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.

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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Watch this session on ECR Live: Monday, March 11, 08:30–10:00, Room N/O
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Organ-sparing surgery and radiation treatment such as intensity-modulated radiotherapy (IMRT) – often combined with chemotherapy – have increased the need for advanced imaging in the head and neck during pre-treament and post-treatment stages. Precision is vital as any tumour that remains undetected outside the treatment field could adversely affect the patients’ prognosis and survival, according to Professor Vincent Vandecaveye, from the department of radiology at the University Hospitals Leuven in Belgium.

It is important to spot any tumour recurrence as early as possible, especially in the post-treatment phase, in order give the patient the best possible chance of salvage treatment. The most common imaging methods in the head and neck area remain CT, MRI and PET-CT; each comes with its own advantages and disadvantages.

Multiparametric MRI for early treatment prediction of chemoradiation in oropharyngeal cancer: Upper row is pre-treatment MRI of right base of tongue cancer (a=contrast enhanced T1 as anatomical correlate; b=native b1000 diffusion-weighted image; c= ADC-map; d=perfusion-map of IUAC). Middle row is 2 weeks during chemoradiation: same imaging sets, tumour volume will not help. No significant change in b1000, ADC nor perfusion-MRI indicate non-response and thus high risk of tumour relapse after end of treatment. Tumour relapse at PET-CT 8 months after end of treatment, proven by histology (k). (Provided by Professor Vincent Vandecaveye)

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Watch this session on ECR Live: Sunday, March 10, 14:00–15:30, Room Z

The ability to spot pathological imaging findings among normal post-mortem signs of degeneration may not be a universal skill among radiologists, but it could prove to be a useful, if not essential one. As the reliability of modern forensic imaging rapidly improves, forensic pathologists are increasingly seeking the help of radiologists to examine bodies non-invasively, so they should be prepared to answer that call, according to experts who will speak in a Special Focus Session on ‘Advances in forensic imaging’ today. The development of techniques such as spiral volumetric CT and, more recently, MRI, have dramatically improved the ability of radiologists to determine causes of death and detect other crucial post-mortem signs, providing an invaluable service that can supplement, and in some cases replace, traditional autopsy.

Bone and metal maximum intensity projection (MIP) reconstruction (a) and volume-rendered (VR) 3D-CT reconstruction (b). Homicidal death: characteristic bony and metallic fragments on the exit side of the skull, where the bullet caused a large loss of brain, leading to shattering of the skull.

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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.

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.

Watch this session on ECR Live: Sunday, March 10, 08:30–10:00, Room E1

Overuse injuries due to excessive exercise are normally seen in professional athletes, but they are also becoming more frequent in amateur athletes. The Refresher Course on overuse injuries in sports will present three examples of how these injuries, caused by different sports, can be diagnosed and treated.

Gymnastic exercises, for example, are very demanding, not only on the axial but also the peripheral skeleton, and they involve strong forces due to hyperextensive and hyperflexion exercises. A certain degree of hypermobility and increased flexibility is necessary to perform some gymnastic exercises, and so training is required to improve this flexibility. Unnatural movements are sometimes necessary in order to increase this hypermobility and flexibility.

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Watch this session on ECR Live: Saturday, March 9, 16:00–17:30, Room G/H

Advanced MR imaging techniques such as perfusion and functional imaging have been a great help in improving the diagnosis and staging of brain tumours. Unlike conventional MR techniques, advanced MR techniques can be used to obtain information not only on the morphological, but also on the functional characteristics of tumours.

One of the most common types of brain tumour is glioblastoma, which is highly malignant and has a high cell reproduction rate due to the fact that it is nourished by a large network of blood vessels. According to the American Brain Tumour Association there are two types of glioblastoma: primary glioblastomas, which tend to form and make their presence known quickly by growing aggressively, and secondary glioblastomas, which are also aggressive but show slower growth and only represent 10% of all diagnoses.

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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

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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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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.

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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