Severe shortage of radiologists creates growing demand for teleradiology services and forces hospitals to outsource, says UK specialist

This year, the main theme of the International Day of Radiology is emergency radiology. To get some insight into the field, we spoke to Dr. Elizabeth Dick, BSc, MD, consultant radiologist and honorary senior lecturer at Imperial College London, United Kingdom.

European Society of Radiology: Could you please describe the role of the radiologist in a typical emergency department in your country?
Elizabeth Dick: It varies. In many hospitals, traditional model remains; radiology and emergency departments are distant from each other. There may be one or two consultant radiologists with an interest in emergency imaging who are the ‘go to’ radiologists for the emergency team during the day. After hours, on-call radiologists will be the point of contact, but they are busy with many services, and increasingly may be remote from the hospital they cover.

Dr. Elizabeth Dick, BSc, MD has worked as a consultant radiologist and honorary senior lecturer at Imperial College London since 2002.

Teleradiology often is used to deliver after-hours care, with obvious advantages. The result is an inevitable loss of personal interaction between the radiology and emergency departments. However, set against this traditional model is the ‘gold standard’. Since 2010, a network of major trauma centres was set up across the UK to deliver excellence in trauma care. In these centres, radiologists usually are an integral part of the trauma team, and the CT scanner is usually co-located in the emergency department. This has a ripple effect: Not only is trauma imaging improved, with resulting lower morbidity and mortality, but all emergency patients benefit from a closer relationship between radiologists and the emergency department team.

ESR: What does a typical day in the emergency department look like for a radiologist?
ED: I start my day at 7am by checking all the reports from the night before so that I can speak to the emergency teams as they do their ward rounds at 8am. Our radiology registrars and residents do two, twelve-hour shifts (8am to 8pm), so this is a good opportunity for the on-call registrars to discuss cases they found particularly challenging. Like all hospitals, we perform more imaging examinations each year. On average, there are at least 25 patients who get imaging (mainly CT) overnight, which means a huge responsibility for the radiology registrars on call. Although they may reach out to the duty consultant during their call, for most scans, registrars issue a report based on their own findings. We regularly audit their reports, and the discrepancy rate is very low – probably due to the fact that they strive to work hard to learn. Also, they get a lot of training and support before, during and after being on call.

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The best submissions for the “MSK manifestations of systemic disease” interlude at ECR 2017

Dear Friends,

Over the last couple of years, one of the last sessions at the ECR has always covered 20 interesting cases from various subspecialties, which the audience is asked to solve in an interactive way to broaden and update their knowledge.

In between, the very best submissions from the global radiological community have been presented in an interlude lecture. The best submission has always been awarded with a prize and a certificate.

Due to time limits, not all submitted cases can actually be shown onsite, but the session’s rising popularity has resulted in increasing numbers of submissions of excellent quality. This is why we would like to give our submitters the opportunity to reach a broader audience by posting the best cases here on the ESR Blog.

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ECR 2018: uniting radiologists to show diversity of discipline

An exclusive interview with the incoming ESR President

ECR Today spoke with the incoming ESR President, Prof. Bernd Hamm, from Berlin, Germany, to learn about his ideas for next year’s congress.

ECR Today: You were already ECR Congress President in 2015. How did you come to be president again in 2018?

Bernd Hamm is professor of radiology and chairman of all three merged departments of radiology at the Charité, Humboldt-Universität zu Berlin and Freie Universität (Campus Mitte, Campus Virchow-Klinikum, and Campus Benjamin Franklin). He is also clinical director of the Charité Center, which includes radiology, neuroradiology, nuclear medicine and medical physics.

Bernd Hamm: This is not the first time that I have been asked: “why are you president again?” It was a great pleasure and responsibility to be the ECR President in 2015. For many years, we had two presidents – one to manage the affairs of the European Society of Radiology (ESR) and another to organise the society’s annual congress (ECR). And frankly, in my opinion this was a good division of labour. However, “the times they are a changin’ …” and, therefore, our society changed its statutes, and now we only have one president, who is both President of the ECR and President of the ESR.

This new combined ESR/ECR President begins his or her term of office at the end of each ECR by organising and chairing the next ECR and then the following year, as Chairman of the Board, focuses on professional and administrative business of the ESR. For me, this means a double honour and double responsibility. When I was elected to be the congress president for ECR 2015, I made a great effort to make the ECR a success and I will do my best to make ECR 2018 a success too.

However, I wish to underline that the ECR is a team effort and that the Programme Planning Committee with its brilliant members is a major asset in compiling an attractive scientific programme and that the organisation of a congress like the ECR is not possible without the highly professional staff of the ESR Office. Working together with many colleagues from many countries and different fields of radiology is very inspiring and is what ultimately underlies an attractive congress. This joint effort is rewarding and enlightening.

ECRT: As a motto for ECR 2018 you chose ‘Diverse and United’. Could you tell us a little about this?

BH: Radiology is such a diverse specialty, ranging from more and more refined diagnostic options to image-guided minimally invasive treatment options. Our specialty has something to offer for all of us and also for future generations of physicians, radiographers and students. However, like in a mosaic, it is the connection of all the pieces that create the big picture. By using this metaphor I wish to express my sincere wish and hope that, despite these different and interesting facets and subspecialties, radiologists should see themselves as a community and join forces to strengthen our specialty in the best interest of our patients.

In 2015 we also had a motto – ‘Radiology without borders’. In the beginning of 2015, none of us would have expected to see new fences being erected in Europe and borders becoming important once again. In view of these tendencies, it is even more important for our scientific community to practice radiology without borders and to advance our specialty through free academic discourse and by benefiting from a diversity of ideas.

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05
Mar 2017
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European Radiology: 25 years of excellence

Watch the European Radiology 25th Anniversary session live on ECR Online, Friday, March 3, 16:00–17:30, Room Z
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Albert L. Baert, Adrian K. Dixon, Maximilian F. Reiser.

25 years of success for the three editors-in-chief of European Radiology: Albert L. Baert, Adrian K. Dixon, Maximilian F. Reiser.

The ESR’s flagship journal, European Radiology, celebrated 25 years of publication in 2016. We spoke to Prof. Albert L. Baert, the journal’s Editor-in-Chief from 1995 to 2007, Prof. Adrian K. Dixon, who headed European Radiology from 2008 until 2013, and our current Editor-in-Chief, Prof. Maximilian F. Reiser. Together, they gave us a comprehensive account of the journal’s development during the last quarter of a century.

 ECR Today: How have you seen the journal develop during the past 25 years?

Albert L. Baert: During this time period the number of published articles has increased spectacularly from 60 articles per year in the first issues to more than 400 per year now. For example, no less than 4,674 pages were published in 2016! European Radiology is now one of the most widely distributed and read scientific journals in the world. Simultaneously, the scientific level of the contents has improved steadily over the years as proven by the current excellent Impact Factor ranking.

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02
Mar 2017
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Celebrating Ten Years of ESOR

Guest article by ESOR Director, Prof. Nicholas Gourtsoyiannis

Nicholas Gourtsoyiannis

Nicholas Gourtsoyiannis is the Educational & Scientific Director of the European School of Radiology (ESOR) and chairman of the ESR’s ESOR Committee.

The European School of Radiology (ESOR) has completed ten years in action. Ten challenging and rewarding years of unfailing commitment and continuous investment in radiological education in Europe. Ten years of envisioning, engaging, delivering, teaching, tutoring, nurturing, and adding value to radiology.

The three main goals of ESOR are still to assist in harmonising radiological education throughout Europe, by supporting the implementation of the European Training Curricula (ETC); to build a genuine and firm interest in subspecialisation in radiology; and to raise the scientific profile of radiological education in Europe and worldwide.

The past ten years of ESOR have been marked by an outstanding growth in a wide range of modular activities, including foundation and advanced courses, teach-the-teachers and visiting professorship programmes, visiting schools, seminars, tutorials, preparatory courses for the European Diploma in Radiology (EDiR), scholarships, exchange programmes for fellowships and full one-year fellowships. So far, ESOR has delivered structured continuing education to almost 17,000 residents and board-certified radiologists worldwide, through 800 programmes.

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02
Mar 2017
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Image-guided interventions: a key pillar in cancer care

Watch this session on ECR Live: Wednesday, March 1, 16:00–17:30, Room F2
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 There is hardly any area of hospital medicine where interventional radiology (IR) has not had some impact on patient management. The range of conditions that can be treated using interventional radiology techniques is continually expanding.

In today’s session, experts will provide an insight into image-guided interventions in oncology with a particular focus on illustrating the importance of quality assurance in image-guided oncological interventions and their effect on treatment outcomes.

In recent years, IR has played a vital role in the field of oncology, and alongside medical, surgical and radiation oncology it constitutes a key pillar in cancer care. Vascular and non-vascular procedures such as transarterial chemoembolisation, radiofrequency ablation (RFA), microwave ablation, radioembolisation, cryoablation and high-intensity focused ultrasound (HIFU) are delivered locally, minimise damage to nearby tissue and avoid the systemic side effects of chemotherapy.

Colorectal lung metastasis before CT – guided microwave ablation.

For the interventional radiologist providing oncologic therapies it is essential to understand the rapidly changing field of oncology and to have a broad knowledge of oncologic diseases and available therapies to treat them. Radiologists providing image-guided interventions in oncology have an outstanding understanding of imaging as well as a diversity of interventional skills. However, they lack formal training in oncology and an understanding of chemotherapy and radiotherapy, according to Prof. Andy Adam from the Department of Radiology at Guy’s and St. Thomas’ Hospital in London. Read more…

ESR and Materialise unveil Medical 3D Printing Experience Center together at annual meeting

3D technology has been transforming the face of healthcare for over 20 years. 3D-printed anatomical models are increasingly being used for evaluating treatment approaches, planning complex procedures and improving the training of medical professionals. And that’s just the start.

The ECR presents a great opportunity to explore the contributions and benefits that Medical 3D Printing brings to healthcare at the 3D Printing Experience Center in the Entrance Hall. To bring this experience to life, the ESR is collaborating with Materialise, as the backbone of the 3D printing industry.

3D-printed skull

You will experience the workflow interactively – from medical images to accurate 3D anatomical model, explore all the different clinical applications of Medical 3D Printing and learn the first steps of setting up a 3D lab in your hospital.

But why exactly is Medical 3D Printing generating so much interest amongst radiologists?

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23
Feb 2017
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IDoR 2016 Cake Competition Winner: the Making Of

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Christina Harter-Felszeghy, co-creator of the amazing winner of our International Day of Radiology cake competition explains the inspiration and production of the winning cake. Don’t miss the photo gallery at the bottom of this post.

My Father, Dr. Scott Harter, is a radiologist and Chief of Radiology Consultants in Little Rock (Arkansas, USA) and I am a confectioner. While researching how Radiology Consultants could celebrate IDoR 2016, Radiology Consultants’ social media manager came across a post about the ESR’s Cake Competition on the International Day of Radiology website. My father and I volunteered to design and bake a cake to share with the group, thinking it would be a wonderful way to celebrate this special day! It turned out to be a truly unique project.

The winning cake (cross section)

The winning cake (cross section)

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IDoR 2016 Cake Competition: VOTE for the winner!

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Over the last few years we have seen more and more people getting into the spirit of the International Day of Radiology (IDoR), holding parties and get-togethers around the world. In the photographs of these celebrations there is often a delicious looking cake, so this year we decided to encourage this as much as possible by launching the IDoR Cake Competition, with a grand prize of free registration for the European Congress of Radiology 2017, along with two nights hotel accommodation.

We received lots of submissions, but below is our jury’s selection of the most original and creative entries. Please vote for your favourite – the cake with the most votes at 12:00 (CET) on November 16 will be our winner!

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Interview: Prof. Boris Brkljačić, professor of radiology and Vice-Dean at the University of Zagreb School of Medicine, Croatia

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This year, the main theme of the International Day of Radiology is breast imaging. To get some insight into the field, we spoke to Prof. Boris Brkljačić, professor of radiology and Vice-Dean at the University of Zagreb School of Medicine, Croatia, and Chairman of the ESR Communications and External Affairs Committee.

European Society of Radiology: Breast imaging is widely known for its role in the detection of breast cancer. Could you please briefly outline the advantages and disadvantages of the various modalities used in this regard?
Boris Brkljačić: Mammography, ultrasound and MRI are three modalities used for the detection of breast cancer. Mammography has been used for many decades, and the introduction of full flat panel digital mammography has enabled image acquisition with a lower radiation dose, and other advantages in image processing and biopsies. Mammography is used widely in breast cancer screening and has been validated through decades of screening. It is also the initial imaging method in women older than 40 and it enables the detection of microcalcifications, the early signs of ductal cancer in situ, and the majority of breast cancers, depending on the radiographic density of the breast. It can also be used to guide biopsy of microcalcifications. The denser the breasts are, the lower the sensitivity of mammography in detecting breast lesions, which is the disadvantage of mammography. The new mammographic method, digital tomosynthesis, improves the detection rate of cancer in dense breasts. Mammography exposes patients to radiation and is therefore not recommended in young women because their breasts are very radiosensitive.

Prof. Boris Brkljačić, Professor of Radiology and Vice-Dean at the University of Zagreb School of Medicine, Croatia, and Chairman of the ESR Communications and External Affairs Committee.

Prof. Boris Brkljačić, Professor of Radiology and Vice-Dean at the University of Zagreb School of Medicine, Croatia, and Chairman of the ESR Communications and External Affairs Committee.

Ultrasound is an imaging method that provides images based on the acoustic properties of tissues. The blood flow in lesions can be analysed by colour Doppler ultrasound, and elasticity of lesions can be analysed and quantified by sonoelastography. The advantage of ultrasound is that it is completely harmless; it does not expose patients to radiation, and is an excellent method for the guidance of biopsies of all sonographically visible lesions. Ultrasound can demonstrate cancers that are not visible in mammographically dense breasts, and is the complementary imaging modality to mammography, both in diagnosis and in screening. Some U.S. states legally oblige physicians to inform women about mammographic density and advise them of additional methods of examination in dense breasts. Among many advantages in ultrasound technology are the automated whole-breast ultrasound systems that have recently been introduced to the market. The disadvantage of ultrasound is that it increases the number of false-positive findings.

Magnetic resonance imaging (MRI) of the breast has gained considerable importance over the last two decades and is used more and more in breast imaging. It is used in high-risk screening, in the detection of occult cancer with positive lymph nodes, and in the evaluation of implants, and it is the best method for detecting the presence of and assessing the distribution and extent of cancer. It can also be used to monitor the success of neoadjuvant chemotherapy, and is an excellent method for looking for residual cancer or recurrence after treatment. MRI is relatively expensive and time consuming, although abbreviated MRI protocols have recently been introduced.

For treatment planning and monitoring it is very important to know the exact type and grade of cancer, and its immunohistochemical profile. Image guided biopsy is crucial in relation to that, and all imaging methods enable precise, image-guided biopsy to obtain an adequate sample from the breast cancer and other breast lesions.
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