ESR meets Switzerland - the European Society of Radiology

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01/09

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Dear Readers,
Contents
Since, as you all know, ECR is the flagship of the European Society of Radiology, most of our activities
revolve around our annual meeting, making it the centre of our working year. So we have now come full circle
once more because – ECR 2009 is almost here again!
Final preparations are well underway; various congress-related media are in pre-production, keeping our
graphic designers and editorial staff busy; distinguished speakers have been invited for the ECR Opening
Press Conference; press releases are being prepared and contacts rekindled with media representatives
from all over the world.
Gearing up for the biggest technical exhibition ever shown at ECR, provides its very own challenges for the
Marketing Department, for which the congress is the crowning point of the well-tended year-round relations
with our industry partners. Booths have been assigned to 280 exhibitors and everyone is looking forward
to getting their first glimpses of the most recent developments in the business.
Some of you may already be giving some thought to what you could do with your spare time in Vienna, so
we would like to draw your attention to ECR’s very own well-known and trusted Arts & Culture website
(www.myESR.org/arts_culture_2009), which gives you a marvellous overview of what Vienna’s artistic
scene has to offer its cherished guests.
If you need any more stimulation for the upcoming congress take a good look at the coverage of some scientific
highlights from page 28 onwards. There is only one thing left to say – we look forward to welcoming
you to Vienna soon! Have a safe trip everybody.
E S R N E W S
05 Letter from the President
07 Alliance for MRI
09 ESOR – European School of Radiology
12 EIBIR News
15 New articles from European Radiology
16 Credit where credits is due: The issue of academic merit
19 News from the Radiology Trainees Forum
21 Subspecialty Society News
23 Congress Calendar
Your ESR Newsletter Team
ESR NEWSLETTER is an official organ of ESR
E C R N E W S
ESR Executive Council
Iain W. McCall, Oswestry/UK
ESR President
Christian J. Herold, Vienna/AT
ESR 1 st Vice-President
Maximilian F. Reiser, Munich/DE
ESR 2 nd Vice-President
Borut Marincek, Zurich/CH
Congress Committee Chairman
Małgorzata Szczerbo-Trojanowska, Lublin/PL
1 st Vice-Chairperson of the Congress Committee
Yves Menu, Le Kremlin-Bicêtre/FR
2 nd Vice-Chairman of the Congress Committee
Adrian K. Dixon, Cambridge/UK
Publications Committee Chairman
Gabriel P. Krestin, Rotterdam/NL
Research Committee Chairman
Éamann Breatnach, Dublin/IE
Education Committee Chairman
Luís Donoso, Sabadell/ES
Professional Organisation Committee Chairman
Fred E. Avni, Brussels/BE
Subspecialties Committee Chairman
Guy Frija, Paris/FR
National Societies Committee Chairman
Luigi Solbiati, Busto Arsizio/IT
Communication & International Relations
Committee Chairman
András Palkó, Szeged/HU
Finance Committee Chairman
Peter Baierl, Vienna/AT
Executive Director
Managing Editor
Julia Patuzzi, Vienna/AT
Sub-Editor
Simon Lee, Vienna/AT
Contributing Writers
Mark Bryant, Portsmouth/UK
Sarah Edwards, Vienna/AT
Paula Gould, Holmfirth/UK
Monika Hierath, Vienna/AT
Simon Lee, Vienna/AT
Christiane M. Nyhsen, Sunderland/UK
Julia Patuzzi, Vienna/AT
Mélisande Rouger, Vienna/AT
Frances Rylands-Monk, St. Meen Le Grand/France
Majda Thurnher, Vienna/AT
Art Direction
Petra Mühlmann, Vienna/AT
Layout
Robert Punz, Vienna/AT
Marketing & Advertisements
Erik Barczik
E-mail: erik.barczik@myESR.org
Contact the Editorial Office
ESR Office
Neutorgasse 9
1010 Vienna, Austria
Phone: (+43-1) 533 40 64-16
Fax: (+43-1) 533 40 64-441
E-mail: communications@myESR.org
ESR Newsletter is published 5x per year
ISSN 1994-4357
Circulation: 15,000
Printed by Angerer & Göschl, Vienna 2009
Date of printing: January 2009
myESR.org
27 Heading the summit of science:
A portrait of the ECR 2009 Congress President
28 ESR meets Switzerland
40 ESR meets the Královské Vinohrady Hospital in Prague
43 Tenth anniversary of IMAGINE at ECR 2009
45 ESR Travel Service
47 Arts & Culture:
Celebrate the 200 th anniversary of Joseph Haydn’s death
E C R 2 0 0 9 – S c i e n c e
31 CT lung cancer screening comes under the spotlight
32 Spinal Imaging and Intervention at the cutting-edge
35 New techniques contribute to improvements in disc pain management
37 Intervention experts address pros and cons of drug-eluting stents
39 Review advances in CT and MR in major trauma
The Editorial Board, Editors and Contributing Writers make every effort to ensure that no inaccurate or misleading data, opinion or statement
appears in this publication. All data and opinions appearing in the articles and advertisements herein are the sole responsibility of the contributor
or advertiser concerned. Therefore the Editorial Board, Editors and Contributing Writers and their respective employees accept no liability
whatsoever for the consequences of any such inaccurate or misleading data, opinion or statement.
Advertising rates valid as per January 2009.
Unless otherwise indicated all pictures © ESR – European Society of Radiology.
3 myESR.org

ESR
Membership
44,259 members
as per November 19, 2008
full membership only €10/Year
corresponding membership for free
Your benefits:
REDUCED REGISTRATION RATES
for the European Congress of Radiology
EUROPEAN RADIOLOGY (ONLINE)
free access to all articles
EUROPEAN RADIOLOGY (PRINTED VERSION)
highly reduced subscription (only €70)
ESOR, THE EUROPEAN SCHOOL OF RADIOLOGY
activities exclusively for ESR members
ESR NEWSLETTER
the latest developments and news in radiology
FREE EDUCATION
access to EPOS TM , EURORAD, EDIPS, eECR, ePACS
A VOICE FOR RADIOLOGY
representation within the European Union
RADIOLOGY FOR PATIENTS
raising public awareness of radiology
myESR.org
MEMBERSHIP

L E T T E R F R O M T H E P R E S I D E N T
Dear Colleagues
The ESR is reaching the end of its first year
European Congress of Radiology. This
ing the congress. This has already been a
as a fully integrated organisation based
is now a global event with almost 18,000
great success with family physicians and
on individual membership. This year has
participants from all continents, with
has resulted in continued dialogue and a
seen many new developments, many of
Asia particularly well represented. The
joint working paper on imaging services
which will take time and hard work to bear
congress is attractive for many reasons,
to primary care. This year we are joining
fruit. In particular, a number of subcom-
not least the high quality of scientific
with the accident and emergency clini-
mittees have been established to address
papers and presentations from all over
cians and we anticipate an excellent ses-
key issues. These include the development
the world. The educational programme
sion and a fruitful outcome.
of standards of service to respond to the
is comprehensive, imaginative and covers
requirements of the proposed cross-border
health services directive and the com-
a wide range of expertise from foundation
courses to state of the art series and
It is also important that we deliver radiology
services efficiently and that we receive
Iain W. McCall
ESR President
munication on telemedicine from the EU
future developments. The development
sufficient resources to fulfil the expecta-
to ensure that patients receive the same
of the electronic presentation online sys-
tions of our patients, and to achieve these
high quality service that they would have
tem by the congress, and the provision of
objectives radiologists must work closely
expected from their own healthcare sys-
refresher courses online, have also greatly
and be involved in the management proc-
tem when they travel or when their images
enhanced the value of the congress,
ess. In recent congresses satellite sessions
are reported through teleradiology. As the
allowing ESR members throughout the
have been run by the European associa-
EU is also promoting audit, initially for
world to continue to review the science
tion of hospital managers but this year
radiation issues but likely to be extended
in the weeks following the congress and
these sessions will be more integrated into
more widely into other areas of radiologi-
for their continued professional develop-
the main meeting. Professor Marincek,
cal care, the radiation and the audit and
ment throughout the year. The congress
who has done an enormous amount of
standards subcommittees will be develop-
has extended a warm welcome to many
work with his planning team, and I wel-
ing policies and guidance in these impor-
national societies through its ‘ESR meets’
come you to the beautiful city of Vienna
tant fields. Following the production of
programme which has greatly increased
to enjoy this great congress.
the ESR’s paper reviewing the status of
the recognition of progress in radiology
molecular imaging and the present role
worldwide.
This is my final contribution to the ESR
of radiology, a new subcommittee has
Newsletter as president of your society.
been formed to take forward and imple-
However, the impact of radiology is felt
It has been a great honour and pleas-
ment the recommendations. It is vitally
throughout the patient’s journey and radi-
ure to serve the ESR and to see this new
important for the future of radiology that
ologists must have a close working rela-
organisation build so successfully on the
radiologists play a full part in this excit-
tionship with their clinical colleagues and
strengths of its predecessors, the ECR and
ing multi-disciplinary development. The
make the patients and the public aware of
EAR. Radiology has developed dramati-
rapid advances in technology that affect
their pivotal role. The range and complex-
cally over the last 30 years and, if any-
radiology considerably have taken place
ity of imaging is such that radiologists
thing, the pace of change is quickening
without a clear understanding of quality
must be proactive in organising imaging
further. A strong ESR is essential for the
and interrelationships. The ICT subcom-
pathways and in discussion of the results
future of our profession and I thank you
mittee is at present addressing these issues
and their clinical implications. The con-
for joining us in this endeavour. I would
to produce guidance for radiologists.
gress is now working to enhance our rela-
like to thank everyone who has contrib-
tionships with our clinical and family
uted so much and in particular the execu-
It is fitting however that the year should
physician colleagues by inviting them to
tive and all in the ESR Office for their sup-
end with the flagship of the ESR; the
participate with a dedicated session dur-
port over the years.
Iain W. McCall, ESR President
5 myESR.org

ESR Newsletter 04/08
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A L L I A N C E F O R M R I
Alliance for MRI
prepares for a busy 2009
By Monika Hierath
Over the last six months there have been no significant
developments in respect of the revision
of EU Physical Agents Directive 2004/40/EC on
electromagnetic fields. The work of the European
Commission and the social partners to prepare
an amendment will get underway in 2009 and
we look forward to working with the Alliance
members to ensure that the future of MRI is fully
safeguarded in the forthcoming proposal by the
European Commission.
Activities of the Alliance for MRI:
July–December 2008
Meetings with some key stakeholders
The Alliance has sought to develop informal dialogues
with key stakeholders in view of the preparation
of an amendment to the Directive to protect
the future of MRI.
MEPs and Unions
Meetings have been held with some key parliamentarians,
including Dr. Peter Liese (EPP/DE)
who has been supportive and sought clarification
of the scientific detail. We have also met with representatives
from the Green Party who have raised
a number of concerns on the issue. In addition,
informal meetings have been held with the European
Federation of Public Sector Unions (EPSU)
to discuss the application of the Directive to MRI
workers.
Commissioner Spidla and the
Commission services
A meeting took place on 10th December with
Commissioner Spidla. An Alliance delegation led
by Prof. Gabriel Krestin, Mary Baker from The
European Federation of Neurological Associations
(EFNA) and Dr. Stephen Keevil met with the
Commissioner and his services in order to discuss
the revision of the Directive. The Alliance raised
concerns regarding the timing issues and notably
the likely publication in 2010 of ICNIRP’s guidelines
on extremely low frequency (ELF), which, it
is supposed, will inform the content of the revised
Directive. The meeting was very constructive and
one outcome was the decision to re-establish the
MR expert working group to consider the need
for limits in respect of MRI. The Commissioner
emphasised that he is currently still investigating
the various options for review and in principle
welcomed the establishment of social dialogue on
the healthcare part of the directive.
Next Steps in 2009:
Commissioner Spidla made clear to the Alliance
that he hopes to prepare a solid text for a revised
Directive before the end of his tenure (end 2009).
In line with social policy legislation under Article
135 of the Treaty, two rounds of consultation will
be undertaken with social partners (i.e. employers
and unions) before a proposal is formally adopted.
The new Commission will then be in a position to
adopt a proposal for an amendment early in 2010.
It is envisaged that the text of the amendment,
if uncontentious, will then be adopted (under
co-decision) by April 2011, allowing one year for
implementation by the Member States prior to
April 2012.
Socio-economic impact assessment
of the Directive
In line with better regulation requirements, the
European Commission has commissioned a
socio-economic impact assessment of the Directive
which will start in January; a preliminary
report will be produced by September and then a
final report by the end of December 2009.
Unusually, due to time constraints, the first consultation
with social partners will be undertaken
at the same time as the impact assessment. We are
given to understand that as a result the Advisory
Committee on Safety and Health (ACSH), which
comprises representatives from the employers,
unions and member states, and its EMF Working
Group will therefore be in regular contact with
the contractors of the impact assessment report.
The report will look into different legislative
options for the European Commission to propose.
One option is the proposal of new binding
legislation based on the latest international recommendations
with conditional exemptions for
specific cases. The Alliance supports this option
as it is in line with its position requesting a derogation
for MRI from the scope of the Directive.
The Alliance for MRI will seek a meeting with the
contractors appointed to undertake this impact
assessment to ensure that the concerns regarding
the impact on MRI are well understood.
Key Events
• In January 2009 the Scientific Committee on
Emerging and Newly Identified Health Risks
(SCENIHR), established by DG Health and
Consumer Affairs (SANCO) will publish its
report on electromagnetic fields.
• In early 2009, ICNIRP is expected to publish its
revised Static Field Guidelines.
• On 11 and 12 February 2009 DG Sanco and DG
Enterprise are co-hosting a workshop on electromagnetic
fields (http://ec.europa.eu/health/
ph_risk/ev_20090211_en.htm). The draft programme
does not currently include a speaker representing
the Alliance for MRI; however we have
requested that a representative of the MR community
will be included in the stakeholder panel.
• The Swedish Presidency is planning to organise
a conference in October 2009 on the future of
the EU Physical Agents Directive 2004/40/EC.
We understand that there will be a panel session
on medical applications and the Alliance will
ensure that its position is represented.
The Alliance for MRI: Next steps
2009 will be a crucial year in the revision process
of the Directive. We look forward to cooperation
with all our members and very much welcome
support for the Alliance’s campaign.
Over the next year it will be important to find the
appropriate platforms to inform interested parties
about the future of the Directive and what is
at stake for patients and research in Europe.
We very much look forward to hearing from you
if you have any ideas as to how you can assist us in
your member state or at EU level.
Alliance for MRI Secretariat
Further information on the Alliance for MRI is
available at www.alliance-for-mri.org
7 myESR.org

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E S O R
ESOR looks forward to new
opportunities for young radiologists
2008 was a very fruitful educational year for the European School of Radiology. One of ESOR’s main goals is to help young
radiologists to obtain the knowledge and skills to fulfil tomorrow’s requirements. With its wide range of activities (see
pages 10/11) ESOR will pursue this goal in 2009 and looks forward to offering more extended educational programmes.
Application for the programmes will start in early February. ESOR would like to encourage all young doctors to take the
chance to receive training in a pre-selected, highly esteemed reference training centre in Europe.
Exchange Programmes for Fellowships
ASKLEPIOS Courses 2009 *NEW*
This programme offers an opportunity to complement subspecialisation
training or an existing structured fellowship programme, through exchange,
in a particular field of radiology. Throughout a three-month programme the
trainee will be provided with intense modular training and will be supervised
by a specialised tutor in a pre-selected, highly esteemed, academic reference
training centre in Europe. The programme is aimed at residents in their last
year of training and/or board certified radiologists within the first two years
after certification, who desire to become subspecialist radiologists.
Five such programmes per subspecialty will be offered and the successful
applicants will receive a joint grant from ESR and the relevant subspecialty
society.
In partnership with
• the European Society of Gastrointestinal and Abdominal Radiology (ESGAR)
• the European Society of Cardiac Radiology (ESCR)
• the European Society of Head and Neck Radiology (ESHNR)
• the European Society of Paediatric Radiology (ESPR).
Further details regarding the application process and available training
centres will be available soon at www.myESR.org/esor
From 2009 ESOR will organise a new course series under the name
‘ASKLEPIOS’.
ASKLEPIOS Course
ESOR multimodality and multidisciplinary course for general radiologists
and private practitioners
September 18–19, 2009
Budapest, Hungary
This course is aimed at general radiologists and private practitioners who
want to update their knowledge on technological improvements, new applications,
optimised protocols and sequences as well as the most recent achievements
in diagnostic imaging, related to topics across the modalities. The
course offers the opportunity to deepen knowledge and skills of state-of-theart
applications of day-to-day practice in radiology and to serve professional
development by continuing radiological education.
The courses are structured in modality-oriented lecture series and interactive
repetition workshops, assigned to internationally renowned European
faculties.
Visiting Scholarship Programme
The ESOR Visiting Scholarship Programme offers qualified trainees the
opportunity to get to know another training environment, and to kick off
an interest for subspecialisation in radiology. Throughout three months of
training the scholars will be provided with a structured, modular introduction
to different subspecialties and will be supervised by a specialised tutor
in a pre-selected, highly esteemed academic training centre in Europe. The
programme is aimed at residents in their 3 rd , 4 th or 5 th year of training.
24 scholarships on various topics will be offered.
TOPICS
• Abdominal Radiology
• Breast Imaging
• Cardiac Imaging
• Chest Imaging
• Musculoskeletal Radiology
• Neuroradiology
• Urogenital Radiology
• PET-CT Protocols
• MRI Protocols
In partnership with Euromedic International.
Asklepios Course
ESOR visiting school in Russia
November 1–2, 2009
Sochi, Russia
The aim of this course is to help the harmonisation of radiological training
in Europe, to familiarise participants from Russia and CIS countries with
recent advances and achievements in diagnostic imaging and to establish an
interest for subspecialisation in radiology in the respective area. The course
is structured in organ-oriented lectures and interactive repetition workshops,
assigned to internationally renowned European faculties and targeting radiologists
in their last phase of training and board-certified radiologists who are
seeking professional development.
Further details on
the courses and registration
are available at
www.myESR.org/esor
Further details regarding eligibility, programme structure, application and
available training centres are available at www.myESR.org/esor
In partnership with Covidien
9 myESR.org

ESR Newsletter 04/08 01/09
E S O R
ESOR
European School
of Radiology
An update on current
training programmes
and courses
All ESOR activities are exclusive to ESR members.
Further information on the activities of ESOR
is available on the ESR website myESR.org/esor.
GALEN Foundation Courses 2009
Abdominal/Urogenital Radiology
May 14–16, 2009
Sofia, Bulgaria
Local Organiser: V. Hadjidekov
Oncologic Imaging
June 18–20, 2009
Sarajevo, Bosnia & Herzegovina
Neuro/Musculoskeletal Radiology
June 25–27, 2009
Ankara, Turkey
Chest/Cardiovascular Radiology
October 15–17, 2009
Belgrade, Serbia
Paediatric Radiology
November 12–14, 2009
Athens, Greece
The courses are aimed at residents in their
1 st , 2 nd or 3 rd year of training in radiology.
Further details on the courses and registration
are available at www.myesr.org/esor.
For
ESR Members
only
GALEN Advanced Courses 2009
Musculoskeletal Cross-Sectional Imaging
September 4–5, 2009
Krakow, Poland
Local Organiser: A. Urbanik
Abdominal Cross-Sectional Imaging
September 11–12, 2009
Latina, Italy
Women’s Cross-Sectional Imaging
October 23–24, 2009
London, United Kingdom
Cardiac Cross-Sectional Imaging
November 6–7, 2009
Rotterdam, The Netherlands
The courses are aimed at residents in their
4 th or 5 th year of training in radiology and
recently board-certified radiologists.
Further details on the courses and registration
are available at www.myesr.org/esor.
For
ESR Members
only
All GALEN courses are kindly supported by GE Healthcare Medical Diagnostics South Central Europe and GE Healthcare.
Education in partnership
ESMRMB School of MRI
Courses 2009
Reduced
fees for
ESR & ESMRMB
Members
• Advanced MR Imaging of the Abdomen
Dubai/UAE, March 26–28
• Applied MR Techniques, Basic Course
Iraklion/GR, April 23–25
• Advanced Cardiac MR Imaging
Leuven/BE, May 14–16
• Advanced Neuro Imaging: Diffusion, Perfusion, Spectroscopy
Budapest/HU, June 25–27
• Advanced MR Imaging in Paediatric Radiology
Genoa/IT, July 2–4
• Applied MR Techniques, Advanced Course
Gdansk/PL, July 9–11
• Advanced Breast & Pelvis MR Imaging
Lausanne/CH, September 24–26
• Advanced MR Imaging of the Musculoskeletal System
Paris/FR, September 24–26
• Advanced MR Imaging of the Abdomen
Coimbra/PT, October 8–10
• Clinical fMRI – Theory and Practice
Thessaloniki/GR, October 15–17
• Advanced Clinical MR Angiography
Dublin/IE, October 22–24
• Advanced MRI of the Chest – NEW!
Heidelberg/DE, October 29–31
• Advanced Head & Neck MR Imaging
Alicante/ES, November 5–7
• Advanced MR Imaging of the Musculoskeletal System –
Spanish Language
Santiago de Compostela/ES, November 12–14
ESNR/ECNR Courses 2009
European Course in Diagnostic and
Interventional Neuroradiology
2 nd Course – 10 th Cycle
Tumours
March 20–24, 2009
Rome, Italy
3 rd Course – 10 th Cycle
Vascular Diseases
October 9–13, 2009
Tarragona, Spain
Further details on the course and registration
are available at www.esnr-ecnr.org.
ECNR is an initiative of ESNR in partnership with ESOR.
Participants of advanced courses should be physicians who have either
attended ESMRMB School of MRI Applied MR Techniques Courses or
who have acquired knowledge in MRI techniques from other sources. In
addition they should have a minimum of 6 months in applied MRI in the
relevant field. All courses are in English unless otherwise stated.
Further details on the dates, programme and registration
are available at www.school-of-mri.org or www.esmrmb.org.
The School of MRI is an initiative of ESMRMB in partnership with ESOR.
European Society of Radiology
10

E S O R
AIMS 2009 – Advanced
Multimodality Imaging
Seminars in China
The Advanced Imaging Multimodality Seminars are organised in
close cooperation with the Chinese Society of Radiology (CSR). The
programme comprises six courses per year, delivered in six different
Chinese cities, with European and Chinese speakers carefully selected
by CSR and ESR/ESOR.
Spring Seminars on Head and Neck Radiology
April 26 – Suzhou
April 28 – Shenzhen
April 30 – Guilin
Summer Seminars on Oncology
July 26 – Shenyang
July 28 – Shi Jiazhuang
July 30 – Xian
Visiting Scholarship
Programme (Europe)
24 scholarships on various topics will be offered to residents in their
3 rd , 4 th or 5 th year of training. Successful applicants will be provided
with a structured modular introduction to different subspecialties for
a period of three months in a pre-selected, highly esteemed, academic
training centre in Europe.
TOPICS
• Abdominal Radiology
• Breast Imaging
• Cardiac Imaging
• Chest Imaging
• Musculoskeletal Radiology
• Neuroradiology
• Urogenital Radiology
• PET-CT Protocols
• MRI Protocols
For
ESR Members
only
Further details on application and available training centres
are available at www.myESR.org/esor.
AIMS, the ESOR Visiting School in China, is made possible
by an unrestricted educational grant from Bracco.
In partnership with Bracco.
Exchange Programmes
for Fellowships
For
ESR Members
only
The ESOR Exchange Programmes for Fellowships are aimed at residents
in their last year of training and/or board-certified radiologists
within the first two years after certification. It offers an opportunity to
complement subspecialisation training or an existing structured fellowship
programme in radiology through three months of intense,
mentored subspecialty training in a pre-selected, highly esteemed
academic training centre in Europe.
Five such programmes per subspecialty will be offered and the
successful applicant will receive a joint grant from ESR and the
relevant subspecialty society.
Visiting Scholarship
Programme (USA)
For
ESR Members
only
One scholarship on Oncologic Imaging will be offered to residents
in their 3 rd , 4 th or 5 th year of training. The successful applicant will be
provided with a structured modular introduction to oncologic imaging
for a period of three months at the Memorial Sloan-Kettering Cancer
Center, New York City.
Further details on application are available at www.myESR.org/esor.
TOPICS
• Abdominal Imaging
• Cardiac Imaging
• Head and Neck Imaging
• Paediatric Radiology
ESOR Graz Tutorials 2009
The tutorials are organised by the University
Clinic of Radiology of the Medical University of
Graz and are aimed at participants from central and
south-eastern European countries.
For
ESR Members
only
In partnership with the European Society of Gastrointestinal and
Abdominal Radiology (ESGAR), the European Society of Cardiac
Radiology (ESCR), the European Society of Head and Neck Radiology
(ESHNR) and the European Society of Paediatric Radiology (ESPR).
Further details on the dates and application are available at
www.myESR.org/esor.
The tutorials are kindly supported by Siemens, Agfa Healthcare
and Nycomed.
11
myESR.org

ESR Newsletter 01/09 04/08
E I B IER
I B I R
The European Institute for
Biomedical Imaging Research
looks back at a successful 2008
Prof. Jürgen Hennig
EIBIR Scientific Director
Another successful year for the European Institute for Biomedical
Imaging Research (EIBIR) has drawn to a close and
we are pleased to announce that the Annual Scientific Report
2008 is now available and provides an update and review of
this year’s activities and research projects, as well as detailed
information on planned activities. The report can be downloaded
at www.eibir.org.
During the past year, EIBIR’s membership has grown to
almost 240 research institutes with a focus on biomedical
imaging or related disciplines. This number shows that networking
activities in our specialty are crucial and that EIBIR
is on the right track towards establishing itself as a bridge
between basic and clinical research, technological and pharmacological
development.
Our goals of creating multi and inter-disciplinary research
environments, bringing together medical doctors, physicists,
mathematicians, molecular biologists and computer
scientists, achieving close co-operation between universities
and major research centres as well as increasing collaboration
between imaging specialists and clinicians, are no doubt
ambitious and require collaboration with the pharmaceutical
industry, system manufacturers, and information technology.
Of course many of our new initiatives would not have been
possible without the continuous support of the European
Society of Radiology and our industry partners who subscribed
to the mission of EIBIR and have provided financial
support right from the beginning. We very much regret that
one of our long-standing supporters, Bayer Schering Pharma
AG, has withdrawn as an Industry Panel member and we
look forward to welcoming new industry members in the
near future. Reduced annual support fees should also enable
smaller companies with an interest in the biomedical imaging
field to become involved in our network.
During 2008 we were pleased to officially welcome two new
organisations as co-shareholders of EIBIR – the European
Association of Nuclear Medicine (EANM) and the European
Federation of Organisations of Medical Physicists (EFOMP)
– and negotiations are also underway with the European
Organisation for Research and Treatment of Cancer (EORTC)
and the European Federation of Societies for Ultrasound in
Medicine and Biology (EFSUMB).
Co-shareholders are represented at the general meetings of
EIBIR, where major strategic decisions are taken and recommendations
are developed for the other bodies and initiatives
of EIBIR. As there are some European organisations that are
eager to support and seek cooperation with EIBIR but are
unable to commit to formal co-shareholdership, mainly due
to their charity status, we are planning to introduce an additional,
less formal form of cooperation with such organisations
under the umbrella of ‘Friends of EIBIR’. This concept is
currently being developed and will be launched in early 2009.
EIBIR’s four joint initiatives, all developed during 2007, have
further expanded their activities. The Chemistry Platform
has set up a consortium of Europe’s leading experts in developing
smart agent probes to prepare a project proposal for the
EU FP7 health call launched in early September.
EuroAIM, the European Network for the Assessment of Imaging
in Medicine, has worked on collecting data on assessment
European Society of Radiology
12

E I B I R
studies carried out by EIBIR member institutions in order to
help investigators find each other and facilitate collaborative
efforts and multicentre studies. In addition, an online survey
on pharmaceutical trials will be launched in December.
2008 has seen the onset of two major research projects cofunded
by the European Union under the coordination of
EIBIR. ENCITE, the European Network for Cell Imaging and
Tracking Expertise, is a large-scale collaborative project that
aims at developing novel imaging tools that will lead to a better
understanding of how cell therapy works, the possibility of
response monitoring in patients, and sufficient safety of the
treatment.
The other project, HAMAM – Highly Accurate Breast Cancer
Diagnosis through Integration of Biological Knowledge,
Novel Imaging Modalities, and Modelling – has the potential
to strengthen Europe’s leadership in the area of imagebased
breast cancer diagnosis. Together with two consortia of
Europe’s top experts in the relevant fields, EIBIR submitted
two new proposals within the EU FP7 programme HEALTH
call in early December.
One project deals with the development of smart agents
that provide maps of values of physico-chemical parameters
such as pH and pO2 or of specific enzymatic activities. The
obtained maps will be fused with anatomical images to provide
completely new information content that has until now
not been accessible via imaging methods. The second project
focuses on nuclear medicine and consists of a literature survey
on dosimetry and health effects of diagnostic applications
of radiopharmaceuticals.
You will find a detailed update on the projects in the Annual
Scientific Report.
Last, but not least, and although still semi-official, it is our
pleasure to inform you about yet another ambitious project
that is currently in the pipeline and that has received positive
feedback from the panel of evaluators: EIBIR and the European
Molecular Biology Laboratory (EMBL) have submitted
a proposal to the European Strategy Forum on Research
Infrastructures (ESFRI) on establishing a European biomedical
imaging infrastructure – from molecule to patient. The
project was presented at an ESFRI conference in Versailles in
December 2008.
Don’t forget to check EIBIR’s website, which is currently
undergoing a facelift, for regular updates on EIBIR’s developments
and initiatives.
We look forward to your active contribution to EIBIR’s
activities and to receiving your ideas for new initiatives and
projects.
Yours sincerely,
Prof. Gabriel Krestin
ESR Representative at the EIBIR General Meeting
ESR Research Committee Chairman
Prof. Jürgen Hennig
EIBIR Scientific Director
Prof. Gabriel Krestin
ESR Representative at the
EIBIR General Meeting
Don’t miss out on EIBIR’s
session at ECR 2009
Don’t miss out on the EIBIR Session at the upcoming
European Congress of Radiology 2009, on
Sunday, March 8, from 10:30–12:00 (Room Z)
to learn about EIBIR’s recent activities and the
results of the ENCITE and HAMAM projects, both
coordinated by EIBIR. The session is open to all
ECR 2009 delegates; pre-registration is not required.
13
myESR.org

Enjoy Europe’s No. 1 journal!
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Your printed version for only € 70
Do not miss a single issue: SUBSCRIBE NOW for 2009
at myESR.org/myUserArea
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European
Radiology
The official journal of the European Society of Radiology
Further information at office@european-radiology or
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Subscriptions are valid from the day of payment until the end of the calendar year.

E U R O P E A N R A D I O L O G Y
New articles from
European
Radiology
A selection by Adrian K. Dixon,
Editor-in-Chief
Full-text articles are available
at Springerlink.com and freely
accessible to members via
www.myESR.org/MyUserArea
The paper by Dr. Tsai and colleagues from Taiwan
has really demonstrated the way in which
CT has evolved in the last few years. Some years
ago it was argued that mechanical devices would
completely prevent useful diagnostic information
at CT. Nowadays, with less metallic prosthetic
valves and better CT equipment, not only
can the structure of valves be assessed by CT but
also their function. On the online version the
images of the dynamic data are most impressive.
Correctness of multi-detector-row computed
tomography for diagnosing mechanical prosthetic
heart valve disorders using operative
findings as a gold standard
The experimental paper from Munich on CT
detection with intestinal bleeding is a useful
piece of laboratory research which is of great
practical importance to clinical radiologists. A
clever model was devised which shows that CT
really should be able to detect any bleeding at
the rate of 1ml per minute and that we have a
fair chance of identifying bleeding at 0.10 and
0.50ml per minute. Such experimental data help
move the emphasis of the imaging in bleeding
(in any part of the body) to CT rather than angiography,
reserving angiography for localised
therapy of a known bleeding point.
Evaluation of dual-phase multi-detector-row
CT for detection of intestinal bleeding using an
experimental bowel model
The review article from Alexander Bankier and
colleagues from Harvard on CT of pulmonary
emphysema is a very useful account which will
help general radiologists understand the latest
theories about emphysema and how CT is essential
for the classification of the sub types. Indeed
it could be argued that CT is now taking over
from pathology in the assessment of emphysema
– and numerous other conditions.
CT of pulmonary emphysema – current status,
challenges, and future directions
Tsai IC, Lin YK, Chang Y, Fu YC, Wang CC, Hsieh
SR, Wei HJ, Tsai HW, Jan SL, Wang KY, Chen MC,
Chen CC
Dobritz M, Engels HP, Schneider A, Wieder H,
Feussner H, Rummeny EJ, Stollfuss JC
Litmanovich D, Boiselle PM, Bankier AA
DOI 10.1007/s00330-008-1232-2
DOI 10.1007/s00330-008-1205-5
DOI 10.1007/s00330-008-1186-4
A 19070
A 19070
European
Radiology
The official journal of the European Society of Radiology
European
Radiology
Vol 18 / No 10 / October 2008
The official journal of the European Society of Radiology
Vol 19 / No 1 / January 2009
Abstract:
The purpose was to compare the findings of
multi-detector computed tomography (MDCT)
in prosthetic valve disorders using the operative
findings as a gold standard. In a 3-year period,
we prospectively enrolled 25 patients with 31
prosthetic heart valves. MDCT and transthoracic
echocardiography (TTE) were done to evaluate
pannus formation, prosthetic valve dysfunction,
suture loosening (paravalvular leak) and pseudoaneurysm
formation. Patients indicated for
surgery received an operation within 1 week. The
MDCT findings were compared with the operative
findings. One patient with a Björk-Shiley
valve could not be evaluated by MDCT due to a
severe beam-hardening artifact; thus, the exclusion
rate for MDCT was 3.2% (1/31). Prosthetic
valve disorders were suspected in 12 patients by
either MDCT or TTE. Six patients received an
operation that included three redo aortic valve
replacements; two redo mitral replacements
and one Amplatzer ductal occluder occlusion
of a mitral paravalvular leak. The concordance
of MDCT for diagnosing and localizing prosthetic
valve disorders and the surgical findings
was 100%. Except for images impaired by severe
beam-hardening artifacts, MDCT provides excellent
delineation of prosthetic valve disorders.
Abstract:
To evaluate dual-phase multi-detector-row computed
tomography (MDCT) in the detection of
intestinal bleeding using an experimental bowel
model and varying bleeding velocities. The model
consisted of a high pressure injector tube with a
single perforation (1 mm) placed in 10-m-long
small bowel of a pig. The bowel was filled with
water/contrast solution of 30–40 HU and was
incorporated in a phantom model containing
vegetable oil to simulate mesenteric fat. Intestinal
bleeding in different locations and bleeding
velocities varying from zero to 1 ml/min (0.05 ml/
min increments, constant bleeding duration of 20
s) was simulated. Nineteen complete datasets in
arterial and portal-venous phase using increasing
bleeding velocities, and seven negative controls
were measured using a 64 MDCT (3-mm slice
thickness, 1.5-mm reconstruction increment).
Three radiologists blinded to the experimental
settings evaluated the datasets in a random
order. The likelihood for intestinal bleeding was
assessed using a 5-point scale with subsequent
ROC analysis. The sensitivity to detect bleeding
was 0.44 for a bleeding velocity of 0.10–0.50 ml/
min and 0.97 for 0.55–1.00 ml/min. The specificity
was 1.00. The area under the curve was calculated
to be 0.73, 0.88 and 0.89 for reader 1, 2
and 3, respectively. Dual-phase MDCT provides
high sensitivity and specificity in the detection
of intestinal bleeding with bleeding velocities
of 0.5–1.0 ml/min. Therefore, MDCT should be
considered as a primary diagnostic technique in
the management of patients with suspected intestinal
bleeding.
Abstract:
Pulmonary emphysema is characterized by irreversible
destruction of lung parenchyma. Emphysema
is a major contributor to chronic obstructive
pulmonary disease (COPD), which by itself
is a major cause of morbidity and mortality in the
western world. Computed tomography (CT) is
an established method for the in-vivo analysis of
emphysema. This review first details the pathological
basis of emphysema and shows how the subtypes
of emphysema can be characterized by CT.
The review then shows how CT is used to quantify
emphysema, and describes the requirements
and foundations for quantification to be accurate.
Finally, the review discusses new challenges and
their potential solution, notably focused on multidetector-row
CT, and emphasizes the open questions
that future research on CT of pulmonary
emphysema will have to address.
Keywords:
Multi-detector-row CT | Computed tomography |
Prosthetic valve | Echocardiography | Mechanical
valve
Keywords:
Computed tomography | Abdominal imaging |
Intestinal bleeding
Keywords:
Emphysema | CT | Quantification | Density |
COPD
15 myESR.org

ESR Newsletter 01/09
E U R O P E A N R A D I O L O G Y
Credit where credit is due:
The issue of academic merit
By Sarah Edwards
Researchers have an ethical obligation to carry out
research with integrity and report their results with
honesty. European Radiology, the leading European
radiological journal, advocates publication practices
that promote ethical and responsible research. To
this end, the journal and its current Editor-in-Chief,
Prof. Adrian Dixon, strive to consistently publish outstanding,
accurate and relevant research results that
the scientific community can rely and build upon. In
light of the problem of research fraud, traditionally
seen as something of a taboo subject, there is an ever
more pressing need to draw attention to good practice
guidelines and potential pitfalls to be aware of when
doing research. The most common forms of scientific
misconduct are: plagiarism (misappropriation of
words or ideas), data fabrication/falsification (intentional
alteration of research processes and results,
image manipulation), data duplication (submitting a
similar manuscript to a different journal with a different
readership) and gift authorship (co-authorship
awarded to a person with no or little involvement in
the research process). It is a justifiable goal, therefore,
to explore preventive measures that help minimise the
risk of authorship disputes arising at a later stage.
Author or Contributor?
The listing of individuals as authors of a research
study may have far-reaching academic, financial and
social implications. Although each journal has its own
policies on authorship credit, there are some basic
guidelines that are common across the entire field of
biomedical scholarly publishing. The International
Committee of Medical Journal Editors (ICMJE) provides
practical guidance to assist researchers in the
preparation of manuscripts.
It must first be noted that authorship is not synonymous
with contributorship. An author deserves
authorship credit if he/she has substantially contributed
to a study under consideration for publication.
To qualify as an author, one must have made a substantive
intellectual contribution to a) conception
and design of a study; b) acquisition and analysis of
data, c) drafting and critically revising the paper for
its intellectual content and d) giving final approval of
the version to be published. Each individual listed as
an author must meet all four conditions.
The Committee on Publication Ethics (COPE) have
developed a rule of thumb for determining contributions
that merit authorship. If there is no portion
or specific task of a study that can be attributed to a
particular participant, then this individual does not
meet the requirements for authorship. Each individual
listed as an author should be able to accept public
responsibility for appropriate portions of any manuscript
on which their name appears. “Merely providing
the equipment does not merit authorship unless
there is also intellectual support for the paper,” says
Editor-in-Chief Prof. Adrian Dixon.
Contributorship, on the contrary, applies in cases where
clear attribution of content fails and authorship criteria
are not met in full. Contributorship credit can duly
be given to someone for acquisition of funding, supervision
of the research process or technical aspects of
data collection. Participating investigators, provided
that they fully meet the criteria set for contributorship,
may be listed in acknowledgments. However, the function
and nature of the respective contributions must
be specified. It is considered good practice to obtain
written permission from any participants you wish to
acknowledge. All other collaborators should also be
named in the acknowledgments section, which is specifically
designed for the disclosure of funding sources,
research grants and material support (e.g. technical
assistance, data analysis) for the research study. It is
essential to start discussing authorship before commencing
research. Individual contributions should then
be assessed according to the criteria set out by COPE,
whose guidelines cover ethical, editorial and publishing
issues with regard to manuscript preparation.
European Radiology journal policy on authorship
credit is in keeping with COPE guidelines. Prof.
Dixon comments that, “As a rule of thumb, any
‘author’ ought to know enough about the work to be
able to stand up in public and present an abstract on
that paper without any preparation.” Consequently,
it is ethically unacceptable for researchers to award
authorship out of politeness, regardless of individual
input. “Being Head of Department should not mean
automatic authorship of every paper performed in
that Department,” says Prof. Dixon, who is keen to
stress that there is now increasing scrutiny about gift
authorship and the publication of duplicate material.
The Radiological Society of North America (RSNA)
recently hosted a meeting in Boston at which radiology
journal editors discussed publication ethics. The
main points on the agenda were issues such as duplicate
publication, plagiarism of sentences or paragraphs
and possible sanctions in confirmed cases of
scientific misconduct.
Following the Spirit of Ethical Research
When asked about the specific authorship problems
that journal editors are currently concerned with,
European Radiology’s Prof. Dixon mentioned the
issue of ‘salami publication’ (also known as ‘salami
slicing’). The term describes the practice of re-using
one’s own previously published material. ‘Salami
publication’ typically involves the publication of two
or more scientific papers covering the same methods,
hypothesis, population or patient data; research
data from a single research study are sliced into many
pieces, and separate manuscripts created from each
piece. Duplicate publication occurs where there is an
approximate two-thirds overlap of data. Sometimes,
‘salami slicing’ results in data duplication.
Prof. Dixon explains that salami publication is a difficult
issue to make a judgement about. “Occasionally
paragraphs have been ‘lifted’ from other papers
and reviewers sometimes bring this to our attention.
There are increasingly sophisticated software packages
which allow recognition of such duplication.”
Although peer review is a very effective method of
detecting breaches of academic integrity, cases of
scientific misconduct are not always easily identified.
“A more difficult problem is whether publication
of a new paper with 50 patients is warranted if the
authors have already described the findings of their
first 20, especially if the original 20 are included in the
European Society of Radiology
16

E U R O P E A N R A D I O L O G Y
C O P E C O M M I T T E E O N P U B L I C AT I O N E T H I C S W W W. P U B L I C AT I O N E T H I C S . O RG
What to do if you suspect redundant (duplicate) publication
(a) Suspected redundant publication in a submitted manuscript
Reviewer informs editor about redundant publication
Thank reviewer and say you plan to investigate
Get full documentary evidence if not already provided
Note: The instructions to authors
should state the journal’s policy on
redundant publication
Asking authors to sign a statement
or tick a box may be helpful in
subsequent investigations
Check degree of overlap/redundancy
Major overlap/redundancy (i.e. based on
same data with identical or very similar
findings and/or
evidence authors have sought to hide
redundancy, e.g. by changing title,
author order or not citing previous papers)
Contact corresponding author in
writing, ideally enclosing signed
authorship statement (or cover
letter) stating that submitted work
has not been published elsewhere
and documentary evidence of
duplication
Author responds No response
Unsatisfactory
explanation/admits
guilt
Consider informing
author’s superior
and/or person
responsible for
research governance
Satisfactory
explanation (honest
error/journal
instructions
unclear/very junior
researcher)
Write to author (all authors if
possible) rejecting submission,
explaining position and expected
future behaviour
Attempt to contact all other
authors (check
Medline/Google for emails)
Inform author(s)
of your action
‘new’ 50! Ideally there must be a new message in the
paper, or very much improved results,” he advises.
Likewise, publishing one’s own previous academic
work in part or in a foreign language journal is not
acceptable unless fully acknowledged and agreed
with both editors. Of course, it can be very difficult
to explain a complex technique in an entirely new way
Minor overlap with some element
of redundancy or legitimate reanalysis
(e.g. sub-group/extended
follow-up/discussion aimed at
different audience)
No response
Contact author in neutral
terms/expressing
disappointment/explaining journal’s
position
Explain that secondary papers must
refer to original
Request missing reference to original
and/or remove overlapping material
Proceed with review
Inform reviewer of
outcome/action
Contact author’s institution requesting your concern is
passed to author’s superior and/or person
responsible for research governance
Try to obtain acknowledgement of your letter
Write to author (all authors if
possible) rejecting submission,
explaining position and expected
future behaviour
Inform reviewer of
outcome/action
If no response,
keep contacting
institution every
3–6 months
No significant
overlap
Discuss with
reviewer
Proceed
with review
Note: ICMJE advises
that translations are
acceptable but MUST
reference the original
and certain technical paragraphs have to be duplicated.
European Radiology places very high importance
on the proper use of source material. Authors
are expected to give full acknowledgment to previously
published papers cited in their new submission
(e.g. publication in a national scientific journal, conference
paper, or electronic media) so that the editor
is aware of any previous work done by the authors in
this area. This is very important as it will help prevent
inadvertent replication. In 2006,
COPE published a series of flowcharts
guiding journal editors
through the steps of due process
in dealing with cases of suspected
scientific misconduct.
Our advice for authors is to
carefully read the Instructions
for Authors published on
our website before submitting
their paper and to take very
seriously the Conflict of Interest
statement. Be mindful not
to award authorship to individuals
who do not expressly
qualify as authors of the submitted
paper. Do not allow
your name to appear on
papers that you know too little
about. To prevent authorship
disputes, always provide
enough information about
the co-authors’ respective
roles in the research process
and their contributions to
that particular publication.
Compliance with authorship
criteria establishes
accountability, credit and
responsibility for scientific
data reported in medical
publications. When doing
research, remember to
never leave unresolved the question of type, quantity
and quality of individual contributions to your study
as a whole. In case of doubt, consult our journal’s
policy on authorship via the link given below or contact
our editorial staff who will be happy to assist with
your query.
office@european-radiology.org
17 myESR.org

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R A D I O L O G Y T R A I N E E S F O R U M
News from the
Radiology Trainees Forum
An Englishman in Zurich –
another successful visit
within the RTF exchange programme
By Mark Bryant, Portsmouth/UK
The RTF cordially invites
you to the ECR!
By Christiane Nyhsen, RTF Chair
In November last year I was fortunate to have the opportunity to visit Switzerland for
a week. My Swiss counterpart on the RTF, Dr. Claudia Neumier and her boss Prof. Dr.
Thomas Roeren were very helpful in organising this short trip to Kantonsspital Aarau
(west of Zurich). As my wife is from Konstanz (Germany) I was keen to brush up on
my linguistic skills whilst getting a glimpse of how the Swiss radiology system works.
After a flight to Zurich, I was warmly welcomed by Prof. Roeren at the Aarau train station
and although it was late I was taken to his house for a light meat and cheese snack,
a glass of wine and possibly my final purely English chat; a very good start. I had a room
in the very comfortable hospital accommodation. Staying in the hospital meant it was
easy to make the early start of 8am, although that is late by Czech standards, it seems
from reading Christiane’s recent report!
I had few preconceived ideas as to what to expect, so it was to my surprise that many
features mirrored those in Portsmouth (England) where I work. The population it
serves and the size of hospital were very similar, but what made it easier to fit in and
understand the functioning of the department was that the PACS, CT and MRI systems
were the same. Dr. Harald Haueisen was my guide for the week and showed me the
department and introduced me to the team. Everyone was very welcoming and happy
to let me batter them with my stuttering Deutsch.
What struck me first was the ambience in the department, created by newly decorated
x-ray rooms and reporting area, all in dark grey and red. It had a very relaxing effect,
away from the cold sterile feeling of bleached white or pale yellow. It was interesting
to see some new procedures, in particular CT-guided facet joint injection and nerve
root stimulation, neither of which we perform in our centre in England. I was lucky to
be able to perform two root stimulations myself and was given the presentation documents
so that we could look into doing the same in Portsmouth.
What impressed me the most was how social the department was and how that helped
all to run smoothly. I had heard that some hierarchical systems were only beneficial
for those at the top, but this was not the case. The team would have lunch together, had
relaxed daily lunchtime teaching sessions and would always help each other out. Every
Friday lunchtime there is a special social break when everyone goes for coffee together
just to chat. This is such a good idea. Sadly I cannot envision that happening where I
work; the pressure of work seems too great, though I believe a lot of good can come
from a short social break for any team under pressure.
The evenings were also full. I was invited to Dr Haueisen’s house one evening, and it
was lovely to meet his family, but little did I know that I was there to bake! I am now
an expert at cheese puff aperitifs. After a few rounds of dice later in the evening they
almost let the Englishman win; I was lucky to come a close second. On the last evening
many of us, including residents and the boss went to a talk on contrast media, which
was part of a retirement event for a well known Professor. He highlighted the demise of
NSF as more people are aware of it and take appropriate precautions. The champagne
and canapés were also most welcome!
With the RTF exchange scheme in its infancy, I encourage anyone who would like to
visit another centre and see how radiology works in another country to take the opportunity.
You can discover much more than you might think in only a week. It is harder
to get the time when you are working full time.
I would like to take the opportunity to wholeheartedly thank everyone in the Radiology
Abteilung at Kantonsspital Aarau for making me so welcome, and repeat my open
offer of an exchange some time in the future. The RTF cordially invites you to the ECR!
Who are we?
RTF stands for Radiology Trainees’ Forum, which consists of one trainee national representative
from each European member society of the ESR. It is therefore not possible
to ‘join’ the RTF as such, but please do take part in the activities we offer at ECR and
beyond. Further details can be found on the ESR website (we can currently be found
under Education and RTF).
What have we got to offer at the ECR?
RTF Booth – Make it your meeting point! The RTF Booth (located in the entrance hall)
has been a great meeting point in the past, where you can have a chat with members of
the RTF executive board (we try to be there as much as possible during breaks) as well
as other national delegates and trainees from all over the world.
RTF Highlighted Lectures – Something for everybody …
This year we have tried to cover three different areas that should all be essential for
trainees. We are delighted to firstly welcome Prof E.J. Stern from Seattle, US, who will
give us his best advice on how to get your paper published with his lecture ‘Top 10 mistakes
of inexperienced authors’. As a deputy editor of AJR, he should know!
This is followed by a clinical lecture on ‘Pitfalls in reporting major trauma’ by Dr G.
Schueller from Vienna. Major trauma on call is always a worry when the phone rings at
2am and we all know the feeling of sitting in CT with some impatient surgeons breathing
down our neck! As a trainee this can be intimidating, and making decisions quickly
is a challenge. This lecture may help you!
And lastly Dr E.R. Ranschaert from ‘s-Hertogenbosch, NL, will show us how to navigate
the net, with ‘Online radiology resources: Top 10 teaching websites and how to
find them’. The internet is a vast and very useful medium, but is also crowded with
often useless and potentially inaccurate information. I am looking forward to getting
some expert advice! But this is not all we offer during the Highlighted Lectures (please
read on below).
You have the chance to win one of three radiology textbooks …
Simply attend the RTF Highlighted Lectures, where raffle tickets will be given out at the
beginning. After each of the three presentations, one book will be given away to a lucky
winner. Don’t miss your chance! For more details please visit our booth at the congress.
RTF Drinks reception – Join the fun …
There is no need to publicise this event further. The RTF Cocktail Party for trainees
is a well established feature of the congress! Therefore we are delighted and grateful
that GE is again prepared to sponsor this event (unfortunately the number will remain
restricted to 250 due to cost constraints – we did ask!). To get your free ticket, please
come along to the RTF booth. We will hand out one ticket per person no earlier than
Friday during the ECR. The tickets have to be stamped at the GE stand. Do not leave it
too late or you may not be able to join in the fun!
RTF General Assembly
The RTF has one general assembly per year, which will be taking place on Sunday during
the ECR. Here we will discuss activities of the RTF, future plans and political topics.
This meeting is open to all interested trainees wishing to attend, so please feel free to
come along …
I look forward to seeing you in Vienna!
19
RTF
INFO CORNER

ONE
INTRODUCING SuperPACS ARCHITECTURE. Now you can synchronize disparate PACS
systems using your existing infrastructure within a multi-site healthcare network, providing
you ONE global worklist no matter where your site or data is located.
SHARE clinical resources and balance radiology workload with ONE rules-based global worklist across all sites.
COLLABORATE with peers, clinicians and referring physicians. Diagnose and REPORT quickly with numerous advanced
clinical tools and set profiles. Experience common reading and reporting for all sources and formats of data.
ONE chair. ONE workstation. ONE solution.
SuperPACS ARCHITECTURE information is provided for planning purposes. Commercial availability is pending submission to and clearance by FDA and other regulatory agencies.
© Carestream Health, Inc. 2009.
Want to find out more?
it.carestreamhealth.com

S U B S P E C I A LT Y S O C I E T Y N E W S
ESGAR – European Society of
Gastrointestinal and
Abdominal Radiology
ESGAR 2009 – 20 th Anniversary Annual Meeting
June 23–26, 2009
Valencia, Spain
Online registration is possible until May 29, 2009
3 rd ESGAR Image-Guided Ablation Workshop 2009
March 25–26, 2009
University College Hospital, London, United Kingdom
Organiser: A. Gillams
The programme and further details are available online.
Registration is possible until March 12, 2009!
4 th ESGAR LIVER IMAGING WORKSHOP
May 7–9, 2009
Verona, Italy
Organiser: R. Manfredi
The programme and further details are available online.
Registration deadline is April 6, 2009
Visit the ESGAR website for updates and further details.
www.esgar.org
ESMRMB 2009
26 th Annual Scientific Meeting in Antalya
Experience an extraordinary scientific meeting on the Turkish
Mediterranean coast!
The meeting will be held from October 1–3, 2009 at the Maritim
Pine Beach Resort in Belek-Antalya, Turkey, again offering a 3-day
educational and scientific programme for clinicians and scientists.
As an incentive for participation and submission of their work, student/resident
members of ESMRMB will enjoy another year free
advanced registration.
Abstract Submission and registration for the ESMRMB 2009
Congress is online now.
www.esmrmb.org
NEW in 2009: ESMRMB Hands-On MRI Courses
ESMRMB is proud to introduce its new Hands-On MRI programme
dedicated to the continuing education of MRI technologists as
well as physicians with a special interest in the field of MRI. Each
Hands-On course will be performed on MRI equipment from a specific
manufacturer. Hands-on training will cover at least 50% of
the available time and will include data-acquisition as well as data
post-processing.
Three Hands-On MRI Courses will be held in 2009:
MR Angiography on Siemens equipment, Basel/CH
May 14–16
Cardiac MRI on Philips equipment, Bonn/DE
October 15–17
fMRI & DTI on GE equipment, Rotterdam/NL
November 5–7
ESSR – European Society
of Musculoskeletal Radiology
Membership 2009 now online
Apply now for ESSR membership for 2009! The society’s membership
is open to all European radiologists who have a primary
interest in musculoskeletal radiology.
Membership Fee: €60.00
Eastern Europe Fee: €40.00
ESSR Members not only have the chance to get reduced registration
fees for the annual meeting of the society, but will also receive
special subscription rates for Skeletal Radiology and/or Seminars
in Musculoskeletal Imaging. Additionally, members will receive an
e-newsletter with relevant information on the congress as well as
on the field of musculoskeletal radiology in general.
In order to apply for membership, please visit the ESSR website.
For further information on ESSR, please visit www.essr.org or
contact office@essr.org
ESUR – The European
Society of Urogenital Radiology
Following a successful meeting in the Bavarian capital of Munich,
ESUR’s next annual symposium will be held in majestic Athens, one
of the oldest cities in the world. From September 10 to 13, 2009,
ESUR’s 16 th uroradiology symposium will entertain the topic ‘Urogenital
Manifestations of Systemic Diseases.
Please visit www.esur.org or www.esur2009.org for more details
on registration and abstract submission. Dr. George Malachias and
his local team are looking forward to greeting you on the peninsula
of Attica in 2009!
For questions and feedback, contact us any time via
ESURsecretary@ecr.org
EuroPACS – European Society
for the Promotion of Picture
rchiving and Communication
Systems in Medicine
Following an extremely successful joint congress with CARS (Computer
Assisted Radiology and Surgery) in Barcelona this summer,
EuroPACS will again hold a joint meeting with CARS in 2009 and
will be back again in the German capital of Berlin (after 2007).
EuroPACS’ 27 th annual meeting will be held June 23–27, 2009.
For more detailed information on abstract submission and registration,
please go to www.cars-int.org
European Society of
Cardiac Radiology
Membership 2009
The ESCR membership application system has just gone online
for 2009 and the number of members has already increased by
almost 300%!
Dynamic Progress – Increasing Possibilities. Be part of it!
ESCR 2009
October 8–10, 2009
Leipzig/DE
European Society of
Breast Imaging
2009 Congress
Registration online
Registration has already gone online for the forthcoming EUSOBI
annual scientific meeting on March 5, 2009 in the Austria Center
Vienna.
In order to register for the EUSOBI Annual Scientific Meeting at a
lower rate, take the opportunity to become a member of EUSOBI
for 2009!
For more information on the final programme as well as the benefits
of membership, please visit our website www.eusobi.org or
contact office@eusobi.org.
We very much look forward to welcoming you to Vienna in March.
GEST 2009
Europe
April 15–18, 2009
Paris/FR
The Global Embolization Symposium and Technologies 2009 Europe
Meeting will cover all areas of embolisation and include highly
focused plenary lectures, hands-on workshops, training courses and
basic materials sessions on radioembolisation, neurointerventional
therapies, tumour therapy, trauma, visceral artery and venous
interventions, paediatric and women’s health, aortic disease, vascular
malformations, gastrointestinal bleeding, liver disease, nonvascular
procedures, cell-based therapies and many more.
Honorary Doctorate for a Pioneer
On January 23, Prof. Dr. Willi A. Kalender, Director of the Institute
for Medical Physics at the University of Erlangen-Nürnberg, was
awarded honorary doctorate of the RWTH Aachen University, Germany.
With this academic degree and the dignity of an honorary
medical doctorate, Prof. Kalender is acknowledged for his unique
achievements as pioneer in multidetector spinal CT.
The laudatory speech was held by Prof. Dr. Rolf Günther, Director of
the Dept. of Diagnostic Radiology at the RWTH Aachen University and
ECR 2000 Congress President.
The European Society of Radiology expresses its most sincere congratulations
to Prof. Kalender, one of its longstanding and meritorious
members.
Visit www.esmrmb.org for more information and registration.
www.escr.org
21 myESR.org

Iopromide
Ultravist ®
New Bayer Schering Pharma booth
location at Extension EXPO A, No. 11
The Well-Balanced Contrast Medium
0 With the right mix of osmolality, viscosity
and iodine concentration, Ultravist® delivers
the right contrast for consistently high
quality imaging results
ULTRAVIST® 150/240/300/370 Composition: Ultravist® 150, 240, 300, 370: 1 ml contains 0.312 g, 0.499 g, 0.623 g, 0.769 g iopromide in aqueous solution. For diagnostic use! Indications: Ultravist 240/300/370: For intravascular use and use in body cavities. Contrast enhancement in
computerised tomography (CT), arteriography and venography, intravenous/intraarterial digital subtraction angiography (DSA); intravenous urography, use for ERCP, arthrography and examination of other body cavities. Ultravist 150: for intraarterial digital subtraction angiography
(DSA), checking the patency of a dialysis shunt. Ultravist 240: also for intrathecal use. Ultravist 370: especially for angiocardiography Ultravist 150/300/370: not for intrathecal use. Contraindications: There are no absolute contraindications to the use of Ultravist. Undesirable effects:
Intravascular use. • Immunological Anaphylactoid reactions/hypersensitivity. (uncommon) Anaphylactoid shock (including fatal cases) (rare). • Endocrine. Alteration in thyroid function, thyrotoxic crisis. • Nervous, Psychiatric: dizziness, restlessness, paraesthesia / hypoaesthesia, confusion,
anxiety, agitation, amnesia, speech disorders, somnolence, unconciousness, coma, tremor, convulsion, paresis / paralysis, cerebral ischaemia/infarction, stroke, transient cortical blindness • Eye. Blurred/disturbed vision (uncommon), conjunctivitis, lacrimation (rare) • Ear. Hearing
disorders. • Cardiac. Arrhythmia Palpitations, chest pain / tightness, bradycardia, tachycardia, cardiac arrest, heart failure, myocardial ischemia/infarction cyanosis. • Vascular. Vasodilatation (uncommon), Hypotension, hypertension, shock Vasospasm,a thromboembolic events (rare) •
Respiratory. Sneezing, coughing (uncommon), rhinitis, dyspnea, mucosal swelling, asthma, hoarse-ness, laryngeal / pharyngeal / tongue / face edema, bronchospasm, laryngeal/pharyngeal spasm, pulmonary edema, respiratory insufficiency, respiratory arrest (rare). • Gastrointestinal.
nausea (common), vomiting, taste disturbance (uncommon), throat irritation, dysphagia, swelling of salivary glands, abdominal pain, diarrhoea (rare) • Skin and subcutaneous tissue. Urticaria, pruritus, rash, erythema (uncommon), angioedema, mucocutaneous syndrome (e.g. Stevens-
Johnson’s or Lyell syndrome) (rare) • Renal and urinary. Renal impairment (uncommon), Acute renal failure (rare) • General disorders and administration site conditions, heat or pain, sensations, headache (common), malaise, chills, sweating, vasovagal reactions (uncommon), pallor, body
temperature alterations, edema, local pain, mild warmth and edema, inflammation and tissue injury in case of extravasation (rare). Intrathecal use. Based on experience with other non-ionic contrast media, the following undesirable effects may occur with intrathecal use in addition to
the undesirable effects listed above: • Nervous, Psychiatric. Neuralgia, meningism (common). Paraplegia, psychosis, aseptic meningitis, EEG-changes (rare). • General disorders and administration site conditions: Micturition difficulties uncommon. back pain, pain in extremities, injection
site pain. Headache, including severe prolonged cases, nausea and vomiting occur commonly. The majority of the reactions after myelography or use in body cavities occur some hours after the administration. ERCP: In addition to the undesirable effects listed above, the following undesirable
effects may occur with use for ERCP: Elevation of pancreatic enzyme levels (common), pancreatitis (rare). Use in other body cavities. The possibility of pregnancy must be excluded before performing hysterosalpingography. Inflammation of the bile ducts or salpinx may increase
the risk of reactions following ERCP or hysterosalpingography procedures. Low osmolar water-soluble contrast media should be routinely used in gastrointestinal studies in newborns, infants and children because these patients are at particular risk for aspiration, intestinal occlusion
or extraluminal leakage into the peritoneal cavity. Special warnings and special precautions: Caution is advised in patients with: hypersensitivity or a previous reaction, bronchial asthma, latent hyperthyroidism or goiter, severe cardiac or cardiovascular diseases; very poor general
state of health, severe renal insufficiency, severe liver dysfunction in case of severe renal insufficiency, metformin therapy, symptomatic cerebrovascular diseases, cerebral convulsive disease, myeloma ore paraproteinaemia, pheochromocytoma, autoimmune disorders, myastenia gravis,
alcoholism, homocystinuria, pregnancy. Instructions for Use/Handling: Ultravist should be warmed to body temperature prior to use. Contrast media should be visually inspected prior to use and must not be used, if discoloured, nor in the presence of particulate matter (including
crystals) or defective containers. Date of revision of the text: October 2006. Please note! For current prescribing information refer to the package insert and/or contact your local Bayer Schering Pharma organisation. Bayer Schering Pharma AG, 13342 Berlin, Germany. EU 2007.0889

C O N G R E S S C A L E N D A R
ESR Congress Calendar
February 2009 – May 2009
This web tool guarantees simple usability and consists of view, search, detail and submitting areas, as well as a print feature, the possibility to send events by e-mail via Outlook
and to save meetings in your personal Outlook calendar. Also, past events stay online in the ‘past events’ area and can be viewed, printed and added to the ‘my events’ list.
Please feel free to submit your radiological events online at congresscalendar.myESR.org.
Date Event City Country Topic Website
February 2009
13.2.–15.2.2009 7. Davoser Tage Davos Switzerland General Radiology www.davosertage.ch
14.2.–17.2.2009 Luxor Breast Imaging & Beyond A New Era in Breast Imaging Luxor & Aswan Egypt Breast www.medifinecorp.com
15.2.–20.2.2009 Optimizing Practices and Workflow in Body Imaging Kona (Kamuela), HI United States Abdominal Viscera http://radiology.ucsf.edu
16.2.–20.2.2009 24 th Annual Winter Cross-sectional Imaging Conference Panama City Panama General Radiology http://www.uphs.upenn.edu
16.2.–20.1.2009 ERASMUS COURSE Head & Neck MRI Vienna Austria Head and Neck www.emricourse.org
19.2.–21.2.2009 9 th Annual MR Advances in Neuroradiology and Sports Medicine Imaging Lake Tahoe, CA United States Magnetic Resonance http://radiologycme.stanford.edu
23.2.–24.2.2009 ESGAR/GE Doctor to Doctor Training on CT-Colonography Buc France Gastrointestinal Tract www.esgar.org
March 2009
01.03.–06.03.2009 Radiology Resident Review San Francisco, CA United States General Radiology www.radiology.ucsf.edu
04.03.–07.03.2009 10 th Annual Advances in Breast Imaging and Intervention Las Vegas, NV United States Breast www.radiologycme.stanford.edu
06.03.–10.03.2009 ECR 2009 – 21 st European Congress of Radiology Vienna Austria General Radiology www.myESR.org
16.03.–19.03.2009 Neonatal ultrasound course. Why, how and when an ultrasound image Florence Italy Ultrasound
23.03.–27.03.2009 Clinical Imaging Essentials in Deer Valley Deer Valley, UT United States General Radiology www.med.nyu.edu
23.03.–27.03.2009 17 th Annual Diagnostic Imaging Update on Maui Maui, HI United States General Radiology www.radiologycme.stanford.edu
25.03.–26.03.2009 3 rd ESGAR Image-guided Ablation Workshop London United Kingdom Gastrointestinal Tract www.esgar.org
27.03.–30.03.2009 Cardiac CT in San Juan San Juan Puerto Rico Cardiac www.uphs.upenn.edu
28.03.–28.03.2009 Kurs zur Aktualisierung der Fachkunde Strahlenschutz Munich Germany Radiographers www.fachkunde-strahlenschutz.de
29.3.–1.4.2009 Breast MRI & Advanced Mammographic Techniques San Juan Puerto Rico Breast http://www.uphs.upenn.edu
April 2009
4.4.–7.4.2009 Charing Cross International Symposium 2009 London United Kingdom Vascular www.cxsymposium.com
15.4.–18.4.2009 GEST 2009 Meeting Europe Paris France Interventional Radiology www.gest2009.eu
16.4.–19.4.2009 68 th Annual Meeting of Japan Radiological Society Yokohama Japan General Radiology www.radiology.jp
21.4.–24.4.2009 2 nd PAARS – Pan Arab Radiology Congress Alexandria Egypt General Radiology www.parcalex.com
22.4.–24.4.2009 VISAR 2009 6 th Vienna Interdisciplinary Symposium on Aortic Repair Vienna Austria Cardiac www.visar.at
26.4.–26.4.2009 ESOR Advanced Imaging Multimodality Seminars Suzhou China Head and Neck www.myESR.org/esor
26.4.–29.4.2009 Reaching Out: The Breast Cource 2009 Nice France Breast www.thebreastpractices.com
27.4.–28.4.2009 ESGAR/GE Doctor to Doctor Training on CT-Colonography Buc France Gastrointestinal Tract www.esgar.org
28.4.–28.4.2009 ESOR Advanced Imaging Multimodality Seminars Shengzheng China Head and Neck www.myESR.org/esor
28.4.–1.5.2009 25 th Iranian Congress of Radiology Tehran Iran General Radiology www.icr2009.ir
30.4.–30.4.2009 ESOR Advanced Imaging Multimodality Seminars Guilin China Head and Neck www.myESR.org/esor
May 2009
7.5.–9.5.2009 4 th ESGAR Liver Imaging Workshop Verona Italy Gastrointestinal Tract www.esgar.org
8.5.–10.5.2009 5 th Annual CT Coros Teaching Course and 1 st CMR Level 1 Course Singapore Singapore Cardiac www.cardiaccttc-cmr.com.sg
14.5.–16.5.2009 ESMRMB – Hands-On MRI – MR Angiography Basel Switzerland Magnetic and Resonance www.esmrmb.org
14.5.–16.5.2009 GALEN Foundation Course on Abdominal/Urogenital Radiology Sofia Bulgaria Abdominal Viscera www.myESR.org/esor
19.5.–22.5.2009 11 th Annual International Symposium on Multidetector-Row CT San Francisco, CA United States Computed Tomography http://radiologycme.stanford.edu
20.5.–23.5.2009 DRK 2009 – 90. Deutscher Röntgenkongress Berlin Germany General Radiolgy www.roentgenkongress.de
25.5.–27.5.2009 Hepatocellular Carcinoma Updates in Diagnosis and Therapy Ravello (SA) Italy Oncology www.ecografiainterventistica.it
27.5.–29.5.2009 II Congreso Cubano de Imagenología Havana Cuba Interventional Radiology http://www.sld.cu
28.5.–29.5.2009 Pathway to Excellence: Interventional Radiology Fellows Conference San Francisco, CA United States Interventional Radiology http://radiologycme.stanford.edu
31.5.–2.6.2009 2 nd World Congress of Thoracic Imaging and Diagnosis in Chest Disease Valencia Spain Chest www.2wcti.org
23 myESR.org

Onward and Upward
in MRI
Optimizing
Contrast Enhancement in:
MRI of the CNS
MRA
Breast MRI
Minimizing risk during MRI
procedures
Saturday
March 7
10:30-12:00
room P
Bracco Satellite
Symposia
Sunday
March 8
12:30-13:30
room R
How to make your CT
exam safer and more
effective?
Patients with chronic
kidney disease: minimizin
the risk of contrast-induced
nephropathy
Optimizing contrast
enhancement in CT:
a) Patient variables
b) Scanner variables
c) Contrast variables
Sunday
March 8
10:30-12:00
room P
New breakthroughs
in Contrast Enhanced
Ultrasound: Clinical
data and
technological
developments
The clinical benefit of CEUS
in General imaging
Clinical benefit of Contrast
Enhanced Ultrasound
in intra-operative ultrasound
New perspectives 3D
contrast imaging
www.bracco.com

ECRNews
01/09

GE Healthcare
Isosmolar Visipaque:
Strong evidence 1-12
Visipaque, at all iodine concentrations, is the only
contrast medium available for intravascular use with
osmolality equal to blood.
We look forward to welcoming you to our exhibition
stand and symposium in Vienna to find out more about
the about benefits the benefits offered offered by isosmolar by isosmolar Visipaque Visipaque
Renal tolerability 1-4
Cardiac
Patient
safety 4-6 comfort 7-12
PRESCRIBING INFORMATION VISIPAQUE iodixanol
Please refer to full national Summary of Product Characteristics (SPC) before prescribing. Indications and
approvals may vary in different countries. Further information available on request.
PRESENTATION An isotonic, aqueous solution containing iodixanol, a non-ionic, dimeric contrast
medium, available in three strengths containing either 150 mg, 270 mg or 320 mg iodine per ml.
INDICATIONS X-ray contrast medium for use in adults in cardioangiography, cerebral angiography
(conventional and i.a. DSA), peripheral arteriography (conventional and i.a. DSA), abdominal angiography
(i.a. DSA), urography, venography, CT enhancement, studies of the upper gastrointestinal tract,
arthrography, hysterosalpinography (HSG) and endoscopic retrograde cholangiopancreatography
(ERCP). Lumbar, thoracic and cervical myelography in adults. In children for cardioangiography, urography,
CT enhancement and studies of the upper gastrointestinal tract. DOSAGE AND ADMINISTRA-
TION Adults and children: Dosage varies depending on the type of examination, age, weight, cardiac
output, general condition of patient and the technique used (see SPC and package leaflet). CONTRA-
INDICATIONS Manifest thyrotoxicosis. History of serious hypersensitivity reaction to VISIPAQUE.
WARNINGS AND PRECAUTIONS A positive history of allergy, asthma, or reaction to iodinated contrast
media indicates need for special caution. Premedication with corticosteroids or H1 and H2 antagonists
might be considered in these cases. Although the risk of serious reactions with VISIPAQUE is
regarded as remote, iodinated contrast media may provoke serious hypersensitivity reactions. Therefore
the necessary drugs and equipment must be available for immediate treatment. Patients should
be observed closely for at least 15 minutes following administration of contrast medium, however
delayed reactions may occur. Non-ionic contrast media have less effect on the coagulation system in
vitro, compared to ionic contrast media. When performing vascular catheterization procedures one
should pay meticulous attention to the angiographic technique and flush the catheter frequently (e.g.
with heparinised saline) so as to minimize the risk of procedure-related thrombosis and embolism.
Ensure adequate hydration before and after examination especially in patients with renal dysfunction,
diabetes mellitus, paraproteinemias, the elderly, children and infants. Particular care is required in
patients with severe disturbance of both renal and hepatic function as they may have significantly
delayed contrast medium clearance. For haemodialysis patients, correlation of time of contrast media
injection with the haemodialysis session is unnecessary. To prevent lactic acidosis in diabetic patients
treated with metformin, administration of metformin should be discontinued at the time of administration
of contrast medium and withheld for 48 hours and reinstituted only after renal function has been
re-evaluated and found to be normal. (Refer to SPC). Special care should also be taken in patients with
hyperthyroidism, serious cardiac disease, pulmonary hypertension, patients predisposed to seizures
(acute cerebral pathology, tumours, epilepsy, alcoholics and drug addicts), and patients with
myasthenia gravis or phaeochromocytoma. One should also be aware of the possibility of inducing
transient hypothyroidism in premature infants receiving contrast media. All iodinated contrast media
may interfere with laboratory tests for thyroid function, bilirubin, proteins, or inorganic substances (e.g.
iron, copper, calcium, and phosphate). An increased risk of delayed reactions (flu-like or skin reactions)
has been associated with patients treated with interleukin-2 up to two weeks previously. PREGNANCY
AND LACTATION The safety of VISIPAQUE in pregnancy has not been established. Contrast media are
poorly excreted in breast milk and minimal amounts are absorbed by the intestine. Breast feeding
may be continued normally. UNDESIRABLE EFFECTS Intravascular use: Usually mild to moderate, and
transient in nature. They include discomfort, general sensation of warmth or cold, pain at the injection
site or distally. Serious reactions and fatalities are only seen on very rare occasions. Nausea and
vomiting are rare, and abdominal discomfort is very rare. Hypersensitivity reactions occur occasionally
with symptoms such as rash, urticaria, erythema, pruritus, dyspnoea or angioedema (immediate or
delayed). Hypotension or fever may occur. Severe reactions such as laryngeal oedema, bronchospasm,
pulmonary oedema and anaphylactic shock are very rare. Neurological reactions such as headache,
dizziness, seizures, and transient motor or sensory disturbance (e.g. taste or smell alteration) are very
rare. Also reported very rarely: vagal reactions, cardiac arrhythmia, depressed cardiac function,
ischaemia, and hypertension. “Iodide mumps” is a very rare complication. Arterial spasm may follow
injection into coronary, cerebral or renal arteries. A minor transient rise in S-creatinine is common.
Renal failure is very rare. Post phlebographic thrombophlebitis or thrombosis is very rare. Arthralgia is
very rare. Severe respiratory symptoms and signs (including dyspnoea and non-cardiogenic pulmonary
oedema), and cough may occur. Intrathecal use: Meningism, photophobia or chemical
meningitis. Transient motor or sensory dysfunction. Confusion. Paraesthesia. Seizures. EEG changes.
Local pain. Headache, nausea, vomiting or dizziness. Use in body cavities: Endoscopic Retrograde
Cholangiopancreatography (ERCP): Elevation of amylase levels, pancreatitis. Oral use: diarrhoea,
nausea, vomiting, abdominal pain. Hysterosalpingography (HSG): Transient pain in the lower abdomen.
Vaginal bleeding/discharge, nausea, vomiting, headache, fever. Arthrography: Pressure sensation and
post procedural pain. PHARMACODYNAMIC PROPERTIES In 64 diabetic patients with serum creatinine
levels of 115 - 308 μmol/L, VISIPAQUE use resulted in 3% of patients experiencing a rise in creatinine
of ≥ 44.2 μmol/L and 0% of the patients with a rise of ≥ 88.4 μmol/L.The release of enzymes (alkaline
phosphatase and N-acetyl-ß-glucosaminidase) from the proximal tubular cells is less than after injections
of non-ionic monomeric contrast media and the same trend is seen compared to ionic dimeric
contrast media. VISIPAQUE is also well tolerated by the kidney. INSTRUCTIONS FOR USE AND HAND-
LING Like all parenteral products, VISIPAQUE should be inspected visually for particulate contamination,
discolouration and the integrity of the container prior to use. The product should be drawn into
the syringe immediately before use. Containers are intended for single use only, any unused portions
must be discarded. VISIPAQUE may be warmed to body temperature (37°C) before administration.
MARKETING AUTHORISATION HOLDER GE Healthcare AS, Nycoveien 1-2, Postboks 4220 Nydalen,
N-0401 Oslo, Norway. CLASSIFICATION FOR SUPPLY Subject to medical prescription (POM). MARKETING
AUTHORISATION NUMBERS PL 0637/0017-19 (Glass vials/bottles and polypropylene bottles with
stopper and screw cap). PL 0637/0026-28 (Polypropylene bottles with a twist-off top). DATE OF
REVISION OF TEXT 19 October 2007. PRICE 320mgI/ml, 10x50ml: £228.81
Adverse events should be reported. Reporting forms and information can be found
at www.yellowcard.gov.uk. Adverse events should also be reported to GE Healthcare.
GE Healthcare Limited, Amersham Place, Little Chalfont, Buckinghamshire, England HP7 9NA.
www.gehealthcare.com
Local prescribing information is available at the stand.
References:
1. Aspelin P et al. N Engl J Med 2003; 348: 491-9.
2. Jo S-H et al. J Am Coll Cardiol 2006; 48: 924-30.
3. Hernandez F et al. Eur Heart J 2007; 28(Suppl.): Abs 454.
4. Nie B et al. Poster presented at SCAI-ACCi2 2008. Chicago, USA.
5. Davidson CJ et al. Circulation 2000; 101: 2172-7.
6. Harrison JK et al. Circulation 2003; 108 (Suppl.IV); Abstract 1660.
7. Verow P et al. Brit J Radiol 1995; 68: 973-8.
8. Tveit K et al. Acta Radiologica 1994; 35: 614-8.
9. Palmers Y et al. Eur J Radiol 1993; 17: 203-9.
10. Justesen P et al. Cardiovasc Intervent Radiol 1997; 20: 251-6.
11. Manke C et al. Acta Radiologica 2003; 44: 590-6.
12. Kløw NE et al. Acta Radiologica 1993; 34: 72-7.
© 2008 General Electric Company – All rights reserved.
GE and GE Monogram are trademarks of General Electric Company.
Visipaque is a trademark of GE Healthcare Limited.
10-2008 JB3438/MB003293/OS UK & INT’L ENG

E C R 2 0 0 9 P R E V I E W
Heading the Summit of Science
A portrait of the ECR 2009
Congress President
By Simon Lee
Prof. Borut Marincek
ECR 2009 Congress President
As the European Congress of Radiology is now fast
approaching, we would like to take the opportunity
to present this year’s Congress President Prof. Dr.
Borut Marincek. The eminent Swiss radiologist has
long been closely involved with ESR and its various
activities, and attended his first ECR back in 1983
after completing his training. Since then he has served
on the ESR Executive Council, sat on the ECR Programme
Planning Committee and taken a leading
role in the ESR’s European School of Radiology. As he
prepares to fulfil his duties at ECR, we take a look at
his past achievements and get to know our ‘head dignitary’
for ECR 2009.
Borut Marincek was born in 1944 in Solothurn, Switzerland,
and received his medical degree from Zurich
University in 1970. It was during this time at medical
school that he resolved to pursue a career in radiology,
following a growing fascination with the possibilities
of correlating imaging, morphology and function as
well as non-invasive mapping of anatomy and disease
processes. It is a fascination that has endured to this
day. “Looking back, choosing this profession was the
best decision I could have made in my life,” he affirms,
“I still find radiology highly absorbing because it plays
a central role in the healthcare system and is one of
the fastest growing areas in medicine, in clinical terms
and the R&D”.
After completing residencies in radiology and nuclear
medicine at the University Hospitals in Zurich and
Berne, Dr. Marincek went on to work at the Institute
of Diagnostic Radiology at the Berne University
Hospital. Then from 1979 to 1981, he was a research
fellow at the Department of Diagnostic Radiology,
Stanford University Hospital, USA, before returning
to the Berne University Hospital where he went on
to achieve the rank of Associate Professor in 1986. In
1987 Dr. Marincek returned to the Zurich University
Hospital where he was appointed Vice Chairman of
the Institute of Diagnostic Radiology, starting a long
professional association with the institution that still
continues. In 1995 he also became Chairman of the
Institute of Diagnostic Radiology and Nuclear Medicine
at the Zug Cantonal Hospital, Switzerland, and
since 1997 he has been Professor of Radiology and
Chairman of the Institute of Diagnostic Radiology at
the University Hospital of Zurich.
Aside from his day-to-day activities, Dr Marincek is
also a member of numerous medical societies, including
the Swiss Society of Radiology, of which he is a
past president, and the European Society of Gastrointestinal
and Abdominal Radiology, of which he is the
current president. In recognition of his many achievements,
he has also been awarded Honorary Membership
of the German Roentgen Society, the Schinz-
Medal, Honorary Membership of the Swiss Society
of Radiology and Honorary Membership of the Royal
Belgian Radiological Society. He has also received the
Distinguished International Member Award of the
Society of Gastrointestinal Radiologists.
Throughout his career Dr. Marincek has published frequently,
authoring or co-authoring 249 peer-reviewed
articles and 47 books or book chapters, mainly in
the field of abdominal and cardiovascular computed
tomography and magnetic resonance imaging. As a
respected authority on such subjects, he has also been
invited to pass on his experience through more than
190 lectures in Europe and overseas. But despite his
many professional activities Dr. Marincek occasionally
finds time to relax. “Of course there is not much
time left for activities beyond my numerous professional
duties, but the satisfaction my work brings me
compensates for that and makes every day of my life
an extraordinary experience,” he says. “In my spare
time I love to go mountain biking in the woods; I enjoy
nature very much and I find it a very pleasant way to
relax the mind and exercise at the same time. Another
favourite sport of mine is rowing, as it is a good way
to get in touch with the elements of nature and a nice
opportunity to spend time with friends.”
Prof. Borut Marincek is the 20 th congress president in
the history of the European Congress of Radiology,
and the first one from Switzerland.
27 myESR.org

ESR Newsletter 01/09
E S R M E E T S
E S R M E E T S
ESR meets
Switzerland
Two months before ECR 2009, ESR Newsletter met Bernhard Allgayer, President of the Swiss Society of
Radiology, to learn more about radiology in the European country with the highest ratio of high-field MR
units per inhabitant.
By Mélisande Rouger
ESR Newsletter: How is Swiss radiology
doing and how does it position itself in
Europe?
Bernhard Allgayer: Swiss radiology has an
increasing role in the medical community
with many clinical and scientific connections
to other European countries.
ESRN: How many radiologists are currently
working in Switzerland? What is
the proportion of men, women and young
people? What is the ratio of radiologists to
inhabitants?
BA: Currently 919 radiologists are working
in Switzerland, with 193 in private practices,
and about 30 to 35 young radiologists per
year undergo the board examination. Switzerland
has 7.56 million inhabitants, so the
ratio is one radiologist per 8,226 inhabitants.
ESRN: How do you see the demography of
your profession evolving in the near future?
BA: I think the total number of radiologists
will increase about 3 to 5% per year.
ESRN: Regarding your introduction to the
‘ESR meets Switzerland’ session, could you
please briefly explain: What is the role of
3.0 T in Switzerland?
BA: Out of 207 MRI units, 42 of them are 3.0T
units. Switzerland has probably one of the
highest densities of MR magnets in Europe
and probably worldwide. The number of 3.0T
magnets, particularly in private practice, is
increasing. 3T has allowed clinical implementation
of sequences that were difficult
to perform previously such as arterial spinlabelling
perfusion.
ESRN: What are you going to talk about
under the theme ‘Matterhorn: top of Europe’?
BA: The Matterhorn is one of the most
famous mountains in Europe and the ratio of
high-field MR units per inhabitant in Europe
is the highest in Switzerland. The presentation
will focus on stroke MRI.
ESRN: What are the demographics of
stroke in Switzerland? How does it compare
to the rest of Europe?
BA: Stroke is one of the three highest causes of
mortality in Switzerland, with cardiac diseases
and cancer, as it is in other developed countries.
It has a major socio-economic impact.
In Switzerland there is a trend to aggressively
diagnose and treat these patients at early
stages. Here, MR technology plays an important
role in the management of these patients.
ESRN: What are the advances made in clinical
Neuro-MR of stroke?
BA: In Neuro-MR, the advent of high field
magnets has allowed us to improve the routine
acquisition of the following techniques:
perfusion imaging, diffusion tensor and
diffusion-weighted imaging, susceptibilityweighted
imaging, arterial spin labelling perfusion,
and clinical functional MRI.
ESRN: In which clinical cases do you use
abdominal and pelvic MRI? What is the
current status of high field abdominal and
pelvic imaging?
BA: The role of 3.0T MRI in the abdomen
and pelvis is not yet defined. 3.0T offers various
advantages, but has its disadvantages. In
addition, imaging at 1.5T has reached a very
high level, and at some point it is difficult to
top this. In general, 3.0T imaging has now
reached the robustness and imaging level
of 1.5T in the abdominal and pelvic region.
With regard to morphologic imaging, 3.0T
imaging seems to be superior at displaying
the biliary and pancreatic duct anatomy,
in particular in patients without dilatation
of the ducts. Moreover, MR angiography
is profiting from the higher field strength.
Morphologic imaging is superior in displaying
the anatomy of the pelvic organs and
the pelvic floor, and probably 3.0T imaging
makes the use of endorectal coils for prostate
imaging unnecessary. However, I personally
believe that in the future the superiority
of 3.0T will be shown, in particular for the
functional applications (such as diffusion,
perfusion assessment, and hybrid imaging).
Professor Bernhard Allgayer has been the Director of the Radiology
Department of the Lucerne Canton Hospital, Switzerland, since 1997.
His main interests are clinical research in CT, MRT, mammography
and interventional radiology.
European Society of Radiology
28

E S R M E E T S
ESRN: What are the typical sports injuries
in Switzerland?
BA: Injuries from winter and summer sport
activities, such as skiing, snowboarding, biking
and running.
ESRN: What are the main challenges faced
by radiology in Switzerland nowadays and
what are the strategies developed by your
society to cope with them?
BA: The main challenges for Swiss radiology
in the future are: a shortage of board-certified
radiologists, in particular in public hospitals;
turf battles in different areas of radiology; and
decreasing revenues because of decreasing
reimbursement by the healthcare providers.
ESRN: Skilled staff are a prerequisite for
the implementation and maintenance of
high-quality radiological services – what do
you do to promote postgraduate education
and training in modern imaging methods?
BA: We offer national and international
courses, such as the Davos course, and many
other local and international activities.
ESRN: How is Swiss radiology meeting
the growing need for a multidisciplinary
approach in radiology?
BA: We have daily clinical meetings, and
interdisciplinary meetings with orthopaedic
surgeons, oncologists, cardiologist et al.
ESRN: Is there any competition between
Swiss radiological services and other
services? If so, how does radiology work
together with those specialities to improve
the situation?
BA: There is competition with angiologists,
vascular surgeons and cardiologists in interventional
vascular radiology, and with cardiologists
in heart CT and MRI.
ESRN: How would you judge the importance
of the exchange of knowledge
between Swiss radiologists and the rest of
the world? Is Switzerland’s geographical
place in Europe an advantage?
BA: This exchange is important for us.
Therefore we have a longstanding tradition
of exchange between Swiss radiologists and
others around the world. For many years
it has been a tradition, particularly in academic
institutions, that young radiologists
undertake a fellowship in another country.
In addition, there is an increasing number
of radiologists who were trained in Switzerland
and who now work in faculty positions
in leading radiology centres worldwide.
Additionally, we also have a longstanding
tradition for postgraduate teaching courses,
which are performed in collaboration with
leading international radiology experts.
Finally, we foster international contracts
through the annual meeting of our society
where we invite opinion leaders for state of
the art lectures. Furthermore, the society
rewards excellence through various honours
and prizes.
ESRN: What are the potential benefits
of SSR taking part in the ‘ESR meets’
programme?
BA: To learn more about radiology and
the work of radiologists in other European
countries
ESRN: What future trends and challenges
do you foresee in radiology?
BA: The trends will focus on higher fields
and faster imaging. The challenge will be to
combine technological changes and clinical
excellence. The next step in radiology is
imaging of function, cellular and molecular
imaging.
ESRN: What was your main motivation for
choosing your profession?
BA: Interest and passion.
ESR meets Switzerland
EM 1 Switzerland – Top of Europe: 3.0 Tesla and the Matterhorn
Saturday, March 7, 10:30–12:00, Room A
Presiding: B. Allgayer; Lucerne/CH
B. Marincek; Zurich/CH
I.W. McCall; Oswestry/UK
• Introduction
B. Allgayer; Lucerne/CH
• Perfusion imaging in the heart of Europe:
1.5 Tesla and more
J. Bremerich; Basle/CH
• The impact of high field MRI on stroke management
K.-O. Løvblad; Geneva/CH
• Abdominal and pelvic MRI: From 1.5 to 3.0 Tesla
D. Weishaupt; Zurich/CH
• Does sports imaging need 3.0 Tesla?
T. Treumann; Lucerne/CH
• Panel discussion
29 myESR.org

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E C R 2 0 0 9 – S C I E N C E
CT lung cancer screening
comes under the spotlight
By Paula Gould
Lung cancer is the biggest cancer killer in the
and possible pitfalls of screening will also be cov-
then patients may be unduly alarmed. Pathology-
Experience has shown that PET can be positive
world, causing more deaths than breast and
ered at the state of the art session.
free images, on the other hand, could confound
in some benign lesions and negative in some
prostate cancer put together. Every 30 seconds,
efforts to encourage smokers to adopt a healthier
non-solid masses, Bellomi said. This has led to
someone, somewhere will die of lung cancer. The
One problem is the lack of evidence proving that
lifestyle. Worse still, symptoms suggestive of can-
errors in patient management. Nodule growth
outlook for individuals diagnosed with the malig-
the strategy is worthwhile, he said. Two large ran-
cer could be ignored on the strength of an ‘all
was under-estimated in some cases and over-esti-
nancy is poor; only one in every 10 will still be
domised controlled trials investigating the value
clear’ screening result.
mated in others owing to variability in automated
alive five years later.
of low dose CT screening in heavy smokers are
measurement tools and subjective evaluations of
currently underway. Interim results from one
Pathological findings are rarely missed when
lesion diameter.
The statistics on lung cancer do not make pleas-
of these trials will be presented at ECR 2009 by
screening for lung cancer with low dose CT,
ant reading. One reason for the poor prognosis
Prof. Dr. Matthijs Oudkerk, chair of radiology at
according to Prof. Massimo Bellomi from the
“Difficult cases are addressed at multidiscipli-
is the late stage at which the malignancy is typi-
the University Medical Centre in Groningen, the
European Institute of Oncology (EIO) in Milan.
nary team meetings,” he said. “We have four
cally diagnosed. By the time most lung cancer
Netherlands. Final results from both trials are not
He recommends using several different image
or five radiologists, a couple of surgeons and
sufferers are identified, the primary tumour will
expected until 2010.
formats when reporting the examinations, rather
some nuclear medicine physicians who all come
have spread to neighbouring organs or produced
than axial views alone. Coronal views, for exam-
together and discuss these cases to improve the
distant metastases. The only treatment available
“At the moment, we are not at a stage where we
ple, make it easier to view the pulmonary hilum
accuracy of a diagnosis.”
at this stage is likely to be palliative rather than
can recommend CT for at-risk individuals, that
and detect small hilar nodules. Radiologists at the
curative.
is, smokers and those with a history of asbestos
EIO also double read cases where possible.
The session will conclude with a panel discussion
exposure. Despite 15 years of research on this
on the thorny issue of self-referral. Information on
If the disease could be identified at stage I, whilst
topic, there is no evidence yet that screening with
“If you have a good PACS and a good worksta-
CT lung cancer screening is widely available on
it was still localised in the lung, then two-thirds of
CT can actually reduce mortality from lung can-
tion, it should take less than 10 minutes. Our
the Internet and many companies are now offer-
patients could be cured, according to Prof. Dr. Ste-
cer,” Diederich said.
mean time is eight minutes per case,” he said. “Of
ing ‘preventative imaging’ to the worried well.
fan Diederich, head of the radiology department
course, if you have a patient with 12 lung nodules,
Chest radiologists need to be well versed in the
at the Marien Hospital in Düsseldorf, Germany.
Smokers whose lung cancer is caught early – and
it takes 20 minutes, and if you have a patient with
pros and cons of screening, and how these can be
Low dose CT screening of high-risk individuals
cured – may still fall prey to another malignancy
none it takes only four minutes.”
communicated to members of the public.
may be the way to achieve this. On the other hand,
triggered by nicotine inhalation, such as oesopha-
it may simply provide false reassurance, or lead to
geal cancer. Many smokers also have cardiovascu-
A trial of low dose CT lung cancer screening in
“The average radiologist at ECR 2009 will won-
unnecessary surgery on patients with benign lung
lar disease, and will be at risk of suffering a stroke
high risk subjects has been running at the Milan
der what to tell patients who turn up at his or her
disease.
or heart attack.
institute since 2000. A second trial of over 5,000
office asking for a CT screening scan. We hope to
subjects began in 2004/2005. Bellomi will use his
be able to provide some advice on how to deal with
Diederich will be discussing the rationale for lung
If lesions identified on CT screening are slow-
ECR 2009 presentation to relay some of the les-
these requests,” Diederich said.
cancer screening at ECR 2009. The likely benefits
growing cancers that are unlikely to prove fatal,
sons learned.
State of the Art Symposium
SA 13
Lung cancer screening
Monday, March 9, 08:30–10:00, Room C
• Chairman’s introduction
T. Saam; Munich/DE
A
B
A
B
• Rationale for screening
S. Diederich; Düsseldorf/DE
• Interim results from the NELSON trial
M. Oudkerk; Groningen/NL
• Problems and pitfalls at lung cancer screening:
Lessons from the EIO trial
M. Bellomi; Milan/IT
C
D
C
D
• Panel discussion:
What to tell the patient at risk of lung
cancer who requests a screening CT?
Inflammatory lesion. A: Annual CT in June 2006 revealed new nodule in upper
left lobe with morphology suspicious for a small cancer. B: Nodule was
not evident on previous CT in 2005. C: One month later, after administering
antibiotics, nodule had reduced in size. D: After three months, the nodule
had almost disappeared. This taught us not to be too anxious and to go to
surgery without a firm diagnosis. (Provided by Prof. M. Bellomi)
A: Small cancer in upper right lobe diagnosed in 2007 on axial CT. B: The
malignancy is also seen on coronal images. C: Same cancer was difficult
to see on axial images from previous screening examination in 2006 and
was missed. D: It was a little more evident on the coronal images from that
year. This taught us to look at coronal views, and not just axial slices and
MIP (maximum intensity projection) images. (Provided by Prof. M. Bellomi)
31 myESR.org

ESR Newsletter 01/09
E C R 2 0 0 9 – S C I E N C E
Spinal Imaging and Intervention
at the cutting-edge
By Majda M. Thurnher, AKH Vienna, Austria
The Categorical Course ‘Spinal Imaging
MR techniques, such as MR spectroscopy,
population also brings an increased number
and Intervention’ will provide a forum for
perfusion, and diffusion imaging has been
of age-related diseases, such as osteoporo-
the presentation and discussion of new and
limited by a number of physical, physiologic,
sis, which is one of the major causes of acute
important developments in spine radiology.
and technical factors. With improving tech-
spine pain.
Topically organised sessions of the course
nology, it is now becoming possible to obtain
will concentrate on various aspects of diag-
biochemical, physiologic, and haemody-
IRS must be performed by a physician with
nostic as well as therapeutic spine tech-
namic information about the human spinal
clinical knowledge of neurological symp-
niques. Experts from Europe and the United
cord in vivo. More recently, as improvements
toms related to central or peripheral par-
States will share their experience with course
in coil technology, hardware, and pulse
tial or total nervous structure damage. The
participants through lectures dedicated to
sequences are made, techniques previously
key to success with this minimally invasive
their field of expertise.
only applicable in the brain, such as BOLD
spine therapy is related to a good correlation
functional MRI (fMRI), magnetomyelog-
between clinical symptoms and diagnos-
Over the centuries, numerous articles,
raphy (MMG) and ultra-short TE (UTE)
tic imaging. Dr. Blake Johnson, Director of
Majda M. Thurnher is Associate
Professor at the Department of
Radiology, Medical University of
Vienna, and coordinator of the
ECR 2009 Categorical Course
‘Spinal Imaging and Intervention’.
hypotheses, and treatment methods for back
pain have been proposed. Even now, the
pathophysiology of back pain is not completely
understood. New insights into old
problems of spinal instability, degenerative
disk disease, and facet joint degeneration
imaging have been performed in the human
spinal cord.
Despite the general lack of optimism about
the usefulness of clinical 3T MR in evaluation
of the spine, the initial gap between
Neuroimaging at the Center for Diagnostic
Imaging (CDI) in Minneapolis, US, who has
treated an impressive number of patients,
will show how image-guided pain management
has reached a new level of success.
will be discussed during the course. Is mye-
promises and clinical reality of 3T spine
Special interest has focused, in recent dec-
lography obsolete? What is the method of
imaging has been partially bridged in recent
ades, on pain and pain management. The
choice for visualisation of disk disease, nerve
years. High-resolution images of the spinal
words of Albert Schweitzer, “Pain is a more
root compression, spinal stenosis? Does
cord, diffusion and diffusion-tensor imaging
terrible lord of mankind than even death
spinal instability really exist? Prof. Johan
(DTI) and even tractography of the spinal
itself,” are still valid, and the search for inter-
van Goethem from Antwerp, Belgium, will
cord is now the reality, and Prof. Meng Law,
ventional pain management techniques is
focus on spinal instability as a significant
Chief of Neuroradiology at the USC Medi-
ongoing. Interventional Pain Management
cause of lower back pain. Although listed
cal Center, Keck School of Medicine in Los
is the discipline of medicine devoted to the
by spinal surgeons as the leading indication
Angeles, US, will demonstrate the clinical
diagnosis and treatment of pain-related dis-
for spinal fusion, spinal instability is poorly
advantages of 3T imaging.
orders, principally with the application of
understood and radiologists are frequently
interventional techniques alone to manage
unfamiliar with specific imaging findings in
Interventional Radiology of the Spine (IRS)
pain, or in conjunction with other modalities
these patients.
includes a number of diagnostic and thera-
of treatment.
peutic procedures, developed in recent years,
Advanced MR imaging techniques are
which are designed to reduce or eliminate
In Europe, many of those procedures are
beginning to demonstrate their utility in
spine pain. Cervical pain, lower back pain,
performed by an anaesthesiologist, or by
studying neurological disorders of the brain,
and sciatica are very common conditions
an orthopaedic surgeon or a neurosurgeon.
such as metabolic diseases, developmental
related to herniated disks or degenerative
Dr. Mario Muto, Chief of Neuroradiology
disorders, traumatic injury, and white mat-
disk disease, and diagnostic imaging with
at the Cardarelli Hospital in Naples, Italy,
ter diseases, including multiple sclerosis,
x-ray, CT, and MR can help us to better
stresses: “It is important that the radiological
neurodegenerative diseases, infections, and
define the cause of spine pain. There are now
community understand that we have, at this
neoplasms. The human spinal cord, by natu-
a greater number of older adults in west-
moment, the unique opportunity to recover a
ral extension, is also susceptible to an array
ern countries because of the high quality of
relationship with patients because we can per-
of neurological disorders. The application of
healthcare; however, this increasing aging
form those treatments in the safest possible
A B C D
Diffusion tensor (DTI) MR tractography (fibre tracking) of the cervical spinal
cord performed at 3T clinical MR unit in two patients.
In spinal cord ependymoma (A, B) destruction of the fibres of the spinal cord
is nicely demonstrated. Displacement and spreading of the fibres was seen
in a small enhancing spinal cord lesion at the C2 level (C, D).
Diffusion Tensor Imaging (DTI) is not only used in the brain and spinal cord, but has also
been successfully applied to the intervertebral disc. On this image you can see the representation
of the main diffusion direction (so-called ‘tractography’) applied to 3 intervertebral
discs. While the top disc shows a concentric pattern representing the normal structure of
the annulus fibrosus, the bottom disc is degenerated and has lost this normal pattern.
European Society of Radiology
32

E C R 2 0 0 9 – S C I E N C E
way under high technological control. Clinical
Radiology must be urged once again to be
ready to act in this competitive medical field!”
The IRS procedures include: spine biopsy,
nerve block tests, treatment, and many therapeutic
procedures. These procedures primarily
relate to the treatment of spine pain due
to different pathologies, such as herniated
disks, porotic fractures, spine tumours, spinal
canal stenosis, as well as the treatment of
chronic pain with a neurostimulator implant.
Diagnostic biopsy must be performed under
CT control to reduce the risk of inadequate
access and ensure that the target lesion is
reached. According to the type of biopsy we
need to perform (cytologic, hystologic, or
cultural) we can use different types of needle.
We can also utilise, in cases of paraspinal soft
tissue lesions, a biopsy device that enables
us to obtain a good tissue sample. Antalgic
blocks can be useful in selected cases to
understand the origin of the pain, but can
also be performed to treat nervous structure
infiltration by invasive tumours, such as at
the level of the ganglium stellatum or of the
celiac plexus, with alcohol injection. Radiofrequency
waves and steroid infiltration at
the cervical and lumbar region are very efficient
and can be used in cases where systemic
medical therapy has failed in treating facet
joint disease or spinal radiculopathy.
Percutaneous treatment of herniated cervical
and lumbar disks includes a wide number
of devices (nucleoplasty, decompression,
oxygen-ozone therapy) that are designed
to reduce intradiscal pressure while minimally
reducing the disk material. Some other
devices attempt to reduce the pain with a
thermal ablation of the peripheral disk nervous
structures (IDET). Dr. Mario Muto and
his co-workers have been using intradiscalintraforaminal
oxygen-ozone therapy to
treat low back pain and sciatica since 1997.
Based on his experience, Dr. Muto considers
this therapeutic approach to disk disease
a safe, low-risk, and high success procedure.
Porotic fractures are a frequent pathologic
condition in older adults, in which the pain
is the first clinical sign. This pathology can
be treated with vertebroplasty (VP) or with
kyphoplasty (KP).
Dr. Gregg Zoarski, Director of Diagnostic
and Interventional Neuroradiology at the
Maryland University in Baltimore, US, and
a past President of the American Society of
Spine Radiology (ASSR), will share his expertise
and knowledge of vertebroplasty and
kyphoplasty. The burning question in performing
vertebroplasty and kyphoplasty is
still ‘who decides what procedure should be
done?’ In vertebroplasty, there is only a simple
cement (PMMA) injection, while, in kyphoplasty,
there is a balloon predilatation followed
by a thick cement injection. Two-thirds
of the patients affected by porotic fractures
can recover within 4–6 weeks after the onset
of the pain, but recent experience has shown
that clinical recovery is faster when VP or KP
are performed soon after injury. The future
of this field will be dependent on new biological
materials that will be designed to have
the same strength as the cement now used,
but more able to withstand biological activity,
similar to triphosphate or calcium. VP
can also be utilised in cases of lytic of mixed
metastatic lesions of the spine to reduce the
pain before radio-chemotherapy. Neurologic
claudication is a clinical condition very often
related to a central spinal canal stenosis due
to degenerative spine disease; this condition
can be treated with a device that increases the
distance between the spinous process, and
can be released percutaneously.
Thus, at this point, it is clear that radiologists
maintain a very strong role in the
diagnostic and therapeutic management of
patients with spinal diseases. The ESR and
ESNR should concentrate, in the future, on
increasing the number of spinal procedures
performed under radiological guidance in
European radiological centres. The primary
goal remains ensuring the best treatment of
patients who are affected by spine pain. The
way to achieve this will be one that considers
both science and clinical practice, with procedures
performed according to evidencebased
medicine, performed by well-qualified,
well trained physicians.
The American Society of Spine Radiology
(ASSR) and the European Society of Neuroradiology
– Diagnostic & Interventional
(ESNR), are proud of their decade of excellent
collaboration, which has led to an exciting
new project, the Joint Symposium on
Spinal Imaging. Prof. Johan van Goethem, a
member of the Executive Boards of ASSR and
ESNR, will co-organise the first joint venture,
which will be held in Rome, Italy, July
9–11, 2009, together with Dr. Bassem Georgy
and Dr. Jeff Stone, President and President-
Elect of the ASSR, Prof. Massimo Gallucci,
local organiser and Dr. Mario Muto for the
ESNR. Internationally recognised speakers
from several continents will lecture on Diagnostic
and Interventional Spinal Imaging
topics. Scientific sessions will feature the latest
approaches and techniques in both spinal
imaging and spinal interventions. Diagnostic
topics will feature advances in CT and MR
imaging, emphasising their practicality in
everyday imaging, as well as the potential for
future clinical applications, while interventional
topics will include sessions on existing
and new techniques usable in daily practice.
MR perfusion of the cervical spine.
MR showing a small median discending herniated disk treated by intradiscal
oxygen-ozone therapy.
Vertebroplasty of C5 in patient affected by osteoangioma
and previously treated with disk prosthesis.
33 myESR.org

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Magnetic Resonance Imaging for cerebral and spinal disease, diseases of the vertebral column, and the other whole-body pathologies (including angiography). Posology and method of administration: The recommended
dose is 0.1 mmol/kg, ie 0.2 mL/kg in adults, children and infants. In angiography, depending on the results of the examination being performed, a second injection may be administered during the same session if necessary.
In some exceptional cases, as the confirmation of isolated metastasis or the detection of leptomeningaeal tumors, a second injection of 0.2 mmol/kg can be administered. The product must be administered by strict intravenous
injection. Contraindications: History of hypersensitivity to gadolinium salts. Contraindications related to MRI: subjects with a pacemaker, subjects with a vascular clip. Special warnings and special precautions for
use: Administer only by strict intravenous injection. Dotarem ® must not be administred by subarachnoid (or epidural) injection. Caution is recommended for anaphylactic-like reactions, renal insufficiency and CNS disorders.
There have been reports of Nephrogenic Systemic Fibrosis (NSF) associated with use of some gadolinium-containing contrast agents in patients with severe renal impairment (GFR < 30 ml/min/1.73 m 2 ). As there is
a possibility that NSF may occur with Dotarem ® , it should only be used in these patients after careful consideration. Interactions with other medicinal products and other forms of interaction. None known to date.
Pregnancy and lactation: Dotarem ® should be used during pregnancy only if strictly necessary. It is advisable to stop breast-feeding for a few days following the examination with Dotarem ® . Undesirable effects: As for
any injection of paramagnetic complex, rare anaphylactic-like reactions exceptionally fatal may occur, requiring an emergency treatment. Very rare general disorders and incidents related to the injection site (extravasation),
very rare skin and subcutaneous tissue disorders, very rare nervous system disorders, very rare muscular disorders. FRENCH PRESENTATION AND MARKETING AUTHORISATION NUMBER: 358 954.2: 5 mL in vial
(glass) - 331 713.4: 10 mL in vial (glass) - 358 953.6: 10 mL in pre-filled syringes (glass) - 331 714.0: 15 mL in vial (glass) - 338 403.0: 15 mL in pre-filled syringes (glass) - 331 715.7: 20 mL in vial (glass)
- 338 404.7: 20 mL in pre-filled syringes (glass). GUERBET - BP 57400 - 95943 Roissy CdG Cedex - tel: +33.(0)1.45.91.50.00 (ref.06/07). For detailed information, see Dictionnaire Vidal. Revised: May 2007.
Terre Neuve - P08 038 DOT - 09/2008.

E C R 2 0 0 9 – S C I E N C E
New techniques contribute to
improvements in disc pain management
By Frances Rylands-Monk
Over the past decade, therapeutic options
for back pain have shifted from the poles of
conservative management involving drugs
and rest or conversely, surgery, to a middle
ground comprising interventional techniques.
Overall, this switch has tended to
result in improved diagnostic accuracy and
reduced treatment time while decreasing
costs, proving beneficial both to patients and
hospital budgets.
Relatively new techniques such as percutaneous
decompression of a herniated disc and
nucleoplasty (disc decompression to ablate
and remove tissue in the nucleus pulposus of
the disc) have been developed. At the same
time, it has become accepted that not all
pain is caused by mechanical compression of
neural structures, but also by inflammation,
which if addressed through techniques such
as steroid and ozone therapy, can be effectively
controlled.
“One of the challenges in evaluating the
origin of spinal pain is that imaging doesn’t
always predict the source of pain. A disc
that looks degenerated on an imaging study
may or may not be the pain generator,” said
Dr. Blake Johnson, director of neuroimaging,
Center for Diagnostic Imaging, Minneapolis,
U.S. “In addition, there are multiple levels
and multiple structures in the spine that are
potential contributors. Isolating the source
of pain is difficult based only on MRI or CT.”
To overcome these challenges, conducting
a physical examination, taking a patient
history, and performing necessary imaging
should be combined with the use of diagnostic
physiologic blocks or tests, whereby
different structures, such as facet joints or
nerves, are anaesthetised. Other tests, like
discography, may be carried out to see if
this reproduces the patient’s pain symptoms.
These blocks and tests are image-guided
with CT or fluoroscopy to increase accuracy
in targeting structures to refine pain source
diagnosis.
Minimally invasive interventional therapy is
possible in selected cases. Provided that the
patient suffering from discogenic disease can
move and feel his or her legs, decompression
devices can be placed inside the disc or substances
such as alcohol gel may be injected.
Alternatively, lasers or coblation can be used
under local anaesthetic to remove materials
from the nucleus pulposus without harming
bone.
During session CC 1316, which will form
part of the new categorical course on spinal
imaging and intervention at ECR 2009,
Johnson and other experts will outline these
relatively new disc therapies and provide an
update for those already involved in intervention.
They also intend to arouse the
interest of general radiologists.
“New techniques cut down treatment time
and costs. Typically, treatment takes half an
hour, and the patient leaves the ward walking
after four hours. This is an ambulatory process
that requires no hospitalisation or anaesthetist,
compared to a standard three or four
day hospitalisation after surgery, which takes
between one and four hours, depending on
the procedure,” said Dr. Alexis Kelekis, lecturer
in interventional and musculoskeletal
radiology at the University of Athens.
Image-guided procedures under local anaesthetic
in the angio suite do not replace all
surgical procedures such as those needed for
spinal stenosis, motor deficit, and free disc
fragment. In these cases, conventional methods
are still the gold standard.
However, with conservative treatment, leg
pain will disappear in around 60% of cases,
and for the remaining 40% of cases an infiltration,
or an image-guided injection of
drugs near the nerve root, should be performed.
Of these, about 60% will respond
well, but a further 40% will be left as a subgroup
that can be treated with percutaneous
techniques such as decompression, lasers,
and coblation.
“Of this subgroup, 60–70% will yield good
results. Through such a process of elimination,
the people who really do need surgery
are left,” Kelekis said. “We don’t know the
full economics of it, but whatever saves time
and frees up the operation room for priority
cases, saves money.”
While laser therapy has been used for about
15 years and coblation has existed since
around 2000, the most recent technique is
the use of alcohol gel, which has been in clinical
trials across Europe. So far it is thought
to be as good as other techniques, and may
even have the edge in some cases due to its
capacity to treat more dehydrated discs.
“New techniques aren’t very complicated
or difficult to learn, but can bring massive
benefits to patients. The interventional radiologist
has the knowledge to understand the
imaging and the procedure. Clinical knowledge
can be increased by attending conferences
and following up patients,” Kelekis
said.
He recommended that radiologists seeking
to become interventional specialists should
have more face-to-face time with patients
and not rely on ‘Chinese whispers’ to gain a
clinical history. The specialist also needs to
give feedback directly to patients and inform
them about treatment options and decisions,
even if they are to be performed by somebody
else, he noted.
“While complex techniques such as disc ablation
and vertebroplasty need higher training
and will often be undertaken by specialised
radiologists in tertiary environments, the
average radiologist should know about and
propose such techniques,” Kelekis said.
Johnson thinks the radiologist is the best
person to carry out such procedures because
they are familiar with the equipment and
with imaging anatomy.
“Orthopaedic surgeons, anaesthetists and
rehabilitation doctors may be in the same
area, but radiologists are best suited to perform
image-guided procedures,” he said.
Kelekis sounded a note of caution, and called
for the non-vascular section of interventional
radiology, to which spine intervention
belongs, to focus on standards and harmonisation,
especially as non-vascular techniques
now accounted for around 50% of interventional
procedures across Europe.
“For me, any radiologist holding a needle
and performing a procedure is part of
the interventional group, and procedures
must be done according to the gold standard
of clinical practice and supervised by a
group such as the Cardiovascular and Interventional
Radiological Society of Europe
(CIRSE),” Kelekis said. “The non-vascular
area has been less organised all these years
than vascular. Techniques such as radiofrequency
ablation and abscess drainage are
now standard throughout radiology departments,
and radiologists should learn how
to perform them in line with specific rules.
These procedures do have standards that
validate them, but not all radiologists know
of these for non-vascular techniques.”
A
C
Four images showing the presence of a herniated disc, with
radicular pain down the leg and a pain score of 8/10. The
patient was treated by percutaneous decompression, under
local anaesthesia, and returned home four hours later. Three
months later, the patient was pain-free. A: T2-weighted MRI
image shows the presence of a significantly protruding hernia
in L4-L5, medially and laterally to the left. B: Lateral image
under fluoroscopy of a discography measuring pressure
and pain response, showing the presence of the posterior
hernia. C: Lateral image under fluoroscopy during percutaneous
decompression of the disc. The presence of contrast
media inside the disc is visible from the discography. D: T2-
weighted MR image, taken one year after the previous MRI
shows the disappearance of the protruding hernia.
(Provided by Dr. Alexis Kelekis)
Categorical Course
CC 1316 What is new in disc therapy?
Monday, March 9, 08:30–10:00, Room B
B
D
Moderator: W. Müller-Forell; Mainz/DE
• Image-guided pain management:
A new level of success
B.A. Johnson; Minneapolis, MN/US
• Minimally invasive therapies for
discogenic disease
A.D. Kelekis; Athens/GR
• Ozone therapy update
M. Muto; Naples/IT
35 myESR.org

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E C R 2 0 0 9 – S C I E N C E
Intervention experts address pros
and cons of drug-eluting stents
By Paula Gould
Stent technology has progressed in leaps and
bounds over the past decade. Bare metal tubes
or ‘scaffolds’ have gone a long way to eliminating
instances of abrupt artery collapse following
balloon angioplasty. Restenosis prevention has
proved to be more difficult, prompting stent manufacturers
to seek a pharmacological solution.
Now developers want to improve performance
further with alternative combinations of drugs
and coatings, as well as novel medical materials.
A special focus session at ECR 2009 will chart
how far drug-eluting stents have come to date,
and where the technology may be going in the
future. The notion of a medicated stent delivering
an anti-restenosis agent was unheard of in clinical
practice 10 years ago. Today, such devices are
often inserted in the coronary arteries to inhibit
the body’s natural response to the ‘controlled
injury’ of angioplasty. Drug-eluting stents are not,
however, commonly used outside the heart. The
question is: will that still be the case in the future?
The efficacy of drug-eluting stents in the coronary
arteries is now supported by good clinical
evidence, according to Prof. Dr. Johannes Lammer,
head of the department of cardiovascular
and interventional radiology at University Hospital
Vienna. Well over 50 randomised trials have
been conducted comparing the various medicated
stents with bare metal stents, and looking at the
benefits of different anti-restenosis drugs. This
does not necessarily mean that drug-eluting stents
will be the best solution for all patients, though.
Other co-pathologies, for example, diabetes, may
need to be taken into account when deciding what
type of stent to select.
In peripheral artery disease, experience is more
limited at the moment. Two randomised studies
have been completed and the results published.
Two further interventional trials are underway.
“These devices are expensive, so from an economic
point of view we also have to consider
which patients should have drug-eluting stents as
standard, and which can be treated equally successfully
with bare metal stents,” Lammer said.
In regions where bare metal stents are being used
without problems, anti-restenosis agents may not
be needed at all. In areas of the body where bare
metal stents have failed to work well, then it may
be worth using drug-eluting stents.
“Nobody is using this type of device in the carotid
arteries because the results are good without
drugs,” said Prof. Dr. Stephan Duda, from the
Centre for Diagnostic Radiology and Minimally
Invasive Therapy at the Jewish Hospital, Berlin.
“Some studies have been done on the vertebral
arteries at the rear of the neck that supply the
cerebellum because bare metal stents have only
yielded poor results there.”
Early results from the two ongoing trials into the
role of drug-eluting stents in the peripheral vasculature
may be available at ECR 2009. Presenters
are making no promises, though. A 100-patient
study that considered the value of paclitaxelcoated
stents inserted in the superficial femoral
artery has already shown promising results, Duda
said. Given the small sample size, however, the
data will need to be confirmed in a larger study.
Long-term follow-up is likely to be an important
part of all trials. One downside to the use of drugeluting
stents is the risk of late stent thrombosis.
Patients who are fitted with a drug-eluting stent
in their coronary vasculature must currently take
platelet anti-aggregation medication for the rest of
their lifetime.
Attempts are being made to overcome this problem
through the use of bioabsorbable stents, Duda
said. These devices are literally absorbed into the
body after a few months once the anti-restenosis
payload has been delivered. The success of this
technology may depend on the speed at which the
stent disappears. If it is absorbed too quickly, then
restenosis may still occur. But if the absorption
process is very slow, then late-stent thrombosis
could still be triggered.
“This idea is still really only on the horizon. The
first feasibility studies using bioabsorbable stents
showed confounding results,” he noted.
Duda will use his ECR 2009 presentation to show
that the motto ‘one size fits all’ does not apply to
drug-eluting stents. As the technology matures,
different devices are likely to emerge to suit specific
areas and applications, he said. For example,
it may turn out that drug-eluting balloons are
more effective at treating small arteries below the
knee than the combination of balloon angioplasty
and drug-eluting stents.
“Atherosclerosis in the superficial femoral artery
is a completely different animal to atherosclerosis
in the renal arteries,” he said. “In the future, we
will probably see different drugs or even different
stents for different anatomical regions. These
devices will be of tremendous value when they
have been perfected for pathology that is currently
difficult to treat.”
Special Focus Session
SF 17d
Drug-eluting stents: Today and tomorrow
Tuesday, March 10, 08:30–10:00, Room N/O
Recent two-year clinical data showed that Abbott’s fully
bioabsorbable drug-eluting coronary stent system successfully
treated coronary artery disease and was absorbed
into the walls of treated arteries within two years,
leaving behind blood vessels that appeared to move and
function similarly to un-stented arteries.
• Chairman’s introduction
J. Lammer; Vienna/AT
• Drug-eluting stents in the coronary arteries:
Current status
H.D. Glogar; Vienna/AT
• Drug-eluting stents and balloons in peripheral
arteries: Early experience
S.H. Duda; Berlin/DE
• Peripheral arteries: Are drug-eluting stents
the future?
L.B. Schwartz; Chicago, IL/US
• Panel discussion:
Who needs drug-eluting stents?
Manufacturers, doctors or patients?
A
A: Typical superficial femoral artery (SFA) occlusion before
treatment. B: Control angiogram after placement of a drugeluting
SMART stent (drug = sirolimus, an immunosuppressant
also known as rapamycin).
(Provided by Prof. Dr. S. Duda)
B
37 myESR.org

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E C R 2 0 0 9 – S C I E N C E
Review advances in CT and MR in
major trauma
By Mélisande Rouger
Trauma is the leading cause of death for people
under 40 and the leading cause of death
for children around the world. It is also the
third most common cause of death for all
adults.
Last year alone, there were 39 million visits
to US emergency departments (EDs)
for trauma-related conditions and 150,000
deaths were trauma-related. Imaging accident
victims is almost routine for a radiologist
doing emergency work, and it has
become crucial to be informed and trained
on the latest methods in trauma imaging.
The comprehensive course ‘Advances in CT
and MR in major trauma’ offered at ECR
2009 will do precisely that, by presenting
progress made in the two modalities over
the last two decades.
Multidetector computed tomography
(MDCT) is perhaps the most important
imaging tool for trauma, since it enables
injuries to be diagnosed very quickly and
very accurately, explained Professor Robert
A. Novelline from Harvard Medical School
in Boston, US.
MDCT has also significantly improved during
the last two decades. Twenty years ago,
it took twenty minutes for radiologists to do
a scan of the head; nowadays, it takes them
only six seconds. It took about an hour and
a half to two hours to image a patient with
multiple trauma of the head, spine or abdomen
back then; today the whole body can be
scanned in two minutes.
This gain in time is the most important
progress made in CT trauma imaging,
Novelline stressed. “Years ago, many trauma
patients couldn’t get the benefit of CT; they
couldn’t be in the CT for one to two hours
because they were too unstable. Now we can
scan the whole body in two minutes, which
means we can scan almost every trauma
patient,” he said.
In thoracic injuries, CT enables a faster and
easier diagnosis of aortic injuries than an
arteriogram, a procedure which would cost
both time and money to the hospital. CT
offers 3D visualisation of blood vessels with
exquisite detail in the diagnosis of vascular
injuries. It also depicts lung laceration and
contusion, which are crucial injuries to diagnose
in major trauma.
Thanks to its high precision, CT tends to
be used as a detection tool for almost every
trauma patient. At Massachusetts General
Hospital (MGH), 100 to 110 CT examinations
are carried out daily in the ED alone
for both traumatic and non-traumatic emergency
conditions. For further examination
of spinal and musculoskeletal trauma, and
complex brain injuries, MR will be used.
The most common and serious injuries in
major trauma are head, spine, abdomen
and chest injuries. Thanks to systematic CT
examination as soon as multiple trauma sufferers
arrive in the ED, those injuries that
used to be so difficult to see are now being
made visible, helping to save a significant
number of lives.
However, in many European Centres CT is
not systematically used for those patients
when they arrive in the ED, either because
of a lack of CT equipment or sometimes
because of the lack of education of the
medical staff, as Dr. Dominic Barron from
Leeds Teaching Hospital, UK, will point out
at the ECR. “At our hospital, we had fifteen
patients last year who should have had CT
prior to surgery. All of these would have had
a different management plan if CT had been
performed earlier in their treatment. These
all had worse morbidity as a result, with several
potentially avoidable deaths.”
Barron, a musculoskeletal trauma radiologist,
plans to stress the necessity of doing a
polytrauma CT scan after an x-ray examination
shows a major pelvic injury, as it is
often accompanied by unexpected bleeding
in the chest, abdomen or spine, which is not
visible on plain film. “Rather than doing a
chest x-ray and sending the patient directly
to surgery, shouldn’t we do a whole CT of the
patient to exclude any other major injuries?”
he asks.
Leeds Teaching Hospital, like many other
hospitals in the UK and the rest of Europe,
lacks equipment. It only has two CT scanners
to deal with about 120,000 emergency
cases per year as well as providing CT cover
for all the in and out patient requests in a
1,500 bed hospital. By comparison, most
hospitals in the USA would use at least five
scanners for the ED alone in a hospital of
this size.
In addition, the lack of education of medical
staff prevents CT from being systematically
used in major pelvic injuries. “A lot
of trauma is managed by junior surgeons
who only know the Advanced Trauma Life
Support (ATLS) standards, which are obsolete
for any major trauma centre. Surgeons
should be more knowledgeable than that,”
explained Barron, who is also an ATLS
instructor.
He also points out that emergency physicians
don’t read the emergency literature but
only the ATLS manual. Sometimes, it is also
a lack of understanding from the ED that is
to blame. “They wait too long before they
send us a patient for CT, or they won’t send
us an unstable patient, when they should,”
he said.
At MGH, collaboration runs smoothly
thanks to regular communication through
monthly meetings, where radiologists and
emergency physicians discuss changes
and initiatives, explained Novelline, who
is Director of Emergency Radiology at the
MGH. What might also help is the presence
of a radiology section directly in the
ED. Two radiologists are working there
24/7, and the section is equipped with two
CT scanners, an MR scanner, an ultrasound
room and three x-ray rooms. “The idea of
placing radiology in the ED is much safer for
the patient. But it is a new trend and most
hospitals still don’t have it,” Novelline said.
Improving the cooperation between radiology
and emergency medicine will be a priority
at ECR 2009, with the initiative ‘ESR
Meets Emergency Physicians’ on March 7.
CTA (CT arteriogram) of a young man injured in a motorcycle
accident who was noted to have decreased right
arm pulses. It shows a right subclavian artery traumatic
occlusion and a right clavicle fracture.
Mini Course:
Advances in CT and
MRI in Major Trauma
MC 119 Head and neck trauma
Friday, March 6,
08:30–10:00, Room N/O
Moderator: K.A. Stringaris; Athens/GR
A. Head
U. Linsenmaier; Munich/DE
B. Facial structures
M. Becker; Geneva/CH
C. Cervical spine
O.C. West; Houston, TX/US
MC 519 Body trauma
Saturday, March 7,
08:30–10:00, Room N/O
Moderator: T. Boehm; Chur/CH
A. Thorax
R.A. Novelline; Boston, MA/US
B. Intraperitoneal structures
K. Shanmuganathan; Baltimore, MD/US
C. Extraperitoneal structures.
M. Scaglione; Castel Volturno/IT
MC 919 Musculoskeletal trauma
Sunday, March 8,
08:30–10:00, Room N/O
Moderator: N. Ramesh; Portlaoise/IE
A. Thoracolumbar spine
D. Weishaupt; Zurich/CH
B. Pelvis and hip
D. Barron; Leeds/UK
C. Extremities
M. Rieger; Innsbruck/AT
39 myESR.org

ESR Newsletter 01/09
E S R M E E T S
E S R M E E T S
ESR meets the
Královské Vinohrady
Hospital in Prague
By Mélisande Rouger
It is a cold day in Prague. But you don’t feel it in the overheated
corridors of the University Hospital Královské Vinohrady –
Fakultní nemocnice Královské Vinohrady in Czech – one of the
three faculty hospitals of the Czech capital.
With 1,400 beds, it is the third biggest hospital in town. It provides
every classic type of hospital care from ophthalmology and
metabolic care to cardiology and trauma. Its plastic surgeons are
particularly renowned, and patients come from across the whole
country to be treated by them.
The Anaesthesiology and Critical Care (ACC) Department, the
Czechs’ equivalent of the emergency department, is nothing like
typical European centres. No administrative desk. No waiting
room. No queuing. No cubicles. Instead, a huge hall with mobile
beds, radiological and respiratory devices, its own operating
room, and an army of freshly graduated doctors and nurses.
“This is the American style. Patients come in here from the street
and we can treat them directly,” explained Professor Jan Pachl,
Director of the ACC Department.
The ACC Department is equipped with 21 beds and dispatches
patients according to the acuteness of their state. Acute emergencies,
generally patients from pre-hospital care transferred
by the Emergency Medical System (EMS), are called primary
admissions. Less serious emergencies and patients from different
departments or hospitals are referred to as secondary admissions.
Reflecting this division, the ACC Department is divided into two
floors. The first floor, which is actually on the street level on the
other side of the hospital, is equipped with ten beds and designed
for short stays – hence no cubicles. Conversely, the third floor
provides more intimacy to the patients who need longer care,
such as chronic diseases sufferers. A unification of the department
is planned for 2012, with financial support from the EU,
which will also enable the building of a helicopter pad on the roof
of the hospital.
On average, the Královské Vinohrady ACC Department provides
emergency care to 800 patients per year (figures from
1998), one half to primary admissions, the other to secondary.
It carries out from 16,000 to 17,000 anaesthesias per year. Classic
critical cases include patients presenting with failing vital
functions, multiple trauma, brain injuries, confusion, epilepsy
episodes, asthma, etc.
Major trauma patients represent an increasing part of the department’s
work. The ACC team treats about 200 major trauma
patients per year, more than 30% of whom have brain injuries.
“We see a lot of car accident victims, many of whom have been
drinking and driving,” said Prof. Pachl.
Trauma will soon become a problem for the hospital if interventional
radiology (IR) doesn’t develop faster, Pachl warns. “We
have a problem finding the people to do that. We should increase
the IR service on the level of standard care,” he said.
“We have no problem providing IR procedures on the standard
level, including vascular procedures such as embolisations,
recanalisations, thrombectomies, thrombolysis, punctions and
drainage. But we are not able to guarantee IR service 24 hours
a day,” said Professor Vaclav Janík, Director of the Radiology
Department.
The first floor of the ACC
Department at University
Hospital Královské Vinohrady.
Prof. Vaclav Janík carrying out
a CT examination close to the
ACC Department.
European Society of Radiology
40

TE OS PR I C M- TE HE TM SE
The hospital lacks experienced personnel: only three fully graduated
interventional radiologists and one IR trainee are currently
working at Královské Vinohrady.
Another burden faced by the hospital is the shortage of nurses.
The ACC Department is, with 90 nurses, an exception. But the
Radiology Department, for instance, employs only three nurses.
Radiology is located on the ground floor but some of its equipment
is already available in the ACC Department. One ceilingmounted
radiographic unit, a mobile radiographic unit, one
C-arm fluorographic unit and one portable US unit (including
Doppler and TEE – transoesophageal – mode) are installed in the
ACC. In addition, a spiral CT scanner is located ten feet away
from the department.
Emergency physicians carry out simple US examinations such as
Doppler, and examinations of the pleural and pericardial fluids. Cardiologists
also perform TEE examinations on their own. But every
other procedure is carried out by a member of the radiological team,
which comprises 19 radiologists, one resident and 37 radiographers.
Emergencies represent about 15% of their workload, Prof. Janík
estimates. In 2008, 2,800 conventional radiological examinations
and 11,000 CT scans were carried out for emergencies alone, out
of 115,000 imaging procedures in total.
countries, is now emerging here as well, but it has yet to be formally
institutionalised.
In the meantime, radiologists and emergency physicians work
together rather smoothly at the Královské Vinohrady Hospital.
“Our cooperation is very good. All emergency physicians, especially
emergency surgeons, obtain all imaging information via
PACS. Moreover we conduct radio-clinical visits with emergency
surgeons every day,” Prof. Janík said.
The impending arrival of modern technology at the hospital will
ease the workflow even more between both specialties. In 2009
a new angiography system will extend IR procedures, and new
MRI equipment will enable cerebral perfusion assessments, as
well as diffusion-weighted MRI.
Prof. Pachl agrees. “With the new equipment coming, cooperation
could improve, for the simple reason that radiologists will
want to stay longer if they have better equipment.”
Another thing that could help things improve further would be
to have a monthly meeting and develop new strategies, he thinks.
Both physicians believe the programme ‘ESR meets Emergency
Physicians’ will help in this sense. “It is an interesting and certainly
valuable initiative, enabling the exchange of experience
between different institutions,” said Prof. Janík.
ESR meets Emergency Physicians
EM 2
Time is life
Saturday, March 7, 16:00–17:30, Room C
Presiding: B. Marincek; Zurich/CH
I.W. McCall; Oswestry/UK
G. Öhlén; Stockholm/SE
• Introduction
B. Marincek; Zurich/CH
G. Öhlén; Stockholm/SE
• Ultrasound as a time-critical diagnostic
tool for the emergency department
P.K. Thompson; Rockhampton, QLD/AU
• The ultrasound issue: Radiologist’s view
G.H. Mostbeck; Vienna/AT
• Overcrowding flow in the emergency
department
M. Cooke; Warwick/UK
• Image triage: Ultrasound, CT or MRI?
P.M. Parizel; Antwerp/BE
• Peripheral arteries: Are drug-eluting stents
the future?
L.B. Schwartz; Chicago, IL/US
• Panel discussion
Things are changing for the Královské Vinohrady Hospital.
Recently, a 128 slice CT scanner and PACS have been installed
in the hospital.
“Sometimes it is good to know how it works in other hospitals,”
Prof. Pachl said. “So maybe I will come and see that myself. After
all, Vienna is not so far away!”
Radiology is adapting itself to new realities in the Czech Republic.
Emergency radiology, a subspecialty recognised in many
The newly installed 128 slice CT
scanner in the Radiology Department.
myESR.org
41 myESR.org

Nobody can look into the future,
but we’re working on it!
Toshiba has a long history of leading innovations and, following the Made for Life
commitment, patients are always the primary focus of our technology innovations.
Like the Vantage Titan. A compact 1.5 Tesla MRI system that combines an ultra short
bore of only 149 cm with a spacious bore diameter of 71 cm. Without compromises
to the scan FOV. Besides the fact that a larger bore can accommodate larger patients,
it also dramaticallly reduces the claustrophobic experienced making it today’s most
patient friendly MRI system.
Large FoV, Non CE-MRA with FATSAT
Convince yourself and visit Toshiba’s satellite lunch symposia on Saturday 7 and
Sunday 8 March 2009 (12.30 - 13.30 hrs) that will show you how we’re working on
the future of Diagnostic Imaging.
Toshiba: Shaping the future of diagnostic imaging!
ULTRASOUND CT MRI X-RAY SERVICES
www.toshiba-medical.eu

E C R 2 0 0 9 P R E V I E W
Tenth anniversary of IMAGINE at ECR 2009
Since 1999, nine high-tech specialty exhibits have underlined the
status of the ECR as a leading conference of advanced technology
to support research and clinical practice within radiology. Following
a successful exhibition in 2008, we are therefore happy to
celebrate the tenth anniversary of IMAGINE at ECR 2009.
IMAGINE 2009 will feature twelve research institutes, university
groups and research departments of industrial companies, who
will present novel and exciting technological developments in the
field of diagnostic and interventional radiology. Focal areas of
IMAGINE are the development of quantitative imaging biomarkers,
computer-aided detection and diagnosis, integrated and
interactive visualisation, therapy planning, image-guided interventions
and robotics, and computer-assisted training. IMAG-
INE 2009 will feature brand new technological developments in
a.o. diagnosis, therapy planning and therapy guidance of cardiovascular
disease, neurological disease and cancer. IMAGINE is
unique, in that it provides a platform to discuss the potential of
these techniques for the near future of radiology, with the people
that are creating them.
Project Group Name Website
AIPG Assoc.Prof. Joachim Kettenbach www.aamir.at; www.mipga.net
Biomedical Imaging Lab Agency for Science,
Technology & Research (A*STAR)
Prof.Dr. Wieslaw L. Nowinski
www.sbic.a-star.edu.sg
Gifu University Prof. Hiroshi Fujita http://fjt.info.gifu-u.ac.jp
Definiens AG Monika Kellner www.definiens.com
DISI, Università degli Studi di Genova Prof. Alessandro Verri www.disi.unige.it
Eindhoven University of Technology Prof.Dr. Bart M. ter Haar Romeny bmia.bmt.tue.nl
ESGAR CTC Assist.Prof. Emanuele Neri www.ct-colonography.org
ETH Zurich Prof.Dr. Gabor Székely www.vision.ee.ethz.ch
MeVis Research GmbH Dr. Guido Prause www.mevis-research.com
Philips Healthcare Dr. Javier Oliván Bescós www.healthcare.philips.com;
www.research.philips.com
University of Freiburg Prof.Dr. Matthias Teschner http://cg.informatik.uni-freiburg.de
VASCOPS Austria Mag. Carmen Gasser www.vascops.com
Our 7 th Annual
ECR Webcast
& eNews Blast
Begins March 6 th
Log-on daily for:
• Business News
Stop By Our
Booth at ECR
#627
Sign-up to
qualify for a
subscription
• Clinical Updates
• Exhibit Highlights
• Expert Insight
& Analysis
Sign-up for the Diagnostic Imaging
eNewsletter for daily news from ECR
Your globally positioned
source for imaging
intelligence.
Go to www.diagnosticimaging.com/ecr2009

ESR Newsletter 04/08
Will I be an artist?
Will I be a doctor?
Will I live to be 100?
Siemens innovative molecular medicine enables early diagnosis
and treatment. Adding years to life, and life to years.
Everyone wants to live a longer, healthier life. Siemens solutions in molecular medicine, laboratory diagnostics and diagnostic
imaging are helping to transform the delivery of patient care. An earlier and more precise diagnosis can lead to care
that is suited not only for a specific problem, but also for a specific patient. Ultimately, personalized health care means
more kids will grow into healthy adults.
www.siemens.com/healthcare +49 69 797 6420
Answers for life.
CC-Z1045-2-7600

E S R T R AV E L S E R V I C E
© Austria Trend Hotel Savoyen Vienna, Style Hotel, Hotel Arcotel Kaiserwasser, Hotel Imperial (3), The Levante Parliament, Hotel Sacher
The ESR Travel Service –
Let Vienna become your second home
The ESR Travel Service is the easiest, fastest and safest way to book your hotel for your stay in Vienna, while allowing you to remain focused on the
Congress. Find the accommodation that suits you best at www.myESR.org/travelservice and feel right at home in the Austrian capital!
Only the ESR Travel Service guarantees you:
• best rates
• breakfast included
• easy online access
• widest choice of rooms
• hotels throughout Vienna
Launched in 2006, the ESR Travel Service has become more and more successful and now offers hundreds of rooms throughout Vienna. From the most
elegant and stylish places to cosy hideaways, from lofty residences to unpretentious private guest houses – the ESR Travel Service provides everybody with
an appropriate selection, and makes sure that each of our delegates have the most pleasant surroundings while attending the ECR.
This service is provided completely free of charge.
Please note that there are dubious platforms and agencies to be found on the internet, offering special rates and rooms which do not exist in the offered
form! Therefore we strongly recommend that you book only via the official ESR Travel Service, which guarantees you safety, respectability, first-class
service, and the best possible rates.
Book your hotel room now at myESR.org/travelservice!
The ESR Travel Service is reserved exclusively for individual bookings. A maximum of 5 rooms can be booked at the same time. For group bookings,
please contact our official partner agency Mondial.
For individual bookings please refer to
ESR Travel Service
Neutorgasse 9
1010 Vienna, Austria
Phone: (+43 1) 533 40 64-0
Fax: (+43 1) 535 70 37
E-mail: travelservice@myESR.org
For group bookings, flights, tickets, etc. please refer to
Mondial Congress – Official Travel Agency
Operngasse 20b
1040 Vienna, Austria
Phone: (+43 1) 588 04-0
Fax: (+43 1) 588 91 85
E-mail: ecr@mondial.at
45 myESR.org

ecause
no two patients
are alike,
we designed
an MR unlike
any other.
The Achieva 3.0T TX automatically adjusts to each patient’s unique anatomy. Proprietary
parallel RF transmission technology tailors signals for enhanced image uniformity, reduced
scan times and improved throughput across a broad
range of clinical applications. Fast, robust and versatile.
It just makes clinical and economic sense. Learn more
at www.philips.com/healthcare.

Celebrate the
200 th anniversary of
Joseph Haydn’s death
This year marks the 200 th anniversary of the death of Joseph Haydn. It may seem paradoxical to speak
of celebrating the anniversary of somebody’s death, but in the case of Joseph Haydn, who was without a
doubt one of the most positive and life-affirming composers of all time, there is no paradox about it.
Everyone who is familiar with Haydn’s Funeral Symphony or La Passione knows that even in these works,
Haydn’s cheerful disposition and irrepressible joie de vivre shines through. HAYDN YEAR 2009 has
been conceived with the goal of giving everyone who visits Burgenland in this year a little of this joie de
vivre to call their own. Haydn wrote nearly as many operas as Giuseppe Verdi. On top of that, he also
composed 107 symphonies, 69 string quartets, 128 baryton-trios and 14 masses. HAYDN YEAR 2009
will make it clear what a universal musical genius Joseph Haydn was. There is an incredible amount to
be discovered in Haydn’s works. But the trip to Burgenland is worth taking not only for the music. The
beautiful landscape, the more relaxed pace of living and the many culinary delights that await guests to
the region are good reasons to visit Haydn’s Burgenland at every season of the year.
Visit www.haydn2009.at and find out more!
© Schloss Esterházy Management

... did you
know?
...
...
...
...
ESR/ECR gives back ...
the ECR’s ‘Invest in the Youth’ Programme will
allow 400 young radiologists to participate
in ECR free of charge, including hotel
accommodation for four nights and free public
transport
approximately 40 scholarships and fellowships
per year worldwide are supported by ESR
current copies of European Radiology are being
sent to radiologists around the world as an
introduction to Europe’s No.1 journal
a new scheme, ‘Radiology – Your Future’,
will bring young Austrian and Swiss medical
students to ECR 2009 for free, to open their
eyes to radiology as a specialty.
myESR.org