ECR NEWSTYLE is an official organ of ECR - myESR.org

CRNEWSTYLE
european congress of radiology
the art of science
You are part of the success!
16,000 participants constitute a record
high attendance for ECR 2006
SPECIAL ISSUE
www.ecr.org
2006

Table of
125,000th registrant receives warm welcome and surprise gift 3
Contents
ECR Radio & TV – a new feature, an instant success 4
Registration
16,000 participants at ECR 2006 2
e-learning
EPOS 3
eECR – the electronic congress 24
ECR Radio & TV
Science
ECR 2006 Quiz Winners 6
ECR meets ... Grumpy old men 6
Inaugural lecturer on history and disease 7
World-renowned radiologists receive honours at ECR 2006 8
EUSOBI Breast Imaging Update 2006 9
‘ECR meets’ guest nations 10
Modern imaging techniques improve treatment of mental ill health 11
MDCT opens up new perspectives for cardiothoracic vascular imaging in infants 11
Scientific Presentation Prizes 12
Imaging plays pivotal role in the management of cancer patients 13
Congress Impressions
Pictures from ECR 2006 14
Hospital Administrator Symposium
Third edition of ECR’s Hospital Administrator Symposium 16
Invest in the Youth
ECR’s ‘Invest in the Youth’ scheme – a popular feature at the congress 21
Children’s congress of Radiology 2006 in Minopolis 21
Industry
ECR thanks all 2006 exhibitors 22
Technical Exhibition ECR 2006 23
Hitachi wins ECR 2006 Exhibit Europe Award 23
ECR Party
The 6 th ECR Party – a successful encounter of styles and cultures 25
The Art of Science
Arts & Culture – Delegates relish in abundance of fine arts 26
Special exhibitions 28
ECR 2007 preview
Interview with the incoming ECR President 29
The Editorial Board, Editors and Contributing Writers make every effort to ensure that no
inaccurate or misleading data, opinion or statement appear in this publication. All data and
opinions appearing in the articles and advertisements herein are the sole responsibility of the
contributor or advertiser concerned. Therefore the Editorial Board, Editors and Contributing
Writers and their respective employees accept no liability whatsoever for the consequences
of any such inaccurate or misleading data, opinion or statement.
Advertising rates valid as per January 2006.
ECR NEWSTYLE is an
official organ of ECR
Editorial Board:
ECR Executive Board
Managing Editors:
Monika Hierath (Vienna/AT)
Julia Patuzzi (Vienna/AT)
Contributing Writers:
Konrad Friedrich (Vienna/AT)
Monika Hierath (Vienna/AT)
Julia Patuzzi (Vienna/AT)
Anita Resch (Vienna/AT)
Layout & Graphics:
Barbara Biegl (Vienna/AT)
Sonja Huber (Vienna/AT)
Petra Mühlmann (Vienna/AT)
ECR graphic_link a department of ECR
www.ecr.org
ECR 2006 Photographers:
ECR graphic_link: Petra Mühlmann
photonews.at: Anna Rauchenberger, Georges Schneider
Contact the Editorial Office:
ECR Office
Neutorgasse 9/2a
AT – 1010 Vienna
Phone: (+43-1) 533 40 64 20
Fax: (+43-1) 535 70 41
E-mail: communications@ecr.org
Marketing & Advertisements: Erik Barczik, ebarczik@ecr.org
This issue is a SPECIAL ECR 2006 ISSUE of ECR NEWSTYLE
Circulation: 16,000
Printed by Angerer&Göschl, Vienna 2006
Date of printing: March 2006
] Contents [
imprint

] Registration [
16,000 participants at ECR 2006:
All-time high registration figures and record
breaking session attendance
The number of attendees at ECR 2006 exceeded all
expectations. Never before in the history of the
congress have there been more participants. 16,000
people from 92 countries and 5 continents came
together in Vienna in March, about 9,000 of them
professionals and 7,000 attending as company
representatives. Thus roughly 1,000 delegates
more than last year were part of the ECR 2006
success story.
Despite this higher number of attendees, ECR registration
managed to significantly reduce queuing
times this year by improving and adjusting some
aspects of the check-in system. The easily accessi-
2 SPECIAL ISSUE ECR 2006
ble online pre-registration and a higher number of
ECR’s famously friendly and competent staff also
contributed to the higher efficiency of the registration
process.
The top five countries with regards to registration
this year were Austria, Germany, Italy, the United
Kingdom and Poland (see chart to the right).
However, not only registration was high at ECR
2006, the scientific programme was also extremely
well received. Compared to 2005, attendance in lecture
rooms went up by 11 percent.
Top 20 countries
ECR 2006
COUNTRY PARTICIPANTS
AUSTRIA 886
GERMANY 859
ITALY 845
UNITED KINGDOM 444
POLAND 423
HUNGARY 330
SWEDEN 296
SPAIN 291
GREECE 279
FRANCE 269
NORWAY 262
UNITED STATES 232
DENMARK 230
NETHERLANDS 227
RUSSIAN FEDERATION 222
SWITZERLAND 220
FINLAND 211
JAPAN 206
BELGIUM 184
CHINA 178

At this year’s annual congress, the electronic scientific exhibition under EPOS
continued its path of success. 768 ECR 2006 scientific and educational exhibits,
13 presentations by invited lecturers and 71 presentations by paper presenters
were on display on 100 computer terminals on the traditional “EPOSTM floor” on
the second level of the congress centre, in addition to the 3,670 electronic posters
already available in the EPOS online database. The online database now contains
the electronic exhibits of ECR 2003-2006 as well as those of several subspecialty
societies that have switched their scientific exhibition to an all-electronic
format, including CIRSE, ESGAR, ESMRMB, ESCR, and ESSR.
Prof. Maximilian Reiser, Chairman of the ECR 2006 Scientific Exhibition Committee,
was pleased that the quality of the electronic poster presentations has
increased compared to previous congresses. “When reviewing the posters, I was
truly impressed by the high quality of the electronic exhibits, and the rejection
rate during abstract submission was fairly high, which is also an indication of an
increasing quality,” he says.
The scientific exhibition was well visited throughout the congress and again,
delegates enjoyed the possibility to email the electronic exhibits to their own
address for reviewing at a later date, with around 10,400 posters having been
emailed during the congress.
The online EPOS database can be accessed free of charge by everybody via
www.ecr.org → e-learning → EPOS.
] EPOS TM [
ECR 2006 electronic posters revealed impressive
quality and attracted higher number of viewers
High visitor traffic at the ECR 2006 scientific exhibition.
www.ecr.org → EPOS
125,000 th registrant receives warm welcome and
surprise gift at ECR 2006
Dr. Miyuki Maruno from Japan is celebrated as ECR’s 125,000 th delegate receiving her surprise gift from
the hands of Henrik Silber, director of ECR registration and membership.
With regards to registration, this year’s meeting saw a further highlight. ECR had
the pleasure to welcome the 125,000th participant of the new-style ECR meetings
held in Vienna since 1991. The registration of Dr. Miyuki Maruno, radiologist at the
Oita University Hospital in Japan, came in as the 125,000th . Dr. Maruno was given
a surprise welcome and awarded a cheque for free registration and free hotel accommodation
for ECR 2007.
Dr. Miyuki Maruno was a truly happy winner. “This is such a great surprise and an
even greater joy,” she said. “This is my first time at ECR and never would I have
dreamed of such a wonderful welcome. I’m very impressed by how well organised
the congress is and very excited about the highly interesting scientific
programme. However, I very much hope that I will also be able to do some sightseeing
in the beautiful city of Vienna.”
SPECIAL ISSUE ECR 2006 3

] ECR Radio & TV [
ECR Radio & TV – a new feature, an instant success
16,000 delegates stayed tuned to ECR’s new onsite media
Some of this year’s delegates were certainly taken by surprise when, after their arrival at the congress centre and check-in, they
were given a free mini radio as well as an ‘ECR on air’ programme leaflet in addition to the traditional congress bag.
ECR’s congress Radio & TV heralded a new era of congress communication providing 12 hours of daily programme, an exciting
mix of breaking news, congress-related information, interviews with renowned scientists, company news as well as cultural and
culinary tips. Over 130 plasma screens spread throughout the congress centre displayed important announcements and
latest news, complemented by two ECR TV Lounges, where delegates could sit down and relax to watch interviews with key opinion
leaders in radiology, image films about this year’s ‘ECR meets’ countries or videos about Vienna’s cultural riches.
At the beginning of onsite registration on March 3, 7 a.m., ECR Radio 93.4 and ECR TV went on air, starting out with a cordial
welcome by this year’s President Prof. Andy Adam, as well as by other ECR and EAR officers and key speakers of the congress. In
between the various contributions, entertaining music, reflecting the young-spirited and innovative drive of the congress,
brightened up delegates’ moods.
4 SPECIAL ISSUE ECR 2006

ECR TV was kindly sponsored by
] ECR Radio & TV [
ECR’s new media could hardly go unnoticed, with over 16,000 mini radios having been distributed during the first three days, and
the TV lounges having become a popular and crowded place to relax.
Apart from scientific interviews with eminent radiologists, ECR Radio also highlighted Viennese life and culture. From the original
Sacher-Torte, the world’s most famous chocolate cake, to great performances at Vienna’s legendary theatres to musical highlights
at the city’s fabulous concert halls, up to the Mozart Haus – paying tribute to the Mozart year in commemoration of Mozart’s 250th birthday.
ECR Radio was kindly sponsored by
The great variety and high quality of ECR Radio & TV was made possible by the inspiration and energy of a hard-working, professional
team. We would like to particularly thank Martin Hecht and his crew as well as Edna & Philip Ward, Brenda Tilke and Jeanette
Marchant.
SPECIAL ISSUE ECR 2006 5

] Science [
ECR 2006
Quiz Winners
The winners of the various ECR 2006 quizzes
have now been determined.
For the Image Interpretation Quiz 218 participants
submitted 1,395 diagnoses. This year the
panel had to face extremely tricky cases – in
one special case not even 1% of the submitters
got the correct answer.
For the Cases-of-the-Day, 43% of the 3,779 answers
were correct.
United they stand: The North American and the European
teams of the Image Interpretation Quiz.
Image Interpretation Quiz
6 correct diagnoses out of 16:
Nevzat Karabulut; Denizli/TR
Takashi Koyama; Kyoto/JP
5 correct diagnoses out of 16:
Isabel Vivas; Pamplona/ES
Cases-of-the-Day
14 correct diagnoses out of 20:
John S. To; Kingsford, MI/US
11 correct diagnoses out of 20:
Canan Altay; Izmir/TR
Wouter Bauters; Gent/BE
Zafer Koc; Adana/TR
Alexandre Lüttich Uroz; Barcelona/ES
Laura Oleaga; Bilbao/ES
Lidmila Ulvrova; Pardubice/CZ
Eric Woo; London/UK
Vincent Zakovic; Bratislava/SK
10 correct diagnoses out of 20:
Javier Ballestin; Valencia/ES
Shotaro Kanao; Kyoto/JP
Antonio J.B.S. Madureira; Porto/PT
Christian Neumann; Eisenstadt/AT
Kai Roeber; Langerwehe/DE
Filip M.H.M. Vanhoenacker; Antwerp/BE
6 SPECIAL ISSUE ECR 2006
ECR meets ... Grumpy old men
A congress sketch by Dr. Paul Dubbins, Plymouth/UK
� So this is Vienna. European Congress of Radiology.
I had to come. Not enough points the chief
said.
� And what is this about CPD? Time was when you
could come to a conference, find a nice quiet and
comfortable corner, take your shoes off, sleep off
the hangover, start again on the martinis at
about 4. Now I’ve been electronically tagged.
How about some points for time in the bar? Continuous
professional drinking!
� Medical Education? You need a degree in Political
Science.
� Can you understand any of the acronyms? You
see James, EAR is the association of all of the
National Societies and the Specialty associations
and each society has one or more votes and
nobody knows exactly how many members there
are and some members can belong to several
specialist societies and the EAR is the political
arm of Europe ... and the ECR? That’s where you
have one man one vote and that is the apolitical
body, responsible for the Scientific and Educational
Programme. Confused yet?
� And now we have ESR. Which is confusing too, I
thought the ESR had been abolished. I am
certainly not allowed to request an erythrocyte
sedimentation rate in my hospital anyway.
�
Anyway – don’t you prefer ECR and EAR? Nobody
gets to talk to anybody unless it is in secret, and
in any case where do we get the intrigue or the
political infighting now? Perhaps that’s it – the
European Secret Society!
And why Vienna? It snows in England too you
know! What has Vienna got? We can match the
lot
� Wolfgang Amadeus – Franz Ferdinand
� Stephansdom – Millennium Dome
� Sachertorte – Cornish Pasty
�
I leave you to make your own choices.
Everything’s so, well, organised:
� All the details about the conference arrive
weeks before I leave.
� The transport from the airport was prompt,
courteous and comfortable.
� My hotel is pleasant and close to all amenities.
� The food is good.
� I can’t even complain about the wine any
more. Whatever was wrong with anti-freeze?
� Even the underground runs to time and my
nose is not forced up against some tall bloke’s
armpit.
� And what’s all this about trusting the travelling
public? They’ve made me honest too! At
home its good sport trying to avoid the automatic
barrier – here I pay my fare like a good
citizen!
� And how is it that everyone speaks English better
than I do – where is the opportunity for me to
shout loudly at some poor unsuspecting individual
demanding proper warm beer?
� They even all speak perfect English in the
presentations. How infuriating is that? There’s no
fun any more scoffing at the funny accents ...
and there are more spelling mistakes on my
slides!
� Which brings me to another point. Why can’t I
get my carousel to fit any of these projector
jobbies and why is there no mismatching double
projection?
� And another thing – why are there no queues?
What’s all this about Express lanes. I set aside an
hour for registration and was badged and bagged
within five minutes.
� I was so disoriented that I had to join the only
available queue – for the social events. I hadn’t
booked any of course, but at least I was able to
complain that I had waited for 15 minutes and
no-one could find my tickets.
� I’ve brought my wife of course. I had to. She is
under the illusion that I am having an affair with
this classic Italian beauty called Passariello. She
didn’t accept my explanation. There can’t be that
many presidents!
� Which brings me on to the shopping. It’s too
damn good. Not only will the credit card bill be of
terrifying proportion when we return home but
“the shoes out there are fabulous, and the handbags
... why can’t we have a Steffl in Plymouth?”
will be the persistent refrain.
� Is it any wonder that I am grumpy?
� It is only down to good fortune that I was stuck
in a ten mile traffic jam on the way to the airport,
went into acute retention as a result and British
Airways managed to lose my baggage on the
direct flight from London to Vienna. Thank God
for some certainties in life ...

Inaugural lecturer presents stunning examples of
how disease has shaped the course of history and
radiology’s role
Prof. Sidney Wallace receives a surprise gift from Prof. Andy Adam.
This year’s inaugural lecture entitled “History and disease: Dyslexia to the New
Deal” was held by Prof. Sidney Wallace from Houston, Texas/US, Professor Emeritus
at the University of Texas M.D. Anderson Cancer Center. The highly decorated
academic tracked the impact of disease on the course of history and on the
people who made it. His lecture attracted a huge audience, who was overwhelmed
by the new perspectives presented as well as by the special multi-media presentation
format.
The ECR editorial team had the pleasure to talk to Prof. Wallace.
Professor Wallace, how has disease shaped leading figures in history and their
achievements?
It has not only shaped leading figures depending on what their specific disease
was, but it has changed the time. Disease from an infectious point of view took
many more people than the wars that may have been. For an example, in World
War I there was a pandemic of influenza. In that pandemic, 40 to 50 million
people died. From the United States in World War I, 675,000 died of the
disease. One tenth of this number died in the battlefield. So there is no question
that infectious diseases have shaped history. But even disease of each individual
along the way, for example in that same series of World War I, the president of
the United States was Woodrow Wilson. Woodrow Wilson had had strokes in a
number of years prior to the end of that war when he was planning his 14 points
and the League of Nations. However, he had a massive stroke during his whistlestop-tour,
trying to sell the treaty to the Americans. That put him in limbo for at
least six months. And the government from his point of view was in fact run by his
physician and his wife and their assistant. So undoubtedly it changed the impact
that office had in trying to formulate and participate in the League of Nations. So
the United States never joined the League of Nations.
Did dyslexia have a strong impact on the work and lives of historic people like for
instance da Vinci, Einstein, Edison and Churchill and who of those was most
affected?
They were all affected. Let me give you probably one example that would be
Winston Churchill, who attended some of the finest schools in all of England, but
he was a disaster as far as a student. He just couldn’t respond. Then he became
a member of the parliament, because of his position and his family’s position. In
addition, he was given a fairly important position in the government, but he was
a far better journalist than he was a politician and as he developed in his
] Science [
approach, at the age of 40, he found out that he could paint fairly well, another
talent that he had. And he put all of his talents together to be one of the finest
Prime Ministers that England has ever had. Consequently, dyslexia shaped him
tremendously and he had to wait so people could understand his problem in a
way. Now he was a phenomenal orator, but he would rather memorise his speech
than read it, because dyslexia is a difficulty with reading.
How does disease affect world affairs today and how is this different from the
effect of diseases in the past?
The times changed and consequently the world changes. Today, perhaps we are
all petrified about avian flu as it rapidly sweeps across the continent. Avian flu
undoubtedly has changed the world in that we are fearful and we don’t know what
to expect or how to meet that disease, because we are totally unprepared to
manage avian flu. That same flu caused pandemics in years past. People have to
work together and not apart. So it will in fact, if it comes, change the world
markedly. But even in the preliminary periods it has made us all stop to think of
which is more important.
What role does radiology play in disease and in world affairs? Is radiology’s role
changing?
Radiology’s role undoubtedly is changing. Primarily we were in an isolated
segment of the medical field in which the rooms were dark and we wore red
glasses and we looked at films with a background of light, so we were in a very
sedentary position. As the new devices came aboard, including computer tomography,
ultrasonography and magnetic resonance imaging, one major change has
been that radiology or the demonstration of the images has become the physical
examination and that the private physician or the practicing physician doesn’t do
an examination. He waits to see what images have yielded and then picks it up
there and continues on. That’s at the detriment of medicine, but on the other
hand the amount of information that is discovered by the imaging devices has
really put the radiologist in the forefront of all the different diseases. For example,
I work and I am now a professor emeritus at a large cancer hospital in the United
States. It is the University of Texas, MD Anderson Cancer Center in Houston,
Texas. We deal primarily with cancer. At our institution we are now at 600
examinations by CT a day. Consequently, first they get the image and then they
look over the image to see the distribution of the disease and the type of disease
and then they consult with the radiologist, so we have a more unified approach.
Prof. Wallace’s lecture was followed by the traditional opening concert, featuring the Radio Symphony
Orchestra Vienna under Alexander Joel and world-famous violinist Julian Rachlin as soloist.
SPECIAL ISSUE ECR 2006 7

] Science [
World-renowned radiologists receive honours at
ECR 2006
By old-established tradition of ECR, some of the radiological community’s best-known and most
esteemed members were decorated at this year’s meeting.
Two esteemed radiologists from the United States were awarded honorary
membership of the European Congress of Radiology and the European Association
of Radiology.
RSNA 2005 President David H. Hussey was born in Savannah, IL/US, in 1937.
He trained in radiology and radiation oncology at the University of Iowa, Iowa
City, and the University of Texas M.D. Anderson Hospital and Tumor Institute in
Houston, where he was on the faculty between 1969 and 1985 and directed the
M.D. Anderson Hospital Fast Neutron Therapy programme. He was then Head of
the Division of Radiation Oncology at the University of Iowa, Iowa City, between
1985 and 2000. Since 2001 he has been Clinical Professor at the University of
Texas Health Science Center in San Antonio, Texas. He is a specialist in the
research of testicular cancer, prostate cancer, and head and neck cancer, and has
always had a particular interest in graduate medical education. Prof. Hussey was
awarded honorary membership in recognition of his outstanding achievements,
especially in the field of radiation oncology, and his untiring efforts in imparting
his knowledge unto future generations of physicians.
Peter R. Mueller was born in Boston, MA/US, in 1947. After graduating he
completed his medical internship at Cincinnati General Hospital in Cincinnati and
his radiology residency at Massachusetts General Hospital in Boston. Since 1977
he has held various academic positions at Harvard Medical School in Boston,
being now Professor of Radiology since 1999. Since 1990 he has served as Head
of Division for Abdominal Imaging and Interventional Radiology at the Massachusetts
General Hospital in Boston. Prof. Mueller states his major research interests
as evaluation of interventional radiology techniques, development of new interventional
radiology procedures, evaluation of percutaneous ablation techniques
for tumours, and evaluation of cross-sectional imaging technologies. He was
awarded honorary membership in recognition of his outstanding influence on
introducing and developing new techniques and procedures, especially in the field
of interventional radiology.
The revered Gold Medal of the European Congress of Radiology and the European
Association of Radiology was this year awarded to two particularly outstanding
members of the European radiological community.
Janet E. Husband from London/UK is counted among the most renowned radiologists
in the world. Among her present appointments are Professor of Diagnostic
Radiology, University of London, Institute of Cancer Research; Consultant Radiologist
and Head of the Academic Department of Diagnostic Radiology, The Royal
Marsden Hospital NHS Foundation Trust and Medical Director, Royal Marsden NHS
Foundation Trust; President of the Royal College of Radiologists; Immediate Past
President of the British Institute of Radiology; Past President, Co-Founder and
Trustee of the International Cancer Imaging Society; and Clinical Director,
Department of Radiology, London Clinic. She has pioneered the development of
cancer imaging in CT and MRI and has held joint programme grants from Cancer
Research UK totalling over £12 million during the last 20 years. She is awarded
the ECR Gold Medal in recognition of her grand contributions to the development
of diagnostic radiology and her unparalleled commitment to cancer research.
Prof. Janet E. Husband, Prof. Holger T.A. Pettersson, Prof. David H. Hussey and Prof. Peter R. Mueller wait to receive their honorary awards at ECR 2006’s opening ceremony.
8 SPECIAL ISSUE ECR 2006
Holger T.A. Pettersson was born in Uddevalla/SE in 1942. He is currently
serving as Professor of Radiology at the University of Lund; as Chief Medical
Officer, Region of Scania (south Sweden); as Director, WHO Collaboration Center
for Education in Radiology, University Hospital, Lund, Sweden; as WHO advisor
and expert for radiological education, WHO Headquarters, Geneva, Switzerland;
as Member, WHO Expert Panel on Radiation, Geneva, Switzerland; as Adjunct
Professor, Department of Radiology, University of Florida, Gainesville, Florida,
USA; and as Adjunct Professor, Sun-Yat Sen University, Guangshou, P.R. China. A
former EAR President (2002-2003) and ECR President (2001) Prof. Pettersson is
awarded the ECR Gold Medal in recognition of his exceptional achievements
particularly in the field of paediatric and skeletal radiology, and his superior
contributions to educating and tutoring younger colleagues all over the world.

EUSOBI Breast Imaging Update 2006
Digital mammography and MR guidance promise new horizons at ECR’s back-to-back meeting
Prof. Thomas Helbich, Vienna/AT
For the third time in a row, the European Society of
Breast Imaging (EUSOBI) held its annual scientific
meeting called Breast Imaging Update one day prior
to the annual ECR congress; the EUSOBI meeting
was this year presided over by Prof. Ingrid Schreer
from the Mammazentrum Kiel, Germany. The stateof-the
art scientific programme of the meeting, which
was traditionally held at the Austria Center Vienna,
attracted around 200 participants from all over
Europe and overseas.
The major topics of this one-day meeting included the latest developments in
digital mammography, which bring about new perspectives in breast imaging. The
key benefits of digital mammography are reduced radiation dose as well as the
implementation of so-called computer assisted diagnosis systems, which help
the radiologist find cancers. Another very challenging perspective of digital
mammography is tele-mammography, i.e. the possibility to send mammograms
to any workstation all over the globe in order to seek expert advice or second
opinions.
Part of the EUSOBI meeting was dedicated to the latest advances in breast intervention,
a growing and constantly developing field in this discipline. Percutaneous
image-guided biopsy is increasingly used as an alternative to surgical biopsy for
the histological assessment of breast lesions. Percutaneous biopsy is faster, less
invasive and less expensive than surgical biopsy. Improved biopsy needles allow a
better retrieval rate and better diagnosis.
A major change in breast imaging is currently being heralded by MR guidance
procedures. “Due to MR guidance, a lot of breast imagers will change their title to
‘MR guided breast therapists’, as we have the possibility not only to diagnose but
also to treat the cancer,” says Prof. Thomas Helbich from the Medical University of
Vienna (AKH) and EUSOBI Secretary General. “Offering numerous possibilities,
including focused ultrasound, laser therapy or cryotherapy, these new procedures
will open up the operating theatre for radiologists,” he adds.
] Science [
One of the highlights of this year’s EUSOBI meeting included a session focussing
on how to avoid lawyers. The speakers at this important session revealed that
communication plays a central role in avoiding legal action by the patient. “If you
explain to your patients that mammography is not a tool that is 100% perfect,
they will be aware that something might go wrong, as is the case with anything
else done by human beings. As a radiologist you have to be a team player and
communicate with surgeons, oncologists and any other parties involved in order
to do the utmost to avoid cancer misses,” Helbich says.
At ECR 2006, breast imaging was also among the topics that were high up on the
agenda. The highlights discussed included MR imaging of the breast, breast
screening, interventional procedures as well as laser mammography, a new
radiological technique for the early detection of breast cancer that is currently
being clinically evaluated and tested in Europe and the United States. "Through
molecular imaging with laser an improved diagnosis of breast tumours has
become possible – and without the slightest exposure to radiation," Helbich says.
At the Medical University of Vienna first trials with around 800 female patients
were carried out – with highly promising results. In the last several years, the
technique has undergone considerable refinement, and the use of computed
tomographic systems in laser imaging has become possible. A computed tomographic
laser light-based scanner for the breast, called computed tomographylaser
mammography (CTLM), has been developed. The basic principle underlying
CTLM imaging is the fact that any malignant tumour requires neovascularisation
to grow beyond 2 mm in size. It does this by elaborating angiogenetic substances,
which stimulate the growth of structurally and functionally abnormal blood
vessels. This neovascularisation, which results in a greater volume of haemoglobin
in a confined area, can be visualised using absorption measurements of laser
light. Within the next years this method of early detection of breast cancer could
be an accessible alternative to mammography. Researchers are now working hard
to develop the ideal contrast agent for this novel imaging method.
For more information on EUSOBI and its upcoming activities, please visit
www.eusobi.org.
FIGURE 1 (a and b). Images obtained from a 44-year-old female patient. (a) Mammography shows an
indistinct mass with pleomorphic microcalcifications, classified as BIRADS IVc. (b) CTLM in 3D MIP reconstruction:
At the corresponding localisation, CTLM shows a volume of increased absorption (large arrow)
with a round shape. Histologic diagnosis of the lesion revealed invasive ductal carcinoma. Also shown:
normal vessels seen from different views (arrowheads).
SPECIAL ISSUE ECR 2006 9

] Science [
‘ECR meets’ guest nations overwhelmed by
interest in their activities and Viennese hospitality
The purpose of the ‘ECR meets’ concept that was introduced at ECR 2003 under
the auspices of the then ECR President Prof. Nicholas Gourtsoyiannis from Iraklion,
Greece, is to forge closer ties between the invited countries and ECR. The
guest countries are attributed dedicated sessions in order to allow their radiological
communities to demonstrate the excellence of radiology in their countries to
congress attendees.
By tradition, one of the ‘ECR meets’ countries is always the home country of the
acting congress president – this year the United Kingdom. Chaired by Prof. Andy
Adam, ECR 2006 President, and Prof. Janet Husband, President of the UK Royal
College of Radiologists, the British inaugurated the series of this year’s ‘ECR
meets’ sessions, presenting the impact of imaging in guiding new approaches to
treatment.
The other two guest nations of this year’s ECR were Russia and Singapore.
ECR meets Russia. Russian key players in radiology meet up with ECR officers.
Over 220 Russians travelled to Vienna to enjoy the science presented at the
meeting, and – of course – the cultural attractiveness of the city. In their dedicated
session, which was co-chaired by Prof. Vladimir Kharchenko, Director of the
Russian Scientific Center of Radiology and President of the Russian Association of
Radiologists, and Prof. Andy Adam, the Russians presented the contribution of
radiology to solving certain problems in medicine. “The main challenges currently
faced by Russian radiologists are above all educational and training issues,” said
Prof. Valentin Sinitsyn from the Cardiology Research Center in Moscow. “Radiology
training should be adapted to European standards in order to keep pace with
the rapid advances made in modern imaging techniques and in order to ensure
optimum patient care,” he added. Recently, a lot of new, high-tech diagnostic
equipment has been introduced into Russian hospitals, thus allowing better
patient management.
Following the previous South-East Asian guest nations South Korea and Japan,
Singapore presented its radiological activities in a session entitled ‘From gene to
screen’ at this year’s ECR. “We decided to focus on the activities of our innovative
10 SPECIAL ISSUE ECR 2006
ECR meets the UK. From left: Prof. Adrian Dixon, Prof. Andy Adam, Prof. Janet E. Husband, Prof. Rodney
H. Reznek.
younger generation of radiologists and on our country’s path to biomedical excellence,”
said Prof. John Hoe, President of the Singapore Radiological Society and
Vice President of the Singapore College of Radiologists, who co-chaired the
session together with the Congress President and presented an introductory
statement. Around one third of Singapore’s radiologists participated in ECR 2006.
“We all like to come to ECR because of the very high scientific content of the
programme and the teaching sessions, as well as because of the numerous innovative
features, such as EPOS,” Hoe pointed out.
The small country faces an extreme shortage of radiologists – there are only 30
radiologists per 1 million inhabitants –, which is why Singapore tries to make the
profession more attractive to students and to hire experts from abroad. The
Singaporean government has also started to outsource certain radiological services
from the country’s public hospitals to other countries in order to cope with the
lack of professionals in this discipline.
ECR meets Singapore. Singaporean top radiologists present interesting insights into their country’s latest
advances in imaging.

Modern imaging techniques bring about dramatic
improvement in understanding and treatment of
mental ill health
Getting inside the human head is one of the greatest remaining challenges for
medical science. Despite the huge advances made in medicine over the past
hundred years, the precise structure and function of the human brain is still
largely a mystery. “Radiology can make an important contribution to unlocking
these secrets,” says Prof. Steve Williams of the department of neurology at the
Institute of Psychiatry at the King’s College Hospital in London, who has been
using radiological methods to investigate the brain, and who presented an invited
talk on that topic at ECR 2006.
The disciplines of radiology and psychiatry first met up in the 1980s when they
started to pull structural imaging assessments together with psychiatric illness,
but it is definitely an evolving process, which is still in an early honeymoon
period.
“In the last 10 to 15 years functional MRI has taken off and probably been used in
psychiatry more than in any other clinical discipline,” Williams says. “This technology
allows us to look at brain activity on the fly while someone is thinking, lying
or making mathematical calculations.”
Modern imaging techniques tell us a lot about mental illness. It is for example
possible to predict the brain’s response to anti-depressant treatment in depression,
to predict ongoing psychotic events in certain patients as well as chronic
schizophrenia. “There are numerous examples that range from autism through
Alzheimer’s, alcoholism, anxiety, anorexia, and that’s just the A’s,” Williams
explains.
“One of my best examples is in the area of schizophrenia where we do much of
our research. At one level, we are now able to visualise hallucinations, as the
person is hearing voices and as we can see the brain responses to these internal
hallucinations, we can develop medications and treatments to perhaps ameliorate
Dr. Andrew Taylor from the Cardiothoracic Unit at Great Ormond Street Hospital
for Children in London, UK, presented a talk on cardiac CT at the ECR 2006
refresher course on paediatric cardiothoracic vascular imaging. Great Ormond
Street is the UK’s premier hospital for the treatment of childhood diseases.
Cross-sectional imaging (MR and CT) has improved dramatically over the last few
years, in particular due to the advent of multi-detector CT, which enables radiologists
to acquire three-dimensional data sets which they can reconstruct in any
imaging plain in a very short period of time, and will have an important impact on
the imaging protocols of many congenital heart diseases.
“We use multi-detector CT in infants to look at the great vessels, the aorta, the
pulmonary arteries or the pulmonary veins, since we currently cannot perform
great ECG gating in small children,” Taylor explains.
Taylor strongly advocates an integrated approach in the diagnosis of congenital
heart defects in infants. “Depending on the questions we are seeking to answer,
most of our young patients would have an echocardiogram in the first instance
followed by either an MRI or a multi-detector CT scan,” he says. MRI is generally
used for patients where cardiac anatomy, cardiac function, and valvular function is
to be visualised, while multi- detector CT is applied particularly in younger patients
and in those patients where the focus is on the anatomy of the great vessels.
With safety being an important issue when dealing with these particularly vulnerable
patients, radiation dose is kept to a minimum. “A low radiation dose is
extremely important, since these children are likely to have multiple investigations
over time. We avoid high radiation doses by performing non ECG-gated
images and by keeping the kV and the mAs to as low a level as possible without
causing degradation on the images we get,” Taylor explains.
] Science [
the patient’s hallucinations,” he adds. At another level, what is very common in
schizophrenia, is poor working memory, poor function to remember one’s own
name, one’s telephone number and the like. Prof. Williams’ group has developed
methodologies that allow visualising of transient brain damage, which can be
corrected by treatment with medications.
As is common in radiology, cost is of course a major issue. These scanners are not
cheap and not widely available. “Also, in psychiatry, many of our patients have no
insight into their condition and that’s also an issue for the clinical management of
the subjects, but in the future I think we will be doing more and more work in
children at risk of developing psychiatric disorders and there is a logistical
challenge for us,” Williams adds.
Some psychiatric disorders are developmental in their origins, such as autism,
which is why some experts postulate that the brain should be looked at in utero,
even before birth, which would enable them to predict where there is a prospect
of a psychological illness in the long term.
With the advent of genetics and better classification of disorder – poor classification
has long been one of the key problems in psychiatry – imaging can now
really add value by being able to phenotype the genotype. “Another benefit
imaging can bring into this field is predicting of whether a patient suffering
mental ill health is going to respond to treatment or not,” Williams says. Many
medications currently available for treating psychiatric illnesses take many
months if not years to work and it would be a great step forward if imaging
techniques could be used to predict within a very short period of time – a few
days or a week – whether a patient is going to respond to an anti-psychotic or
anti-depressant rather than waiting for the long term clinical outcome.
MDCT opens up new perspectives for
cardiothoracic vascular imaging in infants
Performing multi-detector CT is relatively fast (3
to 5 seconds) and easy, therefore many neonates
and infants, who may require general anaesthesia
to undergo an MR scan, can be assessed using
either ‘feed and wrap’ or sedation. Oral sedation
under appropriate monitoring is generally used for
children between 6 months and 5 years, while
children over 5 years usually do not require
sedation, as they are able to hold their breath for
Figure 1: Volume rendered 3D
image viewed from posterior in a 1
the duration of the scan.
day neonate. MDCT angiography
was performed in 4s during a ‘feed
In future, radiologists are facing two major and wrap’. Images show dextracar-
challenges with regard to the use of CT in assessdia,
total anomalous pulmonary venous
drainage, patent arterial duct
ing congenital heart disease in infants. “The first
area is to get better ECG gating, such as we don’t
and aortic coartation.
have to beta block patients as it would be the case at the moment for imaging
adults to get good intra-cardiac anatomy, and good images of the coronary
arteries. Any scanner that could do that would be very useful and also reduce the
acquisition period for these scans,” Taylor says.
“The second challenge is to look at algorithms in which we can use the CT data to
actually further reduce the dose, thus acquiring less data in a similar way that we
would with MRI, and reduce the dose to these patients but still get a good image
quality. These two developments will take CT forward, such that we are not only
looking at the great vessels in these children, but that we are also able to image
the intra-cardiac anatomy and yet keep the dose as low as possible.”
SPECIAL ISSUE ECR 2006 11

] Science [
Scientific Presentation Prizes
The best scientific papers and scientific/educational exhibits have been identified by the subcommittee members and session moderators. The selection criteria comprised
abstract, onsite performance, and images. The presenting authors of the best papers and magna cum laude exhibits will now be awarded the prize of € 1,500.- each, and
offered free registration to ECR 2007.
Best Scientific Presentations
Scientific Papers
Abdominal Viscera
Diffusion-weighted MR in evaluation of liver fibrosis: Role
of apparent diffusion coefficients (ADC) measurement
in diagnosis and determination of a threshold for pathology
(B-367)
R. Girometti, A. Furlan, G. Como, M. Bazzocchi, F. Toso,
C. Zuiani; Udine/IT
Breast
Interval breast cancer: Prognostic features and survival by
subtype and time since screening (B-106)
G.J.R. Porter, A.J. Evans, H.C. Burrell, A.H.S. Lee, I.O. Ellis,
J. Chakrabarti; Nottingham/UK
Cardiac
MR guided intramyocardial injection of substances to infarct
borders for molecular therapy (B-276)
G.A. Krombach, Y. Temur, J.G. Pfeffer, S. Kinzel, R.W. Günther,
A. Bücker; Aachen/DE
Chest
Free-breathing volumetric CT lung imaging using
prospective non-contact gating in a large animal experiment
(B-152)
J. Zaporozhan1 , S. Ley1 , R. Unterhinninghofen1 , Y. Saito2 ,
M. Fabel-Schulte1 , G. Szabo1 , H.-U. Kauczor1 ; 1Heidelberg/DE, 2Tochigi/JP Computer Applications
CAD performance on cancer containing mammograms
initially not detected by the radiologists (B-114)
A. Malich1 , S. Schmidt2 , D. Fischer3 , M. Facius2 , C. Marx4 ;
1 2 3 4 Nordhausen/DE, Jena/DE, Berne/CH, Greiz/DE
Genitourinary
Diffusion-weighted MRI of renal allografts: A comparative
study to healthy volunteers (B-754)
H.C. Thoeny1 , D. Zumstein1 , S. Simon-Zoula1 , U. Eisenberger1 ,
F. De Keyzer2 , C. Boesch1 , F. Frey1 , P. Vock1 , P. Vermathen1 ;
1 2 Berne/CH, Leuven/BE
GI-Tract
Posterior pelvic floor disorders: A prospective comparison
with colpocistodefecography and dynamic vaginal
endosonography (B-696)
S. Piciucchi, R.F. Grasso, M. Sammarra, C.C. Quattrocchi, E. Leo,
C. Gaudino, D. Vaccaro, B. Beomonte Zobel; Rome/IT
Head and Neck
High resolution multislice CT (MSCT) for predicting basal
cochlear length for electric-acoustic stimulation (B-723)
M.G. Mack1 , O. Adunka2 , M. Unkelbach1 , A. Wetter1 , T. Lehnert1 ,
J.O. Balzer1 , T.J. Vogl1 ; 1Frankfurt a. Main/DE, 2Chapel Hill, NC/US
Interventional Radiology
A percutaneously implantable telemetric pressure sensor to
detect endoleaks after endovascular abdominal aortic
aneurysm repair (EVAR) (B-740)
F. Springer, R. Schlierf, J. Pfeffer, J. Tomko, A.H. Mahnken,
U. Schnakenberg, T. Schmitz-Rode; Aachen/DE
Molecular Imaging and Contrast Media
Prediction of GFR with Cockcroft-Gault’s formula based on
the NORIP plasma-creatinine reference intervals and using
various body weight expressions (B-054)
U. Nyman1 , J. Björk2 , G. Sterner3 , A. Grubb2 ; 1Trelleborg/SE, 2 3 Lund/SE, Malmö/SE
Musculoskeletal
Peripheral triangular fibrocartilage tears: Depiction with MR
arthrography after contrast injection into the distal
radioulnar joint (B-244)
C. Rüegger1 , M.R. Schmid1 , C.W.A. Pfirrmann1 , L. Nagy1 ,
L.A. Gilula2 , M. Zanetti1 ; 1Zurich/CH, 2St. Louis, MO/US
Neuro
Tonotopic plasticity effects in the auditory cortex in
unilateral tinnitus patients: An fMRI study (B-511)
S. Kovacs1 , M. Smits2 , D. De Ridder3 , R. Peeters1 , P. Van Hecke1,
S. Sunaert1 ; 1Leuven/BE, 2Rotterdam/NL, 3Edegem/BE Pediatric
Reduction of radiotherapy in children with early stages of
Hodgkin’s lymphoma, influenced by a new imaging and FDG-
PET based strategy (B-419)
I. Sorge, C. Mauz-Koerholz, D. Koerholz, R. Kluge, A. Krausse,
T. Kahn, W. Hirsch; Leipzig/DE
Physics in Radiology
Diffraction enhanced imaging: A new tool for cartilage and
bone studies (B-653)
P. Coan1 , A. Wagner2 , N. Sieber2 , K. Schmuck2 , J. Mollenhauer2 ,
C. Muehleman3 , M. Lohmann4 , A. Bravin1 ; 1Grenoble/FR, 2Jena/DE, 3 4 Chicago, IL/US, Hamburg/DE
Radiographers
Autonomous, sonographer provided, symptomatic breast
clinics for women under the age of 35 years (B-640)
M. Holland1 , C. Theodorakou2 , G. Massey1 , R. Jones1 , I. Britton3 ;
1 2 3 Boston/UK, Hertford/UK, Stoke-upon-trent/UK
Vascular
State-of-the-art cardiovascular imaging with parallel
acquisition techniques on a whole body MR scanner:
Experience in more than 200 individuals (B-431)
H. Kramer, H.J. Michaely, K. Nikolaou, M.F. Reiser,
S.O. Schönberg; Munich/DE
12 SPECIAL ISSUE ECR 2006
Scientific and Educational
Exhibits
Magna Cum Laude
Contrast Media
A comparison of the cytotoxic effects of an iodinated
radiographic contrast medium with gadolinium-based MRI
contrast agents on renal tubular cells in vitro at doses used
for angiography (C-233)
M. Heinrich1 , S. Kohlbacher1 , M.K. Kuhlmann1 , M. Scheer1 ,
A. Grgic1 , M. Heckmann1 , M. Uder2 ; 1Homburg a.d. Saar/DE,
2Erlangen/DE Contrast Media
General considerations for optimizing contrast-enhanced
multidetector CT imaging technique (C-235)
K.T. Bae; St. Louis, MO/US
GI Tract
Clarifying terminology in the multidisciplinary management
of rectal cancer: A pictorial study (C-361)
G. Brown1 , G. Salerno2 , I.R. Daniels2 , A. Wotherspoon3 ;
1 2 3 Sutton/UK, Basingstoke/UK, London/UK
Musculoskeletal
Soft tissue tumors: MR imaging and pathologic features
according to the new WHO classification (C-564)
J.C. Vilanova1 , K. Woertler2 , J.A. Narváez3 , J. Barceló1 ,
S.J. Martínez4 , M. Villalón1 ; 1Girona/ES, 2Munich/DE, 3 4 Barcelona/ES, Durham, NC/US
Abdominal Viscera
CT of blunt pancreatic trauma (C-050)
S.K. Venkatesh; Singapore/SG
Chest
Congenital pulmonary venolobar syndrome: Spectrum of
helical computed tomography and magnetic resonance
angiography findings (C-200)
I. Torres, M. Parron, F. Baudraxler, J. Fernandez Cuadrado,
M. Pardo, T. Berrocal; Madrid/ES
Cum Laude
Abdominal Viscera
Cystic liver lesions: Differential MR imaging features (C-030)
B.J. Op de Beeck1 , R. Salgado2 , C. Geniets1 , K. de Jongh1 ,
R. Salgado1 , B. Corthouts1 , P.P. Parizel1 ; 1Edegem/BE, 2Brussels/BE Cardiac
CE cardiac MRI: From viability to diffuse cardiac diseases
(C-117)
G.K. Schneider, P. Fries, R.M. Seidel, A. Massmann, K. Altmeyer,
M. Boehm, I. Kindermann; Homburg a.d. Saar/DE
Cardiac
Detection of patent foramen ovale using ECG-gated
multidetector cardiac CT angiography (C-133)
E.E. Williamson, P.A. Araoz, L. Alvarez-Maluenda, W.B. Edmister,
D.A. Woodrum, D.K. Borgeson, J.F. Glockner, J.F. Breen;
Rochester, MN/US
Chest
The spectrum of imaging findings in pulmonary aspergillosis
(C-182)
N. Bharwani, J. Raja, G. Munneke, S. Grubnic; London/UK
Chest
Direct visualization of the shunt flow on vascular disorders
of the chest: Usefulness of two-phase contrast-enhanced CT
with a saline flush (C-197)
M. Miyazaki, O. Hasegawa, H. Honjo, T. Tameda, N. Hashimoto,
F. Shishido; Fukushima/JP
Computer Applications
E-learning and medical imaging: A web-based interactive
course about basic principles of magnetic resonance
imaging (C-212)
D. Hoa, G. Gahide, A. Micheau; Montpellier/FR
Genitourinary
Pelvic endometriosis: Usual, unusual imaging
manifestations and pitfalls (C-239)
M. Takeuchi, K. Matsuzaki, H. Nishitani, H. Uehara; Tokushima/JP
Genitourinary
Imaging spectrum of diseases associated with the renal
pelvis (C-274)
Y.-W. Kim, H.-S. In, S. Choi, S.S. Han; Busan/KR
GI Tract
Bare area of the liver: Physiopathology of the
retroperitoneal spreading of malignancies (C-407)
F.M. Danza, M. Cirillo, A. D’Amico, A. Magistrelli, E. Bock,
L. Bonomo; Rome/IT
Musculoskeletal
Posterior cruciate ligament injuries: What the surgeon
needs to know (C-534)
E. LLopis1 , P. Ferrer1 , V. Higueras1 , M. Padron2 ; 1Valencia/ES, 2Madrid/ES Certificate of Merit
Abdominal Viscera
The perihepatic space: Comprehensive anatomy and CT
imaging of pathologic conditions (C-021)
D. Yeh, S. Kim, N. Lee, J. Lee, T. Lee, S. Lee, J. Tae Yong;
Busan/KR
Breast
The diagnostic usefulness of real-time virtual sonography
(RVS) for non-palpable breast lesions (C-109)
A. Sawaki1 , H. Satake1 , S. Ishigaki1 , K. Shimamoto1 , T. Ishigaki1 ,
K. Oda1 , T. Imai1 , T. Nagasaka1 , T. Mitake2 ; 1Nagoya/JP, 2Chiba/JP Computer Applications
Radiology Teacher (www.radiologyteacher.com): An
internet based, user tailored and free of charge teaching file
server for creating interactive radiological teaching files
(C-226)
R. Talanow; Cleveland, OH/US
Genitourinary
Spectrum of CT and MR features in secondary tumors of the
ovary; correlation with pathological findings (C-249)
T. Koyama, Y. Mikami, K. Tamai, S. Umeoka, T. Saga, S. Fujii,
K. Togashi; Kyoto/JP
Genitourinary
Value of diffusion-weighted MR imaging in gynecological
malignancies; its applications and limitations (C-251)
T. Koyama, K. Tamai, T. Saga, S. Umeoka, S. Fujii, K. Togashi;
Kyoto/JP
Genitourinary
Sarcomatoid type renal cell carcinomas: Multidetector CT
findings in nine patients (C-284)
K. Kim, K. Kim, C. Lee, J. Choi, C. Park, I. Cha; Seoul/KR
GI Tract
Carcinoid tumors: Spectrum of CT and MRI findings (C-401)
M.D. Marra, C. Hoeffel, M.D. Crema, A. Oudjit, L. Arrivé,
J.-M. Tubiana; Paris/FR
GI Tract
Abdominal emphysematous conditions: A pictorial essay
(C-402)
B. Nieto Baltar, Y. Martinez Alvarez, E. Huelga Zapico, A. Herrasti
Gallego, A. Veron Sanchez, M. Montes Fernandez; Madrid/ES
GI Tract
CT evaluation of the bulging papilla: Correlation with
endoscopy (C-404)
D. Yeh, S. Kim, T. Kim, J. Lee, C. Kim, S. Lee, G. Kim; Busan/KR
Head and Neck
Congenital conductive hearing loss in children and young
adults on high resolution computed tomography of the
temporal bone (C-421)
P. Tang1 , J. Goh1 , T. Tan1 , W. Smoker2 , L.R. Gentry3 ;
1 2 3 Singapore/SG, Iowa, IA/US, Madison, WI/US
Head and Neck
Imaging of mandibular lesions: Odontogenic and
nonodontogenic cysts and tumors of the jaws (C-429)
M. Martin, A.-G. Alcalá, F. Ballenilla, L. Herraiz, A. Bermejo,
I. Arribas; Madrid/ES
Interventional Radiology
Peri-diaphragmatic venous anatomy associated with gastric
varices for successful endovascular treatment:
Demonstration by multidetector row CT (C-450)
H. Kiyosue, S. Matsumoto, S. Ueda, Y. Kubota, M. Maruno,
H. Mori; Oita/JP
Molecular Imaging
Implication of tumor-induced angiogenesis in functional CT
imaging: Pathophysiological nature of tumor-induced
neovascularization and technical overview of functional CT
imaging (C-495)
T. Ueda1 , H. Suito2 , M. Minami1 ; 1Tsukuba/JP, 2Okayama/JP Neuro
Hippocampal age-dependent ADC changes measured with
low and high b-value DWI (C-610)
J.M. García Santos, C. Ordóñez González, F. Lloret Estañ,
S. Torres del Río; Murcia/ES
Pediatric
Sonographic imaging of umbilical disorders in childhood
(C-677)
M. Vakaki, M. Papadaki, G. Pitsoulakis, P. Antonopoulou,
E. Karamanoli, C. Koumanidou; Athens/GR

Imaging plays pivotal role in the management
of cancer patients
Survival times for patients with many common
forms of cancer have improved considerably over
recent decades. That is due in no small way to the
efforts of clinical staff in specialised cancer treatment
centres like the Royal Marsden Hospital in
South London. Prof. Janet Husband, who is head
of the academic department of diagnostic radiology,
was the co-ordinator of the ECR 2006 categorical
course on cancer staging and presented
strategies related to this hot topic in imaging at
the congress. Husband is also current president of
the UK Royal College of Radiologists.
Prof. Janet E. Husband
Ever increasing longevity is one of the factors
from London/UK
which has led to a steady rise in the incidence of cancer in western societies,
which has had an impact on the role of radiologists in oncology departments. Individuals
are living much longer with cancer and many more patients are cured.
“This has had a great impact on diagnostic radiology across the western world because
imaging is now central to the patient’s management. Furthermore we use
imaging to follow the patient’s cancer through treatment and after treatment, so
many patients will have multiple investigations repeated during their follow up
and this in itself increases workload,” Husband says.
Malignant melanoma. A metastasis from malignant melanoma in the right atrium (arrow).
In addition to that, there is an increased patient awareness of cancer and of its
early symptoms. Some cancers are now the subject of screening programmes
and these two aspects together make for earlier diagnosis and earlier intervention
in the patient pathway. Therefore, diagnostic imaging needs to deal with these
advances in diagnosis and be able to diagnose tumours early and to stage them
appropriately. “Overall, the workload for radiologists in cancer has exploded over
the last decade and a group of radiologists in Europe and the United States has
formed the International Cancer Imaging Society,” Husband adds.
Cancer imaging has improved considerably during the past years. The introduction
of CT 30 years ago was the corner stone on which cancer imaging has been
built. “Even in the very early years in the 1970s it was clear that body CT was
going to make a major impact, because for the first time it was possible to visu-
] Science [
alise tumours directly,” she explains.
Later on MRI has become
the technique of choice for the
staging of certain cancers. Very
recently PET/CT has been developed
as a promising, new technique,
and PET/MRI is already in
the pipeline.
“These novel techniques combine
anatomical imaging with functional
imaging. So we are beginning to
obtain a detailed portrait of a tumour,
not only in terms of its
anatomical location, its morphology,
its relationships to other structures,
but also in terms of its
behaviour, its composition and the
great goal ahead is to define the
Prostate cancer. MRI of the prostate gland showing a
tumour so precisely that we are tumour in the right peripheral zone, stage early T3a.
able to predict whether it will respond
to a certain type of therapy
There is also benign prostatic hypertrophy.
or whether a similar tumour of the same organ of origin, but with a different phenotype
will respond to a different therapy,” Husband says. This new approach is
going to lead to some very exciting developments in the near future.
Speaking of cancer care, the radiologist plays a pivotal and central role in this
multidisciplinary field. “Imaging allows to demonstrate to the surgeon, the clinical
oncologist, that is the radiotherapist and the medical oncologist, how best that
treatment should be given and in what order, because not only is the treatment
defined to a large extent by imaging parameters, but treatment today is multidisciplinary,”
Husband explains. “So
we may begin treatment with
chemotherapy, which is followed
by surgery and imaging will define
whether the tumour has shrunk
sufficiently for surgery to be the
most appropriate option or
whether a tumour is so advanced
that surgery is contraindicated
and radiotherapy is the best option.”
Today cancer treatment relies
strongly on the accuracy of staging.
“Accurate staging provides
Carcinoma of the oesophagus. There is concentric thickening
of the oesophagus with extension of tumour
the detail of tumour extent for the
treatment decision to be made,”
beyond the wall, stage T3.
she says. If a tumour has spread beyond the organ of origin to distant sites, removing
the primary tumour is not always the best treatment for the patient at
that time and chemotherapy might be the best option first and surgery later, or
surgery might be completely contraindicated. Defining precisely how far the primary
tumour has spread within an organ or beyond an organ, gives important
prognostic information to both the clinician and the patient. Patients increasingly
need and want to be involved in their treatment choice and want to know the
long-term prospects of their treatment and for their survival. Accurate staging
can help to clarify the pathway for the patient and the treatment options available.
One of the key challenges ahead in cancer imaging is the standardisation of imaging
protocols, which will promote best practice, ensure comparability of imaging
data and be of benefit to the individual patient.
SPECIAL ISSUE ECR 2006 13

] Congress Impressions [
14 SPECIAL ISSUE ECR 2006

] Congress Impressions [
SPECIAL ISSUE ECR 2006 15

] Hospital Administrator Symposium [
Third edition of ECR’s Hospital Administrator
Symposium pulled in the crowds at ECR 2006
In co-operation with European Hospital, this year’s Hospital Administrator Symposium
has been dedicated three sessions, bringing together hospital administrators, IT experts
and leading radiologists to discuss the future challenges for innovation, personnel
management training and financing. As radiology involves heavy capital expenditure
and a need for state-of-the-art information technology, the discipline plays a key role
for hospital managers. The eminent speakers of the three sessions that focused on
management, information technology and financing presented an exciting programme
and attracted a high number of visitors.
On the following pages you will find summary statements of the key speakers of
this year’s symposium.
How to manage your radiologist
Side effects for public hospitals aiming at greater
profitability
By Dr. Jürg Hodler, Head of the Radiology Department
at the University Hospital Balgrist, Zurich/CH
Radiology in public hospitals is under economic
pressure due to limited public funding, partially
decreasing radiology fees, capitation payment
systems, central planning of capital investment, as
well as the increasing complexity and cost of equipment.
At the same time the administrative burden,
which includes budgeting rules, WTO purchasing rules, FDA regulations or formal
quality improvement procedures, are increasingly using radiologists’ time and
energy and adding cost. Restructuring and alliance building may be inevitable in
the fragmented healthcare systems of many countries. From the point of view of
a radiologist, however, such projects typically mean disruption of current operations,
frustrated employees and additional meetings and paperwork. In addition,
radiologists working in the public system tend to carry a more than proportional
burden of nonprofitable procedures, emergency services, teaching and continuing
education. Direct comparison of productivity with private practice is frustrating for
radiologists working in a public system.
Privatisation of radiology may reduce many of these problems by reducing
regulatory costs. More typically, a satisfactory solution must be found within the
current organisation. The radiologists’ motivators to stay in the public system,
such as educational tasks and research time, should be protected. These activities
are not necessarily lost from an economical point of view, because they may
represent a marketing opportunity and a competitive advantage. The radiologists’
time required for purely administrative tasks should be reduced by consistently
using informatics and the administration’s resources. Problems associated with
restructuring should not be hidden behind marketing slogans but should rather be
acknowledged and solved. On the other hand, the administrator can and should
require radiologists’ active participation in the economics of running the department.
For this purpose, radiologists need training in basic concepts such as
depreciation, cost of financing and overheads cost. Economic goals should be
included in a radiologist’s contract, as far as he/she can influence the result. The
administrator may also point to advantages associated with a public hospital
setting, such as consistent interaction with clinical specialists, more complex and
therefore more interesting cases, a steady flow of emergency and hospitalised
patients, as well as pensions and healthcare insurance.
Six Sigma
The Son Dureta experience
By Carles Ricci Voltas, CEO of Son Dureta Hospital, Palma de Mallorca/ES
Healthcare has no room for inefficiencies. Public healthcare managers, especially
for hospitals, have to provide an increasing volume of high-level healthcare
16 SPECIAL ISSUE ECR 2006
in co-operation with
services with limited resources. The quality of delivered services is not only to do
with the users’ perceptions, but also with clinic and business metrics. In this environment,
process improvement is the name of the game.
What changes in processes should be made to maximise
the impact in our key quality metrics? What are
the factors to be controlled to ensure our processes
meet specifications? Somebody tries to fix a problem
by subcontracting a guru who then applies similar solutions
to those problems that have already remedied
problems in another, similar organisation. This can
prove faulty, if the problem is about a complex organisation,
complex process and a complex environment,
as in a hospital. If you do not want to try
solving a problem by serendipity, you must apply a
method based on facts, but ‘your’ facts.
Six Sigma is a robust, rigorous methodology to reduce defects. Based on
measured data, analysed by statistics, it is fact driven. However, some organisations
have found Six Sigma difficult to implement. It was perceived as a hermetic
art, understood only by the initiated. If your colleagues do not call you Master
Black Belt, you probably do not understand what Six Sigma means. In organisations
such as this, Six Sigma and quality relates to the quality department.
Other companies claim big earnings due to Six Sigma. These are the ones that
think the quest for quality in an organisation is not just a matter for the quality
department or methodology knowledge. They believe the search for excellence
involves everyone – starting with the management. Change acceptance is the
Holy Grail for quality. People need to perceive the necessity of change and be
committed to change. Only after gain, and people’s acceptance of change, can
you apply quality methodology.
This is the vision for Son Dureta Hospital, a 900 bed public hospital in the Balearic
Islands, which has a new Board of Directors devoted to healthcare quality and
interested in new management methods. The hospital is involved in implementing
Six Sigma and change facilitation methodologies learnt not from a consultant
company, but from a partner who is using it in his own business.
Telemonitoring remote patients
By Dr. Hans-Aloys Wischmann, Business Development Manager Telemedicine at
Philips Medical Systems, Hamburg/DE
Chronic diseases like heart failure (HF), diabetes, and chronic obstructive pulmonary
disease (COPD) affect millions of lives worldwide and consume over 50%
of health services expenditure.
In many projects, telemonitoring has been shown to
improve survival and increase quality of life in a costefficient
manner, at least for HF. To reach even better
clinical and economic outcomes, we have developed
an interactive telemedicine platform that aims to
support remote patient management by
assisting patients to understand their diseases,
assess their current state, and adapt their daily
habits and behaviour accordingly. In addition to telemonitoring
of vital parameters, the system provides
personalised feedback, questions, and individualised
educational videos on the patient’s TV.

Clinical activity based process-cost coupling
A tool for the development of clinical pathways
By Prof. Eckhart G. Hahn, Professor of Internal Medicine, Dept. of Medicine 1, and
Consultant for Internal Medicine and Gastroenterology of the University Hospital
Erlangen and Friedrich-Alexander-University Erlangen-Nuremberg/DE
Reimbursement for hospitals in Germany has undergone
a complete change since the introduction of the
German Diagnosis Related Group system (G-DRG).
Therefore hospitals need rigorous quality and cost
control to survive with a fixed and externally defined
income. Evidence-based guidelines and clinical pathways
are helpful to achieve that goal, but key
problems in their development are relevance for the
individual patient and integration into clinical
practice.
Aim: The objective is to develop a time-driven clinical
activity (CA) system for process and cost control in a complex university department
of medicine under G-DRG conditions, and to use it for the development of
clinical pathways (CPs).
Methods: We have suggested an approach to process-cost coupling based on
defined CA derived from procedures commonly used in internal medicine. We
have further analysed components of such activities down to elementary processes
and determined its respective staff costs and material consumption. Multidisciplinary
teams conducted department-wide interviews, with intensive information
and involvement of all employees. Processes were acquired by multidisciplinary
teams and were mapped in MS Excel by a special template called STOP
(Standardised and Optimised Processes). An activity-based instrument was
programmed for sustained activity change management. MS Excel is used to
assemble all clinical activities applied to single patients in a particular clinical path
(i.e. acute pancreatitis) on each day. 10-20 patients are then pooled and analysed
for overlapping CAs. Pathway attributes are assembled in ARIS (IDS Scheer) and
pathways modelled using common evidence-based guidelines. Visio software is
used to visualise complex CPs.
Results: About 700 activities were defined, analysed and assessed for elementary
processes. Human and material resources were measured, calculated or
estimated by experts. Complete CA patterns of individual patients and patient
clusters could be used efficiently to design evidence-based CPs. The CPs
generated with this method reflected actual clinical practice and could be easily
used to determine quality (adherence to CP) and costs (timedriven valued CAs).
Discussion: Contrary to common belief it was possible to define all elementary
processes in a complex university department of medicine by this co-professional
approach, including real costs. It was also possible to use common, practicable
clinical entities, CAs. CPs could be composed of such CAs, and quality and accrued
costs monitored at all times until discharge of the patient. This system will now be
used to further model internal medicine processes, optimise quality and resources
used, develop more clinical pathways and construct information
technology tools to help in every day application and sustained adaptation to
future changes of CA.
Managing complex healthcare organisations
The essentials
By Prof. Abdulrahman AlNuaim, Professor of Medicine,
Consultant Endocrinologist & Diabetologist, and
Assistant Chief Executive Director at the King Faisal
Specialist Hospital and Research Centre, Riyadh/SA
Managing a modern healthcare organisation is
complex. Complexity stems from the variables that
need to be entertained, which are highly unpredictable.
There has been a change in health
paradigm, as well as expectations of the ‘new
patient’. Existing healthcare systems neither meet
] Hospital Administrator Symposium [
the quality goals nor patient expectations. There is a need to identify the vision,
strategy and direction of a hospital; this should be reflected in the goals and
objectives, which should be transmitted to hospital staff. Healthcare organisations,
such as hospitals, are dynamic and require periodic revisiting of the organisation
structure for more enhancement and better realignment of services. There
is need for executive councils/committees to oversee the medical and non-medical
operation. There is a need to adopt change and engineering to advance the
organisational cause. Leadership and empowerment at different levels of the
organisation is an essential component for success. There is a need to identify
who should lead and who should manage.
Health information system is a vital component for managing patients, as well as
the well-being of the organisation. There is a need for a data warehouse system
to provide executive dashboards to monitor performance. New technology and
automation of processes is essential for augmenting patient care.
Patient safety is an important aspect. Several checking mechanisms should be
embedded to ensure delivering the highest safety measures. An online adverse
occurrence reporting system will give an accurate estimate of morbidity
incidences. Executive rounds and management, by senior hospital executives
wandering around, is important. Medical errors and risk management should be
part of the integrated measures for patient safety.
Performance improvement initiatives should be embedded throughout an organisation’s
culture. Balanced scorecard is a powerful tool for monitoring and improving
hospital performance. These issues will be fully presented during the Forum.
How to buy a HIS
By Dr. Max Laimböck, Administrative Director of the State Hospital Innsbruck –
University Clinics, and Managing Director of SALK (Salzburg District Hospitals
group)/AT
SALK, a hospital company based in Salzburg, has a
budget of €350 million for three hospitals and
employs 4,500 people who serve 80,000 patients and
300,000 outpatients per annum.
A HIS from a medium-sized company (after an
invitation to tender in 1997) and two PACS, from two
providers, were running. The HIS provider was sold
twice and the last owner decided to terminate the
product within the next few years. SALK, the only
customer in Austria, paid a lot for each exchange in
the billing, and major features were not introduced: operating theatre and outpatient
scheduling, operating room documentation; hard- and software decisions
where pending.
In 2004, SALK’s new management ranked IT a high priority and decided to
develop a HIS/PACS strategy. The IT head and his deputy could not provide a
reasonable HIS/PACS strategy, so a ‘HIS/PACS project group’ was established to
do this, to be led by two administration managers.
We analysed the market before issuing an invitation to tender, because we did not
want to be slaves to this formal process and wanted to understand software
products beforehand. We considered providers, who were supposed to be
financially solid, major players in this market, now and in the future, with a strong
commitment in Europe, active product development and an attractive product for
multi-hospital groups. An experienced adviser supported the evaluation process.
Four products were identified, presented to user groups and evaluated. During
site visits, project group members checked software efficiency. Since one product
of a major player was running on a broad scale only in the US, we made site
visits there. The IT manager and his deputy left the company. Our new IT
manager is now part of the decision process.
Discussions of available product launches, implementation steps and support
began. Two products were left as frontrunners; we contacted their top
management and declared our interest. Invitation to tender began, products and
SPECIAL ISSUE ECR 2006 17

] Hospital Administrator Symposium [
offers have been evaluated, objective decisions for one of the two top providers
were taken and implementation will begin in February 2007.
IT slows you down – so why bother?
By Leonie Paskin, head of the Delivery unit at St.
Thomas’ Hospital, London/UK
Those who live in the 21st century must adapt to technology
moving ever onwards. In the home we are
connected to the workplace, our bank and retail
avenues, any time we choose.
Are the benefits of this IT invasion those we actually
perceive? Do we sacrifice speed to gain other
tangible benefits? Do similar systems benefit all in
the same way? The IT revolution is here to stay and decisions will be taken on
investment, education and training and impact on patient management. Evaluation
of new hard- and software will be part of our everyday life.
Embracing advanced features and keeping our brains in tune with technology
advances will be a significant challenge. How should our life plan and work plan
reflect this? Is our ability to deliver consistently high quality healthcare ever
compromised by our dependence on technology? Does it add to ‘medical’ fatigue?
The potential for use of IT in the Clinical Imaging environment has changed
emphasis on the ‘image capture’ equipment to just about every other process
taking place.
From requesting and scheduling to image processing and distribution; from
statistical analysis to measuring outcome; huge reservoirs of information are
gathered and never tapped. Audit trails are visible but do they alter efficiency or
effectiveness? Is there a conflict between our knowledge and experience that eats
up our time as we conflict with the opinion of the computer mastermind?
Technology can be difficult to master leading to error and potentially devastating
consequences. How much time is given to designing robust, new systems with
intuitive interfaces? If we don’t take the lead, then who will? How much of our
time should be spent influencing the technology with which we work?
How many of us work in an environment with specific function systems that do
not communicate with others appropriately? Moving between systems is time
consuming as well as annoying. Trying to move towards a total system approach
is the only way forward.
‘Connecting for Health’, the National Programme for IT in England has taken decisions
on ‘one size fits all technology’. It is striving to address issues of information
sharing and connecting, but is it coming up with some fairly insurmountable
obstacles? Was speed at all relevant to them in system design?
This presentation looked at the time costs sacrificed when embracing new
technology and posed the question "Are we doing the right thing?"
The vendor, system administrator and manager
in a new fully digital environment
By Dr. Attila Tóth, Cardiovascular Surgery Department
of Semmelweis University, Budapest/HU
The Cardiovascular Surgery Department at Semmelweis
University made a big improvement to all its IT
systems, as part of a university-wide upgrade plan.
The installation of a new Hospital Information System
(HIS) preceded the transition to complete digital
archiving and was accompanied by the setting up of a
new Economic Software platform.
Because all these components are produced by separate vendors (AGFA/Impax,
ISH/Medsol, SAP), careful planning and central co-ordination of all events was
fundamental. Project members face several issues – expected and unexpected –
during such a thorough renewal. A flawless link of all systems was needed,
18 SPECIAL ISSUE ECR 2006
especially the full-featured communication between the systems responsible for
digital data handling and for hospital data management.
The project members needed to solve the problem of the separate buildings of the
department. Sometimes it was also hard to establish the communication between
the modalities and the PACS, in view of some older medical equipment. It was
also necessary to set up a broker and to provide work lists for all possible modalities.
Besides technical tasks, staff training is also vital to provide smooth transition
and prevent a revolt. It isn’t easy to satisfy time constraints and avoid outage
in medical services. There will always be dissatisfied staff members to handle.
During meetings the stages of our department’s approach were reviewed. Both
the planning and implementation phases were discussed in detail. Special
features of the actual case were also be presented.
The PACS and HIS systems were introduced successfully. Film costs could be
reduced, and the previous ancient system is just a memory. Hopefully, by highlighting
necessary steps and some pitfalls, we could provide our audience at the
Forum with a guideline for fruitful revolution in their own hospitals.
Images and data integration in the healthcare
information system
By Riccardo Ceccarelli, Information Systems and
Material Manager at the Policlinico Gemelli Hospital –
Catholic University of the Sacred Heart, Rome/IT
The introduction of digital images to medicine took
place in the 1970, thanks to ACR-NEMA studies. The
DICOM standard was not born until 1993, and hospitals
began to discuss integrated hospital information
system (HIS) from the beginning of the 90s. This
timing was governed by the necessity to develop
more new powerful hard/software solutions and to consolidate international standards.
The Catholic University of the Sacred Heart Hospitals decided to follow the
European Standard HISA, to achieve an open platform, capable of integrating all
data relevant for the enterprise and making these accessible throughout public
services, independent of the specific technical products and configuration. The
architectural principles are structured from the following perspectives: enterprise,
information and computation. Such architecture has been realised with a middleware
called DHE. Clinical, administrative and directional information are stored
and shared in a reliable enterprise repository. On this platform, the basic philosophy
is: ‘All information must be connected to the patient’. This is crucial because
a patient has several hospital contacts (admission, day clinics, ambulatory
access, etc.) and, during each contact, a patient receives clinical attention (examinations,
therapies, surgical operations, etc.) and each uses resources (personnel,
materials, medicines, rooms, modalities, etc.) and clinical items are produced
(results, medical reports, etc). All these data are very important – first, for the
patient, healthcare processes and clinical history, and second for the DRG, cost
analysis and savings. In the system, the request cycle flow always follows the
same steps for each kind of examination.
In current opinion, images and connected reports are a fundamental and integral
part of the corporate information asset, therefore such data also must be integrated
in the common model, and connect to the relevant coded information (e.g.
a patient’s image should be connected to that patient’s personal data, a scanned
referral letter should connect to admission, PACS images should be connected to
the requested examination, a PDF report from the lab should be connected to the
examination, etc).
The Policlinico Gemelli approach is based on the extension of the scope of the
PACS in the overall enterprise, by leading it to represent a sort of ‘enterprise
imaging archive’, responsible for managing the storage of all multimedia data. To
implement such an approach it has been necessary to define an appropriate hardware
solution and set-up for the archiving system, mechanisms that allow other
applications to store and retrieve any type of multimedia data objects, in
synchronous modality and ensuring performances suitable for embedding in
interactive, online transactions.

Procuring large equipment
By Ulrich Bosch, Managing Director of Sana Management
GmbH Munich/DE
Around € 18 billion annually is spent on medical technology
in Germany. After the US and Japan, the German
medical technology market is the third largest in
the world. The financing of large medical technology
equipment for German hospitals (and therefore also
for radiology departments) has been regulated by law
since 1972: The investment costs are contributed by
the Federal States, operating costs must be met by the medical insurers. There
are different types of governmental investment assistance. Individual assistance
can be applied for building projects or the acquisition of equipment. Then there
are flat rate subsidies based on the size of a hospital. Although this gives individual
hospitals a certain amount of flexibility, one has to take into account that
governmental funding has decreased by 25% over the last 15 years, so that the
backlog of investments required across the whole of the hospital sector (building
and technology) is currently between around € 12-50 billion.
In the past, due to its interdisciplinary use across the hospital, investment
decisions on radiology equipment in hospitals have had priority. The purchase of
large-scale radiology equipment via governmental funding is by far the most
common form of financing in German hospitals (68%). Only 3.6% of investments
are financed via credit, 20% are financed through the hospitals’ own resources,
and around 6% of investments are financed through the hospital operators. Apart
from these conventional means of financing, more flexible types of financing such
as ‘try and lease’, ‘pay per use’ and public/private partnerships are on the
increase. Even if these types of financing are only reluctantly accepted by public
hospital operating companies, they have become much more common among
private hospital operating companies. Considering that more and more public
hospitals are now being privately financed, these new types of financing are set to
become much more widespread in the German hospital market.
Acquiring up-to-date medical technology
By Claus Henneberger, General Manager of Philips
Medical Capital Europe, Wuppertal/DE
Technology is central to the future of healthcare. It
provides the healthcare sector with a wide variety of
tools to deliver improved care. At the same time
technology also provides a wide variety of tools to
manage the healthcare sector more efficiently and
effectively.
Providing the technology to upgrade the healthcare
industry will require a massive capital investment and present a major opportunity
for the leasing industry. Because of the limited time and capacity of many
healthcare providers to focus on the details of their needed capital investment,
the most successful leasing companies will be those competing on service – not
price. These will be leasing companies that combine the equipment delivery with
additional services, such as service agreements, system upgrades and remarketing
services.
Flexible solutions during and after the contract term are essential. Why should a
client commit to an inflexible solution with a long lease term, just to obtain a
lower monthly instalment and the option to buy at the end of lease at a fair
market value, when they could choose a flexible solution instead, enabling them
to react to technological changes and leaving the remarketing to specialists?
These flexible leasing solutions are already established in markets where technological
changes are rapid. IT leasing companies, for example, offer ‘Swap’
contracts, which enable their customers to exchange or upgrade their leasing
equipment during the lease and return it End-of-Lease without further obligation.
The leasing company will then remarket the equipment or resell them to
specialised brokers. Today, more and more customers want this solution.
] Hospital Administrator Symposium [
The required combination of expertise for success in the leasing industry will
include an understanding of the general financial benefits of leasing coupled with
an understanding of the productivity requirements of the healthcare system and
an ability to package and explain leasing services that provide financial benefits,
as well as productivity benefits, to the medical community.
These are the challenges medical equipment manufacturers are confronted with
today – to satisfy their clients.
Regulations and laws
By Dr. Reiner Vehrenkamp, Director of Business Unit
Healthcare Europe at De Lage Landen B.V., Europe
Division, Eindhoven/NL
In 2005, De Lage Landen financed (worldwide)
medical equipment worth US$ 1 billion, by various
methods such as loan, lease, rent and ppp, either
directly with end-users or indirectly by refinancing
manufacturers. At the Administrator Forum, Dr. Reiner
Vehrenkamp addressed the rise in demand for
external financing from European hospitals as they
undergo changes such as privatisation, out-sourcing and legal form changes,
while at the same time the amount of Governmental funds made available to
them is decreasing.
"Most hospitals are subjected to various internal and external regulations and civil
and tax laws, varying from country to country, which superimpose further difficulties
when ‘designing’ any financing solution for a hospital," he observed. His
presentation provided examples of such cases and he discussed some potential
solutions and ‘workarounds’. He also highlighted financing of IT, as well as PPPmodels
and the integration of Governmental funds.
Financing methods
The pros and cons
By Dr. Nikos Maniadakis, General Manager & President
of the University General Hospital of Iraklion,
Crete/GR
Over the last 50 years healthcare delivery has
changed dramatically. New epidemics, aging populations,
patients’ expectations, mobilisation of populations,
the globalisation and dissemination of
information, all demand new patterns of healthcare
delivery. Above all the technological revolution is raising healthcare costs in an
exponential manner.
These changes put challenges before healthcare managers in terms of how to
plan and fund new investments. Private money and equity has been the
traditional approach. It is easy to implement projects if you have money, which is
not often the case. Leasing represents a good alternative option, especially for
medical equipment, because it spreads cost over years and makes it possible to
follow technological advances. Recently, private/public partnership has been used
by the public sector to develop large investments, with initial funding from the
private sector. This option has advantages: the cost is spread over years and usually
private firms are better at delivering projects on time and on cost compared
to the public sector.
Donations can be a large source of income and there are prominent institutions
that annually receive large amounts of money, but it is not a viable solution for the
great majority of hospitals. Overall, different methods of funding have advantages
and disadvantages and they are more suitable for certain types of projects. It is
important when implementing healthcare projects to obtain other views, apart
from the financial one. In many cases it is useful to consider the cost-benefit of
new projects not just in money terms, but to consider also the life years gained for
every Euro spent in new investments.
images: © photonews.at: Georges Schneider, Anna Rauchenberger
SPECIAL ISSUE ECR 2006 19

] ECR cares [
ECR
4 tons of apples ...
... kindly sponsored by ECR
free massage ...
... kindly sponsored by SIEMENS
40,000 bottles of water ...
... kindly sponsored by GE Healthcare
20 SPECIAL ISSUE ECR 2006
cares ...

ECR’s ‘Invest in the Youth’ scheme has become a
very popular feature at the congress
At this year’s ECR you may have noticed many young faces and groups of young
people from many different nations all around the congress venue. This was
partly due to the ECR programme ‘Invest in the Youth’.
The programme ‘Invest in the Youth’ was called into life three years ago. It aims
at enabling young radiologists and radiographers still in training to attend the
congress in Vienna by reducing the costs.
For ECR 2006, 280 young radiology residents and radiographers from over 30
different European countries were accepted into the programme. Successful
applicants were granted free registration for the whole conference, 3 nights’ hotel
accommodation, free public transport for the duration of the congress as well as a
one-year subscription to ‘European Radiology’ online.
The criteria for eligibility are based on age and depend on the duration of the
various national training schemes in radiology. Other than that, the offer is
available on a first-come, first-served basis, but ECR retains the right to ensure a
geopolitical spread.
“The programme has become a very important tradition to us,” states Peter
Baierl, managing director of ESR. “Investing in the youth means investing in the
future. That’s why I very much hope that we will be able to continue our investment
in the youth for many years to come. I definitely look forward to welcoming
Europe’s next generation of radiologists to Vienna in 2007.”
Dr. Bogdan Avram from Romania, participant of ‘Invest in the Youth 2006’, points
out the importance of the programme, “ECR 2006 was my first contact with a
While 16,000 people from over
90 countries discussed the
newest developments in the
discipline of radiology at ECR
2006, across the street from the
Austria Center a somewhat
‘smaller’ radiological meeting
took place. On Sunday, March 5,
more than 800 children attended
the ‘Children’s Congress of Radiology’
at the city of Minopolis.
Dr. Thomas Rand explaining Ultrasound at the ‘Children’s
Congress of Radiology 2006’ in Minopolis, Vienna.
Minopolis is a theme park for
children, a city completely rebuilt in kids’ size with 25 different theme stations
mirroring the life in a real city, featuring e.g. a fire department, a TV station, a
supermarket, a train station – and a hospital. The whole city is solely for
children; they can playfully take over and try for themselves all the different
professions necessary to keep a city going.
On the occasion of ECR 2006 and in cooperation with Siemens, all children were
granted half price entry to Minopolis on Sunday, March 5, to attend the ‘small’
radiological congress at the Minopolis-Hospital. The radiological department of the
Minopolis-Hospital is equipped with replica high-tech radiological devices by
congress outside my country and I was very impressed. ‘Invest in the Youth’ helps
young doctors to get in contact with the latest news and technologies in our
specialty. For me, it was a good opportunity because in my country young doctors
earn very little money per month (€ 150).”
His statement is supported by that of his colleague from Croatia, Dr. Anton Krnic,
“The programme allows young radiologists in training to attend the congress
without looking for a sponsor or paying on their own, which makes us highly
privileged among young doctors of various specialties in our countries.”
Dr. Caius Giurca from Romania points out that “it is a very motivating opportunity
to meet such important specialists, most of them well-known from their books
and papers, in person.”
Children’s Congress of Radiology 2006 in
Minopolis – the children’s city
Siemens Medical Solutions. All Sunday, radiologists from the Vienna University of
Medicine (AKH) were present at the Minopolis-Hospital to answer the children’s
questions and explain the basics of radiological examinations.
The children’s response and interest was enthusiastic. “I’m not a hundred percent
sure yet if I want to become a doctor, but I think this here is very cool. We can see
what it looks like deep inside the body,” 8-year-old Lisa stated.
The management of Minopolis
has already expressed their wish
to repeat the children’s congress
in 2007.
ECR would like to thank Dr. Sylvia
Metz-Schimmerl, Dr. Christina
Plank, Dr. Joachim Kettenbach,
Dr. Philipp Peloschek, Dr. Stefan
Puig and Dr. Thomas Rand from
the Vienna University of Medicine
(AKH) for their time and commitment.
] Invest in the Youth [
SPECIAL ISSUE ECR 2006 21

] Industry [
ECR thanks all 2006 Exhibitors
A
Adani
Agfa Europe
Albatross Projects
Alliance Medical Group
Aloka Holding Europe
American College of Radiology
American Roentgen Ray Society
Anexa
Apelem
Arcoma
Array
ATS
aycan Digitalsysteme
B
Barco
Bard
Baylis Medical
Beijing Wandong Medical Equipment
BIBA Medical – publisher
Bluecare Medical
Bracco
C
Campden Publishing – publisher
Canon Europa
CAT Medical Systems
Cedara Software, a Merge Healthcare
Company
Celon / Olympus
Celon medical instruments
Cerner Deutschland
Chison Medical Imaging
Codonics
Confirma
ContextVision
Control-X Medical
CPI International
D
D.A.T.A. Corporation – AUTOMED
Danum International
DatCard Systems
Del Medical Systems
Diagnostic Imaging Europe – publisher
Diagnostic Medical Systems (DMS)
DigiMed-mcs / Esinomed
DIGIX Systems
DOBI Medical International
Dunlee Medical Components
Dynamic Imaging
E
E-Z-EM
Ebit AET
Echonet, The Ultrasound Network
Eizo Nanao
Elektron
Ella Legros
Elsevier – publisher
EMC
EMD Technologies
ESAOTE
ETIAM
ETS-Lindgren
European Hospital – publisher
F
Ferrania Technologies
FIMI Philips
Fluke Biomedical
Foresight Imaging
Frohberg Medical Booksellers – bookseller
Fuji Film (Europe)
G
Gammex-RMI
GE Healthcare
GE Healthcare – Medical Diagnostics
General Medical Merate
Gilardoni
GIT Verlag – publisher
Dr. Goos-Suprema
Gruppo Soluzioni Tecnologiche
guerbet
22 SPECIAL ISSUE ECR 2006
H
H.S. Hospital Service
Hitachi Medical Systems Europe
Hologic
Hoorn Holland
Hospital – journal
I
i-Med
IAE
IAE
iCAD
iCRco
Image Diagnost International
Imaging Diagnostic Systems
Imaging Management – journal
Imedco
IMIX ADR
IMS Internazionale Medico Scientifica
Incom Storage
Innomed Medical
Instrumentarium Dental
Integra NeuroSciences
Intelmedtechnika
Intermedical Italia
International Hospital Equipment &
Solutions – publisher
Invivo
iSOFT Deutschland
Italray
Itel Telecomunicazioni
K
King Faisal Specialist Hospital, Dept of Radiology
Kiran Medical Systems
Kodak [Eastman Kodak Company]
Konica Minolta Medical & Graphic Imaging Europe
Kyphon Europe
L
Leidel & Kracht Schaumstoff-Technik
Linde, Linde Gas Division
Linos Photonics
LMT Lammers Medical Technology
M
Maxant Technologies
MCI Optonix
Mecall
Med.e.Com
Medex Biomedical
Median Technologies
Medical Imaging International – publisher
Medicor Medical Supplies
Medis medical imaging systems
Medison
Medisys
Medrad Europe
Medtron
3mensio Medical Imaging
Mercury Computer Systems
Metaltronica
Micrus Endovascular
Mindray
MMS-Medicor Medical Supplies
MR-Schutztechnik Kabinenbau
N
National Display Systems
NEC Display Solutions Europe
NeoRad
Neusoft Medical Systems
Nical
Noras Roentgen- und Medizintechnik
P
Pausch technologies
PEHA Med. Geräte
Philips Medical Systems
Pie Medical Imaging
Planar Systems
Planmed
Plasmon Data
PrimaX International
Protec medical information systems
Protec Medizintechnik
PTW-Freiburg
R
R2 Technology
Radcal
Radiological Society of North America
Radiology OneSource Europe
Rapid Biomedical
Raymed
Reichert – bookseller
Rein EDV – Division MeDiSol
REM
Rendoscopy
Resosafe
Rimage Europe
Rogan-Delft
RTI Electronics
S
Sanochemia Diagnostics International Ltd.
Scanditronix Wellhöfer
Schering
Schiller Médical
Sectra
Sedecal
Dr. Sennewald Medizintechnik
Shantou Institute of Ultrasonic Instruments
Shenzhen Landwind Industry
Shimadzu Deutschland
Sidam
Siemens, Display Technologies and OEM Business
Siemens, Medical Solutions
SMAM
Sony Professional Services Europe
Springer-Verlag – publisher
Suinsa Medical Systems
Swemac Medical Appliances
Swiss Medical Care
T
T-Systems Austria
Taramed Distribution
Technix
tecnologe avanzate
Telemedicine Clinic
TeraRecon
Thales Electron Devices
Georg Thieme Verlag – publisher
Tiani Spirit
Toshiba Electronics Europe
Toshiba Medical Systems Europe
Totoku Electric
Trixell
Tyco Healthcare / Mallinckrodt
U
ulrich medical
Unfors Instruments
V
VacuTec Meßtechnik
Varian Medical Systems
Vidar Systems
Villa Sistemi Medicali
Visus Technology Transfer
W
3W-Informed – bookseller
WIDE
Wiener Krankenanstaltenverbund
Wiroma
Wisepress – bookseller
X
XIMIS
Z
Ziehm Imaging
Zonare Medical Systems

The Technical Exhibition 2006 –
more space, more people, more success
ECR 2006 was again accompanied by an exceptional
technical exhibition with some important improvements
compared to 2005. Over the last year the
Austria Center Vienna, ECR’s traditional congress
venue, has undergone a major facelift including
refurnishing and modernisation of the session rooms
and offices as well as of the exhibition area, thus
providing even better equipped and suitably fitted
booths for the exhibitors. Right next to the Austria
Center, ECR’s long-term partner MAW (Medizinische
Ausstellungs- und Werbegesellschaft) had again
erected a huge tent offering even more space for a
beautiful trade show.
Over 200 companies from 24 nations followed the
call to Vienna to show their newest products and
latest developments in regard to medical equipment,
networking solutions, and innovations in
Multi-modality player Hitachi wins ECR
2006 Exhibit Europe Award
Mr. Kiyoshi Hamamatsu, Hitachi Vice President and Executive Officer, receives the Exhibit Europe award from Prof. Andy Adam.
The company was selected for the accolade by a
panel of judges in recognition of its commitment to
innovation and the advancement of patient care, as
well as its outstanding constant support for ECR.
The award was presented to Mr. Kiyoshi Hamamatsu
from Japan, Hitachi Vice President and Executive
Officer, by ECR 2006 President, Prof. Andy Adam, on
the occasion of the President’s traditional walk
through the technical exhibition on the opening day
of the congress.
Hitachi is the first company that decided to exhibit
1:1 models of real CT and MR scanners, which is an
every radiology-related aspect. 29 exhibitors took
part for the first time – and were as impressed and
satisfied with the event as the ‘old hands’ that have
been with the ECR for years. More than 7,000
people from 80 different countries worked at the
various booths supplying their clients with all kinds
of information and advice. Apart from all the people
registered especially for the exhibition, 9,000
technically interested professional ECR delegates
cheerfully strolled through the expo picking up
relevant news here and there. Listening to their
enthusiastic comments and their sincere promises
to see each other again next year, the organisers
can be sure to have fulfilled the industry’s
expectations, and can already look forward to a
successful exhibition in 2007.
enjoyable premiere that adds tremendous value to
ECR’s technical exhibition. Hitachi’s senior management
is of the opinion that live scanners have become
mandatory at medical meetings, as this is
strongly requested by the delegates. The equipment
presented by Hitachi included an open MRI scanner
for patient comfort, multi-slice CT scanners as well
as a complete family of digital ultrasound systems.
The company’s mission at ECR 2006 was to emphasise
its role as a multi-modality player, covering all
product segments and presenting latest technologies
such as sono-elastography and virtual sonography
to the radiological community.
] Industry [
SPECIAL ISSUE ECR 2006 23

] eECR – the electronic congress [
eECR – the electronic congress brings you the
scientific highlights from ECR 2006
You missed something at the congress? Here is your opportunity to catch up:
ECR’s electronic congress tool eECR, formerly known as Cyber Ricci, brings the
scientific highlights of ECR right to your home. More than 100 presentations from
ECR 2006 were put online on March 20, providing access to the most interesting
lectures and sessions only two weeks after the meeting.
You will find presentations from the ‘ECR meets’ sessions (this year: UK, Russia,
Singapore), the Categorical Courses on ‘The Staging of Cancer’ and ‘Thermal
Tumor Ablation’, the Foundation Course on Musculoskeletal Radiology, Interactive
Image Teaching Sessions, Special Focus Sessions and New Horizons Sessions,
Refresher Courses on Chest and Musculoskeletal Radiology, State-of-the-Art Symposia,
the Image Interpretation and Junior Image Interpretation Quizzes, as well
as 13 Hospital Administrator Symposia presentations. 18 Satellite Symposia presentations
will be online shortly. In addition you may view the honorary lectures
by Prof. David J. Hawkes, Prof. Gabriel P. Krestin and Prof. Frederick S. Keller.
HONORARY LECTURES
Wilhelm Conrad Röntgen - Honorary Lecture (HL 1)
� Image guided interventions
Peter Mansfield - Honorary Lecture (HL 2)
� Non-invasive cardiac imaging: Friend or foe?
Josef Rösch - Honorary Lecture (HL 3)
� Interventional radiology - quo vadis?
ECR MEETS UK
Guiding new approaches to treatment: The impact of
imaging (EM 1)
� Introduction
� Measuring the effects of imaging
� HRCT of the lungs: More than just the diagnosis
� Pelvic cancer: How MRI helps to develop treatments
ECR MEETS RUSSIA
Some problems of medicine: Contribution of radiology
(EM 2)
� Introduction
� 3D/4D ultrasound imaging
� CT-perfusion imaging in diagnosis and staging of brain tumors
� Changing role of modern cardiovascular imaging
� Modern imaging of battle trauma
ECR MEETS SINGAPORE
Radiology in Singapore: From gene to screen (EM 3)
� Introduction
� Gene expression in neo-intimal hyperplasia
� Cerebral perfusion in angiogenesis and stroke
� Limb salvage with infrapopliteal angioplasty
� Unique features of breast screening programme in Singapore
CATEGORICAL COURSE: THE STAGING OF CANCER
TNM staging: Overview (CC 116)
� Strategies in cancer staging
� Significance of results in staging
Primary tumor staging (1): Thoracic malignancy (CC 516)
� Lung
� Oesophagus
Primary tumor staging (2): Head and neck tumors (CC 816)
� Nasopharynx
� Hypopharynx and larynx
Primary tumor staging (3): Gastrointestinal tumors
(CC 916)
� Pancreas
� Rectum
Primary tumor staging (4): Urological cancers (CC 1216)
� Kidney
� Prostate
Primary tumor staging (5): Gynecological cancers
(CC 1316)
� Cervix/Endometrium
� Ovary
Primary tumor staging (6): Hemato-oncological malignancy
(CC 1616)
� Myeloma
� Lymphoma
Staging nodal and distant metastases (CC 1716)
� Bone
� Abdomen
� Lymph nodes
CATEGORICAL COURSE: THERMAL TUMOR ABLATION:
IMAGING AND INTERVENTION
Thermal tumor ablation: Principles and methods (CC 119)
� Thermal ablation: How it works
� Radiofrequency ablation: Equipment and techniques
� Laser and microwave ablation
Thermal tumor ablation: Imaging guidance, monitoring,
and follow-up (CC 419)
� Real-time guidance and treatment monitoring
� Assessment of tumor response
� Standardized terms and reporting criteria
Thermal ablation of liver tumors (CC 519)
� Hepatocellular carcinoma
� Liver metastases
� Prevention and management of complications
Thermal tumor ablation: Clinical application beyond the
liver (1) (CC 819)
� Bone
� Kidney
� Lung
24 SPECIAL ISSUE ECR 2006
At the eECR lounge onsite 37,692 presentations were burned on 2,291 CDs,
which is more than twice as much as in 2005.
As you might well know, 168 presentations from ECR 2004 and 2005 as well as 19
presentations from ESGAR and ESMRMB meetings have already been online for
months.
Look for yourself how easily accessible the electronic congress is! It also offers a
search function, allowing visitors to search the database by topic, title and keywords.
eECR holds something for everyone and can be accessed free of charge.
http://cyberricci.myecr.org/
Thermal tumor ablation: Clinical application beyond the
liver (2) (CC 1219)
� Breast
� Retroperitoneum and pelvis
� Head and neck
Advanced approaches in thermal tumor ablation (CC 1519)
� Surgically-assisted tumor ablation
� Angiographically-assisted tumor ablation
� Computer-assisted tumor ablation
E³ - EUROPEAN EXCELLENCE IN EDUCATION: FOUNDATION
COURSE - MUSCULOSKELETAL RADIOLOGY
Trauma (E³ 120)
� Appendicular trauma including pelvis
� Spinal
Arthritis (E³ 220)
� Peripheral arthritis
� Degeneration and spinal inflammatory disorders
Tumors (E³ 520)
� Plain film diagnostic approach to bone tumors
� Common benign and malignant bone tumors
Necrosis and infection (E³ 620)
� Osteonecrosis
� Spinal and bone infection
Mechanical disorders of joints (E³ 920)
� Mechanical joint disorders
� Imaging of tendons and ligaments
Metabolism and self assessment (E³ 1020)
� Metabolic bone disorders
E³ - EUROPEAN EXCELLENCE IN EDUCATION: INTERACTIVE
IMAGE TEACHING
Interactive image teaching (1) (E³ 320)
� Acute abdomen
Interactive image teaching (4) (E³ 1520)
� Musculoskeletal lesions: Mistakes you shouldn’t make
SPECIAL FOCUS SESSIONS
Laser treatment of varicose veins (SF 1)
� Radiologic management of varicose veins
� Technique of laser ablation for varicose veins
� Setting up an IR practice for treatment of varicose veins: How
I did it
Virtual autopsy (SF 17b)
� Virtual autopsy (Introduction)
� Postmortem CT and MR imaging in forensic medicine
� Virtual autopsy and postprocessing of data
� Postmortem dynamic angiography using a modified heart-lung
machine
� Virtual autopsy: Adjunct to or replacement of autopsy?
NEW HORIZONS SESSIONS
Imaging hypoxia: Importance in tumor biology and noninvasive
assessment by imaging (NH 4)
� Imaging hypoxia: Importance in tumor biology and noninvasive
assessment by imaging (Introduction)
� Tumor hypoxia: Detection methods and role in acquired
treatment resistance
� Non-invasive measurement of hypoxia by PET
� Assessment of hypoxia by F-19 and BOLD MR imaging
� BOLD assessments of antivascular cancer treatments
Cell-specific MR imaging of inflammatory disorders (NH 5)
� Cell-specific MR imaging of inflammatory disorders
(Introduction)
� Central nervous system
� Atherosclerosis
� Nephritis
� Rheumatoid arthritis
New horizons in tumor ablation (NH 9)
� New horizons in tumor ablation (Introduction)
� Principles and advantages of real time MR-thermometry for
monitoring tumor ablation
� Thermal ablation of uterine fibroids with MR-controlled focused
US
� Thermal ablation of prostatic tumors with focused US
STATE-OF-THE-ART SYMPOSIUM
Explore it or ignore it? How to manage incidentally
detected pulmonary nodules (SA 8)
� Explore it or ignore it? How to manage incidentally detected
pulmonary nodules (Introduction)
� Epidemiology, biology and evaluation with biomarkers: The
essentials
� Radiological assessment of pulmonary nodules: The criteria
� Management approach to pulmonary nodules in low risk and
high risk patients
REFRESHER COURSE: CHEST
HRCT of diffuse lung diseases (RC 104)
� Reticular pattern
� Ground-glass pattern
REFRESHER COURSE: MUSCULOSKELETAL
MR imaging of the hip (RC 110)
� Differential diagnosis of bone marrow edema
� Imaging of the acetabular labrum
IMAGE INTERPRETATION QUIZ
"North America vs. Europe: Judgement Day" (IIQ)
JUNIOR IMAGE INTERPRETATION QUIZ
"Northern Europe vs. Southern Europe" (JIIQ)
SATELLITE SYMPOSIA ORGANISED BY GE HEALTHCARE
There is no need to accept risks if they can be avoided.
A radiographers and technologists symposium (SY 4)
� Working in an emergency environment and keeping safety
high can be done!
� Health and safety in the medical imaging environment: The
impact of the EU legislation
� Needlestick injuries
Enhanced imaging solutions (SY 6)
� MR contrast media
Breast MRI and contrast protocols: Current status
Brain perfusion: From morphology to function
� MR technologies
New developments in body and vascular MRI
Re-imagined radiology with digital technology (SY 9)
� Definium 8000: Digital radiography room and advanced
applications in clinical practice
� First clinical experience with a mobile flat panel digital
radiography system
� Dose reduction with GE flat panel radiographic system
Contrast media and CT: Reducing risk and defining best
practice (Results from a pan-European survey) (SY 11)
� What is the 1st European contrast media usage patterns
survey?
� Attitudes to contrast media and risk: Is there a problem?
� Prima non nocere ("first do no harm" - the first medico-ethical
principle): Use of contrast media in CT - what is best practice?
Re-imagined CT: Clinical challenges today and tomorrow
(SY 15)
� Welcome
� BrightSpeed Elite: First clinical results
� LungVCAR: Lung nodules detection and segmentation.
Increased confidence for nodule detection
� LightSpeed VCT: Clinical experience in cardiovascular imaging
� VCT adaptive technologies
� Conclusion
HOSPITAL ADMINISTRATOR SYMPOSIUM
Management (HA 1)
� How to manage your radiologist: Side effects for public
hospitals aiming at more profitability
� Six Sigma tools to improve hospital management: The Son
Dureta experience
� Remote patient management via TV: Telemedicine systems for
patients with chronic diseases
� Clinical activity based process-cost coupling: A tool for the
development of clinical pathways
� Essentials of managing complex healthcare organisations
IT solutions (HA 2)
� How to buy a HIS: Management and strategies for a
successful IT implementation
� „IT slows you down - why bother?“
� Vendor, system administrator and management in a new fully
digital environment
� Centralising the management of patient data: e-health
becomes reality
Financing (HA 3)
� Financing of high-performance equipment in radiology
� New leasing and financing strategies to guarantee up-to-date
medical technology for practitioners and hospitals
� Advanced financing solutions for hospitals in compliance with
regulations and laws: IT financing, PPP-models, governmental
fund integration and cross border transactions
� The pros and cons of different financing methods to fund
healthcare investments: A focus on leasing, private
investments, private equity, PPP and fund raising

The 6 th ECR Party – a successful encounter of
styles and cultures
The ECR Party 2006 took place on the last evening
of the congress at a very special, unusual, and
magnificent location – the atelier of the Academy of
Fine Arts, formerly known as Semperdepot.
Originally, this building served as depot for the sets
of the imperial and royal opera and theatre. When
these were moved to another place, it was unoccupied
for decades and in 1975 threatened by demolition,
which was only prevented by public outcry. For
many years disputes between various institutions
hindered any progress. Finally in 1990 the
Semperdepot was dedicated to the Academy of Fine
Arts and completely restored, taking into consideration
the unique architectural characteristics. Since
1996 it has served as atelier for the Academy and as
exhibition space for the Academy’s master classes,
as studio for painting, photography, new media and
stage design, as an exclusive place for symposia,
presentations, art performances and music events,
as well as one of the most impressive and sublime
locations for elegant and exclusive affairs – such as
the ECR Party!
Designed in honour of Wolfgang Amadeus Mozart,
whose 250th birthday is celebrated this year
throughout the world, and as a bow to the home
country of ECR 2006 congress president Professor
Andy Adam, the theme of this year’s ECR Party was
summarised in its title – ‘The Beatles meet Mozart’.
After a few beautiful songs from the Cypriot artist
Loukia Agapiou, the diverse and exciting programme
featured ‘A Little Jazzmusic’, presenting a
concept developed by an ensemble of young musicians
under the well-known contrabassist Florian
Wieninger especially for the ‘Mozartjahr’ – the year
of Mozart: delightful, enchanting Mozart melodies
newly interpreted as swinging, groovy jazz tunes.
The next act introduced a unique acrobatic show,
‘Magic Elements’, based on motives from ‘The Magic
Flute’ and representations of the four elements.
Papageno danced through the halls, carried along by
the melodies from Mozart’s most popular opera. His
visions of fire, earth, air and water were translated
into fascinating, colourful images through incredible
light effects that enhanced the exquisite movements
and artistry of the acrobats.
As culmination of an outstanding evening, the
British cult band ‘The Bootleg Beatles’ performed
exclusively for the ECR delegates. The band was
founded in 1980 by members of the cast of the
musical ‘Beatlemania’, and has since become rightly
famous in its own way, its performances impressing
even two of the original ‘Fab Four’, Paul McCartney
and George Harrison.
] ECR Party [
After all this inspiring entertainment, the party
guests were invited to become active themselves
and thereupon practically stormed the dance floor.
Supported by the beautiful selection of finest music
provided by the legendary Viennese DJ t-jah, delegates
rocked the Semperdepot into the wee hours.
A worthy ending of a spectacular, enthralling
evening that reflected the spirit of some of the
greatest exponents of the art of music – in more
than one way.
SPECIAL ISSUE ECR 2006 25

] Arts & Culture [
ECR 2006 delegates relish in the abundance of
fine arts at Vienna’s museums
This year for the second time ECR contributed to
Vienna’s reputation as one of the capitals of the
cultural world by presenting its delegates with a
special Arts&Culture counter in the entrance hall of
the congress venue. In addition every ECR participant
received an elaborate and beautifully designed
brochure that offered a comprehensive overview of
all cultural events taking place during ECR 2006.
Inspired by this advice ECR guests virtually flocked
to those various artistic treats. A great many
delegates decided on a night at the opera, others
enjoyed musical delights at one of Vienna’s
magnificent concert halls, whereas those more
drawn to the quiet and individual pleasure of a
museum faced the choice of various highly
fascinating special exhibitions.
At the Albertina, the probably most acclaimed and
best publicised exhibit dealt with the work of the
world-famous Austrian artist Egon Schiele,
displaying a lesser known part of his exceptional
œuvre, namely his drafts and sketches.
Together with Gustav Klimt and Oskar Kokoschka,
Egon Schiele was one of the pioneers of modern art
in Austria. While his paintings are still more rooted
in Symbolism, his watercolours and sketches represent
Schiele’s artistic peak, establishing him as the
outstanding Austrian expressionist. The exhibition’s
curator Klaus Albrecht Schröder (the Albertina’s
director) chose 130 works from the Albertina’s own
holdings, complementing them by some 90
important loans from all over the world, thus
offering an unprecedented in-depth presentation of
Egon Schiele, Selbstbildnis mit herabgezogenem Augenlid (Self-
Portrait with Lowered Eyelid), 1910 © Albertina Vienna
26 SPECIAL ISSUE ECR 2006
Egon Schiele, Weibliches Liebespaar (Women Lovers), 1915 © Albertina Vienna
Schiele’s activity as a draughtsman. The focus of the
show was on the artist’s revolutionary period
between 1910 and 1915, and concentrated
primarily on his nudes and self-portraits, with
another highlight being the deeply moving series of
ten watercolours executed by Egon Schiele during
his traumatic imprisonment in Neulengbach.
For those more interested in a broader overview of
Austrian art the well-known Sammlung Essl (Essl
Collection) offered the perfect exhibition: Austria
1900 – 2000, Confrontations and Continuities
presented a panorama of styles, forms and contents
of visual arts in Austria in the 20th century, the
period in art history characterised by the most
profound changes. The exhibition featured 111
artists from the areas of painting, sculpture,
drawing and the new media. The presentation of
approx. 270 works of art spanned The Essl Collection’s
entire exhibition premises of 3,200 sq. m.
Like a coordinate system, the exhibition mapped the
most important confrontations and continuities in
20th century Austrian art: the continuities provided
the vertical axis, while the horizontal axis reflected
the confrontations which are perpetuated from era
to era. One of the continuities was a line reaching
from expressive to abstract art, containing names
such as Richard Gerstl, Herbert Boeckl and Josef
Mikl. Another line could be drawn from the exalted
poses of Egon Schiele’s figures to late 20th century
Body Art, while aspects of the uncanny depicted by
Alfred Kubin and Klemens Brosch were continued,
for instance, in the work of Günter Brus.
Herbert Boeckl, Erzberg, 1942
Courtesy Neue Galerie Graz am Landesmuseum Joanneum
© Nachlass Herbert Boeckl

Confrontations included contrasting views rooted in
personal rivalry, as for instance between the early
Oskar Kokoschka and Max Oppenheimer, or differences
in principle, as between the notions of
‘Josephinism’ and Baroque. They culminated in the
conflict between Adolf Loos and Karl Kraus on the
one hand, and the group around Gustav Klimt and
the Wiener Werkstätte on the other. In the post-war
era, these oppositions were continued in the
dualism separating the artists surrounding Otto
Mauer (Arnulf Rainer, Josef Mikl, Wolfgang Hollegha,
Markus Prachensky) and the School of Phantastic
Realism (Arik Brauer, Ernst Fuchs, Rudolf Hausner,
Wolfgang Hutter, Anton Lehmden).
Contemporary artistic positions were represented by
Michael Kos, Dorit Margreiter, Martin Schnur, Eva
Wagner et al, offering a preview into the 21st century.
An individual show of the paintings by Xenia
Hausner at the KunstHausWien rounded off the
‘tour des beaux-arts’ for the art-loving ECR delegate.
Xenia Hausner, the daughter of the prominent
phantastic realist Rudolf Hausner (1914-1995),
started her career as stage designer working for
some of the most famous theatres in Europe, such
as Burgtheater in Vienna, Covent Garden in London
and Theâtre de la Monnaie in Brussels. In 1992 she
decided to dedicate her life exclusively to painting,
since then she has had her work exhibited in
Xenia Hausner, Adler und Engel, 2005
© VBK Wien/Xenia Hausner, 2006
Salzburg, Munich, Berlin, Leipzig, Hamburg, New
York, St. Petersburg, Vienna, Basle, and Los
Angeles.
In her new work, Xenia Hausner constructs a
fictitious reality, which she re-invents taking unexpected
turns. She explores a utopia of failures and
possibilities and thus comments our time. One can
see people walking on tightrope, continually
imperilled by the stumbling blocks of the reality of
the absurd, and the moments of happiness to which
they submit. In these moments, the conception of
reality coincides with the concrete experience. The
first nature and the second, the reflected one, are
unquestioningly united for a short while. In the ideal
case, the construction of the reality is identical with
its nature. The viewer sees the portrayed persons in
amazingly extreme situations, their existence has
been thrown off balance; what remains is their
yearning. They can experience happiness, but they
are always threatened by the fall into disaster. This
illustrates Xenia Hausner’s attitude that defines her
art – "Life is an experiment". At the KunstHausWien
40 large works from the last two years were on display,
among them 20 large format works that were
shown for the very first time.
In summary it may be said that ECR guests with a
penchant for visual arts were spoilt for choice. What
will it be next year? Portraits from the Baroque?
Great Italian masters? Viennese Actionism? You
may already look forward to Vienna’s cultural offer
for 2007, which will again be presented to you in
advance on the ECR website as well as in our
various media.
] Arts & Culture [
Christian Ludwig Attersee, Kreuzzug, 1994/95
© Christian Ludwig Attersee Sammlung Essl
Wolfgang Holegha, Weinzeiger, 2001
© Sammlung Essl Privatstiftung Sammlung Essl
SPECIAL ISSUE ECR 2006 27

] The Art of Science [
The Art of Science – ECR’s motto was represented
in three exciting special exhibitions
In compliance with ECR’s tradition of offering its delegates an ambitious supporting programme at the annual congress and following ECR’s aim to combine science and
art, this year three highly contrasting exhibitions were presented, each extraordinary and fascinating in its own way.
28 SPECIAL ISSUE ECR 2006
Under the heading Reality as Model ECR 2006 presented a selection of the work
of Linda Leeb, an exceptional artist from Graz, capital of the Austrian province of
Styria. She introduced her impressive graphic art, which incorporates radiological
images in an unexpected and astonishing manner.
Ms. Leeb graduated from the master class for sculpture at the International
Summer Academy in Salzburg, and attended courses at the University for Applied
Arts in Vienna and at the Accademia delle belle arti in Perugia. In 1974 she
became a member of the prestigious Sezession Graz, one of Austria’s leading
institutions for fine arts; since 1983 she has been its president.
Linda Leeb’s play on forms has been called enigmatic. Her thoughts and emotions
circle around life and the world. Intuitively, she recognises the
interrelation between chaos and cosmos. Her work reflects the tension between
liberty and order, dreams and realities. The cycle of old and new,
origin and end, alpha and omega, create the basis for Leeb’s energy and ideas.
Dr. Werner Schuster, a radiologist from Neunkirchen, Lower Austria, presented
his highly unusual and impressive pictures as X-Fruits –
Pictures without a camera.
Born in Vienna in 1957 and raised in Lower Austria, Dr. Schuster received his
medical education at the University of Vienna. After years of residency in
Vienna and Neunkirchen, he opened his own practice as radiologist in 1993. When
he purchased new mammography equipment in 2002, Dr. Schuster decided to
provide an unconventional setting for the presentation. An avid photographer
from his childhood, he took the logical step, combining his passion and his profession
– taking pictures without a camera, using his very own high-tech devices.
The aim was to demonstrate the highest achievable definition and resolution.
After numerous tests, a deep-frozen fish proved to be the perfect object.
Dr. Schuster then started to experiment with various X-ray-proof entities, until his
efforts culminated in the present collection.
The German Röntgenmuseum was again invited to present its new exhibition
Wounds and Weapons. X-Rays and War. This year’s remarkable collection of
images and photographs, which clearly illustrates the role of radiology in war, has
again been assembled by Professor Hermann Vogel from Hamburg/DE with
the assistance of Ulrich Hennig, the museum’s director.
Prof. Dr. Hermann Vogel, head physician at the Albers-Schönberg-Institute, the
department of radiology at St. Georg Hospital in Hamburg, noticed during a stay
as visiting professor in Monterrey, Mexico, a different kind of violence in South
America than in Central Europe. In addition, he observed that social behaviour
could be read from radiological results. His methodical collecting led to findings of
victims of war, torture and various other crimes (A Radiologic Atlas of Abuse,
Torture, Terrorism, and Inflicted Trauma, CRC Press 2003). A request for images
from amnesty international initiated the first exhibition. Today there are four
exhibits available, with legends in German, English, French, Polish and Arabic,
which have been shown more than 50 times throughout the world.
The exhibition at ECR 2006 showed the relationship between X-rays and war,
using X-ray technology and weapons as examples. The victims’ agony and the
cruelty of war and of the employed weapons were demonstrated through
shocking images that speak for themselves. The enormous significance of X-rays
for medicine and all other sciences is indisputable; however, in this exhibition
these achievements were put in sharp contrast to the horror of the weapons and
the horror of their use.

Interview with the incoming ECR President
The ECR editorial team had the pleasure to interview the incoming ECR 2007
President, Prof. Christian Herold, who is Head of the Medical Diagnostic Division of
the Vienna University of Medicine (AKH).
You are the first Austrian president of the ECR since Vienna was adopted as a permanent
congress venue in 1991. Will this make it more or less difficult to be an
ECR president? Will it put on an additional pressure?
Certainly, expectations are very high, especially by my Austrian colleagues. But
this, on the other hand, is very stimulating because we will have to meet the
highest possible standards to put on a great meeting. Secondly, the pressure is on
because it will be very difficult to bring even more Austrian professionals to the
meeting. We already had 886 Austrian attendees this year. On the other hand, as
an Austrian presidency is easier, because I know Vienna, how to pull strings to
make things happen.
Overall, it is a truly exceptional honour but also obligation to be ECR president
and it’s very exciting to shape the educational, scientific and social programme for
such a great meeting.
How far advanced are your plans for ECR 2007?
Since the preparations for our annual meeting start two years before the actual
meeting, a significant part of the programme, especially the educational programme
has already been developed. Abstract submission for scientific contributions
will open in early July and will be available until mid-September. The social
programme will be, at least in parts, surprising, so I will not reveal too much
about that at this stage. And obviously the Austria Center is such a great location
that we will remain in this building for 2007.
What new features can delegates expect for ECR 2007?
There will be a new categorical course on multi-detector CT imaging with international
superb speakers and I am confident that this course will draw huge crowds.
Second, we have a new interactive course on “Signs in Imaging”, which will feature
the clinically most important signs in imaging in all the various subspecialties.
I suspect that this will be very attractive for the audience. Then, we will have
two new mini-courses which are also innovative features of the ECR meeting: One
course on women’s imaging and one on molecular imaging.
Your professional background is chest radiology. Which parts of the educational
and scientific programme are you particularly excited about?
I am of course excited about the entire programme, because we have received
such great input from the members of the Programme Planning Committee and
everyone else involved in ECR. Being a chest radiologist, I am particularly excited
about the chest sections of the refresher course programme, the multi-detector
CT course and the signs in imaging course. But, I am also particularly looking forward
to the cardiac imaging foundation course. And finally, there will be a special
focus session on acute chest pain, which should alert attendees to the possibility
of using CT to search for potential causes of chest pain.
What other innovations are going to surprise ECR 2007 delegates?
There will be a series of innovations. One that I would specifically like to highlight
is the e-learning centre, and the e-learning initiative. There will be a centre where
the most innovative features of e-learning will be made available to the delegates
of ECR.
Prof. Christian Herold from Vienna/AT will preside over ECR 2007.
] Preview ECR 2007 [
Apart from Austria, as the home country of the President, will there be other ‘ECR
meets’ nations?
There will be two ‘ECR meets’ countries, one will be the Czech Republic, which is
quite an obvious choice, since it is a neighbouring country of Austria and shares
common historical roots and many familial and professional ties. The second
country will be China, continuing ECR’s tradition to invite an overseas country. I
have already received enthusiastic responses from both the Czech Republic and
China.
The ECR 2007 congress poster looks quite extravagant. How did you select it and
who is the artist behind it?
The congress poster is part of another interesting project, which I believe goes
well with ECR’s mission of being the most innovative congress in the word.
The work is a piece of art by Hans Weigand, a contemporary Austrian artist of international
reputation, produced specifically for ECR. It is a collage of famous
sights of Vienna, its surroundings, its arts, culture and medicine. Overall, this is a
multimedia project, with the printed poster representing the analogue end. The
multimedia version of the collage will be displayed at next year’s ECR.
SPECIAL ISSUE ECR 2006 29

March 9-13, 2007
VIENNA, AUSTRIA
www.ecr.org The annual meeting of the European Society of Radiology