The ESR Travel Service - myESR.org

If you could support this many applications,You’d bea star too!The Agfa DRYSTAR TM family of hardcopy imagers offer an exceptional range ofcapabilities for a wide variety of applications. From centralized high-throughput todecentralized table-top, they are a proven choice in facilities worldwide. With thesingle-step process of Agfa’s Direct Digital Imaging technology, DRYSTAR’s solidstateimaging provides long-life and consistent quality. Enhanced by A#Sharp TM ,a standard feature, they provide outstanding image sharpness across multipleapplications. Compact, versatile and offering an excellent price/performance ratio,is it any wonder they call them stars?Come visit Agfa HealthCare at ECR 2009, Expo A, booth nr 103.Agfa and the Agfa rhombus, A#Sharp and DRYSTAR are trademarks of Agfa-Gevaert N.V. or its affiliates. All rights reserved.

Dear Readers,ContentsSince, as you all know, ECR is the flagship of the European Society of Radiology, most of our activitiesrevolve around our annual meeting, making it the centre of our working year. So we have now come full circleonce more because – ECR 2009 is almost here again!Final preparations are well underway; various congress-related media are in pre-production, keeping ourgraphic designers and editorial staff busy; distinguished speakers have been invited for the ECR OpeningPress Conference; press releases are being prepared and contacts rekindled with media representativesfrom all over the world.Gearing up for the biggest technical exhibition ever shown at ECR, provides its very own challenges for theMarketing Department, for which the congress is the crowning point of the well-tended year-round relationswith our industry partners. Booths have been assigned to 280 exhibitors and everyone is looking forwardto 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, sowe 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 artisticscene 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 scientifichighlights from page 28 onwards. There is only one thing left to say – we look forward to welcomingyou to Vienna soon! Have a safe trip everybody.E S R N E W S05 Letter from the President07 Alliance for MRI09 ESOR – European School of Radiology12 EIBIR News15 New articles from European Radiology16 Credit where credits is due: The issue of academic merit19 News from the Radiology Trainees Forum21 Subspecialty Society News23 Congress CalendarYour ESR Newsletter TeamESR NEWSLETTER is an official organ of ESRE C R N E W SESR Executive CouncilIain W. McCall, Oswestry/UKESR PresidentChristian J. Herold, Vienna/ATESR 1 st Vice-PresidentMaximilian F. Reiser, Munich/DEESR 2 nd Vice-PresidentBorut Marincek, Zurich/CHCongress Committee ChairmanMałgorzata Szczerbo-Trojanowska, Lublin/PL1 st Vice-Chairperson of the Congress CommitteeYves Menu, Le Kremlin-Bicêtre/FR2 nd Vice-Chairman of the Congress CommitteeAdrian K. Dixon, Cambridge/UKPublications Committee ChairmanGabriel P. Krestin, Rotterdam/NLResearch Committee ChairmanÉamann Breatnach, Dublin/IEEducation Committee ChairmanLuís Donoso, Sabadell/ESProfessional Organisation Committee ChairmanFred E. Avni, Brussels/BESubspecialties Committee ChairmanGuy Frija, Paris/FRNational Societies Committee ChairmanLuigi Solbiati, Busto Arsizio/ITCommunication & International RelationsCommittee ChairmanAndrás Palkó, Szeged/HUFinance Committee ChairmanPeter Baierl, Vienna/ATExecutive DirectorManaging EditorJulia Patuzzi, Vienna/ATSub-EditorSimon Lee, Vienna/ATContributing WritersMark Bryant, Portsmouth/UKSarah Edwards, Vienna/ATPaula Gould, Holmfirth/UKMonika Hierath, Vienna/ATSimon Lee, Vienna/ATChristiane M. Nyhsen, Sunderland/UKJulia Patuzzi, Vienna/ATMélisande Rouger, Vienna/ATFrances Rylands-Monk, St. Meen Le Grand/FranceMajda Thurnher, Vienna/ATArt DirectionPetra Mühlmann, Vienna/ATLayoutRobert Punz, Vienna/ATMarketing & AdvertisementsErik BarczikE-mail: erik.barczik@myESR.orgContact the Editorial OfficeESR OfficeNeutorgasse 91010 Vienna, AustriaPhone: (+43-1) 533 40 64-16Fax: (+43-1) 533 40 64-441E-mail: communications@myESR.orgESR Newsletter is published 5x per yearISSN 1994-4357Circulation: 15,000Printed by Angerer & Göschl, Vienna 2009Date of printing: January 2009myESR.org27 Heading the summit of science:A portrait of the ECR 2009 Congress President28 ESR meets Switzerland40 ESR meets the Královské Vinohrady Hospital in Prague43 Tenth anniversary of IMAGINE at ECR 200945 ESR Travel Service47 Arts & Culture:Celebrate the 200 th anniversary of Joseph Haydn’s deathE C R 2 0 0 9 – S c i e n c e31 CT lung cancer screening comes under the spotlight32 Spinal Imaging and Intervention at the cutting-edge35 New techniques contribute to improvements in disc pain management37 Intervention experts address pros and cons of drug-eluting stents39 Review advances in CT and MR in major traumaThe Editorial Board, Editors and Contributing Writers make every effort to ensure that no inaccurate or misleading data, opinion or statementappears in this publication. All data and opinions appearing in the articles and advertisements herein are the sole responsibility of the contributoror advertiser concerned. Therefore the Editorial Board, Editors and Contributing Writers and their respective employees accept no liabilitywhatsoever 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

ESRMembership44,259 membersas per November 19, 2008full membership only €10/Yearcorresponding membership for freeYour benefits:REDUCED REGISTRATION RATESfor the European Congress of RadiologyEUROPEAN RADIOLOGY (ONLINE)free access to all articlesEUROPEAN RADIOLOGY (PRINTED VERSION)highly reduced subscription (only €70)ESOR, THE EUROPEAN SCHOOL OF RADIOLOGYactivities exclusively for ESR membersESR NEWSLETTERthe latest developments and news in radiologyFREE EDUCATIONaccess to EPOS TM , EURORAD, EDIPS, eECR, ePACSA VOICE FOR RADIOLOGYrepresentation within the European UnionRADIOLOGY FOR PATIENTSraising public awareness of radiologymyESR.orgMEMBERSHIP

L E T T E R F R O M T H E P R E S I D E N TDear ColleaguesThe ESR is reaching the end of its first yearEuropean Congress of Radiology. Thising the congress. This has already been aas a fully integrated organisation basedis now a global event with almost 18,000great success with family physicians andon individual membership. This year hasparticipants from all continents, withhas resulted in continued dialogue and aseen many new developments, many ofAsia particularly well represented. Thejoint working paper on imaging serviceswhich will take time and hard work to bearcongress is attractive for many reasons,to primary care. This year we are joiningfruit. In particular, a number of subcom-not least the high quality of scientificwith the accident and emergency clini-mittees have been established to addresspapers and presentations from all overcians and we anticipate an excellent ses-key issues. These include the developmentthe world. The educational programmesion and a fruitful outcome.of standards of service to respond to theis comprehensive, imaginative and coversrequirements of the proposed cross-borderhealth services directive and the com-a wide range of expertise from foundationcourses to state of the art series andIt is also important that we deliver radiologyservices efficiently and that we receiveIain W. McCallESR Presidentmunication on telemedicine from the EUfuture developments. The developmentsufficient resources to fulfil the expecta-to ensure that patients receive the sameof the electronic presentation online sys-tions of our patients, and to achieve thesehigh quality service that they would havetem by the congress, and the provision ofobjectives radiologists must work closelyexpected from their own healthcare sys-refresher courses online, have also greatlyand be involved in the management proc-tem when they travel or when their imagesenhanced the value of the congress,ess. In recent congresses satellite sessionsare reported through teleradiology. As theallowing ESR members throughout thehave been run by the European associa-EU is also promoting audit, initially forworld to continue to review the sciencetion of hospital managers but this yearradiation issues but likely to be extendedin the weeks following the congress andthese sessions will be more integrated intomore widely into other areas of radiologi-for their continued professional develop-the main meeting. Professor Marincek,cal care, the radiation and the audit andment throughout the year. The congresswho has done an enormous amount ofstandards subcommittees will be develop-has extended a warm welcome to manywork 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 Viennatant fields. Following the production ofprogramme which has greatly increasedto enjoy this great congress.the ESR’s paper reviewing the status ofthe recognition of progress in radiologymolecular imaging and the present roleworldwide.This is my final contribution to the ESRof radiology, a new subcommittee hasNewsletter as president of your society.been formed to take forward and imple-However, the impact of radiology is feltIt has been a great honour and pleas-ment the recommendations. It is vitallythroughout the patient’s journey and radi-ure to serve the ESR and to see this newimportant for the future of radiology thatologists must have a close working rela-organisation build so successfully on theradiologists play a full part in this excit-tionship with their clinical colleagues andstrengths of its predecessors, the ECR anding multi-disciplinary development. Themake the patients and the public aware ofEAR. Radiology has developed dramati-rapid advances in technology that affecttheir pivotal role. The range and complex-cally over the last 30 years and, if any-radiology considerably have taken placeity of imaging is such that radiologiststhing, the pace of change is quickeningwithout a clear understanding of qualitymust be proactive in organising imagingfurther. A strong ESR is essential for theand interrelationships. The ICT subcom-pathways and in discussion of the resultsfuture of our profession and I thank youmittee is at present addressing these issuesand their clinical implications. The con-for joining us in this endeavour. I wouldto produce guidance for radiologists.gress is now working to enhance our rela-like to thank everyone who has contrib-tionships with our clinical and familyuted so much and in particular the execu-It is fitting however that the year shouldphysician colleagues by inviting them totive and all in the ESR Office for their sup-end with the flagship of the ESR; theparticipate with a dedicated session dur-port over the years.Iain W. McCall, ESR President5 myESR.org

ESR Newsletter 04/08McKesson’s PACS Ensures You ReceiveCritical Information on DemandMcKesson’s PACS gives you the power to improve patient outcomes.The power to access comprehensivepatient data.The power to make better care decisions.The power to perform.Image capture is only part of the equation.The real power lies in sharing and accessingpatient information immediately where youneed it most — at the point of care. Studyinterpretations, diagnosis and care treatmentplans, along with pertinent images, are keyto improving patient outcomes.McKesson’s image-enabled solutions aredesigned for large, academic and regionalhealthcare organizations. The advancedvisualization, workflow and collaborationtool advances the performance of your entirecare team. The result? Better, safer decisionsabout patient care.McKesson is dedicated to delivering highqualityhealthcare solutions that reducecosts, streamline processes, and improvethe quality and safety of patient care.Learn more about our industry-leadingenterprise imaging solutions — HorizonMedical Imaging , Horizon Cardiology and Horizon Study Share .Join us at the European Congress of Radiology(ECR 2009)March 6-10, 2009Expo Extension A BuildingBooth # 009For more information, contact us via e-mailat for.customers@mckesson.com.Copyright © 2009 McKesson Corporation and/or one of its subsidiaries. All rights reserved.

A L L I A N C E F O R M R IAlliance for MRIprepares for a busy 2009By Monika HierathOver the last six months there have been no significantdevelopments in respect of the revisionof EU Physical Agents Directive 2004/40/EC onelectromagnetic fields. The work of the EuropeanCommission and the social partners to preparean amendment will get underway in 2009 andwe look forward to working with the Alliancemembers to ensure that the future of MRI is fullysafeguarded in the forthcoming proposal by theEuropean Commission.Activities of the Alliance for MRI:July–December 2008Meetings with some key stakeholdersThe Alliance has sought to develop informal dialogueswith key stakeholders in view of the preparationof an amendment to the Directive to protectthe future of MRI.MEPs and UnionsMeetings have been held with some key parliamentarians,including Dr. Peter Liese (EPP/DE)who has been supportive and sought clarificationof the scientific detail. We have also met with representativesfrom the Green Party who have raiseda number of concerns on the issue. In addition,informal meetings have been held with the EuropeanFederation of Public Sector Unions (EPSU)to discuss the application of the Directive to MRIworkers.Commissioner Spidla and theCommission servicesA meeting took place on 10th December withCommissioner Spidla. An Alliance delegation ledby Prof. Gabriel Krestin, Mary Baker from TheEuropean Federation of Neurological Associations(EFNA) and Dr. Stephen Keevil met with theCommissioner and his services in order to discussthe revision of the Directive. The Alliance raisedconcerns regarding the timing issues and notablythe likely publication in 2010 of ICNIRP’s guidelineson extremely low frequency (ELF), which, itis supposed, will inform the content of the revisedDirective. The meeting was very constructive andone outcome was the decision to re-establish theMR expert working group to consider the needfor limits in respect of MRI. The Commissioneremphasised that he is currently still investigatingthe various options for review and in principlewelcomed the establishment of social dialogue onthe healthcare part of the directive.Next Steps in 2009:Commissioner Spidla made clear to the Alliancethat he hopes to prepare a solid text for a revisedDirective before the end of his tenure (end 2009).In line with social policy legislation under Article135 of the Treaty, two rounds of consultation willbe undertaken with social partners (i.e. employersand unions) before a proposal is formally adopted.The new Commission will then be in a position toadopt a proposal for an amendment early in 2010.It is envisaged that the text of the amendment,if uncontentious, will then be adopted (underco-decision) by April 2011, allowing one year forimplementation by the Member States prior toApril 2012.Socio-economic impact assessmentof the DirectiveIn line with better regulation requirements, theEuropean Commission has commissioned asocio-economic impact assessment of the Directivewhich will start in January; a preliminaryreport will be produced by September and then afinal report by the end of December 2009.Unusually, due to time constraints, the first consultationwith social partners will be undertakenat the same time as the impact assessment. We aregiven to understand that as a result the AdvisoryCommittee on Safety and Health (ACSH), whichcomprises representatives from the employers,unions and member states, and its EMF WorkingGroup will therefore be in regular contact withthe contractors of the impact assessment report.The report will look into different legislativeoptions for the European Commission to propose.One option is the proposal of new bindinglegislation based on the latest international recommendationswith conditional exemptions forspecific cases. The Alliance supports this optionas it is in line with its position requesting a derogationfor MRI from the scope of the Directive.The Alliance for MRI will seek a meeting with thecontractors appointed to undertake this impactassessment to ensure that the concerns regardingthe impact on MRI are well understood.Key Events• In January 2009 the Scientific Committee onEmerging and Newly Identified Health Risks(SCENIHR), established by DG Health andConsumer Affairs (SANCO) will publish itsreport on electromagnetic fields.• In early 2009, ICNIRP is expected to publish itsrevised Static Field Guidelines.• On 11 and 12 February 2009 DG Sanco and DGEnterprise are co-hosting a workshop on electromagneticfields (http://ec.europa.eu/health/ph_risk/ev_20090211_en.htm). The draft programmedoes not currently include a speaker representingthe Alliance for MRI; however we haverequested that a representative of the MR communitywill be included in the stakeholder panel.• The Swedish Presidency is planning to organisea conference in October 2009 on the future ofthe EU Physical Agents Directive 2004/40/EC.We understand that there will be a panel sessionon medical applications and the Alliance willensure that its position is represented.The Alliance for MRI: Next steps2009 will be a crucial year in the revision processof the Directive. We look forward to cooperationwith all our members and very much welcomesupport for the Alliance’s campaign.Over the next year it will be important to find theappropriate platforms to inform interested partiesabout the future of the Directive and what isat stake for patients and research in Europe.We very much look forward to hearing from youif you have any ideas as to how you can assist us inyour member state or at EU level.Alliance for MRI SecretariatFurther information on the Alliance for MRI isavailable at www.alliance-for-mri.org7 myESR.org

Advancing insight through pioneering imaging solutions-Our vision is to pioneer imaging solutions.Because the needs of your workplace constantly evolve – so do we.We are committed to innovation, to improved efficiency and increasedpatient safety through revolutionary and integrated contrast mediadelivery systems.We are your comprehensive imaging partner – providing advancedsolutions and knowledge to help medical professionals make accuratediagnoses and improve patient outcomes.Covidien Imaging Solutions. [Advancing insight]Visit us at ECR 2009, Vienna, Booth 317 (Expo C lower level)to gain an insight into our innovative and complete rangeof contrast delivery solutions.COVIDIEN, COVIDIEN with Logo and marked brands are trademarks of Covidien AGor an affiliate.© 2009 Covidien AG or an affiliate. All rights reserved.G-ECR-AI/INTLEMEA/01/2009

E S O RESOR looks forward to newopportunities for young radiologists2008 was a very fruitful educational year for the European School of Radiology. One of ESOR’s main goals is to help youngradiologists to obtain the knowledge and skills to fulfil tomorrow’s requirements. With its wide range of activities (seepages 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 thechance to receive training in a pre-selected, highly esteemed reference training centre in Europe.Exchange Programmes for FellowshipsASKLEPIOS Courses 2009 *NEW*This programme offers an opportunity to complement subspecialisationtraining or an existing structured fellowship programme, through exchange,in a particular field of radiology. Throughout a three-month programme thetrainee will be provided with intense modular training and will be supervisedby a specialised tutor in a pre-selected, highly esteemed, academic referencetraining centre in Europe. The programme is aimed at residents in their lastyear of training and/or board certified radiologists within the first two yearsafter certification, who desire to become subspecialist radiologists.Five such programmes per subspecialty will be offered and the successfulapplicants will receive a joint grant from ESR and the relevant subspecialtysociety.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 trainingcentres will be available soon at www.myESR.org/esorFrom 2009 ESOR will organise a new course series under the name‘ASKLEPIOS’.ASKLEPIOS CourseESOR multimodality and multidisciplinary course for general radiologistsand private practitionersSeptember 18–19, 2009Budapest, HungaryThis course is aimed at general radiologists and private practitioners whowant to update their knowledge on technological improvements, new applications,optimised protocols and sequences as well as the most recent achievementsin diagnostic imaging, related to topics across the modalities. Thecourse offers the opportunity to deepen knowledge and skills of state-of-theartapplications of day-to-day practice in radiology and to serve professionaldevelopment by continuing radiological education.The courses are structured in modality-oriented lecture series and interactiverepetition workshops, assigned to internationally renowned Europeanfaculties.Visiting Scholarship ProgrammeThe ESOR Visiting Scholarship Programme offers qualified trainees theopportunity to get to know another training environment, and to kick offan interest for subspecialisation in radiology. Throughout three months oftraining the scholars will be provided with a structured, modular introductionto different subspecialties and will be supervised by a specialised tutorin a pre-selected, highly esteemed academic training centre in Europe. Theprogramme 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 ProtocolsIn partnership with Euromedic International.Asklepios CourseESOR visiting school in RussiaNovember 1–2, 2009Sochi, RussiaThe aim of this course is to help the harmonisation of radiological trainingin Europe, to familiarise participants from Russia and CIS countries withrecent advances and achievements in diagnostic imaging and to establish aninterest for subspecialisation in radiology in the respective area. The courseis structured in organ-oriented lectures and interactive repetition workshops,assigned to internationally renowned European faculties and targeting radiologistsin their last phase of training and board-certified radiologists who areseeking professional development.Further details onthe courses and registrationare available atwww.myESR.org/esorFurther details regarding eligibility, programme structure, application andavailable training centres are available at www.myESR.org/esorIn partnership with Covidien9 myESR.org

ESR Newsletter 04/08 01/09E S O RESOREuropean Schoolof RadiologyAn update on currenttraining programmesand coursesAll ESOR activities are exclusive to ESR members.Further information on the activities of ESORis available on the ESR website myESR.org/esor.GALEN Foundation Courses 2009Abdominal/Urogenital RadiologyMay 14–16, 2009Sofia, BulgariaLocal Organiser: V. HadjidekovOncologic ImagingJune 18–20, 2009Sarajevo, Bosnia & HerzegovinaNeuro/Musculoskeletal RadiologyJune 25–27, 2009Ankara, TurkeyChest/Cardiovascular RadiologyOctober 15–17, 2009Belgrade, SerbiaPaediatric RadiologyNovember 12–14, 2009Athens, GreeceThe courses are aimed at residents in their1 st , 2 nd or 3 rd year of training in radiology.Further details on the courses and registrationare available at www.myesr.org/esor.ForESR MembersonlyGALEN Advanced Courses 2009Musculoskeletal Cross-Sectional ImagingSeptember 4–5, 2009Krakow, PolandLocal Organiser: A. UrbanikAbdominal Cross-Sectional ImagingSeptember 11–12, 2009Latina, ItalyWomen’s Cross-Sectional ImagingOctober 23–24, 2009London, United KingdomCardiac Cross-Sectional ImagingNovember 6–7, 2009Rotterdam, The NetherlandsThe courses are aimed at residents in their4 th or 5 th year of training in radiology andrecently board-certified radiologists.Further details on the courses and registrationare available at www.myesr.org/esor.ForESR MembersonlyAll GALEN courses are kindly supported by GE Healthcare Medical Diagnostics South Central Europe and GE Healthcare.Education in partnershipESMRMB School of MRICourses 2009Reducedfees forESR & ESMRMBMembers• Advanced MR Imaging of the AbdomenDubai/UAE, March 26–28• Applied MR Techniques, Basic CourseIraklion/GR, April 23–25• Advanced Cardiac MR ImagingLeuven/BE, May 14–16• Advanced Neuro Imaging: Diffusion, Perfusion, SpectroscopyBudapest/HU, June 25–27• Advanced MR Imaging in Paediatric RadiologyGenoa/IT, July 2–4• Applied MR Techniques, Advanced CourseGdansk/PL, July 9–11• Advanced Breast & Pelvis MR ImagingLausanne/CH, September 24–26• Advanced MR Imaging of the Musculoskeletal SystemParis/FR, September 24–26• Advanced MR Imaging of the AbdomenCoimbra/PT, October 8–10• Clinical fMRI – Theory and PracticeThessaloniki/GR, October 15–17• Advanced Clinical MR AngiographyDublin/IE, October 22–24• Advanced MRI of the Chest – NEW!Heidelberg/DE, October 29–31• Advanced Head & Neck MR ImagingAlicante/ES, November 5–7• Advanced MR Imaging of the Musculoskeletal System –Spanish LanguageSantiago de Compostela/ES, November 12–14ESNR/ECNR Courses 2009European Course in Diagnostic andInterventional Neuroradiology2 nd Course – 10 th CycleTumoursMarch 20–24, 2009Rome, Italy3 rd Course – 10 th CycleVascular DiseasesOctober 9–13, 2009Tarragona, SpainFurther details on the course and registrationare 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 eitherattended ESMRMB School of MRI Applied MR Techniques Courses orwho have acquired knowledge in MRI techniques from other sources. Inaddition they should have a minimum of 6 months in applied MRI in therelevant field. All courses are in English unless otherwise stated.Further details on the dates, programme and registrationare 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 Radiology10

E S O RAIMS 2009 – AdvancedMultimodality ImagingSeminars in ChinaThe Advanced Imaging Multimodality Seminars are organised inclose cooperation with the Chinese Society of Radiology (CSR). Theprogramme comprises six courses per year, delivered in six differentChinese cities, with European and Chinese speakers carefully selectedby CSR and ESR/ESOR.Spring Seminars on Head and Neck RadiologyApril 26 – SuzhouApril 28 – ShenzhenApril 30 – GuilinSummer Seminars on OncologyJuly 26 – ShenyangJuly 28 – Shi JiazhuangJuly 30 – XianVisiting ScholarshipProgramme (Europe)24 scholarships on various topics will be offered to residents in their3 rd , 4 th or 5 th year of training. Successful applicants will be providedwith a structured modular introduction to different subspecialties fora period of three months in a pre-selected, highly esteemed, academictraining centre in Europe.TOPICS• Abdominal Radiology• Breast Imaging• Cardiac Imaging• Chest Imaging• Musculoskeletal Radiology• Neuroradiology• Urogenital Radiology• PET-CT Protocols• MRI ProtocolsForESR MembersonlyFurther details on application and available training centresare available at www.myESR.org/esor.AIMS, the ESOR Visiting School in China, is made possibleby an unrestricted educational grant from Bracco.In partnership with Bracco.Exchange Programmesfor FellowshipsForESR MembersonlyThe ESOR Exchange Programmes for Fellowships are aimed at residentsin their last year of training and/or board-certified radiologistswithin the first two years after certification. It offers an opportunity tocomplement subspecialisation training or an existing structured fellowshipprogramme in radiology through three months of intense,mentored subspecialty training in a pre-selected, highly esteemedacademic training centre in Europe.Five such programmes per subspecialty will be offered and thesuccessful applicant will receive a joint grant from ESR and therelevant subspecialty society.Visiting ScholarshipProgramme (USA)ForESR MembersonlyOne scholarship on Oncologic Imaging will be offered to residentsin their 3 rd , 4 th or 5 th year of training. The successful applicant will beprovided with a structured modular introduction to oncologic imagingfor a period of three months at the Memorial Sloan-Kettering CancerCenter, New York City.Further details on application are available at www.myESR.org/esor.TOPICS• Abdominal Imaging• Cardiac Imaging• Head and Neck Imaging• Paediatric RadiologyESOR Graz Tutorials 2009The tutorials are organised by the UniversityClinic of Radiology of the Medical University ofGraz and are aimed at participants from central andsouth-eastern European countries.ForESR MembersonlyIn partnership with the European Society of Gastrointestinal andAbdominal Radiology (ESGAR), the European Society of CardiacRadiology (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 atwww.myESR.org/esor.The tutorials are kindly supported by Siemens, Agfa Healthcareand Nycomed.11myESR.org

ESR Newsletter 01/09 04/08E I B IERI B I RThe European Institute forBiomedical Imaging Researchlooks back at a successful 2008Prof. Jürgen HennigEIBIR Scientific DirectorAnother successful year for the European Institute for BiomedicalImaging Research (EIBIR) has drawn to a close andwe are pleased to announce that the Annual Scientific Report2008 is now available and provides an update and review ofthis year’s activities and research projects, as well as detailedinformation on planned activities. The report can be downloadedat www.eibir.org.During the past year, EIBIR’s membership has grown toalmost 240 research institutes with a focus on biomedicalimaging or related disciplines. This number shows that networkingactivities in our specialty are crucial and that EIBIRis on the right track towards establishing itself as a bridgebetween basic and clinical research, technological and pharmacologicaldevelopment.Our goals of creating multi and inter-disciplinary researchenvironments, bringing together medical doctors, physicists,mathematicians, molecular biologists and computerscientists, achieving close co-operation between universitiesand major research centres as well as increasing collaborationbetween imaging specialists and clinicians, are no doubtambitious and require collaboration with the pharmaceuticalindustry, system manufacturers, and information technology.Of course many of our new initiatives would not have beenpossible without the continuous support of the EuropeanSociety of Radiology and our industry partners who subscribedto the mission of EIBIR and have provided financialsupport right from the beginning. We very much regret thatone of our long-standing supporters, Bayer Schering PharmaAG, has withdrawn as an Industry Panel member and welook forward to welcoming new industry members in thenear future. Reduced annual support fees should also enablesmaller companies with an interest in the biomedical imagingfield to become involved in our network.During 2008 we were pleased to officially welcome two neworganisations as co-shareholders of EIBIR – the EuropeanAssociation of Nuclear Medicine (EANM) and the EuropeanFederation of Organisations of Medical Physicists (EFOMP)– and negotiations are also underway with the EuropeanOrganisation for Research and Treatment of Cancer (EORTC)and the European Federation of Societies for Ultrasound inMedicine and Biology (EFSUMB).Co-shareholders are represented at the general meetings ofEIBIR, where major strategic decisions are taken and recommendationsare developed for the other bodies and initiativesof EIBIR. As there are some European organisations that areeager to support and seek cooperation with EIBIR but areunable to commit to formal co-shareholdership, mainly dueto their charity status, we are planning to introduce an additional,less formal form of cooperation with such organisationsunder the umbrella of ‘Friends of EIBIR’. This concept iscurrently being developed and will be launched in early 2009.EIBIR’s four joint initiatives, all developed during 2007, havefurther expanded their activities. The Chemistry Platformhas set up a consortium of Europe’s leading experts in developingsmart agent probes to prepare a project proposal for theEU FP7 health call launched in early September.EuroAIM, the European Network for the Assessment of Imagingin Medicine, has worked on collecting data on assessmentEuropean Society of Radiology12

E I B I Rstudies carried out by EIBIR member institutions in order tohelp investigators find each other and facilitate collaborativeefforts and multicentre studies. In addition, an online surveyon pharmaceutical trials will be launched in December.2008 has seen the onset of two major research projects cofundedby the European Union under the coordination ofEIBIR. ENCITE, the European Network for Cell Imaging andTracking Expertise, is a large-scale collaborative project thataims at developing novel imaging tools that will lead to a betterunderstanding of how cell therapy works, the possibility ofresponse monitoring in patients, and sufficient safety of thetreatment.The other project, HAMAM – Highly Accurate Breast CancerDiagnosis through Integration of Biological Knowledge,Novel Imaging Modalities, and Modelling – has the potentialto strengthen Europe’s leadership in the area of imagebasedbreast cancer diagnosis. Together with two consortia ofEurope’s top experts in the relevant fields, EIBIR submittedtwo new proposals within the EU FP7 programme HEALTHcall in early December.One project deals with the development of smart agentsthat provide maps of values of physico-chemical parameterssuch as pH and pO2 or of specific enzymatic activities. Theobtained maps will be fused with anatomical images to providecompletely new information content that has until nownot been accessible via imaging methods. The second projectfocuses on nuclear medicine and consists of a literature surveyon dosimetry and health effects of diagnostic applicationsof radiopharmaceuticals.You will find a detailed update on the projects in the AnnualScientific Report.Last, but not least, and although still semi-official, it is ourpleasure to inform you about yet another ambitious projectthat is currently in the pipeline and that has received positivefeedback from the panel of evaluators: EIBIR and the EuropeanMolecular Biology Laboratory (EMBL) have submitteda proposal to the European Strategy Forum on ResearchInfrastructures (ESFRI) on establishing a European biomedicalimaging infrastructure – from molecule to patient. Theproject was presented at an ESFRI conference in Versailles inDecember 2008.Don’t forget to check EIBIR’s website, which is currentlyundergoing a facelift, for regular updates on EIBIR’s developmentsand initiatives.We look forward to your active contribution to EIBIR’sactivities and to receiving your ideas for new initiatives andprojects.Yours sincerely,Prof. Gabriel KrestinESR Representative at the EIBIR General MeetingESR Research Committee ChairmanProf. Jürgen HennigEIBIR Scientific DirectorProf. Gabriel KrestinESR Representative at theEIBIR General MeetingDon’t miss out on EIBIR’ssession at ECR 2009Don’t miss out on the EIBIR Session at the upcomingEuropean Congress of Radiology 2009, onSunday, March 8, from 10:30–12:00 (Room Z)to learn about EIBIR’s recent activities and theresults of the ENCITE and HAMAM projects, bothcoordinated by EIBIR. The session is open to allECR 2009 delegates; pre-registration is not required.13myESR.org

E U R O P E A N R A D I O L O G YNew articles fromEuropeanRadiologyA selection by Adrian K. Dixon,Editor-in-ChiefFull-text articles are availableat Springerlink.com and freelyaccessible to members viawww.myESR.org/MyUserAreaThe paper by Dr. Tsai and colleagues from Taiwanhas really demonstrated the way in whichCT has evolved in the last few years. Some yearsago it was argued that mechanical devices wouldcompletely prevent useful diagnostic informationat CT. Nowadays, with less metallic prostheticvalves and better CT equipment, not onlycan the structure of valves be assessed by CT butalso their function. On the online version theimages of the dynamic data are most impressive.Correctness of multi-detector-row computedtomography for diagnosing mechanical prostheticheart valve disorders using operativefindings as a gold standardThe experimental paper from Munich on CTdetection with intestinal bleeding is a usefulpiece of laboratory research which is of greatpractical importance to clinical radiologists. Aclever model was devised which shows that CTreally should be able to detect any bleeding atthe rate of 1ml per minute and that we have afair chance of identifying bleeding at 0.10 and0.50ml per minute. Such experimental data helpmove the emphasis of the imaging in bleeding(in any part of the body) to CT rather than angiography,reserving angiography for localisedtherapy of a known bleeding point.Evaluation of dual-phase multi-detector-rowCT for detection of intestinal bleeding using anexperimental bowel modelThe review article from Alexander Bankier andcolleagues from Harvard on CT of pulmonaryemphysema is a very useful account which willhelp general radiologists understand the latesttheories about emphysema and how CT is essentialfor the classification of the sub types. Indeedit could be argued that CT is now taking overfrom pathology in the assessment of emphysema– and numerous other conditions.CT of pulmonary emphysema – current status,challenges, and future directionsTsai IC, Lin YK, Chang Y, Fu YC, Wang CC, HsiehSR, Wei HJ, Tsai HW, Jan SL, Wang KY, Chen MC,Chen CCDobritz M, Engels HP, Schneider A, Wieder H,Feussner H, Rummeny EJ, Stollfuss JCLitmanovich D, Boiselle PM, Bankier AADOI 10.1007/s00330-008-1232-2DOI 10.1007/s00330-008-1205-5DOI 10.1007/s00330-008-1186-4A 19070A 19070EuropeanRadiologyThe official journal of the European Society of RadiologyEuropeanRadiologyVol 18 / No 10 / October 2008The official journal of the European Society of RadiologyVol 19 / No 1 / January 2009Abstract:The purpose was to compare the findings ofmulti-detector computed tomography (MDCT)in prosthetic valve disorders using the operativefindings as a gold standard. In a 3-year period,we prospectively enrolled 25 patients with 31prosthetic heart valves. MDCT and transthoracicechocardiography (TTE) were done to evaluatepannus formation, prosthetic valve dysfunction,suture loosening (paravalvular leak) and pseudoaneurysmformation. Patients indicated forsurgery received an operation within 1 week. TheMDCT findings were compared with the operativefindings. One patient with a Björk-Shileyvalve could not be evaluated by MDCT due to asevere beam-hardening artifact; thus, the exclusionrate for MDCT was 3.2% (1/31). Prostheticvalve disorders were suspected in 12 patients byeither MDCT or TTE. Six patients received anoperation that included three redo aortic valvereplacements; two redo mitral replacementsand one Amplatzer ductal occluder occlusionof a mitral paravalvular leak. The concordanceof MDCT for diagnosing and localizing prostheticvalve disorders and the surgical findingswas 100%. Except for images impaired by severebeam-hardening artifacts, MDCT provides excellentdelineation of prosthetic valve disorders.Abstract:To evaluate dual-phase multi-detector-row computedtomography (MDCT) in the detection ofintestinal bleeding using an experimental bowelmodel and varying bleeding velocities. The modelconsisted of a high pressure injector tube with asingle perforation (1 mm) placed in 10-m-longsmall bowel of a pig. The bowel was filled withwater/contrast solution of 30–40 HU and wasincorporated in a phantom model containingvegetable oil to simulate mesenteric fat. Intestinalbleeding in different locations and bleedingvelocities varying from zero to 1 ml/min (0.05 ml/min increments, constant bleeding duration of 20s) was simulated. Nineteen complete datasets inarterial and portal-venous phase using increasingbleeding velocities, and seven negative controlswere measured using a 64 MDCT (3-mm slicethickness, 1.5-mm reconstruction increment).Three radiologists blinded to the experimentalsettings evaluated the datasets in a randomorder. The likelihood for intestinal bleeding wasassessed using a 5-point scale with subsequentROC analysis. The sensitivity to detect bleedingwas 0.44 for a bleeding velocity of 0.10–0.50 ml/min and 0.97 for 0.55–1.00 ml/min. The specificitywas 1.00. The area under the curve was calculatedto be 0.73, 0.88 and 0.89 for reader 1, 2and 3, respectively. Dual-phase MDCT provideshigh sensitivity and specificity in the detectionof intestinal bleeding with bleeding velocitiesof 0.5–1.0 ml/min. Therefore, MDCT should beconsidered as a primary diagnostic technique inthe management of patients with suspected intestinalbleeding.Abstract:Pulmonary emphysema is characterized by irreversibledestruction of lung parenchyma. Emphysemais a major contributor to chronic obstructivepulmonary disease (COPD), which by itselfis a major cause of morbidity and mortality in thewestern world. Computed tomography (CT) isan established method for the in-vivo analysis ofemphysema. This review first details the pathologicalbasis of emphysema and shows how the subtypesof emphysema can be characterized by CT.The review then shows how CT is used to quantifyemphysema, and describes the requirementsand foundations for quantification to be accurate.Finally, the review discusses new challenges andtheir potential solution, notably focused on multidetector-rowCT, and emphasizes the open questionsthat future research on CT of pulmonaryemphysema will have to address.Keywords:Multi-detector-row CT | Computed tomography |Prosthetic valve | Echocardiography | MechanicalvalveKeywords:Computed tomography | Abdominal imaging |Intestinal bleedingKeywords:Emphysema | CT | Quantification | Density |COPD15 myESR.org

ESR Newsletter 01/09E U R O P E A N R A D I O L O G YCredit where credit is due:The issue of academic meritBy Sarah EdwardsResearchers have an ethical obligation to carry outresearch with integrity and report their results withhonesty. European Radiology, the leading Europeanradiological journal, advocates publication practicesthat promote ethical and responsible research. Tothis end, the journal and its current Editor-in-Chief,Prof. Adrian Dixon, strive to consistently publish outstanding,accurate and relevant research results thatthe scientific community can rely and build upon. Inlight of the problem of research fraud, traditionallyseen as something of a taboo subject, there is an evermore pressing need to draw attention to good practiceguidelines and potential pitfalls to be aware of whendoing research. The most common forms of scientificmisconduct are: plagiarism (misappropriation ofwords or ideas), data fabrication/falsification (intentionalalteration of research processes and results,image manipulation), data duplication (submitting asimilar manuscript to a different journal with a differentreadership) and gift authorship (co-authorshipawarded to a person with no or little involvement inthe research process). It is a justifiable goal, therefore,to explore preventive measures that help minimise therisk of authorship disputes arising at a later stage.Author or Contributor?The listing of individuals as authors of a researchstudy may have far-reaching academic, financial andsocial implications. Although each journal has its ownpolicies on authorship credit, there are some basicguidelines that are common across the entire field ofbiomedical scholarly publishing. The InternationalCommittee of Medical Journal Editors (ICMJE) providespractical guidance to assist researchers in thepreparation of manuscripts.It must first be noted that authorship is not synonymouswith contributorship. An author deservesauthorship credit if he/she has substantially contributedto a study under consideration for publication.To qualify as an author, one must have made a substantiveintellectual contribution to a) conceptionand design of a study; b) acquisition and analysis ofdata, c) drafting and critically revising the paper forits intellectual content and d) giving final approval ofthe version to be published. Each individual listed asan author must meet all four conditions.The Committee on Publication Ethics (COPE) havedeveloped a rule of thumb for determining contributionsthat merit authorship. If there is no portionor specific task of a study that can be attributed to aparticular participant, then this individual does notmeet the requirements for authorship. Each individuallisted as an author should be able to accept publicresponsibility for appropriate portions of any manuscripton which their name appears. “Merely providingthe equipment does not merit authorship unlessthere is also intellectual support for the paper,” saysEditor-in-Chief Prof. Adrian Dixon.Contributorship, on the contrary, applies in cases whereclear attribution of content fails and authorship criteriaare not met in full. Contributorship credit can dulybe given to someone for acquisition of funding, supervisionof the research process or technical aspects ofdata collection. Participating investigators, providedthat they fully meet the criteria set for contributorship,may be listed in acknowledgments. However, the functionand nature of the respective contributions mustbe specified. It is considered good practice to obtainwritten permission from any participants you wish toacknowledge. All other collaborators should also benamed in the acknowledgments section, which is specificallydesigned for the disclosure of funding sources,research grants and material support (e.g. technicalassistance, data analysis) for the research study. It isessential to start discussing authorship before commencingresearch. Individual contributions should thenbe assessed according to the criteria set out by COPE,whose guidelines cover ethical, editorial and publishingissues with regard to manuscript preparation.European Radiology journal policy on authorshipcredit 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 beable to stand up in public and present an abstract onthat paper without any preparation.” Consequently,it is ethically unacceptable for researchers to awardauthorship out of politeness, regardless of individualinput. “Being Head of Department should not meanautomatic authorship of every paper performed inthat Department,” says Prof. Dixon, who is keen tostress that there is now increasing scrutiny about giftauthorship and the publication of duplicate material.The Radiological Society of North America (RSNA)recently hosted a meeting in Boston at which radiologyjournal editors discussed publication ethics. Themain points on the agenda were issues such as duplicatepublication, plagiarism of sentences or paragraphsand possible sanctions in confirmed cases ofscientific misconduct.Following the Spirit of Ethical ResearchWhen asked about the specific authorship problemsthat journal editors are currently concerned with,European Radiology’s Prof. Dixon mentioned theissue of ‘salami publication’ (also known as ‘salamislicing’). The term describes the practice of re-usingone’s own previously published material. ‘Salamipublication’ typically involves the publication of twoor more scientific papers covering the same methods,hypothesis, population or patient data; researchdata from a single research study are sliced into manypieces, and separate manuscripts created from eachpiece. Duplicate publication occurs where there is anapproximate two-thirds overlap of data. Sometimes,‘salami slicing’ results in data duplication.Prof. Dixon explains that salami publication is a difficultissue to make a judgement about. “Occasionallyparagraphs have been ‘lifted’ from other papersand reviewers sometimes bring this to our attention.There are increasingly sophisticated software packageswhich allow recognition of such duplication.”Although peer review is a very effective method ofdetecting breaches of academic integrity, cases ofscientific misconduct are not always easily identified.“A more difficult problem is whether publicationof a new paper with 50 patients is warranted if theauthors have already described the findings of theirfirst 20, especially if the original 20 are included in theEuropean Society of Radiology16

E U R O P E A N R A D I O L O G YC 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 RGWhat to do if you suspect redundant (duplicate) publication(a) Suspected redundant publication in a submitted manuscriptReviewer informs editor about redundant publicationThank reviewer and say you plan to investigateGet full documentary evidence if not already providedNote: The instructions to authorsshould state the journal’s policy onredundant publicationAsking authors to sign a statementor tick a box may be helpful insubsequent investigationsCheck degree of overlap/redundancyMajor overlap/redundancy (i.e. based onsame data with identical or very similarfindings and/orevidence authors have sought to hideredundancy, e.g. by changing title,author order or not citing previous papers)Contact corresponding author inwriting, ideally enclosing signedauthorship statement (or coverletter) stating that submitted workhas not been published elsewhereand documentary evidence ofduplicationAuthor responds No responseUnsatisfactoryexplanation/admitsguiltConsider informingauthor’s superiorand/or personresponsible forresearch governanceSatisfactoryexplanation (honesterror/journalinstructionsunclear/very juniorresearcher)Write to author (all authors ifpossible) rejecting submission,explaining position and expectedfuture behaviourAttempt to contact all otherauthors (checkMedline/Google for emails)Inform author(s)of your action‘new’ 50! Ideally there must be a new message in thepaper, or very much improved results,” he advises.Likewise, publishing one’s own previous academicwork in part or in a foreign language journal is notacceptable unless fully acknowledged and agreedwith both editors. Of course, it can be very difficultto explain a complex technique in an entirely new wayMinor overlap with some elementof redundancy or legitimate reanalysis(e.g. sub-group/extendedfollow-up/discussion aimed atdifferent audience)No responseContact author in neutralterms/expressingdisappointment/explaining journal’spositionExplain that secondary papers mustrefer to originalRequest missing reference to originaland/or remove overlapping materialProceed with reviewInform reviewer ofoutcome/actionContact author’s institution requesting your concern ispassed to author’s superior and/or personresponsible for research governanceTry to obtain acknowledgement of your letterWrite to author (all authors ifpossible) rejecting submission,explaining position and expectedfuture behaviourInform reviewer ofoutcome/actionIf no response,keep contactinginstitution every3–6 monthsNo significantoverlapDiscuss withreviewerProceedwith reviewNote: ICMJE advisesthat translations areacceptable but MUSTreference the originaland certain technical paragraphs have to be duplicated.European Radiology places very high importanceon the proper use of source material. Authorsare expected to give full acknowledgment to previouslypublished papers cited in their new submission(e.g. publication in a national scientific journal, conferencepaper, or electronic media) so that the editoris aware of any previous work done by the authors inthis area. This is very important as it will help preventinadvertent replication. In 2006,COPE published a series of flowchartsguiding journal editorsthrough the steps of due processin dealing with cases of suspectedscientific misconduct.Our advice for authors is tocarefully read the Instructionsfor Authors published onour website before submittingtheir paper and to take veryseriously the Conflict of Intereststatement. Be mindful notto award authorship to individualswho do not expresslyqualify as authors of the submittedpaper. Do not allowyour name to appear onpapers that you know too littleabout. To prevent authorshipdisputes, always provideenough information aboutthe co-authors’ respectiveroles in the research processand their contributions tothat particular publication.Compliance with authorshipcriteria establishesaccountability, credit andresponsibility for scientificdata reported in medicalpublications. When doingresearch, remember tonever leave unresolved the question of type, quantityand quality of individual contributions to your studyas a whole. In case of doubt, consult our journal’spolicy on authorship via the link given below or contactour editorial staff who will be happy to assist withyour query.office@european-radiology.org17 myESR.org

Faced with more challenges and economic scrutiny,your department needs a strategic medical imagingsolution. You want an easy to use solution that isalso simple to implement and expand. You wanteverywhere access to advanced clinical workflows.You want to communicate clinical results throughoutyour enterprise. You want support. Always.Advanced visualization has changed.Advanced visualization software for the life of your enterprise.www.vitalimages.com

R A D I O L O G Y T R A I N E E S F O R U MNews from theRadiology Trainees ForumAn Englishman in Zurich –another successful visitwithin the RTF exchange programmeBy Mark Bryant, Portsmouth/UKThe RTF cordially invitesyou to the ECR!By Christiane Nyhsen, RTF ChairIn November last year I was fortunate to have the opportunity to visit Switzerland fora 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 onmy 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 stationand 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 roomin the very comfortable hospital accommodation. Staying in the hospital meant it waseasy to make the early start of 8am, although that is late by Czech standards, it seemsfrom reading Christiane’s recent report!I had few preconceived ideas as to what to expect, so it was to my surprise that manyfeatures mirrored those in Portsmouth (England) where I work. The population itserves and the size of hospital were very similar, but what made it easier to fit in andunderstand the functioning of the department was that the PACS, CT and MRI systemswere the same. Dr. Harald Haueisen was my guide for the week and showed me thedepartment and introduced me to the team. Everyone was very welcoming and happyto let me batter them with my stuttering Deutsch.What struck me first was the ambience in the department, created by newly decoratedx-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 interestingto see some new procedures, in particular CT-guided facet joint injection and nerveroot stimulation, neither of which we perform in our centre in England. I was lucky tobe able to perform two root stimulations myself and was given the presentation documentsso that we could look into doing the same in Portsmouth.What impressed me the most was how social the department was and how that helpedall to run smoothly. I had heard that some hierarchical systems were only beneficialfor those at the top, but this was not the case. The team would have lunch together, hadrelaxed daily lunchtime teaching sessions and would always help each other out. EveryFriday lunchtime there is a special social break when everyone goes for coffee togetherjust to chat. This is such a good idea. Sadly I cannot envision that happening where Iwork; the pressure of work seems too great, though I believe a lot of good can comefrom 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 itwas lovely to meet his family, but little did I know that I was there to bake! I am nowan expert at cheese puff aperitifs. After a few rounds of dice later in the evening theyalmost let the Englishman win; I was lucky to come a close second. On the last eveningmany of us, including residents and the boss went to a talk on contrast media, whichwas part of a retirement event for a well known Professor. He highlighted the demise ofNSF as more people are aware of it and take appropriate precautions. The champagneand canapés were also most welcome!With the RTF exchange scheme in its infancy, I encourage anyone who would like tovisit 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 harderto get the time when you are working full time.I would like to take the opportunity to wholeheartedly thank everyone in the RadiologyAbteilung at Kantonsspital Aarau for making me so welcome, and repeat my openoffer 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 representativefrom each European member society of the ESR. It is therefore not possibleto ‘join’ the RTF as such, but please do take part in the activities we offer at ECR andbeyond. Further details can be found on the ESR website (we can currently be foundunder 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 ofthe RTF executive board (we try to be there as much as possible during breaks) as wellas 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 fortrainees. We are delighted to firstly welcome Prof E.J. Stern from Seattle, US, who willgive us his best advice on how to get your paper published with his lecture ‘Top 10 mistakesof 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 at2am and we all know the feeling of sitting in CT with some impatient surgeons breathingdown our neck! As a trainee this can be intimidating, and making decisions quicklyis a challenge. This lecture may help you!And lastly Dr E.R. Ranschaert from ‘s-Hertogenbosch, NL, will show us how to navigatethe net, with ‘Online radiology resources: Top 10 teaching websites and how tofind them’. The internet is a vast and very useful medium, but is also crowded withoften useless and potentially inaccurate information. I am looking forward to gettingsome expert advice! But this is not all we offer during the Highlighted Lectures (pleaseread 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 thebeginning. After each of the three presentations, one book will be given away to a luckywinner. 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 traineesis a well established feature of the congress! Therefore we are delighted and gratefulthat GE is again prepared to sponsor this event (unfortunately the number will remainrestricted to 250 due to cost constraints – we did ask!). To get your free ticket, pleasecome along to the RTF booth. We will hand out one ticket per person no earlier thanFriday during the ECR. The tickets have to be stamped at the GE stand. Do not leave ittoo late or you may not be able to join in the fun!RTF General AssemblyThe RTF has one general assembly per year, which will be taking place on Sunday duringthe 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 tocome along …I look forward to seeing you in Vienna!19RTFINFO CORNER

ONEINTRODUCING SuperPACS ARCHITECTURE. Now you can synchronize disparate PACSsystems using your existing infrastructure within a multi-site healthcare network, providingyou 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 advancedclinical 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 SESGAR – European Society ofGastrointestinal andAbdominal RadiologyESGAR 2009 – 20 th Anniversary Annual MeetingJune 23–26, 2009Valencia, SpainOnline registration is possible until May 29, 20093 rd ESGAR Image-Guided Ablation Workshop 2009March 25–26, 2009University College Hospital, London, United KingdomOrganiser: A. GillamsThe programme and further details are available online.Registration is possible until March 12, 2009!4 th ESGAR LIVER IMAGING WORKSHOPMay 7–9, 2009Verona, ItalyOrganiser: R. ManfrediThe programme and further details are available online.Registration deadline is April 6, 2009Visit the ESGAR website for updates and further details.www.esgar.orgESMRMB 200926 th Annual Scientific Meeting in AntalyaExperience an extraordinary scientific meeting on the TurkishMediterranean coast!The meeting will be held from October 1–3, 2009 at the MaritimPine Beach Resort in Belek-Antalya, Turkey, again offering a 3-dayeducational and scientific programme for clinicians and scientists.As an incentive for participation and submission of their work, student/residentmembers of ESMRMB will enjoy another year freeadvanced registration.Abstract Submission and registration for the ESMRMB 2009Congress is online now.www.esmrmb.orgNEW in 2009: ESMRMB Hands-On MRI CoursesESMRMB is proud to introduce its new Hands-On MRI programmededicated to the continuing education of MRI technologists aswell as physicians with a special interest in the field of MRI. EachHands-On course will be performed on MRI equipment from a specificmanufacturer. Hands-on training will cover at least 50% ofthe available time and will include data-acquisition as well as datapost-processing.Three Hands-On MRI Courses will be held in 2009:MR Angiography on Siemens equipment, Basel/CHMay 14–16Cardiac MRI on Philips equipment, Bonn/DEOctober 15–17fMRI & DTI on GE equipment, Rotterdam/NLNovember 5–7ESSR – European Societyof Musculoskeletal RadiologyMembership 2009 now onlineApply now for ESSR membership for 2009! The society’s membershipis open to all European radiologists who have a primaryinterest in musculoskeletal radiology.Membership Fee: €60.00Eastern Europe Fee: €40.00ESSR Members not only have the chance to get reduced registrationfees for the annual meeting of the society, but will also receivespecial subscription rates for Skeletal Radiology and/or Seminarsin Musculoskeletal Imaging. Additionally, members will receive ane-newsletter with relevant information on the congress as well ason 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 orcontact office@essr.orgESUR – The EuropeanSociety of Urogenital RadiologyFollowing a successful meeting in the Bavarian capital of Munich,ESUR’s next annual symposium will be held in majestic Athens, oneof the oldest cities in the world. From September 10 to 13, 2009,ESUR’s 16 th uroradiology symposium will entertain the topic ‘UrogenitalManifestations of Systemic Diseases.Please visit www.esur.org or www.esur2009.org for more detailson registration and abstract submission. Dr. George Malachias andhis local team are looking forward to greeting you on the peninsulaof Attica in 2009!For questions and feedback, contact us any time viaESURsecretary@ecr.orgEuroPACS – European Societyfor the Promotion of Picturerchiving and CommunicationSystems in MedicineFollowing an extremely successful joint congress with CARS (ComputerAssisted Radiology and Surgery) in Barcelona this summer,EuroPACS will again hold a joint meeting with CARS in 2009 andwill 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.orgEuropean Society ofCardiac RadiologyMembership 2009The ESCR membership application system has just gone onlinefor 2009 and the number of members has already increased byalmost 300%!Dynamic Progress – Increasing Possibilities. Be part of it!ESCR 2009October 8–10, 2009Leipzig/DEEuropean Society ofBreast Imaging2009 CongressRegistration onlineRegistration has already gone online for the forthcoming EUSOBIannual scientific meeting on March 5, 2009 in the Austria CenterVienna.In order to register for the EUSOBI Annual Scientific Meeting at alower rate, take the opportunity to become a member of EUSOBIfor 2009!For more information on the final programme as well as the benefitsof membership, please visit our website www.eusobi.org orcontact office@eusobi.org.We very much look forward to welcoming you to Vienna in March.GEST 2009EuropeApril 15–18, 2009Paris/FRThe Global Embolization Symposium and Technologies 2009 EuropeMeeting will cover all areas of embolisation and include highlyfocused plenary lectures, hands-on workshops, training courses andbasic materials sessions on radioembolisation, neurointerventionaltherapies, tumour therapy, trauma, visceral artery and venousinterventions, paediatric and women’s health, aortic disease, vascularmalformations, gastrointestinal bleeding, liver disease, nonvascularprocedures, cell-based therapies and many more.Honorary Doctorate for a PioneerOn January 23, Prof. Dr. Willi A. Kalender, Director of the Institutefor Medical Physics at the University of Erlangen-Nürnberg, wasawarded honorary doctorate of the RWTH Aachen University, Germany.With this academic degree and the dignity of an honorarymedical doctorate, Prof. Kalender is acknowledged for his uniqueachievements as pioneer in multidetector spinal CT.The laudatory speech was held by Prof. Dr. Rolf Günther, Director ofthe Dept. of Diagnostic Radiology at the RWTH Aachen University andECR 2000 Congress President.The European Society of Radiology expresses its most sincere congratulationsto Prof. Kalender, one of its longstanding and meritoriousmembers.Visit www.esmrmb.org for more information and registration.www.escr.org21 myESR.org

IopromideUltravist ®New Bayer Schering Pharma boothlocation at Extension EXPO A, No. 11The Well-Balanced Contrast Medium0 With the right mix of osmolality, viscosityand iodine concentration, Ultravist® deliversthe right contrast for consistently highquality imaging resultsULTRAVIST® 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 incomputerised 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. Hearingdisorders. • 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, bodytemperature 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 tothe 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, injectionsite 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 undesirableeffects 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 increasethe 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 occlusionor 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 generalstate 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 (includingcrystals) 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 RESR Congress CalendarFebruary 2009 – May 2009This 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 Outlookand 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 WebsiteFebruary 200913.2.–15.2.2009 7. Davoser Tage Davos Switzerland General Radiology www.davosertage.ch14.2.–17.2.2009 Luxor Breast Imaging & Beyond A New Era in Breast Imaging Luxor & Aswan Egypt Breast www.medifinecorp.com15.2.–20.2.2009 Optimizing Practices and Workflow in Body Imaging Kona (Kamuela), HI United States Abdominal Viscera http://radiology.ucsf.edu16.2.–20.2.2009 24 th Annual Winter Cross-sectional Imaging Conference Panama City Panama General Radiology http://www.uphs.upenn.edu16.2.–20.1.2009 ERASMUS COURSE Head & Neck MRI Vienna Austria Head and Neck www.emricourse.org19.2.–21.2.2009 9 th Annual MR Advances in Neuroradiology and Sports Medicine Imaging Lake Tahoe, CA United States Magnetic Resonance http://radiologycme.stanford.edu23.2.–24.2.2009 ESGAR/GE Doctor to Doctor Training on CT-Colonography Buc France Gastrointestinal Tract www.esgar.orgMarch 200901.03.–06.03.2009 Radiology Resident Review San Francisco, CA United States General Radiology www.radiology.ucsf.edu04.03.–07.03.2009 10 th Annual Advances in Breast Imaging and Intervention Las Vegas, NV United States Breast www.radiologycme.stanford.edu06.03.–10.03.2009 ECR 2009 – 21 st European Congress of Radiology Vienna Austria General Radiology www.myESR.org16.03.–19.03.2009 Neonatal ultrasound course. Why, how and when an ultrasound image Florence Italy Ultrasound23.03.–27.03.2009 Clinical Imaging Essentials in Deer Valley Deer Valley, UT United States General Radiology www.med.nyu.edu23.03.–27.03.2009 17 th Annual Diagnostic Imaging Update on Maui Maui, HI United States General Radiology www.radiologycme.stanford.edu25.03.–26.03.2009 3 rd ESGAR Image-guided Ablation Workshop London United Kingdom Gastrointestinal Tract www.esgar.org27.03.–30.03.2009 Cardiac CT in San Juan San Juan Puerto Rico Cardiac www.uphs.upenn.edu28.03.–28.03.2009 Kurs zur Aktualisierung der Fachkunde Strahlenschutz Munich Germany Radiographers www.fachkunde-strahlenschutz.de29.3.–1.4.2009 Breast MRI & Advanced Mammographic Techniques San Juan Puerto Rico Breast http://www.uphs.upenn.eduApril 20094.4.–7.4.2009 Charing Cross International Symposium 2009 London United Kingdom Vascular www.cxsymposium.com15.4.–18.4.2009 GEST 2009 Meeting Europe Paris France Interventional Radiology www.gest2009.eu16.4.–19.4.2009 68 th Annual Meeting of Japan Radiological Society Yokohama Japan General Radiology www.radiology.jp21.4.–24.4.2009 2 nd PAARS – Pan Arab Radiology Congress Alexandria Egypt General Radiology www.parcalex.com22.4.–24.4.2009 VISAR 2009 6 th Vienna Interdisciplinary Symposium on Aortic Repair Vienna Austria Cardiac www.visar.at26.4.–26.4.2009 ESOR Advanced Imaging Multimodality Seminars Suzhou China Head and Neck www.myESR.org/esor26.4.–29.4.2009 Reaching Out: The Breast Cource 2009 Nice France Breast www.thebreastpractices.com27.4.–28.4.2009 ESGAR/GE Doctor to Doctor Training on CT-Colonography Buc France Gastrointestinal Tract www.esgar.org28.4.–28.4.2009 ESOR Advanced Imaging Multimodality Seminars Shengzheng China Head and Neck www.myESR.org/esor28.4.–1.5.2009 25 th Iranian Congress of Radiology Tehran Iran General Radiology www.icr2009.ir30.4.–30.4.2009 ESOR Advanced Imaging Multimodality Seminars Guilin China Head and Neck www.myESR.org/esorMay 20097.5.–9.5.2009 4 th ESGAR Liver Imaging Workshop Verona Italy Gastrointestinal Tract www.esgar.org8.5.–10.5.2009 5 th Annual CT Coros Teaching Course and 1 st CMR Level 1 Course Singapore Singapore Cardiac www.cardiaccttc-cmr.com.sg14.5.–16.5.2009 ESMRMB – Hands-On MRI – MR Angiography Basel Switzerland Magnetic and Resonance www.esmrmb.org14.5.–16.5.2009 GALEN Foundation Course on Abdominal/Urogenital Radiology Sofia Bulgaria Abdominal Viscera www.myESR.org/esor19.5.–22.5.2009 11 th Annual International Symposium on Multidetector-Row CT San Francisco, CA United States Computed Tomography http://radiologycme.stanford.edu20.5.–23.5.2009 DRK 2009 – 90. Deutscher Röntgenkongress Berlin Germany General Radiolgy www.roentgenkongress.de25.5.–27.5.2009 Hepatocellular Carcinoma Updates in Diagnosis and Therapy Ravello (SA) Italy Oncology www.ecografiainterventistica.it27.5.–29.5.2009 II Congreso Cubano de Imagenología Havana Cuba Interventional Radiology http://www.sld.cu28.5.–29.5.2009 Pathway to Excellence: Interventional Radiology Fellows Conference San Francisco, CA United States Interventional Radiology http://radiologycme.stanford.edu31.5.–2.6.2009 2 nd World Congress of Thoracic Imaging and Diagnosis in Chest Disease Valencia Spain Chest www.2wcti.org23 myESR.org

Onward and Upwardin MRIOptimizingContrast Enhancement in:MRI of the CNSMRABreast MRIMinimizing risk during MRIproceduresSaturdayMarch 710:30-12:00room PBracco SatelliteSymposiaSundayMarch 812:30-13:30room RHow to make your CTexam safer and moreeffective?Patients with chronickidney disease: minimizinthe risk of contrast-inducednephropathyOptimizing contrastenhancement in CT:a) Patient variablesb) Scanner variablesc) Contrast variablesSundayMarch 810:30-12:00room PNew breakthroughsin Contrast EnhancedUltrasound: Clinicaldata andtechnologicaldevelopmentsThe clinical benefit of CEUSin General imagingClinical benefit of ContrastEnhanced Ultrasoundin intra-operative ultrasoundNew perspectives 3Dcontrast imagingwww.bracco.com

ECRNews01/09

GE HealthcareIsosmolar Visipaque:Strong evidence 1-12Visipaque, at all iodine concentrations, is the onlycontrast medium available for intravascular use withosmolality equal to blood.We look forward to welcoming you to our exhibitionstand and symposium in Vienna to find out more aboutthe about benefits the benefits offered offered by isosmolar by isosmolar Visipaque VisipaqueRenal tolerability 1-4CardiacPatientsafety 4-6 comfort 7-12PRESCRIBING INFORMATION VISIPAQUE iodixanolPlease refer to full national Summary of Product Characteristics (SPC) before prescribing. Indications andapprovals may vary in different countries. Further information available on request.PRESENTATION An isotonic, aqueous solution containing iodixanol, a non-ionic, dimeric contrastmedium, 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, cardiacoutput, 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 contrastmedia indicates need for special caution. Premedication with corticosteroids or H1 and H2 antagonistsmight be considered in these cases. Although the risk of serious reactions with VISIPAQUE isregarded as remote, iodinated contrast media may provoke serious hypersensitivity reactions. Thereforethe necessary drugs and equipment must be available for immediate treatment. Patients shouldbe observed closely for at least 15 minutes following administration of contrast medium, howeverdelayed reactions may occur. Non-ionic contrast media have less effect on the coagulation system invitro, compared to ionic contrast media. When performing vascular catheterization procedures oneshould 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 inpatients with severe disturbance of both renal and hepatic function as they may have significantlydelayed contrast medium clearance. For haemodialysis patients, correlation of time of contrast mediainjection with the haemodialysis session is unnecessary. To prevent lactic acidosis in diabetic patientstreated with metformin, administration of metformin should be discontinued at the time of administrationof contrast medium and withheld for 48 hours and reinstituted only after renal function has beenre-evaluated and found to be normal. (Refer to SPC). Special care should also be taken in patients withhyperthyroidism, serious cardiac disease, pulmonary hypertension, patients predisposed to seizures(acute cerebral pathology, tumours, epilepsy, alcoholics and drug addicts), and patients withmyasthenia gravis or phaeochromocytoma. One should also be aware of the possibility of inducingtransient hypothyroidism in premature infants receiving contrast media. All iodinated contrast mediamay 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. PREGNANCYAND LACTATION The safety of VISIPAQUE in pregnancy has not been established. Contrast media arepoorly excreted in breast milk and minimal amounts are absorbed by the intestine. Breast feedingmay be continued normally. UNDESIRABLE EFFECTS Intravascular use: Usually mild to moderate, andtransient in nature. They include discomfort, general sensation of warmth or cold, pain at the injectionsite or distally. Serious reactions and fatalities are only seen on very rare occasions. Nausea andvomiting are rare, and abdominal discomfort is very rare. Hypersensitivity reactions occur occasionallywith symptoms such as rash, urticaria, erythema, pruritus, dyspnoea or angioedema (immediate ordelayed). 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 veryrare. Also reported very rarely: vagal reactions, cardiac arrhythmia, depressed cardiac function,ischaemia, and hypertension. “Iodide mumps” is a very rare complication. Arterial spasm may followinjection 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 isvery rare. Severe respiratory symptoms and signs (including dyspnoea and non-cardiogenic pulmonaryoedema), and cough may occur. Intrathecal use: Meningism, photophobia or chemicalmeningitis. Transient motor or sensory dysfunction. Confusion. Paraesthesia. Seizures. EEG changes.Local pain. Headache, nausea, vomiting or dizziness. Use in body cavities: Endoscopic RetrogradeCholangiopancreatography (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 andpost procedural pain. PHARMACODYNAMIC PROPERTIES In 64 diabetic patients with serum creatininelevels of 115 - 308 μmol/L, VISIPAQUE use resulted in 3% of patients experiencing a rise in creatinineof ≥ 44.2 μmol/L and 0% of the patients with a rise of ≥ 88.4 μmol/L.The release of enzymes (alkalinephosphatase and N-acetyl-ß-glucosaminidase) from the proximal tubular cells is less than after injectionsof non-ionic monomeric contrast media and the same trend is seen compared to ionic dimericcontrast 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 intothe syringe immediately before use. Containers are intended for single use only, any unused portionsmust 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). MARKETINGAUTHORISATION NUMBERS PL 0637/0017-19 (Glass vials/bottles and polypropylene bottles withstopper and screw cap). PL 0637/0026-28 (Polypropylene bottles with a twist-off top). DATE OFREVISION OF TEXT 19 October 2007. PRICE 320mgI/ml, 10x50ml: £228.81Adverse events should be reported. Reporting forms and information can be foundat 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.comLocal 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 WHeading the Summit of ScienceA portrait of the ECR 2009Congress PresidentBy Simon LeeProf. Borut MarincekECR 2009 Congress PresidentAs the European Congress of Radiology is now fastapproaching, we would like to take the opportunityto present this year’s Congress President Prof. Dr.Borut Marincek. The eminent Swiss radiologist haslong been closely involved with ESR and its variousactivities, and attended his first ECR back in 1983after completing his training. Since then he has servedon the ESR Executive Council, sat on the ECR ProgrammePlanning Committee and taken a leadingrole in the ESR’s European School of Radiology. As heprepares to fulfil his duties at ECR, we take a look athis 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 ZurichUniversity in 1970. It was during this time at medicalschool that he resolved to pursue a career in radiology,following a growing fascination with the possibilitiesof correlating imaging, morphology and function aswell as non-invasive mapping of anatomy and diseaseprocesses. It is a fascination that has endured to thisday. “Looking back, choosing this profession was thebest decision I could have made in my life,” he affirms,“I still find radiology highly absorbing because it playsa central role in the healthcare system and is one ofthe fastest growing areas in medicine, in clinical termsand the R&D”.After completing residencies in radiology and nuclearmedicine at the University Hospitals in Zurich andBerne, Dr. Marincek went on to work at the Instituteof Diagnostic Radiology at the Berne UniversityHospital. Then from 1979 to 1981, he was a researchfellow at the Department of Diagnostic Radiology,Stanford University Hospital, USA, before returningto the Berne University Hospital where he went onto achieve the rank of Associate Professor in 1986. In1987 Dr. Marincek returned to the Zurich UniversityHospital where he was appointed Vice Chairman ofthe Institute of Diagnostic Radiology, starting a longprofessional association with the institution that stillcontinues. In 1995 he also became Chairman of theInstitute of Diagnostic Radiology and Nuclear Medicineat the Zug Cantonal Hospital, Switzerland, andsince 1997 he has been Professor of Radiology andChairman of the Institute of Diagnostic Radiology atthe University Hospital of Zurich.Aside from his day-to-day activities, Dr Marincek isalso a member of numerous medical societies, includingthe Swiss Society of Radiology, of which he is apast president, and the European Society of Gastrointestinaland Abdominal Radiology, of which he is thecurrent president. In recognition of his many achievements,he has also been awarded Honorary Membershipof the German Roentgen Society, the Schinz-Medal, Honorary Membership of the Swiss Societyof Radiology and Honorary Membership of the RoyalBelgian Radiological Society. He has also received theDistinguished International Member Award of theSociety of Gastrointestinal Radiologists.Throughout his career Dr. Marincek has published frequently,authoring or co-authoring 249 peer-reviewedarticles and 47 books or book chapters, mainly inthe field of abdominal and cardiovascular computedtomography and magnetic resonance imaging. As arespected authority on such subjects, he has also beeninvited to pass on his experience through more than190 lectures in Europe and overseas. But despite hismany professional activities Dr. Marincek occasionallyfinds time to relax. “Of course there is not muchtime left for activities beyond my numerous professionalduties, but the satisfaction my work brings mecompensates for that and makes every day of my lifean extraordinary experience,” he says. “In my sparetime I love to go mountain biking in the woods; I enjoynature very much and I find it a very pleasant way torelax the mind and exercise at the same time. Anotherfavourite sport of mine is rowing, as it is a good wayto get in touch with the elements of nature and a niceopportunity to spend time with friends.”Prof. Borut Marincek is the 20 th congress president inthe history of the European Congress of Radiology,and the first one from Switzerland.27 myESR.org

ESR Newsletter 01/09E S R M E E T SE S R M E E T SESR meetsSwitzerlandTwo months before ECR 2009, ESR Newsletter met Bernhard Allgayer, President of the Swiss Society ofRadiology, to learn more about radiology in the European country with the highest ratio of high-field MRunits per inhabitant.By Mélisande RougerESR Newsletter: How is Swiss radiologydoing and how does it position itself inEurope?Bernhard Allgayer: Swiss radiology has anincreasing role in the medical communitywith many clinical and scientific connectionsto other European countries.ESRN: How many radiologists are currentlyworking in Switzerland? What isthe proportion of men, women and youngpeople? What is the ratio of radiologists toinhabitants?BA: Currently 919 radiologists are workingin Switzerland, with 193 in private practices,and about 30 to 35 young radiologists peryear undergo the board examination. Switzerlandhas 7.56 million inhabitants, so theratio is one radiologist per 8,226 inhabitants.ESRN: How do you see the demography ofyour profession evolving in the near future?BA: I think the total number of radiologistswill increase about 3 to 5% per year.ESRN: Regarding your introduction to the‘ESR meets Switzerland’ session, could youplease briefly explain: What is the role of3.0 T in Switzerland?BA: Out of 207 MRI units, 42 of them are 3.0Tunits. Switzerland has probably one of thehighest densities of MR magnets in Europeand probably worldwide. The number of 3.0Tmagnets, particularly in private practice, isincreasing. 3T has allowed clinical implementationof sequences that were difficultto perform previously such as arterial spinlabellingperfusion.ESRN: What are you going to talk aboutunder the theme ‘Matterhorn: top of Europe’?BA: The Matterhorn is one of the mostfamous mountains in Europe and the ratio ofhigh-field MR units per inhabitant in Europeis the highest in Switzerland. The presentationwill focus on stroke MRI.ESRN: What are the demographics ofstroke in Switzerland? How does it compareto the rest of Europe?BA: Stroke is one of the three highest causes ofmortality in Switzerland, with cardiac diseasesand cancer, as it is in other developed countries.It has a major socio-economic impact.In Switzerland there is a trend to aggressivelydiagnose and treat these patients at earlystages. Here, MR technology plays an importantrole in the management of these patients.ESRN: What are the advances made in clinicalNeuro-MR of stroke?BA: In Neuro-MR, the advent of high fieldmagnets has allowed us to improve the routineacquisition of the following techniques:perfusion imaging, diffusion tensor anddiffusion-weighted imaging, susceptibilityweightedimaging, arterial spin labelling perfusion,and clinical functional MRI.ESRN: In which clinical cases do you useabdominal and pelvic MRI? What is thecurrent status of high field abdominal andpelvic imaging?BA: The role of 3.0T MRI in the abdomenand pelvis is not yet defined. 3.0T offers variousadvantages, but has its disadvantages. Inaddition, imaging at 1.5T has reached a veryhigh level, and at some point it is difficult totop this. In general, 3.0T imaging has nowreached the robustness and imaging levelof 1.5T in the abdominal and pelvic region.With regard to morphologic imaging, 3.0Timaging seems to be superior at displayingthe biliary and pancreatic duct anatomy,in particular in patients without dilatationof the ducts. Moreover, MR angiographyis profiting from the higher field strength.Morphologic imaging is superior in displayingthe anatomy of the pelvic organs andthe pelvic floor, and probably 3.0T imagingmakes the use of endorectal coils for prostateimaging unnecessary. However, I personallybelieve that in the future the superiorityof 3.0T will be shown, in particular for thefunctional applications (such as diffusion,perfusion assessment, and hybrid imaging).Professor Bernhard Allgayer has been the Director of the RadiologyDepartment of the Lucerne Canton Hospital, Switzerland, since 1997.His main interests are clinical research in CT, MRT, mammographyand interventional radiology.European Society of Radiology28

E S R M E E T SESRN: What are the typical sports injuriesin Switzerland?BA: Injuries from winter and summer sportactivities, such as skiing, snowboarding, bikingand running.ESRN: What are the main challenges facedby radiology in Switzerland nowadays andwhat are the strategies developed by yoursociety to cope with them?BA: The main challenges for Swiss radiologyin the future are: a shortage of board-certifiedradiologists, in particular in public hospitals;turf battles in different areas of radiology; anddecreasing revenues because of decreasingreimbursement by the healthcare providers.ESRN: Skilled staff are a prerequisite forthe implementation and maintenance ofhigh-quality radiological services – what doyou do to promote postgraduate educationand training in modern imaging methods?BA: We offer national and internationalcourses, such as the Davos course, and manyother local and international activities.ESRN: How is Swiss radiology meetingthe growing need for a multidisciplinaryapproach in radiology?BA: We have daily clinical meetings, andinterdisciplinary meetings with orthopaedicsurgeons, oncologists, cardiologist et al.ESRN: Is there any competition betweenSwiss radiological services and otherservices? If so, how does radiology worktogether with those specialities to improvethe situation?BA: There is competition with angiologists,vascular surgeons and cardiologists in interventionalvascular radiology, and with cardiologistsin heart CT and MRI.ESRN: How would you judge the importanceof the exchange of knowledgebetween Swiss radiologists and the rest ofthe world? Is Switzerland’s geographicalplace in Europe an advantage?BA: This exchange is important for us.Therefore we have a longstanding traditionof exchange between Swiss radiologists andothers around the world. For many yearsit has been a tradition, particularly in academicinstitutions, that young radiologistsundertake a fellowship in another country.In addition, there is an increasing numberof radiologists who were trained in Switzerlandand who now work in faculty positionsin leading radiology centres worldwide.Additionally, we also have a longstandingtradition for postgraduate teaching courses,which are performed in collaboration withleading international radiology experts.Finally, we foster international contractsthrough the annual meeting of our societywhere we invite opinion leaders for state ofthe art lectures. Furthermore, the societyrewards excellence through various honoursand prizes.ESRN: What are the potential benefitsof SSR taking part in the ‘ESR meets’programme?BA: To learn more about radiology andthe work of radiologists in other EuropeancountriesESRN: What future trends and challengesdo you foresee in radiology?BA: The trends will focus on higher fieldsand faster imaging. The challenge will be tocombine technological changes and clinicalexcellence. The next step in radiology isimaging of function, cellular and molecularimaging.ESRN: What was your main motivation forchoosing your profession?BA: Interest and passion.ESR meets SwitzerlandEM 1 Switzerland – Top of Europe: 3.0 Tesla and the MatterhornSaturday, March 7, 10:30–12:00, Room APresiding: B. Allgayer; Lucerne/CHB. Marincek; Zurich/CHI.W. McCall; Oswestry/UK• IntroductionB. Allgayer; Lucerne/CH• Perfusion imaging in the heart of Europe:1.5 Tesla and moreJ. Bremerich; Basle/CH• The impact of high field MRI on stroke managementK.-O. Løvblad; Geneva/CH• Abdominal and pelvic MRI: From 1.5 to 3.0 TeslaD. Weishaupt; Zurich/CH• Does sports imaging need 3.0 Tesla?T. Treumann; Lucerne/CH• Panel discussion29 myESR.org

.artundwork designbüroHitachi Real-time Tissue Elastography:Discoveringwith all senses.Hitachi Real-time Tissue Elastography (HI-RTE)HI-RTE is an emerging ultrasoundmodality for the assessment and realtimecolour display of tissue elasticity.The value of this 2nd generationultrasound modality has been provenin a variety of different clinical areas,including breast, urology, endoscopyand many more.This unique HI-RTE modality...· Extracts strain data ensuring that quantitativemeasurements are available from the Strain Ratio tool· Is easy to perform, fast, accurate and reproducible· Incorporates an adjustable colour transparencyfeature, enabling instant correlation between thenative B-mode and elasto image· Is available for the new range of HI VISION platformsA longitudinal scan shows a mixedpattern of stiffness in this thyroid lesion.Don't miss our ECR Lunch Symposium onReal-time Tissue Elastography – Proven diagnostic performanceSaturday, March 7, 2009Hitachi Medical Systems Europe Holding AG · Sumpfstrasse 13 · CH-6300 Zugwww.hitachi-medical-systems.comHitachi Medical Systems Europe Holding AG · Sumpfstrasse 13 · CH-6300 Zugwww.hitachi-medical-systems.com

E C R 2 0 0 9 – S C I E N C ECT lung cancer screeningcomes under the spotlightBy Paula GouldLung cancer is the biggest cancer killer in theand possible pitfalls of screening will also be cov-then patients may be unduly alarmed. Pathology-Experience has shown that PET can be positiveworld, causing more deaths than breast andered at the state of the art session.free images, on the other hand, could confoundin some benign lesions and negative in someprostate cancer put together. Every 30 seconds,efforts to encourage smokers to adopt a healthiernon-solid masses, Bellomi said. This has led tosomeone, somewhere will die of lung cancer. TheOne problem is the lack of evidence proving thatlifestyle. Worse still, symptoms suggestive of can-errors in patient management. Nodule growthoutlook for individuals diagnosed with the malig-the strategy is worthwhile, he said. Two large ran-cer could be ignored on the strength of an ‘allwas under-estimated in some cases and over-esti-nancy is poor; only one in every 10 will still bedomised controlled trials investigating the valueclear’ screening result.mated in others owing to variability in automatedalive five years later.of low dose CT screening in heavy smokers aremeasurement tools and subjective evaluations ofcurrently underway. Interim results from onePathological findings are rarely missed whenlesion diameter.The statistics on lung cancer do not make pleas-of these trials will be presented at ECR 2009 byscreening for lung cancer with low dose CT,ant reading. One reason for the poor prognosisProf. Dr. Matthijs Oudkerk, chair of radiology ataccording 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, theEuropean Institute of Oncology (EIO) in Milan.nary team meetings,” he said. “We have fourcally diagnosed. By the time most lung cancerNetherlands. Final results from both trials are notHe recommends using several different imageor five radiologists, a couple of surgeons andsufferers are identified, the primary tumour willexpected until 2010.formats when reporting the examinations, rathersome nuclear medicine physicians who all comehave spread to neighbouring organs or producedthan axial views alone. Coronal views, for exam-together and discuss these cases to improve thedistant metastases. The only treatment available“At the moment, we are not at a stage where weple, make it easier to view the pulmonary hilumaccuracy of a diagnosis.”at this stage is likely to be palliative rather thancan recommend CT for at-risk individuals, thatand detect small hilar nodules. Radiologists at thecurative.is, smokers and those with a history of asbestosEIO also double read cases where possible.The session will conclude with a panel discussionexposure. Despite 15 years of research on thison the thorny issue of self-referral. Information onIf the disease could be identified at stage I, whilsttopic, 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 onit was still localised in the lung, then two-thirds ofCT can actually reduce mortality from lung can-tion, it should take less than 10 minutes. Ourthe 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. “Ofing ‘preventative imaging’ to the worried well.fan Diederich, head of the radiology departmentcourse, if you have a patient with 12 lung nodules,Chest radiologists need to be well versed in theat the Marien Hospital in Düsseldorf, Germany.Smokers whose lung cancer is caught early – andit takes 20 minutes, and if you have a patient withpros and cons of screening, and how these can beLow dose CT screening of high-risk individualscured – may still fall prey to another malignancynone 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 togeal 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 lunglar disease, and will be at risk of suffering a strokehigh risk subjects has been running at the Milander what to tell patients who turn up at his or herdisease.or heart attack.institute since 2000. A second trial of over 5,000office asking for a CT screening scan. We hope tosubjects began in 2004/2005. Bellomi will use hisbe able to provide some advice on how to deal withDiederich will be discussing the rationale for lungIf 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 benefitsgrowing cancers that are unlikely to prove fatal,sons learned.State of the Art SymposiumSA 13Lung cancer screeningMonday, March 9, 08:30–10:00, Room C• Chairman’s introductionT. Saam; Munich/DEABAB• Rationale for screeningS. Diederich; Düsseldorf/DE• Interim results from the NELSON trialM. Oudkerk; Groningen/NL• Problems and pitfalls at lung cancer screening:Lessons from the EIO trialM. Bellomi; Milan/ITCDCD• Panel discussion:What to tell the patient at risk of lungcancer who requests a screening CT?Inflammatory lesion. A: Annual CT in June 2006 revealed new nodule in upperleft lobe with morphology suspicious for a small cancer. B: Nodule wasnot evident on previous CT in 2005. C: One month later, after administeringantibiotics, nodule had reduced in size. D: After three months, the nodulehad almost disappeared. This taught us not to be too anxious and to go tosurgery without a firm diagnosis. (Provided by Prof. M. Bellomi)A: Small cancer in upper right lobe diagnosed in 2007 on axial CT. B: Themalignancy is also seen on coronal images. C: Same cancer was difficultto see on axial images from previous screening examination in 2006 andwas missed. D: It was a little more evident on the coronal images from thatyear. This taught us to look at coronal views, and not just axial slices andMIP (maximum intensity projection) images. (Provided by Prof. M. Bellomi)31 myESR.org

ESR Newsletter 01/09E C R 2 0 0 9 – S C I E N C ESpinal Imaging and Interventionat the cutting-edgeBy Majda M. Thurnher, AKH Vienna, AustriaThe Categorical Course ‘Spinal ImagingMR techniques, such as MR spectroscopy,population also brings an increased numberand Intervention’ will provide a forum forperfusion, and diffusion imaging has beenof age-related diseases, such as osteoporo-the presentation and discussion of new andlimited by a number of physical, physiologic,sis, which is one of the major causes of acuteimportant developments in spine radiology.and technical factors. With improving tech-spine pain.Topically organised sessions of the coursenology, it is now becoming possible to obtainwill concentrate on various aspects of diag-biochemical, physiologic, and haemody-IRS must be performed by a physician withnostic as well as therapeutic spine tech-namic information about the human spinalclinical knowledge of neurological symp-niques. Experts from Europe and the Unitedcord in vivo. More recently, as improvementstoms related to central or peripheral par-States will share their experience with coursein coil technology, hardware, and pulsetial or total nervous structure damage. Theparticipants through lectures dedicated tosequences are made, techniques previouslykey to success with this minimally invasivetheir field of expertise.only applicable in the brain, such as BOLDspine therapy is related to a good correlationfunctional 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 ofMajda M. Thurnher is AssociateProfessor at the Department ofRadiology, Medical University ofVienna, and coordinator of theECR 2009 Categorical Course‘Spinal Imaging and Intervention’.hypotheses, and treatment methods for backpain have been proposed. Even now, thepathophysiology of back pain is not completelyunderstood. New insights into oldproblems of spinal instability, degenerativedisk disease, and facet joint degenerationimaging have been performed in the humanspinal cord.Despite the general lack of optimism aboutthe usefulness of clinical 3T MR in evaluationof the spine, the initial gap betweenNeuroimaging at the Center for DiagnosticImaging (CDI) in Minneapolis, US, who hastreated an impressive number of patients,will show how image-guided pain managementhas reached a new level of success.will be discussed during the course. Is mye-promises and clinical reality of 3T spineSpecial interest has focused, in recent dec-lography obsolete? What is the method ofimaging has been partially bridged in recentades, on pain and pain management. Thechoice for visualisation of disk disease, nerveyears. High-resolution images of the spinalwords of Albert Schweitzer, “Pain is a moreroot compression, spinal stenosis? Doescord, diffusion and diffusion-tensor imagingterrible lord of mankind than even deathspinal instability really exist? Prof. Johan(DTI) and even tractography of the spinalitself,” are still valid, and the search for inter-van Goethem from Antwerp, Belgium, willcord is now the reality, and Prof. Meng Law,ventional pain management techniques isfocus on spinal instability as a significantChief of Neuroradiology at the USC Medi-ongoing. Interventional Pain Managementcause of lower back pain. Although listedcal Center, Keck School of Medicine in Losis the discipline of medicine devoted to theby spinal surgeons as the leading indicationAngeles, US, will demonstrate the clinicaldiagnosis and treatment of pain-related dis-for spinal fusion, spinal instability is poorlyadvantages of 3T imaging.orders, principally with the application ofunderstood and radiologists are frequentlyinterventional techniques alone to manageunfamiliar with specific imaging findings inInterventional Radiology of the Spine (IRS)pain, or in conjunction with other modalitiesthese patients.includes a number of diagnostic and thera-of treatment.peutic procedures, developed in recent years,Advanced MR imaging techniques arewhich are designed to reduce or eliminateIn Europe, many of those procedures arebeginning to demonstrate their utility inspine pain. Cervical pain, lower back pain,performed by an anaesthesiologist, or bystudying neurological disorders of the brain,and sciatica are very common conditionsan orthopaedic surgeon or a neurosurgeon.such as metabolic diseases, developmentalrelated to herniated disks or degenerativeDr. Mario Muto, Chief of Neuroradiologydisorders, traumatic injury, and white mat-disk disease, and diagnostic imaging withat the Cardarelli Hospital in Naples, Italy,ter diseases, including multiple sclerosis,x-ray, CT, and MR can help us to betterstresses: “It is important that the radiologicalneurodegenerative diseases, infections, anddefine the cause of spine pain. There are nowcommunity understand that we have, at thisneoplasms. The human spinal cord, by natu-a greater number of older adults in west-moment, the unique opportunity to recover aral extension, is also susceptible to an arrayern countries because of the high quality ofrelationship with patients because we can per-of neurological disorders. The application ofhealthcare; however, this increasing agingform those treatments in the safest possibleA B C DDiffusion tensor (DTI) MR tractography (fibre tracking) of the cervical spinalcord performed at 3T clinical MR unit in two patients.In spinal cord ependymoma (A, B) destruction of the fibres of the spinal cordis nicely demonstrated. Displacement and spreading of the fibres was seenin 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 alsobeen successfully applied to the intervertebral disc. On this image you can see the representationof the main diffusion direction (so-called ‘tractography’) applied to 3 intervertebraldiscs. While the top disc shows a concentric pattern representing the normal structure ofthe annulus fibrosus, the bottom disc is degenerated and has lost this normal pattern.European Society of Radiology32

E C R 2 0 0 9 – S C I E N C Eway under high technological control. ClinicalRadiology must be urged once again to beready to act in this competitive medical field!”The IRS procedures include: spine biopsy,nerve block tests, treatment, and many therapeuticprocedures. These procedures primarilyrelate to the treatment of spine pain dueto different pathologies, such as herniateddisks, porotic fractures, spine tumours, spinalcanal stenosis, as well as the treatment ofchronic pain with a neurostimulator implant.Diagnostic biopsy must be performed underCT control to reduce the risk of inadequateaccess and ensure that the target lesion isreached. According to the type of biopsy weneed to perform (cytologic, hystologic, orcultural) we can use different types of needle.We can also utilise, in cases of paraspinal softtissue lesions, a biopsy device that enablesus to obtain a good tissue sample. Antalgicblocks can be useful in selected cases tounderstand the origin of the pain, but canalso be performed to treat nervous structureinfiltration by invasive tumours, such as atthe level of the ganglium stellatum or of theceliac plexus, with alcohol injection. Radiofrequencywaves and steroid infiltration atthe cervical and lumbar region are very efficientand can be used in cases where systemicmedical therapy has failed in treating facetjoint disease or spinal radiculopathy.Percutaneous treatment of herniated cervicaland lumbar disks includes a wide numberof devices (nucleoplasty, decompression,oxygen-ozone therapy) that are designedto reduce intradiscal pressure while minimallyreducing the disk material. Some otherdevices attempt to reduce the pain with athermal ablation of the peripheral disk nervousstructures (IDET). Dr. Mario Muto andhis co-workers have been using intradiscalintraforaminaloxygen-ozone therapy totreat low back pain and sciatica since 1997.Based on his experience, Dr. Muto considersthis therapeutic approach to disk diseasea safe, low-risk, and high success procedure.Porotic fractures are a frequent pathologiccondition in older adults, in which the painis the first clinical sign. This pathology canbe treated with vertebroplasty (VP) or withkyphoplasty (KP).Dr. Gregg Zoarski, Director of Diagnosticand Interventional Neuroradiology at theMaryland University in Baltimore, US, anda past President of the American Society ofSpine Radiology (ASSR), will share his expertiseand knowledge of vertebroplasty andkyphoplasty. The burning question in performingvertebroplasty and kyphoplasty isstill ‘who decides what procedure should bedone?’ In vertebroplasty, there is only a simplecement (PMMA) injection, while, in kyphoplasty,there is a balloon predilatation followedby a thick cement injection. Two-thirdsof the patients affected by porotic fracturescan recover within 4–6 weeks after the onsetof the pain, but recent experience has shownthat clinical recovery is faster when VP or KPare performed soon after injury. The futureof this field will be dependent on new biologicalmaterials that will be designed to havethe same strength as the cement now used,but more able to withstand biological activity,similar to triphosphate or calcium. VPcan also be utilised in cases of lytic of mixedmetastatic lesions of the spine to reduce thepain before radio-chemotherapy. Neurologicclaudication is a clinical condition very oftenrelated to a central spinal canal stenosis dueto degenerative spine disease; this conditioncan be treated with a device that increases thedistance between the spinous process, andcan be released percutaneously.Thus, at this point, it is clear that radiologistsmaintain a very strong role in thediagnostic and therapeutic management ofpatients with spinal diseases. The ESR andESNR should concentrate, in the future, onincreasing the number of spinal proceduresperformed under radiological guidance inEuropean radiological centres. The primarygoal remains ensuring the best treatment ofpatients who are affected by spine pain. Theway to achieve this will be one that considersboth science and clinical practice, with proceduresperformed according to evidencebasedmedicine, 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 excellentcollaboration, which has led to an excitingnew project, the Joint Symposium onSpinal Imaging. Prof. Johan van Goethem, amember of the Executive Boards of ASSR andESNR, will co-organise the first joint venture,which will be held in Rome, Italy, July9–11, 2009, together with Dr. Bassem Georgyand Dr. Jeff Stone, President and President-Elect of the ASSR, Prof. Massimo Gallucci,local organiser and Dr. Mario Muto for theESNR. Internationally recognised speakersfrom several continents will lecture on Diagnosticand Interventional Spinal Imagingtopics. Scientific sessions will feature the latestapproaches and techniques in both spinalimaging and spinal interventions. Diagnostictopics will feature advances in CT and MRimaging, emphasising their practicality ineveryday imaging, as well as the potential forfuture clinical applications, while interventionaltopics will include sessions on existingand new techniques usable in daily practice.MR perfusion of the cervical spine.MR showing a small median discending herniated disk treated by intradiscaloxygen-ozone therapy.Vertebroplasty of C5 in patient affected by osteoangiomaand previously treated with disk prosthesis.33 myESR.org

Because Gd 3+ can bite... Control it!Contrast for Life,DOTAREM ®Gadoteric acidby ChoiceDotarem ® 0.5 mmol/mL, solution for injection in vials and pre-filled syringes: Indications and approvals may vary in different countries. Please refer to the local Summary of Product Characteristics (SPC) beforeprescribing. Further information available on request. - QUALITATIVE AND QUANTITATIVE COMPOSITION PER 100 mL: Gadoteric acid* (27.932 g) corresponding to DOTA (20.246 g) - Gadolinium oxide(9.062 g) - Excipients: Meglumine, water for injections (*Gadoteric acid: gadolinium complex of 1,4,7,10 tetraazacyclododedane-N,N’,N’’,N’’’ tetraacetic acid). CLINICAL PARTICULARS: Therapeutic indications: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 recommendeddose 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 intravenousinjection. 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 foruse: 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 isa 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 forany 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 ENew techniques contribute toimprovements in disc pain managementBy Frances Rylands-MonkOver the past decade, therapeutic optionsfor back pain have shifted from the poles ofconservative management involving drugsand rest or conversely, surgery, to a middleground comprising interventional techniques.Overall, this switch has tended toresult in improved diagnostic accuracy andreduced treatment time while decreasingcosts, proving beneficial both to patients andhospital budgets.Relatively new techniques such as percutaneousdecompression of a herniated disc andnucleoplasty (disc decompression to ablateand remove tissue in the nucleus pulposus ofthe disc) have been developed. At the sametime, it has become accepted that not allpain is caused by mechanical compression ofneural structures, but also by inflammation,which if addressed through techniques suchas steroid and ozone therapy, can be effectivelycontrolled.“One of the challenges in evaluating theorigin of spinal pain is that imaging doesn’talways predict the source of pain. A discthat looks degenerated on an imaging studymay or may not be the pain generator,” saidDr. Blake Johnson, director of neuroimaging,Center for Diagnostic Imaging, Minneapolis,U.S. “In addition, there are multiple levelsand multiple structures in the spine that arepotential contributors. Isolating the sourceof pain is difficult based only on MRI or CT.”To overcome these challenges, conductinga physical examination, taking a patienthistory, and performing necessary imagingshould be combined with the use of diagnosticphysiologic blocks or tests, wherebydifferent structures, such as facet joints ornerves, are anaesthetised. Other tests, likediscography, may be carried out to see ifthis reproduces the patient’s pain symptoms.These blocks and tests are image-guidedwith CT or fluoroscopy to increase accuracyin targeting structures to refine pain sourcediagnosis.Minimally invasive interventional therapy ispossible in selected cases. Provided that thepatient suffering from discogenic disease canmove and feel his or her legs, decompressiondevices can be placed inside the disc or substancessuch as alcohol gel may be injected.Alternatively, lasers or coblation can be usedunder local anaesthetic to remove materialsfrom the nucleus pulposus without harmingbone.During session CC 1316, which will formpart of the new categorical course on spinalimaging and intervention at ECR 2009,Johnson and other experts will outline theserelatively new disc therapies and provide anupdate for those already involved in intervention.They also intend to arouse theinterest of general radiologists.“New techniques cut down treatment timeand costs. Typically, treatment takes half anhour, and the patient leaves the ward walkingafter four hours. This is an ambulatory processthat requires no hospitalisation or anaesthetist,compared to a standard three or fourday hospitalisation after surgery, which takesbetween one and four hours, depending onthe procedure,” said Dr. Alexis Kelekis, lecturerin interventional and musculoskeletalradiology at the University of Athens.Image-guided procedures under local anaestheticin the angio suite do not replace allsurgical procedures such as those needed forspinal stenosis, motor deficit, and free discfragment. In these cases, conventional methodsare still the gold standard.However, with conservative treatment, legpain will disappear in around 60% of cases,and for the remaining 40% of cases an infiltration,or an image-guided injection ofdrugs near the nerve root, should be performed.Of these, about 60% will respondwell, but a further 40% will be left as a subgroupthat can be treated with percutaneoustechniques such as decompression, lasers,and coblation.“Of this subgroup, 60–70% will yield goodresults. Through such a process of elimination,the people who really do need surgeryare left,” Kelekis said. “We don’t know thefull economics of it, but whatever saves timeand frees up the operation room for prioritycases, saves money.”While laser therapy has been used for about15 years and coblation has existed sincearound 2000, the most recent technique isthe use of alcohol gel, which has been in clinicaltrials across Europe. So far it is thoughtto be as good as other techniques, and mayeven have the edge in some cases due to itscapacity to treat more dehydrated discs.“New techniques aren’t very complicatedor difficult to learn, but can bring massivebenefits to patients. The interventional radiologisthas the knowledge to understand theimaging and the procedure. Clinical knowledgecan be increased by attending conferencesand following up patients,” Kelekissaid.He recommended that radiologists seekingto become interventional specialists shouldhave more face-to-face time with patientsand not rely on ‘Chinese whispers’ to gain aclinical history. The specialist also needs togive feedback directly to patients and informthem about treatment options and decisions,even if they are to be performed by somebodyelse, he noted.“While complex techniques such as disc ablationand vertebroplasty need higher trainingand will often be undertaken by specialisedradiologists in tertiary environments, theaverage radiologist should know about andpropose such techniques,” Kelekis said.Johnson thinks the radiologist is the bestperson to carry out such procedures becausethey are familiar with the equipment andwith imaging anatomy.“Orthopaedic surgeons, anaesthetists andrehabilitation doctors may be in the samearea, but radiologists are best suited to performimage-guided procedures,” he said.Kelekis sounded a note of caution, and calledfor the non-vascular section of interventionalradiology, to which spine interventionbelongs, to focus on standards and harmonisation,especially as non-vascular techniquesnow accounted for around 50% of interventionalprocedures across Europe.“For me, any radiologist holding a needleand performing a procedure is part ofthe interventional group, and proceduresmust be done according to the gold standardof clinical practice and supervised by agroup such as the Cardiovascular and InterventionalRadiological Society of Europe(CIRSE),” Kelekis said. “The non-vasculararea has been less organised all these yearsthan vascular. Techniques such as radiofrequencyablation and abscess drainage arenow standard throughout radiology departments,and radiologists should learn howto perform them in line with specific rules.These procedures do have standards thatvalidate them, but not all radiologists knowof these for non-vascular techniques.”ACFour images showing the presence of a herniated disc, withradicular pain down the leg and a pain score of 8/10. Thepatient was treated by percutaneous decompression, underlocal anaesthesia, and returned home four hours later. Threemonths later, the patient was pain-free. A: T2-weighted MRIimage shows the presence of a significantly protruding herniain L4-L5, medially and laterally to the left. B: Lateral imageunder fluoroscopy of a discography measuring pressureand pain response, showing the presence of the posteriorhernia. C: Lateral image under fluoroscopy during percutaneousdecompression of the disc. The presence of contrastmedia inside the disc is visible from the discography. D: T2-weighted MR image, taken one year after the previous MRIshows the disappearance of the protruding hernia.(Provided by Dr. Alexis Kelekis)Categorical CourseCC 1316 What is new in disc therapy?Monday, March 9, 08:30–10:00, Room BBDModerator: W. Müller-Forell; Mainz/DE• Image-guided pain management:A new level of successB.A. Johnson; Minneapolis, MN/US• Minimally invasive therapies fordiscogenic diseaseA.D. Kelekis; Athens/GR• Ozone therapy updateM. Muto; Naples/IT35 myESR.org

Louminous details!In medicine every detail counts – we make it visible.With our contrast agent injectors for CT/MRI and our CO 2Insufflator.CO 2Insufflatorfor virtual coloscopy• completely automatic insufflation• increase of patient comfort• significant improvement ofdiagnostic resultsECRbooth 326Expo CLower Levelulrich GmbH & Co. KG l Buchbrunnenweg 12 l 89081 Ulm l GermanyPhone: +49 731 9654-234 l Fax: +49 731 9654-2706E-Mail: injector@ulrichmedical.com l Internet: www.ulrichmedical.com

E C R 2 0 0 9 – S C I E N C EIntervention experts address prosand cons of drug-eluting stentsBy Paula GouldStent technology has progressed in leaps andbounds over the past decade. Bare metal tubesor ‘scaffolds’ have gone a long way to eliminatinginstances of abrupt artery collapse followingballoon angioplasty. Restenosis prevention hasproved to be more difficult, prompting stent manufacturersto seek a pharmacological solution.Now developers want to improve performancefurther with alternative combinations of drugsand coatings, as well as novel medical materials.A special focus session at ECR 2009 will charthow far drug-eluting stents have come to date,and where the technology may be going in thefuture. The notion of a medicated stent deliveringan anti-restenosis agent was unheard of in clinicalpractice 10 years ago. Today, such devices areoften inserted in the coronary arteries to inhibitthe body’s natural response to the ‘controlledinjury’ of angioplasty. Drug-eluting stents are not,however, commonly used outside the heart. Thequestion is: will that still be the case in the future?The efficacy of drug-eluting stents in the coronaryarteries is now supported by good clinicalevidence, according to Prof. Dr. Johannes Lammer,head of the department of cardiovascularand interventional radiology at University HospitalVienna. Well over 50 randomised trials havebeen conducted comparing the various medicatedstents with bare metal stents, and looking at thebenefits of different anti-restenosis drugs. Thisdoes not necessarily mean that drug-eluting stentswill be the best solution for all patients, though.Other co-pathologies, for example, diabetes, mayneed to be taken into account when deciding whattype of stent to select.In peripheral artery disease, experience is morelimited at the moment. Two randomised studieshave been completed and the results published.Two further interventional trials are underway.“These devices are expensive, so from an economicpoint of view we also have to considerwhich patients should have drug-eluting stents asstandard, and which can be treated equally successfullywith bare metal stents,” Lammer said.In regions where bare metal stents are being usedwithout problems, anti-restenosis agents may notbe needed at all. In areas of the body where baremetal stents have failed to work well, then it maybe worth using drug-eluting stents.“Nobody is using this type of device in the carotidarteries because the results are good withoutdrugs,” said Prof. Dr. Stephan Duda, from theCentre for Diagnostic Radiology and MinimallyInvasive Therapy at the Jewish Hospital, Berlin.“Some studies have been done on the vertebralarteries at the rear of the neck that supply thecerebellum because bare metal stents have onlyyielded poor results there.”Early results from the two ongoing trials into therole of drug-eluting stents in the peripheral vasculaturemay be available at ECR 2009. Presentersare making no promises, though. A 100-patientstudy that considered the value of paclitaxelcoatedstents inserted in the superficial femoralartery has already shown promising results, Dudasaid. Given the small sample size, however, thedata will need to be confirmed in a larger study.Long-term follow-up is likely to be an importantpart of all trials. One downside to the use of drugelutingstents is the risk of late stent thrombosis.Patients who are fitted with a drug-eluting stentin their coronary vasculature must currently takeplatelet anti-aggregation medication for the rest oftheir lifetime.Attempts are being made to overcome this problemthrough the use of bioabsorbable stents, Dudasaid. These devices are literally absorbed into thebody after a few months once the anti-restenosispayload has been delivered. The success of thistechnology may depend on the speed at which thestent disappears. If it is absorbed too quickly, thenrestenosis may still occur. But if the absorptionprocess is very slow, then late-stent thrombosiscould still be triggered.“This idea is still really only on the horizon. Thefirst feasibility studies using bioabsorbable stentsshowed confounding results,” he noted.Duda will use his ECR 2009 presentation to showthat the motto ‘one size fits all’ does not apply todrug-eluting stents. As the technology matures,different devices are likely to emerge to suit specificareas and applications, he said. For example,it may turn out that drug-eluting balloons aremore effective at treating small arteries below theknee than the combination of balloon angioplastyand drug-eluting stents.“Atherosclerosis in the superficial femoral arteryis a completely different animal to atherosclerosisin the renal arteries,” he said. “In the future, wewill probably see different drugs or even differentstents for different anatomical regions. Thesedevices will be of tremendous value when theyhave been perfected for pathology that is currentlydifficult to treat.”Special Focus SessionSF 17dDrug-eluting stents: Today and tomorrowTuesday, March 10, 08:30–10:00, Room N/ORecent two-year clinical data showed that Abbott’s fullybioabsorbable drug-eluting coronary stent system successfullytreated coronary artery disease and was absorbedinto the walls of treated arteries within two years,leaving behind blood vessels that appeared to move andfunction similarly to un-stented arteries.• Chairman’s introductionJ. Lammer; Vienna/AT• Drug-eluting stents in the coronary arteries:Current statusH.D. Glogar; Vienna/AT• Drug-eluting stents and balloons in peripheralarteries: Early experienceS.H. Duda; Berlin/DE• Peripheral arteries: Are drug-eluting stentsthe future?L.B. Schwartz; Chicago, IL/US• Panel discussion:Who needs drug-eluting stents?Manufacturers, doctors or patients?AA: Typical superficial femoral artery (SFA) occlusion beforetreatment. B: Control angiogram after placement of a drugelutingSMART stent (drug = sirolimus, an immunosuppressantalso known as rapamycin).(Provided by Prof. Dr. S. Duda)B37 myESR.org

Ultra-Portable Flat Panel DetectorLighter. Smaller. Better.Lighter than ever before. Less than an inch thick. And delivering unmatched digital image quality. Canon’s new CXDI-60G detector bringsunparalleled portability and exibility to DR imaging. It covers the widest range of applications available, while ensuring easy handling andeffortless maintenance. Canon invented portable DR. We have the longest experience. Today we’re taking DR to the highest level of all.www.canon-europe.com/medical - email: medical.x-ray@canon-europe.com

E C R 2 0 0 9 – S C I E N C EReview advances in CT and MR inmajor traumaBy Mélisande RougerTrauma is the leading cause of death for peopleunder 40 and the leading cause of deathfor children around the world. It is also thethird most common cause of death for alladults.Last year alone, there were 39 million visitsto US emergency departments (EDs)for trauma-related conditions and 150,000deaths were trauma-related. Imaging accidentvictims is almost routine for a radiologistdoing emergency work, and it hasbecome crucial to be informed and trainedon the latest methods in trauma imaging.The comprehensive course ‘Advances in CTand MR in major trauma’ offered at ECR2009 will do precisely that, by presentingprogress made in the two modalities overthe last two decades.Multidetector computed tomography(MDCT) is perhaps the most importantimaging tool for trauma, since it enablesinjuries to be diagnosed very quickly andvery accurately, explained Professor RobertA. Novelline from Harvard Medical Schoolin Boston, US.MDCT has also significantly improved duringthe last two decades. Twenty years ago,it took twenty minutes for radiologists to doa scan of the head; nowadays, it takes themonly six seconds. It took about an hour anda half to two hours to image a patient withmultiple trauma of the head, spine or abdomenback then; today the whole body can bescanned in two minutes.This gain in time is the most importantprogress made in CT trauma imaging,Novelline stressed. “Years ago, many traumapatients couldn’t get the benefit of CT; theycouldn’t be in the CT for one to two hoursbecause they were too unstable. Now we canscan the whole body in two minutes, whichmeans we can scan almost every traumapatient,” he said.In thoracic injuries, CT enables a faster andeasier diagnosis of aortic injuries than anarteriogram, a procedure which would costboth time and money to the hospital. CToffers 3D visualisation of blood vessels withexquisite detail in the diagnosis of vascularinjuries. It also depicts lung laceration andcontusion, which are crucial injuries to diagnosein major trauma.Thanks to its high precision, CT tends tobe used as a detection tool for almost everytrauma patient. At Massachusetts GeneralHospital (MGH), 100 to 110 CT examinationsare carried out daily in the ED alonefor both traumatic and non-traumatic emergencyconditions. For further examinationof spinal and musculoskeletal trauma, andcomplex brain injuries, MR will be used.The most common and serious injuries inmajor trauma are head, spine, abdomenand chest injuries. Thanks to systematic CTexamination as soon as multiple trauma sufferersarrive in the ED, those injuries thatused to be so difficult to see are now beingmade visible, helping to save a significantnumber of lives.However, in many European Centres CT isnot systematically used for those patientswhen they arrive in the ED, either becauseof a lack of CT equipment or sometimesbecause of the lack of education of themedical staff, as Dr. Dominic Barron fromLeeds Teaching Hospital, UK, will point outat the ECR. “At our hospital, we had fifteenpatients last year who should have had CTprior to surgery. All of these would have hada different management plan if CT had beenperformed earlier in their treatment. Theseall had worse morbidity as a result, with severalpotentially avoidable deaths.”Barron, a musculoskeletal trauma radiologist,plans to stress the necessity of doing apolytrauma CT scan after an x-ray examinationshows a major pelvic injury, as it isoften accompanied by unexpected bleedingin the chest, abdomen or spine, which is notvisible on plain film. “Rather than doing achest x-ray and sending the patient directlyto surgery, shouldn’t we do a whole CT of thepatient to exclude any other major injuries?”he asks.Leeds Teaching Hospital, like many otherhospitals in the UK and the rest of Europe,lacks equipment. It only has two CT scannersto deal with about 120,000 emergencycases per year as well as providing CT coverfor all the in and out patient requests in a1,500 bed hospital. By comparison, mosthospitals in the USA would use at least fivescanners for the ED alone in a hospital ofthis size.In addition, the lack of education of medicalstaff prevents CT from being systematicallyused in major pelvic injuries. “A lotof trauma is managed by junior surgeonswho only know the Advanced Trauma LifeSupport (ATLS) standards, which are obsoletefor any major trauma centre. Surgeonsshould be more knowledgeable than that,”explained Barron, who is also an ATLSinstructor.He also points out that emergency physiciansdon’t read the emergency literature butonly the ATLS manual. Sometimes, it is alsoa lack of understanding from the ED that isto blame. “They wait too long before theysend us a patient for CT, or they won’t sendus an unstable patient, when they should,”he said.At MGH, collaboration runs smoothlythanks to regular communication throughmonthly meetings, where radiologists andemergency physicians discuss changesand initiatives, explained Novelline, whois Director of Emergency Radiology at theMGH. What might also help is the presenceof a radiology section directly in theED. Two radiologists are working there24/7, and the section is equipped with twoCT scanners, an MR scanner, an ultrasoundroom and three x-ray rooms. “The idea ofplacing radiology in the ED is much safer forthe patient. But it is a new trend and mosthospitals still don’t have it,” Novelline said.Improving the cooperation between radiologyand emergency medicine will be a priorityat ECR 2009, with the initiative ‘ESRMeets Emergency Physicians’ on March 7.CTA (CT arteriogram) of a young man injured in a motorcycleaccident who was noted to have decreased rightarm pulses. It shows a right subclavian artery traumaticocclusion and a right clavicle fracture.Mini Course:Advances in CT andMRI in Major TraumaMC 119 Head and neck traumaFriday, March 6,08:30–10:00, Room N/OModerator: K.A. Stringaris; Athens/GRA. HeadU. Linsenmaier; Munich/DEB. Facial structuresM. Becker; Geneva/CHC. Cervical spineO.C. West; Houston, TX/USMC 519 Body traumaSaturday, March 7,08:30–10:00, Room N/OModerator: T. Boehm; Chur/CHA. ThoraxR.A. Novelline; Boston, MA/USB. Intraperitoneal structuresK. Shanmuganathan; Baltimore, MD/USC. Extraperitoneal structures.M. Scaglione; Castel Volturno/ITMC 919 Musculoskeletal traumaSunday, March 8,08:30–10:00, Room N/OModerator: N. Ramesh; Portlaoise/IEA. Thoracolumbar spineD. Weishaupt; Zurich/CHB. Pelvis and hipD. Barron; Leeds/UKC. ExtremitiesM. Rieger; Innsbruck/AT39 myESR.org

ESR Newsletter 01/09E S R M E E T SE S R M E E T SESR meets theKrálovské VinohradyHospital in PragueBy Mélisande RougerIt is a cold day in Prague. But you don’t feel it in the overheatedcorridors of the University Hospital Královské Vinohrady –Fakultní nemocnice Královské Vinohrady in Czech – one of thethree faculty hospitals of the Czech capital.With 1,400 beds, it is the third biggest hospital in town. It providesevery classic type of hospital care from ophthalmology andmetabolic care to cardiology and trauma. Its plastic surgeons areparticularly renowned, and patients come from across the wholecountry to be treated by them.The Anaesthesiology and Critical Care (ACC) Department, theCzechs’ equivalent of the emergency department, is nothing liketypical European centres. No administrative desk. No waitingroom. No queuing. No cubicles. Instead, a huge hall with mobilebeds, radiological and respiratory devices, its own operatingroom, and an army of freshly graduated doctors and nurses.“This is the American style. Patients come in here from the streetand we can treat them directly,” explained Professor Jan Pachl,Director of the ACC Department.The ACC Department is equipped with 21 beds and dispatchespatients according to the acuteness of their state. Acute emergencies,generally patients from pre-hospital care transferredby the Emergency Medical System (EMS), are called primaryadmissions. Less serious emergencies and patients from differentdepartments or hospitals are referred to as secondary admissions.Reflecting this division, the ACC Department is divided into twofloors. The first floor, which is actually on the street level on theother side of the hospital, is equipped with ten beds and designedfor short stays – hence no cubicles. Conversely, the third floorprovides more intimacy to the patients who need longer care,such as chronic diseases sufferers. A unification of the departmentis planned for 2012, with financial support from the EU,which will also enable the building of a helicopter pad on the roofof the hospital.On average, the Královské Vinohrady ACC Department providesemergency care to 800 patients per year (figures from1998), one half to primary admissions, the other to secondary.It carries out from 16,000 to 17,000 anaesthesias per year. Classiccritical cases include patients presenting with failing vitalfunctions, multiple trauma, brain injuries, confusion, epilepsyepisodes, asthma, etc.Major trauma patients represent an increasing part of the department’swork. The ACC team treats about 200 major traumapatients per year, more than 30% of whom have brain injuries.“We see a lot of car accident victims, many of whom have beendrinking and driving,” said Prof. Pachl.Trauma will soon become a problem for the hospital if interventionalradiology (IR) doesn’t develop faster, Pachl warns. “Wehave a problem finding the people to do that. We should increasethe IR service on the level of standard care,” he said.“We have no problem providing IR procedures on the standardlevel, including vascular procedures such as embolisations,recanalisations, thrombectomies, thrombolysis, punctions anddrainage. But we are not able to guarantee IR service 24 hoursa day,” said Professor Vaclav Janík, Director of the RadiologyDepartment.The first floor of the ACCDepartment at UniversityHospital Královské Vinohrady.Prof. Vaclav Janík carrying outa CT examination close to theACC Department.European Society of Radiology40

TE OS PR I C M- TE HE TM SEThe hospital lacks experienced personnel: only three fully graduatedinterventional radiologists and one IR trainee are currentlyworking at Královské Vinohrady.Another burden faced by the hospital is the shortage of nurses.The ACC Department is, with 90 nurses, an exception. But theRadiology Department, for instance, employs only three nurses.Radiology is located on the ground floor but some of its equipmentis already available in the ACC Department. One ceilingmountedradiographic unit, a mobile radiographic unit, oneC-arm fluorographic unit and one portable US unit (includingDoppler and TEE – transoesophageal – mode) are installed in theACC. In addition, a spiral CT scanner is located ten feet awayfrom the department.Emergency physicians carry out simple US examinations such asDoppler, and examinations of the pleural and pericardial fluids. Cardiologistsalso perform TEE examinations on their own. But everyother 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. Janíkestimates. In 2008, 2,800 conventional radiological examinationsand 11,000 CT scans were carried out for emergencies alone, outof 115,000 imaging procedures in total.countries, is now emerging here as well, but it has yet to be formallyinstitutionalised.In the meantime, radiologists and emergency physicians worktogether rather smoothly at the Královské Vinohrady Hospital.“Our cooperation is very good. All emergency physicians, especiallyemergency surgeons, obtain all imaging information viaPACS. Moreover we conduct radio-clinical visits with emergencysurgeons every day,” Prof. Janík said.The impending arrival of modern technology at the hospital willease the workflow even more between both specialties. In 2009a new angiography system will extend IR procedures, and newMRI equipment will enable cerebral perfusion assessments, aswell as diffusion-weighted MRI.Prof. Pachl agrees. “With the new equipment coming, cooperationcould improve, for the simple reason that radiologists willwant to stay longer if they have better equipment.”Another thing that could help things improve further would beto have a monthly meeting and develop new strategies, he thinks.Both physicians believe the programme ‘ESR meets EmergencyPhysicians’ will help in this sense. “It is an interesting and certainlyvaluable initiative, enabling the exchange of experiencebetween different institutions,” said Prof. Janík.ESR meets Emergency PhysiciansEM 2Time is lifeSaturday, March 7, 16:00–17:30, Room CPresiding: B. Marincek; Zurich/CHI.W. McCall; Oswestry/UKG. Öhlén; Stockholm/SE• IntroductionB. Marincek; Zurich/CHG. Öhlén; Stockholm/SE• Ultrasound as a time-critical diagnostictool for the emergency departmentP.K. Thompson; Rockhampton, QLD/AU• The ultrasound issue: Radiologist’s viewG.H. Mostbeck; Vienna/AT• Overcrowding flow in the emergencydepartmentM. Cooke; Warwick/UK• Image triage: Ultrasound, CT or MRI?P.M. Parizel; Antwerp/BE• Peripheral arteries: Are drug-eluting stentsthe future?L.B. Schwartz; Chicago, IL/US• Panel discussionThings are changing for the Královské Vinohrady Hospital.Recently, a 128 slice CT scanner and PACS have been installedin 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. Afterall, Vienna is not so far away!”Radiology is adapting itself to new realities in the Czech Republic.Emergency radiology, a subspecialty recognised in manyThe newly installed 128 slice CTscanner in the Radiology Department.myESR.org41 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 Lifecommitment, 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 shortbore of only 149 cm with a spacious bore diameter of 71 cm. Without compromisesto 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 mostpatient friendly MRI system.Large FoV, Non CE-MRA with FATSATConvince yourself and visit Toshiba’s satellite lunch symposia on Saturday 7 andSunday 8 March 2009 (12.30 - 13.30 hrs) that will show you how we’re working onthe future of Diagnostic Imaging.Toshiba: Shaping the future of diagnostic imaging!ULTRASOUND CT MRI X-RAY SERVICESwww.toshiba-medical.eu

E C R 2 0 0 9 P R E V I E WTenth anniversary of IMAGINE at ECR 2009Since 1999, nine high-tech specialty exhibits have underlined thestatus of the ECR as a leading conference of advanced technologyto support research and clinical practice within radiology. Followinga successful exhibition in 2008, we are therefore happy tocelebrate the tenth anniversary of IMAGINE at ECR 2009.IMAGINE 2009 will feature twelve research institutes, universitygroups and research departments of industrial companies, whowill present novel and exciting technological developments in thefield of diagnostic and interventional radiology. Focal areas ofIMAGINE are the development of quantitative imaging biomarkers,computer-aided detection and diagnosis, integrated andinteractive visualisation, therapy planning, image-guided interventionsand robotics, and computer-assisted training. IMAG-INE 2009 will feature brand new technological developments ina.o. diagnosis, therapy planning and therapy guidance of cardiovasculardisease, neurological disease and cancer. IMAGINE isunique, in that it provides a platform to discuss the potential ofthese techniques for the near future of radiology, with the peoplethat are creating them.Project Group Name WebsiteAIPG Assoc.Prof. Joachim Kettenbach www.aamir.at; www.mipga.netBiomedical Imaging Lab Agency for Science,Technology & Research (A*STAR)Prof.Dr. Wieslaw L. Nowinskiwww.sbic.a-star.edu.sgGifu University Prof. Hiroshi Fujita http://fjt.info.gifu-u.ac.jpDefiniens AG Monika Kellner www.definiens.comDISI, Università degli Studi di Genova Prof. Alessandro Verri www.disi.unige.itEindhoven University of Technology Prof.Dr. Bart M. ter Haar Romeny bmia.bmt.tue.nlESGAR CTC Assist.Prof. Emanuele Neri www.ct-colonography.orgETH Zurich Prof.Dr. Gabor Székely www.vision.ee.ethz.chMeVis Research GmbH Dr. Guido Prause www.mevis-research.comPhilips Healthcare Dr. Javier Oliván Bescós www.healthcare.philips.com;www.research.philips.comUniversity of Freiburg Prof.Dr. Matthias Teschner http://cg.informatik.uni-freiburg.deVASCOPS Austria Mag. Carmen Gasser www.vascops.comOur 7 th AnnualECR Webcast& eNews BlastBegins March 6 thLog-on daily for:• Business NewsStop By OurBooth at ECR#627Sign-up toqualify for asubscription• Clinical Updates• Exhibit Highlights• Expert Insight& AnalysisSign-up for the Diagnostic ImagingeNewsletter for daily news from ECRYour globally positionedsource for imagingintelligence.Go to www.diagnosticimaging.com/ecr2009

ESR Newsletter 04/08Will I be an artist?Will I be a doctor?Will I live to be 100?Siemens innovative molecular medicine enables early diagnosisand 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 diagnosticimaging are helping to transform the delivery of patient care. An earlier and more precise diagnosis can lead to carethat is suited not only for a specific problem, but also for a specific patient. Ultimately, personalized health care meansmore kids will grow into healthy adults.www.siemens.com/healthcare +49 69 797 6420Answers 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 SacherThe ESR Travel Service –Let Vienna become your second homeThe 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 theCongress. 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 ViennaLaunched in 2006, the ESR Travel Service has become more and more successful and now offers hundreds of rooms throughout Vienna. From the mostelegant and stylish places to cosy hideaways, from lofty residences to unpretentious private guest houses – the ESR Travel Service provides everybody withan 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 offeredform! Therefore we strongly recommend that you book only via the official ESR Travel Service, which guarantees you safety, respectability, first-classservice, 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 toESR Travel ServiceNeutorgasse 91010 Vienna, AustriaPhone: (+43 1) 533 40 64-0Fax: (+43 1) 535 70 37E-mail: travelservice@myESR.orgFor group bookings, flights, tickets, etc. please refer toMondial Congress – Official Travel AgencyOperngasse 20b1040 Vienna, AustriaPhone: (+43 1) 588 04-0Fax: (+43 1) 588 91 85E-mail: ecr@mondial.at45 myESR.org

ecauseno two patientsare alike,we designedan MR unlikeany other.The Achieva 3.0T TX automatically adjusts to each patient’s unique anatomy. Proprietaryparallel RF transmission technology tailors signals for enhanced image uniformity, reducedscan times and improved throughput across a broadrange of clinical applications. Fast, robust and versatile.It just makes clinical and economic sense. Learn moreat www.philips.com/healthcare.

Celebrate the200 th anniversary ofJoseph Haydn’s deathThis year marks the 200 th anniversary of the death of Joseph Haydn. It may seem paradoxical to speakof celebrating the anniversary of somebody’s death, but in the case of Joseph Haydn, who was without adoubt 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 hasbeen conceived with the goal of giving everyone who visits Burgenland in this year a little of this joie devivre to call their own. Haydn wrote nearly as many operas as Giuseppe Verdi. On top of that, he alsocomposed 107 symphonies, 69 string quartets, 128 baryton-trios and 14 masses. HAYDN YEAR 2009will make it clear what a universal musical genius Joseph Haydn was. There is an incredible amount tobe discovered in Haydn’s works. But the trip to Burgenland is worth taking not only for the music. Thebeautiful landscape, the more relaxed pace of living and the many culinary delights that await guests tothe 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 youknow?............ESR/ECR gives back ...the ECR’s ‘Invest in the Youth’ Programme willallow 400 young radiologists to participatein ECR free of charge, including hotelaccommodation for four nights and free publictransportapproximately 40 scholarships and fellowshipsper year worldwide are supported by ESRcurrent copies of European Radiology are beingsent to radiologists around the world as anintroduction to Europe’s No.1 journala new scheme, ‘Radiology – Your Future’,will bring young Austrian and Swiss medicalstudents to ECR 2009 for free, to open theireyes to radiology as a specialty.myESR.org