New floor-mounted radiography system – guest post by Siemens Healthineers

In radiography, the way patients and referring physicians perceive your institution can enhance – or hinder – your success. MULTIX Impact is an innovative digital imaging machine that makes a positive impression on patients, staff, and referring physicians. Its user-friendly, state-of-the-art technology is designed at an economical price to improve access to care and helps you produce excellent images in a more personal way. 

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10,000 twitter followers?! This is a reason to celebrate!

We have THREE FREE places at ECR 2019 to give away to our fantastic followers.

To be entered into our draw, all you need to do is:

1) Follow the European Society of Radiology’s Twitter account, @myESR (existing followers also qualify)

2) Either like, comment, or re-tweet one of our tweets between now and June 10 (deadline: 23:00 CEST).

All personal* Twitter accounts meeting those two simple criteria will be entered into our random draw for free ECR 2019 registration.

Thanks for following us and good luck!

*Accounts representing companies, societies, institutions or other organisations will not be eligible. Anyone found to use multiple accounts to enter will also be ineligible.
Full terms and conditions of this competition can be found here.

The winners of the ECR 2018 Cases of the Day Quiz are as follows:

Mehmet Serindere; Hatay/TR
Sungeun Park; Seoul/KR
Seungchul Han; Seoul/KR
Sewoo Kim; Seoul/KR
S. A. Sohaib; Sutton/UK
Rafal Darecki; Koscierzyna/PL

To view the cases please click here.

Congratulations to all winners!

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 and didactic value. 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.

This year’s topic was Normal variant or disease to avoid misdiagnosis, overdiagnosis, unnecessary and costly work-up, as well as patient’s concerns.

When we think back of our time in medical school and remember our studies of embryology, we have probably all thought at some stage, how astonishing it is that a viable fetus develops and a healthy newborn is delivered. Embryological development is so complex that an awful lot can go wrong at any stage. Fortunately, real malformations are rare. In our professional life as radiologists, though, we are not infrequently dealing with normal variants, when development is arrested at a certain stage or turns the wrong way round. Even first year residents are familiar with right sided aortic arch, azygos lobe and accessory ossification centres. Over time, one encounters a whole array of normal variants and learns to interprete them as such. Of course, one can only identify, what one has learnt to see and there is a large spectrum of slight developmental abnormalities, which should not be misdiagnosed as abnormality in need of further imaging, invasive diagnostic procedures or treatment. On the other hand, some developmental disorders have clinical significance and you could be the first to advise the patient.

Below, we are pleased to present the best submissions for the “Normal variant or disease” interlude at ECR 2018:

• “Intrathyroidal thymus with ectopic cervical thymus”
  Zeynep Nilüfer Tekin; Istanbul/TR
• “Lingual thyroid with the thyroglossal duct”
  Anna Salwa; Cracow/PL
• “Abernathy malformation”
  Anirudh Nair; Ioanina/GR
• “Arrested pneumatization of the sphenoid sinus”
  Paula Concejo Iglesias; Madrid/ES
• “VACTERL association”
  Margaret Mary Cariño; Taguig/PH
• “Congenital porto-systemic shunt Type 1”
  Andrea Posteraro; Parma/IT
• “Crossed renal ectopia”
  Marta Sarabia Unibaso; Bilbao/ES
• “Female hernia”
  Claire Elliott; London/UK

By Julia Patuzzi

As has been our tradition for a few years now on the final day of our congress, we already look ahead to next year’s ECR. We therefore spoke with Prof. Lorenzo E. Derchi from Genoa, Italy, who, as incoming ESR President, is in charge of ECR 2019. He told us about his plans and ideas for the next European Congress of Radiology.

ECR Today: Professor Derchi, next year’s European Congress of Radiology will be the 25^th to be held in Vienna. Are there any specific celebrations planned that you can already share with us?

As incoming ESR president, Prof. Lorenzo E. Derchi, Head of the Department of Radiology at the University of Genoa, will preside over ECR 2019.

Lorenzo E. Derchi: We are still thinking about them. An anniversary like this is something more than an opportunity for a big celebration. It is the right moment to re-think our history and what we have reached over the years. To always have the congress in the same city since 1991, at first every other year and then, after 1999, annually, has been a radical change. The new formula proved successful and ECR has become the European meeting to come to in order to learn the latest clinical and technical advances in our discipline as well as to present the results of the previous year’s research.

In my experience, however, it has become much more. From 1991 up until today all congress chairpersons have been part of the same team in a relay race, each handing off the baton to the next one. This continuity can be felt in the special atmosphere at each meeting, and has allowed the congress to become the annual appointment to meet old friends and make new ones; to discuss any radiological topic and then to start working together on it; and finally a place to meet periodically to share problems, advancements and results of long-term projects.

ECRT: Were you here for the first ECR in Vienna in 1991? If not, when did you attend your first ECR? What do you recall from that visit?

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by Katharina Miedzinska

Saturday’s ‘ESR meets Portugal’ session is a successful combination of science, culture and entertainment, offering the opportunity to discover how Portugal has contributed to the practice of radiology over the years and foresee the future of Portuguese radiology.

In an interview with ECR Today, Dr. Filipe Caseiro Alves, professor at the University Clinic of Radiology, Coimbra University Hospitals, Portugal, outlined some central themes and highlights of Saturday’s highly anticipated session.

One of the first reports and image of cerebral angiography. From, Moniz E, de Carvalho L, Lima A. La radioartériographie et la topo-graphie cranioencephalique. J Radiol Electrol Med Nucl 1928;12:72. (Provided by Prof. Filipe Caseiro Alves)

At the beginning, Caseiro Alves plans to go on a short time travel through the history of Portuguese radiology. “Portugal’s greatest contributions to radiology are closely interwoven with the Portuguese School of Angiography, which began with the work of Egas Moniz, who was the first to perform a cerebral arteriography in 1927,” he explained.

Since then, Portugal has yielded many outstanding pioneers in the field of vascular radiology, among them Reynaldo dos Santos, a professor of surgery in Lisbon, who, among others, is known for the invention of aortography in 1929. Others include Lopo de Carvalho, who successfully introduced pulmonary angiography in 1931, Álvaro Rodrigues, Sousa Pereira and Roberto de Carvalho, who are known for their innovative work on lymphography (1933), Reynaldo’s son, João Cid dos Santos, who successfully introduced direct phlebography of the limbs in 1938, and Ayres de Sousa, whose name will always be closely associated with microangiography. “All these pioneer works were at the forefront of one of the most important achievements in healthcare and proved instrumental in shaping today’s medical practice,” Caseiro Alves said. Read more…

by Viviene Raper

How to create hand-made chocolate masterpieces isn’t your usual radiology talk but, in tomorrow’s session, radiologists with a sweet tooth can learn all about truffle making and other confectionery arts from a leading Swiss chocolatier – interspersed with more conventional talks about radiology in Switzerland.

Andreas Trumpler, managing director marketing and group CMO at Läderach chocolatier suisse, will be giving two short presentations about how Swiss chocolate is transformed from cacao bean to chocolate, and then into a hand-made masterpiece. The company employs more than 800 people and since 1962, it has established a reputation for chocolate and confectionery specialties. Läderach’s products are sold throughout Switzerland and Germany, as well as by partners in the Middle East and Asia, and it supplies the top end of the gastronomy and hotel industry with semi-finished and finished products.

Fresh Chocolate with almonds from Läderach chocolatier suisse: the original view.

The connection between Swiss chocolate and Swiss radiology is one of quality, according to Prof. Dr. Dominik Weishaupt, who has been President of the Swiss Society of Radiology (SGR-SSR) since 2016 and is chairing tomorrow’s session.

“Over the 100 years of the Society’s history, we have undertaken several initiatives to improve the quality of Swiss radiology. And chocolate is considered as one of the highest quality products manufactured in Switzerland,” he noted.

Weishaupt, who is chief physician in the Institute of Radiology and Nuclear Medicine at City Hospital Zurich, explained that Swiss chocolate needs precision manufacturing, and Swiss radiology also prides itself on its attention to detail. He said that the SGR-SSR was the first medical society to introduce board exams, as well as clinical audits for radiology departments in the private and public sector, which they developed in close collaboration with the Ministry of Health. Read more…

by Prof. Bernd Hamm, ESR President

It is my great pleasure to welcome you to ECR 2018!

The European Congress of Radiology has attendees from all over the world – from over 140 countries and many diverse cultures. It is a multi-professional meeting where international experts can shake hands with students, medical residents exchange ideas with physicists, and radiographers share their perspectives with industry representatives.

I chose ‘Diverse & United’ as our congress motto this year, as radiology is such a diverse specialty, covering a huge range of medical and scientific topics: from ever more refined diagnostic options to image-guided minimally invasive treatment options. Alongside our diversity, as radiologists and radiographers we should also stay united, which is in the interest of our specialty and our patients. This is what our congress is: something to offer for everyone, regardless of profession, cultural background or specialisation.

ESR President 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. He is also clinical director of the Charité Center, which includes radiology, neuroradiology, nuclear medicine and medical physics.

Being Congress President in 2015 gave me the unique opportunity for re-evaluation and to implement new things that I feel strongly about as well as fine-tune features that already existed. It was generally important to me to introduce new ideas in order for those of you who’ve even been coming to Vienna for decades, just like me, to get the chance to experience multiple innovations.

MyT3 is a new session format, adapting the ECR even more to these fast-moving times. 240 daring colleagues will present their scientific thesis in just three minutes! As if this wasn’t dramatic enough, we decided to hold these speedy sessions on the Sky High Stage which overlooks the city of Vienna, as only the sky is the limit for this new generation of radiology professionals.

Additionally, we created another new session format, ‘Coffee & Talk’, which is highly interactive with much more time for discussion than usual and in a relaxed atmosphere, with the possibility to also enjoy a coffee or other hot beverage. The interesting lectures on offer in these sessions call for an exciting exchange, bringing together different statements and opinions as well as Viennese coffee culture.

For the first time, the CUBE will open its doors to you: a theme park for interventional radiology (IR), designed for residents who haven’t specialised yet. Challenges, quizzes, training and much more will be focused on IR in emergencies plus other everyday topics, including the aorta, oncology, peripherals, and stroke. Without wanting to give away too much, I recommend paying the Cube a visit during lunchtime for ‘the main event’: the daily highlight involving experts in the arena, less challenging as well as more challenging interventions and much more. Come and be part of it!

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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. Csaba Traply, head of the emergency department radiology unit and chief emergency radiology consultant at the radiology department of Odense University Hospital in Odense, Denmark.

European Society of Radiology: Could you please describe the role of the radiologist in a typical emergency department in your country?
Csaba Traply: Our emergency department, which opened five years ago, is the first of its kind in Denmark. I was the first Danish radiologist to be employed as a full-time, emergency radiologist.
Together with my younger colleagues (who are in rotation in various radiology subsections, including our emergency section) we are part of a team in the emergency department. Our main focus is to give optimal, expedient examinations and diagnoses to incoming patients. Our goal is for patients to have a preliminary diagnosis within four hours of arriving at the emergency department, no matter what the time of day. In our case, patients usually receive a final diagnosis within this period, thanks to having a radiology unit physically located in the emergency department and available around the clock.
In other hospitals in Denmark, similar emergency departments have just been established. Unfortunately, not all of these will include an on-site radiology unit, and among those that do, not all will have an on-site radiologist.
Personally, I cannot imagine emergency radiology without the constant, physical presence of a radiologist, as the condition and required diagnostics for emergency patients can change rapidly. Therefore, I think that our presence and participation as part of the emergency team is essential.

Dr. Csaba Traply is head of the radiology unit in the emergency department and chief consultant in emergency radiology at the radiology department at Odense University Hospital in Odense, Denmark.

ESR: What does a typical day in the emergency department look like for a radiologist?
CT: In the early morning, only few new patients arrive. At around 10:00, the number of patients starts to increase, and the number of visitors peaks between 14:00–20:00. I think that this is a universal pattern in all emergency departments. Naturally, the workload follows this timeline.
Every morning begins by reporting examinations from the previous night, as well as visitation of the previous referrals and the beginning of new examinations. In the meantime, examinations of the newly arriving patients also commence.

ESR: Teamwork is crucial in an emergency department. How is this accomplished in your department and who is involved?
CT: As I already mentioned, in our emergency department, there is an on-site radiology unit with an on-site radiologist and technicians. We are an active part of the team, and in many cases, we are guiding clinicians to choose the appropriate examinations, and often our report influences patients’ treatment. This happens through direct communication and collaboration with the clinicians, often before our final report is released. So far, this works well and is a model in emergency medicine in Denmark. This is why I find it difficult to imagine that examinations take place in the emergency department, but the reporting takes place outside the emergency department.
If necessary, we cooperate and consult with the other subsections in our radiology department (e.g. neuroradiology, thoracic and abdominal radiology).

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This year, the main theme of the International Day of Radiology is emergency radiology. To get some insight into the field, we spoke to Prof. Damir Miletić, head of the radiology department at the Clinical Hospital Centre in Rijeka, Croatia.

European Society of Radiology: Could you please describe the role of the radiologist in a typical emergency department in your country?
Damir Miletić: Radiologists are involved with the majority of patients admitted to the emergency department because most adult patients require radiology services as part of their treatment. Sometimes we wonder if all these cases really are emergencies. However, during a busy shift, we don’t have time to check the indication, particularly for conventional radiography. We notice that proper clinical examinations are sometimes not only supplemented with, but often replaced with imaging and blood tests. That is magnified when the emergency department workload overwhelms the staff’s capacity. We encounter ‘defensive medicine’ in some clinical scenarios, but in emergency radiology, it is more evident than in other radiology specialties. Radiologists are imaging consultants for cross-sectional imaging indications like CT, MR or ultrasound in emergency settings because referring physicians are required to contact the radiologist to briefly explain their requests. Conventional radiography, however, does not usually require a radiologist’s approval.

Prof. Damir Miletić is an abdominal radiologist who is head of the radiology department at the Clinical Hospital Centre in Rijeka, Croatia; and chairman of radiology at the medical faculty at the University of Rijeka.

ESR: What does a typical day in the emergency department look like for a radiologist?
DM: A typical day for a radiologist in our country varies with the size of the hospital and its spectrum of specialty departments. In some hospitals, that means 20 patients per 12-hour shift. However in others, that number may increase up to 80 to 120 patients, including 10 to 15 CT scans and 5 to 10 ultrasound examinations. In hospitals with 24-hour shifts, that may be exhausting for radiologists and residents. In Croatian hospitals, interventional and paediatric radiologists have daily or weekly on-call duties. A pilot study in the Croatian university hospital revealed that ultrasound requests doubled and CT requests tripled within the 10-year follow-up, while the number of patients admitted to the emergency department is held constant. That study clearly shows a significant increase in cross-sectional diagnostics per emergency patient.

ESR: Teamwork is crucial in an emergency department. How is this accomplished in your department and who is involved?
DM: A typical radiology team in the emergency-radiology department includes a radiologist, a resident and a radiology technologist. During day shifts, they take care of emergency patients and synchronise emergency examinations with those of regularly scheduled patients. Frequently, experts in various radiology specialties are consulted and, when necessary, directly involved in problem-solving. They enrich quality of our radiological service, particularly when postoperative complications are suspected or in complex interdisciplinary cases. Overnight and weekend shifts are completely different because radiologists and residents are dealing with the whole spectrum of radiological emergencies. In paediatric emergencies, clinicians frequently follow their patients to radiology to attend the examination. This is also the case for adult patients who present with life-threatening emergencies and for patients who require a CT examination due to polytrauma.

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