Experts explain how to avoid pitfalls in FDG PET/CT imaging

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Watch this session on ECR Live: Thursday, March 6, 16:00–17:30, Room I/K
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The demand for PET/CT studies is increasing and so is the need for radiologists to improve their knowledge of this important modality. One of the many areas that require their attention is the occurrence of pitfalls related to the uptake of Fludeoxyglucose (18F), commonly called FDG, the most commonly used tracer in PET/CT imaging. A dedicated Special Focus session at the ECR will offer attendees useful clues on how to avoid these pitfalls and correctly interpret images.

Katrine Åhlström Riklund is director of the medical school and deputy head of the department of radiation sciences at Umeå University, Sweden. She is 2nd vice-chairperson of the ESR’s Congress Committee.

Katrine Åhlström Riklund is director of the medical school and deputy head of the department of radiation sciences at Umeå University, Sweden. She is 2nd vice-chairperson of the ESR’s Congress Committee.

FDG uptake by tissue is also a marker for glucose uptake, which is closely correlated with certain types of tissue metabolism. This means that FDG can show not only disease-related changes but also normal, healthy metabolic changes in the body. “Not everything that shines is pathological. To know the difference, you have to train and learn what is really a disease and what is the physiological distribution of this tracer,” said Professor Katrine Åhlström Riklund, a radiologist specialised in nuclear medicine at Umeå, Sweden, who will moderate the session.
To help radiologists, speakers will share advice regarding FDG uptake in oncology, neurology and cardiology.

Most FDG PET/CT studies are currently being carried out to help stage cancer, and plan and follow-up therapy. The combination of FDG and PET/CT imaging is particularly useful in several different malignancies. Because a tumour cell divides rapidly and has a high rate of metabolism, FDG uptake usually corresponds to disease. Once physicians know the extent of the disease, they can make a more accurate diagnosis and treatment plan, especially in targeted therapies.

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06
Mar 2014
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Spanish radiologists celebrate IDoR 2013 in Madrid

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ESR staff writer Mélisande Rouger was in Madrid on November 8 and took the chance to catch up with members of the Spanish Society of Medical Radiology (SERAM) celebrating the International Day of Radiology.

Fans of medical imaging celebrated the 2nd International Day of Radiology (IDoR) on November 8, with many events taking place all over the world. More than 100 radiology-related societies observed the day and organised their own events, including SERAM, who held a well attended public event at the headquarters of the Spanish Association Against Cancer, in Madrid.

IDoR, which was launched by the European Society of Radiology (ESR), the Radiological Society of North America (RSNA) and the American College of Radiology (ACR) last year, aims to bring radiology closer to the public. This year’s theme was lung imaging, and Spanish radiologists provided clues on how to highlight the role of the radiologist in lung disease management in their lectures last Friday.

From left to right:  Dr. Inmaculada Herráez Ortega, Dr. Angel Gayete Cara, Ms. Elena Serrano García, Dr. Joaquin Ferreiros Dominguez, Dr. Carmen Ayuso Colella, Dr. Eva Castañer Gonzalez and Dr. Jesus De La Torre Fernandez. Photo courtesy of SERAM.

From left to right: Dr. Inmaculada Herráez Ortega, Dr. Angel Gayete Cara, Ms. Elena Serrano García, Dr. Joaquin Ferreiros Dominguez, Dr. Carmen Ayuso Colella, Dr. Eva Castañer Gonzalez and Dr. Jesus De La Torre Fernandez.
Photo courtesy of SERAM.

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ESR invites more friends to Vienna

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This year the European Society of Radiology (ESR) will again invite three national radiological societies and a partner discipline to take part in the popular ‘ESR meets’ programme during its annual meeting, the European Congress of Radiology (ECR). Delegations from Russia, home country of ECR 2014 President, Professor Valentin Sinitsyn, Mexico and Serbia will present their latest achievements in imaging. The European Society of Cardiology (ESC) will focus on the cooperation between cardiologists and radiologists in the field of cardiac imaging. The European Federation of Radiographers Societies (EFRS) will also take part in joint sessions with Russian radiographers, to stress the role of this important partner discipline.

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07
Nov 2013
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IDoR and patients’ organisations: new collaborations to benefit all

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In the course of preparing a book on lung imaging that will be published to mark the International Day of Radiology (IDoR), the ESR spoke to Nicola Bedlington, executive director of the European Patients’ Forum (EPF), who shared her views on healthcare in the EU and explained why she chose to participate in IDoR 2013.

ESR: What is the overall aim of your organisation?

Nicola Bedlington: Our vision is high quality, patient-centred and equitable healthcare for all patients throughout the European Union.
The European Patients’ Forum is an umbrella organisation that works with patients’ groups in public health and health advocacy across Europe. Our members represent specific chronic disease groups at EU level, or are national coalitions of patients. We currently represent almost 60 such organisations.
Our mission is to be the collective patients’ voice at EU level, manifesting the solidarity, power and unity of the EU patients’ movement, and to provide a strong and united patients’ voice in order to put patients at the centre of EU health policy and programmes. In this regard we are the key interlocutor with EU institutions on cross-cutting issues affecting all patients.

Nicola Bedlington, executive director of the European Patients’ Forum (EPF)

Nicola Bedlington, executive director of the European Patients’ Forum (EPF)

ESR: What exactly does your organisation do to meet this aim?

NB: The EPF helps to empower patients’ organisations through educational seminars, policy initiatives and projects. We coordinate best practice exchanges between patient organisations at European and national levels. Our programmes also help to strengthen organisational and advocacy capacity.

ESR: Your organisation has experience working with various chronic disease groups. Do many patients suffer from chronic diseases in the EU?

NB: Following consultation with our members we estimate there are at least 150 million patients with chronic conditions across the European Union. This figure is likely to increase given the ageing population.

ESR: Many EU countries face significant health budget cuts, leading to shorter hospital stays and less access to modern equipment (i.e. long waiting lists for MRI exams). How can patient care be promoted in this context?

NB: The EPF is working with its member organisations to ensure health is seen as an investment, and patients are not perceived as purely cost drivers. Major health inequalities exist across the EU which impact enormously on patients’ access to care.
Building on the three pillars of quality information, health literacy and empowerment, patients can be agents of change and sources of innovation, particularly in terms of equity and sustainability of care. There need to be meaningful opportunities for patient involvement throughout the healthcare sector. We promote meaningful patient involvement in all forms of innovation, whether it is in high or low technology, pharmaceuticals, information technology, social change or systems change. The patient community seeks partnerships with researchers, policy-makers and industry in order to achieve greater impact in this arena.

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Next year’s ECR set to be Russian Affair

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ECR Today spoke with the next ECR president, Prof. Valentin Sinitsyn. He is chief of the radiology department at the Federal Centre of Medicine and Rehabilitation in Moscow, Russia, and currently serves as president of the European Society of Cardiac Radiology (ESCR).

ECRT: What will be the main highlights of ECR 2014’s scientific programme?

Valentin Sinitsyn: Prepare for more interactivity. People are increasingly interested in interactive sessions to assess what they have learned from a lecture. The ECR has been developing interactive sessions for several years now, but we want to increase that. Today, you can find a lot of information on the internet and many people might not think it is necessary to travel to a congress. We want to create something attractive and show that it is worth coming here. Nothing can replace shaking hands with your colleagues from other countries. I would be very sad if the ECR were entirely online. This is why we are making live meetings more interactive.

ECR 2014 Congress President Valentin Sinitsyn, from Moscow, Russia.

ECR 2014 Congress President Valentin Sinitsyn, from Moscow, Russia.

We would also like to change the format of scientific sessions. Our lectures have the same format they had one or two hundred years ago: a stage and an auditorium. We are currently discussing the concept of a multimedia classroom, a model which was successfully introduced during the last SIRM congress in June 2012. This multimedia classroom offered 60 work stations from different companies with 25 different cases which were discussed at the end. We are currently discussing the structure with Professor E. Neri from Pisa, who was responsible for the scientific programme of that project.

Soon we are going to use smart phones for voting during audience response sessions. But wireless technology has its limits and sometimes networks crash, so it needs a lot of work. Keypads are an old technology but they are very reliable. I am sure that next year, or the year after that, everybody will be able to vote with their own iPads or tablets.

We will also increase the number of multidisciplinary sessions. This is not something we have to do just during the ECR. This year we had the Imaging Biomarker’s Course the day before the congress, which was organised by the European School of Radiology. This will take place again next year with radiation oncology as the topic.

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ESR set to tackle personalised medicine and face economic realities in 2013

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In an interview with ECR Today, incoming ESR President, Professor Guy Frija explained how the ESR should address the challenges raised by the explosion of ‘omics’ data and the advent of personalised medicine, as well as how it should assess the impact of the financial crisis on the specialty.

ECR Today: What are your plans and ambitions regarding your presidency?
Guy Frija: The development of the ESR since its establishment in 2005 has been amazing: the ESR is now the biggest radiological society in the world, and its annual meeting, the European Congress of Radiology (ECR), is one of the best radiology congresses worldwide. All of this is the result of intense activity in several fields, such as education, research, professional challenges and publications, for the development of which the role of my predecessors was instrumental, along with the dedication of many of our colleagues. Therefore my first goal is to keep up this momentum and run the society appropriately, in accordance with its new statutes. However, life is challenging, and we will have to face many new issues in the coming year.

Professor Guy Frija is head of the imaging department at the Georges Pompidou European Hospital (Hôpital Européen Georges Pompidou, H.E.G.P.) in Paris.

Professor Guy Frija is head of the imaging department at the Georges Pompidou European Hospital (Hôpital Européen Georges Pompidou, H.E.G.P.) in Paris.

The explosion of ‘omics’ (such as metabolomics, proteomics, genomics) data is changing the face of medicine so considerably and rapidly that, if we don’t pay enough attention, our specialty could be threatened. Personalised medicine is not a just a dream, but an actual reality, and we have to adapt our specialty to this new paradigm. This year, DNA sequencing could become available for less than €750 (US$1,000), and in the UK, the Prime Minister David Cameron has launched a programme for the development of personalised medicine. The development of personalised imaging, which has already begun in oncology, should be taken further, and we have to appreciate its impact on education. I will ask two or three subspecialties to reconsider their training charters in light of these new developments. The data explosion related to these changes raises not only the problem of their management, but also of their interpretation in an integrated way: the imaging parameters should be included in this new data knowledge organisation, where knowledge modelling will become a major challenge. The establishment of imaging biobanks should be promoted along with adapted data privacy regulation.

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11
Mar 2013
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Record participation for diploma examination at ECR

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The increasingly popular European Diploma in Radiology (EDiR) attracted a record number of candidates from all over the world to the ECR. As many as 62 residents and radiologists travelled to Vienna to sit the examination, a 50% increase in participation from last year.

This rise reflects the growing quality and recognition of the diploma, according to Dr. Éamann Breatnach from Dublin, scientific director of the European Board of Radiology (EBR), which organises the examination. “People start to see that the diploma is a qualification agreed to by both the EBR and the European Society of Radiology (ESR). There is more recognition of the value of the diploma, which people see as useful for their individual career paths. Holding the diploma shows your employer that you are enthusiastic and have a good knowledge base, and ultimately you can use it to look for employment elsewhere,” he said.

Mariana Jakubowicz and Santiago Andrés from Buenos Aires, Argentina, were amongst the candidates at the European Diploma in Radiology exams which took place Wednesday to Friday during the ECR.

Mariana Jakubowicz and Santiago Andrés from Buenos Aires, Argentina, were amongst the candidates at the European Diploma in Radiology exams which took place Wednesday to Friday during the ECR.

The diploma is officially recognised by the European Union of Medical Specialists (UEMS), and its reputation extends well beyond Europe. Candidates from the Gulf countries have come in large numbers since the introduction of the diploma two years ago, and Americans are beginning to show an interest as well. Furthermore, the Argentine Society of Radiology paid for two young radiologists to take the diploma exam, and covered their travel and accommodation costs. Dr. Mariana Jakubowicz and Dr. Santiago Andrés, residents at the Deutsches Hospital in Buenos Aires, found it to be a great experience and acknowledged the quality of the examination.

“The exam really covered every aspect of general radiology. The written part was tough. There were lots of questions and little time to answer them. Cases were not the simplest. The examination was challenging because of the language, but I know the examiners take that into account. I felt more comfortable during the oral exam though and could comment on the images. Besides, the examiners were very friendly and helpful,” Andrés said.

“One difficulty is that we do things differently back home. For instance I would never do an MR examination for appendicitis but rather an ultrasound or abdominal CT scan, so I am not used to seeing this pathology on MRI. That was a bit confusing. But having a mock exam beforehand could help in this regard,” said Jakubowicz, who confirmed the huge interest among young Argentinean radiologists in working abroad.

Andrés and Jakubowicz also presented papers through EPOS™ – on mammography, usual metastatic sites in PET, whole-body PET-CT examination and on the selection of biopsy sites with PET-CT. Part of the reason why they took the exam in Vienna was so they could also attend the ECR, and diploma candidates were given free access to the congress this year. Conveniently, the examination started a day before the beginning of the ECR, to enable candidates to attend sessions afterwards. Furthermore, the examination was split over three days, sparing candidates long waiting times between the written and oral tests.

This time, diploma organisers invited a panel of observers to attend the orals, in order to train them to become examiners next year. Organisers also announced that they would include a list of recommended literature for the next examination, after candidates requested this option.

“We would like to encourage people to be familiar with the ESR publications, which include the publication on the revised training charter and curriculum, the journals European Radiology and Insights into imaging, and the case material available on Eurorad. But this list is not exclusive and we are aware that there are very good books in languages other than English, so I want to stress that point, and also insist on the European nature of this examination, which is not a language test,” Breatnach said.

In the future, organisers would like to see the diploma become accepted as equivalent to some national qualifications, and negotiations are currently underway.
The examination will also be held during the annual meeting of the Turkish Society of Radiology in November. Candidates will have the option of taking the oral test either in English or in the local language.

Success in the examination will certify a standard of radiological knowledge deemed appropriate by the ESR for independent practise in general radiology. The examination is open to radiologists and radiology residents in their fifth year of training. Examination costs are €500 for ESR full members and members in training, and €1,100 for ESR corresponding members.

ECR 2013 set to welcome top medical students and residents

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The European Society of Radiology (ESR), which organises the ECR, strives to stay at the cutting-edge of science, helping it shape the future of medical imaging. This commitment goes beyond technology and research, as the society nurtures the talented physicians of tomorrow through support programmes. These programmes help them discover the wonders of imaging and, hopefully, choose radiology as their specialty.

Students and residents are highly encouraged to take part in the ‘Rising Stars’ programme, which grants students free registration to the ECR. This initiative has produced significant results, with more than 1,400 students visiting the ECR last year, making it the world’s leading student meeting in medicine.

Medical students and radiographers in training under the age of 30 and without an academic degree can register for the congress free of charge. They can also submit abstracts (the best submitters are offered free accommodation and travel) and attend Hands-on Workshops on ultrasound and many other scientific sessions.

Student Sessions for Saturday, March 8

Student Sessions for Saturday, March 8

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08
Mar 2013
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Vascular disease comes under growing scrutiny

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Watch sessions from this Categorical Course on ECR Live:

Imaging the arteries is a daily task for interventional radiologists like José Ignacio Bilbao, president of this year’s ECR, but other subspecialists should know about the main clinical problems associated with the blood vessels. The Clinical Lessons for Imaging Core Knowledge (CLICK) courses, starting this Saturday and finishing Monday, will present delegates with various clinical scenarios and state-of-the-art techniques for imaging vascular disease.

Cardiovascular events still account for the majority of deaths worldwide. Diabetes and hypertension are well-known risk factors that should be monitored and treated appropriately. But the combination of metabolic and cardiovascular factors should also be included in the equation, according to Lars Lönn, professor of vascular surgery and radiology at the National Hospital in Copenhagen. “Cardio-metabolic factors such as obesity are a major risk nowadays; for instance overweight people have a tendency to get fat in the liver, which also gives you a risk for diabetes,” said Lönn, who will chair the course, ‘How old are you in reality? Vascular age and clinical events,’ today at the ECR. Considering these factors is fundamental since the incidence of obesity will continue to rise in the near future, and with it the number of potential cardiovascular complications.

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Mar 2013
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ECR gives platform to radiographers in ultrasound management debate

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Watch this session on ECR Live: Friday, March 8, 16:00–17:30, Room F1

The global demand for medical imaging examinations has been growing rapidly over the past decade. Sustaining a workforce to match demand is becoming a challenge, as an increasing number of hospitals are facing a shortage of radiologists. Some countries have filled the gap by allowing radiographers to perform and interpret ultrasound examinations independently, to relieve the pressure on staff. This option continues to divide the European radiological community, and many seem to be against delegating a medical act to non-doctors. However, new educational opportunities and radiographers’ growing interest in medical science are challenging this concept, a panel of radiographers will show during a Special Focus Session chaired by a radiologist and a radiographer at ECR 2013.

Dean Pekarovic from the University Hospital of Ljubljana, Slovenia.

Dean Pekarovic from the University Hospital of Ljubljana, Slovenia.

Ultrasound is a widely available modality and many medical specialists are using it without the help of radiologists, sometimes without sufficient knowledge and to the detriment of patients. However, radiographers who have received proper theoretical and clinical training know how to best use the modality and read images correctly, according to Dean Pekarovic, a radiographer at the University Hospital of Ljubljana, Slovenia, and member of the advisory board of the European Federation of Radiographer Societies (EFRS). “Ultrasound is a very competitive field, everybody wants to use it. But not everyone has the ability to perform an examination and interpret images appropriately. Radiographers with specific training are able to carry out such examinations and can even write reports on their own,” he said.

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