East meets west at ECR 2015


With its slogan ‘radiology without borders’ ECR 2015 embodies the spirit of European cooperation: bringing together imaging experts from all around the world to exchange and discuss the latest trends in their discipline. One of the best examples of ECR’s commitment to international collaboration is the ‘ESR meets’ programme, which invites three national radiological societies to present facts about imaging in their country, and a partner discipline to focus on its cooperation with radiology.

Germany, home to ECR President Prof. Bernd Hamm from Berlin, will kick off the programme on Friday with a session organised by the German Radiological Society (DRG) and entitled ‘Tradition goes digital: getting ready for the future’.

“This session will deal with changes facing radiologists as their world becomes digital; this does not refer to digital imaging modalities but rather to aspects of new options for radiologist training, population-based imaging and hybrid imaging techniques,” Prof. Hamm said.

“Today, in many areas of life, digitisation is the most important trend. Radiology, due to its everyday use of technology, is at the forefront of medical specialties in this respect. Digitisation, as we all know, needs a conscious effort on the part of the user: as radiologists, we do not want to be led but to lead. So we should stop a moment and think how digitisation impacts our profession. Some examples will be given in the session,” said DRG President Prof. Norbert Hosten from Greifswald, who will co-moderate the session.

The first speaker, Dr. Martin G. Mack from Munich, will present the achievements of Akademie online, a teaching platform run by the German Roentgen Association. “Akademie online is a very successful tool in which top-notch speakers debate around state-of-the-art clinic, technology and other aspects of our work as radiologists. There are special sessions for medical students to get them interested in radiology and help them with their exams. Technical assistants have their own sessions and even courses required by the authorities may be completed here,” Prof. Hosten explained.

Dr. Katrin Hegenscheid, also from Greifswald, will then introduce the results of population-based MRI studies led by radiologists and epidemiologists to offer evidence-based data. “Evidence is not always as good as desired by reimbursement agencies. Study samples, for example, are slow and endpoints are often somewhat soft. In Greifswald, an old university town near the Baltic Sea and the Polish border, radiologists have teamed up with epidemiologists and performed free whole-body MRI in healthy subjects. Radiogenomics, metabolomics and genomics are available for all patients screened. Early signs of disease on MRI may thus be determined, as patients will be followed for decades,” Prof. Hosten said.

Finally, developments in the emerging and promising field of MRI-PET will be at the heart of the presentation given by Dr. Claus D. Claussen and Dr. Nina F. Schwenzen, both from Tübingen. “As a technology-driven medical profession, new technology is the air we breathe. We are optimistic about the future of MRI-PET. Think of MRI – did it really look so promising in the beginning? Remember the joke by other specialists that NMR stands for no money remains. It proved to be utterly wrong, and maybe MRI-PET is closer to clinical reality than we now think,” Prof. Hosten said.

Interludes will shed a light on other interesting characteristics of German radiology. Prof. Reinhard R.W. Loose from Nürnberg will first talk about radiation protection and the concept of justifying indications, an increasingly important aspect of healthcare in the advent of teleradiology. “Justifying an indication means asking for the radiologist’s confirmation that the risks and benefits are considered before an examination using ionising radiation is performed. Obviously, this strengthens the role of the radiologist. Compromises have to be made for teleradiology. But the danger is that teleradiology facilitates the commoditisation of radiology – radiology reports become something like oxygen in the OR, delivered without a doctor. Justifying indications in the context of teleradiology requires contact between a physician on the site serviced by teleradiology and a radiologist. The future will show how this works out, with other European countries being much more liberal,” Prof. Hosten concluded.

Dr. Bernhard Lewerich from Berlin will for his part present the Röntgenhaus, the house in which Wilhelm Conrad Röntgen was born and which is currently being renovated.

Last but not least, the European Federation of Radiographer Societies (EFRS) will take part in the programme through the EFRS meets Germany session, which will explore the place of high-end and hybrid technology in the clinical and research work of radiographers.

As every year, the ‘ESR meets’ programme will welcome a partner discipline to talk about its cooperation with radiology. The European Association of Urology (EAU) has prepared a session in which urologists and specialised radiologists will discuss their strengthening collaboration in the early detection and surveillance of prostate cancer.

“Prostate cancer is one of the most common malignancies in the western world and the second leading cause of death from all cancers, with 382,000 new cases and around 89,000 deaths per year in Europe. It has more recently become a very hot topic, as we are approaching a more proactive attitude in terms of early detection and screening in the male population. We published a paper in European Urology last year promoting early detection of prostate cancer (1). We prefer early detection rather than screening, as it has been misused by so many colleagues and authors over the years,” said EAU President Prof. Per-Anders Abrahamsson from Malmö, Sweden, who will explain the association’s view on prostate specific antigen (PSA) screening tests.

A panel of international experts will give talks on the role of multiparametric MRI in early detection, active surveillance strategies and the role of imaging in active surveillance, with the aim of stressing the importance of the cooperation not only between radiologists and urologists, but also more generally the medical team.

“Our collaboration in terms of diagnosis and management is crucial, as not only MRI but also PET scans with choline or any modern tracer are critical in order to optimise radical treatment. In most leading centres across Europe, there is a close interaction and multidisciplinary approach with not only radiologists but also pathologists and medical oncologists. The critical issue is to optimise prostate cancer units and define requirements in order to provide our patients with the best care, not only in terms of diagnosis, but also treatment and follow-up,” Prof. Abrahamsson said.

The panel discussion will try to answer questions about MRI use in prostate cancer management, for instance if MRI should be used before or after prostate biopsy and if multiparametric MRI is cost effective in screening. “Multiparametric MRI is of course of importance as transrectal ultrasound with multiple biopsies is obviously not the optimal way to diagnose prostate cancer. We miss too many significant cancers. Evaluation of multiparametric MRI examination is still ongoing as we have a problem to differentiate between low risk, medium risk and high-risk prostate cancer. There is an interesting improvement in terms of transrectal ultrasound with tracer and in the future, perhaps, using both transrectal ultrasound in combination with MRI will be the optimal way to minimise the number of biopsies, in order to identify significant cancers,” he said.

The session should help improve an already well-established relationship, Abrahamsson believes. “The relationship between radiologists and urologists is by far much better in Europe than other parts of the world. It means, however, that there are exceptions to the rule in some European countries but I can see a great future ahead of us working very closely together,” he said.

Travelling further east, the delegation from the Korean Society of Radiology (KSR) will host the session ‘CT in lung cancer screening and COPD evaluation’ on Saturday.

KSR President Prof. Tae-Hwan Lim from Seoul will present the history of the society and the challenges it is currently facing. Speakers will then deliver talks on lung cancer screening in Korea, the role of computer-aided nodule detection and volumetry in lung cancer screening, and the use of CT in chronic obstructive pulmonary disease (COPD).

The interludes will provide delegates with an insight into Korean culture and an introduction to the Korean Society of Thoracic Radiology. The concluding panel discussion will question whether CT is an effective tool for management of lung cancer screening and COPD.

On Sunday, the delegation of the Turkish Society of Radiology, led by Prof. Abdulhakim Coşkun from Kayseri, will feature prominent experts to present state-of-the-art imaging in Turkey, starting with a talk on percutaneous treatment of liver hydatid cysts.

Hydatic disease caused by echinococcus granulosus is still an endemic disease and a public health problem, not only in Turkey but also more generally in the Mediterranean, Middle East and South America. The major criteria for assessing the indications for treatment of hydatid disease of the liver are primarily based on imaging findings, and ultrasonography is the major classification tool of liver hydatidosis, according to Prof. Okan Akhan from Ankara, who will give the presentation.

Surgery remains the conventional treatment for hydatid liver disease, but it is associated with considerable mortality, morbidity, high recurrence rates and hospital stays which can last up to 30 days. The alternative treatment provided by interventional radiology helps to reduce risks, Prof. Akhan argues.

“The long-term follow-up of the lesions treated with the percutaneous approach shows that this treatment is highly successful, reported to be over 98%. It is associated with lower complication and recurrence rates and shorter hospital stay in comparison with surgery. The percutaneous approach is also a treatment alternative to surgery for hepatic cancer located in other organs such as spleen, kidney, peritoneum, lungs, soft tissue, surrenal gland, orbita and parotid gland whenever indicated,” he said.

Prof. Akhan will underline the importance of the stage-specific approach, and present the indications and different techniques available to radiologists, namely the PAIR technique, catherisation with hypertonic saline and alcohol, and MoCat.

The other presentations will focus on fMRI of the brain, with a speaker from Izmir, Prof. Cem Calli, and advanced hepatopancreaticobiliary imaging with Dr. Sukru Mehmet Ertürk from Istanbul, who will discuss the latest advances made in the field and the remaining challenges.

“The global challenge of hepatopancreaticobiliary imaging is to define and use an analytical diagnostic approach that uses all available tools such as functional MR imaging methods, hepatobiliary-specific MR contrast agents, CT perfusion imaging, and hybrid imaging techniques including PET-CT and MRI-PET, in the work-up of disease entities. This approach needs to be economically viable as well, considering the increasing financial pressure on the healthcare systems of the countries over the world. This is Turkey’s challenge too,” he said.

In between presentations, delegates will be treated to a music show, to bring a festive note to the debates.

“I think that all societies invited to these sessions put in a lot of effort to make their sessions outstanding. I am confident that these sessions will be a highlight of the congress. I hope that all participants of our congress will live our motto and embrace this unique opportunity for meeting colleagues from so many countries and benefit from this platform for international exchange in the radiological community,” Prof. Hamm concluded.

(1): European Urology 64 (2013) 347-354.

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