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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Interview: Dr. Ilse Vejborg, head of radiology at the University Hospital of Copenhagen, Rigshospitalet, Denmark.

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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 Dr. Ilse Vejborg, head of radiology at the University Hospital of Copenhagen, Rigshospitalet and head of the Capital Mammography Screening programme in Denmark.

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?
Ilse Vejborg: Mammography is a fast examination, showing the whole breast, if performed properly. Mammography has a high sensitivity to fatty tissue but the sensitivity can be compromised in dense breasts. Ultrasonography is an important supplementary examination which should be used in diagnostic examinations of women with palpable lumps or other symptoms in the breast. In experienced hands, ultrasound is the best examination for distinguishing a solid from cystic palpable lump but often also for evaluating whether the lump looks benign or malignant. Ultrasonography offers the possibility of evaluating the blood flow (Doppler) and stiffness (elastography) in a process and can be used to perform ultrasound-guided interventions.

MR Mammography has the highest sensitivity of all the imaging modalities but a more varying specificity; the latter is probably partly explained by the fact that in contrast to mammography screening, where high volume readers reading more than 5,000 examinations a year are mandatory, high volume readers of MR mammography are rarer.

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Dr. Ilse Vejborg, head of radiology at the University Hospital of Copenhagen, Rigshospitalet and head of the Capital Mammography Screening programme in Denmark.

ESR: Early detection of breast cancer is the most important issue for reducing mortality, which is one reason for large-scale screening programmes. What kind of programmes are in place in your country and where do you see the advantages and possible disadvantages?
IV: In Denmark we have nationwide, organised, population-based mammography screening. Mammography screening is offered every second year free of charge in the target age group of women aged 50–69 years. Mammography screening is the only imaging modality proven to reduce breast cancer mortality. It is a fast and inexpensive examination which can be performed without the presence of the physicians. In Denmark, all screening centres have digital mammography equipment and RIS and PACS systems.

Nationwide mammography screening in Denmark was implemented rather late compared to our Nordic neighbours and Denmark has had a higher mortality of breast cancer than the other Nordic countries. Mammography screening started in Copenhagen municipality in 1991, in the county of Fyn in 1993 and in the municipality of Frederiksberg (close to Copenhagen) in 1994. These programmes offering screening only to around 20% of the target population were for many years the only screening programmes in Denmark. Not until 2010 did we have a nationwide roll out of mammography screening.

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Interview: Dr. Viera Lehotská, head of radiology at Comenius University and St. Elizabeth’s Cancer Institute, Bratislava, Slovakia.

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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 Dr. Viera Lehotská, Associate Professor and Head of the 2nd Radiology Department of the Faculty of Medicine Comenius University and St. Elizabeth’s Cancer Institute, Bratislava, Slovakia.

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?
Viera Lehotská: Mammography, including recent trends (e.g. tomosynthesis), is considered to be an essential, highly sensitive and representative method in the diagnostics of non-palpable breast lesions, especially those with the presence of microcalcifications. Based on this fact, mammography is generally accepted as the only proper method for active detection of breast cancer in the screening process. One disadvantage is the use of ionising radiation, and some patients might also consider the need for breast compression during imaging another disadvantage. But its contribution to the diagnosis of early stages of breast cancer significantly outweighs these limitations.

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Dr. Viera Lehotská, Associate Professor and Head of the 2nd Radiology Department of the Faculty of Medicine Comenius University and St. Elizabeth’s Cancer Institute, Bratislava, Slovakia.

Ultrasound examination of the breast and the axilla serves as the main complementary method to mammography: for differentiation between cystic and solid lesions as well as for the elimination of occult lesions in dense breast glands. For younger women (under 40), pregnant women, or women during lactation, as well as for women with inflammatory breast disease or impaired mammary implants, ultrasound is used as the first choice examination method. Its benefit is not only its low cost but also its repeatability and non-risk character. Together with newer trends such as US-elastography and contrast-enhanced ultrasound (CEUS), it contributes to the assessment of lesions dignity (whether it is benign or malignant). It is very helpful in the follow-up of operated and irradiated breast and is therefore an important part of the monitoring of patients after surgery for breast cancer.

MR-mammography has strictly defined indications, which, if they are kept to, makes it a robust method. It has high sensitivity in the diagnosis of invasive breast carcinoma. Its specificity can be increased by using functional MRI methods such as diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) MRI, and MR-spectroscopy. In addition, its potential is not only in the assessment of the extent of breast cancer (multiplicity, etc.) or in the assessment of early response to neoadjuvant chemotherapy, but also in its high sensitivity in high risk groups.

Interventional methods also play a very important role, whether under the MG-stereotactic, ultrasound or MR-navigation. Preoperative histologisation of breast lesions by standard vacuum-assisted biopsy or by the Intact BLES (Breast Lesion Excision System) is an indispensable part of the exact diagnosis of the character of breast lesions. Similarly, image-guided localisation techniques enable effective surgical treatment of breast cancer.

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Interview: Dr. Sophie Dellas, head of breast imaging and diagnostics at the University Hospital Basel, Switzerland

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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 Dr. Sophie Dellas, assistant professor of radiology and division head of breast imaging and diagnostics at the University Hospital Basel, Switzerland, and a core team member of the certified breast centre at the same institution.

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?
Sophie Dellas: Mammography is the imaging modality of choice for breast cancer screening, but also for diagnosis, evaluation, and follow-up of people who have had breast cancer. Long-term results of randomised controlled trials of mammography screening on average show a decrease in breast cancer mortality of 22% in women aged 50 to 74 years. The main problem of mammography is that it is not a perfect method. Mammography generates 2D images based on the density of tissue for penetrating x-rays. The compression of the breast that is required during a mammogram can be uncomfortable. The compression is necessary to reduce overlapping of the breast tissue. A breast cancer can be hidden in the overlapping tissue and not visible on the mammogram. This is called a false negative mammogram. Mammography is associated with a false negative rate in the order of 10% to 20%. On the other hand, mammography can identify an abnormality that looks like a cancer, but turns out to be normal. This is called a false positive mammogram. Besides worrying about being diagnosed with breast cancer, a false positive means more tests and follow-up examinations. Furthermore, at least some of the cancers found with screening mammography would never otherwise be diagnosed in a patient’s lifetime. The magnitude of such overdiagnosis is a topic of much debate. It is likely to represent up to 10% of breast cancers found on screening mammography and results in potentially unnecessary treatments.

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Dr. Sophie Dellas, assistant professor of radiology and division head of breast imaging and diagnostics at the University Hospital Basel, Switzerland.

Breast ultrasound is complementary to both mammography and magnetic resonance imaging (MRI) of the breast. It does not use radiation. It is therefore the initial diagnostic method of choice if breast imaging is required below the age of 40. It allows the confident characterisation of not only benign cysts but also benign and malignant solid masses and the characterisation of palpable abnormalities. The high spatial and contrast resolution of modern breast ultrasound equipment allows the detection of subtle lesions at the size of terminal duct lobular units such as DCIS and small invasive cancers. In women with dense breasts and a negative mammogram, ultrasound therefore is increasingly used as a supplemental screening tool. The major disadvantage of ultrasound as a screening tool is the high risk of false positive findings resulting in unnecessary biopsies. The rate of false positives is much higher with screening ultrasound than with mammography or screening MRI.

Unlike mammography, MRI of the breast does not use radiation. It is safe even though it does require an intravenous injection of a contrast medium. It has a sensitivity exceeding 90% for detecting breast cancer and is superior to mammography and ultrasound. Annual MRI screening is recommended for women with a high lifetime risk of getting breast cancer. Although breast MR imaging is extremely sensitive, its specificity is limited, leading to additional workups and benign biopsies. Good quality breast MR imaging is expensive, time-consuming, and not universally available. Patients with pacemakers, certain aneurysm clips or other metallic hardware, an allergy to contrast agents, or severe claustrophobia are unable to undergo MR imaging.

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The best unused cases submitted for the popular “Know Your Calcifications” interlude at ECR 2016

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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 are 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, only a small number of 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 2016 Cases of the Day Winners

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The winners of the ECR 2016 Cases of the Day Quiz are as follows:

S.A. Sohaib; Sutton/UK
Kemal Kara; Istanbul/TR
Ersin Ozturk; Istanbul/TR
Bertram Feil; Zurich/CH
Miguel Nogueira; Marinha/PT
Yu Kuo; Taipei/TW
Filip M.H.M. Vanhoenacker; Antwerp/BE
Bilal Battal; Ankara/TR
Floor van der Wolf – de Lijster; Sneek/NL

To view the cases please click here.

Congratulations to all winners!

New ESR/ECR president to make youth a central theme at ECR 2017

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ECR Today spoke with the new ESR/ECR President, Prof. Paul M. Parizel, from Antwerp, Belgium, to learn about this new position, his visions for the society and his ideas for next year’s congress.

Prof. Paul M. Parizel, chairman of Antwerp University Hospital’s department of radiology and full professor of radiology at the University of Antwerp’s faculty of medicine, is the incoming ESR/ECR President.

Prof. Paul M. Parizel, chairman of Antwerp University Hospital’s department of radiology and full professor of radiology at the University of Antwerp’s faculty of medicine, is the incoming ESR/ECR President.

ECR Today: You are the first officer of the European Society of Radiology to take on the new position of combined ESR/ECR President. Could you please briefly explain to our readers how this change came about and what it means? What are your main tasks and responsibilities in this position?
Paul M. Parizel: It is a great honour, and also a huge responsibility, to assume this new position of combined ESR/ECR President. The ESR is one of the most important and prestigious international scientific societies, with more than 63,000 members throughout the world. The ECR is well established as the foremost congress in radiology in Europe. Until a few years ago, nominations and elections for the ‘cursus honorum’ of the ECR and ESR were made independently of each other. This implies that we have had brilliant presidents of our society, who never became president of the congress, and vice versa. As both the society and the congress were getting bigger, and more mature, it was decided to re-evaluate and retune the strategic plan and to change the statutes so that appointments were fully integrated, instead of running on parallel tracks, as was previously the case. Bringing the congress and the society under one and the same leadership umbrella is an efficient way to better utilise our resources (human, political and financial). I am convinced that this will improve communication with our members, enhance our international standing and facilitate relationships with other societies and with the industry.
This combined ESR/ECR presidency is certainly a daunting task, and I admit that I am a little bit nervous. On the other hand, I can rely on the work of my predecessors and especially on the creative input and unflagging energy of my friends and colleagues of the Board of Directors, the Executive Council, the statutory committees, subcommittees, working groups, and, last but not least, the experience, professionalism and efficiency of the ESR staff. Our society is healthy, both politically and financially, and we are steering a stable and steady course.

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Prof. Katrine Riklund introduces ECR 2016

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Dear Friends, dear Colleagues

I hope you are looking forward to the European Congress of Radiology (ECR) 2016 as much as I am. Every year I love being at this wonderful event and it is a great privilege to be taking part as the Congress President this year. The task of putting together the programme for this year’s congress has been long, but very enjoyable, and I would now like to introduce a few of the highlights to you.

ECR 2016 Congress President, Prof. Katrine Riklund, from Umeå University Hospital, Sweden.

ECR 2016 Congress President, Prof. Katrine Riklund, from Umeå University Hospital, Sweden.

First of all, the ‘ESR meets’ sessions are always among the most anticipated every year and are a great example of how our congress brings people together from throughout the world. This year you will have the chance to learn about some fascinating topics, such as breast radiology in the Nordic countries, state-of-the-art radiology in Japan, and the transition from practice to reality in Colombia. It is important to note that these sessions are not aimed just at attendees from the guest countries, but at everyone, with the idea that you can discover something new. The same can be said of our guest discipline, nuclear medicine, which will feature in a joint session on hybrid imaging. You can also witness the launch of the new European Society for Hybrid Medical Imaging (ESHI) at the congress, and I encourage you to visit the ESHI booth in the entrance hall, where you can pick plenty of information about the new society.

The new formats introduced to the educational programme last year, under the European Excellence in Education E3 heading, will remain this year, which means you will find sessions with the right level of complexity, wherever you are in your professional development. From the Rising Stars Programme to the ECR Master Classes, there is something to suit everyone, and the sessions are marked with the knowledge level they are intended for. I strongly suggest seeking out your level and making the most of these sessions.

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