Caceres’ Corner Case 147 (Update: Solution)

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Dear Friends,

Today we are showing a case in recognition of the International Day of Radiology, which takes place tomorrow.

Below are images of a 35-year-old woman with chest pain and progressive dyspnoea for the last three weeks. Leave your thoughts in the comments section and come back on Friday for the answer.

Most likely diagnosis:

1. Lymphoma
2. Pleural metastases
3. Mesothelioma
4. Any of the above

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07
Nov 2016
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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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Caceres’ Corner Case 146 (Update: Solution)

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Dear Friends,

Today we’re showing chest radiographs of a 57-year-old man with chest pain and dyspnoea.

Check the images below, leave your thoughts in the comments, and come back on Friday for the answer.

Diagnosis:

1. Carcinoma of the lung
2. Thymoma
3. Lymphoma
4. None of the above

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24
Oct 2016
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Caceres’ Corner Case 144 (Update: Solution)

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Dear Friends,

Today we are showing another pre-op case, including a PA chest radiograph of a 62-year-old man with lumbar hernia. Check the image below, give us your thoughts in the comments, and come back on Friday for the answer.

Diagnosis:

1. TB
2. Carcinoma
3. Pulmonary hypertension
4. None of the above

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03
Oct 2016
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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!

Radiology: What the future holds

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guest post by Dr. Rowland Illing, Affidea Chief Medical Officer

The healthcare industry as a whole has become increasingly sub-specialised, some would say fragmented. Many more healthcare professionals are involved in each patient’s care than in the past and this has both advantages and disadvantages. Amidst the complexity, there is a risk of losing focus on the patient. As with all advanced healthcare practices, the trend in radiology will, or at the very least should, tend towards a patient-centred approach to care provision. Coordinating such a vast system of referral, diagnosis, treatment and recovery therapy is a complex job in itself. The personal touch is all too easily forgotten. Services are delivered in a way that fits the system, rather than with actual patient needs.

The human factor in providing healthcare services

The human factor in providing healthcare services

The challenge for the future will not be in advancing technology even further, that progress is well under way. Rather the challenge is to re-orientate today’s healthcare around the patient and develop treatments, therapies and processes that provide a holistic solution to their given healthcare needs.

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08
Mar 2016
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Caceres’ Corner Case 132 (Update: Solution)

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Dear Friends,

Today we are presenting a PA chest of a 28-year-old woman with fever and pain in the right hemithorax. What do you see? Check the images below, leave your thoughts in the comments section, and come back on Friday for the answer.

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07
Mar 2016
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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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