This year’s ECR programme features another great selection of sessions aimed at radiographers. ECR Today spoke to Jonathan McNulty, co-chairman of the ECR 2014 radiographers subcommittee, and Prof. Graciano Paulo, president of the European Federation of Radiographer Societies (EFRS), for their views on the sessions taking place on Sunday.

RC 1214: How important are state-of-the-art displays to radiology?
Watch it on ECR Live: Sunday, March 9, 08:30–10:00, room BRA
Tweet #ECR2014BRA #RC1214

Jonathan McNulty: Most of the technology we use now in Europe is digital, so what this session aims to look at is the state-of-the-art displays we are using today in medical imaging. Their quality is essential so that we continue to be able to pick up on the most subtle anatomical and pathological detail in our images, so the resolution and contrast specifications are important, as are design features that help minimise reflection or glare. A lot of research and design goes into the primary class displays that radiologists use to report from, because that report is vital and can change things dramatically for a patient if a pathology is picked up or missed. There has also been a lot of discussion about handheld devices and the appropriateness of using iPads, other tablets, smartphones or PDAs to view radiology images. Dr. Rachel Toomey, one of the speakers in this session, has done quite a lot of research looking at such devices, which can be very good for reviewing certain types of radiological images but are far from suitable for others.

So this session is going to show what the primary class displays are capable of and why we use them; what the advantages of the more portable devices are and when they can be used appropriately; and then the final presentation will look at quality assurance. Whatever display you use, whether it is a primary class display, a smartphone, or a regular PC monitor, what do we need to keep in mind? What are the quality assurance requirements for clinical use? What do we need to do to on a daily, weekly, or monthly basis to make sure that our displays are not dropping below their peak performance level?

Read more…

Watch this session on ECR Live: Saturday, March 8, 16:00–17:30, Room B
Tweet #ECR2014B #EM3

At each ECR Since 2007, the ‘ESR meets’ programme has included a partner discipline along with the three guest countries, as a way to build formal bridges between the European Society of Radiology (ESR) and other branches of medicine, and to give congress participants an opportunity to learn about something a little different. At ECR 2014, the programme includes a visit from undoubtedly the largest medical discipline to take part in the initiative so far: cardiology, represented by one of the biggest medical societies in Europe, the European Society of Cardiology (ESC). Cardiology has much in common with radiology, but this is the first time that the two European societies have come together for an official joint session at a major meeting.

Read more…

This year’s ECR programme features another great selection of sessions aimed at radiographers. ECR Today spoke to Jonathan McNulty, co-chairman of the ECR 2014 radiographers subcommittee, and Prof. Graciano Paulo, president of the European Federation of Radiographer Societies (EFRS), for their views on the sessions taking place on Saturday.

Read more…

Watch this session on ECR Live: Friday, March 7, 16:00–17:30, room BRB
Tweet #ECR2014BRB #NH7

Radiologists often say that the brain is the next frontier. But as diffusion MRI techniques progress, the most mysterious organ in the human body starts to unveil more and more of its secrets, and what was once inconceivable a decade ago is now almost at hand.

White matter fibre pathways of the brain as depicted with MR
tractography.
(Provided by Patric Hagmann, CHUV-UNIL, Lausanne, Switzerland)

Researchers are now better able to understand how neurons connect with one another and how disease affects these connections in the human brain. The production and later study of maps of neural connections obtained with MRI are vital to this task. A dedicated New Horizons session will cover this fascinating topic today at the ECR.

Patric Hagmann, who will chair the session, is an attending physician and neuroradiologist at Lausanne University Hospital (CHUV, Centre hospitalier universitaire vaudois) in Switzerland. In his introduction, he will describe what he calls the connectome, a term he coined in his thesis on diffusion MRI and brain connectomics back in 2005*.

“We could sum up the connectome as a comprehensive map of neural connections in the brain. The production and study of connectomes is what we refer to as connectomics; it may range from a detailed map of neurons and synapses within part of, or all of, the nervous system to a description of the functional and structural connectivity between all cortical areas and subcortical structures,” he said.

In his presentation, Hagmann will not only introduce important concepts related to connectomics like scaling, the relation between structural and functional connectivity, and the integration-segregation, but also show how advances in MRI facilitate the mapping of the human connectome.

Read more…

Watch this session on ECR Live: Friday, March 7, room F1
Four separate sessions, starting 08:30, 10:30, 14:00, and 16:00
Tweet #ECR2014F1 #MC422 #MC522 #MC622 #MC722

For the fourth year in a row, the European Society of Radiology (ESR) and the Radiological Society of North America (RSNA) will hold a joint course on a hot topic in radiology. After oncologic imaging for the past three years, emergency radiology will be under the scope of North American and European radiologists, who will share and compare their experiences in the dedicated Mini Course today at the ECR*.

MDCT is the best modality for identifying lesions as subtle as active mesentric bleeding and infiltration
(arrow) caused by blunt abdominal injury (lap-belt compression). (Provided by András Palkó)

Medical emergencies and trauma are responsible for high levels of morbidity and mortality in all age groups worldwide, and trauma is the leading cause of death in people younger than 45. Consequently, the use of imaging in emergency departments has been increasing exponentially since the 1990s. The demand for CT examinations from emergency departments is, for instance, growing annually by 5% to 15%, depending on the institution.

Even with all the advanced tools imaging has to offer, trauma remains a challenge for most emergency services, according to Ulrich Linsenmaier, associate professor of radiology and head of the department of diagnostic and interventional radiology at KMPP Clinics in Munich, Germany. “Even for advanced level 3 medical centres running their own emergency radiology unit, it is a challenge to integrate advanced radiology services into an interdisciplinary team treating patients with acute traumatic and non-traumatic emergencies,” he said.

Read more…

Watch this session on ECR Live: Thursday, 16:00–17:30, Room E2
Tweet #ECR2014E2 #MS3

Malignant primary bone tumours like osteosarcoma and Ewing’s sarcoma are very serious diseases mainly affecting children and teenagers. General radiologists are not likely to see these patients every day at their practice, but when they do, they must know what they have to do to optimise patient care and improve outcomes. Experts will give instructions and share useful advice during the dedicated Multidisciplinary Session today at the ECR.

Conventional x-ray of a tumour in the knee
(Image provided by Prof. Koenraad Verstraete)

Read more…

Watch this session on ECR Live: Thursday, March 6, 16:00–17:30, Room I/K
Tweet #ECR2014IK #SF3

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.

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.

Read more…

Dear Friends,

Today I am presenting radiographs of a 43-year-old woman with moderate dyspnoea. Disregard the widening of the right superior mediastinum, secondary to long-standing goiter. Leave me your thoughts and diagnosis in the comments sectiona and come back on Friday for the answer.

Diagnosis:
1. Thymoma
2. Heart disease
3. Lymphoma
4. None of the above

Read more…

A-255 B. CT

J. Vilar | Saturday, March 9, 10:30 – 12:00 / Room A

Interpretation of chest images is fraught with errors. Confusing images may occur in chest CT and conventional radiography. Understanding the cause of the error and using some “ tricks” the radiologist may overcome these situations. Three aspects that may be of useful are: Gravity, Space and Time. Gravity may help the radiologist by using simple manoeuvres such as prone or lateral decubitus. Space relates to the location of the lesion. Upper or lower lobe locations are associated with certain pathologies. Time lapse is a major factor that may influence our diagnosis. Previous studies are essential. Fast growth or reduction of a lesion usually is associated with non-neoplastic disorders. Follow-up in acutely ill patients may be of great value and well as in lesions in oncologic patients. The lecture will present cases of variable difficulty where using these simple “tricks” the diagnostic problem can be solved.

A-545 A. Diagnosis

M. Krokidis | Monday, March 11, 08:30 – 10:00 / Room E1

Oesophageal cancer is the sixth leading cause of death from cancer worldwide. More than 90 % of oesophageal cancers are either squamous-cell carcinomas or adenocarcinomas. Approximately, three quarters of all adenocarcinomas are found in the distal oesophagus, whereas squamous cell carcinomas are more evenly distributed between the middle and lower third. The cervical oesophagus is an uncommon site of disease. The pathogenesis of oesophageal cancer remains unclear. At the time of the diagnosis of oesophageal cancer, more than 50 % of patients have either unresectable tumours or visible metastases on imaging. The most common symptom of presentation is dysphagia which is present in >70% of the cases; odynophagia may also be present in a smaller percentage of patients. The patients are usually presented also with significant weight loss which appears to be also an important prognostic factor of the outcome of the disease. Diagnosis is based on the findings of a contrast swallow- which is usually the first exam to be performed; oesophageal cancer may present as polypoid, infiltrative, varicoid, or ulcerative lesions. Endoscopy usually confirms the findings of the swallow study, revealing the presence of a mass and offering the possibility of taking biopsy samples. Endoscopic ultrasound is the imaging method that is used for local staging and CT and PET-CT are used to determine the presence of metastatic disease. In case of presence of enlarged lymphnodes, fine needle aspiration or even open biopsy may be performed.