; Oxford/UK

myESR.org #ECR2017 4 HIGHLIGHTS ECR TODAY | WEDNESDAY, MARCH 1, 2017

BY MÉLISANDE ROUGER Eminent radiologist to be presented with Honorary Membership today In recognition of his outstanding achievements in imaging and radiation Professor James A. Brink from protection, Professor James A. Brink from Boston, MA, United States, Boston, United States, will be presented with ESR Honorary will be presented with ESR Honorary Membership at ECR 2017. Membership today.

James A. Brink is radiolo- nostic dilemmas on a daily basis,” Ray Society and currently serves as sponsor than primary investigator,” ing and artificial intelligence will gist-in-chief at Massachusetts Gen- he said. chair of the board of chancellors for he said. enable us to automate or semi-auto- eral Hospital (MGH), Boston, and the He joined the faculty at the Mall- the American College of Radiology. He expects personalised medi- mate our tasks to meet these needs Juan M. Taveras professor of radiol- inckrodt Institute of Radiology, The emerging field of data sci- cine to significantly change radiol- on a broad scale,” he said. ogy at Harvard . Washington University School of ence and machine learning, and ogy practice, and believes artificial Prof. Brink has written more Prof. Brink received his medical Medicine in St. Louis, where he their influence in healthcare, have intelligence will play an increas- than 140 publications and given degree from Indiana University and rose to the rank of associate pro- recently caught his attention. ing role in helping doctors focus on more than 270 presentations all completed his radiology residency fessor, and he served as chair of the “I have a long standing interest patient care. over the world. Vienna, home of the and fellowship at MGH in 1990. department of diagnostic radiology in issues related to radiation pro- “The end point won’t change – we ECR, has become a regular destina- Before opting for a career in med- at Yale University from 2006 to 2013 tection, including the monitor- will always strive for excellence in tion for him and he cannot remem- icine, he envisioned himself as an before returning to MGH. ing and control of radiation expo- patient care. However, how we get ber the year he first attended the engineer and received a Bachelor His work focuses on utilisa- sure for medical imaging. Recently, there will change. Care will need congress. of Science degree in electrical engi- tion and management of imaging I have become very interested in to be immediate, convenient, per- “I think it was when I was still in neering from Purdue University, resources, and monitoring and con- the impact of clinical data science sonal and affordable. We need to training. I recall presenting a paper Indiana. His initial interest has ena- trol of medical radiation exposure. on medical imaging and interven- shift from a disease-focused mind- on gallstone lithotripsy, which, bled him to appreciate radiology on Prof. Brink currently serves as tion. Machine learning and arti- set to a patient-focused mindset. given how long ago this proce- an additional level. scientific vice-president for radia- ficial intelligence have the poten- Mrs. Jones is no longer a cancer dure fell out of favour, highlights “I enjoy that radiology sits at the tion protection in medicine on the tial to greatly impact medicine at patient; she’s a patient with cancer. how long it has been! I recall being intersection of technical innova- National Council on Radiation Pro- large, and it is incumbent upon us Where we need to focus is increased impressed with the multinational tion and . I like tection and Measurements and to stay at the forefront of these personalisation. While we do this in and multicultural exchange of the challenge of leveraging imaging vice-chair of the nuclear and radia- advancements for the benefit of specialised circumstances, we need ideas, independent of political and technology to diagnosis and treat tion studies board for the National our patients and our profession. As to expand this with great emphasis national barriers. These are attrib- disease with as little invasiveness Academies of Sciences, Engineering Chair of the Department of Radiol- on phenotype characterisation to utes that continue to impress me as possible. Much as a sleuth solves and Medicine. He is also past-pres- ogy at MGH, my role in these inves- keep pace with targeted, personal- each time I attend the ECR,” he said. mysteries, radiologists solve diag- ident of the American Roentgen tigations is more that of executive ised . Here, machine learn-

BY MÉLISANDE ROUGER Honorary Membership awarded to leading paediatric radiologist from Chile In recognition of her contribution to paediatric imaging and her involvement in the advan- cement of the field, especially in Latin America, Professor Gloria Soto Giordani from Santia- go, Chile, will be awarded ESR Honorary Membership at ECR 2017.

Prof. Gloria Soto Giordani is a modality for children. This was my “I have assisted in the incorpo- She has also served as a consultant paediatric radiologist at the Ger- first contact with radiology. After ration of many diagnostic imag- to the World Health Organization, man Hospital in Santiago, having completing my radiology residency, ing advances and in the imple- filling in as an invited speaker dur- previously headed the department I had the opportunity to do a year mentation of a complete new way ing the 68th World Health Assem- of radiology of Roberto del Río Chil- of training in paediatric ultrasound of organising day-to-day radiologi- bly side event ‘Imaging for Saving dren’s Hospital in the same city. at the Hospital for Sick Children, in cal work. I have seen how the roles Kids – the Inside Story about Patient She graduated with the best Toronto, where I not only learned of diagnostic imaging and radiolo- Safety in Paediatric Radiology’. graduate award from the Pontifi- about paediatric radiology but also gists have changed to what they are Prof. Soto has also served as pres- cal Catholic University of Chile and met great mentors, made life-long today: a fundamental part of med- ident of the Chilean Society of Radi- completed her residency in radiol- friends and experienced how a high icine and healthcare. These contin- ology, the Latin American Society of ogy at Roberto del Río Children’s level paediatric radiology depart- uous professional challenges have Paediatric Radiology and the Inter Hospital. Prof. Soto has always ment worked,” she said. made my life as a radiologist a great American College of Radiology, wanted to work with children but Back in Chile, Prof. Soto played journey, which I have fully enjoyed,” where she is currently Director of did not initially consider radiology an active role in the implementa- she said. Education. She sits on the execu- as a career path. tion of paediatric ultrasound in her Prof. Soto took on the role of tive committee of LatinSafe, an ini- “When I graduated from med- country. Her main fields of interest president of the World Federation tiative to promote imaging safety in ical school I did a paediatric resi- are whole-body imaging, paediatric of Pediatric Imaging (WFPI) in 2016. the region. dency; I wanted to be a paediatri- ultrasound and foetal MRI. “This position offers me the chal- She believes her engagement Professor Gloria Soto Giordani from cian! However, during my training I She has witnessed the gigan- lenge of improving access and qual- with international radiological Santiago, Chile, will be awarded ESR had the opportunity to learn about tic leaps made in imaging technol- ity of paediatric imaging world- organisations has broadened her Honorary Membership at today’s ultrasound, at that time an emerg- ogy and the shifting role of the spe- wide, with a special emphasis in low vision of radiological practice from Opening Ceremony. ing and very promising imaging cialty in healthcare over the years. resource settings,” she said. a local to a more global perspective.

#ECR2017 myESR.org ECR TODAY | WEDNESDAY, MARCH 1, 2017 HIGHLIGHTS 5

“It has given me the opportunity to continue to produce better diagno- idly evolving changes. The greatest eties have an important role in this our of participating in representa- work and try to improve the level of sis with lower radiation doses. risk for us radiologists is to get lost respect,” she insisted. tion of Latin America,” she said. radiological practice not only in Chile “Minimally invasive procedures among new great technology, beau- Prof. Soto has visited the ECR Her best ECR memory is the but also in Latin America,” she said. and image-guided interventions tiful images and quantitative data, regularly since 2010. “I enjoy the ‘ESR meets Chile’ session in 2013, an Prof. Soto has lectured in most will continue to develop, replac- isolating ourselves from clinicians friendly atmosphere of the con- “exciting and very rewarding expe- Latin American countries, and at the ing more aggressive procedures. and patients.” gress, with many opportunities to rience that gave us the opportunity ECR, RSNA and international pae- Besides this, enhancement of dig- From a more global perspective share with colleagues and make to share with the audience radiolog- diatric radiology meetings. She has ital working environments is to she believes it is ethically impera- new friends. I give a special men- ical research that is done in Chile, published numerous papers and be expected, including a continu- tive to ensure radiological advances tion to the interesting side events and to bring a little bit of our cul- authored or co-authored six books. ous trend towards standardised, and high quality radiological prac- that take place during the meeting, ture to Vienna, including deliver- In the future, she expects structured reporting. The main tices become available in lower such as the International Summit, ing a short talk about Chilean poets advances in imaging technology to challenge is to adapt to these rap- resourced areas. “Radiological soci- in which I have had twice the hon- and wine.”

BY BECKY MCCALL London team prepares to show how imaging contributes to patient outcome in mental health disorders The concept of mental illness as illustrated by neuroimaging is the theme of today’s eagerly awaited session on how imaging in obsessive compulsive disorder (OCD) and Tourette’s syndrome (TS) is shedding light on disease understanding and potential avenues for for these life-changing illnesses.

help to determine if real differences ulate information processing in the exist and the nature of these.” target brain area. The electrode is Yousry, who started his career in connected to a battery positioned Cairo, Egypt, but has worked exten- under the skin of the chest. sively in Germany and in the UK DBS has been shown to be effec- since 2001, pointed out that there tive in 50–60% of patients with was poor understanding around the extremely severe OCD. Turning nature of, and the explanations for, to the history of neuroimaging in brain abnormalities related to OCD. this condition, she plans to discuss “It took some time to understand how early PET findings demon- that it was an organic disease, not strated that patients with OCD just a problem related to an abusive have increased metabolism in childhood or whatever, but that fronto-striatal circuitry, but then there is something fundamentally decreased following successful wrong in the brain,” he said, adding pharmacological treatment. This that what exactly is wrong is diffi- concept of OCD as a network dis- cult to determine, however. order has been elaborated on since Now with the latest imaging then, but has also been found to be techniques, far more is visible, and more complex. this is helping to clarify how the Joyce hopes to explain that trac- brains of individuals with OCD or tography studies, for example, have Prof. Eileen Joyce is professor of TS function differently. shown altered topography and con- neuropsychiatry at the UCL Institute “We are asking whether the cables nectivity between the orbitofrontal of London. connected between different parts cortex and striatum; structural MRI Coronal MR image shows the position of bilateral electrodes targeting the of the brain are wrongly wired, or has demonstrated reduced volumes ventral anterior capsule and ventral striatum in a patient undergoing deep Chaired by Prof. Tarek Yousry, pro- whether the connections are of of not only prefrontal and cingulate brain stimulation for obsessive compulsive disorder. fessor of neuroradiology, brain repair poor quality,” Yousry continued. cortex but also hippocampus and Provided by Ludvic Zrinzo. & rehabilitation at the UCL (Univer- “Sometimes fundamental function- increased volumes of pallidum and sity College London) Institute of ing of the brain can be different in thalamus. Furthermore, MRI spec- Neurology, Queen Square, London, patients with mental health disor- troscopy has contributed to our the session aims to show how neu- ders compared to the brains of peo- understanding of the neurochem- roimaging is elucidating the nature ple not considered to be sick.” ical basis of OCD, with abnormali- of OCD and TS, and speakers will Speaking on the subject of net- ties of GABA (gamma-aminobutyric address the central role of neuroim- works in OCD will be Prof. Eileen acid) and glutamate being impli- aging in optimising functional neu- Joyce, professor of neuropsychi- cated. In the light of these neuro- rosurgery of these conditions. atry at the UCL Institute of Neu- imaging findings the psychological Multidisciplinary Session Although imaging has played rology. She intends to address how understanding of the behavioural an increasingly important role in understanding of the neural basis characteristics of OCD has been Wednesday, March 1, 16:00–17:30, Room E2 mental health over the past dec- of OCD is important in order to modified, and this might pave the MS 4 Neuroimaging and mental health disorders ade, mental health is still too infre- develop new treatments and better way for better interventions. quently the focus of imaging stud- targets for deep brain stimulation Also speaking in the session will »» Chairman’s introduction ies, according to Yousry. (DBS, also known as functional ste- be Dr. Tom Foltynie, also from UCL, T.A. Yousry; London/UK “Usually in patients with schiz- reotactic ) as a treat- who will describe the potential of »U» npicking obsessive compulsive disorder (OCD) networks with ophrenia, or OCD for example, ment for the condition. Ultimately, DBS as a treatment for severe, med- neuroimaging there is little to see with neuro- there is a need to develop effective ication refractory TS. He will intro- E. Joyce; London/UK imaging, but this is changing and treatments for OCD for the 10–20% duce the concept of patient-specific »» Bridging movement and mind: neuroimaging in we are seeing a lot more imaging of patients who remain resistant to simulations of the DBS electrical Tourette-Syndrome research that is detecting differ- existing treatments. field using neuroimaging. Finally, T. Foltynie; London/UK ences between patients with men- Joyce is currently leading a neurosurgeon Ludvic Zrinzo, from »» Precision neurosurgical targeting in Tourette’s and obsessive tal health problems and patients study into the use of DBS in OCD. the same London facility, will dis- compulsive disorder (OCD): critical role of neuroimaging without the disease,” he told ECR The procedure involves implant- cuss the critical role of neuroimag- L. Zrinzo; London/UK Today in a pre-congress interview. ing bilateral electrodes and deliv- ing in precision neurosurgical tar- “Quantitative techniques can then ering an electrical current to mod- geting in OCD and TS. »M» ultidisciplinary case presentation and discussion

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ECR TODAY | WEDNESDAY, MARCH 1, 2017 HIGHLIGHTS 7

BY SHANE FOLEY Radiographers’ sessions go from strength to strength at ECR 2017 ECR 2017 will feature the largest radiographers’ programme to date at the European Congress of Radiology, and is now recognised as the official annual scientific meeting in medical imaging for radiographers by both the European Federation of Radiographer Societies (EFRS) and the European Society of Radiology (ESR).

hope you will show your support for phers programme this year, both there are a range of other Refresher appropriate image quality: what we these stars of tomorrow and attend taking place on Saturday and both Courses on offer throughout the have to know’ (EU 2), ‘European CT these sessions, starting on Thursday. of which look at the importance of ECR covering many areas of rele- dose repository’ (EU4) and ‘Improving Of particular interest to the younger teamwork in medical imaging and vance for radiographers, which may efficiency in radiology departments’ members of the radiography pro- . Radiogra- also be of interest. (PIER Session 1). Finally worth men- fession will be the EFRS Radiog- phy and radiology: more than the As usual there are a large number tioning is the Pros & Cons Session raphers’ Basic Session (Satur- sum of their parts (Saturday, March of scientific sessions covering a vari- (Friday, March 3, 16:00–17:30, Room day, March 4, 08:30–10:00, Room L8), 4, 08:30–10:00, Room K) looks in par- ety of topics over the five days from K) which will look at the sometimes another new session which looks at ticular at challenges and respon- the modality-specific areas such as controversial topic of ‘Providing an the various professional roles avail- sibilities facing the professions CT, MRI and breast imaging to dose effective ultrasound service: how able for radiographers, including and how they can work together optimisation, education and profes- and by whom?’, which will look at all within management, academia and to improve outcomes, while A sional issues, as well as more gen- sides of the debate on whether radi- industry, perhaps broadening your team approach towards ensuring eral topics. No doubt there is some- ologists or radiographers should lead horizons with exposure to roles patient safety and care (Saturday, thing for everyone. Likewise, there the provision of ultrasound services. Shane Foley, PhD, is BSc Radiogra- beyond the typical clinical remit. March 4, 14:00–15:30, Room K) will are plenty of other sessions through- On behalf of the ECR 2017 Radi- phy Programme Coordinator at the Another motivating addition in explore topics such as reporting, out the congress with radiographer ographers Scientific Subcommittee University College Dublin, Ireland, 2017 is a dedicated EFRS Workshop the interventional room and involvement or of interest to radi- and the EFRS, we hope you have and member of the Radiographers on Authorship and Reviewing (Sat- patient safety, where radiographers, ographers, in particular during the an enjoyable and rewarding meet- Scientific Subcommittee for ECR 2017. urday, March 4, 16:00–17:30, Room radiologists and medical physicists EuroSafe Imaging sessions, which ing. Don’t forget to pick up the spe- K), in association with Radiogra- can work together to maximise will be of great interest to all, looking cial Radiographers Programme at In fact the number of sessions spe- phy (Elsevier), the official journal patient benefits. at topics such as ‘Dose reduction: tips the congress bags counter in the cifically for radiographers has been of the EFRS, which aims to encour- This year’s Special Focus session, and tricks’ (RC 1212), ‘Clinical diagnos- entrance hall! increased to 18, meaning that there age radiographers, and indeed any which is also a EuroSafe Imaging tic reference levels’ (EU 1), ‘Focus on are now dedicated radiographer ses- other novice authors or review- session, will centre on How radiog- sions for the duration of the confer- ers attending the ECR, to publish raphers enhance paediatric imag- Refresher Courses ence, covering topics of interest and their own work so that the evi- ing (Sunday, March 5, 08:30–10:00, relevance to all. With most radiogra- dence base for the profession can Room K). Some very pertinent top- Wednesday, March 1, 08:30–10:00, Room K pher sessions taking place in Room be improved, but also to familiar- ics will be presented, including the RC 114 MRI technology and techniques K, these sessions will this year offer ise attendees with the peer-review very topical and common question Moderators: V . Syrgiamiotis; Athens/GR the additional benefit of being simul- process for publication, which may of informed consent and whether A. Mizzi; Msida/MT taneously translated into German, seem daunting at first glance, but is it is actually possible to obtain for Italian, Polish, and Spanish, offering eminently achievable and reward- paediatric patients, given the vari- »» A. Recent developments in structural and quantitative spinal attendees the ability to listen to pres- ing for those who do complete it. ety of ages and levels of maturity cord imaging at 3T entations in their choice of language Of particular interest will be the encountered. Dose reduction steps M.C. Yiannakas; London/UK and hopefully improving engage- tips and advice for success as well will likewise be covered, as well as »B» . RF-related heating in clinical MRI ment, participation and enjoyment as the stimulating panel discussion what promises to be a stimulating T. Owman; Lund/SE presentation on personality traits for everyone. at the end, where knowledge from »» C. The benefits of diffusion imaging and how these can be used to max- The EFRS, who are the umbrella authors, reviewers and publishers J. Castillo; Msida/MT organisation representing more will be shared. imise cooperation from patients. than 100,000 radiographers and This year the EFRS will once There are five Refresher Courses »» Discussion and questions: How is patient care more than 8,000 student radiog- again host its own ‘EFRS Meets’ ses- for radiographers, covering a diverse affected by MRI technology and techniques? raphers through 36 national soci- sion for radiographers, in conjunc- range of topics from Wednesday eties and 57 educational institu- tion with representatives of the to Friday; they include MRI tech- Wednesday, March 1, 16:00–17:30, Room K tions from across 33 countries, will Association des Professionnels en nology and techniques (Wednes- RC 414 Modern imaging of major trauma also host a Radiographers Lounge Imagerie Médicale (APIM) and the day, March 1, 08:30–10:00, Room K), Moderators: P.H. Hogg; Salford/UK outside Room K for the duration Vereniging Medisch Beeldvorm- Modern imaging of major trauma L. van den Hauwe; Antwerp/BE of ECR 2017. ers (VMBv) during the EFRS meets (Wednesday, March 1, 16:00–17:30, Also new for ECR 2017 is the excit- Belgium Session (Friday, March 3, Room K), CT imaging: the role of »» A. Use of MSCT in disaster victim identification ing addition, for the first time, of a 14:00–15:30, Room K). We look for- the radiographer and technologi- J. Kroll; Maastricht/NL separate ‘Rising Stars’ session dedi- ward to hearing about the radiogra- cal developments (Thursday, March »B» . Conventional radiography in major trauma: role, technique cated to radiography students. This phy profession in Belgium, but also 2, 08:30–10:00, Room K), The educa- modification and impact on interpretation is a fantastic opportunity to show- some patient safety initiatives and tion and training of radiographers M. Hardy; Bradford/UK (Thursday, March 2, 16:00–17:30, Room case the talents of radiographers radiation protection practices in use »»C. Applications of ultrasound in the evaluation of major trauma K) and Patient safety: profes- in training across Europe and more throughout Belgium, which we may T. Herlihy; Dublin/IE importantly to disseminate the all learn from. sional and clinical responsibility results of the important research There are two Professional Chal- of the radiographer (Friday, March »» Discussion and questions: Imaging of major trauma – what are projects they are involved in. So we lenges sessions in the radiogra- 3, 08:30–10:00, Room K). Remember, the challenges

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ECR TODAY | WEDNESDAY, MARCH 1, 2017 CLINICAL CORNER 9

New tools for radiologists: from liquid Image-guided interventions: a key ESR and UEMS team up to impact on EU 10 biopsy to artificial intelligence 11 pillar in cancer care 15 issues facing radiology

BY FRANCES RYLANDS-MONK Age assessments based on bone maturation raise complex scientific and ethical issues Mass migration triggered by the unfolding crisis in Syria has heightened interest in radio- logy’s role in the protection of children. For young unaccompanied persons arriving in Eu- rope without documentation, imaging can be used to determine age and as a result, their refugee status, having a direct impact on the aid they receive and where they can live.

At the other end of the spectrum body movement, this is a signifi- ous socioeconomic backgrounds. of its uses, bone assessment is also cant limitation of its use children. TW, based on data compiled in a means to gauge the skeletal age Other factors in bone age esti- 1962 from British children born of football players in tournaments mation remain controversial: gen- between 1940 and 1955, involves the such as the under-17 and under-20 der, ethnicity, nutrition, physical assignment of a score to each of the world cups. This need arises when activity, geographical location, ossification centres, involving 20 personal documents are lacking for other socioeconomic factors, and bones, visible in the x-ray. The devel- players who come from countries exposure to the sun as an acceler- opment of each bone within the with no official birth registration ation factor in maturation should hand/wrist complex is divided into a systems and when there is a sus- all be considered. Widening study series of stages from A (initial radi- picion that an older player is being cohorts to include a range of differ- ological aspect) to H (final mature included in a younger age category. ent groups of subjects could also be radiological aspect), when the bone “This misclassification entails looked at, and would constitute a has achieved full adult morphology. A not only physical risk of exposing way of reaching consensus on pro- Each bone is assessed individually weaker players to injuries caused tocols and grade scales. These stud- for stage, with each stage assigned A: Clinical x-ray of a young male by older players but also under- ies must be wide, multicentre, and a numeric score. All numeric scores with a chronological age of 16 years mines the system of recognition guarantee the inclusion of these are then added together to achieve and 4 months. or economic reward, which may different factors, according to Diaz. a cumulative score, which is then be considerable in some cases,” Beyond determining age in foot- related to a chronological age. said Dr. Sandra Diaz Ruiz, PhD, ball and forensic medicine, a key The method was updated with paediatric radiologist at the Astrid application of bone age assess- data from Scotland in 1975 (TW2) Lindgren Children’s Hospital, ment is the evaluation of growth and then again in 2001 (TW3) with part of the Karolinska University and puberty disorders. Dr. Fabrice data from Europe, Argentina, Hospital, Stockholm. Dedouit, PhD, head of the Imaging Japan, and the U.S. However, it is Part of the appeal of MRI in young and Forensic Anthropology Unit of time-consuming, difficult to learn, footballers is its lack of ionising radi- the University Center of Legal Med- involves arbitrary assignment of ation, and the modality has been icine, Lausanne-Geneva, Switzer- scores to the degrees of maturity, used in wrist assessments by the land, thinks such evaluation is fun- and only gives a rough staging of International Federation of Associa- damental to determining patient ossification of the ulna and radius, tion Football (FIFA) since 2003. management and choice of therapy. according to Dedouit. MRI is not currently used to “In patient follow-up it is critical Bone age assessment has a key assess bone age in routine practice, to continue using the same method role in the confirmation of normal B but Diaz believes that it could be and not change to a different means variants of growth, interpretation standardised to become an option of assessment,” he said. of hormone blood levels in chil- B: The closest image in the Greulich both in clinical diagnosis of special The two most widely used sys- dren during puberty, and diagnosis & Pyle Atlas is the male standard syndromes and in forensic work, tems are the Greulich & Pyle Atlas of precocious puberty and hyper- number 28 corresponding to a skele- the latter being the main focus (GP) and the Tanner Whitehouse androgenism, such as congenital Measurements taken from knee tal age of 16 years old. A limitation of of her presentation today. As an (TW) methods. Published in 1959, GP adrenal hyperplasia characterised MRI can help determine age, but bone maturation assessment using adjunct to other methods, MRI is the most widely used. It is based by advanced bone age. Assessment protocols and grade scales must be GP atlas images is that similarity yields accurate results to specific on hand x-rays from 1,000 Ameri- is also pivotal in the decision to standardised for routine practice in can only help determine skeletal age, questions, but there are pitfalls, cans of northern European descent treat or not to treat children with bone maturation assessment. (Provi- not chronological age. (Provided by and problems can arise from the living in Ohio, aged between 0 years precocious puberty and congenital ded by Dr. Sandra Diaz Ruiz, PhD). Dr. Fabrice Dedouit, PhD) absence of standards to ensure that and 18 years, which were taken adrenal hyperplasia, in monitoring the age established by the scientific from the Brush Foundation longi- skeletal response to the treatment, Special Focus Session evidence is correct. Moreover, the tudinal study between 1931 and 1942 and also defining the right moment fact that research predominantly and compiled into an atlas. To help to start replacement treatment in Wednesday, March 1, 08:30–10:00, Room O pertains to males and Caucasians determine bone age, plain x-rays children with hypogonadism. Eval- SF 1 Assessing age, based on bone maturation: means that it cannot be used as a of the left hand and wrist can be uating children with growth retar- scientific and ethical aspects general reference. compared with reference atlas dation and advanced or delayed “There are not enough studies images for each age category and puberty and monitoring paediatric »» Chairman’s introduction that represent the entire popu- for both sexes. patients being treated with growth K. Rosendahl; Bergen/NO lation. Instead small studies aim Evaluation is based on the exist- hormone replacement therapy are »» Bone age assessment: indications and methods to answer specific questions,” she ence and morphology of the epi- two other areas that rely on bone F. Dedouit; Lausanne/CH told ECR Today. “Furthermore, physes of the metacarpals and the age assessment. »» Precision and accuracy of an automated radiographic method some involve several grade scales phalanges and their fusion, the car- “Radiological results of bone age H.H. Thodberg; Holte/DK of the same body part examined pal bones, and the inferior epiphy- must always be combined with with different MR field strengths. seal points of the ulna and radius. clinical evaluation and paraclinic »» Precision and accuracy of MRI The interpretation of these grade While it is simple, with low inter results – hormonological if nec- S. Diaz; Stockholm/SE scales may be confusing to inexpe- and intra-observer differences, crit- essary – to explore and assess the »E» thical and legal aspects of using bone age to determine age rienced radiologists.” ics state that the method is based on or to help determine K. Chaumoitre; Marseille/FR She pointed to other studies an old study and is not representa- chronological age,” he noted. »P» anel discussion: Should bone age be used to estimate chrono- which found that because MRI is tive of modern, multi-ethnic, taller, logical age – alone or in combination with additional methods? a lengthy process and sensitive to and heavier populations from vari- myESR.org #ECR2017 10 CLINICAL CORNER ECR TODAY | WEDNESDAY, MARCH 1, 2017

BY VIVIENNE RAPER New tools for radiologists: from liquid biopsy to artificial intelligence Liquid biopsies, deep learning and biomarkers, and novelties in molecular imaging will all come under intense scrutiny on the opening day of ECR 2017 during a professional challenges session on rapidly emerging technologies.

amount of data to give a similar performance to people. It requires millions of scans to ‘learn’ how to characterise a particular disease. A solution is to give annotated features to the algorithm rather than let it extract features from the images, reducing the number of scans needed, according to Alber- ich-Bayarri. He intends to present an example – an algorithm trained with 4,000 images – designed to identify the main findings on x-rays and CT scans. Another important aspect is the performance of neural networks. He supports a new kind of network – a generative adversarial network (GAN) – that promises to improve deep learning by giving better per- formance with less training, and fewer images needed. GAN uses two competing neu- ral networks. One takes random data as input and generates sample images. The other receives gener- ated images and the sample images, and must discriminate between the two sources. The two networks are trained simultaneously and – in Lung nodule detected by a deep-learning-based classifier of medical images on a plain chest radiograph. (Provided by Dr. Angel Alberich-Bayarri) theory – compete to make the gen- erated images indistinguishable “My whole message to radiolo- sciences company GRAIL aims to in everyday clinical practice today, discuss some of the limitations of from the real images. gists is that liquid biopsy is com- develop a test to detect all cancers. he explained. In the future, as the artificial intelligence (AI) in radiology. Finally, Alberich-Bayarri will plementary to the imaging evalu- In his talk, Ignatiadis intends technology evolves, he believes that “AI, like deep learning, shouldn’t discuss how different manufac- ation. It provides another layer of to explain about the potential of NGS approaches will be used more alarm radiologists,” he commented. turers calculate imaging biomark- information to tailor treatment to liquid biopsy to personalise treat- often in the clinic for the detection “They are tools to help radiologists ers, quantifiable biological indica- patients,” said Prof. Michail Ignati- ment. A patient with metastatic and characterisation of ctDNA. work faster and more safely. They tors of disease, in different ways. adis, from the Department of Med- cancer who relapses, for example, Detecting circulating tumour cells have to have human expertise.” There are two major organisations ical at the Jules Bordet can have their circulating tumour (CTC) can identify cancer patients at Deep learning uses computer seeking to establish a consensus: the Institute in Brussels. DNA (ctDNA) tested, and the treat- risk of relapse – before the growing algorithms to select and extract European Imaging Biomarkers Alli- Liquid biopsy, unlike traditional ment changed based on the ctDNA tumour is visible with imaging. In features from medical images, but ance (EIBALL) and the Quantitative biopsy, uses a simple blood draw. results. This can be repeated after the Treat CTC clinical trial, Ignati- a limitation is that it needs a huge Imaging Biomarkers Alliance (QIBA). This means it is minimally invasive each progression of the disease adis and his co-authors used liquid and can be repeated multiple times. using a simple blood draw. biopsy to identify breast cancer Combined with radiology, it can be Liquid biopsy can detect whether patients who had completed Professional Challenges Session used to monitor how the tumour the tumour’s molecular compo- and adjuvant chemotherapy but still molecular landscape varies with sition has evolved – information had circulating tumour cells. Wednesday, March 1, 08:30–10:00, Room E1 response to treatment. that is not available from an image. “This is a new model for drug PC 1 Will emerging technology replace the radiologist? Already liquid biopsies are help- The blood draw works by detecting development in breast cancer,” he ing clinicians make treatment deci- tumour cells and/or tumour DNA noted. “If we can demonstrate that »» Chairman’s introduction sions in metastatic cancer, Igna- circulating in the patient’s blood. a drug can clear CTC or ctDNA from L. Donoso; Barcelona/ES tiadis told ECR Today. On June 1, Tumour tissue has detectable the blood, this might eventually cure »C» omputer-aided and computer-determined diagnosis 2016, the first liquid biopsy test was molecular alterations compared to more women. You treat the disease K.J. Dreyer; Boston, MA/US approved by the U.S. Food and Drug healthy tissue. much earlier. You also speed up drug »» Liquid biopsy: a new kid on the block Administration (FDA) to identify Circulating tumour DNA can be development because you don’t have M. Ignatiadis; Brussels/BE patients with metastatic non-small investigated using next genera- to wait for a relapse.” »N» ovelties in molecular imaging cell lung cancer (NSCLC) who are tion sequencing (NGS) and digital Speaking in the same session, Dr. K. Riklund; Umea/SE eligible for the drug Tarceva (erlo- polymerase chain reaction (PCR) Angel Alberich-Bayarri from the tinib), a chemotherapy medicine. techniques. While NGS gives broad Biomedical Imaging Research Group »» Deep learning and biomarkers: the engineer’s view In the future, liquid biopsy may coverage of the tumour genome, at La Fe Polytechnic and University A. Alberich-Bayarri; Valencia/ES be used for cancer diagnosis. U.S. life digital PCR is more easily applicable Hospital in Valencia, Spain, plans to »P» anel discussion: Should we start to worry?

Visit the Arts & Culture booth in the entrance hall Friedl Dicker-Brandeis, Double portrait Pavel and Maria Brandeis, 1936, Jewish Museum Vienna, inv. no. 13388

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BY KATHARINA MIEDZINSKA Image-guided interventions: a key pillar in cancer care There is hardly any area of where interventional radiology (IR) has not had some impact on patient management. The range of conditions that can be treated using interventional radiology techniques is continually expanding.

In today’s session, experts will tional radiology. Sub-specialisation entire spectrum of interventional provide an insight into image- in interventional oncology is likely oncology that is necessary for them guided interventions in oncology to increase and has substantial to be dependable partner for oncol- with a particular focus on illustrat- advantages, as it provides a clear ogists, surgeons, hepatologists, urol- ing the importance of quality assur- path for referrals and makes it eas- ogists or radiation therapists. Fur- ance in image-guided oncological ier for interventional oncologists thermore, there is still a relatively interventions and their effect on to participate fully at multidiscipli- low level of evidence of clinical tri- treatment outcomes. nary meetings,” said Adam. als within interventional oncology. In recent years, IR has played a In his presentation, Adam plans A lot of international studies pro- vital role in the field of oncology, to highlight the importance of vide levels of evidence that remain and alongside medical, surgical and clinical practice in image-guided lower than those usually encoun- radiation oncology it constitutes a interventions in oncology and to tered in oncology. Additionally, in A C key pillar in cancer care. Vascular outline the related curriculum that some European countries, a certain and non-vascular procedures such is being developed. level of competition between med- Case No 1: A) Colorectal liver Case No 1: C) Colorectal liver metas- as transarterial chemoembolisa- “The curriculum will focus on the ical disciplines restricts the devel- metastasis, 3D-planning prior tasis, first control at follow-up with tion, radiofrequency ablation (RFA), basics of the biology and physiol- opment and the establishment of to thermal ablation. MR imaging showing a complete microwave ablation, radioembolisa- ogy of cancer and the essentials of interventional treatments in stand- necrosis with granulomatous rim. tion, cryoablation and high-inten- medical, surgical and radiation ard algorithms. Finally, perform- sity focused ultrasound (HIFU) are oncology, as well as on the advanced ing large clinical studies remains delivered locally, minimise damage understanding of interventional challenging without the support of to nearby tissue and avoid the sys- radiological procedures employed large pharmaceutical companies,” temic side effects of chemotherapy. in the treatment of cancer patients,” explained Pereira. For the interventional radiolo- said Adam. Also in this session, Prof. Eric de gist providing oncologic therapies Following Adam’s presentation, Kerviler, from the Department of it is essential to understand the Dr. Lizbeth Kenny, from the Divi- Radiology at the Saint-Louis Hospi- rapidly changing field of oncology sion of Oncology at the Royal Bris- tal in Paris, will provide an update and to have a broad knowledge bane and Women’s Hospital in Aus- on how molecular imaging and of oncologic diseases and availa- tralia, will discuss the importance image fusion are shaping oncology ble therapies to treat them. Radi- of quality in image-guided inter- and will also summarise the main ologists providing image-guided ventions in oncology and the con- developments in molecular imaging. interventions in oncology have tent of practice standards, which B an outstanding understanding have been developed by the Cardi- of imaging as well as a diversity ovascular and Interventional Radi- Case No 1: B) Colorectal liver metastasis, of interventional skills. How- ological Society of Europe (CIRSE) 2D-positioning of the microwave antenna. ever, they lack formal training in for that purpose. The 14 standards, oncology and an understanding which have been broadly divided of chemotherapy and radiother- into three areas, including facility apy, according to Prof. Andy Adam management, treatment planning from the Department of Radiology and delivery, and safety and quality at Guy’s and St. Thomas’ Hospital management, will support quality in London. care for patients in the future. A “Insufficient knowledge of medi- Prof. Philippe Pereira, from the cal, surgical and radiation oncology Clinic of Radiology, Minimally Inva- Case No 2: A) Colorectal lung and the unwillingness to practise sive Therapies and Nuclear Med- metastasis before CT-guided as a clinician are currently, among icine at SLK-Kliniken Heilbronn, microwave ablation. others, the biggest challenges for Germany, on the other hand, will interventional radiologists working look at a different angle in his talk. in the field of cancer care. Practis- He will specifically outline the evi- ing as a clinician makes it easier for dence base for image-guided inter- the interventional radiologist to ventions in oncology as well as prepare the patient appropriately, major current trials and registries. to obtain true informed consent “High-quality guidelines are nec- and to ensure adequate follow up. essary for a structured knowledge It is very important to consider transfer. Evidence-based guidelines the patient and not the image,” serve as a basis for the optimisa- he emphasised, adding that inter- tion of disease management pro- B ventional radiologists practising grammes and for the definition of in this field need to take primary quality indicators, which are being Case No 2: B) Colorectal lung clinical responsibility for their own used for the certification process metastasis, 3D-positioning of the patients before and after a proce- of comprehensive cancer centres,” microwave antenna before starting dure, as well as during it. he said, emphasising that evi- with thermal ablation. According to Adam, this is the dence-based guidelines and stand- Special Focus Session only way to ensure that inter- ard operation procedures are an ventional radiological proce- important tool for the medical com- Wednesday, March 1, 16:00–17:30, Room F2 dures are put in perspective in munity in general, but especially SF 4a Image-guided interventions in oncology: relation to other potential meth- for oncology, a discipline for which the pieces of the jigsaw ods of treatment; that complica- multidisciplinarity and combined tions are treated effectively and therapies are essential for treat- »» Chairman’s introduction promptly; and that recurrent or ment success. J.I. Bilbao; Pamplona/ES residual tumours are detected and “Nevertheless, it must be noted »H» ow molecular imaging and image fusion are shaping oncology re-treated appropriately. Further- that apart from hepatocellular E. de Kerviler; Paris/FR C more, he sees a problem in the lack carcinoma and more recently for »R» egistries, trials and the evidence base of sub-specialisation. colorectal cancers, international rec- P.L. Pereira; Heilbronn/DE “It is a disadvantage when com- ommendations of expert societies Case No 2: C) Colorectal lung metas- municating with physicians of do not seem to recognise the real tasis, controlling after microwave »» Clinical practice: why it matters and how to do it other medical disciplines. The inter- value of interventional oncology ablation showing a surrounding A. Adam; London/UK ventional oncologist should under- due to many reasons. The expertise ground glass opacity reflecting a »» Quality assurance: an essential development stand the disease and be familiar for these treatments is still limited; complete coagulation of the tumour. L.M. Kenny; Brisbane/AU with treatment alternatives other only a few hospitals have radiol- (All images provided by Prof. »P» anel discussion: What will be the future of image-guided than those offered by interven- ogy departments that can offer the Philippe Pereira) interventions in oncology? myESR.org #ECR2017 12 CLINICAL CORNER ECR TODAY | WEDNESDAY, MARCH 1, 2017

BY KATHARINA MIEDZINSKA Experts to provide insights into the management of pelvic pain in women

nant patients point by point and the patient and operator; its effi- more importantly on gynaecologi- “MRI plays a crucial role in assess- explain how to recognise various ciency may be limited in patients cal causes, including endometriosis, ing women with chronic pelvic pain, emergencies of the female pelvis. who are uncooperative due to suf- adenomyosis, leiomyomas and adhe- especially in regard to diagnosing Gynaecological causes of pel- fering from excessive pain, as well as sions, which often result from pelvic endometriosis, the most common vic pain span a broad range from due to inexperienced investigators, inflammatory disease, as she noted. cause of chronic pelvic pain in functional ovarian cysts, a com- for example. CT enables the assess- The ambiguity about what con- women of childbearing age. In gen- mon source of acute pelvic pain, to ment of the entire abdomen within stitutes chronic pelvic pain makes eral, it is helpful in identifying dif- adnexal torsion, ectopic pregnancy, a very short time, and therefore is appropriate evaluation, diagno- ferent causes of chronic pelvic pain, endometriosis, adenomyosis and also often performed in patients sis and management challenging. however, these need to be set into pelvic inflammatory disease (PID), with acute pelvic pain, especially to Besides pelvic, musculoskeletal and the proper clinical context to ensure a sexually transmitted infection exclude non-gynaecological causes other examinations, imaging plays optimal patient care,” Forstner said, ascending from the cervix to the of non-specific abdominal pain. MRI an important role in the diagnosis adding that in patients with pelvic upper genital tract with subse- offers a possibility to overcome some and the management. Ultrasound congestion syndrome, ovarian vein quent infection that can involve of the drawbacks of ultrasound and (transvaginal, rectal, transperineal, embolotherapy may also be offered. the endometrium, fallopian tubes, CT, as it enables the assessment of combined rectovaginal), which aids Finally, Dr. Mike Weston, from ovaries and peritoneum. the entire abdomen within a few in the diagnosis of various causes of the Department of Radiology at St. The clinical presentation may minutes without ionising radiation chronic pelvic pain and which is usu- James’s University Hospital, Leeds, be unspecific and in some cases and provides sensitivity similar to ally the first imaging modality used UK, will speak about causes of pel- the differential diagnosis between that of CT. to identify fibroids, focal adenomyo- vic pain specific to pregnancy. Dur- A 31-year-old woman with deep endo- lower abdominal and pelvic pain During his talk, Manfredi intends sis, and to rule out other pelvic and ing his talk he especially plans to metriosis involving the posterior for- may be difficult, as acute pelvic pain to explain how to optimise MRI adnexal masses; MRI, which can be illustrate how pregnancy alters the nix and adjacent rectum, suffering may exist in the absence of a gynae- of the female pelvis in patients invaluable for obtaining a detailed way imaging is undertaken and to from chronic pelvic pain aggrava- cological cause, for instance due to with acute pelvic pain and to and relatively high-resolution look familiarise ECR delegates with the ting during menstruation. (Provided urological, gastrointestinal or neu- illustrate how to optimise image at soft issue; and CT, which is useful increasing role that MRI can play. by Prof. Rosemarie Forstner) rological causes. interpretation to narrow the differ- in patients with pelvic masses and Because of the clinical history, ential diagnosis. might be helpful in differentiating In a Special Focus session today frequently occurring nonspecific In the second part of today’s ses- an ovarian from an uterine mass, on female pelvic pain, three experts physical examination findings, and sion, Prof. Rosemarie Forstner, from are all of particular importance will illustrate the most frequently the clinical presentations of the the Department of Radiology at within this clinical setting. encountered gynaecological dis- underlying gynaecological, obstet- Paracelsus Medical Private Univer- eases responsible for acute and ric, urological, and gastrointestinal sity Salzburg, Austria, will discuss chronic pelvic pain, with the aim conditions that often vary widely the prevalence and the etiologies of Special Focus Session of raising awareness among radiol- and frequently overlap, acute pelvic chronic pelvic pain. Chronic pelvic ogists of how to ensure adequate pain can represent a major diagnos- pain, which is defined as pain occur- Wednesday, March 1, 16:00–17:30, Room M 2 patient care and management of tic challenge. ring below the umbilicus that lasts SF 4b The female pelvis gynaecological conditions. Imaging plays an increasing role for at least six months, is a common Acute pelvic pain in women is in the emergency setting, as it helps problem, presenting a major chal- »» Chairman’s introduction a common clinical presentation clinicians to diagnose acute gynae- lenge to healthcare providers due R.A. Kubik-Huch; Baden/CH necessitating urgent medical evalu- cological pathologies and to guide to its often unclear etiology and »A» cute pelvic pain ation. The duration of acute pelvic treatment, either medical or surgical. complex natural history. Similar to R. Manfredi; Rome/IT pain may range from several hours For the initial diagnostic imaging acute pelvic pain, its causes may be »» Chronic pelvic pain to several days. Prof. Riccardo Man- evaluation, ultrasound is the modal- of gynaecological and non-gynaeco- R. Forstner; Salzburg/AT fredi, from the Department of Radi- ity of choice. High-frequency endo- logical nature. In her talk, Forstner »P» ain in pregnant women ology at the University of Rome – vaginal transducers allow excellent plans to focus on musculoskeletal M. Weston; Leeds/UK Policlinico ‘A. Gemelli’, Italy, plans to anatomic depiction and pathologic pain disorders such as sacroileitis, go over the underlying aetiologies characterisation. However, ultra- insufficiency fractures, gastrointes- »P» anel discussion: The management of pelvic pain: is imaging of acute pelvic pain in non-preg- sound is highly dependent on both tinal and genitourinary causes, but always needed?

BY ADELARD DE BACKER Observational study on the incidence of NSF in patients with renal impairment

Considering the very low risk major risk factors for NSF are the thought to be the trigger for NSF. of inducing nephrogenic systemic use of high-dose and specific gado- In patients with renal insuffi- The gadolinium ions which enhance fibrosis (NSF) with the use of a mac- linium-based contrast agents and a ciency, the excretion half-life is pro- the signals in MR images are very rocyclic gadolinium-based contrast pro-inflammatory state. longed, allowing more time for expo- toxic, so in the contrast medium agent and the high diagnostic accu- There are differences in the inci- sure to GBCA. The exact mechanism molecule they have to be strongly racy of MRI, it appears beneficial dence of NSF with the different by which NSF develops after gad- interact with tissue macrophages. attached to a chelate to avoid for a patient with advanced kidney GBCA, which appear to be related olinium exposure has been related Once in tissues, a cascade of events adverse effects. The linear chelate disease to undergo a well-indicated to differences in physico-chemical to endogenous cations, such as iron ensues that may lead to the develop- molecules are open chains which enhanced MRI examination. properties and stability. Gadolinium (Fe3+), inducing gadolinium to disso- ment of fibrosis and NSF. can fold and unfold off the gadoli- NSF is a progressive, potentially chelates for MRI can be composed ciate from its chelate (dechelation or Because of the lack of effective nium ion with ease. In contrast, the fatal, multi-organ system fibrosing linearly with a chain-shaped chelate transmetallation). In plasma, cations treatment for NSF, prevention is macrocyclic chelate molecules disease related to exposure of molecule or macrocyclically with bind to the chelate portion of the important. Careful evaluation of are rigid rings of almost optimal patients with renal failure to some a ring-shaped chelate molecule. GBCA and Gd3+ binds to available renal function is mandatory in size to cage the gadolinium ion. gadolinium-based contrast agents Macrocyclic gadolinium chelates, anions, such as phosphate, carbonate every patient with renal insuffi- Experimental data, both in vitro (GBCA) used in MRI. Patients with which are pre-organised rigid rings and hydroxide, to form insoluble ciency before GBCA exposure. If and in vivo, and clinical observa- severe renal insufficiency, a glomer- of almost optimal size to cage the salts. This process may lead to pro- MRI using GBCA is well indicated tions, have confirmed the lower ular filtration rate (GFR) less than gadolinium ion, show high stability. longed exposure to biologically active for patients with renal insuffi- stability of the linear gadolinium- 30 mL/min/1.73m2, and patients The stability of the gadolinium che- gadolinium and potentially result in ciency, care should be taken to use based molecules compared to the with acute kidney injury with a lates influence the quantity of gad- toxicity. This gadolinium may pass agents with the lowest risk for NSF more stable macrocyclic agents. GFR of more than 30 mL/min/1.73 olinium released from the chelate from the intravascular space to the (see www.ESUR.org – ESUR guide- m2 are at increased risk. Additional in the body. This free gadolinium is extravascular space where it may lines on contrast media).

#ECR2017 myESR.org ECR TODAY | WEDNESDAY, MARCH 1, 2017 CLINICAL CORNER 13

I will present an ongoing world- For several diseases, the diagnostic sidering the very low risk of induc- wide post-marketing study in which efficacy of MRI is superior to other ing NSF with the use of macrocyclic Scientific Session patients with at least moderate renal imaging procedures, such as con- GBCA and the high diagnostic accu- impairment, scheduled to undergo trast-enhanced CT. The risk of devel- racy of MRI, it appears beneficial Wednesday, March 1, 10:30-12:00, Room N a routine contrast-enhanced MRI oping NSF in patients with severe for a patient with advanced renal SS 207 Kidney and urinary tract I using a macrocyclic non-ionic GBCA renal insufficiency after exposure to disease to undergo a well-indicated Moderators: G .P. Krestin; Rotterdam/NL ® (gadoteric acid, Dotarem , Guerbet, a macrocyclic agent is close to zero. enhanced MRI examination using a R. Salvador; Barcelona/ES France), are included and followed Although NSF may be a devastating macrocyclic GBCA. up within two years. The incidence disease, contrast-induced nephrop- »O» bservational study on the incidence of nephrogenic systemic of NSF is being evaluated and inter- athy is also a serious complication Dr. Adelard De Backer is a fibrosis in patients with renal impairment following gadoteric mediate data analysis shows no and is associated with increased radiologist at General Hospital acid administration cases of NSF. morbidity and even mortality. Con- Sint-Lucas, Ghent, Belgium. A.I.B. De Backer; Ghent/BE

BY VIVIENNE RAPER Can radiology ever be more like widget manufacturing? Prof. Christoph Wald from Boston Prof. Dr. Wieland Sommer from will speak about quality manage- Munich chairs today’s session on Radiologists could adopt the systematic quality ment for radiology reports. structured reporting. control methods of the manufacturing industry, must re-familiarise themselves with that most of his colleagues want to the case, add an addendum to the gravitate to the median behaviour above and beyond the use of structured reporting. report, and spend 20 minutes fix- for their peer group. ing a problem that they could have Chairing the session, Prof. Dr. That’s the belief of Prof. Christoph Wald, chairman quickly solved at the time. Wieland Sommer, head of onco- “Our radiologists appreciate logic imaging at Großhadern Hospi- of radiology at Lahey Hospital & Medical Centre and being told in real time that some- tal, Ludwig Maximilian University thing is missing, and the majority in of Munich, Germany, aims to intro- professor of radiology at Tufts University Medical our practice are positively disposed duce some of the pros and cons of to this,” he said. implementing different forms of School in Boston, U.S. Another novel use of the NLP structured reporting. engine is analysing in real time A major obstacle is that some how much time radiologists spend radiologists feel limited by strict reporting each examination. The reporting software. Many of them main benefit is economic because want to discuss their findings in the salary of radiologists is one of their own words, in free text, he the biggest costs to the practice. explained. They can feel forced into In one analysis, Wald’s team looked choosing a certain category when at CT angiographies of the head and there are contraindications in the neck. While five radiologists took an examination. Moreover, introduc- average of 31 minutes to read each ing structured reporting can slow examination, the sixth took an hour down workflow because a typical and 12 minutes. This prompted a con- radiologist can dictate a free text Each dot is a radiologist in training. Each dot is a neuroradiologist. Data Data show the decrease in median versation with that radiologist, rais- report in minutes. Colours denote training year. Data shown are CT angiography of the dwell time by training year of trainee ing the prospect of offering training Sommer wants the session to shown are for fiscal year 2016. As head and neck exams for fiscal year radiologists, which can be inter- or asking the individual to focus on cover various initiatives on struc- trainees progress, their annual 2016. Median dwell time for inter- preted as being due to increasing other types of examination. tured reporting. These include the report volume goes up (x-axis) and pretation of this complex exam is 31 proficiency. The statistics can be The group is also analysing the joint initiative between the Euro- the median dwell time (time it takes minutes. One radiologist is an outlier further broken down by modality, length of reports and how many pean Society of Radiology (ESR) to report) goes down. The initial in- who takes 1:12h on average. and even exam code, with the aim of negative (and positive) findings and and Radiological Society of North terpersonal variation also goes down discovering room for improvement filler words are contained in each. America (RSNA). over time due to training. and monitoring progress. If there are too many negative find- ings per report, its value decreases. “Radiologists need to care more mismatches between radiology this is required. For the first time, Again, radiologists can be made about the integrity of the work reports and the gender in the elec- he can systematically look across aware that their reporting habits product we put into the world, tronic health record (EHR). It can the entire 360,000 reports from his differ from the average. Wald says namely our radiology report,” he identify in real time where, for core practice and see for a pros- told ECR Today in a pre-congress instance, the report is of a prostate tate MRI, for example, how many interview. “The flaw in the current but the patient’s gender is recorded people used the language and how Professional Challenges Session setup is radiologists act like a pro- as female. This can be an error in many didn’t. Where radiologists are fessional services manufacturing the report or the EHR, and finding non-compliant, this can be brought Wednesday, March 1, 16:00–17:30, Room G hybrid, putting out hundreds of this type of error in the EHR can to their attention, and training pro- PC 4 Design and implementation of structured reporting thousands of widgets a year with- help stop a male patient receiving a vided where necessary. out systematically looking at them.” reminder to attend a mammogram. In the future, the intention is to »» Chairman’s introduction Systematic quality control is long Wald says the system also prevents check compliance in real time. The W.H. Sommer; Munich/DE accepted in the manufacturing the potentially embarrassing, acci- system would spot that a radiol- »» Beyond templates: modular multilingual structured reporting industries, but less so in profes- dental inclusion of wrong gender ogist hadn’t, for example, run the M. Fatehi; Tehran/IR sional services such as radiology, organs in the radiologist dictation, required macro for reporting a »» Introducing quality management for radiology reports according to Wald. which can result from voice recog- prostate and could flag this up. C. Wald; Boston, MA/US In today’s session, he plans to nition errors and the use of tem- One advantage is that some issues »» Structured reporting: two decades of surveys and subcommit- discuss how a natural language plated language. with the report are corrected before tees, but what do we wish to achieve? processing (NLP) engine is helping The engine is now being used to it enters the clinical environment, J.M.L. Bosmans; Ghent/BE his practice ensure its radiology check whether radiologists in his Wald explained. This avoids the reports are of consistent quality. practice are using structured lan- ‘dreaded e-mail’ whereby radiologists »P» anel discussion: Structured reporting in ten years: large-scale The system is used to flag gender guage to report on images, where are told they have missed something, or fairy-tale?

myESR.org #ECR2017 14 CLINICAL CORNER ECR TODAY | WEDNESDAY, MARCH 1, 2017

BY JOHN DAMILAKIS AND DAVID LURIE CT Refresher Course to provide early morning energy boost

respects) is the approach of using of low energy and high energy data References dual x-ray sources, mounted on (see Figure). the same gantry but orthogonal Patient radiation dose and 1 McCullough CH et al. Dual- and to one another. The tube potential associated risks are always areas multienergy CT: principles, tech- of the sources can be controlled for concern. Initial studies have nical approaches, and clinical independently, allowing truly shown that dual-energy CT deliv- applications. Radiology 2015, simultaneous dual-energy CT to be ers higher doses to patients than 276, 637-653. accomplished1. The disadvantage single-energy CT5. However, more 2 Genant H and Boyd D. Quantita- here is that data recorded by one recent publications have shown tive bone mineral analysis source-detector pair may be cor- that dual-energy CT is associated using dual-energy computed rupted by scattered photons arising with patient doses similar to those tomography. Invest. Radiol. 1977, from the other x-ray source. The received during single-energy CT6. 12, 545-551. latest technology for dual-energy However, it should be stressed that 3 Kalender WA et al. Evaluation (or indeed multi-energy) CT makes limited information on this is avail- of a prototype dual energy use of so-called photon-counting able in the literature at present; dif- computed tomographic detectors1,4. These make use of a ferences in acquisition techniques apparatus. I. Phantom studies. single x-ray source, but the detec- have important implications on Med. Phys. 1986, 13, 334–339. tors are able to discriminate the patient radiation doses and further 4 Shikhaliev PM, Fritz SG and energies of photons, so allowing studies are needed to fully investi- Chapman JW. Photon counting them to contribute to separate gate this topic. multienergy x-ray imaging: reconstructed images, effectively effect of the characteristic x rays obtained at a range of kV values. John Damilakis is Professor of on detector performance. Med. Although energy-discriminating Medical Physics at the University Phys. 2009, 36, 5107–5119. Axial images demonstrating simultaneous dual-energy CT acquisitions solid-state detectors have been used of Crete, Greece, and is President 5 Ho LM et al. Dual-energy including the 100kVP source image from tube A, 140 kVP image from tube B, in for some time, of the European Federation of versus single-energy MDCT: the mixed 100/140 kVP image and the perfusion blood volume (surrogate for their employment in CT had to wait Organisations for Medical Physics measurement of radiation dose pulmonary perfusion). The window level and width for all four images were for improvements in technology, (EFOMP); he will chair the refresher using adult abdominal imaging the same. The lower kilovoltage (100 kVP ) image clearly demonstrates increa- especially as regards the ability to course. protocols. Acad. Radiol .2009, 16, sed iodine conspicuity and may be of added value for better depiction of the cope with the very high exposure David Lurie is Professor of 1400-1407. peripheral embolus or in circumstances of poor contrast bolus tracking. rates used in CT. Biomedical Physics at the 6 Henzler T et al. Dual-energy CT: Case courtesy of Dr. Charlie Chia-Tsong Hsu, Radiopaedia.org, rID: 31363. Dual-energy CT was clinically University of Aberdeen, UK; he is Radiation dose aspects. AJR 2012, endorsed after the introduction of Chair of the Physics in Radiology 199, S16-S25. Dual-energy computed tomogra- CT was developed by Genant and dual-source CT systems in 2006. Subcommittee of ECR 2017. phy (CT) was first proposed in the Boyd in 19772. Using a conventional Now, the latest CT technology allows 1970s, but it is only now that it is CT scanner, two scans were carried simultaneous image acquisition at beginning to find widespread clini- out, one after the other, at differ- two or more energies, making the cal use, as a result of improvements ent kV settings. This technique method applicable and useful in a in CT technology. The main bene- was not very successful due to the variety of clinical applications. fit of dual-energy CT arises from high radiation dose, image regis- Dual-energy CT offers superior the fact that x-ray attenuation is tration and other problems. The lesion detection and characterisa- energy-dependent and the form of next key development took place in tion. It is used for detection and Refresher Course the energy dependence varies with the 1980s and made use of a single characterisation of renal stones, atomic number. CT images obtained x-ray source, the kV of which could renal masses and liver lesions, in Wednesday, March 1, 08:30–10:00, Room G at two energies (i.e. two kV values of be switched rapidly between two oncologic imaging, in vascular RC 113 Single-dual-multi-energy CT the x-ray beam) can therefore be values during the scanning proce- imaging and in metallic implant used to decompose the images into dure; this meant that two CT scans, imaging (artefact reduction). More- »» Chairman’s introduction different materials (e.g. bone and at different tube potential values, over, there are several promising J. Damilakis; Iraklion/GR iodine) in order to better distinguish could be obtained almost simulta- applications under investigation in »» A. Basics of diagnostic dual-energy CT them1. Today’s Refresher Course neously3. The method suffered ini- other areas such as musculoskeletal T. Klinder; Hamburg/DE will provide attendees with essen- tially from the inability to switch and cardiac imaging. Each CT man- »B» . Photon counting detector technology for diagnostic CT tial information about the technol- the tube current quickly enough; ufacturer uses different algorithms I. Blevis; Haifa/IL ogy, methods and applications of later advances in the technology for material decomposition. Thus, »» C. Do we really need multi-energy CT? dual and multi-energy CT. did, however, enable the technique virtual monoenergetic images can S.T. Schindera; Aarau/CH A method for quantitative bone to be used in clinical CT scanners. be created or blended images can mineral analysis using dual-energy More efficient (and simpler, in some be produced using a combination »P» anel discussion: How many ‘energies’ do we need in CT?

RTF MEET & GREET SESSIONS Today, at the RTF Booth in the ESOR & Rising Stars Lounge (M Building) you will be able to meet the following Radiology Trainees Forum (RTF) representatives:

11:00–12:30 Martin Reim (Estonia) 13:30–14:30 Christine Tolman (The Netherlands) 14:30–16:00 Biljana Vujović (Montenegro) 16:00–17:30 Luisa Andrade (Portugal)

Join your European colleagues and representatives in an Join us also at the RTF Quiz with Quizmasters José Cáceres informal and relaxed discussion, exchange opinions and points and José Vilar tomorrow, Thursday, March 2, 12:30–13:30 in of view with them and present your ideas. Take advantage of this Room B (second level) and the RTF Delegates’ Meeting great opportunity! (General Assembly) tomorrow, Thursday, March 2, 16:00–17:30 in Room 0.96/0.97 (entrance level). Don’t miss the Meet & Greet Session with ESR President Paul M. Parizel (tomorrow, Thursday, March 2, 13:30–13:50) For more detailed information please visit the RTF Meeting Point in the ESOR & Rising Stars Lounge in the M Building. in the ESOR & Rising Stars Lounge.

#ECR2017 myESR.org ECR TODAY | WEDNESDAY, MARCH 1, 2017 CLINICAL CORNER 15

BY MÉLISANDE ROUGER ESR and UEMS team up to address EU issues facing radiology In Europe medical practice is heavily influenced by EU policies but radiologists often ignore political issues. This attitude may become problematic as radiology has a delicate position sitting at the crossroads of many medical disciplines. A panel of experts will try to pique radiologists’ interest and show the collaborative work done by the ESR and the European Union of Medical Specialists (UEMS), during a joint session at the ECR.

as the ESR European Training Cur- straints often make it impossible for riculum to promote uniform stand- doctors alone to politically support ards,” Maillet echoed. their interests and follow the work- The UEMS adopted its Charter flow of the EU Council, Commission on Training of Medical Specialists in and Parliament. That’s the reason 1994, with the aim of setting the basis why cooperation with partner organ- for high quality standards in medi- isations and other similar European cal training. Chapter 6 of this charter medical organisations should be is written by each specialist section carefully considered,” he said. to detail and update the essential The ESR has established an EU Prof. Jane Adam, Chair of the ESR Prof. Paolo Ricci, Section President of requirements for adequate training liaison within the ESR Board of Quality, Safety and Standards the UEMS Section for Radiology, will in their particular discipline. Directors and assigned experts Committee, will talk about the focus on the harmonisation of The EU Directive on Professional who are dedicated to European recognition of qualifications. radiology training in Europe in Qualifications will be revised in political dossiers. today’s joint session. 2020. With this deadline in mind, the Furthermore, the society closely ESR and UEMS plan to work to help monitors EU legislation and has The ESR started to work with “In addition to requesting the revise the directive with conditions successfully built relations with rel- Dr. Bernard Maillet, UEMS Treasurer the UEMS (Union Européenne des listing of one specialty only, ‘radi- that better match the reality and evant EU institutions, international and former Secretary General, will Médecins Spécialistes) on EU affairs ology’, we have suggested that the diversity of the European continent. organisations and other stakehold- speak about the position of the UEMS a few years ago. A dedicated office in minimum number of training years “It will be interesting to see how ers over recent years. within the EU in today’s session. the UEMS’s home, known as Domus indicated for radiology should be this issue develops, as with telera- The ESR European Action Plan Medica Europaea and located raised from four to five in order to diology, the issue of cross border for Medical Imaging was launched are not distant occurrences with lit- near EU institutions in Brussels, be in line with the ESR European recognition of qualifications is of at the European Parliament in 2014, tle effect on our professional range was established in 2016 to further Training Curriculum for Radiology,” particular relevance for radiology,” which sets out priorities for action of activities: on the contrary, the enhance this collaboration. said ESR Quality, Safety and Stand- Adam said. in Quality & Safety, Education & impact of EU legislation has heavily Both organisations believe there ards Committee Chairperson, Prof. Within the UEMS, a dedicated Training, Research, and eHealth, influenced our profession. It is not is room for improvement in the EU Jane Adam from London, UK. section for radiology helps radiolo- to improve access to better and at all easy to enter the secret rooms Directive on Professional Qualifica- One of the main elements in the gists to maintain their place in the safer healthcare for citizens, pro- in Brussels and understand current tions (Directive 2005/36/EC, amended 2013 directive, the European Profes- medical team. mote good health, prevent diseases trends while there is still time to cre- by Directive 2013/55/EU), which aims sional Card (EPC) for interested pro- “One of the main aims of the sec- and protect Europe’s citizens from ate joint efforts to manage,” Ricci said. to facilitate cross-border mobility of fessions, aims to facilitate the recog- tion is to ensure radiologists have cross-border health threats. Radiologists need to overcome professionals within the EU. nition of professional qualifications their own space in comparison to Cooperation between the ESR and their geographical, cultural and For starters, in the Directive’s across member states. “The UEMS other medical specialties, whose the UEMS has been successful in the linguistic differences in order to current form, radiology has an was involved in the EPC Steering boundaries and competencies often past and helped achieve a derogation produce a strong unified voice that identity problem, according to Committee and the ESR partici- overlap. That is even more serious for Magnetic Resonance Imaging could summarise national require- UEMS Treasurer and former Sec- pated in the EC Focus Group on the when it comes to evaluating access (MRI) from the limit values for elec- ments and play a decisive role in retary General, Dr. Bernard Maillet EPC. However, the proposal is con- to the profession, because it will tromagnetic fields defined in the guiding EU decision-making pro- from Brussels, Belgium. troversial, and language issues and directly involve patient safety and EMF Directive 2013/35/EU, to ensure cesses, he added. “Radiology is listed as two spe- current differences in radiological quality standards. Some erosion the unimpeded use of the modality cialties in the directive: ‘radiology’ and training across the EU need to be of the radiologists’ profession and, in patient care and research. ‘diagnostic radiology’. The problem is acknowledged,” Adam said. even worse, a fragmentation within All parties hope the ECR ses- that many EU countries usually only To date, the EPC is not available the radiological profession are real sion will help raise awareness of recognise one of these. If you move for medical doctors. risks,” said Section President Prof. European affairs work among from one country to another, the The ESR has highlighted that, with Paolo Ricci from Rome, Italy. radiologists. specialty you are qualified in must or without a professional card, the His team is currently lobbying for a “Doctors still need to become be recognised in the new country in European Training Curriculum for fair definition of the curriculum and aware that EU policy developments order for you to be acknowledged as Radiology (ETCR) and the European of post-graduate medical training. a specialist,” he said. Diploma in Radiology (EDiR), both Another area of great interest for Joint Session Furthermore, the directive only initiatives of the society, demon- the section is Continuous Medical acknowledges training duration, not strate how it is possible to harmonise Education (CME) and Continuing Wednesday, March 1, 16:00–17:30, Room L 8 contents. In medicine, this is just not training and promote uniform pro- Professional Development. Joint Session of the ESR and UEMS enough, Maillet explained. fessional standards in Europe. “That’s another ‘battle’ of Euro- (European Union of Medical Specialists) “We find this approach a little The ESR European Training Cur- pean radiologists: to closely moni- ESR and UEMS: a strong professional partnership simplistic; for instance a surgeon riculum is now endorsed by 66 tor the EU Professional Qualifica- who has only performed appen- national radiology societies and tions Directive and ensure the full »» Chairmen’s introduction dectomies for the past five years 15 subspecialty organisations, and mobility of radiologists and a fair L. Bonomo; Rome/IT can perform every other kind of EDiR is an independent qualification international recognition system of P. Ricci; Rome/IT surgery abroad. So we would really that is proving increasingly popular. CME credits. The Section of Radi- »»Structure of the UEMS and position of the UEMS within the EU like to include skills in the list of “Where individuals achieve the ology is equally involved in the EU B. Maillet; Brussels/BE criteria,” he said. required standard in the diploma, Workforce for Health, Cross-border »» Harmonising radiology training in Europe The ESR has been active in con- this should give employers outside Patient Safety, Personalised Medi- P. Ricci; Rome/IT sultations on drafting Directive their own member state confidence cine and eHealth,” Ricci said. L. Oleaga Zufiria; Barcelona/ES 2013/55/EU, has liaised with the in their professional competence, Influencing EU legislation in national radiology societies who and this could serve as an exam- the healthcare field is particularly »R» ecognition of qualifications are ESR institutional members, ple to other professional groups,” difficult due to strong internal Z. Fras; Ljubljana/SI and, alongside the UEMS, broadly Adam said. debate in the medical community E.J. Adam; London/UK supports the Directive’s aims. How- “Having a European exam that and profound discrepancies in the »C» ontinuing professional development (CPD) ever, the ESR agrees that quality reflects high quality is a guarantee. functioning of national healthcare M. Adriaensen; Heerlen/NL contents of training, along with cul- The main advantage of EDiR is that systems, he explained. D. Negru; Iasi/RO tural differences between member it is a neutral examination, and we “Not only is the terrain steep, but »» Questions states, should not be overlooked. fully support this initiative as well also time and geographical con-

myESR.org #ECR2017 16 CLINICAL CORNER ECR TODAY | WEDNESDAY, MARCH 1, 2017

BY BYUNG GEON PARK AND SEUNG HYUN CHO Rectal cancer: modified three- point MRI-predicted TRG incorporating DWI

Since preoperative chemoradio- analyse tumour changes, especially who underwent PCRT followed by ease-free survival (DFS) rate depend- prognosis to PCRT prior to surgery. therapy (PCRT) followed by a total in differentiating radiation fibrosis surgery, were enrolled to evaluate ing on the modified MRI-predicted Detailed results will be presented mesorectal excision has been estab- from residual viable tumours based the prognostic relevance of a mod- TRG. The modified MRI-predicted in our ECR 2017 scientific session. lished as the standard treatment in on T2WI alone. To make MRI-pre- ified three-point MRI-predicted TRG was independently associated patients with locally advanced rec- dicted TRG readily acceptable and TRG incorporating DWI. Two expe- with the three-year DFS. Interest- Byung Geon Park, MD is a resident tal cancer (LARC), many investiga- up-to-date, image interpretation rienced radiologists independently ingly, ymrT staging which has been in radiology at Kyungpook tors have tried to predict treatment must be simplified. reviewed pre- and post-CRT MRIs always used in routine radiologic National University Hospital in response to PCRT prior to surgery. Recently, many studies and evaluated MRI-predicted TRG reports was not an independently Daegu, Korea The identification of treatment have demonstrated that diffu- based on T2-weighted images and associated factor. Overall, the Seung Hyun Cho, MD, PhD is response to PCRT may help opti- sion-weighted imaging (DWI) high b-value DWIs (0, 1000 s/mm2) results indicated that a modified associate professor of radiology at mise individual treatment strategies enhances clinical response assess- using the following grades: Grade three-point MRI-predicted TRG Kyungpook National University such as consolidation of chemo- ment over T2WI for LARC after 0, good regression (no obvious incorporating DWI can provide Chilgok Hospital in Daegu, Korea. therapy or the deferral of surgery. PCRT. This might be because DWI tumour signal intensity on T2WI additional information beyond Although the pre-existing five-point, produced higher lesion-to-back- and DWI, corresponding to the classical yTNM staging and may MRI-predicted tumour regression ground contrast, which allowed preceding five-point MRI-predicted be used as a surrogate for expected grade (MRI-predicted TRG) based easier image interpretation. In addi- TRG 1); Grade 1, intermediate regres- on qualitative analysis of MRI-pre- tion, previous studies have reported sion (dominant fibrosis outgrowing Scientific Session dicted tumour change between that quantitative tumour volum- residual viable tumour; regressed pre- and post-chemoradiotherapy etry based on DWI is significantly area > 50%,corresponding to the Wednesday, March 1, 10:30-12:00, Room C (CRT) T2-weighted images (T2WIs) correlated with histopathologic preceding five-point MRI-predicted SS 201b Rectal cancer: response assessment and diagnostic could be a workable approach that TRG. Given all these factors, we TRG 2 + 3); Grade 2, poor regression biomarkers can be used at the moment, the five- hypothesised that a modified three- (dominant residual viable tumour Moderators: L. Cevasco; Genoa/IT point MRI-predicted TRG has not point MRI-predicted TRG incorpo- with obvious fibrosis; regressed S. Schmidt; Lausanne/CH been widely used in daily practice rating DWI could be easily used as a area ≤ 50%,corresponding to the except in some European countries. surrogate for expected prognosis to preceding five-point MRI-predicted »» A modified 3-point MRI-predicted tumour regression grade This is because it may not be easy PCRT prior to surgery. TRG 4 + 5). incorporating diffusion-weighted image: locally advanced for abdominal radiologists, or even In our retrospective study, 118 The results showed a significant rectal cancer rectal MRI experts, to qualitatively patients with middle/lower LARC, difference in the three-year dis- B. Park, S. Cho, M. Lee; Daegu/KR

BY MARC DEWEY Clinical Trials in Radiology presented today and tomorrow at ECR

Since 2015, the European Con- scientific evidence for imaging tests lectures are given by experts in This year, for the first time, we Marc Dewey is Heisenberg gress of Radiology has been pre- that will change the clinical practice the respective fields and will allow also invited selected CTiR abstracts Professor of Radiology at the senting late-breaking clinical trials of every radiologist in the future. participants to better understand for simultaneous fast-track publica- Charité – Universitätsmedizin in radiology (CTiR) during dedicated CTiR abstracts and lectures will which clinical changes should be tion in European Radiology. Please Berlin, Germany. sessions. The clinical trials selected be presented today, from 12:30 to made based on the CTiR results. check the European Radiology for presentation during the CTiR 13:30, and tomorrow, Thursday, For ECR 2017, we received an website (http://link.springer.com/ sessions are definite highlights in March 2, again from 12:30 to 13:30. all-time high number of CTiR journal/330/onlineFirst/page/1) for the field of radiology and can be Both CTiR sessions will be taking submissions. Of the 124 abstracts the full text of these high-impact expected to have a large clinical place in Room M 1. Each of the clin- submitted, the independent CTiR clinical trials. impact. All attendees of ECR 2017 ical trials in radiology presented evaluation committee selected The CTiR sessions will be mod- should consider joining the CTiR during these two sessions is accom- eight abstracts in a blinded review erated by Richard Baron and sessions, which will again present panied by a short lecture. These process for the two CTiR sessions. Marc Dewey.

Clinical Trials in Radiology Sessions Clinical Trials in Radiology Sessions

Wednesday, March 1, 12:30–13:30, Room M 1 Thursday, March 2, 12:30–13:30, Room M 1 Clinical Trials in Radiology (CTiR) 1 Clinical Trials in Radiology (CTiR) 2 Moderators: R.L. Baron; Chicago, IL/US Moderators: R.L. Baron; Chicago, IL/US M. Dewey; Berlin/DE M. Dewey; Berlin/DE »N» ew insights into preoperative breast magnetic resonance »N» on-invasive treatment of osteoid osteoma with MRgFUS in imaging (MRI) from the multicentre individual patient analysis paediatric patients only: a retrospective multicentre study (MIPA) study F. Arrigoni; L’Aquila/IT R.M. Trimboli; San Donato Milanese/IT Discussant: L.-S. Ording Muller; Oslo/NO Discussant: E.M. Fallenberg; Berlin/DE »» Iodixanol versus iopromide in contemporary coronary CT »» The MICRA trial: Minimally Invasive Complete Response angiography: lumen opacification and effect on heart rhythm Assessment of the breast after neoadjuvant systemic therapy in the randomised IsoCOR trial M.E.M. van der Noordaa; Amsterdam/NL M.M. Lubbers; Rotterdam/NL Discussant: F.J. Gilbert; Cambridge/UK Discussant: G.A. Krombach; Giessen/DE »» The MULTIPROS study – Multiparametric MRI with »C» omparison of pretest probability with prevalence of subsequent randomisation to MRI/US fusion guided biopsy obstructive coronary artery disease using invasive coronary vs TRUS biopsy in the diagnosis of prostate cancer angiography or computed tomography angiography M.J. Szewczyk-Bieda; Dundee/UK S. Feger; Berlin/DE Discussant: P. Asbach; Berlin/DE Discussant: C. Loewe; Vienna/AT »»Study design and inclusion ROBINSCA trial: large-scaled »» Diagnostic value of novel MRI techniques for the primary population based (CT) screening trial for cardiovascular disease staging and restaging of rectal cancer: multicentre study M. Vonder; Groningen/NL D.M.J. Lambregts; Amsterdam/NL Discussant: M. Francone; Rome/IT Discussant: U. Attenberger; Mannheim/DE

#ECR2017 myESR.org ECR TODAY | WEDNESDAY, MARCH 1, 2017 TECHNOLOGY & RESEARCH 17

EIBIR – helping researchers Clinical Diagnostic ESR participates in European 19 secure EU funding 21 Reference Levels 23 cancer initiatives

BY INGA STEVENS ECR 2017 exhibitors display ultrasound’s 3D capabilities, resilience and adaptability From 3D technology to digital-beam-forming and extended field-of-view images, ultrasound manufacturers continue to strive to deliver better overall image quality, ergonomics, and workflow and more mechanisation of both automated systems and point-of-care machines.

i800 can be used for a range of dif- ferent clinical cases, and includes a high-frequency transducer (24 MHz) and the iDMS active matrix technology that makes it easier for users to image superficial struc- tures and can expand the use of diagnostic ultrasound. The Aplio i-series provides intui- tive ergonomics to boost productiv- ity during daily routine and com- plex exams with iSense, and the systems offer an image-guided user interface to visually guide the clini- cian through the exam to simplify system operation and help improve Spleen vasculature visualised with B-Flow imaging, a visualisation technique efficiency, Toshiba claims. To make that displays the blood flow echoes in grey scale imaging, with different ultrasound exams faster, the sys- grey intensities according to the reflectors speed and dynamics. (Provided tems feature touch-control screens by GE Healthcare) and real-time Quick Scan, which Three-dimensional image of ovarian follicles using inversion technology makes automatic image adjust- on the Aplio i-series i800 machine. (Provided by Toshiba) Samsung’s S-Detect for Breast has friendly solution, the vendor stated. ments without pushing a button. applied a data bank of test results to Its XDclear transducers have been The manufacturer is also pre- shed more light on breast ultrasound. migrated to this platform, report- senting the compact Xario Plati- “Applying data from 10,000 accu- edly resulting in better perfor- num Series, consisting of the Xario mulated breast exams from the mance and penetration on difficult 100 Platinum and Xario 200 Plat- Samsung Medical Center over the to image patients. Also, the system inum. These systems can be used last 20 years to ultrasound imaging, now has an enhanced industrial to carry out various radiological, S-Detect helps radiologists under- design featuring a wide screen dis- obstetric and cardiovascular exams. stand characteristics of breast play and a larger touch screen. The Xario 200 Platinum comes with lesions to determine whether This follows an earlier announce- the added visualisation benefits of they’re malignant or benign in a few ment about the launch of the Toshiba’s Superb Micro-Vascular clicks,” said Doug Kim, communica- pocket-sized, dual-probe device, Imaging (SMI), an ultrasound Dop- tions manager at Samsung Medi- the Vscan Extend. This app-based pler technique that employs an son. “By adopting such a data-based machine can be used in hospitals, algorithm that allows visualisation algorithm in the processes of lesion ambulances, and in rural areas, of minute vessels with slow veloc- segmentation, analysis of charac- making the modality more acces- ity but without having to use a teristics and assessment, healthcare sible. It uses a novel touch screen contrast agent. professionals are now provided and weighs just 406 grams. Aiming Screen capture demonstrates Samsung’s S-Detect for breast ultrasound. with more accurate results with all to build on the success of previous Technical Exhibition (Provided by Samsung) information being made available pocket-sized ultrasound units, the Opening Hours in a single report.” Vscan Extend offers smooth integra- Vendors at ECR 2017 are showcas- tional product manager for ultra- GE Healthcare has reconsidered tion with a hospital’s DICOM sys- Thursday, ing new and upgraded ultrasound sound at Hitachi. “The resulting virtually every element of the imag- tems to complement existing docu- March 2 to Saturday, March 4: devices that aim to enable users to throughput, efficiency, and patient ing chain, from the pulse of the mentation and reporting solutions 10:00–17:00 make more of the technology, but comfort make Sofia the ideal solu- probes to the clarity of the pixels on along with cloud-based image stor- are also more affordable. tion for women with dense breasts.” the display. The Logiq E9 XDclear 2.0 age and communication, GE stated. Sunday, March 5: Hitachi Medical Systems is Meanwhile, Samsung is intro- system, which was originally show- Elsewhere in the technical exhibi- 10:00–14:00 demonstrating its full product line, ducing its latest contrast-enhanced cased at ECR 2016, now combines tion, Toshiba Medical is introducing and is introducing the Sofia 3D innovation, CEUS+. Its automatic this probe technology with the the Aplio i-series ultrasound plat- breast ultrasound system to a Euro- brightness-control feature opti- XDclear platform. This platform is form. The Aplio i-series is a scalable pean audience. Powered by the pre- mises imaging in real-time, provid- built on the Agile Acoustic Architec- ultrasound device that includes mium Arietta platform, the product ing users with enough time to make ture, the XDclear processing engine iPerformance technologies and captures a 3D volume dataset for an a diagnosis, according to a com- and a widescreen display. reportedly delivers extreme process- entire breast in only 30 seconds. The pany statement. The product also For a variety of patient cases, GE ing power and allows healthcare data for each breast are then sent to improves the diagnosis of small is also showing a portfolio of ultra- providers to do and see more, faster. the radiology workstation as a single lesions, and its clear expression of sound hardware and software prod- Toshiba’s beam-forming product, 3D volume where review tools ena- tissue boundaries helps users to ucts, including the Logic S7 ultra- iBeam, seeks to optimise the effi- ble shortened interpretation times. achieve interventional procedures sound unit with XDclear, which is ciency of the beam, and is designed “By presenting radiologists with with ease and accuracy, it adds. designed to provide better images, to increase penetration, spatial res- a single dataset per breast, Sofia The company is also demonstrat- enhanced ergonomics, and innova- olution, and contrast resolution, streamlines the interpretation pro- ing extra features on its premium tive tools to improve workflow and while at the same time reducing cess,” said Anne-Laure Jet, interna- system, the RS80A with Prestige. patient throughput in a budget- artefacts and clutter. The Aplio myESR.org #ECR2017 18 TECHNOLOGY & RESEARCH ECR TODAY | WEDNESDAY, MARCH 1, 2017

BY STEPHEN HOLLOWAY Staff Box Editorial Board

ESR Executive Council

Katrine Riklund, Umeå/SE Chairperson of the ESR Board A step closer to Doc of Directors Paul M. Parizel, Antwerp/BE President Bernd Hamm, Berlin/DE McCoy’s favourite toy? 1st Vice-President Lorenzo E. Derchi, Genoa/IT The idea of hand held ultra- cols, on-field for let device, with the scanning soft- ing and user support will certainly 2nd Vice-President sound (HHUS) is not a new one, musculoskeletal damage assess- ware downloaded as an app. Some drive greater penetration than early Luis Donoso, Barcelona/ES with first-generation systemsment and even vascular line place- systems are also now wireless, fur- releases. Additionally, combination Past-President being available for almost a dec- ment. In addition, there has been ther adding to the flexibility of use. of ultrasound with smart electronic Boris Brkljačić, Zagreb/HR ade. These first devices were a a greater push from vendors on More adaptability hardware also opens the potential for Communication and External Affairs marvel in shrinking ultrasound user-education. As a significant Probe design has also evolved sharing ultrasound images between Committee Chairperson technology into a smart-phone proportion of second-generation showcased by ‘dual-probe’ models, physicians or patient records, regard- Paul M. Parizel, Antwerp/BE sized device. They also prompted a HHU is based on smart-phone or combining two transducers within less of location. HHUS can also ECR 2017 Congress Committee media scrum of headlines boasting smart-tablet hardware, the abil- a single probe housing (most com- play a role in driving ultrasound in Chairperson that all physicians would shortly ity to quickly download training monly linear and phased array). telemedicine, allowing use in more Bernd Hamm, Berlin/DE be wielding hand-held Star Trek modules is far simpler than with This increases the diagnostic capa- remote or out-of-clinic locations. ECR 2018 Programme Planning ‘medical tricorders’ capable of conventional ultrasound. This can bility of the system to cater for a However, do not expect every Committee Chairperson on-the-spot diagnosis for all man- therefore help in driving adop- wider array of clinical uses with- to be carrying one in the Laura Oleaga, Barcelona/ES ner of conditions. tion in non-traditional ultrasound out the need to swap transducers next few years. Ultrasound use and Education Committee Chairperson Despite the hype, actual adop- user bases and into wider general between or during exams. interpretation, as is often discussed Michael Fuchsjäger, Graz/AT tion of HHUS was weak. Image medical practice. Vendors of HHUS systems are by veteran-users, is a complex art Finance and Internal Affairs quality of early HHUS was poor in More capability also targeting future generations that takes years of experience to Committee Chairperson comparison to other compact and From a technological perspective, of users with focus on training for learn its many and varied nuances. Christoph D. Becker, Geneva/CH cart-based ultrasound system and significant improvements have also students. Online training tutori- While training, simplification and National Societies Committee they were still relatively expensive. been made. Image quality of HHUS als and downloadable content for increased on-device support will go Chairperson Above all, they lacked a clear spec- has been improved from the initial ultrasound will increasingly become some way to solving this, growing Regina Beets-Tan, Amsterdam/NL ificity of clinical purpose, initially first generation offerings, capital- common. Moreover, to mitigate the user expertise in new clinical user Publications Committee Chairperson positioned as a diagnostic tool for ising on advances in smart phone still relatively high cost of these groups and the wider physician E. Jane Adam, London/UK general medicine and general prac- and tablet processing power. In HHU devices, a variety of subscrip- community will require more than Quality, Safety and Standards addition, miniaturisation of system tion and rental models for education Committee Chairperson tice, two areas where physician just better HHUS systems. capability and training for ultra- and probe technology has allowed and training users are emerging. Olivier Clément, Paris/FR sound use is limited at best. a variety of designs, exemplified by A step in the right direction Stephen Holloway is principal Research Committee Chairperson At the same time, ultrasound was ‘system in a transducer’ designs, in It’s clear then that the new wave of analyst and company director Catherine M. Owens, London/UK undergoing a quiet revolution. Use which all ultrasound hardware is HHUS devices are a great improve- at Signify Research and Allied Sciences Committee Chairperson of ultrasound in applications such cased within the probe body. This ment on first-generation devices. (www.signifyresearch.net), a as anaesthesiology, emergency med- means the transducer can simply be More targeted functionality, sys- health tech, market-intelligence Nicholas Gourtsoyiannis, Athens/GR Director of the European School icine and critical care was proliferat- plugged into a smart-phone or tab- tem capability and accessible train- firm based in Cranfield, U.K. of Radiology (ESOR) ing, with a growing base of bulkier Peter Baierl, Vienna/AT compact and cart-based systems Executive Director designed to aid specific procedures Market snapshot for Hand Held Ultrasound (HHUS) or diagnoses (such as needle guid- ance in anaesthesiology and FAST Market today: Very small <5% of all ultrasound shipment volume in 2016 protocol in ). Editors Today a new range of HHUS is Julia Patuzzi, Vienna/AT Outlook: Strong double-digit growth (from small base) Philip Ward, Chester/UK entering the market. So, what should we expect from this next generation? Key target clinical uses: Emergency Medicine More specificity MSK (Sports Medicine) Associate Editors Most striking has been the Out-of-clinic, primary care (& OB/GYN) Training & Education Michael Crean, Vienna/AT Simon Lee, Vienna/AT increased focus on designing General Practice HHUS specific for defined use- Vascular cases. Recent releases of HHU have Main market competitors GE Healthcare, Philips Healthcare, Konica Minolta, Clarius Ultrasound, Contributing Writers offered more focus on scan type, Stefanie Bolldorf, Vienna/AT Healcerion, Rivanna, Signostics, Mobisante, Analogic Michael Crean, Vienna/AT from automatic bladder scanning, Source: Signify Research 2017 Florian Demuth, Vienna/AT emergency medicine triage proto- Peter Gordebeke, Vienna/AT Katharina Krischak, Vienna/AT Becky McCall, London/UK Katrina Megget, London/UK Katharina Miedzinska, Vienna/AT Rebekah Moan, San Francisco, CA/US Lucie Motloch, Vienna/AT ESOR Professional Development Vivienne Raper, London/UK Mélisande Rouger, Madrid/ES Programmes 2017 Frances Rylands-Monk, St. Meen Le Grand/FR Inga Stevens, Dubai/UAE Visiting Scholarship One-year Fellowships (Europe) Kathrin Tauer, Vienna/AT Programmes (Europe) •• board-certified radiologists within Pamela Zolda, Vienna/AT •• residents in training years 3–5 their first three years of practice •• three months •• 12 months Design & Layout •• Application closes March 12 •• Applications accepted in November Nikolaus Schmidt, Vienna/AT Visiting Scholarship Exchange Programmes Programmes (USA) for Fellowships (USA) Marketing & Advertisements Konrad Friedrich •• residents in training years 3–5 •• board-certified radiologists (three E-Mail: [email protected] •• three months to six years professional experience) •• MSKCC, New York •• at least a one-year involvement in •• Case Western Reserve University, breast imaging Contact the Editorial Office Cleveland •• six months ESR Office •• Application March 13 – April 9 •• MSKCC, New York Neutorgasse 9 •• Applications accepted in September 1010 Vienna, Austria Exchange Programmes Phone: (+43-1) 533 40 64-0 E-Mail: [email protected] for Fellowships (Europe) •• board-certified radiologists within their first three years of practice ECR Today is published 5x during ECR 2017. •• three months Circulation: 15,000 •• Application closes March 12 Printed by agensketterl Druckerei GmbH, Vienna 2017 myESR.org myESR.org/esor

For further information on the detailed programmes Education in partnership and registration, please visit myESR.org/esor

#ECR2017 myESR.org ECR TODAY | WEDNESDAY, MARCH 1, 2017 TECHNOLOGY & RESEARCH 19

BY PETER GORDEBEKE EIBIR – helping researchers secure EU funding From proposal preparation to project management, the European Institute for Biomedical Imaging Research (EIBIR) provides researchers with support every step of the way in proposals for Horizon 2020 and other European funding schemes.

services for collaborative research ments for each section. Through •C• oordinating the reporting identity, website and social projects and clinical studies. their experience, the EIBIR Team process and ensuring media presence By providing management ser- have gained a clear understanding its timeliness •R• epresentation at scientific vices as a full partner in a project of what the European Commis- •C• ontractual management meetings or congresses consortium, EIBIR relieves research- sion expects in each section of a •• Financial management •• Organisation of outreach events, ers of the administrative burden, research proposal. •D• ay-to-day administrative tasks such as workshops, symposia or allowing them to focus on the scien- EIBIR also offers financial man- •M• eeting organisation, either summer schools Navigating the rules and regula- tific work and ensuring the best pos- agement support during proposal face-to-face or electronically Since its establishment in 2006, tions of Horizon 2020 while carrying sible outcome for your project. preparation and can assist in draft- A large part of any international EIBIR has helped to secure over out an innovative, first-rate research EIBIR has extensive expertise in ing and finalising the budget, which research project is good internal €68 million in research funding project with partners from across proposal preparation is often a difficult and sensitive task. and external communication. In for biomedical imaging. This is Europe can be challenging, even There are several unique advan- All aspects of proposal prepara- addition to project management testament to our effectiveness in more so when deadlines are loom- tages to having EIBIR support the tion are carried out by a team of tasks, EIBIR can assume responsi- promoting and supporting biomed- ing. Multidisciplinary and multina- preparation of a research proposal. experienced scientific writers with bility for the communication and ical research. tional consortia require professional Our Scientific Advisory Board, with knowledge of the European Com- dissemination aspects of a project. At ECR 2017, EIBIR will host a project management to ensure the more than 35 international experts mission’s requirements and the It has an established and extensive session on EU research on cancer successful accomplishment of the from various specialties, can provide European research landscape. network of contacts from among its imaging on Friday, March 3, 08:30- project’s goals. critical scientific feedback on project Professional project manage- network members, industry part- 10:00 in Room M2, with speakers Over the course of the past decade, ideas. EIBIR can also assist research- ment for your research ners and shareholder organisations, from a range of other EIBIR-sup- EIBIR, a non-profit research organi- ers in consortium formation, and Upon successful evaluation such as the European Society of ported projects, including the sation founded by the European identify suitable academic, industry of your proposal, EIBIR guides Radiology. This enables us to com- recently launched Horizon 2020 Society of Radiology, has helped or SME partners for your project. researchers through all phases of municate your research widely and projects HYPMED and GLINT. shape the landscape of European Furthermore, EIBIR provides contract preparation and nego- rapidly. To learn more about Euro- biomedical imaging research by sup- expert support for writing research tiation, and takes on the project EIBIR can also provide a tailored pean research funding and porting scientists and helping them proposals. The EIBIR Team has over management. During the project, communication and dissemination EIBIR’s services, please visit secure funding for their projects. a decade of experience in preparing EIBIR’s project management ser- strategy which includes: www.eibir.org or stop by our booth EIBIR offers expert advice, project research proposals, and can provide vices include: •W• riting, design and distribution in the M building to discuss your management and coordination, call-specific templates with detailed •M• onitoring and managing of dissemination material project idea, and how we can communication and dissemination descriptions and input require- the overall project •• Development of a visual help make it a reality.

PLANNING A EUROPEAN RESEARCH PROJECT? LET US HELP

Courtesy of Zeiss Microscopy – Michael W. Davidson, Florida State University, US

myESR.org #ECR2017 20 TECHNOLOGY & RESEARCH ECR TODAY | WEDNESDAY, MARCH 1, 2017

BY BÁLINT SZILVESZTER Structured reporting platform improves CAD-RADS assessment

How to eliminate human error well readers (man) are able to classify could alter patient management from the equation patients into various CAD-RADS cat- and also lead to lower data integrity Coronary CT angiography imag- egories versus an automated CAD- in research. Interestingly, 4.6% of ing is a robust non-invasive tool RADS scoring tool (machine). We all cases were falsely classified by for the assessment of coronary therefore compared the automated the readers into non-existing CAD- artery disease (CAD), and is exten- CAD-RADS evaluation with the read- RADS categories (e.g. 2/N; Stenosis 4 sively utilised in patients with low er’s manual performance. without A or B; missing S or G due to to intermediate risk for obstructive In a single-centre study, we pro- inattention). A discrepancy between CAD. Considering that high varia- spectively analysed the reports the manual and automated scoring bility and inconsistency exist in the of 500 consecutive patients who might lead to changes in patient reporting of coronary CT angiogra- underwent coronary CTA between management recommendations in phy (CTA) findings, a standardised August and December 2016. Five up to 15% of cases. framework for CAD assessment has experienced readers evaluated Structured reporting tools in car- long been desired. CAD-RADS stenosis categories (0, diac imaging have been predomi- Main factors related to inconsistency in CAD-RADS classification and The Coronary Artery Disease – 1, 2, 3, 4A, 4B, 5) and modifiers (V, N, nantly implemented for research coronary CTA reporting. Reporting and Data System (CAD- S, G) using a structured reporting purposes to improve workflow RADS) was recently introduced to platform blinded to the automated and data integrity. Our work sug- support clinical decision-mak- Bálint Szilveszter MD, PhD candi- facilitate interdisciplinary communi- CAD-RADS results. The reporting gests that the implementation of ing. We would like to invite you to date is a member of the MTA-SE cation of coronary CTA results and to platform (machine) automatically automated CAD-RADS classifica- come to our session and hear more Cardiovascular Imaging Research guide further diagnostic testing and determined the CAD-RADS clas- tion using a structured reporting about the advantages of structured Group at Semmelweis University in therapy. This joint effort of various sification based on the input of platform can reduce the number reporting and additional factors Budapest, Hungary. societies (Society of Cardiovascular the physician, while the doctors of mistakes, which can improve related to common errors leading to Computed Tomography, American reported their CAD-RADS value the quality of healthcare services. CAD-RADS misclassification. College of Radiology and North manually (man). Nonetheless, we also strongly American Society for Cardiovascular We detected a total agreement in encourage regular training of clini- Scientific Session Imaging) represents the first impor- 80.2% of the cases. The agreement cians to ensure the proper use of tant step to achieving uniform and in stenosis categories was 86.8%. In CAD-RADS. Consequently, effective Wednesday, March 1, 14:00-15:30, Room E1 consistent coronary CTA reporting addition, we investigated the agree- communication of coronary CTA SS 305 Machine learning in image interpretation using a standardised terminology. ment of modifiers with the follow- results and adequate clinical deci- Moderators: T. Bauerle; Erlangen/DE Implementation of CAD-RADS could ing results: 95.6% for V, 95.8% for N, sion-making can be established. E. Svedstrom; Turku/FI result in decreased variability in 96.8% for S, and 99.4% for G, respec- Structured reporting platforms image interpretation, assuming that tively. Although agreement seems with automated CAD-RADS score »E» valuation of CAD-RADS in coronary CTA: man vs machine readers can adequately read coronary to be almost perfect, this means calculations reduce human error B. Szilveszter, M. Kolossváry, J. Karády, Z. Bagyura, M. Károlyi, CTAs and learn to use the CAD-RADS that the readers forgot to apply due to inattention; therefore, they A. Panajotu, Á. Jermendy, B. Merkely, P. Maurovich-Horvat; scheme. We sought to assess how the ‘S’ modifier in 17 cases, which might improve data quality and Budapest/HU

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#ECR2017 myESR.org ECR TODAY | WEDNESDAY, MARCH 1, 2017 TECHNOLOGY & RESEARCH 21

BY PETER VOCK Clinical Diagnostic Reference Levels

For two reasons, today’s EuroSafe Imaging session will be entirely dedicated to diagnostic reference levels (DRLs). First, Article 56.2 of the European Basic Safety Standards (Council Directive 2013/59/EURATOM) asks the Member States to transpose the establishment of DRLs for radiodiagnostic examinations into their national legislation by February 2018, and second, the methods for establishing DRLs and their practical use vary a lot, which underlines the need for recognised standards.

from methodological region-related practical and cultural differences ologists, radiographers, medical DRLs to DRLs based on clinical indi- between the two continents. For physicists or administrative and IT cations, and he will be able to show example, using the effective diam- team members of departments of both the ICRP’s draft for recom- eter of patients’ trunks, the DIR radiology in Europe. mendations of DRLs in medicine uses future-oriented, software-gen- and the results of the consultation erated and size-specific dose esti- Peter Vock is retired chairman and on this draft. It is an important mates (SSDE) to adapt exposure to senior consultant radiologist at intention of the ICRP to standard- the size of the patient. the University Hospital of Bern, ise the methodology of establish- The panel of session chairs and Switzerland; he chaired the ESR ing DRLs, and he will include the speakers will conclude the talks by Radiation Protection Subcommit- related recommendations. discussing the future role and limi- tee for many years and is now the Recognising the need for clini- tations of clinical DRLs, the cooper- coordinator of EuroSafe Imaging’s cal DRLs, the ESR started a pilot ation with EuroSafe Imaging Stars Subgroup for Clinical DRLs. survey in 2015 to establish DRLs and answering questions from for a few frequent indications for the participants. CT. The results of this survey will The session – through the imple- be presented by Prof. Peter Vock mentation of the new European The session will be chaired by of conventional DRLs. He will do so from Spiegel, Switzerland, member Directive – addresses most congress Prof. Guy Frija from Paris, chair of by explaining that patients are not of the EuroSafe Imaging Steering participants, whether they are radi- the EuroSafe Imaging Campaign, usually standard sized and different Committee. Not only did this sur- and Mr. Georgi Simeonov from Lux- clinical questions (indications) do vey demonstrate the feasibility of EuroSafe Imaging Session embourg, European Commission not need the same image quality in online DRL surveys, it also allowed Directorate-General for Energy. order to be answered, which means the definition of DRLs for these few Wednesday, March 1, 16:00–17:30, Room M 1 First, Frija will introduce the con- DRLs should reflect the indication indications. Furthermore, it showed EU 1 Clinical diagnostic reference levels cept of clinical DRLs. DRLs were and patient size. a wide variation of results. Many Moderators: G . Frija; Paris/FR proposed around 20 years ago as an Prof. Reinhard W.R. Loose from factors contribute to the spread of G. Simeonov; Luxembourg/LU optimisation tool in medical imag- Nürnberg, chair of the ESR Radi- data, and some will be analysed in ing using ionising radiation where ation Protection Subcommittee, the session (Figure 1). Of course, one »» Introduction – other than for occupational expo- will then illustrate the reasons for has to avoid complexity and con- G. Frija; Paris/FR sure and other uses – individual clinical DRLs, their basics in the centrate on the most important fac- »» Clinical diagnostic reference levels: from concept to impact in dose constraints do not apply, and different imaging modalities and tors. Lessons learnt from this pilot clinical practice where doing more good than harm their practical impact. Radiogra- survey will help define more strict R.W.R. Loose; Nurnberg/DE is the supreme rule. phy, fluoroscopy and intervention, methods for future surveys among »» ICRP perspective: from methodological region-related DRLs to DRLs are defined for the differ- as well as nuclear medicine, require EuroSafe Imaging Stars. DRLs based on clinical indications ent modalities and body regions by clinical DRLs, but since CT is the The final lecturer, Prof. Richard L. E. Vaño; Madrid/ES the 75th percentile of the dose dis- major contributor to the medical Morin from Jacksonville, U.S., will tribution in a population of stand- population dose, he will dedicate present the approach of the Ameri- »E» uroSafe Imaging clinical DRLs: detailed results of the pilot ard-sized patients. While exposure a major part of his presentation to can College of Radiology to defining survey and lessons learnt for the survey among the EuroSafe in an individual patient may thus the specific implementation of clin- DRLs using the Dose Index Registry Imaging Stars exceed the specific DRL, the median ical DRLs in computed tomography. (DIR). While the American and the P. Vock; Spiegel/CH dose of the whole group of patients Prof. Eliseo Vaño from Madrid, European DRL projects share the »N» orth American DRLs: a view from across the pond (at a local, national or regional level) chair of Committee 3 of the Inter- aim of optimising medical imag- R.L. Morin; Jacksonville, FL/US has to stay within the DRL in order to national Commission on Radiolog- ing radiation exposure and reach- »P» anel and public discussion avoid unnecessarily high exposure. ical Protection (ICRP), will present ing the image quality needed for Frija will also point to the limitations the ICRP’s approach to changing the specific task, there are subtle This session is part of the EuroSafe Imaging campaign.

BY FILIPE CASEIRO-ALVES Portugal to adopt ESR’s European Training Curriculum for Radiology

In Portugal, the radiology train- includes a final board examination. ented than organ-oriented. Several organ-oriented services in radiology, This is our big agenda for the ing programme has been based on Until now this system has prevailed, organisational issues need to be promoting and protecting time for years to come for the sake of radiol- a 4+1 module since its inception in but we are currently in the midst met before we can fully embrace clinical interaction in multidisci- ogy and for the sake of educational 1999, and at that time Portugal was of a changing process in order to the 3+2 European structure. The plinary meetings, along with more harmonisation throughout Europe. among the first countries to include accommodate the European Train- Portuguese Society of Radiology involvement in clinical research. the concept of subspecialisation; ing Curriculum for Radiology, and Nuclear Medicine (SPRMN) has The educational activities of the Prof. Filipe Caseiro-Alves is a with the last year of residency and deliver a 3+2 (Level I+II) post- collaborated closely with the Euro- ESR, especially the annual exchange radiologist at the Centro Hospitalar devoted to the choice of one of the graduate course to our residency pean Society of Radiology (ESR) in programmes such as fellowships, Universitario de Coimbra, Portugal, specific fields of neuroradiology, programmes. This will be a major the past to promote the ESR’s edu- together with the subspecialisa- and President of the Sociedade paediatric radiology, interventional endeavour since the majority of cational view, but locally a profes- tion learning by the School of the Portuguesa de Radiologia e radiology and general radiology. Portuguese Hospitals still deliver sional cultural change will undoubt- SPRMN, are instrumental tools to Medicina Nuclear (SPRMN, The residency programme in residency programmes in radiol- edly be needed. University hospitals deliver and anchor the future for- Portuguese Society of Radiology Portugal is highly demanding and ogy that are more technique-ori- will need to focus more and more on mat of radiology training. and Nuclear Medicine).

myESR.org #ECR2017 22 TECHNOLOGY & RESEARCH ECR TODAY | WEDNESDAY, MARCH 1, 2017 EuroSafe Imaging Stars: Erasmus Medical Center in Rotterdam

committed to best practice in radi- Imaging Stars network. Why to at least have a close look at your MvS: Yes, we would absolutely ation protection, the Stars initia- did you apply and what are your routine protocols and rethink the recommend this: Don’t reinvent the tive will give radiation protection thoughts on this initiative? rationale behind them. wheel! Use best practice instead! efforts greater visibility, have a Marcel van Straten: We applied ECRT: What are your sugges- direct impact on clinical practice for the Imaging Stars network tions for improving the EuroSafe and enable the European Society of because it allows us to share our Imaging Stars initiative? Radiology to collect data for analy- experience in medical radiation MvS: The self-evaluation com- sis and benchmarking. protection with others and to share prises 26 criteria, and we would like One of the EuroSafe Imaging it with our patients. This initiative to have more background informa- Stars institutions is the department reflects our own efforts on this tion on the topics mentioned in this of radiology & nuclear medicine, topic within our department. self-evaluation. headed by Professor Gabriel P. Kres- ECRT: One important contri- ECRT: Which future cooper- tin, part of the Erasmus Medical bution EuroSafe Imaging Stars ation and activities within the Center in Rotterdam. The EMC is are expected to make is to partic- network of Stars would you like the Netherlands’ largest univer- ipate in the data collection initia- to see? Dr. Marcel van Straten is a medical sity medical centre, committed to a tives through the ‘Is your Imaging MvS: It would be nice to see how physicist. He has more than 15 years healthy population and excellence EuroSafe?’ surveys on CT dose. other departments throughout of experience in the optimisation in healthcare through research What is your opinion on these sur- Europe deal with the implementa- and dosimetry of x-ray computed and education. veys and how useful do you think tion of the new Basic Safety Stand- tomography. Please read below an interview the EuroSafe Imaging survey find- ards Directive, which has to be with Dr. Marcel van Straten from ings will be for your daily clinical transposed by February 2018. EuroSafe Imaging Stars is the department of radiology & activity? ECRT: Would you recom- EuroSafe Imaging’s latest initiative nuclear medicine of the EMC, which MvS: Like all surveys, these sur- mend other facilities to become to promote quality and safety in is a five-star facility. veys try to grasp the complex daily EuroSafe Imaging Stars? If so, medical imaging. By recruiting a ECR Today: Your radiology practice in a few simple questions. what arguments would you use to network of imaging departments department joined the EuroSafe Filling in these surveys forces you convince them?

BY BOEL HANSSON Short-term effects during examinations in an actively shielded 7T MR

Willingness to undergo a future 7T MR was high both as research sub- ject and patient (90%, 96%). Actively shielded 7T MR exami- nations are well tolerated although short-term effects such as incon- sistent movement, dizziness and twitches are more commonly reported compared to literature on passively shielded UHF systems. Healthcare strategies assuring patient compliance with UHF MR could preferably focus on increas- ing acceptance of short-term effects by means of cognitive and behavioural methods to cope with Information and support is provided before entering the 7T magnet. After the examination the 7T experience is thoroughly recorded in a short-term effects combined with web-based questionnaire. practical measures facilitating an examination for patients – such The number of magnetic reso- formed during a 14-month period information status, motion sick- sea, headache and metallic taste. as increased comfort, balanced nance (MR) examinations in clinical in an actively shielded UHF 7T ness and willingness to repeat a Twitches, an expression of PNS, information and instructions, reas- routine and research are increas- MR), to extract knowledge from scan. Scanner output on predicted were reported in 67% of examina- surance during examinations and ing rapidly along with the range the data that allows us to design peripheral nerve stimulation (PNS) tions, occurring primarily in torso, empathic care. of indications and body parts to be patient-oriented and personalised values was recorded in a subcohort. hands and arms, and tended to examined. Technical advances have care models and to facilitate future The short-term effects reported increase with higher predicted PNS Boel Hansson is a 7T research allowed an increase in MR field examinations that are both as com- were dizziness (84% of examina- values. Furthermore, 23% of the radiographer at the department of strengths to ultra-high fields (UHF; fortable as possible and of the highest tions), inconsistent movement research subjects experienced light diagnostic radiology, Skåne above 4 Tesla), homogenous enough diagnostic quality. (70%), nausea (53%), headache (53%) flashes, scanner noise levels were University Hospital in Lund, Sweden. to create images of very high quality, Special focus is set on the occur- and metallic taste (43%). Although well tolerated and the communi- and opening up new insights into rence and strength of short-term short-term effects are common, cation system was well perceived. disease pathophysiology. Increas- effects, their dependence on spatial median VAS values for strength ing field strength, new technical position and motion in the scan- are in general very low: 22 for diz- advances, such as actively shielded ner in relation to isocenter, and ziness while entering the scanner, Scientific Session UHF scanners, and the urge to move the comparison to published data fewer than 10 for dizziness and to diagnostic clinical scanning at from passively shielded magnets. inconsistent movement at all other Wednesday, March 1, 14:00-15:30, Room K UHF, justify taking another look at Research subjects undergoing 7T spatial locations and none for nau- SS 314 MR imaging nursing care factors related to pos- MR examinations answered a web- sea, headache and metallic taste. As Moderators: L. Natale; Rome/IT sible short-term effects experienced based questionnaire on occurrence expected, a scan position with the K. Taylor; Cambridge/UK during MR examinations. (n) and strength (VAS, visual-ana- head first (used for examinations The purposes of our study are to logue scale) of inconsistent move- of the brain for example) showed »» Short-term effects during examinations in an actively shielded collect information on frequency ment, dizziness, nausea, headache, higher VAS values for inconsistent 7T MR and quality of short-term effects metallic taste, twitches and light movement (p<0.001) and dizziness B. Hansson¹, P. Höglund¹, O. Johan¹, K. Markenroth-Bloch¹, (reported by 124 research persons flashes, and regarding tempera- (p<0.002) compared to feet first, but M. Nilsson¹, J. Frankel², J. Wilén², T. Owman¹, J. Arborelius¹; after examinations (n=154) per - ture, noise, communication system, no significant differences for nau- ¹Lund/SE, ²Umea/SE

#ECR2017 myESR.org ECR TODAY | WEDNESDAY, MARCH 1, 2017 TECHNOLOGY & RESEARCH 23

BY FLORIAN DEMUTH ESR participates in European cancer initiatives Since August 2014, the European Society of Radiology (ESR) has been a member of the European Commission’s (EC) expert group on cancer control with a three-year office term.

was also focused on preparations support software to improve the plenary meeting, where the first for an update of the colorectal can- appropriate utilisation of health- four European screening recom- cer screening guidelines in 2017 led care services like diagnostic imag- mendations were published. The by the EC’s Joint Research Centre. ing. The final CanCon conference ECIBC will also develop a Euro- In 2014, the ESR joined the Euro- concluding the Joint Action’s work pean quality assurance scheme for pean Joint Action on Cancer Con- will be held in March 2017 in Malta. breast cancer services supported trol (CanCon JA) as a collaborating Since 2015, the ESR has partici- by accreditation and referring to partner. This follow-up initiative to pated in a number of stakeholder high-quality, evidence-based guide- the European Partnership on Action consultations of the European lines, and has already published Against Cancer (EPAAC), which Commission Initiative on Breast a number of calls providing the started its work in March 2014, aims Cancer (ECIBC). The aim of this opportunity for stakeholders to to further the goal of reducing can- initiative is to revise the European provide their feedback. cer incidence by 15 percent by 2020. Guidelines for Quality Assurance in For the International Day of © Cancon – Cancer Control Joint Action. The CanCon Joint Action aims at In October 2015, the ESR was Breast Cancer Screening and Diag- Radiology 2016’s book on breast reducing cancer in Europe by 15 percent until 2020. appointed a member of the Can- nosis and develop the new Euro- imaging, the ECIBC contributed Con JA policy paper drafting pean guidelines for breast cancer an article detailing its objectives The group holds regular meet- cancer prevention, clinical cancer group, which provides scientific screening and diagnosis, as well as in the areas of cancer screening, ings and assists in drawing up legal research, as well as cross-cutting feedback on the policy paper on establish a platform for high-qual- diagnosis, treatment, rehabili- instruments, policy documents, themes related to cancer. ‘Equity mainstreaming in the can- ity guidelines for stages of breast tation, follow-up and palliative guidelines and recommendations During 2016, the expert group’s cer control in Europe’. Three pol- cancer care other than screening care. Through a quality assurance on cancer control at the request focus was on the Cancer Control icy papers were finalised over the and diagnosis. The ECIBC’s focus is scheme, evidence-based recom- of the Commission. It also, upon Joint Action (see below) and issues course of 2016, including a paper on long-term sustainability, build- mendations, training guidance and request, helps prepare guidelines like cross-disciplinary training, for on more appropriate utilisation of ing upon a platform that brings the dissemination of knowledge on cancer data including epide- which the ESR is working to include healthcare interventions. Among together a wide range of actors at and information, the ECIBC aims to miology, cancer screening, qual- radiology, nuclear medicine and other measures, the ESR advocates EU level in a transparent way. The reduce the burden of breast cancer ity assurance and information on cancer screening. The expert group support tools like clinical decision ESR participated in the 2016 ECIBC in Europe..

BY ANDREA LAGHI AND YAN LIU ESOI highlights importance of training radiologists for clinical trials Oncology is a rapidly developing field of medicine thanks to the discovery of new therapeutic strategies, based on drugs targeted at specific cellular metabolic pathways or, more recently, on empowering the innate immune system (immunotherapy).

to innovation in advanced imaging ity of imaging techniques, lack of EORTC is a leader in multinational techniques, imaging is now con- standardisation across multivendor and multidisciplinary cancer clin- sidered as a potential biomarker platforms, and paucity of optimised ical trials, with robust standard (imaging biomarker). Imaging bio- trial design and operational sup- operating procedures. The EORTC markers may serve to identify and port. For those reasons, there is an Imaging Group operates to estab- validate therapeutic targets and to unmet need to involve radiologists lish and maintain the scientific and provide evidence of drug efficacy. at an early stage, so as to bring novel clinical value of advanced imag- The use of imaging biomarkers has and robust imaging technologies to ing and optimise the EORTC clin- several advantages. It can obtain optimise study design and support ical trials. The two organisations a measure of disease extent as a imaging operation. On the other launched the first joint workshop function of treatment that is more hand, it is also essential to provide in November 2016 in Rome. The objective and reproducible than adequate training on trial method- hands-on workshop covered many achieved by considering symptoms ology for radiologists, who would important topics, from RECIST to or clinical status, and it can help to potentially be involved in clinical advanced imaging criteria in assess- better understand a tumour at an trials. Well-defined training pro- ing response to cancer treatment, earlier time than is possible with grammes would expand the under- and attracted 54 international par- other biomarkers or with primary standing of trial design and conduct ticipants (fully booked) from 24 dif- end-points, such as overall survival/ for radiologists, helping to reduce ferent countries worldwide. Follow- mortality or disease-specific sur- the gap between advanced imaging ing its success, this joint workshop vival/mortality. It can also reduce methods and clinical translation. will continue and the next edition Delegates at work during the joint workshop of ESOI and the EORTC in Rome, either the time or the sample size The European Society of Onco- is scheduled to be held in Amster- November 2016. in clinical trials testing new ther- logic Imaging (ESOI), whose mis- dam in autumn 2017. apies, including drugs, surgery or sion is to provide high-quality Before a new drug enters rou- istic that is objectively measured imaging-guided interventional pro- teaching in the field of oncologic Prof. Andrea Laghi is professor tine practice, validation through and evaluated as an indicator of cedures. In addition, after the drug imaging, has started a series of of radiology at La Sapienza – a clinical trial is needed. A clinical normal biological processes, path- enters use, imaging biomarkers play workshops focused on the use of University of Rome and ESOI trial is a study of human subjects ogenic processes, or pharmacologic important roles in monitoring drug imaging in assessing response to Board Member. to test if a specific new drug is able responses to a therapeutic inter- safety and relapse. cancer therapy. Since last year, Prof. Yan Liu is head of the EORTC to improve therapeutic interven- vention” (Biomarkers Definitions Despite the obvious value of this series of workshops has been Translational Research, Radiothe- tion compared with current prac- Working Group. Clin Pharmacol imaging, the integration of imaging held in partnership with the Euro- rapy, and Imaging Department. tice. This validation is measured Ther. 2001 Mar; 69:89-95). Thanks to biomarkers into trials faces various pean Organisation for Research through biomarkers, “a character- improvements in image quality and challenges, such as the complex- and Treatment of Cancer (EORTC). myESR.org #ECR2017 24 TECHNOLOGY & RESEARCH ECR TODAY | WEDNESDAY, MARCH 1, 2017

BY NICOLA SVERZELLATI ESTI to continue multidisciplinary and inter-subspecialty cooperation

For more than 24 years, the Euro- new science that will be of great the largest European trial, the increases with multidisciplinary heart and coronary arteries, as they pean Society of Thoracic Imaging interest to the attendees. Further- Dutch-Belgian Randomized Lung discussion among clinicians, radi- used to do with earlier generations (ESTI) has been promoting educa- more, an ESTI symposium intended Cancer Screening Trial (NELSON). ologists and pathologists. However, of CT scanner. Conversely, cardiac tion and research in chest imaging, as a tribute to Dr. Nestor L. Muller Nevertheless, a pooled analysis recent studies have shown some CT examinations should be system- with the aim of improving patient – one of the giants of chest radiol- has recently suggested a trend for limitations in the multidisciplinary atically reviewed for chest disease. care. The strong history of ESTI ogy – will be organised in Barcelona improvement in survival, though diagnosis of some interstitial lung As for other imaging subspe- supports its continuous progress in from September 28 to 29, 2017. not significant, and a pan-European disorders underscoring an urgent cialty societies, the effects of the moving forward, namely its enor- ESTI is narrowing its strategy pooling is planned (estimated > need for standardised diagnostic economic crisis and the continuous mous growth in recent years. for future meetings based on the 37,000 subjects randomised to either guidelines. Another major ESTI changes in daily workload present The last two annual meetings, major research topics in chest CT or control arm) to quantify the goal is to further promote collabo- challenges for ESTI in identifying held in Amsterdam in 2014 and Bar- imaging. The joint session at the overall mortality reduction in lung ration between the pulmonologist the best way to promote education celona in 2015, were overall attended ESOI 2015 meeting stimulated an cancer screening randomised-con- and the chest radiologist. Following on chest imaging in the forthcom- by more than 1,400 participants. important discussion on both lung trolled trials. Furthermore, there the successful joint session on air- ing years. With the hope of provid- The 2016 ESTI summit in Krakow cancer screening and assessment is also an urgent need for better way disease at ECR 2016, another ing its members with an easy edu- was also quite successful with more of response to new therapies for definition of imaging criteria in the joint session with the European cational tool, ESTI is offering six than 250 participants, a noteworthy lung cancer. Indeed, ESTI wishes to assessment of lung cancer response Respiratory Society (ERS) on idio- webinars a year. Webinar subjects proportion of them coming from continue such an essential multi- to new treatments, such as immu- pathic interstitial pneumonia will will range from basic topics (e.g. the the United States and Korea. In disciplinary, as well as inter-subspe- notherapeutic and molecular tar- certainly ensure another important HRCT patterns) to recent research Krakow, speakers presented the lat- cialty, cooperation. geted agents. The implementation multidisciplinary discussion. ESTI topics, and online discussion with est research and technical advances European lung cancer screen- of tools extracting high throughput would like these joint sessions to the experts will be integrated into in chest imaging. The meeting was ing trials have been conducted of quantitative descriptors from continue and to be steadily inte- the learning system. an excellent place to expand knowl- independently in different coun- routinely acquired CT scans can grated into future ERS and ESTI For more information, please visit edge, renew old contacts and build tries and have not yet provided play a significant role as parameters meetings. our website (www.myesti.org) and new cooperation, particularly with the clear-cut advantage reported for lung cancer response. ESTI and the European Society the ESTI Booth in the M Building. both American and Eastern socie- by the NLST, allegedly because of The clinical value of radiology in of Cardiovascular Radiology (ESCR) ties. In 2017, ESTI will be a member the intrinsic statistical limitation interacting with clinicians and other are going to organise a joint meet- Dr. Nicola Sverzellati is associate of the organising committee of the deriving from the fragmentation specialists should not be underesti- ing in Geneva, in 2018. This meet- professor, researcher and fourth World Congress of Thoracic of the total population into small mated, and the need for maintain- ing is going to be quite appropriate consultant radiologist at the Imaging (WCTI), which will be held cohorts. While smaller trials have ing and improving non-technical given the recent advances in the University Hospital of Parma, Italy, in Boston from June 18 to 21. The already disclosed the absence of skills should be encouraged for integrated cardio-thoracic imaging. and ESTI President. WCTI Program Committee has put a significant improvement in sur- thoracic radiologists. The diagnos- Modern thoracic radiologists can together an outstanding agenda of vival, results are still pending for tic accuracy of diffuse lung diseases no longer miss the assessment of

Visit our booth #16 (Hall X2) and get your free Cartoon within 2 minutes! #GYCartoon @toshiba_med #ECR2017 Together, we ©ANDREAS FLORIS complete the image.

SATELLITE HANDS ON HII / ULTRASOUND LUNCH SYMPOSIUMS MARCH 2-4 WORKSHOP MARCH 1

12:30 – 13:30 | ROOM F2 ENTRANCE LEVEL 12:30 – 14:45 | ROOM 0.14 ENTRANCE LEVEL

THURSDAY, MARCH 2 | CT 12:30 – 13:30 | HII Ten years of area detector CT Lung tumor volumetry Dr. Stefan Niehues (Charité FRIDAY, MARCH 3 | MRI Advances in musculoskeletal Universitätsmedizin, Berlin, Germany) MR imaging 13:45 – 14:45 | Ultrasound SATURDAY, MARCH 4 | Ultrasound Ultra-high frequency approach to See More. Earlier. Faster. diagnostics of shoulder and ankle Dr. Jan Veryser (AZ Zeno, Knokke, Belgium)

For a complete overview of our educational program please visit www.toshiba-medical.eu/ecr2017

#ECR2017 myESR.org ECR TODAY | WEDNESDAY, MARCH 1, 2017 COMMUNITY NEWS 25

Successful start for ESR’s new journal, ESR Gold Medals awarded during European Society of Paediatric 26 European Radiology Experimental 27 Opening Ceremony today 29 Radiology to tackle global challenges

BY STEFANIE BOLLDORF Maximilian F. Reiser steps down as Editor-in-Chief of European Radiology Prof. Maximilian F. Reiser from Munich, Germany, is the outgoing chair of the Ludwig Maximilians University’s department of radiology in Munich, a position he has held since 1993. He also served as Dean of the medical faculty at the LMU from 2008–2016. Prof. Reiser has served the ECR and ESR in many functions, culminating in his ECR presidency in 2008 and ESR presidency in 2010–2011. He has been the Editor-in-Chief of European Radiology since 2014.

which is the number of published MFR: These necessary changes and highly talented colleagues was articles; we were too slow in reduc- should be made together with a a great experience. ing the acceptance rate accordingly new editor; it would be more con- The role of the reviewers cannot to the increasing submissions, vincing to start a new beginning be emphasised enough. They are which we are doing now. On a per- with a new personality. Together carefully selected experts in their sonal note I would like to mention with the recently appointed edi- field who devote extra time, dili- that I really struggle when I have to tors of Insights into Imaging and gence and engagement to the cru- reject an article and with a rejection European Radiology Experimental cially important task of reviewing rate of more than 80% this happens a renewed team of editors of the the manuscripts submitted to Euro- very frequently. ESR journal family would send out pean Radiology, thus allowing me Another reason for the decrease a compelling message. to make appropriate editorial deci- in the Impact Factor is the fact that I therefore decided to step down sions. I cannot thank them enough! we had very highly cited guidelines from my post by the end of this Having said that, what I really with several hundred citations in year. I would like to emphasise that hate is to reject manuscripts, as it previous years; other articles could European Radiology is very close to means disappointing researchers not compensate for these. my heart and that it was and still is who have invested a lot of time and It is truly a weak point, but I a wonderful experience to have deep energy into their research and writ- would like to mention that many insight into the ‘editorial business’. ing the manuscript. I will surely not other parameters of the journal are Publications in scientific journals miss this duty. excellent, for example the usage: play a key role in the careers of scien- ECRT: A final question: Who are Prof. Maximilian F. Reiser is the outgoing chair of the Ludwig Maximilians we saw a substantial growth in tists and in the reputation of a spe- the people behind European Radi- University’s department of radiology in Munich, and has been the Editor-in- article downloads – for 2016 we had cialty. Therefore, the editor of a scien- ology and how do they interact? Chief of European Radiology since 2014. an impressive 623,000 downloads, tific journal has a huge responsibility. MFR: We have an outstanding which proves that the journal is ECRT: What did you like and team of Deputy Editors who have ECR Today: European Radiol- reviews, special reports and clini- highly appreciated and widely read. what did you dislike as Editor-in- special expertise in various fields ogy has come a long way; you are cal guidelines issued by scientific ECRT: What needs to happen in Chief of European Radiology? of radiology: Professors Rahel heading the celebrations of the societies, while political statements order to keep European Radiology MFR: It is indeed fascinating Kubik, Sujal Desai, Jean-François 25th anniversary at this ECR. How and educational articles are mostly running successfully for the next to have insight into the latest Geschwind, Jose Maria Garcia San- do you see the journal’s past and published in Insights into Imaging. 25 years? research developments in our spe- tos and Peter Vock. Together with present? European Radiology Experimental MFR: The selection of excellent cialty. Selecting the articles to be the ESR Editorial Office under the Maximilian F. Reiser: The anal- is devoted to preclinical and meth- articles should be improved and published offers an opportunity to leadership of Stefanie Bolldorf, as ysis of the present needs some odological topics, which have not the journal should be the forum for make a contribution in shaping the well as Dr. Katrin Deininger, the retrospection. All my predecessors yet entered the practice of clinical cutting edge radiological research in future of radiology. scientific assistant in the Munich have done outstanding jobs to make radiology. Europe and worldwide. In my view, We have introduced the ‘Albert office, the strategy and policy of European Radiology a highly recog- ECRT: The Impact Factor has not the journal needs a facelift, as well L. Baert Editorial Fellowship’ and European Radiology and critical nised radiology journal. Over time, developed as positively as many as increased interaction with readers have so far hosted three fellows manuscripts are regularly dis- and also with the foundation of the other parameters of the journal and authors. More active scouting in Munich. This fellowship aims cussed. I would like to express my two other journals, Insights into over the past two years. How do for hot topics and the top authors to introduce young and especially gratitude for their great expertise, Imaging and recently European you explain this? will also be necessary, but this takes promising radiologists to editorial dedication and engagement. Last Radiology Experimental, European MFR: Over the past decade, sub- a lot of time and effort parallel to skills, such as manuscript evalua- but not least, I would like to thank Radiology has become a highly sci- missions to European Radiology managing the peer-review process tion, manuscript editing, organisa- the representatives of our pub- entific journal. Now the journal more than doubled! of 2,300 article submissions per year! tion of peer review, manuscript pro- lisher Springer (Dr. Ute Heilmann, accepts almost exclusively original Despite an increase in citations, ECRT: How do you see your duction and publishing, including Dr. Isabel Arnold) for their contin- articles with a clear focus on clinical the Impact Factor went down due role in light of all these suggested electronic publication. The contact uous and competent support. radiology, but also some systematic to an increase in ‘source items’ changes? and interaction with these young

celebrating

myESR.org #ECR2017 26 COMMUNITY NEWS ECR TODAY | WEDNESDAY, MARCH 1, 2017

BY KATHRIN TAUER Successful start for ESR’s new journal, European Radiology Experimental Launched in December 2016, European Radiology Experimental is the newest member of the ESR’s journal family. We spoke to Prof. Francesco Sardanelli, from Milan, Italy, about what the future holds for the new publication.

It is my hope that the new journal ECRT: How did you decide on the basis for a good scientific paper work the best visibility as a prem- will play a pivotal role in promoting your editorial board? is the soundness of study design ise for large clinical studies. innovation – a multifactorial pro- FS: Our goal was to include and methods. This is absolutely ECRT: Do you have any advice cess – and introducing new imaging non-radiologists in our journal crucial for studies concerning any for aspiring authors who would modalities and techniques for indi- editorial board: physicists, bioengi- type of innovation. Without good like to submit to European Radiol- vidual risk stratification, diagnosis, neers, biologists, chemists, informa- methodology, we risk creating false ogy Experimental? prognosis and image-guided ther- tion technology experts, as well as hopes or decreasing the chances for FS: First, authors should verify apy (interventional). pathologists and colleagues from new ideas that could change clinical that their manuscript corresponds ECRT: How did this new jour- other medical specialties, or any practice in the future. I think that with the aims and scope of the jour- nal come into being, what is its other professionals with an inter- my methodological background nal. Second, the instructions for overall purpose? est in innovation in radiology. Thus, will be helpful for selecting articles authors should be read carefully Dr. Francesco Sardanelli is Professor FS: The main aim is to foster a the board is composed of radiolo- that can contribute to shaping our and all requirements should be ful- of Radiology and Director of the strong connection between radi- gists with a strong commitment future and that I will be able to help filled. Third, authors should make Postgraduate School in Radiodiag- ology in the experimental setting to experimental studies and other authors to correct weaknesses in sure that their manuscript has nostics at the University of Milan, and basic science. This connection professionals, especially those their manuscripts. intrinsic value. Italy, and the first Editor-in-Chief of is obvious for imaging research con- involved in basic science working in ECRT: What do you think the ECRT: The Impact Factor is still European Radiology Experimental. cerning phantom studies, cell mod- the world of medical imaging. biggest challenges will be for considered an important measure els and radiobiology, animal models, ECRT: How will your back- European Radiology Experimen- of a journal’s success; do you think ECR Today: As the recently new modalities/techniques, new ground help you in your role as tal, in the beginning? the initial lack of an Impact Fac- appointed first Editor-in-Chief of contrast materials, tracers, ther- Editor-in-Chief? FS: I predict two big challenges. tor can be compensated by other European Radiology Experimen- anostics, and all their interplays. FS: My experience comes from The first is to attract scientists things? tal, what are your hopes and plans However, the new journal also wel- clinical imaging: breast and cardio- who are not radiologists but work FS: The Impact Factor is an impor- for the journal? comes reports on 3D modelling, vascular imaging have been major for the progress of medical imag- tant measure of a journal’s suc- Francesco Sardanelli: Medicine printing and simulation, advanced areas of interest for me. From the ing. If they consider European cess, but it is no longer considered is becoming increasingly innovative teleradiology and new image recon- technical side, I dedicated a lot of Radiology Experimental as ‘their’ the only measure for an author’s and the medical specialties involved struction algorithms and post-pro- work to MR imaging/spectroscopy journal, that will be a big success. or article’s success. Other metrics, in this process will be in a very good cessing. The sections of the jour- and the clinical use of contrast mate- The second is to convince radiolo- such as the number of quotations professional position in the future. nal were not created according to rials. However, during my career I gists working in the experimental and the h-index are increasingly This is also true for medical imaging. typical radiological subspecialties developed a particular interest in setting that the new journal, with considered. This means that the The role of radiologists in the next or body parts, but according to research methodology, statistics, and its particular scientific profile and accessibility of a paper through decades depends on their ability to cross-border topics between medi- the application of evidence based its gold open access status, is the open access is very important be a major part of this movement. cal radiology and basic science. medicine in radiology. In my view, most suitable tool for giving their for authors.

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#ECR2017 myESR.org ECR TODAY | WEDNESDAY, MARCH 1, 2017 COMMUNITY NEWS 27

BY MÉLISANDE ROUGER Pioneer in interventional radiology honoured at ECR 2017 In recognition of his pioneering contribution to the advancement of interventional radiology, Professor José Ignacio Bilbao Jaureguízar, from Pamplona, Spain, will be awarded the ESR Gold Medal at ECR 2017.

José Ignacio Bilbao Jaureguízar ble deciding between surgery and Europe (CIRSE) and as a member of have to learn how to manage and, is professor of radiology, head of radiology, I opted for the latter. In its executive committee. if the case presents itself, lead care, interventional radiology, and a con- 1982, during my residency in Hou- He has authored close to 200 pub- investigation and teaching,” he said. sultant radiologist at the University ston, I discovered interventional lications and 40 book chapters, and Having presided over the ECR Clinic of Navarra (UCN), where he and vascular radiology, and this has sits on several editorial boards. He in 2013 and served at many levels was also previously chairman of become my daily duty ever since,” has received the Gold Medal of the within the ESR – he was notably a the radiology department. recalled Bilbao. Spanish Society of Radiology and member of the Executive Commit- Prof. Bilbao received his medical His research interests are por- the Gold Medal of CIRSE. tee of the European Association of degree from the medical faculty of tal hypertension, gene therapy, Having been involved in many Radiology, the precursor to the ESR Navarra University and completed and percutaneous treatment of leadership roles, he has a broad –, he still remembers his first time his residency in radiology at UCN. tumours, including chemotherapy vision of radiology and expects at the Vienna meeting as if it were He trained in interventional radiol- and embolisation, especially in the field to tighten its links with yesterday. ogy at MD Anderson Cancer Center liver tumours. He is very actively nuclear doctors while opening up “I have attended all ECR meetings in Houston, United States, and involved in research to this day. to new skills in other disciplines. except in 2007 as I had to sit for a received his PhD with a cum laude “I am interested in all the possibili- He also warns against losing touch national examination. In 1991 I was award from Navarre University. ties offered by my subspecialty even Professor José Ignacio Bilbao from with the patient. invited to moderate a session on His combined fascination for if I have dedicated more time and Pamplona, Spain, will be awarded “Radiology is in perpetual motion, musculoskeletal imaging in Room medicine and art led him to study efforts to two of them, namely onco- the ESR Gold Medal during today’s but I think that morphology and A – I had never been in such a huge radiology, and then later interven- logic interventionism and hepatic Opening Ceremony. function will increasingly go hand lecture hall. I loved everything, the tional radiology. . I have dedicated and still in hand and our links with nuclear atmosphere of the Austria Center “I always loved to study lines and do dedicate a large amount of time on computational models. “We hope medicine will become tighter. New Vienna, which hosts the ECR each volumes, even before I started stud- to experimental interventional radi- to learn more about how morphol- image specialists will work with year, the elegance with which every ying medicine. I tried to combine ology and have worked with a wide ogy or positioning of the microcath- other disciplines, such as engineers act is being carried out, the pro- my studies with my passion for arts variety of animal models. Right now eter inside the vase light influence or biologists, to analyse the large gramme’s quality and the profes- and history. In my fourth year of we are working on two projects, one the correct distribution of tumour amounts of information that need to sionalism of the organising office. I medicine, I was shown a chest x-ray in rabbits on hepatic radioembolisa- treatment,” he added. be managed. I also think that tech- decided I would always attend and and I stood impressed: so many tion and another in swine on gene Prof. Bilbao is a co-founding nological advances must not dazzle it has always surpassed my expecta- lines, spaces and shapes in just one therapy,” he said. member and past-president of the us so much as to lose sight of the tions. I could never have imagined, in picture! In my sixth year another Prof. Bilbao is also working Spanish Society of Vascular and patient and population health, true the first years, that I would one day great teacher showed me surgi- together with the Engineers School Interventional Radiology. He has axes of our activity. In interventional salute the delegates in the opening cal capabilities and instruments, at Navarra University on fluid served as congress co-chairman radiology, as in other subspecialties, ceremony. It’s easy to understand and I got another perspective of dynamics and the distribution of of the Cardiovascular and Inter- we will be included in multidiscipli- how grateful I felt, surrounded by anatomy. Even though I had trou- radioembolisation particles based ventional Radiological Society of nary teams even more and we will my family, in this moment,” he said.

BY MÉLISANDE ROUGER Outstanding radiologist and former ESR President awarded Gold Medal in today’s opening ceremony In recognition of his lifelong achievements in radiology and work in radiation protection, Professor Guy Frija from Paris, France, will receive the ESR Gold Medal at ECR 2017.

Guy Frija is professor emeritus radiation protection and he has his presidency, the ESR tackled Society for Strategic Studies in of radiology and consultant at cooperated in the establishment of many key issues including educa- Radiology in 2007. the imaging department of Paris guidelines and protocols in France. tion, accreditation, imaging bio- He was advisor to the French Min- Georges Pompidou European Hospi- He is a member of the scientific markers, clinical decision support istry of Health for the deployment tal (GPEH), where he has previously committee of the Institute for Radi- and radiation protection. He previ- of PACS in the country and is a for- served as chairman. He is also a part- ological Protection and Nuclear ously served as General Secretary of mer IAEA consultant. time professor of radiology at the Safety, co-chair of the imaging sec- the European Association of Radiol- Prof. Frija is Doctor Honoris Causa faculty of health sciences of McMas- tion of MEDICEN, a French business ogy, the forerunner of the ESR, and of the University of Montreal, and ter University in Ontario, Canada. cluster specialising in biomedical subsequently as a member of the an honorary fellow of several radi- Prof. Frija is a recognised expert in engineering, and chair of the steer- Executive Council of the ESR. ological societies. He was appointed thoracic imaging and contrast prod- ing committee of EuroSafe Imaging. He has also presided over the Knight of the French Order of the ucts and has also helped to intro- Prof. Frija has served in many French Society of Radiology Legion of Honour in 2001. Professor Guy Frija from Paris, duce information technologies to leadership roles, notably as pres- for 12 years, turning it into the He has published more than 175 France, will receive the ESR Gold daily radiological practice. Recently, ident of the European Society of most important scientific society papers in peer-reviewed journals Medal today at ECR. his main area of research has been Radiology from 2013 to 2014. Under in France, and the International and co-written 30 books.

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BY MÉLISANDE ROUGER Distinguished specialist in high technology imaging to receive Gold Medal at ECR 2017 In recognition of his major contribution to radiology, especially in the fields of oncology and education, and more recently radiation protection, Professor Stephen J. Golding from Oxford, UK, will be presented with the ESR Gold Medal at ECR 2017.

Stephen J. Golding is a radiology special interests at the institute pelvis. As such, my research was work here. The challenge inherent fellow at Oxford University College, included paediatric and head and largely in clinical applications but in this is that we have to be pre- having previously served as lec- neck tumours, and his main inter- later, as a result of involvement pared to share roles if we are to turer and chairman of radiology at est throughout his career has been in the EC group, I built a research serve the patient’s interest to our Oxford University Hospitals. oncology imaging. programme in radiation protection, best ability,” he said. Prof. Golding received his medical He ran the first CT service at the especially to replace CT with other Prof. Golding has attended many degree from London University and University of Oxford from 1982, techniques,” he said. international meetings and given trained in surgery, but switched to and continued to provide a service Recently he has been busy with numerous talks all over the world. radiology after sharing enlightening to the Oxford health region for contributions to establish national He started attending the ECR in discussions with other physicians. ten years until CT devolved to and international undergraduate 1993, a year he fondly remembers “I was alerted to radiology by general departments. curricular standards for radiol- as he visited the Wiener Staat- a chance conversation with my Like many radiologists of his ogy. He chaired the Royal College soper, Vienna’s state opera house, anaesthetist one afternoon. A short generation working with CT, he of Radiologists’ working party on for the first time. period of exploring the subject was also invited to plan, design undergraduate education from 2003 “Any congress has to be a place for with a few radiologists convinced and commission the local services to 2005 in the UK, and led the new meeting and sharing with friends, me that my principal interests lay for MRI when it became generally Professor Stephen J. Golding from ESR initiative on undergraduate and making new networks, and in diagnosis, and the diagnostic available. He was Oxford MRI Cen- Oxford, UK, will be presented with radiology for six years until last year. ECR has certainly been this for me. chase remains the most satisfy- tre’s director for five years between the ESR Gold Medal at today’s Prof. Golding has also served as At my very first attendance I met ing aspect for me: we are, after all, 1989 and 1994. Opening Ceremony. president of the British Institute of my good friends Marten Klop and medicine’s natural detectives. How- Prof. Golding was appointed a Radiology, the UK Congress of Radi- the late Helen Redman at the regis- ever, I would have to temper that fellow at University College in 1988 ian to the UK Department of Health ology and the European Society of tration desk and an invitation from with the satisfaction that has also and was postgraduate tutor for radi- and on the National Imaging Board Head and Neck Radiology. them led to my first experience of come from seeing radiology come ology in the Oxford Health Region of the Department of Health. He expects to see increasing the Wiener Staatsoper. Opera is a to interact more strongly with ther- from 1990. He notably co-created His versatility has given him the cooperation between radiology and passion of mine, so my first ECR apy,” he said. the university’s first Master’s course opportunity to assess the specialty other medical disciplines in the could not have started more propi- Prof. Golding completed his in radiology and has personally from many different angles and he near future. tiously! Being experienced in con- residency in general radiology at supervised more than 80 students has derived tremendous enjoyment “In my view we are going to see ference and congress management Guy’s Hospital and became sen- taking higher degrees in radiology. from doing so. radiologists coming to interact I also appreciated the highly pro- ior research fellow to Prof. Dame In 1994 he joined a new European “My interests grew from oncol- even more closely with other clin- fessional management of the con- Janet Husband at the UK Institute Commission (EC) working group on ogy into specialised head and neck ical specialists in pursuit of high gress: it was and is an impressive of Cancer Research, to work on radiation dose and image quality in work, though I retained an interest quality medical care – and I am show, which has continued to grow the then new technique of CT. His CT, and also served as clinical guard- in body imaging, especially in the not thinking only of interventional and develop,” he said.

BY HÉLÈNE VERNHET KOVACSIK, JULIEN SIMMONET, JEAN-YVES GAUVRIT AND JEAN-FRANÇOIS MEDER The extraordinary era of innovation in radiology: the French experience

How can radiology assess consulting missions. But there are in health located in the area of Paris. entific sessions, especially research SFR, which now has to deal with innovation? several limitations to this realistic The Innovation Committee of the sessions, and benefit from media population ageing and growth. It can be done from the user per- approach. First, the necessity to SFR was created in 2015. It includes coverage during the congress. For What will be the radiologist’s spective by changing the solution or close knowledge gaps in technol- radiologists in public and private instance, during JFR 2015, the award job with the advent of artificial a part of the service (e.g. connected ogies that are potentially helpful, practice, biomedical engineers, radi- for innovation was awarded to intelligence, predictive medicine devices), changing the user’s activity and not yet used in radiology, and ophysicists and professionals from LLETC for their creative solution and big data management? Imag- (e.g. introducing new ablation tech- the ability to integrate them. Sec- MEDICEN Paris Région, SNITEM that allows non-destructive and ing societies have a major role to niques, which are responsible for ond, the difficulty of building up a (national union of industries in the real-time analysis of biopsy speci- play as ‘design thinkers’ driving new usages in tumour destruction) programme in a restricted market field of medical technology) and mens in the radiological room. Dur- innovation, a role already taken on or improving the user’s experience. and third, the trouble for a scien- from other organisations involved ing JFR 2016, the coup de cœur was by the SFR. For instance, due to the widespread tific society of dealing with con- in the field of research (INRIA) or awarded to Instent for having devel- use of the iPad people are now used flicts of interest. medical counselling. oped a catheter allowing a qualita- Prof. Hélène Vernhet Kovacsik is to finger-zooming on screen. The Another way to innovate is to Each year, during the Journées tive analysis of thrombi which could head of the department of car- market should follow this trend so have a look at new technologies, Françaises de Radiologie diagnos- have an impact on indication in cer- diovascular and interventional that future workstations adopt this even those not intended for radi- tique et interventionnelle (JFR) ebral mechanical thrombectomy. radiology at the Centre Hospitalier very ‘zooming experience’. ological use. The French Society the SFR-Medicen-SNITEM award, Coaching to build-up experimen- Universitaire de Montpellier and a How can an imaging society of Radiology (Société Française de including the Innovation Award tal and clinical research, radiolog- member of the Innovation Study assess innovation? Radiologie – SFR) has decided to and the coup de cœur award, is ical expertise on the relevancy of Group of the SFR. Again by using the user perspec- promote this approach in order to awarded to two start-ups for devel- innovations and the existence of Dr. Julien Simmonet is a member tive, by thinking about the need to support innovation. In this regard, oping innovative concepts. Ten to future markets are services offered of the Innovation Study Group of improve our practice beforehand close collaboration was estab- twelve start-ups are selected by the by the Innovation Committee to the SFR. Prof. Jean-Yves Gauvrit is and being aware of new technol- lished between the SFR and the Innovation Committee to exhibit start-ups, in addition to collabora- head of the department of neuro- ogies in order to encourage firms French competitiveness clusters at the JFR congress in a dedicated tion with incubators and accelera- radiology at the Centre Hospitalier to create them. This conventional that actively promote collaborative area – the Innovation Village – near tors of start-ups provided by major Universitaire de Rennes. Prof. approach relies on contracting research and international develop- the technical exhibition. Interactive engineering schools involved in Jean-François Meder is head of the between radiologists, universi- ment such as Medicen. Medicen is a meetings are facilitated between health technologies. department of neuroradiology at ties or institutions and industry leader in promoting innovation for start-ups, firms and radiologists. Organisational innovation is the Centre Hospitalier Sainte-Anne through scientific partnerships or start-ups and enterprises involved Start-ups are invited to attend sci- also a challenging task for the in Paris and President of the SFR.

#ECR2017 myESR.org ECR TODAY | WEDNESDAY, MARCH 1, 2017 COMMUNITY NEWS 29

BY RUTGER JAN NIEVELSTEIN & JACQUES SCHNEIDER European Society of Paediatric Radiology to tackle global challenges The European Society of Paediatric Radiology (ESPR) was founded in France in 1963, and is the leading European society for radiologists whose main area of work and interest are imaging or image-guided procedures in children and foetal imaging. The importance of a child-specific approach and the provision of specialist imaging services for children and young adults has been recognised for many years.

This examination will reflect the content of the ECPR course and will also include relevant questions on anatomy and techniques. Performing clinical research within paediatric radiology poses a major challenge, due to the com- paratively low prevalence of many disease entities in children and the resulting sample size constraints. Cooperation with global insti- tutions and joint ventures with industry is key. The Paediatric Research Committee, led by Prof. Karen Rosendahl, and the Euro- pean Excellence Network on Pae- diatric Radiology (EENPR), led by Prof. Erich Sorantin, brings experts within the fields together and coor- dinates the various research plat- forms. Moreover, the ESPR has five very active task forces: child abuse, CT and dose, musculoskeletal, neu- roradiology and uroradiology. It is worth mentioning that the ESPR has been a shareholder of the Euro- pean Institute for Biomedical Imag- ing Research (EIBIR) since 2011. To facilitate translational research, the Guy Sebag Research Grant for Clinical, Basic or Translational Research in Paediatric Radiology is awarded every second year during the Annual Meeting of the ESPR. The ESPR’s 53rd Annual Meeting and 39th Postgraduate Course will take place from May 28 to June 3, 2017, in Davos, Switzerland. Through these initiatives, the ESPR is making research one of its key Performing effective examinations been actively involved in world- was set up to provide basic training non-profit organisations in the field institutional aims. depends upon gaining the coop- wide outreach initiatives, on an in paediatric radiology, addressing of education and outreach in paedi- The ESPR’s official journal,Pedi - eration of the child, which means individual basis, or through inter- important needs within Central atric radiology. atric Radiology, plays an important examinations are age dependent. In national regional and global aid and Eastern European areas, where In line with other European sub- role in the distribution of relevant younger and uncooperative children, organisations. no established paediatric radiology specialty societies, the ESPR is cur- educational and scientific mate- sedation or general anaesthesia may Their current involvement exists, and where there is no access rently establishing a new European rial, and is led by Dr. Oystein Olsen, be required. The needs of parents mainly focuses on onsite educa- or restricted availability to teaching, Paediatric Radiology Educational its new European editor. Pediat- or carers should also be understood tion, hands-on training and diag- expertise, and best practice within Curriculum, including a European ric Radiology informs its readers and addressed when considering any nostic consultation (more recently, paediatric imaging. Diploma in Paediatric Radiology of new findings and highlights paediatric service. via teleradiology services). Within Besides plenary lectures covering (EDiPR). The primary aim of the progress in all areas of paediatric At the Society’s 53rd Annual Meet- the European Union, the ESPR has all aspects of basic paediatric radi- EDiPR is to become an interna- imaging and related fields. This ing and 39th Postgraduate Course well-established collaboration with ology needs, the course included tionally recognised certificate of is achieved by a blend of original from May 28 to June 3, 2017, pro- the European Society of Radiol- workshops in small groups and par- paediatric radiology excellence, by papers, complemented by reviews fessionals and friends will meet in ogy (ESR) via the European School ticipation in practical (hands-on) ensuring a single European stand- that set out the present state of Davos, Switzerland. The meeting of Radiology (ESOR) [www.esor. procedures. The evaluation of the ard of paediatric radiology training knowledge within a particular venue is the Congress Center of org]. This particular collaboration course by the participants was very and education. The next European area of the specialty or summarise Davos. We will discuss both new focuses on organising both basic positive. As a consequence of this Course in Paediatric Radiology specific topics in which discussion scientific and technical innovations and advanced imaging courses, in success and due to the large num- (ECPR), organised annually by the has led to clear recommendations from the diagnostic and interven- particular within areas of perceived ber of applicants (of which many ESPR, will be the first course of this and conclusions. tional field. There have been several need, including Eastern and Cen- had to be rejected because of lim- newly developed three-year cyclical Do not hesitate to visit the ESPR new challenges in the field of paedi- tral European countries, as well as ited capacity) the faculty decided to educational curriculum. It will be website for further information atric radiology, with the emergence offering exchange programmes for offer a similar basic teaching course held in Utrecht, the Netherlands on upcoming society projects, and of the Zika virus epidemic in Latin paediatric imaging fellowships to on paediatric radiology in 2017. from October 11 to 13, 2017 (www. to find out how to become a mem- America affecting mothers and centres of excellence within the EU. A fundamentally important ecpr2017.org). The theme of ECPR ber and contribute to the progress their newborns, and the migration Furthermore, in 2016 the ESPR global initiative in line with these 2017 will be paediatric musculo- of paediatric imaging within and crisis in Europe involving children initiated and financially supported initiatives was the foundation of skeletal imaging, covering state-to- beyond Europe. and young adults of unknown age. a new ‘Essentials in paediatric radi- the World Federation of Pediatric the-art imaging in paediatric acci- www.espr.org Both topics challenge medical and ology and imaging’ course (Level Imaging (WFPI) at IPR 2011, with dental and non-accidental trauma, legal systems and cause dilemmas I–II), which was organised and run the ESPR as one of the founding , orthopaedic diseases, Dr. Rutger A.J. Nievelstein is a paedi- which will be discussed in depth as an inter-university project by societies [www.wfpiweb.org]. WFPI oncology and skeletal dysplasia. The atric radiologist and director of the with leading physicists, radiologists the University of Medicine and aims to ‘provide an international scientific programme will include local residency programme at the and specialised research groups. (UMF) ‘Iuliu Hatieganu’ platform for paediatric radiology state-of-the-art plenary lectures University Medical Center These global and intricate chal- in Cluj-Napoca, Romania and the organisations, united to address with several interactive hands-on Utrecht, the Netherlands and Chair lenges underscore the importance Division of Paediatric Radiology the challenges in global paediatric and case-based sessions, presented of the ESPR Educational Committee. of an integrated approach between within the Department of Radiol- imaging, training and the deliv- by an international faculty of international radiological and pae- ogy at the Medical University of ery of services’. Starting from four renowned speakers in the field of Dr. Jacques Schneider is consul- diatric organisations whose goals Graz (MUG), Austria, in coopera- founding society members, WFPI paediatric and musculoskeletal tant radiologist at the Hirslanden reflect and complement those of tion with the Paediatric Radiology has now grown to over 12 society radiology. At the end of the course a Clinics in Aarau, Switzerland, and the ESPR. For many decades, Euro- Group of the Romanian Radiologi- members worldwide and several written examination will be admin- a member of the ESPR Congress pean paediatric radiologists have cal Society (GRP-SRIM). The course partnerships with professional and istered as part of the new EDiPR. Committee. myESR.org #ECR2017 30 COMMUNITY NEWS ECR TODAY | WEDNESDAY, MARCH 1, 2017

BY FRIDON TODUA Georgian Association of Radiology hosts its 4th international congress

the challenges of the current job world last year. Oncology imaging, in Tbilisi, Georgia. More than 600 market, the GAR promotes support neuroimaging in epilepsy, quantita- representatives from 18 countries for young specialists for training in tive imaging in neurodegenerative were involved in this meeting and their subspecialty of interest within disease and multiple sclerosis are ESR officials also participated in radiology departments abroad. the focus of recent research. Active the congress. The different sec- Oncologic imaging remains a collaboration with different inter- tions included neuroradiology, main emphasis of Georgian radiol- national partners underlines the oncologic imaging, cardiovascular ogists. Imaging has become essen- scientific level of this research work. imaging, interventional radiology, tial in all aspects of cancer care, Considering concerns about the and many more. The scientific from disease detection and char- increasing exposure of the pop- sessions, invited lectures and case acterisation, to treatment response ulation to ionising radiation, we reports gained the active atten- assessment and post-treatment are extending the diagnostic role tion of attendees from different surveillance. Recent progress in of conventional whole-body MRI fields of medicine. It was a won- imaging technology has presented systems and performing studies to derful platform to exchange ideas new opportunities for improving demonstrate where MR could even- and experience. There was also a Prof. Fridon Todua (centre) presided over the 4th International GAR Congress clinical care. Rapid progress in the tually replace x-ray-based proce- special session organised jointly of Radiology, which took place in May 2016 in Tbilisi, Georgia. field of and the dures and nuclear medicine meth- with Youth Scientific Union for installation of the newest radi- ods. We are a member of EuroSafe students and residents. A small Radiology is the most rapidly Caucasus and Central Asia. There is ation therapy systems has com- Imaging and have collaborated grant was established by the developing field of medicine in also some ‘medical diagnostic tour- pletely changed the management closely with them. GAR to support the activities of Georgia, and the Georgian Associ- ism’ from neighbouring countries quality of oncology patients in Radiology has participated in junior participants. ation of Radiology (GAR) plays a to Georgian clinics. Georgia. This field is developing in the recent trend towards com- The success of the congress crucial role in this progress. Techni- The GAR works constantly to close cooperation with diagnostic puterised management in the showed the need for regional cal innovations, installation of new improve postgraduate and con- imaging departments. There is also health service in Georgia, and it scientific forums for radiolo- diagnostic systems and training of tinuing in the active research being performed has responded to the demand for gists. In 2017, the GAR is planning specialists have improved the radio- country. New radiology tests for in oncologic imaging using mod- cost efficient and rapid communi- to organise a meeting dedicated logical service in the country. Geor- the national radiology diploma ern advanced and quantitative cation between departments and to the recent advances in gian hospitals are now equipped and qualification exams have been imaging methods for monitoring the different specialists. The GAR magnetic resonance imaging and with most modern imaging tools developed in accordance with mod- disease progression and the effects is helping its member institutions computed tomography. and in comparison to past years ern standards. Taking into consid- of therapeutic interventions (e.g. to establish telemedicine in differ- there is relatively less disparity in eration the popularity of this spe- with diffusion, perfusion and spec- ent parts of the country. Consult- Prof. Fridon Todua is President radiological services between the cialty, there is strong competition troscopic parameters). ant support is available from the of the Georgian Association of capital and the provinces. It can for residency places in radiology. At The availability of modern imag- best professionals in the country Radiology (GAR). be stated that with an established the same time, new directions like ing tools has established a good as well as from abroad. network of radiological services PET imaging and interventional base for advanced research work The year 2016 was a very impor- and trained specialists, Georgia has radiology are emerging, which by Georgian radiologists. Relevant tant one for the GAR, because in become a regional leader in diag- provide new job opportunities for papers and talks were presented by May 7–8 it organised the 4th Interna- nostic imaging within the southern young professionals. Considering Georgian radiologists around the tional GAR Congress of Radiology

BY ANTONIO PINTO Italian Society encourages radiologists to reduce inappropriate examinations

In the last 20 years, there has been the physician refuses to perform of the procedure itself (i.e., radia- order to discuss the importance of 6 Patel MR, Spertus JA, Brindis RG, a significant increase in referrals for high-risk procedures. It can also tion or contrast exposure) and the appropriateness in radiology. Hendel RC, Douglas PS, Peterson diagnostic imaging examinations, take the form of assurance behav- downstream impact of poor perfor- ED, Wolk MJ, Allen JM, Raskin especially in the emergency depart- iour and is called positive defen- mance such as a delay in diagnosis Prof. Antonio Pinto is medical direc- IE. American College of Cardiol- ment. However, if the efficacy of a sive medicine when extra tests or (false negatives) or inappropriate tor of the department of radiology, ogy Foundation ACCF proposed radiological examination is related procedures are performed. Positive diagnosis (false positives). This A. Cardarelli Hospital, in Naples, method for evaluating the to a positive change in patient man- defensive medicine, which leads implies potential harm for patients Italy, and President of the Section appropriateness of cardiovascu- agement, its ‘overuse’ without clin- to unnecessary diagnostic exami- undergoing imaging (who take the of Ethics and Forensic Radiology of lar imaging. J Am Coll Cardiol ical advantages may have negative nations and therapeutic interven- risks of an imaging study without the SIRM. 2005;46:1606 -1613. effects for the patient, especially in tions, can be invasive and costly. a commensurate benefit), excessive 7 Picano E. The risks of inappro- terms of radiation protection and Every year, five billion imaging delay in the waiting lists for other References priateness in cardiac imaging. the healthcare system in terms of tests are performed worldwide and patients needing the examination Int J Environ Res costs1. about half of these are cardiovas- and an exorbitant cost for society, 1 Squillaci E, Bolacchi F, Sca- 2009;6(5):1649-1664. There are several types of inap- cular examinations3. According to with no improvement and possibly ggiante J, Ricci F, Pugliese L, 8 Carpeggiani C, Marraccini P, propriateness, such as radiological recent estimates, at least one-third a reduction in care quality7. Bergamini A, Garaci F, Floris R. Morales MA, Prediletto R, Landi examinations that have already of all examinations are partially Inappropriateness in medical Inappropriateness of diagnostic P, Picano E. Inappropriateness been performed (e.g. at another hos- or totally inappropriate, in other imaging is not only extremely imaging examinations in the of cardiovascular radiological pital), execution of imaging investi- words the risks and costs outweigh costly, but is also an unnecessary inpatient setting: a case study imaging testing; a tertiary care gations whose results are unlikely the benefits4. The number of appro- risk for the patient when per- research. Radiol med (in press) referral center study. PLoS One to affect patient management, priate cardiac CT examinations is formed with ionising radiation (in DOI 10.1007/s11547-016-0708-4 2013;8(11):e81161. excessive number of examinations, still around 20% today, and was radiology and nuclear medicine), in 2 Tancredi LR, Barondess JA. The incorrect type of examination and around 30% a few years ago5. Fol- spite of recent determinations by problem of defensive medicine. the absence of appropriate clinical lowing the definition of the Amer- scientific societies to promote radi- Science 1978; 200 (4344): 879-882 information and justification for ican College of Founda- ological responsibility and imaging 3 Picano E. Economic and biolog- the imaging investigation. tion, an appropriate imaging study appropriateness. Moreover, many ical costs of cardiac imaging. Defensive medicine is another is one in which the expected incre- medical acts (imaging, therapy and Cardiovasc Ultrasound 2005;3:13. cause of inappropriateness related mental information, combined with intervention) contribute to wasted 4 Herzog C, Rieger CT. Risk of to radiological examinations. This is clinical judgement, exceeds any money and decreased levels of cancer from diagnostic X-rays. a practice performed by healthcare expected negative consequences safety in contemporary medicine8. Lancet 2004;363:340-341. providers to safeguard themselves by a sufficiently wide margin for The Italian Society of Medical 5 Ayyad AE, Cole J, Syed A, Desai from patients’ claims, while disre- a specific indication so that the Radiology (Società Italiana di Radi- MY, Halliburton S, Schoenhagen garding improvements in patients’ procedure is generally considered ologia Medica – SIRM) encourages P, Flamm SD, Sola S. Temporal health2. It can take the form of acceptable care and a reasonable radiologists to drastically reduce trends in utilization of cardiac avoidance behaviour and is called approach for the indication6. Nega- inappropriate radiological exami- computed tomography. J Cardio- negative defensive medicine when tive consequences include the risks nations and to organise meetings in vasc Comput Tomogr 2009;3:16-21.

#ECR2017 myESR.org Special Exhibition: Contemporary Art. Andy Warhol to Anselm Kiefer

ALBERTINA 1010 Vienna, Albertinaplatz 1 www.albertina.at

Alex Katz, Black Hat 2, 2010, Albertina, Vienna – Batliner Collection © Bildrecht, Vienna, 2016 WHAT’S ON TODAY IN VIENNA? WEDNESDAY, MARCH 1, 2017

Mark Seibert in Schikaneder © VBW / Deen van Meer 2016

Stefanie Reinsperger in Medea by Franz Grillparzer Markus Meyer in Ludwig II based on Visconti’s movie Tugan Sokhiev © Patrice Nin © www.lupispuma.com / Volkstheater © Reinhard Werner / Burgtheater

THEATRE & DANCE CONCERTS & SOUNDS OPERA & MUSICAL

Ludwig II Wiener KammerOrchester Peer Gynt based on Luchino Visconti’s movie Conductor Stefan Vladar by Werner Egk AKADEMIETHEATER | 20:00 Isabelle van Keulen, violin Conducted by Leo Hussain, 1030 Vienna, Lisztstraße 1 directed by Peter Konwitschny W.A. Mozart: Concerto for violin and orchestra d Phone: +43 1 51444 4145 With Bo Skovhus, Maria Bengtsson, Natascha major K 218; L. van Beethoven: Romance for violin www.burgtheater.at Petrinsky, Nazanin Ezazi, Cornelia Horak, and orchestra g major op. 40, Romance for violin Andrew Owens, Rainer Trost and orchestra f major op. 50; F. Schubert: ORF Radio-Symphonieorchester Wien, Arnold Hexenjagd Symphony No. 8 c major D 944 by Arthur Miller Schoenberg Chor KONZERTHAUS | 19:30 BURGTHEATER | 19:00 1030 Vienna, Lothringerstraße 20 THEATER AN DER WIEN | 19:00 1060 Vienna, Linke Wienzeile 6 1010 Vienna, Universitätsring 2 www.konzerthaus.at Phone: +43 1 51444 4145 www.theater-wien.at www.burgtheater.at Orchestre Nationale du Capitole Heute im Foyer … de Toulouse Monsieur Claude und seine Töchter String quartet playing music by Conductor Tugan Sokhiev by Philippe de Chauveron und Guy Laurent W.A. Mozart a.o. J. Massenet: Don Quijote KAMMERSPIELE DER JOSEFSTADT | 19:30 VOLKSOPER | 19:30 1010 Vienna, Rotenturmstraße 20 MUSIKVEREIN | 19:30 1090 Vienna, Währingerstraße 78 Phone: +43 1 42 700 300 1010 Vienna, Bösendorferstraße 12 www.volksoper.at www.josefstadt.org www.musikverein.at Onegin Diese Mauer fasst sich selbst zusammen Koglmann / Arcari / Pasztor Ballet by Pyotr Ilyich Tchaikovsky, und der Stern hat gesprochen, der Stern (Austria/Italy) hat auch was gesagt choreography by John Cranko PORGY & BESS (JAZZ) | 20:30 WIENER STAATSOPER | 19:30 by Miroslava Svolikova 1010 Vienna, Riemergasse 11 1010 Vienna, Opernring 2 www.porgy.at SCHAUSPIELHAUS | 20:00 www.wiener-staatsoper.at 1090 Vienna, Porzellangasse 19 Phone: + 43 1 317 01 01 Schikaneder www.schauspielhaus.at Musical by Stephen Schwartz Sieben Sekunden Ewigkeit & Christian Struppeck by Peter Turrini RAIMUNDTHEATER | 18:30 1060 Vienna, Wallgasse 18–20 THEATER IN DER JOSEFSTADT | 19:30 www.musicalvienna.at 1080 Vienna, Josefstädter Straße 26 Phone: +43 1 42 700 300 www.josefstadt.org Don Camillo & Peppone Musical by Michael Kunze & Dario Farina Medea RONACHER | 18:30 by Franz Grillparzer 1010 Vienna, Seilerstätte 9 www.musicalvienna.at VOLKSTHEATER | 19:30 1070 Vienna, Neustiftgasse 1 Phone: 43 1 52111 400 www.volkstheater.at

Please note that all theatre performances are in German.