ECR TODAY 2015 DAILY NEWS FROM EUROPE’S LEADING IMAGING MEETING | FRIDAY, MARCH 6, 2015

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HIGHLIGHTS CLINICAL CORNER TECHNOLOGY FOCUS COMMUNITY NEWS ESR seeks to build on Computer-aided diagnosis CT manufacturers edge Three distinguished initiatives to replace can act like a spell check towards optimum blend of radiologists receive antiquated equipment for small polyps accuracy and safety ESR Gold Medal

BY MICHAEL CREAN Outstanding hybrid imaging researcher delivers Honorary Lecture today

member of several scientific societies In recognition of his significant expertise in the including the German Radiological Society, the German Society for Inter- field of hybrid imaging and his great achievements ventional Radiology, the Röntgen in the field of research, Professor Gerald Antoch, Society of North-Rhein-Westfalia, the German Society for Radiation Prof. Gerald Antoch from Düsseldorf, Germany, will deliver Protection in Medicine, the German from Düsseldorf, Germany, has been invited to deli- today’s Wilhelm Conrad Röntgen Society for Interdisciplinary Medi- Honorary Lecture on hybrid cine and, of course, the European ver the Wilhelm Conrad Röntgen Honorary Lecture imaging. Society of Radiology. He is also no at ECR 2015. stranger to the ECR, where he has lectured and served on the ECR 2015 “Hybrid technology forms the Programme Planning Commiee. basis for a new era of medical Gerald Antoch is professor of interventional radiology at Düssel- work with a number of awards. In At ECR 2015, Prof. Antoch will imaging. This technology requires radiology and chairman of the dorf University Hospital. 2003, he received the Alavi-Mandell deliver the Wilhelm Conrad Röntgen expertise in both, radiology and department of diagnostic and inter- “I am highly honoured to be invited Award from the Society of Nuclear Honorary Lecture entitled ‘Hybrid nuclear medicine. Therefore, just ventional radiology at Düsseldorf by the ESR to give the Wilhelm Medicine, United States, and that imaging: let the two worlds of radi- hybridising imaging systems is not University Hospital. Conrad Röntgen Honorary Lecture at same year he won Aunt Minnie’s ology and nuclear medicine come enough. To guarantee high-qual- Aer completing his medical train- ECR 2015. With high-quality scientific Best Scientific Paper Award, which together’ ity hybrid imaging in the future ing, Prof. Antoch began working in sessions and refresher courses the he won again in 2004. In 2005 he hybridisation will have to include general surgery before starting his ECR aracts an increasing number was awarded the Lodwick Award the physicians involved!” training in diagnostic and interven- of radiologists and technicians each at Harvard Medical School followed tional radiology at Essen University year. In my opinion the ECR will by awards from the Bavarian Asso- Hospital. He became a board certi- evolve into the radiological meeting ciation of Nuclear Medicine and the Don’t miss today’s Honorary Lecture fied radiologist in 2004. From 2004 worldwide,” he said. German Cancer Research Center in to 2008, he worked as a consultant Prof. Antoch’s scientific research the same year. In 2007 the German Friday, March 6, 12:15-12:45, Room A #ECR2015A radiologist and became vice chair- focuses on clinical hybrid imaging. Radiological Society presented Prof. Wilhelm Conrad Röntgen Honorary Lecture man of the department of radiology He has published 209 original scien- Antoch with the Wilhelm Conrad at Essen University Hospital in 2008. tific articles and reviews, as well as Röntgen Award. » Hybrid imaging: let the two worlds of radiology and nuclear In 2010 he was appointed chairman 20 book chapters. He has received Apart from his scientific and clin- medicine come together of the department of diagnostic and widespread recognition for his ical work, Prof. Antoch is an active Gerald Antoch; Düsseldorf/DE myESR.org DUAL SOFT BAG INJECTION SYSTEM

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allée Jacques Monod - 69800 Saint-Priest – France • Document revision date: 2014. : Guerbet, Shutterstock. : ANNAPURNA 8000 - Photos December 2014 - Conception ECR TODAY | FRIDAY, MARCH 6, 2015 HIGHLIGHTS 3

BY MÉLISANDE ROUGER Germany presents future plans in ‘ESR meets’ session

“Justifying an indication means All eyes will be on Germany today, as it kicks off the ‘ESR meets’ asking for the radiologist’s confir- mation that the risks and benefits programme with an ambitious session entitled ‘Tradition goes digi- have been considered before an tal: geing ready for the future’. The German Radiological Society examination using ionising radia- tion is performed. Obviously, this (DRG), which prepared the session, will reveal what the future has in strengthens the role of the radiolo- gist. Compromises have to be made store for radiologists and how Germany, a country at the forefront for teleradiology. But the danger is that teleradiology facilitates the of medicine, is tackling challenges linked to the digitisation of the commoditisation of radiology – radi- ology reports become something like discipline. oxygen in the OR, delivered without a doctor. Justifying indications in the biomarkers that may serve as a valu- Interludes will shed a light on context of teleradiology requires able source for the detection of early other interesting characteristics of contact between a physician on the disease states and identifying novel German radiology. site serviced by teleradiology and a imaging biomarkers of risk. They Dr. Bernhard Lewerich from Berlin radiologist. The future will show how also aim to determine the predictive will, for his part, present the Rönt- this works out, with other European value of findings from whole-body genhaus, the house in which Wilhelm countries being much more liberal,” MRI on the incidence of chronic Conrad Röntgen was born and which Prof. Hosten said. diseases over the follow-up period, is currently being renovated. In the aernoon, the European establish reference values for various Prof. Reinhard R.W. Loose from Federation of Radiographer Socie- organs and organ parts, and correlate Nürnberg will talk about radiation ties (EFRS) will explore the role of MRI findings with metabolomic and protection and the concept of justi- high-end and hybrid technology in genome-wide analysis. fying indications, an increasingly the clinical and research work of “For instance, MRI data from the important aspect of healthcare in radiographers in Germany. brain of the study population have the advent of teleradiology. been used to generate three-dimen- sional volumes of the brain’s grey and white maer, or specific regions in Prof. Norbert Hosten from Dr. Katrin Hegenscheid from ESR/EFRS meets Sessions the brain that were later associated Greifswald is president of the Greifswald will present the Friday, March 6, 10:30–12:00, Room B #ECR2015B #EM1 German Radiological Society latest results from studies on with genetic, psychosocial and clin- and will co-chair today’s session population-based MRI. ical factors in large consortiums. In ESR meets Germany ‘ESR meets Germany’. this way, gen loci and risk factors, EM 1 Tradition goes digital: geing ready for the future e.g. smoking, have been identified Moderators: B. Hamm; Berlin/DE that influence specific parts of the N. Hosten; Greifswald/DE human brain that are associated “Digitisation, as we all know, needs factors for various disease states, with cognitive diseases. In the same » Welcome by the ESR President a conscious effort on the part of the their power is limited to the number way, five gen loci have been identi- L. Bonomo; Rome/IT user: as radiologists, we do not want of overt events in the source popu- fied influencing facial morphology in to be led but to lead. So we should lation. Over the last two decades, Europeans. Furthermore, MRI data » Introduction stop for a moment and think how imaging has increasingly been imple- from SHIP have been used to gener- N. Hosten; Greifswald/DE digitisation impacts our profession,” mented in population-based cohorts ate MRI reference values for organs, » State-of-the-art teaching in German radiology: Akademie said DRG president, Prof. Norbert in order to obtain information on the e.g. the aorta and aortic wall, the online Hosten from Greifswald, ahead of presence and extent of subclinical liver, the lungs, or the female breast M.G. Mack; Munich/DE the session he will moderate together disease burden, allowing for a more tissue,” Dr. Hegenscheid said. » Interlude I: Radiation protection: the concept of ‘justifying with his compatriot, ECR 2015 presi- comprehensive assessment of the Training is an important place indication’ dent, Prof. Bernd Hamm from Berlin. development of disease states. As a to prepare radiologists and medi- R.W.R. Loose; Nurnberg/DE New options for population-based result, a comprehensive phenotyp- cal students for new paradigms in » Population-based MRI: SHIP (study of health in Pomerania) and imaging, radiology training and ing of the human body in its various radiology. In a dedicated lecture, the national cohort hybrid imaging techniques have normal and abnormal conditions is Dr. Martin G. Mack from Munich K. Hegenscheid; Greifswald/DE been developed to help radiologists possible,” she said. will present the achievements of understand and lead the evolution Hegenscheid will also present Akademie Online, a teaching plat- » Interlude II: The Röntgenhaus: Wilhelm Conrad Röntgen’s of their discipline. key information on SHIP’s popula- form run by the German Roentgen birthplace Imaging large cohorts of patients tion-based cohort study, which was Association. B. Lewerich; Berlin/DE is a growing trend in healthcare. first conducted in 1997. “Akademie Online is a very success- » MRI-PET: a new modality for clinical imaging Such studies provide evidence-based “SHIP has two main objectives: to ful tool in which top-notch speakers C.D. Claussen; Tubingen/DE data useful for the advancement of assess the prevalence and incidence debate about state-of-the-art clinics, N. Schwenzer; Tubingen/DE science and reimbursement agen- of common risk factors, subclinical technology and other aspects of » Panel discussion: cies. They also serve to emphasise disorders and clinical diseases, and to our work as radiologists. There are Cross-linking radiology: opportunity or threat? the radiologist’s role in medicine, by investigate the complex associations special sessions for medical students showing how their work contributes among risk factors, subclinical disor- to get them interested in radiology to patient welfare and the advance- ders and clinical diseases. A particular and help them with their exams. Friday, March 6, 14:00–15:30, Room B #ECR2015B #EM5 ment of science. characteristic of SHIP is that it does Technical assistants have their own EFRS meets Germany In Greifswald, an old university not specifically address one selected sessions, and even courses required (European Federation of Radiographer Societies) town near the Baltic Sea and Polish disease, it rather aempts to describe by the authorities may be completed EM 5 High-end and hybrid technology in clinical and research border, radiologists have teamed up health-related conditions with the here,” Prof. Hosten explained. work of radiographers in Germany with epidemiologists to perform widest possible focus,” she said. To prepare for the future, keep- whole-body MRI in healthy subjects Since 2008, a standardised MRI ing up to date with technological Moderators: C. Vandulek; Kaposvar/HU as part of the Study of Health in protocol has been part of the advances is vital. Developments in A. Ohmstede; Oldenburg/DE Pomerania (SHIP). entire examination procedure and the emerging and promising field of Katrin Hegenscheid, a radiologist performed using a 1.5T MR machine. MRI/PET will be at the heart of the » Introduction at Greifswald University, is SHIP’s The basic programme includes native presentation given by Dr. Claus D. C. Vandulek; Kaposvar/HU head of MRI studies. She will explain whole-body MRI of the head, neck, Claussen and Dr. Nina F. Schwenzen, A. Ohmstede; Oldenburg/DE why imaging techniques are increas- chest, abdomen, pelvis and spine. both from Tübingen. » Teaching and learning with VERT (Virtual Environment for ingly being used in large cohort stud- Following the basic programme, “As a technology-driven medical Radiation Therapy Training) ies for epidemiological research. contrast-enhanced cardiac MRI and profession, new technology is the air C. Garske; Berlin/DE “Traditionally, longitudinal stud- MR angiography are performed in we breathe. We are optimistic about » Selective Internal Radiation Therapy (SIRT) ies have relied on the clinical assess- men, whereas cardiac MRI and MR the future of MRI/PET. Think of MRI B. Kulitzscher; Berlin/DE ment of risk factors at baseline and mammography are performed in – did it really look so promising in » Interlude: German Röntgen Museum their relation to the incidence of clin- women. the beginning? Remember the joke B. Lewerich; Berlin/DE ical events, such as stroke, myocar- The MRI studies aim to assess by other specialists that NMR stands dial infarction or death during the prevalence estimates of subclinical for no money remains. It proved to be » PET-CT follow-up period. While this design MRI findings and normal variants uerly wrong, and maybe MRI/PET K. Hagele; Bobingen/DE has served well for the identifica- in the general population, along is closer to clinical reality than we » MRI-PET tion of many now established risk with deriving subclinical imaging now think,” Prof. Hosten said. V. Diehl; Bremen/DE myESR.org

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BY FRANCES RYLANDS-MONK ESR seeks to build on initiatives to replace antiquated equipment The ESR’s EuroSafe campaign is gaining momentum, following publication of the position paper on machine renewal. The document states equipment that is up to five years old is considered state-of- the-art technology. Properly maintained equipment that is six to ten years old is suitable for practice, but radiology departments should develop a strategy to replace them. Machines over ten years old must be replaced.

he noted. This leads to delays in units and Greece having the most CT renewing old equipment. equipment with 34.8 CT scanners per “The ESR’s Working Group on million population. Outside the EU, Economics is looking at the differ- Iceland had the highest number of ent procurement processes across CTs with 40.5 per million inhabitants. Europe. Certainly in Croatia the legal With aging equipment comes procedure needs to be simplified and decreasing safety for patients and companies need to accept a cheaper staff – particularly in terms of radia- bidder winning a tender without tion exposure – and delays in terms of pursuing it with complicated legal accurate diagnosis and appropriate proceedings. The ESR could help to treatment for the patients because of do this,” he said. poorer quality images. Another issue In many countries, money for is the increasing cost of maintenance machine purchases still comes from and spare parts. Some countries are governmental health funds, all of moving ahead with renewal incen- which have suffered from recent tives; in Turkey, for example, reim- austerity measures. This is why it is bursement is lower if MR procedures vital for authorities to be acquainted are carried out on older MR equip- with the importance of radiology’s ment. While such incentives are not role in patient care, particularly given applicable to the public sector, in all that the majority of important work national health systems, questions takes place in large, usually public about future strategies for machine hospitals and educational centres replacement must be raised now, where radiologists train. Allow- today’s speakers concur. ing radiology residents to train on In a statement to ECR Today ahead new equipment has a fundamental of the congress, ESR’s Immediate impact on the level of their expertise Past President Prof. Guy Frija high- in routine practice, Brkljačić noted. lighted the need for modernising The challenges are manifold; imaging equipment across Europe, even before the economic crisis, the as well as the importance of devel- proportion of gross domestic prod- oping and politically supporting key uct allocated to health differed from quality and safety indicators. country to country, and in 2012 the “Quality of care and patient number of machines per country safety can only improve if we invest also differed. Surprisingly, the U.K. in education and training,” noted had only 6.8 MRI units and 8.7 CT Frija. “The ESR’s European Training scanners per million population in Curriculum for Radiology and the 2012, while Greece, Cyprus and Italy European Diploma in Radiology are were among the countries with the important instruments for support- highest machine numbers, Italy ing these harmonisation efforts.” being the highest with 24.6 MRI This 16-slice multislice CT scanner was installed at the University Hospital Dubrava in Zagreb a decade ago. It is still functioning, but should be replaced. (Provided by Prof. Boris Brkljačić)

Delegates in public sector hospi- National societies can use the machines and the quality of images Professional Challenges Session tals must approach the relevant document when negotiating with are particularly crucial for vulner- Friday, March 6, 16:00–17:30, Room F2 #ECR2015F2 #PC12a authorities for the budget to renew regulators, hospital administrators able sectors, such as paediatrics, PC 12a Harmonised approach for imaging in Europe: such machines, according to speak- and equipment buyers or when where radiation doses have to be myth or reality? ers at today’s session. Presenters lobbying the government or inform- kept at minimum levels. For all imag- also intend to elaborate on the ESR’s ing the media, he adds. ing studies with aging machines, » Chairman’s introduction analysis of the public procurement Radiologists are under pressure, images lose quality, and with lots of L. Donoso; Barcelona/ES process across Europe, which is continued Brkljačić, who is also use machines break down quicker highly variable in complexity from a member of the ESR’s Working and create higher maintenance costs, » Current heterogeneities in imaging in Europe country to country. Group on Economics. Older equip- he explained. G. Frija; Paris/FR “For the first time, we can define ment cannot accommodate high ESR’s efforts have been challenged » Imaging equipment: an ESR perspective our official position, which is more patient throughput needs and by the economic crisis, which hit B. Brkljačić; Zagreb/HR or less in line with the lifecycle guid- cannot provide sufficient quality of some European countries harder » Equipment age – COCIR ance published by the American examinations. than others, leading to a highly varied N. Denjoy; Brussels/BE College of Radiology (ACR) and the “Although the ESR is a professional situation in terms of equipment, » Training and certification Canadian Association of Radiology,” and scientific society, not a politi- according to Brkljačić. In Croatia, B. Ertl-Wagner; Munich/DE said Prof. Boris Brkljačić, chair of the cal one, if providers don’t agree to public hospitals and large academic Department of Radiology, University finance the renewal of machines, centres have old CT equipment, » Issues related to coding terminology and IT access Hospital Dubrava, Zagreb, and head some individuals may feel the urge to while some smaller centres tend to be P. Mildenberger; Mainz/DE of ESR’s Communications and Exter- inform patients and the public that beer equipped. The main problem » Panel discussion: A global plan for imaging nal Affairs Commiee. “The ESR’s they are being imaged on older and stems from local issues surround- J. Griebel; Neuherberg/DE (HERCA Chair of the Working Group paper might be in many instances a less suitable equipment,” he warned. ing renewal. Public procurement on Medical Applications – BfS, Germany) crucial reference in talks with hospi- The position paper is the fruit through the tender process is long- T. Peetso; Brussels/BE (Policy Officer of Unit ‘Health and tal authorities and the government of ESR’s long-established efforts to winded, sometimes taking up to one Wellbeing’ – DG CNECT, European Commission) when dealing with the important decrease the heterogeneity of equip- year. Moreover, because of the lack of A. Rys; Brussels/BE (Director Health systems and products – topic of equipment renewal, which ment, so that radiologists across clarity in the process, tenders oen DG SANCO, European Commission) represents a huge problem in many Europe can practise in a state-of- fail when unsuccessful bidders file G. Simeonov; Luxembourg/LU (Policy Officer Radiation countries and departments.” the-art manner. Both the safety of complaints about minor legal points, Protection Unit – DG ENER, European Commission) myESR.org

FRIDAY, MARCH 6, 2015 CLINICAL CORNER 9

Good communication skills Flawed diagnostic processes How best to avoid 11and procedures prove vital 12contribute to poor risk 13 pitfalls in sports injuries on radiation risk assessments in prostate cancer of the knee

BY FRANCES RYLANDS-MONK Computer-aided diagnosis can act like a spell check for small polyps

Computer-aided diagnosis (CAD) can only enhance performance if used correctly, and does not reduce the need for training, experts agree. Furthermore, CAD is moving away from pure detection to clinical decision support, but the adoption of new reading paradigms for the screening scenario and impro- vements in how the technology presents results are both vital if it is to become an essential imaging tool.

strange shape marked by CAD is too first-reader CAD (DR FR CAD). irregular to be a polyp and dismiss CAD initially reads the image, and 3D endoluminal image of the ascending colon demonstrates an irregular it as either a fold or retained faecal this first interpretation is around polypoidal lesion (arrows) correctly identified by CAD. In a reader study, residue. In some cases missing a real 90% sensitive. Then the radiologist this lesion was initially missed and only detected using second read CAD lesion like this can have dramatic looks at the image with a primary by two of 10 readers. (Provided by Prof. Stuart Taylor) consequences for the patient as a 2D read. In experienced hands, this missed polyp may be, or can become, double-reading paradigm works cancerous.” well and leads to fast and accurate False negatives can present a chal- reporting, according to the project’s lenge too. Typically the computer emerging data (Radiology, Vol. 268, programme looks for the rounded No. 3, September 2013). bowler-hat contours of a polyp “If CT colonography is imple- which stand proud of the bowel mented as a population screening wall. It may miss the flaer polyps test, there will be very large numbers and even large mass-like lesions that of datasets to read by a relatively don’t have typical rounded contours. small number of trained radiologists. Most manufacturers are further Implementing CAD in a DR FR CAD Prof. Stuart Taylor from London developing CAD using validated paradigm may allow the reading of CT colonography cases containing large case numbers in a limited time,” examples of unusually shaped flat said Taylor. lesions and also cancers, writing At today’s update session, dele- these characteristics into their so- gates will also hear how the mass CAD for colonography has shown ware and training their programmes screening programmes of the 1980s particular promise, and most radi- to recognise them. The diagnostic are now moving towards an indi- ologists will come across it in their capacity of CAD is, therefore, contin- vidualised screening dynamic. For workflow and will need to under- ually improving. this to become optimal, any CAD A 68-year-old asymptomatic female underwent routine mammographic stand sensitivity and specificity CAD advances may also have a tool needs to factor in risk constel- screening. A subtle small spiculated mass was correctly detected by issues, as well as when CAD should positive impact on patients with lation and point the radiologist to CAD in the upper-outer quadrant of the right breast, best seen on the be deployed in this area. The tech- regard to full bowel preparation prior the best imaging studies for the mediolateral oblique (MLO) view. Percutaneous biopsy and subsequent nique’s major diagnostic benefits to the procedure. patient, according to Prof. Dr. Ulrich surgical excision confirmed a 10-mm well-differentiated, lymph-node are in small 6–9 mm polyps, which “Refinements in soware mean Bick, professor of radiology and vice negative invasive ductal cancer in the right breast [pT1b pN0 (sn) G1], oen are difficult for the radiologist that the CAD programmes will chair of the radiology department which had an excellent prognosis due to its early detection through to spot. increasingly be able to differentiate at The Charité university hospital mammography screening. (Provided by Prof. Dr. Ulrich Bick) “CAD acts like a spell check for retained stool from real lesions, due in Berlin. small polyps,” Prof. Stuart Taylor, to the increased aenuation of resi- “Traditional CAD doesn’t take into professor of medical imaging and due following the use of oral iodi- account risk factors such as age or consultant gastrointestinal radiol- nated tagging agents. This should genetics. This combined with its 98% ogist at University College London mean CAD will work beer aer sensitivity for finding microcalcifi- told ECR Today in an interview ahead reduced or non laxative preparation cations means that the radiologist of the congress. “There are also so that patients will no longer have to must decide whether or not the instances when tumours and large take unpleasant bowel preparation oen numerous findings are clini- Refresher Course: Computer Applications polyps are missed by the radiologist before CT colonography,” Taylor said. cally relevant,” said Bick, who will be before CAD draws aention to them.” Evidence suggests that second- presenting an update on breast CAD Friday, March 6, 16:00–17:30, Room MB 3 #ECR2015MB3 #RC1205 However, he is keen to highlight read CAD is more effective in increas- at today’s session. RC 1205 Update on computer-aided diagnosis (CAD) that CAD is not 100% accurate, nor ing sensitivity but adds to reporting Results from the European breast does it obviate the need for training time, he explained. “Conversely, while cancer diagnosis project, HAMAM, » Chairman’s introduction in CT colonography interpretation. concurrent reading may take less which uses CAD in a more patient-tai- M. Langer; Freiburg/DE “The idea that doctors will not time, radiologists can be tempted lored approach, are promising. The » A. CT colonography and CAD need to read as many validated to only look at CAD marks, which project integrates MRI, mammog- S.A. Taylor; London/UK cases to train themselves is incor- may distract them from scrutinis- raphy and ultrasound with risk » B. CAD for lung nodules rect, particularly in the detection of ing non-prompted parts of the colon factors such as age and gene muta- A.R. Larici; Rome/IT unusually shaped lesions, which is where there may be lesions.” tion carrier information. Some risk when the radiologist’s own eyes and A large multicentre Italian screen- » C. CAD for breast cancer detection knowledge will pay off,” Taylor noted. ing study has pointed to greater time U. Bick; Berlin/DE “An untrained doctor may think a efficiency of using double-reading continued on page 10 » Panel discussion: Is CAD ready for prime time? myESR.org 10 CLINICAL CORNER ECR TODAY | FRIDAY, MARCH 6, 2015

continued from page 9 factors, such as breast density and For the moment, some of CAD’s case, time still risks being wasted With optimising CAD prompts assistant but only in response to the composition can even be extracted advantages are clear-cut: e.g., find- on recalls, which in a screening in mind, Bick pointed to a Dutch expert’s request for feedback,” said and factored into CAD’s findings. ing microcalcifications is tedious programme should not exceed 5% project which uses interactive deci- Bick. “We are interested in this work “For example, CAD could distin- for the reader, as the image needs for a human reader. sion support instead of traditional particularly as in one study, 29 radi- guish that four calcifications clus- to be checked in quadrants due to “I believe that CAD should be CAD prompts. The reader points ologists each reading 300 mammo- tered together in a young patient resolution issues. CAD, however, used routinely, but it is vital for the to an area of uncertainty and the grams from a large database of with dense breasts are more likely speeds up the process by looking at radiologists to make the right call computer either concurs with mammography found only marginal to be relevant than in a 70-year-old the full image in full resolution and between real and false prompts. In concerns through placing a marker, benefit from using traditional CAD. with low-density fay breasts,” Bick pointing to these microcalcifications. a screening situation two radiolo- or does not. Such selective interac- Everyone realises that the way that noted. “At present the commercial This frees up the human reader to gists may go through 250 cases in tive prompting has yielded beer traditional prompting works is not application of CAD is in pure detec- concentrate on other areas such as two-and-a-half hours. Things may results than traditional prompting, best suited to radiologists or to the tion. However the research points to density, masses and architectural be missed if there isn’t thorough according to the study by Rianne screening scenario.” integrating different modalities, risk distortions for which the computer training and a different way for Hupse, MSc, et al. factors and detection into a clinical is less trained. However, with CAD’s computers to present results,” he “Using this paradigm, the decision aid.” average of one false prompt per explained. computer acts like a sharp-sighted

BY EDNA ASTBURY-WARD No second chance: incidence of lawsuits looks set to rise across the board Radiology is one of the specialties most liable to claims based on medical malpractice, and radiologists do not get a second chance to amend an initial interpretation of an examination, according to an expert who will be speaking at today’s medicolegal session.

“There seems to exist a serious In today’s session, delegates will importance of good insurance and ‘infection’ of patients with ‘litigo- learn how to increase their aware- documentation, co-presenter Dr. sis’ due to the cash-back mentality ness and knowledge of malpractice Jane Adam makes a clear and simple of consumers,” said Vienna-based risks in the era of ‘epidemic malprac- point: “Nobody is perfect and things lawyer Dr. Markus Ludvik. “Expect tice suits’ and identify strategies that go wrong, however hard we try.” an increase of malpractice cases reduce and minimise the problems Adam, a consultant radiologist all over the world, especially for leading to malpractice litigation. at St. George’s Hospital in London, those patients with legal protection Ludvik plans to provide tips and asks whether human error necessar- insurances.” advice on how best to reduce the ily equates to substandard care, and Most complaints about radiol- chances of legal action by expand- suggests that radiologists should try ogists’ liability issues are based ing their medicolegal horizon. He to identify the root cause of errors, on failures of diagnosis, he noted. urges radiologists to think like a learn from mistakes made, and Radiological error is multi-facto- patient and to communicate with design systems and working prac- rial, including failures due to poor patients in a consistent manner and tices to minimise them and prevent technique, perception, lack of take time to ensure that the patient repeat mistakes happening. knowledge and misjudgements, fully understands the diagnosis “Radiologists cannot always avoid errors in interpretation, poor and treatment. Various electronic error, unless we never commit communication as well as the fail- programmes supporting the record- ourselves to an opinion, in which ure to suggest the next appropriate ing of patient data are on the market, case we are not doing our job,” she Expect an increase in malpractice Patients tend to think imaging procedure. but their benefit strongly depends emphasised. cases, warns Dr. Markus Ludvik, will always give the answer and Despite most doctors being on accurate data administration and Adam thinks that in the case of a lawyer based in Vienna. (Credit: is infallible, according to Dr. Jane well-informed about the basics of management, he added. errors, a culture of openness and Foto Fayer, Vienna). Adam from London. medicolegal malpractice, he thinks Ludvik is also keen to stress the clarity – as opposed to secrecy and there is still a need for professional importance of scrupulous documen- evasion – may help ameliorate the programmes to highlight the issues tation by providing wrien instruc- chances of ill feeling and possibly and there seems to be a lack of tions and appropriate documenta- reduce the risk of a malpractice information concerning the specif- tion, which reflects the standard of lawsuit. She also considers patients ics. He considers this is partly due care given. He recommends provid- may have an unrealistic expecta- to the fact that radiology may not ing legible wrien and/or data-pro- tion about the accuracy of imaging, have kept pace with changes in cessed records, which should suggesting that a well informed this arena. Furthermore, due to the contain adequate identification of patient who understands the real- variety of new diagnostic systems, the patient, the condition and initial ity that imaging may not reveal there are various scientific plat- reason for seeking advice, diagnosis, what the clinician suspects, may forms and discussions targeting new treatment provided, insurance and be less likely to sue in the case of a approaches to this topic. billing details, social security number mis-diagnosis. Professional Challenges Session Ludvik also thinks that this situa- and a documentation of allergies, “Patients now tend to be under the tion may have something to do with including contrast agents and other impression that imaging will always Friday, March 6, 16:00–17:30, Room Z #ECR2015Z #PC12b what he refers to as a “faint physi- medical complications. All patient give the answer and is infallible,” she PC 12b Medicolegal aspects in daily practice cian-patient relationship.” records received from other health- added. “When a radiologist receives an care providers should be included. Adam will also consider the impact » Chairman’s introduction order or request from another Only those terms and abbrevia- of error on the radiologist. She is J.I. Bilbao; Pamplona/ES physician to perform an imaging tions common to all medical profes- clear that in the case of a mis-di- » Inadequate consent, missed lesions and misinterpretation: legal study or procedure on a patient, sionals should be used. Ludvik is also agnosis or mis-interpretation of challenges in radiology the radiologist becomes part of a keen advocate of the necessity to an image, invariably this will cause E.J. Adam; London/UK the patient’s medical team,” he make a clear record of professional great distress for the radiologist. » When is a radiologic error simply an error and when is it explained. “However, the radiologist competence by continuously docu- Other than informal peer support malpractice? will frequently have no personal menting all education and training from colleagues, there is not much in A. Cannavale; Rome/IT contact with ‘their patient’ at all, but received, and he urges radiologists to the way of a formal support network this does not exempt them from legal be properly insured against malprac- for the radiologist who has made an » The lawyer’s point of view obligations due to the requirements tice risks and legal expenses. error or is being accused of having M. Ludvik; Vienna/AT for comprehensive counselling and Despite such expert advice and done so, and the stress can have an » Panel discussion: How present are medicolegal aspects in our daily information.” strenuous warnings about the immense impact. clinical practice?

myESR.org ECR TODAY | FRIDAY, MARCH 6, 2015 CLINICAL CORNER 11

BY CYNTHIA E. KEEN Good communication skills and procedures prove vital on radiation risk A lile knowledge is a dangerous thing. This 18th century English proverb is certainly applicable in the 21st century with respect to the subject of radiation risk from diagnostic imaging. As media from many sources incites the concerns of the general public, patients, and physicians, radiology professionals need to address the subjects of assessment of radiation risk and how to communicate this.

audits undertaken of the data iden- many associated with long-term tifies outliers that might otherwise outcomes that are possibly debilitat- go unidentified.” ing, and even controversial. The more In 2010, Ireland launched an a patient knows, the beer informed Imaging Management Informa- he will be to understand treatment tion System, and dose monitoring options offered and their potential systems are now in use in 40 hospi- outcome, according to Briers. tals. Aer discovering significant He encourages more collaboration variations for the same CT exami- between urologists and radiologists. nation, the country has initiated a “To make a proper diagnosis, patients proactive optimisation programme need the most appropriate imaging to standardise procedures and radi- procedures. If a radiologist receives ation doses. Over time, collection an order that is not appropriate, or of data from the dose monitoring not the best type to achieve the best system will contribute to a greater diagnosis, it is imperative that he amount of research that will enable provides consultation to the urolo- us to more accurately calculate risks. gist or other ordering physician. Men Gilligan believes that radiation suspected of having prostate cancer Be continuously vigilant on dose, advises Paddy Gilligan. Benchmarking: flexible analytics comparing dose to external risks are small, and can be further deserve this.” benchmarks, including QuiRCC, NCRP ICRP, and ACR. (Provided by Bayer reduced by optimisation. During the They also need to be informed Healthcare) session, he plans to discuss practical of the benefits associated with steps that radiologists can take today procedures that deliver the high- to evaluate patients with respect to est appropriate radiation doses. “I risk of a procedure, to use quantita- have never heard of a patient with tive dose information to realistically suspected or proven metastatic assess risk, and to convey both risk prostate cancer refusing a PET and benefit of a given procedure scan out of concern for radiation. to the ordering physician and the The PET scan enables oncologists patient. to target the treatment. As a result Gilligan, whose career spans 23 of these findings, they may be able years as a medical physicist, has been to live a year longer. Similarly, most a member of the Health Service Exec- patients are willing to undergo utive’s National Safety Radiation radiotherapy treatments if it will Commiee (NRSC) in Ireland since improve their quality of life in treat- its inception in 2007. He chairs its ing their cancers,” he noted. population dose subcommiee and Briers believes radiologists have its medical physics expert subgroup. the ability to provide expert counsel, The role of the NRSC includes and would like to see them become Protocol Management: assists in maintaining revision-controlled establishing population dose levels, much more visible to patients who repository for protocol management across the enterprise. (Provided monitoring radiation dose reference undergo imaging. He observed that Radiologists must become much more visible to patients, according by Bayer Healthcare) levels established by the Irish Medi- in Europe, most patients only inter- to Dr. Erik Briers. cal and Dental Councils, overseeing act in a radiology department with a the safety of imaging modalities in nurse or a technologist, and they may Today’s session will confront this who administer imaging examina- use throughout Ireland, reviewing feel inhibited asking about the risks issue with a frank discussion focus- tions as low as possible, as well as relevant new clinical risk practices to of a procedure. Much more educa- ing on risks, perceptions, and mean- the safety of contrast agent admin- ensure that exposures and outcomes tion is needed about the benefits ingful dialogues with patients and istration and MRI scans as safe as are in accordance with international imaging offers. It is needed to coun- referring doctors. possible, emphasises Paddy Gilligan, best practices, and providing guid- ter fears about radiation that might Every medical procedure has a risk principal medical physicist at Mater ance notes and recommendations be downright inaccurate or not at all and a reward. With the extraordinary Private Hospital in Dublin. as needed. realistic, he thinks. advances in imaging over the past 40 “Radiology professionals and Dr. Erik Briers, an ex-officio years, appropriately ordered exami- hospitals need to be continuously member of the board of directors of nations and radiotherapy treatments vigilant,” he said. “Technological inno- Europa Uomo, the European Pros- offer a much greater evidence-based vations such as automatic exposures tate Cancer Coalition, is convinced Refresher Course: Physics in Radiology reward over potential risk. But control and iterative reconstruction that patients are accepting of radi- Friday, March 6, 16:00–17:30, Room M #ECR2015M #RC1213 because no evidence exists to prove have enabled CT dose to be reduced ation dose risk when they are well RC 1213 Good radiation and bad radiation? How to assess that the risk from radiation is zero, it by up to 60%, but if this technology informed. Prostate cancer is not a is the responsibility of the profession is not being used appropriately, it is homogenous disease, and a diagnosis and communicate radiation risk to patients and referring to keep radiation dose exposure both not enabling these procedures to be of high, intermediate or low risk pros- physicians to patients and clinical professionals safer. Dose monitoring soware and tate cancer offers diverse treatments, Moderator: O. Ciraj-Bjelac; Belgrade/RS

» A. Radiation risk: a patient’s perspective E. Briers; Hasselt/BE » B. Radiation risks for patients and staff P. Gilligan; Dublin/IE » C. Risk in MRI R. Peeters; Leuven/BE » D. Communicating risks to patients and the public N. Leitgeb; Graz/AT This session is part of the EuroSafe Imaging campaign. myESR.org 12 CLINICAL CORNER ECR TODAY | FRIDAY, MARCH 6, 2015

BY EDNA ASTBURY-WARD Flawed diagnostic processes contribute to poor risk assessments in prostate cancer Active surveillance in the prostate-specific antigen (PSA) era is an important solution to some of the problems of over-diagnosis and over-treatment of patients with low risk prostate disease, according to Prof. Anwar Padhani, consultant radiologist at the Paul Strickland Scanner Centre, Middlesex, U.K.

cancer imaging at London’s Institute He recommends MP-MRI before of Cancer Research, plans to discuss active surveillance for men who the challenges and benefits of initi- have raised PSA as the only unfa- ating active surveillance and how, vourable feature of their disease, by using multiparametric (MP) MRI, and also believes that using MP-MRI physicians can increase the precision during active surveillance shows of patient selection for active surveil- changes in tumour phenotype over lance at initial triage. time. Padhani thinks MP-MRI can A central question here is: Can MRI increase the precision of patient substitute for early (end of year 1) selection for active surveillance and re-confirmatory biopsy in active minimise the inclusion of higher risk surveillance patients? patients and that MP-MRI shows Resected prostates of potential changing tumour phenotype during active surveillance candidates have the active surveillance period. been shown to have unfavoura- “Why wait two to three years ble pathologic characteristics in a before the bad players reveal substantial proportion, and template themselves?” he remarked. “The biopsies with systematic sampling key to successful implementation Radiologists’ involvement is in potential active surveillance of MP-MRI is a combination of crucial for the success of active candidates or active surveillance good integration, reporting and surveillance, Prof. Arnauld Villers patients (<1 year) indicate a 30–40% communication.” believes. Multiparametric MR image shows a typical 15 mm right anterior apical mis-classification rate using conven- Prof. Arnauld Villers, chief of the lesion, depicted on T2-weighted, b2000, ADC map (top row), and on tional diagnostics, he explained. This urology service at Hôpital Claude dynamic contrast enhanced (DCE) imaging (boom row: unenhanced, may be related to the fact that this Huriez, CHRU Lille, France, is equally earliest phase ‘t’, then 11 sec later). This aggressive lesion was diagnosed process has only been established concerned about the current impre- in a man with a high PSA (8 ng/mL) for four years, and two negative since 2012. cise eligibility criteria for detection of series. All 12 systematic biopsies were negative, whereas the four cognitive MR-guided target biopsies were positive for a Gleason 4+3=7 Furthermore, among the chal- prostate tumours. aggressive cancer. (Provided by Dr. Philippe Puech, department of lenges of using active surveillance “Only recently has active surveil- radiology, Lille University Hospital) are that the optimal selection crite- lance inclusion criteria included MRI ria are still not completely known results, and radiologists’ involvement and the strategies and inclusion is crucial for active surveillance indi- criteria for active surveillance cation,” he noted. “These criteria are In many cases, however, the offer consensus on defining eligibility and vary between hospitals. But MRI not very accurate, and the issue of active surveillance is not made as identifying disease progression, and addresses these challenges because is how to beer identify patients physicians do not fully accept this it is easy to understand why poor it offers better characterisation harbouring very low risk or insig- approach because they do not under- uptake and suspicion of the process before active surveillance begins, nificant disease using the current stand their role in active surveillance of active surveillance is a concern, which in turn reduces the initial diagnosis pathway.” and because of its imprecise diag- he explained. inclusion of patients with unfa- Expertise and successful outcome nostic process. Also, patients may Today ECR delegates will have vourable pathology. Also, MRI may in this field requires education and not accept active surveillance as an an opportunity to hear first-hand help in the identification of trig- weekly case discussions with histo- option because they perceive such why active surveillance should be gers for definitive therapy during logical results and feedback during approaches to be ‘doing nothing’. Add adopted more frequently when active surveillance – or “picking up multidisciplinary team meetings Prof. Anwar Padhani from the Paul Strickland Scanner Centre, to this the low adherence to active appropriate to do so. During his talk, the bad players earlier,” as Padhani with urologists and pathologists, but Middlesex, U.K., will explain surveillance protocols and lack of Padhani, who is also a professor of puts it. he warns that it takes time to achieve the role of imaging in active results. Traditional sampling strat- surveillance in today’s joint egies have been based on a lack of session with the EAU. ESR meets Session understanding of the prevalence of anterior cancers, which is why inter- Friday, March 6, 16:00–17:30, Room B #ECR2015B #EM2 ventional MRI holds such promise, ESR meets EAU (European Association of Urology) he added. EM 2 Joint ESR-EAU prostate cancer session The American Association of Moderators: P.-A. Abrahamsson; Malmö/SE Urology has released new guidelines B. Hamm; Berlin/DE for the early detection of prostate not recommend widespread mass cancer, explains Prof. Per-Anders screening for prostate cancer, and Abrahamsson, from the department early detection in well-informed » Welcome by the ESR President of urology, Skåne University Hospi- men is strongly supported. A base- L. Bonomo; Rome/IT tal, Malmö, Sweden. The guidelines line PSA determination at age 40 to » Introduction do not recommend PSA screening 45 has been suggested, upon which P.-A. Abrahamsson; Malmö/SE in men under 40 years of age, and the subsequent screening interval B. Hamm; Berlin/DE do not recommend PSA screening may then be based. Furthermore, the » PSA screening: the EAU view in men between 40 and 54 years at EAU guidelines do not use a specific P.-A. Abrahamsson; Malmö/SE average risk, but they do recommend chronological age as a threshold for » Role of a multiparametric MRI in early detection a shared decision-making for men screening, but screening in men with G.M. Villeirs; Gent/BE aged 55 to 69. They also advocate a a life expectancy > 10 years is recom- screening interval of ≥ 2 years, and mended, independent of chronolog- » Active surveillance strategies in prostate cancer do not recommend PSA screening ical age. A. Villers; Lille/FR in men age 70+ or in men with a life It is important to be aware of » Role of imaging in active surveillance expectancy < 10 to 15 years. the limitations of PSA, understand A.R. Padhani; London/UK Based on the current evidence in how to personalise prostate cancer » Panel discussion: the literature, the European Associ- screening, and know about the indi- When should MRI be used? Before or aer prostate biopsy? Qualitative or quantitative MRI reading? ation of Urology (EAU) has a differ- cations for prostate MRI from the Cost-effectiveness of mpMRI as a tool for prostate cancer screening. Can mpMRI detect clinically ent recommendation for the early urological point of view, according significant prostate cancer? detection of prostate cancer. It does to Abrahamsson.

myESR.org ECR TODAY | FRIDAY, MARCH 6, 2015 CLINICAL CORNER 13

BY BECKY MCCALL How best to avoid pitfalls in sports injuries of the knee Take a closer look at the meniscus when imaging and avoid over- or under-calling common meniscus pathologies. That’s the advice of Dr. Gustav Andreisek, head of musculoskeletal and MR imaging at the University Hospital of Zurich, Switzerland. In particular, portions of the meniscus, such as the roots or the ligamentous aachments of the meniscus to the capsule, are usually missed during reporting, he explained in an interview with ECR Today.

intermediate portions, but it is also ty-trochlear groove (TT-TG) distance, key questions should be answered very important to have a close look rotational deformities of the lower by means of imaging: the integrity at the roots of the meniscus. Missing limb and patellar tilt. Her talk aims of the cartilage over the lesion, the a tear may result in instability.” to improve the reporting of osteo- stability of the (osteo)chondral frag- He also pointed out the importance chondral injuries and patellofemoral ment and the integrity of the carti- of radiologists using clear language abnormalities. lage of the opposite side of the joint. accompanied by a precise descrip- She highlighted that with MRI, She also intends to discuss diag- tion in addition to rating systems the characteristic paern of acute nosis and therapeutic options for to describe meniscus abnormalities. injuries and the severity of lesions chronic instability. “It is extremely “This is more likely useful for the can be assessed accurately, and in important to consider that the cause clinician than any grading system.” the diagnosis of acute and oen is usually multifactorial, so that ther- Asymptomatic meniscal tears are overlooked lateral patellar disloca- apeutically a unilateral approach also worth noting. A landmark paper tion, the modality provides critical oen does not lead to improvement by Zanei et al (American Journal information. in symptoms,” she highlighted. of Roentgenology, September 2003, “Acute and oen overlooked lateral “Important factors to consider are Volume 181, Number 3) showed that patellar dislocation can be estab- trochlear dysplasia, patella alta, several meniscal abnormalities are lished with magnetic resonance TT-TG distance, rotational deform- frequently found in asymptomatic imaging because of its characteris- ities of the lower limb and patellar patients. The authors evaluated the tic paern of injury. In particular, tilt.” contralateral healthy knee in 100 the integrity of the MPFL [medial A typical pitfall in the diagnosis patients who underwent MRI of a patellofemoral ligament] should be and treatment of chronic instabil- symptomatic knee. It was shown assessed carefully. This ligament is ity is that not all relevant aetiolog- that especially horizontal and the most important passive stabi- ical factors are considered during oblique meniscus tears are very liser of the patellofemoral joint. The preoperative planning. “One could frequent in the asymptomatic knees, MPFL should be assessed on trans- suggest the following diagnostic Image shows lateral discoid meniscus. Instead of the normal meniscal whereas radial, vertical complex, and verse images,” she noted. procedures as guidelines in the shape (triangular in cross-section and C-shaped), it appears in the shape displaced tears are likely more rele- Waldt highlighted that treatment preoperative assessment: radio- of a disc. (Provided by Dr. Gustav Andreisek) vant and associated with pain and decisions with respect to osteochon- graphs in two planes, a CT to assess symptoms. dral lesions (surface lesions that have potential rotational deformities and Andreisek added that it was very a traumatic aetiology and involve the TT-TG distance and MRI in the likely that those abnormalities/ both the cartilage and subchondral acute seing,” she concluded. Abnormalities of the meniscus are standard anatomy of the menisci tears do not have any clinical rele- bone), required that the following common, especially in the elderly including the roots and their liga- vance. “These abnormalities need population. Depending on a patient’s mentous aachments, as well as to be considered during image age, meniscal tears have been clinical cases aimed at illustrating interpretation.” Refresher Course: Musculoskeletal reported to occur in about one third the most common pitfalls in the pre- Continuing the theme of diagnos- to one half of patients complaining and postoperative knee, with advice tic and therapeutic challenges, Dr. Friday, March 6, 16:00–17:30, Room E1 #ECR2015E1 #RC1210 of knee problems. Andreisek pointed on how to avoid them. Simone Waldt, associate professor of RC 1210 Sports injuries to the knee: improving my report out that a distinction needs to be Firstly, Andreisek highlighted the radiology at the Technical University Moderator: P. Robinson; Leeds/UK made between meniscal tears related importance of using an appropriate of Munich, Germany, intends to raise to an acute trauma and tears second- imaging protocol. “Most frequently the subject of patellofemoral insta- » A. Reporting meniscal tears: pitfalls and how I avoid them ary to degeneration. Among those coronal and sagial fast spin echo bility and osteochondral lesions in G. Andreisek; Zurich/CH tears related to sports injuries, the sequences with a high resolution and her talk, during the same session. In most frequent causes include skiing, a good contrast are used,” he began. the refresher course, she will discuss » B. The collateral ligaments and posterolateral corner: what are football, field hockey, squash. “Secondly, it is important to really standardised imaging methods in they, why do they maer and how do I assess them? Today he plans to discuss some of look at every portion of the meniscus order to assess abnormalities that V. Vasilevska Nikodinovska; Skopje/MK the technical issues relating to imag- and this includes the meniscus roots. are predisposing for patellofemoral » C. The patellofemoral joint and osteochondral injuries: how do I ing protocols in order to acquire high Oen, radiologists only look at the instability, for example, trochlear assess and what do I report? quality images of the meniscus, the anterior and posterior horn and the dysplasia, patella alta, tibial tuberosi- S. Waldt; Munich/DE

ESOR ASKLEPIOS Courses 2015

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

Oncologic Imaging Multimodality Course Multidisciplinary Approach May 14–15, Sochi/Russia October 1–2, Geneva/Switzerland to Cancer Imaging October 15–17, Brussels/Belgium

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

myESR.org 14 CLINICAL CORNER ECR TODAY | FRIDAY, MARCH 6, 2015

BY BARBARA BENNANI-BAITI MRI for diagnosis of malignancy in mammographic microcalcifications: a systematic review and meta-analysis A comprehensive literature review and meta-analysis examining the reliability of breast MRI in assessing microcalcifications detected by mammography

Appearance of a biopsy proven DCIS G3 in mammography and MRI: Panel A shows a screening mammogram of a 62 year old female patient unveiling pleomorphic and ductal branching segmental BI-RADS 5 microcalcifications in the right breast. Panel B shows an MRI scan (contrast enhanced T1w subtractions) of the same patient depicting a large segmental non-mass lesion with heterogeneous enhancement corresponding to the microcalcifications. (Images provided by Dr. Barbara Bennani-Baiti)

Despite an ongoing debate about It has been previously shown cally guided vacuum-assisted biopsy published on the topic since 1996 to Dr. Barbara Bennani-Baiti is the value of mammography in breast that breast MRI is a valuable tool validation. date. The study revealed that patient a resident at the Department of cancer screening, the majority of for excluding malignancy in equiv- So can breast MRI be used as selection, study design, and, first and Biomedical Imaging and Image- breast imaging experts agree on the ocal findings that are not asso- a problem-solving tool in breast foremost, the image interpretation Guided Therapy, General Hospital fact that mammography saves lives. ciated with microcalcifications. microcalcifications detected by methodology strongly impact yield of Vienna, Medical University of Mammography does, however, have This led us to further explore the mammography? The short answer results. Most importantly, our find- Vienna, Austria. limitations and can yield equivocal much-debated utility of breast MRI is yes and no. Yes, because several ings call for more standardised meth- findings, such as those pertaining in resolving microcalcifications. In studies reported combined breast ods and ensuing streamlined proto- to lesions associated with scarring this year’s presentation, we run a MRI specificities and sensitivities of cols, something that would greatly tissue, or other ambiguous architec- systematic review and meta-anal- mammography-detected microcalci- benefit policy makers, radiologists, tural abnormalities, or those showing ysis of all studies investigating the fications in excess of 90%. No, owing referring physicians and patients. up in only one orthogonal view, thus use of contrast-enhanced breast to the substantial heterogeneity of requiring further diagnostic work-up. MRI for the differentiation of the studies and surrounding political Furthermore, definite lesions that are mammographically detected micro- debate. Our findings mirror, in a way, classified as Breast Imaging Report- calcifications. This is an important the great divide between MRI enthu- ing and Data System (BI-RADS) cate- analysis because mammographic siasts who praise the high sensitivity gory three (probably benign) and microcalcifications make up nearly of the method and MRI opponents four (suspicious abnormality) are one third of all mammographic who refer to the high cost inherent Scientific Session: Breast usually selected to undergo ultra- results. The relevance of our find- to the procedure. However, if we sound-guided biopsies (BI-RADS ings presented at this year’s meet- manage to focus on the patient diag- Friday, March 6, 10:30–12:00, Room C #ECR2015C #SS1002 four) or put in short-term follow-up ing is further underscored by the nosed with microcalcifications, who SS 1002 Breast MRI indications and MR-guided biopsy programmes for two years (BI-RADS very low positive predictive values would psychologically and physically Moderators: G. Esen; Istanbul/TR three). Since the majority of patients (PPV) of mammographic microcal- benefit greatly from a swi non-in- S. Schrading; Aachen/DE with these findings end up having cification findings associated with vasive diagnostic work-up, would it benign lesions only, these patients BI-RADS three (PPV range: 2.7–7%) be factually safe to rely on the MRI » MRI for diagnosis of malignancy in mammographic would greatly benefit from alterna- and even BI-RADS four lesions (PPV findings? This is the question we set microcalcifications: a systematic review and meta-analysis tive options. range: 20–25%) following stereotacti- out to answer by analysing all studies B. Bennani-Baiti, P. Baltzer; Vienna/AT

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

09:00–10:00 Thomas Knogler (Austria) 12:00–13:00 Filipe Veloso Gomes (Portugal) 10:00–11:00 Ekaterina Kasatkina (Russia) 13:00–14:00 Tom de Beule (Belgium) 11:00–12:00 Kabir Abraham Varghese (United Kingdom) 14:00–15:00 Marijana Basta Nikolic (Serbia)

Join your European colleagues and representatives in an informal and relaxed discussion, exchange opinions and points of view with them and present your ideas. Take advantage of this great opportunity! Don’t miss the Meet & Greet Session with ESR President Lorenzo Bonomo today, 13:20–13:40, in the Rising Stars & RTF Lounge.

myESR.org ECR TODAY | FRIDAY, MARCH 6, 2015 CLINICAL CORNER 15

BY SAYED MASOUD HASHEMI AMROABADI, SHABNAM HOMAMPOUR, NARINDER S. PAUL Diagnostic ultra-low dose CT with a novel ultrafast compressed sensing algorithm Computed Tomography (CT) reconstructs 3D images from a number of x-ray projections acquired from multiple angles around the patient. CT results in a relatively large radiation dose compared to conventional radiography, and this is of concern for increasing the long-term risk of developing cancer.

Scientific Session: Physics in Radiology Friday, March 6, 10:30–12:00, Room M #ECR2015M #SS1013 SS 1013 Optimisation of patient dose in CT Moderators: A. Del Guerra; Pisa/IT A. Kowalik; Poznan/PL

» Diagnostic ultra-low dose CT with a novel ultrafast compressed sensing algorithm S. Hashemi Amroabadi, S. Homampour, N.S. Paul; Toronto, ON/CA

GAST 2015

4TH JOINT MEETING OF THE GERMAN, Comparison of LACT images reconstructed with FBP and UF-CS. Top: an axial CT image from a custom-made AUSTRIAN & TURKISH coronary plaque phantom. Boom: in vivo trans-axial CT image of the mid thorax displayed using standard RADIOLOGICAL window width (W 1500) and level (L -650). Images are reconstructed by (Le) FBP from 360 degree projections, (Middle) FBP from 100 degree projections, (Right) UF-CS from 100 degree projections. SOCIETIES

The focus of CT development over lower radiation dose scan protocol. acquired by the scanners, this signif- the past decade, including iterative However, CS significantly increases icantly decreases the reconstruction CT reconstruction algorithms, has the computational complexity, which error; and secondly, it has both a fast been on diagnostic low-dose CT in turn increases the reconstruction forward and a fast rewind calcula- that maintains spatial and contrast time. At ECR 2015, we present a new tion algorithm, which accelerates image resolution. Filtered back ultrafast CS-based CT reconstruc- the reconstruction process. UF-CS projection (FBP) is currently the tion algorithm (UF-CS) that recon- combines the measure of similarity standard reconstruction method, structs diagnostic LACT images from between image blocks and PPFT due to its image reconstruction approximately 100 degree projec- to reconstruct diagnostic low-dose speed and good image quality, when tions. This approach decreases x-ray LACT images in a few seconds. many projections are available. radiation and improves CT temporal However, FBP requires data from resolution simultaneously. all projections acquired around the The major problem in CS-based Sayed Masoud Hashemi Amro- patient to reconstruct a full fidelity LACT reconstruction is that the abadi, Shabnam Homampour image. Therefore, limited-angle CT theoretical conditions needed for and Narinder S. Paul work at MAY 1-2, 2015 (LACT) images reconstructed with CS are not fully satisfied. UF-CS the University Health Network, FBP are of non-diagnostic quality; addresses this problem by group- Toronto General Hospital, Toronto, while, LACT is of a great interest in ing similar 2D image fragments (i.e. Canada. cardiothoracic applications due to blocks) into 3D data arrays. This its improved temporal resolution helps CS to reveal the fine details that minimises the respiratory and shared by grouped blocks and, at the cardiac motion-blurring artefacts. same time, preserve the features of Moreover, low-dose CT images recon- each individual block. Consequently, structed with FBP suffer from signif- UF-CS improves the quality of the icant image degradation. images reconstructed by CS from Compressed sensing-based (CS) CT a set of incomplete projections. To reconstructions hold great promise reduce the computational burden Organising Office 4TH44TOERG Office THT for low-dose CT. This is a relatively of conventional CS-based recon- new theory that enables the recov- structions, a Fourier-based method c/o ESR Office ery of data from few measurements. is used. UF-CS uses pseudo-polar Neutorgasse 9, 1010 Vienna, Austria Using this property, CS-based recon- Fourier transform (PPFT), which has T. +43/1/532 05 07, F. +43/1/533 40 64 448 structions are capable of recon- two important properties that make E-Mail. offi[email protected] structing high-quality images from it a good alternative to conventional a substantially smaller number Fourier-based methods. First of all, of x-ray projections than needed the pseudo-polar domain is very www.oerg.at for FBP, thereby requiring a much close to equiangular projections myESR.org 16 CLINICAL CORNER ECR TODAY | FRIDAY, MARCH 6, 2015

BY BARRY HUTCHINSON Are we overcalling pulmonary embolism and why? Discordance in interpretation of CTPA between general and chest radiologists

CT pulmonary angiography (CTPA) We assembled a three-mem- Therefore, potentially 1 in 4 of that misdiagnosis of PE is an unrec- Dr. Barry Hutchinson is a radi- is widely accepted as the imaging ber ‘expert’ panel of experienced all patients diagnosed with PE in ognised, widespread issue. ologist at University College Hos- gold standard in the investigation subspecialist chest radiologists from our institution in a single year was And finally, there is ongoing pital Galway, Ireland. of pulmonary embolism (PE). It has specialist centres in Ireland and the misdiagnosed. debate, with no definitive consen- also repeatedly been shown that the USA who would blindly reinterpret Cases of suspected misdiagnosis sus, over the correct management majority of clinicians will initiate CTPAs for the presence of PE. A were relatively evenly distributed of isolated subsegmental PEs diag- anti-coagulation treatment in the CTPA interpreted as positive for the through a staff of experienced, nosed on CTPA. This study serves as a event of a radiologist reporting the presence of PE would be revised to fellowship-trained, consultant reminder that some of these ‘emboli’ presence of PE, regardless of pre-test negative if all three panel members radiologists. may not be present at all. probability or other clinical factors. were in agreement. The majority of misdiagnosed In this presentation, I will describe However, as in all other areas of This rigorous a standard has never PEs were isolated ‘emboli’, located the methodology and results of this radiology, there will be cases of false been employed in studies of CTPA in peripheral segmental or subseg- study in more detail and show multi- positive CTPA interpretation, usually diagnostic accuracy in the past and mental pulmonary artery branches. ple real examples of artefacts that due to an array of artefacts that we believe it is the best reference Motion artefact related to breathing were reported as PE. can simulate PE which have been standard that can reasonably be or cardiac pulsation was found to be well-described over the past 20 years. achieved. causative for misinterpretation in This creates the potential for We reviewed all CTPAs performed the majority (53.3%) of cases. patients needlessly suffering compli- in a calendar year (937) in a busy We feel the findings and message Scientific Session: Chest cations of anti-coagulation and tertiary-referral University Hospi- of this study are very important for Friday, March 6, 10:30–12:00, Room D1 #ECR2015D1 #SS1004 falsely being labelled as high risk tal. We sub-selected all studies which a number of reasons. for thrombosis in the future. were reported as positive for the Firstly, it highlights the many SS 1004 Pulmonary hypertension and thromboembolic We wanted to audit our practice to presence of PE (174 [18.6%]) and these mimics of PE on CTPA and the disease determine our own false positive rate studies were blindly and separately importance of being aware of these Moderators: E.E.J.G. Coche; Brussels/BE and the causes for misinterpretation. reinterpreted by our expert panel. pitfalls, given the willingness of B. Graca; Coimbra/PT As there is no defined reference The results were alarming with 45 many to accept a positive CTPA as standard with which an interpreted (25.9%) of these studies being rein- completely diagnostic of PE. » Are we overcalling pulmonary embolism and why? Discordance in CTPA can be compared to in order to terpreted as negative for PE by our Secondly, as reported rates of interpretation of CTPA between general and chest radiologists measure accuracy, we had to create panel with a near-perfect inter-ob- CTPA positivity vary between 6% B. Hutchinson1, P. Navin1, E. Marom2, M. Truong2, J. Bruzzi1; 1Galway/ one of our own. server agreement. and 30%, we feel it is highly possible IE, 2Houston, TX/US

BY FAISE AL-BUNNI The role of magnetic resonance enterography in evaluating the activity of paediatric Crohn’s disease

Magnetic resonance enterography kg) as intravenous contrast; the MR relative contrast enhancement and detect both small-bowel and colonic is a non-invasive, ionising radia- examination was performed at 1.5T. the presence of mucosal ulcerations. involvement in a paediatric popu- tion-free imaging technique that can The feasibility of this examina- However, we used this in a different lation with Crohn’s disease, and identify inflammatory changes along tion is demonstrated by the MR manner from the validated study supports the MaRIA score as an the small bowel in the diagnosis and examination’s sensitivity related to mentioned above, as the values imaging-based quantitative index of follow-up of Crohn’s disease in chil- terminal ileum and colonic involve- in our investigation related to the disease activity correlated with endo- dren. Currently, there is no standard- ment of 71% and 94% respectively colon (ascending colon, transverse scopic and clinical activity indices. ised approach that uses small-bowel on a per-patient basis, and 51% on colon, descending colon, sigmoid and colonic MR examinations in the a per-segment basis compared to and rectum) were added to the ones same session. The purpose of this endoscopy as a reference standard, related to the small bowel (jejunum, Dr. Faise Al-Bunni is a radiolo- article is to show our experience in in a paediatric population of 24 cases. ileum and terminal ileum). gist at Dirigente medico ULSS 18 paediatric MR enterography in this Moreover, small-bowel involvement, In this study, we show a moderate in Rovigo, Italy. respect. except terminal ileum, was detected correlation (Spearman correlation We introduced the capability to in 13 patients. r=0.5; p<0.01) between the MaRIA examine the small bowel and colon Furthermore, the aim of the study score, calculated for colon and with oral contrast for simultaneous is to support an imaging-based index small bowel, and the popular clini- luminal distension in the following of disease activity, useful for guiding cal index PCDAI (paediatric Crohn’s way: a bowel cleansing procedure the therapeutic decisions and evaluating disease activity index). There was Scientific Session: Paediatric day before the examination with PEG the efficacy of the laer on follow-up. also a good correlation (Spearman solution tailored to patient weight, In order to quantify disease activ- correlation r=0.7; p<0.01) between the Friday, March 6, 10:30-12:00, Room MB 2 #ECR2015MB2 #SS1012 and 20ml/kg of a solution with a ity based on MR examination find- MaRIA score, calculated for the colon SS 1012 Abdominal imaging dose of 17.4g PEG dissolved in 500ml ings, we used the simplified MaRIA and terminal ileum only, and the Moderators: M. Haliloglu; Ankara/TR of water, ingested between 60 and (Magnetic Resonance Index of Activ- simple endoscopic score for Crohn’s A.S. Liooij; Leiden/NL 15 minutes before the examination. ity score, proposed and validated disease, obtained by terminal ileum This protocol uses hyoscine butylb- by Rimola et al.), which considers colonoscopy. » The role of magnetic resonance enterography in the evaluation of romide as an antispasmodic agent parietal thickness, parietal oedema In conclusion the performed MR activity of paediatric Crohn’s disease and gadolinium chelate (0.1mmol/ expressed by T2w signal intensity, examination protocol allows us to F. Al Bunni, M. Zuliani, F. Pomerri; Padua/IT

myESR.org FRIDAY, MARCH 6, 2015 TECHNOLOGY FOCUS 17

EIBIR active in European European radiation Management in 19Union funded research 21protection research 23 Radiology hosts projects on the move sessions at ECR 2015

BY JOHN BONNER CT manufacturers edge towards optimum blend of accuracy and safety

Achieving the right balance between diagnostic quality and public safety is oen critical to the advancement of novel CT applications. In the ECR 2015 technical exhibition, leading CT vendors are demonstrating how their latest products can provide greater clinical utility while limiting any potential risks from radiation dose.

Notable among these is Siemens’ have time to adjust the scanning Somatom Definition Edge, which protocols,” Freund pointed out. has overcome the main drawback of single-source dual energy scanners Philips has responded to the pres- and will allow this technology to be sure on vendors to address potential deployed in routine clinical use. health risks by introducing the Dose- “What we have been trying to do is Wise portal, radiation dose manage- to close some loopholes in the clin- ment soware solution aimed at ical performance of CT scanners by managing exposure risk to patients developing technologies that are not and their caregivers. fully exploited at the moment and This is based on the DoseAware to make them more accessible to a personal monitoring system that wider range of customers,” explained measures and displays an individu- Jan Freund, head of product market- al’s exposure to radiation in real-time. ing for CT. In addition, DoseAware Xtend makes The problem with conventional real-time dose measurement even dual energy devices is that the data more precise and useful in a single are acquired with two beams used display, giving immediate feedback sequentially (fast kV switching), on scaered x-ray dose per proce- which tends to reduce image qual- dure to help staff manage exposure, ity, or the two spectra are separated according to the vendor. on the detector side, aer the radi- Philips describes the soware as ation has already passed through ‘vendor-agnostic’ and says it can be the patient’s body. This means the used with multiple imaging modal- The PUREViSION detector can also aid visualisation of the coronary arteries (0.49 mSv, 30 ml contrast). extra morphological information ities, including CT, mammography, obtained when using beams at two fluoroscopy, and radiography. energy levels can only be achieved by increasing the dose. Meanwhile, GE Healthcare is The company’s twin-beam dual spinning out three new additions energy system uses filters that split to its Revolution family of high-end the beam into different energy spec- scanners. The original product was tra before it reaches the patient. This displayed last year at ECR as a work provides improved tissue differenti- in progress and has now received its ation and defines more precisely the CE mark and has been installed in distribution of any contrast medium. hospital sites across Europe. The technology may be particularly Revolution is ideally suited to the useful in, for example, identifying a particular demands of cardiac and pulmonary embolism or revealing paediatric imaging, explains Karl more about the composition of a Blight, general manager of GE’s liver tumour. Northern Europe medical imaging With Definition Edge, Siemens business. is also providing two software “This is a very fast scanner with upgrades intended to further reduce a 0.28 second rotation time, which dose and improve diagnostic efficacy. means that you can do a whole heart These are the Admire model-based scan in a single rotation. So you iterative reconstruction procedure are unlikely to need beta blockers and the iMAR (iterative metal arte- to slow down the heart rate to get Control study of a liver metastasis aer microwave ablation treatment. Monoenergetic image at 50 keV (le) fact reduction) technology. The laer high quality images,” he said. “Speed and a fused virtual non-contrast (VNC) / iodine image (right) show a hypodense lesion in the liver and in the significantly reduces the impact on is also important in paediatric exam- right kidney. The image contrast is greatly increased by monoenergetic imaging, using a Somatom Definition image quality of artefacts resulting inations because it is so difficult to Edge system. Both lesions show no significant enhancement in the fused VNC / iodine image, therefore, from the presence of amalgam fill- persuade children to stay still and residual tumour tissue can be confidently excluded and a kidney cyst can be diagnosed. ings, bone screws, pacemakers, etc. the faster the rotation and the more (Copyright: University Erlangen-Nuremberg, Erlangen, Germany) “This will help in detecting small coverage that you get then the beer lesions lying near the metal object the results.” which, without correction, can go undetected. It is also impor- tant that this is an automatic function. That may be very valu- able in an acute care situation where the medical staff might not continued on page 18 myESR.org 18 TECHNOLOGY FOCUS ECR TODAY | FRIDAY, MARCH 6, 2015

continued from page 17

The PUREViSION detector is to be available on all scanners in the Aquilion series from Toshiba, and can offer improvements in lung subtraction.

Hitachi’s Scenaria 128-slice wide-bore scanner has cardiac applications. Adaptive iterative dose reduction 3D (AIDR 3D) from Toshiba can help to reduce patient dose.

Revolution Evo is the first in a trio new levels in high quality but ultra- reconstructions for beer workflow, of new scanners, and is designed to low-dose imaging with up to 40% it says. meet the demands of busy emer- reductions in both radiation and “ECG Dose Modulation, an addi- gency care centres. It features the contrast. The system also incorpo- tional dose reduction technol- company’s new Clarity Imaging rates the company’s next generation ogy for cardiac studies which will System, which it says provides iterative reconstruction technique, complement the existing Cardiac much beer spatial resolution over AIDR 3D Enhanced. Package and together with Cardio previous generation scanners, as “Aquilion Lightning is an envi- Conductor and Cardio Harmony well as the adaptive statistical iter- ronmentally friendly system which (as well as unique Hitachi Intelli- ative reconstruction (ASiR) method supports a wide range of premium center Lateral table shi), will make that can lower dose by up to 82% in applications like SEMAR to improve cardiac studies fast, efficient and safe patients of all ages, without compro- visualisation of implants, support- for the patients,” noted a corporate mising workflow. ing bone and adjacent so tissue. It statement. The technology was also devel- also has SURESubtraction soware oped with one eye on future devel- which provides unsurpassed visual- Choosing and applying an appro- opments in the field and offers isation of vessels and contrast-en- priate contrast medium is, of course, the flexibility for the customers to hanced tissue structures. Meanwhile critical to achieving the highest diag- SATELLITE LUNCH expand into advanced applications its variable helical pitch allows seam- nostic accuracy with CT. At ECR 2015, such as trans-catheter aortic valve less change of pitch during one Bracco staff are demonstrating their SYMPOSIUM implantation (TAVI) planning and continuous acquisition,” explained web-based support tool Tailored high heart rate coronary CT angiog- Henk Zomer, senior manager with Protocol Soware, available on the FRIDAY, MARCH 6 raphy (CCTA) as well as examinations Toshiba’s European CT business unit. company website (Braccomdct.com). in patients with implants. This was developed by a group of COMPUTED TOMOGRAPHY In addition, GE will be demonstrat- A leading araction at the Hitachi expert users and will help radiolo- ing the Revolution GSI (Gemstone stand is the Supria 64ch CT scanner, gists to fine-tune their contrast-en- New detector technology Spectral Imaging) system intended which is scheduled to be launched hance scanning parameters to the for use by those centres with a across Europe later this year. needs of individual patients, noted improves patient safety strong interest in spectral imaging. According to a statement from the vendor. This scanner is designed for use in the company, “Supria has a patient- Chair: Prof. A. de Roos, Leiden University Medical Center, tissue characterisation and advanced friendly game-changing 75 cm-wide The Netherlands functional imaging. gantry bore, equipped with newest The third new system is Revo- iterative reconstruction dose reduc- FRIDAY, MARCH 6, INVITATION lution HD, which can help users tion technology. It is a high-speed 12:30 – 13:30, ROOM C achieve their imaging goals with scanner with less than 1 sec/rotation improved efficiency and expanded speed and the latest 3D reconstruc- Safer imaging – clearer outcomesmes applications, while delivering diag- tion that provides rapid coverage for Jeffrey Hall, Clinical Marketing Manager, Toshiba Medical nostic confidence with lower levels efficient and precise examinations. System Corporation, Japan of radiation, the company says. Supria 64ch only has three system components which makes it very New detector technology in clinical practice Toshiba is unveiling Aquilion compact and economical.” Dr. R. Bull, Consultant Radiologist, Bournemouth Hospital, UK Lightning, which can safeguard the Hitachi is also demonstrating Widening the scope of clinical CT applications patient by minimising both their a major soware upgrade for its radiation exposure and contrast Scenaria 128-slice wide-bore scan- Prof. Dr. M. Prokop, Head of Radiology Department, Radboud dose. The key to this is the new ner. This will provide enhancement University Medical Center Nijmegen, The Netherlands PUREViSION detector, which will in reconstruction speed, real-time be available on all scanners in the image display during scan acquisi- Aquilion series. This technology is tion, prioritising post-reconstruc- For a complete overview of our claimed to redefine detector technol- tions and allowing faster multiplanar educational program please visit ogy, enabling radiologists to reach www.toshiba-medical.eu/ecr2015

Technical Exhibition Opening Hours www.toshiba-medical.eu Thursday, March 5 to Saturday, March 7 10:00–17:00 Sunday, March 8 10:00–14:00

myESR.org ECR TODAY | FRIDAY, MARCH 6, 2015 TECHNOLOGY FOCUS 19

BY ALENA MORRISON Staff Box Editorial Board

ESR Executive Council

EIBIR active in Lorenzo Bonomo, Rome/IT President Luis Donoso, Barcelona/ES European Union 1st Vice-President Paul M. Parizel, Antwerp/BE 2nd Vice-President Guy Frija, Paris/FR funded research projects Past-President Boris Brkljačić, Zagreb/HR Communication and External Affairs EIBIR continues to contribute to three EU-funded projects Commiee Chairperson Bernd Hamm, Berlin/DE with a focus on breast cancer, GIST and dementia Congress Commiee Chairperson Katrine Åhlström Riklund, Umea/SE 1st Vice-Chairperson of the Congress Dedicated to the coordination The envisaged personalised treat- ners from Europe and the U.S. in the and breast reconstruction. For more Commiee and support of European research ment concept combines innovative VPH-PRISM project coordinated by details see mapbreast.inescporto.pt Birgit Ertl-Wagner, Munich/DE projects, the European Institute strategies for biopsy, inline tissue EIBIR, with Fraunhofer MEVIS as www.vphprism.eu Education Commiee Chairperson for Biomedical Imaging Research analysis, molecular tumour charac- Scientific Coordinator. Nicholas Gourtsoyiannis, Athens/GR (EIBIR) is currently involved in terisation, theranostics by imaging In the second project year, exten- VIRTUAL PHYSIOLOGICAL ESOR Commiee Chairperson three thriving projects: two projects technologies and companion radi- sive progress was made on the techni- HUMAN: DEMENTIA RESEARCH Michael Fuchsjäger, Graz/AT under the Virtual Physiological opharmaceuticals followed by the cal backbone of the project, a central ENABLED BY IT (VPH-DARE@IT) Finance and Internal Affairs Human theme, VPH-PRISM and assessment of biodistribution, dose database which will allow the project VPH-DARE@IT will explore the Commiee Chairperson VPH-DARE@IT, continue to progress calculation and measurement of to evaluate the integration of hetero- lifestyle and environmental factors Deniz Akata, Ankara/TR towards improvements in the treat- therapeutic effectiveness. In addi- geneous multidisciplinary data and that predispose dementia develop- National Societies Commiee ment in breast cancer and dementia. tion, new concepts of minimally-in- data processing tools. Extending ment and will deliver more objective Chairperson Both projects will enter their third vasive treatment will be applied. far beyond clinical data, this work and accurate differential diagnosis Guy Frija, Paris/FR project year in 2015. MITIGATE, Since MITIGATE´s kick-off in aims at correlating population based by shortening the current average Nominations and Awards advancing the treatment of gastroin- October 2013, the consortium has imaging studies with extensive clin- 20-month time lapse between the Commiee Chairperson testinal stromal tumours (GIST) and focused on the refinement of endo- ical data on breast cancer cohorts. onset of cognitive and memory defi- Lorenzo E. Derchi, Genoa/IT funded under the HEALTH theme, scopic biopsy systems, the optimisa- Additionally, a major focus of the cits and its specific clinical diagnosis. Publications Commiee Chairperson completed a successful year in 2014. tion of approaches for generation of project was data collection under- Having successfully completed E. Jane Adam, London/UK single cell suspensions, the analysis taken at the project’s four clinical the first year review of the project, Quality, Safety and Standards Closed-loop molecular environ- of different GIST cell lines by mass partner sites. The project expects to work in year two continues to see Commiee Chairperson ment for minimally invasive treat- spectrometry (MS)-biotyping for obtain prospectively collected data the integration between the differ- Hans-Ulrich Kauczor, Heidelberg/DE ment of patients with metastatic molecular signatures, the develop- from at least 200 patients that will ent strands of work in the project Research Commiee Chairperson gastrointestinal stromal tumours ment of an innovative, highly immu- provide insights into the individual being brought together and stronger Paul M. Parizel, Antwerp/BE (MITIGATE) nocompromised mouse model, and preconditions and factors affecting links developed between the Work Strategic Review Commiee The ambitious four year project the assessment of the first magnetic disease progression to allow for selec- Packages. Chairperson MITIGATE aims to develop and resonance (MR) perfusion images. tion of the best possible treatment Initial version of the clinical plat- Catherine M. Owens, London/UK validate an integrated closed-loop www.mitigate-project.eu option. form, a soware tool to support early Subspecialties and Allied Sciences process to effectively treat patients From July 13–17, 2015, the differential diagnosis of dementias Commiee Chairperson with metastatic GIST, who are resist- VIRTUAL PHYSIOLOGICAL VPH-PRISM consortium is proud from a desktop computer, is one of Peter Baierl, Vienna/AT ant to the currently available tyros- HUMAN: PERSONALISED PREDIC- to announce the Summer School the major project outcomes expected Executive Director ine kinase inhibitors TKIs. TIVE BREAST CANCER THERAPY on Multidisciplinary Advances in in the upcoming year. Find out more Coordinated by the Rupre- THROUGH INTEGRATED TISSUE Personalised Breast Cancer Surgery at www.vph-dare.eu Editors cht-Karls-University Heidelberg and (MAP), hosted in collaboration with MICRO-STRUCTURE MODELLING Julia Patuzzi, Vienna/AT EIBIR, six distinguished research (VPH-PRISM) the VPH-PICTURE project. The For more details about EIBIR, Philip Ward, Chester/UK organisations and four Small and Optimised clinical breast cancer School will focus on computer-sup- please visit www.eibir.org or visit

Medium Enterprises enthusiasti- care encompasses the prevention ported methods to solve clinical prob- us at our booth in the entrance hall. Associate Editor cally pursue their ultimate goal to of over-diagnosis, reduction of lems of so-tissue surgery through Simon Lee, Vienna/AT develop new protocols and guide- over-treatment, and avoidance of image analysis and biophysical or lines to effectively diagnose and treat unsuccessful treatments. These statistical modelling with an empha- Contributing Writers patients with metastatic GIST. goals are targeted by 8 research part- sis on applications in breast surgery Edna Astbury-Ward, Chester/UK John Bonner, London/UK Michael Crean, Vienna/AT Florian Demuth, Vienna/AT EIBIR Sessions Peter Gordebeke, Vienna/AT Javeni Hemetsberger, Vienna/AT Friday, March 6, 10:30–12:00, Room L 1 #ECR2015L1 Cynthia Keen, Sanibel Island, FL/US Katharina Krischak, Vienna/AT What’s new in biomedical imaging research: an update of Simon Lee, Vienna/AT EIBIR activities Becky McCall, London/UK Rebekah Moan, San Francisco, CA/US » Chairman’s introduction Alena Morrison, Vienna/AT G.P. Krestin; Roerdam/NL Mélisande Rouger, Madrid/ES Frances Rylands-Monk, St. Meen Le » Presentation from the European Commission on Horizon 2020 Grand/France A.-S. Costescu; Brussels/BE Kathrin Tauer, Vienna/AT » EIBIR Joint Initiative for Paediatric Radiology K. Rosendahl; Bergen/NO Art Direction Petra Mühlmann, Vienna/AT » EIBIR Joint Initiative: Biomedical Image Analysis Platform W.J. Niessen; Roerdam/NL Design & Layout » EIBIR Joint Initiative for Image Guided Radiotherapy Marlene Schaufler, V. Valentini; Rome/IT www.studio-marlene.at, Vienna/AT » EIBIR Joint Initiative for Euro-BioImaging S. Aime; Turin/IT Marketing & Advertisements Konrad Friedrich E-Mail: [email protected] Friday, March 6, 14:00–15:30, Room L 1 #ECR2015L1 MITIGATE consortium: state of the art imaging and therapy Contact the Editorial Office ESR Office in GIST Neutorgasse 9 Chairpersons: S.O. Schönberg; Mannheim/DE 1010 Vienna, Austria I. Virgolini; Innsbruck/AT Phone: (+43-1) 533 40 64-0 E-Mail: [email protected] » Selective internal radiotherapy in GIST patients S. Diehl; Mannheim/DE ECR Today is published 5x during ECR 2015. » Multimodal imaging in GIST Circulation: 20,000 D. Longo; Torino/IT Printed by Holzhausen, Vienna 2015 » Principle of X-Nuclei MR imaging: what the radiologist should know L. Schad; Mannheim/DE myESR.org myESR.org 20 TECHNOLOGY FOCUS ECR TODAY | FRIDAY, MARCH 6, 2015

BY NICOLA GOATMAN Golden age of CT may be over but all is not lost

Growth in the global CT market has been restricted by a number of factors over the last five years. The economic down-turn in 2009 resulted in a significant decline, from which many developed markets are only now starting to recover.

12%

10%

8%

6%

4%

2%

0% 2014 2015 2016 2017 2018 -2% Global Unit Western Europe Unit Eastern Europe, Middle East & Shipment Growth Shipment Growth Africa Unit Shipment Growth

Comparative 4 year unit shipment growth for CT equipment in Western Europe, Eastern Europe Middle East & Africa and Global

Following the rapid succession images to be quickly accessed and and pulmonary diagnosis. Over the of new systems offering increased analysed. This aims to significantly past two years interest in systems slice technology, many tipped dose speed up unscheduled and sched- tailored towards these specific care reduction to be the next wave of uled CT scans, allowing equipment to areas has intensified. Despite radia- technology innovation to grip the be utilised by an increasing number tion concerns there is a preference market. There has certainly been of patients. Speeding up the over- for the use of CT over other imag- a concerted effort to develop radi- all protocol of CT exams is vital to ing modalities in these applications. ation dose reduction software offset declining reimbursement for Furthermore, a focus on minimally and monitoring, with numerous CT equipment, particularly in the invasive interventional procedures WORKSHOP systems refining this technology developed US market. has also generated aention. Focus October 15–17, 2015 Register now for free: launched between the period 2012 and refinement of systems for www.pidrl.eu/workshop to 2014. Perhaps more importantly SCALABILITY specific clinical applications that Lisbon School of Health Technology/ scrutiny over protocols and evalu- Across the board market leaders help support physician workflow Escola Superior de Tecnologia da ation of the overuse of CT in many Siemens Healthcare, Philips Health- will enable vendors to experience Saúde de Lisboa disciplines has had two major care, Toshiba Medical Systems, GE heightened growth in the devel- Lisbon, Portugal consequences: firstly, greater focus Healthcare and Hitachi Medical oped, saturated markets of the US on clinical application; secondly, Systems are now offering scalable and Western Europe. development of systems to stream- systems. The majority of equipment The ‘golden age’ of the CT market line patient care. is available in a number of slice is now a distant memory. Manufac- Three key trends are emerging as configurations, with the option of turers are today expected to ‘prove’ key drivers for technology innova- virtual scan soware to increase the clinical excellence and improved tion in 2015; automated workflow, analysis and image resolution. This clinical outcomes of their systems to Abstract call open until scalability and clinical focus. allows the technology to be utilised purchasers. Unit shipments of CT 30 April 2015 by a wide range of users in a variety systems are projected to increase by AUTOMATED WORKFLOW of developed and emerging markets. 20 percent over the next five years Unscheduled CT scans from the Furthermore, scalable systems allow with long term cost savings will be emergency department account for multi-national suppliers to develop at the forefront of purchasing deci- approximately 40% of all CT scans their installed base in emerging sions. Consequently, those suppliers in the hospital. This means they regions. Basic configuration systems that can develop a portfolio inclusive are largely explorative and take up can be purchased at lower cost by of scalable, automated and clinically valuable time and money. Stream- first generation users. As their focused equipment will reap the lining patient care in this type of requirements develop software rewards in the long-term. scenario will significantly increase add-ons, upgrades and additional patient through-put and return of features can be purchased. This type investment for hospital providers. of flexibility is increasingly common Manufacturers have made signifi- particularly in the high-cost medical cant advances in reducing the length imaging market such as CT where Nicola Goatman is a senior ana- of scan in CT exams. It is argued by technology from leading manufac- lyst with IHS Medical Technology. many now that scan speeds are as turers is desired, but the up-front IHS Medical Technology pro- short as they can be. To further cost restricts purchasers in emerg- vides high quality and in-depth increase patient throughput, the ing markets. market research and consul- complete CT protocol needs to be tancy services to the medical considered. Automated workflow CLINICAL FOCUS device industry. Coverage includes features and pre-programmed Increased clinical focus is not a medical imaging equipment, standard scans are increasingly new trend to the medical imaging clinical care devices, healthcare seen in new CT systems. Further- market. CT has shown superior imag- IT, consumer medical devices, more, integration of CT equipment ing for lung cancer, early detection of medical displays and wearable with healthcare IT systems allows cystic fibrosis in addition to cardiac technologies.

myESR.org ECR TODAY | FRIDAY, MARCH 6, 2015 TECHNOLOGY FOCUS 21

BY JACQUES REPUSSARD European radiation protection research on the move

The Multidisciplinary European research. The objective is to aract » The signing of a Memorandum of training and education resources new avenues for multidiscipli- Low Dose Initiative (MELODI) was scientists working with new tech- Understanding (MOU) between needed to provide radiation nary open calls, and lately to the founded in 2009 to address gaps in nologies and platforms in order to MELODI and sister platforms protection research with highly proposal for the EJP CONCERT scientific knowledge of the effects investigate radiation protection (radioecology with ALLIANCE; qualified scientists. MELODI now provides a strong signal to the of low doses of ionising radiation on scientific issues and thus stimulate dosimetry with EURADOS; emer- has unique experience in devel- research communities about the humans and the environment, which the formation of research teams gency preparedness with NERIS) oping such priorities, and assem- consistent effort currently being may have the potential to undermine gathering different disciplines. has brought together the respec- bling them in strategic research made under the H2020 banner the robustness and effectiveness of » Second, a holistic scientific strat- tive communities, not to merge agenda (SRA) proposals, which to enhance radiation protection the radiation protection regulatory egy based on well established them, but to identify how common are then discussed and tested in research in Europe over the years system. Such knowledge gaps may priorities should be developed actions could benefit them all. open workshops gathering repre- ahead. CONCERT will thus gather constitute obstacles to innovation in order to rationalise research Similarly, a few months ago, sentative portions of the scientific a majority of European research and the improvement of techniques efforts and to enhance the feasi- another similar MOU was signed communities concerned. Thus in institutions and universities with needed to ensure adequate protec- bility and success rate of research between MELODI, EURADOS and Barcelona, the sixth version of the a high interest in radiation protec- tion of people and the environment, projects by ensuring that the the five main European medical MELODI SRA was presented. It is tion research. and may be one of the causes of the resources needed are available. associations which gather health available on the MELODI website patent lack of consensus in society, in » Third, a coherent, stable and professionals directly concerned www.melodi-online.eu MELODI and the other European Europe in particular, about the opti- reliable Europe-wide funding by the use of ionising radiation for » The further development of future platforms work together to deliver mal conditions for the use of nuclear system should be established for medical purposes: EANM (nuclear EURATOM calls aiming for a wider a bright future for the research technology for energy, medicine, a significant period. This system medicine), ESTRO (radiotherapy), range of scientific aspects of radi- communities concerned with radi- research, etc. should be competitive and based ESR and EFRS (radiology), EFOMP ation protection research and a ation protection science, facilitating on scientific excellence, and act as (medical physicists). Thus, gradu- strategic approach to funding advanced research programmes MELODI has identified several a driver for the implementation ally, a new radiation protection of radiation protection research addressing important and highly key challenges which need to be of the recognised strategic prior- platform centred on the benefi- in Europe. It will also provide complex issues with a good chance of addressed collectively: ities across the whole spectrum of cial use of medical exposure has reliable and aractive compet- success. These associations are open radiation protection scientific emerged, with its own priorities itive call programmes open to for membership. Please join them to » First, the problem is not only scien- issues. consistent with those of MELODI the whole scientific community, strengthen their actions, and benefit tific; it also raises issues of the » Last, but not least, radiation and EURADOS. including non-EU countries who from the influential network they organisation of multidisciplinary protection research must also » A key aspect of the research strate- have arrangements with the EU already represent today. research across Europe. To achieve investigate societal aspects of the gies to be developed hinges on the allowing them to participate (with this, an operational plan is needed problem. development of a good consensus their own funds) in EURATOM to integrate the scientific exper- on research priorities, and on needs R&D programmes. The progres- Dr. Jacques Repussard is the tise and resources in Europe, with The 6th MELODI public workshop, for access to experimental infra- sion from the network of excel- President of the Multidisciplinary the aim of challenging the knowl- held in October 2014 showed the structures or other scientific data lence instrument (DoReMi) to European Low Dose Initiative edge gaps in radiation protection progress made: (biobanks, cohorts, etc.), as well as the OPERRA project, which tests (MELODI).

VISIT THE EUROSAFE IMAGING POSTER EXHIBITION ECR LIVE & EPOS LOUNGE FIRST LEVEL

More than 30 posters on radiation protection practices by experts from the ESR, European and international institutions, radiological subspecialty societies, related medical professions and industry partners.

www.eurosafeimaging.org

myESR.org 22 TECHNOLOGY FOCUS ECR TODAY | FRIDAY, MARCH 6, 2015

BY ANTHONY WALLACE Data distributions and the impact of iterative reconstruction algorithms from the first three years of the Australian MDCT DRL project (2011–2014)

This presentation will highlight iterative reconstruction is achieving clients to indicate whether or not current data from the Australian dose savings of 20–30% compared iterative reconstruction was applied national MDCT DRL survey that with similar non-IR scans in routine to the submied set of patient data demonstrates the dose saving practice. for a specific protocol. Figure 1 outcome of applying iterative recon- For each compliant survey submit- shows the dose reduction achieved struction (IR) to standard MDCT ted a Facility Reference Level (FRL) with IR for adult scans surveyed as acquisitions. was computed. Surveys are consid- compared with non-IR scans and the The Australian National Diagnos- ered compliant if they include data existing national DRLs for the same tic Reference Level Service (NDRLS) for at least 10 patients per protocol, anatomical regions. In broad single has been collecting national MDCT however for beer statistical preci- figure terms, the use of IR is achiev- dose data since August 2011. To date, sion we recommend that data for ing dose savings of around 20–30% a total of over 2100 compliant surveys 20 patients be entered. The NDRLS in routine practice. have been submied from over 240 survey does not place a weight I invite you all to aend and hear facilities. MDCT scans are broadly restriction on selected patient data. how the introduction of iterative stratified by age cohort (baby, The FRL is the median value of the reconstruction has had a beneficial child, adult) and anatomical region relevant dose index, i.e. the volume impact on Australian MDCT patient (head, neck, chest, abdomen-pel- Computed Tomography Dose Index dose. vis, chest-abdomen-pelvis, lumbar (CTDIvol, mGy) and Dose Length spine). Adult data submied to the Product (DLP, mGy.cm). The median Australian Radiation Protection and metric value is used as it is a more Nuclear Safety Agency (ARPANSA), robust indicator than the mean and Anthony Wallace is Director of since May 2013, where iterative vs less sensitive to outlier data. Medical Imaging, Australian Radi- non-iterative scans have been iden- The NDRLS database was ation Protection & Nuclear Safety tified, has indicated that the use of amended in April 2013 to enable Agency in Yallambie, Australia.

Figure 1: MDCT scan DLP with and without iterative reconstruction compared with existing Australian MDCT DRLs.

Figure 2: Percentage dose reduction per anatomical region with iterative reconstruction (Graphs provided by Anthony Wallace)

Scientific Session: Physics in Radiology Friday, March 6, 10:30–12:00, Room M #ECR2015M #SS1013 SS 1013 Optimisation of patient dose in CT Moderators: A. Del Guerra; Pisa/IT Top radiologists read more than just images A. Kowalik; Poznan/PL » Data distributions and the impact of iterative reconstruction www.european-radiology.org algorithms from the first three years of the Australian MDCT DRL project (2011–2014) A.B. Wallace, P. Thomas, A. Hayton; Yallambie/AU

myESR.org ECR TODAY | FRIDAY, MARCH 6, 2015 TECHNOLOGY FOCUS 23

BY PETER MILDENBERGER Management in Radiology hosts sessions at ECR 2015 MIR@ECR is a unique opportunity to pick up new information and gain knowledge of current trends from leading radiologists. For the fourth time, the ECR will host a Management in Radiology (MIR) Symposium with a focus on professional issues in radiology, and quality and safety.

This year, the first MIR@ECR follow with an ‘Update on social approach’. The session will then be session will focus on professional media in radiology’, a topic that was rounded off by a panel discussion issues in radiology and will comprise already discussed with great interest on ‘learning from critical situations a ‘best of’ selection of cuing-edge at the recent 2014 MIR Annual Meet- or errors’. Highly renowned speakers topics. ing in Italy. The first session will be from throughout Europe and North Aer an introduction about the closed by ESR Communications & America will discuss their personal MIR Subcommiee by its chairman External Affairs commiee chairper- experiences and share their expertise Prof. Peter Mildenberger, Prof. Erika son, Prof. Boris Brkljačić, speaking on with meeting participants, who we Denton, from the U.K., will give a talk economics. invite to actively contribute to our titled ‘Update on radiology: a strategy The second session is on improv- sessions with their own experience for the future’. She will be followed ing quality and safety in radiology. and advice. by Prof. Emanuele Neri, from Italy, Dr. Adrian Brady, from Ireland, will Both sessions will include enough who will speak about imaging present a lecture titled ‘First experi- time for discussion, including partic- biobanks, based on his long experi- ences from a nation-wide peer review ipation from the floor; and the break ence in this field and as chairman of in radiology’. The second talk will be in between will offer a good chance the ESR Working Group on Imaging delivered by Dr. Peter Cavanagh, from to discuss topics individually or in Biobanks. The next lecture will be the U.K., on ‘How to organise mean- groups with the speakers or other an ‘Update on decision support for ingful audits in radiology’; and last radiologists. radiology’, delivered by Prof. Keith but not least, Prof. David Koff, from Prof. Peter Mildenberger, Dreyer from the United States. Prof. Canada, will talk about ‘Errors in radi- Find out more about MIR at chairman of the MIR sessions, Sergey Morozov, from Russia, will ology: how to learn from a systematic www.mir-online.org is professor of radiology and leader of the IT group at the department of radiology at the University Clinic Mainz, MIR @ ECR Session 1 MIR @ ECR Session 2 Germany. Friday, March 6, 13:00–15:00, Room D2 #ECR2015D2 Friday, March 6, 15:30–17:30, Room D2 #ECR2015D2 MIR: best of professional issues in radiology Improving quality and safety in radiology Moderators: S. Morozov; Moscow/RU Moderators: J.A. Brink; Boston, MA/US E. Schouman-Claeys; Paris/FR R. FitzGerald; Shropshire/UK

» 13:00 Overview on MIR activities and why aending MIR » 15:30 First experiences from a nation-wide peer review in conferences radiology P. Mildenberger; Mainz/DE A. Brady; Cork/IE » 13:10 Update on radiology: a strategy for the future » 15:50 How to organise meaningful audits in radiology E. Denton; Norfolk/UK P. Cavanagh, London/UK » 13:30 Update on imaging biobanks » 16:10 Errors in radiology: how to learn from a systematic E. Neri; Pisa/IT approach » 13:50 Update on decision support for radiology D.A. Koff; Hamilton, ON/CA K.J. Dreyer; Boston, MA/US » 16:30 Panel Discussion: » 14:10 Update on social media in radiology Learning from critical situations or errors: examples from S. Morozov; Moscow/RU around the world E. Denton; Norfolk/UK » 14:30 Update on economics J. Jakobsen; Oslo/NO B. Brkljačić; Zagreb/HR U. Senol; Antalya/TR » 14:50 Discussion J.A. Brink; Boston, MA/US C. Kahn; Philadelphia, PA/US M. Fatehi; Tehran/IR P. Valdes Solis; Marbella/ES

myESR.org MARCH 7, 2015 HOFBURG PALACE, 1010 VIENNA STARTS: 9 PM GET YOUR TICKET AT THE REGISTRATION COUNTER, €40 incl. VAT FRIDAY, MARCH 6, 2015 COMMUNITY NEWS 25

Top tips for trainees ESR Journals, European and teachers Special Exhibition 26Radiology & Insights into 29Part 3: Management 30 at the Belvedere: Imaging – Moving up! in radiology Jasper Johns

BY MICHAEL CREAN Pioneer in new imaging modalities receives ESR Gold Medal

In recognition of his pioneering work in novel imaging technology and his German Radiological Society and the dedication to strengthening ties between radiologists in Europe, Professor Claus European Society of Gastrointestinal and Abdominal Radiology’s congress D. Claussen, from Tübingen, Germany, will be awarded the Gold Medal of the in 1999. He is president of the Society European Society of Radiology at ECR 2015. for Promoting Biotechnology and Medical Technology South-West Claus D. Claussen is professor of vice-chairman of the department in PET imaging technology since 2006, Germany, Stugart, and was chair- radiology at Eberhard-Karls Univer- 1984 and was promoted to professor which has major potential in the field man of the ESR’s Ethical Compliance sität Tübingen in Germany and of radiology in 1986. He moved to the of molecular imaging. Over the last Subcommiee. was chairman of the department University of Tübingen in 1988 and ten years, together with Prof. Pichler, In recognition of his work, Prof. of radiology at University Hospital served as chairman and full profes- he has built up one of Europe’s larg- Claussen has received numer- Tübingen from 1988 to the end of sor of radiology until 2014. He also est and most successful preclinical ous awards and honours, includ- March 2014. He has been director of served as a visiting professor at the molecular imaging laboratories in ing honorary membership of the metabolic imaging at the German Mayo Clinic Rochester in Minnesota, Tübingen. Austrian, French, and German Soci- Diabetes Center in Tübingen since United States. He has published in a large range ety of Radiology and ESGAR. April 2014. Over the last four decades, he has of highly regarded peer-reviewed In 1971, Prof. Claussen gradu- been one of the pioneers in devel- scientific journals, including the “I am happily married with my Prof.Claus D. Claussen, from ated from Heidelberg University oping and introducing new imaging New England Journal of Medicine, wife Jua. We have three children. Tübingen, Germany, will be with a degree in medicine. He later modalities, together with his team, Nature Medicine, Circulation, JACC, Cora (26), she is a dentist at the Char- awarded the Gold Medal of the completed a residency in radiology into clinical practice; dynamic-CT Radiology and European Radiology. ité University Hospital, Berlin, Carla European Society of Radiology. at the University of Heidelberg and (1980), gadolinium contrast MRI He has also served as a reviewer for (24), she is a student at the Medical worked as a staff radiologist until (1983), cardiac CT (1998), 3T MRI Radiology, European Radiology and School in Munich, and Constantin 1979. During his time from 1979 until (2000), whole-body MRI (2004 ). With the Journal of Nuclear Medicine. (22), just received his Bachelor degree and I am member of the board of 1988 working in the department of a particular interest in MR/PET, Prof. Claussen also works to in business from the University St. trustees of the state Gallery in Stu- radiology at the university hospital in Prof. Claussen has been involved support international cooperation Gallen in Switzerland. My personal gart. I also love jogging and tennis,” Berlin (since 1990 Charité) he became in the development of hybrid MR/ and has served as president of the interests are opera, theatre and art said Prof. Claussen.

BY MICHAEL CREAN ESR Gold Medal awarded to renowned expert in gastrointestinal and oncologic imaging

In recognition of his long and dedicated service to the European Society of Radi- commied to advancing the profes- sion and science of radiology. He ology and his outstanding work in the field of gastrointestinal radiology, Professor served as president of ECR 2011 and Yves Menu from Paris, France will be awarded the Gold Medal of the European on many ECR’s Programme Planning Society of Radiology at ECR 2015. Commiees. He was also chairman of the Professional Organisation Commiee and is now the scientific Yves Menu is professor of radiol- chairman of the department of radi- to 1996, he was editor-in-chief of director of the European Board of ogy and chairman of the department ology at Bichat Hospital in Paris. He the Journal de Radiologie, the offi- Radiology (EBR). of radiology at Saint Antoine Hospi- returned to Beaujon Hospital in 1993 cial journal of the French Society of tal, Pierre & Marie Curie University and served as chairman of the radi- Radiology, and served as reviewer in Paris, France. ology department until 2003, when for other journals like Intensive Care “Needless to say, I am hon- Originally from Dijon in the east of he assumed until 2008 the post Medicine, European Journal of Radi- oured. Anybody would be. The France, Prof. Menu graduated from of chairman of Bicêtre Hospital’s ology, Gastroentérologie Clinique et ESR is something special for me. the University of Paris VI Medical department of radiology and profes- Biologique, Translational Oncology While serving this young society, School in 1976, and began his resi- sor of radiology at the University of and Radiology. In 2010, he received I have been involved in its fan- dency in neurosurgery, endocri- Paris XI. the Editor’s Recognition Award from tastic scientific and professional Prof. Yves Menu from Paris, nology and radiology at the Assis- Prof. Menu’s main areas of inter- the journal Radiology, for his many achievements. And this was, and France will be awarded the Gold tance Publique Hôpitaux de Paris est are in the fields of gastrointes- years of service as a reviewer, and remains, an araction for so many Medal of the European Society of and University of Paris in 1977. He tinal radiology, oncologic imaging he is now an associate editor for this talented colleagues. If I remember Radiology. became a board certified radiologist and emergency radiology. He has journal. He is an honorary member of one feature, it would be that in the in 1981 and then a fellow at Beaujon published 191 peer-reviewed scien- the RSNA, Tunisian Society of Radi- ESR, everyone gives their best to Hospital’s department of radiology tific articles, 19 book chapters and ology and the Romanian Society of achieve a common goal. And the in Clichy. At Beaujon Hospital, he a book. He has also delivered 290 Radiology. reason they give so much is that was promoted to professor of radi- lectures, presentations and invited A long-time and active member it is so rewarding. I gave a lot, but ology, and in 1990 he was appointed talks around the world. From 1992 of the ESR, Prof. Menu has been I received at least ten times more!” myESR.org 26 COMMUNITY NEWS ECR TODAY | FRIDAY, MARCH 6, 2015

BY MICHAEL CREAN Dedicated teacher and gastrointestinal expert receives ESR Gold Medal In recognition of his dedication to international cooperation and rela- tions, as well as his outstanding contribution to radiological education, Professor András Palkó, from Szeged, Hungary, will be awarded the Gold Medal of the European Society of Radiology today at ECR 2015.

András Palkó is chairman and the department of radiology at Pécs foundation, Prof. Palkó has been wide, memories of which I treasure head of the department of radiology County Hospital before becoming actively involved in the work of the for the rest of my life,” said Prof. Prof. András Palkó, from Szeged, at Szeged University Medical School. chairman and head of the depart- European School of Radiology and Palkó. Hungary, will be awarded the He is also editor-in-chief of the jour- ment of radiology at Szeged Univer- now serves as editor-in-chief of the During his long and distinguished Gold Medal of the European nal Magyar Radiológia. sity Medical School. ESR Education on Demand service. career, Prof Palkó has published 91 Society of Radiology. A native of Budapest, Hungary, A dedicated teacher, Prof. Palkó He is also a member of the European articles in peer-reviewed journals Prof. Palkó graduated from the has received several ‘best teacher’ Society of Abdominal and Gastro- and 31 book chapters. He has also University of Pécs Medical School awards from his students over the intestinal Radiology and currently delivered more than 200 invited in 1977 and became a board-cer- years. His main field of interest is serves as its secretary-general. lectures around the world. He has “It is the dream of many radi- tified radiologist in 1981. He also abdominal-gastrointestinal radi- “Being the president and member received widespread recognition for ologists to stand one day on the received his Ph.D. degree from ology, with a special emphasis on of the board of directors of the ESR his achievements and contributions stage in front of the peers of ESR the University of Pécs in 1994. In oncologic and emergency imaging. allowed me not only to reach the to radiology, having previously been on the occasion of receiving the 1993, he spent a year working as a Prof. Palkó has been an active summit of my career but, even more awarded honorary membership by Gold Medal of the society, and it is senior registrar in Kuwait, and has member of the ESR for many years importantly, to have the opportu- the Austrian, French, Irish, Polish, hard to believe that this year it is also visited the United States and and served on the ESR’s Board of nity to work together and become Romanian, and Serbian radiological me who may enter the line of those Germany during his career. From Directors between 2009 and 2013 friends with so many outstanding societies, as well as the Radiological most distinguished colleagues 1996 to 1999, he served as head of and as president in 2012. Since its colleagues from Europe and world- Society of North America. who had earned this merit before.”

ESR Journals, European Radiology & Insights into Imaging – Moving up!

During the Editorial Board meet- will be awarded. These papers were 3500 ing of European Radiology, which will ‘ESUR prostate MR guidelines 2012’ 2978 take place at noon today, Prof. Maxi- (Barentsz JO, et al.) followed by ‘CT 3000 milian F. Reiser will report on his first image quality improvement using 2500 full year of editorship. adaptive iterative dose reduction 2109 2142 2097 1984 2060 2020 With an increase of 16% in submis- with wide-volume acquisition on 1971 1951 2000 1752 1800 1659 1697 1672 sions, the journal now receives nearly 320-detector CT’ (Gervaise A, et al.) and 1591 1562 1610 1473 1545 2,100 initial submissions per year, ‘Model-based iterative reconstruction 1500 1353 1388 1231 1179 approximately a fih of which get technique for radiation dose reduc- 866 accepted for publication. Due to the tion in chest CT: comparison with 1000 increased workload and expertise the adaptive statistical iterative 500 needed to handle all submissions with reconstruction technique’ (Katsura care and in a timely manner, Prof. M, et al.). 0 Reiser will also introduce a growing The European Radiology Editorial 2007 2008 2009 2010 2011 2012 2013 2014 team of Deputy Editors, which has Board meeting will be followed by the Initial Submissions All submissions (incl. Revisions) Original Article submissions been recently joined by Dr. Sujal Insights into Imaging Board meeting, Desai from London, U.K., who will be hosted by Prof. Robert Hermans. European Radiology Submissions 2007–2014 handling submied chest papers. Insights into Imaging will proudly Another highlight will be the pres- announce that it has reached the entation of the 2013 ISI Impact Factor, 190,000+ full text download mark in 4.5 which rose up to 4.338; this means 2014, an impressive increase of 28% 4.338 an increase of around 0.8 points compared to 2013. Three papers were 4 compared to the previous year, and published on behalf of the ESR in 3.651 3.589 3.594 3.548 places the journal at rank 13 out of 2014, including the most recent ESR 3.5 3.405 121 journals listed in the ‘radiology, publications: ‘Renewal of radiological 3.222 nuclear medicine and molecular equipment’ (Sept. 2014) and ‘Interna- 3 imaging’ section. tional Summit 2014: Organisation of 2.554 2.5 2.437 Reiser will further report on the clinical ultrasound in the world’ (Nov. 2.364 journal’s various promotional activ- 2014). Prof. Hermans will also present 2 1.969 ities, as well as on the first Albert some editorial statistics, and at the 1.5 L. Baert Editorial Fellow Dr. Giulia end of the meeting he will hand over 1.321 1.37 Zamboni’s visit to Munich and Vienna the awards for the 3 most downloaded 1.119 1 0.897 (read an interview with Dr. Zamboni papers in 2014: ‘Bowel wall thicken- 0.783 in Sunday’s edition of ECR Today). In ing at CT: simplifying the diagnosis’ 0.5 2015, the Editorial Fellow will be Dr. (Teresa Fernandes, et al.), ‘Musculo- Ryan Shulman from Harefield, U.K. skeletal ultrasound: technical guide- 0 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 At the end of the meeting, the most lines’ (Carlo Martinoli et al.) and ‘Imag- cited papers published in 2012 (and ing in otosclerosis: A pictorial review’ subsequently cited in 2013 and 2014) (Bela Purohit, et al.). European Radiology Impact Factor

myESR.org ECR TODAY | FRIDAY, MARCH 6, 2015 COMMUNITY NEWS 27

BY NORBERT HOSTEN Be creative on tech assessment, DRG president urges Dr. Michael Forsting, president of the German Radiological Society (DRG) from 2011 to 2013, set out his views on the future of radiology, linking the concept of medical imaging with references to ‘viable interconnections.’ On the one side is the doctor practising his or her profession, and on the other side is the infinite potential of inter- connected archives. These, I think, are the two poles between which our specialty moves.

The extremely short innovative thing that I would call ‘diffusion’. The vast amount of imaging data cycles in our specialty have caused Every department has MRI studies will first have to be sied. Anybody some areas of radiological science of rare bone tumours, but there is who has prepared 30 examinations to mutate into something which no index that would allow access for a receiver operating characteristic you could provocatively term a ‘test to all the rare bone tumours that (ROC) analysis knows how difficult drive’ for the latest models in the are now archived in our facilities, this is to achieve in everyday clini- equipment industry. Each gener- even though this is exactly what is cal practice. How should these vast ation of equipment can do more needed to provide evidence that a quantities of data be evaluated? Are than its predecessor did, and each contrast-enhanced MRI examina- digital evaluation procedures really generation produces more beauti- tion or diffusion-weighted imaging the only option? ful images. But to what end? How leads to longer indicators of survival Here again, the general realities does the patient benefit? Radi- than an unenhanced MRI. of life in our society offer possible otherapy, as a related specialty, Big data shows us how. Mammog- solutions. People are prepared to has an easier task here. ‘Survival’ raphy also does, insofar as it is commit themselves to causes they or ‘duration of recurrence-free summarised in the screening. Despite believe to be worthwhile. Thousands Prof. Norbert Hosten from survival’ is the criteria by which all the difficulties involved in defin- searched the satellite photos of the Greifswald, Germany. the success of radiotherapy can ing it with scientific accuracy, the Indian Ocean available on the Inter- and must be measured. value of this method for patients and net, for free, to look for debris from Our specialty is caught in a healthy women, the patient numbers the missing aircra MH 307. dilemma. Radiology, even interven- on which the present publications The task of searching through radi- tional radiology, is so closely bound are based, are absolutely unique. This ological images for a single well-de- to the entire process of treatment, to is not the case with any other indica- fined criterion is no more complex. the patient’s entire case history, that tion or modality. Our epidemiological colleagues have it is difficult to assess the influence of The people whose data we use developed training and quality algo- individual radiological procedures in must give their consent, of course. rithms. What is to stop us making a scientifically honest manner. The Data protection must be guaran- 100,000 CT images available on the indicators of radiation oncology do teed and we need ethical approval Internet and asking the radiolog- not apply. That’s the first part of the for each individual trial. Here, we, ical community to look for poly- dilemma. as medical professionals, rise above morphic calcifications, round foci, As for the second part of the commercial factors. or ‘flame signs’ on the neck vessels dilemma, today’s developed socie- of people who have had accidents? ties are, as a rule, not prepared to pay COOPERATION IS THE MAGIC And perhaps we could offer this to more for medical care, and health, WORD our 10,000 reporting workstations in along with health management, is The Academy of German Trauma Germany. perceived as a cost factor, as an exces- Surgeons has an impressive collec- Radiology, as a technology-based sively burdensome item in ancillary tion of clinical data on patients who discipline, has a great opportunity labour costs. According to this view, have suffered accidents in Germany. to exploit the potential of new scien- medicine is not about consumption, In the past few years, they have tific participation in ways which have it’s about costs. We all know what started to facilitate the exchange only been touched upon here. On this that means. Innovation can only be of radiological imaging data. Not all note, I look forward to exchanging achieved through readjustment or of us have been happy about this. views about these prospects with redistribution. Many of us have technical prefer- you. Techniques like PET/CT and PET/ ences which we very much want to MRI are famous examples of inno- see implemented. This is, of course, More information about the vations that doctors and patients our right. German Radiological Society can be value very highly and which benefit This raises one question: shouldn’t found at www.drg.de the patients, but that authorities do we use the opportunities to access not reimburse. The main reason: the this treasure trove of clinical infor- costs are too high. The argument put mation and imaging data that we Prof. Norbert Hosten is pro- forward is that there is no evidence actually helped to create? To this fessor of diagnostic and inter- for these methods. end, the DRG has entered into a ventional radiology at Univer- cooperation agreement with the sity Hospital Greifswald and the BIG DATA: A NEW ROUTE TO German Society of Trauma Surgery current president of the German EVIDENCE to allow shared scientific access to Radiological Society (DRG). The classic proof of causality in these resources. This is a rocky path clinical medicine is the randomised to tread. But wouldn’t it be fascinat- prospective clinical trial, perfected ing to conduct a study of 100,000 in the English-speaking world and accident victims to investigate Editor’s note: This article is an edited since implemented globally. This is whether the 40,000 people exam- version of a translation of an inter- difficult to achieve in radiology for ined with state-of-the-art CT had view carried out in German and pub- the reasons described above. beer survival rates than the 60,000 lished online on 21 May by the DRG. Most of our images are available examined with older machines? Isn’t Translation by Syntacta Translation digitally and so are theoretically that an objective that makes collab- & Interpreting. The edited English available globally, but their scien- oration with our clinical colleagues translation originally appeared on tific evaluation is impeded by some- worthwhile? AuntMinnieEurope.com.

myESR.org 28 COMMUNITY NEWS ECR TODAY | FRIDAY, MARCH 6, 2015

ESGAR offers large range of educational opportunities for 2015

shops. A new technically oriented imaging approach’ will take place in ESGAR is devoted to working on. workshop will also take place from Lisbon, Portugal. These new ESGAR The recently published guidelines February 7–9, 2015 in Muscat, Oman. workshops will be more practi- on CTC clinical indications were This initiative will deal with MR cal and more multidisciplinary, produced jointly with the ESGE and MDCT of the abdomen and approaching related colleagues (European Society of Gastrointes- how to perform the best examina- and societies to analyse the disease tinal Endoscopy). tions for specific clinical questions. through all the relevant biological, Finally, in 2015 the ESGAR Annual Apart from this course, the follow- clinical and imaging aspects. Differ- Meeting will take place in Paris, ing workshops will be offered in ent abdominal, gastrointestinal France (June 9–12) under the meet- 2015: and disease-oriented societies are ing presidency of Prof. Yves Menu. » April 15–17: CT Colonography now working with ESGAR to deter- The programme is very promising Workshop in Bruges, Belgium; mine which topics are of common and new features were introduced. Local Organisers: P. Lefere, S. interest. For the first time there will be two Gryspeerdt In addition, a new educational different postgraduate courses » April 24–25 Liver Imaging Work- activity is planned for junior resi- on the first day of the meeting, shop in Novi Sad, Serbia; Local dents. The Summer School will addressing ‘MRI of the abdomen’ Organiser: S. Stojanovic offer, for the first time, an inter- and ‘Oncologic imaging.’ The best The next ESGAR Annual Meeting will take place in Paris, France » May 7–8: Pancreas Workshop in active case-based learning activity protocols, functional tools, inter- (June 9–12) under the meeting presidency of Prof. Yves Menu. (© Fotolia.com – eyetronic) Athens, Greece; Local Organiser: were attendees will interact with ventional procedures and clinical C. Triantopoulou teachers on real practical cases, advice will allow radiologists to » September 16–18: CT Colonogra- reporting studies and managing lead patient-oriented innovation in The European Society of Gastro- initiated a number of successful phy Workshop in Florence, Italy, patients. healthcare. The Research Centre, intestinal and Abdominal Radiology workshops on CT colonography, Local Organiser: E. Neri Furthermore, the ESGAR Web- promoting adequate methodology, (ESGAR), is an active society which liver, pancreas and bowel imaging. » October 8–9: Liver Imaging Work- site (www.esgar.org) has been and School of ESGAR, following the supports education, research and These workshops provide compre- shop in Valencia, Spain Local launched to better present the European Training Curriculum for innovation in abdominal and pelvic hensive coverage of all the main Organiser: L. Martí-Bonmatí new activities and services that residents, are also major innova- radiology. As a European subspe- pathologies by means of an inte- To complement these workshops, the society offers to its members. tions in our meetings. The Annual cialty society, ESGAR is an Insti- grated multimodality approach. new clinically oriented workshops, The e-Education Portal, electronic Meeting 2015 will offer everyone tutional Member of the European The workshops include formal held jointly with related societies, posters, Cases of the Month and a very rewarding experience with Society of Radiology (ESR). The Soci- lectures and interactive discussions will focus on pelvic floor and e-Library are attractive solutions interactivity at the educational, ety has progressively increased its on real clinical cases. inflammatory bowel disease imag- for new opportunities to improve scientific and cultural level. number of members, which rose to Since 2014, ESGAR workshops ing. On November 6–7 the joint the practice of abdominal radiology more than 1,500 in 2014. have been structured according to ESGAR/ESDO course (UEG) ‘Hepa- through education and innovation. Focusing on education and tech- three different themes: technical, tobiliary, pancreatic and GI tract On the ESGAR website, you can also More information about ESGAR nical standardisation, ESGAR has clinical and multidisciplinary work- neoplasms: a multidisciplinary find the Society Guidelines, which can be found at www.esgar.org

BY MAREK SASIADEK Poland enhances education with European Diploma

The current term (2013–2016) of the improve the quality of their scientific European societies and journals, with the European Board of Radiol- formal subspecialisations and intro- Polish Medical Society of Radiology work. Now there are three awards: e.g. Prof. Agnieszka Trojanowska is ogy, to hold the next EDiR exam in duce a hybrid imaging certificate for (PMSR) Board, which includes Marek an annual award for the best publi- the ESHNR’s treasurer, Prof. Iwona Warsaw in April 2015. radiologists, as well as ‘turf bales’ Sasiadek as president and Andrzej cation, an annual award for best Sudol-Szopinska is chair of the ESSR As already mentioned, our Society with other specialties which try to Urbanik and Marek Stajgis as publication in the Polish Journal of Arthritis Subcommiee, Prof. Jerzy organises a lot of educational courses take over radiological procedures, vice-presidents, has been very active Radiology and an award for the best Walecki is a member of Neuroradiol- for radiology residents. In recent especially interventional radiology so far, with many new initiatives. overall publication record during the ogy’s Editorial Board and Prof. Marek years it has been supplemented by ones. In 2014 new regulations were The PMSR keeps a uniform struc- three-year period between PMSR Sasiadek is a member of the ESNR courses for radiographers, which also introduced to change the offi- ture, covering all subspecialties. We congresses. Scientific Programme Commiee. gained wide popularity. cial duration of the working day for do not have subspecialty or modality The quality of scientific work of Our other scientific activities In response to the needs of our radiologists and radiographers from societies, but there are 14 subspecialty Polish radiologists has improved include organising European members, three new sections of five hours to seven hours and 35 sections of the PMSR, which have a markedly, which is reflected by inter- congresses and courses. In 2014 we the Society have been established minutes per day. This has resulted in great deal of autonomy. We believe national scientific awards. The most organised an ESOR Galen Course in recently: the Interventional Neuro- a decrease in salaries in most public it makes us stronger in negotiations prestigious in recent years was Prof. Wroclaw and the EuSoMII Congress radiology Section, Emergency Radi- departments of radiology and disap- with government institutions and Małgorzata Szczerbo-Trojanowska in Warsaw. In the next two years we ology Section and the Imaging in pointment for many colleagues. other medical specialties. obtaining honorary membership of will also host the ESHNR Congress Sports Medicine Section. Despite these problems, my view The PMSR holds a large radiol- the RSNA in 2013. Besides that, Dr. (Krakow 2015) and ESCR Congress We recently established certificates of the future of Polish radiology and ogy congress every three years. We Joanna Bladowska was awarded by (Krakow 2016). of the Society for ten subspecialties the PMRS is optimistic. I believe we had a very successful congress in the ESNR for the best neuroradiology In 2014, the new national curricu- (following the European curricu- will continue to achieve further 2013 in Wroclaw (1,500 aendees, 25 publication in 2013, Dr. Anna Zimny lum in radiology, based on the Euro- lum). The first group of colleagues development in the following years. foreign invited lecturers), and we are won the award for the best neurora- pean curriculum, was introduced. has already obtained the certificates. now preparing the next congress in diological oral presentation during In addition, the Polish Ministry of The other big task that was More information about the Polish Krakow, which will take place in 2016. ECR 2013, Prof. Andrzej Cieszanowski Health agreed to recognise the Euro- completed in 2014 was developing a Medical Society of Radiology can be Meanwhile, our sections organise received the first award of ECR 2014 pean Diploma in Radiology as equiv- detailed description of all the radi- found at www.polradiologia.org multiple annual conferences and for the best oral presentation on alent to the Polish national exam. ological procedures which use radi- educational courses (about 25 each the topic of abdominal viscera, and This has resulted in great interest ation, while emphasising the role year), including the Polish School Prof. Andrzej Urbanik and Dr. Robert from Polish residents in taking the of radiologists in supervising and of Radiology, School of MR, as well Chrzan were recognised with the EDiR exam. In the last two years, 36 reporting these procedures, and as annual interventional radiology, Summa Cum Laude Award at the Polish candidates have passed EDiR. gaining approval of this document CT, sonography and mammography Congress of the American Society In April 2014, we held an EDiR exam from the Ministry of Health. workshops. of Neuroradiology in 2014. in Poland (Warsaw) with 28 Polish Apart from the successes Recently we changed the regu- Polish radiologists’ scientific activ- candidates (21 of them passed the mentioned above, we have also had Prof. Marek Sasiadek is Presi- lations of the PMSR’s scientific ities are also evidenced by their exam) and five candidates from other many problems and failures. This dent of the Polish Medical Society awards to encourage our members to activity on the boards of prominent countries. We have decided, together includes the failure to establish of Radiology.

myESR.org ECR TODAY | FRIDAY, MARCH 6, 2015 COMMUNITY NEWS 29 TOP TIPS for trainees and teachers

BY CHRISTIANE NYHSEN PART 3: Management in radiology WHY TRAINEES AND JUNIOR RADIOLOGISTS SHOULD BE INTERESTED

You’ve read past the headline; congratulations! Management is really not as boring as many radiologists may think, and there are also many interesting projects to consider for radiology trainees, which really can be done in every clinical seing, as Prof. Peter Mildenber- ger from Mainz, Germany, explains below. He is the current chair- man of the Management Subcommiee of the ESR and chairman of the Management in Radiology (MIR) Annual Meeting held every autumn, so he is the best person to give you further insights!

ECR Today: I am a radiologist; do I if someone is thinking about finan- ECRT: Are there any suitable » level of recommendations for really need to know anything about cial issues as the only or main aspect. conferences, courses or qualifica- further and follow-up imaging management? Which different Management covers a lot of different tions for trainees or junior radiol- according to guidelines aspects does management cover? professional issues, including leader- ogists, which would look good on » follow-up of recommendations How could I make a difference? ship, education, mentoring, commu- their CVs? Peter Mildenberger: The term nication, radiation dose monitoring, PM: The ESR is offering a half-day ECRT: Where could I learn more ‘management’ might be misleading, quality and safety in radiology. session at the ECR, today from 13:00 about management in radiology? to 17:30 in Room D (see page 23 for Are there any journals or websites details of the session). This year there you could recommend? will be updates on several relevant PM: Besides the MIR website, issues and also a dedicated session which offers access to different on quality and safety. The ESR is information and presentations from also organising the Management in past meetings, there are different Radiology (MIR) Annual Conference, journals, which cover professional which is linked with a postgraduate issues. The most important journal course. High-level speakers from in Europe is Insights into Imaging, Europe and abroad will present there which offers free access to several Turns every and will be available for individual papers from the ESR, for example discussions. Regarding the CV, there those about standards for reporting Prof. Peter Mildenberger is is the European Diploma in Radiol- or renewal of equipment. The jour- turn into fun. professor of radiology and leader ogy, which certifies a high-level of nal of the ACR is another interesting of the IT group at University professionalism in radiology. source, as well as websites from other All conditions are perfect conditions. Clinic Mainz, Germany. He serves The new Audi A6 Avant with the superior national societies, such as the Royal as chair of the ESR Management ® technology for more precision quattro ECRT: Do you have any advice College of Radiologists in the UK or in Radiology Subcommiee. and driving dynamics. on possible audit or research the French Society of Radiology. project topics that may be suitable for a poster, presentation or even ECRT: Any other advice? publication (locally, nationally or PM: In my understanding, it is internationally)? very important for young radiolo- PM: There are many potential gists to have broad expertise in many topics for research projects, which different clinical areas, followed by are suitable in many different places, some subspecialisation to keep up such as outpatient practice, and with our referring colleagues and smaller or large hospitals. Examples offer an excellent clinical radiology would be: service. But there are also a lot of » optimising the justification professional issues worth thinking process for imaging requests about, because these are relevant to » dose optimisation and radiation improving the quality in imaging, dose registers for improving imag- reporting, communication etc., and ing protocols (see also the ESR to providing beer service to our EuroSafe Imaging campaign) patients (see also the ESR Training » introducing a CIRS (critical inci- Curriculum for Radiology). dent reporting system) » communicating unexpected or Dr. Christiane Nyhsen is con- urgent findings sultant radiologist at Sunderland » peer-review system (quality of Royal Hospital, UK, and former reports, checking for errors, double chairperson of the ESR Radiology reading parts of reports, etc.) Trainees Forum.

www.audi.at

Total fuel consumption ( l/100 km) 5,3 – 7,6. CO2-emissions (g/km) 138 – 177.

myESR.orgmyESR.org 30 ARTS & CULTURE ECR TODAY | FRIDAY, MARCH 6, 2015

JASPER JOHNS: REGRETS

AN EXHIBITION AT THE BELVEDERE

Jasper Johns, Regrets, 2013, Courtesy the artist © Bildrecht, Vienna, 2015, Photo: © Jerry Thompson ECR TODAY | FRIDAY, MARCH 6, 2015 ARTS & CULTURE 31

With Jasper Johns: Regrets, the Upper Belvedere is present- ing not only one of the most important and multifaceted Amer- ican artists, but also premieres the artist’s most recent body of Belvedere work, developed over the last year and a half, and gives visitors the chance to see one of the most important series in Jasper Prinz Eugen-Str. 27 John’s contemporary work. The exhibition features around 30 works, including two paintings, sketches and prints. Each 1030 Vienna of the two paintings is titled Regrets. This title is developed from a stamp that Johns had produced about five years ago, Opening hours: in order to swily decline the stream of requests and invita- Daily 10am – 6pm tions that he frequently receives. Enlarged as a screen print, Wednesday 10am – 9pm the words on the stamp appear in the top right corner of the two paintings, serving both as the artist’s signature and as the works’ titles. In June 2012, Johns discovers an old photograph www.belvedere.at of the young artist Lucian Freud in an auction catalogue. The photograph, part of a series taken around 1964 by the British photographer John Deakin, shows Lucian Freud perched on a bed, one arm raised to obscure his face in an introspective gesture. Jasper Johns was not only inspired by the scenery but also by the damages the image had suffered over the years. In the following months, the image became the starting point for his Regrets-series, where he takes the image through a BELVEDERE succession of numerous permutations. The Belvedere is one of the world’s most important museums “I am especially delighted that with the Regrets series by with collections spanning from the Middle Ages to the present Jasper Johns the Belvedere is able to vividly show the artist’s day. The museum is housed in the Belvedere Palace, which pioneering artistic practice as one of the main representatives Prince Eugene of Savoy had built as a summer residence. The of American postwar-modernism,” Agnes Husslein-Arco, direc- collections of the 19th and 20th centuries are housed in the tor of the Belvedere and 21er Haus, states. “His most recent Upper Belvedere with works by Biedermeier artists (Ferdi- series, which is based on the painterly, graphic and print graphic nand Georg Waldmüller, Jakob Alt etc.), French Impression- processing of one single photograph, refers to the intertwine- ists (Claude Monet, Auguste Renoir etc.) and masterpieces ment between everyday life and classic artistic expression by Gustav Klimt, Egon Schiele, and Oskar Kokoschka. In so characteristic for his work. This is also what created his the Lower Belvedere the Museum of Medieval Art and the canonical position in art history. The exhibition therefore links Baroque Museum are located. The two buildings are linked by history with present, which is a central goal of our interven- a unique Baroque garden. The entire ensemble ranks among tions series,” Agnes Husslein-Arco adds. the world’s most beautiful and best preserved historic palaces The Regrets series takes the image of Freud through a succes- and parks. From the north side of the Upper Belvedere one Jasper Johns, Untitled, 2012, Private collection sion of cross-medium permutations, including small pencil can appreciate the renowned and stunning view of Vienna. © Bildrecht, Vienna, 2015, Photo: © Jerry Thompson sketches, a set of four ink-on-plastic drawings, and two prints, each presented along with a variety of preliminary states. But Johns not only incorporated the photograph of Freud into his work (most oen doubled by its mirrored image), but also the physical qualities of the original black-and-white print, which Freud had extensively torn and creased in the course of his studio practice. A loss on the original photograph, for example, plays a prominent role in the composition throughout the series, creating a dominant dark form in the centre foreground. A large-scale watercolour, also titled Regrets, obscures the image nearly into abstraction, exploring the theme in yet another way. This series lays bare the importance of process and experimentation, the cycle of dead ends and fresh starts, and the incessant interplay of materials, meaning, and representation so characteristic of Johns’ career over the last 60 years. This is a significant opportunity to see one of his most important series of contemporary works. Having emerged as a leading voice in American art in the late 1950s with paintings of iconic motifs such as flags, targets, and numbers, Johns has since developed a body of work of extraordinary narrative complexity and technical virtuosity. During his career, Johns has created some of the most important and compelling works of modern times. This exhibition Jasper Johns: Regrets is based upon one originally organised by The Museum of Modern Art, New York and organised by Christophe Cherix, Ann Temkin, and Ingrid Langston. The Belvedere is the third iteration of Jasper Johns: Regrets – parts of it were presented at the Courtauld Gallery in London – and is the first major solo exhibition in Vienna since his retrospective of prints at the Vienna Secession in 1987. Jasper Johns, Study for Regrets, 2012, Private collection © Bildrecht, Vienna, 2015, Photo: © Jerry Thompson

myESR.org 32 WHAT’S ON TODAY IN VIENNA? ECR TODAY | FRIDAY, MARCH 6, 2015

Sven Dolinski, Markus Meyer, Falk Rockstroh, Barbara Petritsch in Please note that all performances, except at Vienna’s English Theatre, Bei Einbruch der Dunkelheit by Peter Turrini © Georg Soulek / Burgtheater Theatre & Dance are in German.

Akademietheater 16:00 Die Schneekönigin 1030 Vienna, Lisztstraße 1 by Hans Christian Andersen Phone: +43 1 51444 4145 www.burgtheater.at

Burgtheater 20:00 Bei Einbruch der Dunkelheit 1010 Vienna, Universitätsring 2 by Peter Turrini Phone: +43 1 51444 4145 www.burgtheater.at

Rabenhof 20:00 Sekundenschlaf 1030 Vienna, Rabengasse 3 Solo performance Phone: + 43 1 712 82 82 by the Viennese actor and vaudevillian Andreas Vitásek 300 el x 50 el x 30 el by FC Bergman at the Tanzquartier Wien www.rabenhoheater.com © Sofie Silbermann Schauspielhaus 20:00 Das Gemeindekind 1090 Vienna, Porzellangasse 19 by Anne Habermehl and Gerald Resch Phone: + 43 1 317 01 01 www.schauspielhaus.at

Tanzquartier Wien 20:30 300 el x 50 el x 30 el 1070 Vienna, Museumsplatz 1 FC Bergman (Belgium) Phone: + 43 1 581 35 91 www.tqw.at

Theater in der Josefstadt 19:30 Liebelei 1080 Vienna, Josefstädter Straße 26 by Arthur Schnitzler Phone: +43 1 42 700 300 www.josefstadt.org Rainer Frieb, Thomas Kamper, Erich Schleyer in Die Physiker by Friedrich Dürrenma © Christoph Sebastian Vienna’s English Theatre 19:30 Venus in Fur 1080 Vienna, Josefsgasse 12 by David Ives Phone: +43 1 402 12 60 0 www.englishtheatre.at

Volkstheater 19:30 Die Physiker 1070 Vienna, Neustigasse 1 by Friedrich Dürrenma Phone: 43 1 52111 400 www.volkstheater.at

Concerts & Sounds

Konzerthaus (Classical Music) 19:30 ORF Radio-Symphonieorchester Wien, conductor Ernst Theis 1030 Vienna, Lothringerstraße 20 Wiener Singakademie, chorus RSO Wien © Carlos Suarez / Konzerthaus Wien www.konzerthaus.at K. Weill: The Ballad of Magna Charta, Down in the Valley

Musikverein (Classical Music) 19:30 Wiener Symphoniker, conductor Philippe Jordan 1010 Vienna, Bösendorferstraße 12 Camilla Tilling, soprano www.musikverein.at F. Schubert: Symphony No. 6, G. Mahler: Symphony No. 4

Porgy & Bess (Jazz) 20:30 Akkordeonfestival 1010 Vienna, Riemergasse 11 Karl Hodina & Peter Havlicek (Austria) / Yuri Lemeshav & www.porgy.at Pamela Stickney (Russia/US)

Arena (Alternative Music) 19:00 Donots (Germany) 1030 Vienna, Baumgasse 80 19:00 Colour Haze (Germany) + Radio Moscow (US) Donots www.arena.co.at + Cherry Coke (UK) © 2010.donauinselfest.com

Szene Wien 20:00 Schwesta Ewa 1110 Vienna, Hauffgasse 26 www.szenewien.com

Opera & Musical Theatre

Volksoper 19:00 Die Hochzeit des Figaro 1090 Vienna, Währingerstraße 78 by Wolfgang Amadeus Mozart www.volksoper.at

Schwesta Ewa Wiener Staatsoper – Vienna 19:30 I Puritani by Vincenzo Bellini, conducted by Marco Armiliato © rap.de State Opera With Jongmin Park, John Tessier, Carlos Álvarez, Olga 1010 Vienna, Opernring 2 Peretyatko www.wiener-staatsoper.at

Raimundtheater 19:30 Mamma Mia! 1060 Vienna, Wallgasse 18–20 by Benny Andersson & Björn Ulvaeus www.musicalvienna.at

Ronacher 19:30 Mary Poppins 1010 Vienna, Seilerstäe 9 by Richard M. Sherman & Robert B. Sherman www.musicalvienna.at

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