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

Osteoarthritis, a degenerative joint disease, affects a large number of people worldwide. But with the emergence of new MRI techniques, researchers believe they will be able to prevent its development in the near future. Experts will present the latest methods to assess cartilage tissue quality at a very early stage and discuss remaining challenges, in a dedicated New Horizons Session, today at the ECR.

Cartilage is composed of collagen and glycosaminoglycans (GAG), which are responsible for the biomechanical properties of cartilage tissue. An interesting way to image cartilage is to look at the amount of GAG, which decreases at the onset of tissue degeneration, a process which occurs due to ageing or an induced defect, for instance trauma or surgical intervention in the joints. If left untreated, a tissue defect can lead to osteoarthritis. GAGs are known to be among the earliest biomarkers of cartilage degeneration, and if a focal reduction in the amount of GAG can be identified, then therapy to avoid further damage can begin.

Sodium image in the axial plane of the patella shows the patellar cartilage. At the border from the medial to the lateral facet of the patella an area with decreased sodium signal-to-noise ratio (SNR) is visible which corresponds to a decreased content of glycosaminoglycan (GAG) although the cartilage thickness is preserved. This means an early stage of cartilage degeneration in this area with a focal loss of GAG.
(Provided by Prof. Siegfried Trattnig and the MR Centre of Excellence)

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Watch this session on ECR Live: Friday, March 8, 08:30–10:00, Room F1

There are a wide range of treatment options available when dealing with hepatocellular carcinoma (HCC), ranging from interventional and endovascular procedures to surgical interventions such as liver transplantation. The main reason for performing endovascular procedures when treating patients with hepatocellular carcinoma is the fact that liver neovascular networks are nourished exclusively by the arteries.

Liver tumours, both primary and metastatic, are almost entirely supplied by branches known as neo-vessels, which originate in the hepatic arteries. The surrounding peritumoural liver parenchyma is vascularised mainly by portal vein branches. When an HCC is larger than two centimetres in diameter the afferent vessel can be identified and then targeted via an arterial endovascular approach. These unique characteristics – dual vascular supply and the ability to identify the afferent vessels – are the rationale behind the use of endovascular treatments, and several different techniques have been developed over the last 30 years. Among the most frequently used are the infusion of chemotherapy and the introduction of particles, either as occluding devices or as carriers of an active agent, which attacks the tumoural cells and surrounding neovessels.

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Dr. Alexander Sachs, the Rising Stars representative on the ESR’s Undergraduate Education Subcommittee, talked about his numerous projects and his passion for teaching in an interview with ECR Today.

ECR Today: When did you first take part in the Rising Stars programme?
Alexander Sachs: I first took part in the Rising Stars programme in 2011. I applied to present Sono4You, an ultrasound peer-teaching student project, which I had become involved in. It was the first time I gave a presentation in front of a large audience, but I thought I would just give it a try and so I took a practical approach.

Dr. Alexander Sachs from Vienna is the Rising Stars representative on the ESR’s Undergraduate Education Subcommittee.

ECRT: It seems it paid off since you were elected best student presenter.
AS: Yes, it did have some positive effects. The year after, the ESR asked me if I wanted to coordinate the Hands-on Ultrasound Workshops at ECR 2012, which are strongly connected to the Sono4You tutorials. It was a great opportunity. It went really well and we are repeating the experience this year, with one advanced session and three basic workshops.
I like the idea of raising young people’s interest in radiology. In doing so, I am in contact with many people internationally, be they students or teachers. I really enjoy meeting people of different ages with different ideas; it is quite interesting to see what happens, how they connect, and the results of their cooperation.

ECRT: Can you please tell us about some of the new features of Rising Stars at ECR 2013?
AS: The Sono4You workshops will offer more advanced content to match the level of first-year radiology residents. Generally, the contents will be more interesting; thanks to the feedback we received last year.
Another nice development is that people have become more motivated to enrol as tutors for the peer-teaching sessions. Last year, I really had to motivate people to do so, but now it is much easier, there is a much bigger interest on their part. More students are participating in the programme every year, and I am happy to add my experience or work to this initiative.

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Watch this session on ECR Live: Thursday, March 7, 16:00–17:30, Room F1

Postgraduate radiology training is high on the agenda in Europe, with a great deal of attention in recent years being given to the harmonisation of educational standards across the continent, but there is a growing feeling within the discipline that radiology should not lose sight of the equally important issue of undergraduate education. Exposing undergraduates to radiology not only serves the obvious and vital purpose of inspiring potential radiologists, but also ensures that students who go on to follow careers in other disciplines are well versed in what radiology can offer and how it operates. In broad terms, the net result is a combination of helping to secure the discipline’s future and making life easier for its practitioners.

However, making sure undergraduates are given sufficient contact with radiology is no easy task. The competing clinical, managerial and academic demands on radiologists’ time and skills, which increase with every year, mean that any additional activities run the risk of being excluded. The time and resources needed, not just to teach, but also to carry out the necessary preparation for effective teaching, can often make it impossible to fit in to an already hectic schedule.

Professor Stephen J. Golding (left) from Oxford will chair today’s Professional Challenges Session on undergraduate teaching.

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Watch this session on ECR Live: Thursday, March 7, 16:00–17:30, Room D2

Over the past decade, technological improvements have led to the widespread use of imaging modalities in the prediction, diagnosis and follow-up of coronary disease. Radiologists now have the ability to obtain information on the structure of cardiac muscle with MRI and evaluate cardiac arteries with CT, while hybrid imaging will soon allow them to do both. Cardiac CT will also provide more functional information in the future, and its use will continue to grow. Experts will present the newest and upcoming possibilities of cardiac imaging today at the ECR.

Advances in cardiac CT have brought its use in clinical routine to unprecedented levels. The main reason is that image acquisition optimisation strategies allow radiologists to assess blood vessels with the same efficiency as coronary angiography, non-invasively and almost instantaneously.

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Dear Friends,

Dr. Manel Martínez, a long-time friend of the Muppet, has provided the following case: an asymptomatic 67-year-old man in whom a mass was discovered in the chest radiographs.

Diagnosis:

1. Aortic aneurysm
2. Hydatic cyst of lung
3. Left pulmonary artery aneurysm
4. None of the above

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Dear Friends,

This week I’m presenting the case of a 9-year-old child with pain in the leg after trauma.

Diagnosis:
1. Aneurysmal bone cyst
2. Simple bone cyst
3. Giant-cell tumour
4. Osteosarcoma

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With the development of functional imaging, the way patients are imaged has changed, and so has the role of the radiologist. While taking pictures in the basement of a hospital was considered good enough in the twentieth century, radiologists are now required to act as clinicians within multidisciplinary teams. Subspecialisation has become necessary for radiologists in order to keep their leading position in image interpretation. But that is not the only field where radiologists should take the lead, some experts believe. If radiologists were to increase their contribution further up in the diagnostic phase, it would have a significant impact on clinical outcomes and healthcare management. A panel of eminent radiologists will explore ways to do so during a dedicated Professional Challenges Session at ECR 2013.

Professor Andy Adam, professor of interventional radiology at the University of London, will speak about the role of the radiologist in the 21st century.

In the past, radiologists were expected to act as technicians with excellent knowledge of the anatomy. But with the creation of functional imaging, things have become more complicated. The capacity to depict and interpret functions using MRI or PET/CT scans calls for more than the ability to read images, and now thorough knowledge of functional processes and organ systems is expected of radiologists.

Meanwhile, many physicians have been increasingly working with images in recent years. For instance surgeons rely on images to prepare for an intervention, and so do radiotherapists to determine the necessary dose and precise location of a tumour to be destroyed. As their experience with reading images is growing, it is likely that these specialists will find it easier to do so without the help of radiologists in the future.

To put it in a nutshell, if radiology is to achieve its full potential, radiologists will have to make a clinical contribution as well. “If radiologists wish to retain their role as experts in image interpretation, they will not only need a thorough understanding of imaging, but also a detailed understanding of anatomy and pathophysiology, and they will need to subspecialise. That is really something we have to take into account in the future. Radiologists will have to get closer to the patient and talk to the referring physician or surgeon. They will have to become more like clinical doctors than they have been until now,” said Andy Adam, professor of interventional radiology at the University of London.

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Intensive care units are special working environments, presenting radiologists with complex cases and patients with severe conditions. Diagnostic imaging examinations and the work of the radiologist have to be adapted towards these special circumstances, which can be one of the biggest challenges when working in an intensive care unit. Today there is a strong need for accurate, clinically relevant radiological input, which often has to be worked out while facing a lack of adequate image material and patients suffering from life-threatening conditions.

Prof. András Palkó from Szeged, Hungary, will chair the session on imaging in intensive care patients.

The ECR 2013 Special Focus Session on imaging in intensive care patients, chaired by ESR Past-President, Professor András Palkó from Szeged Medical School in Hungary, will give an up-to-date overview on the use of common imaging methods in the ICU environment. Special Focus Sessions are clearly aimed at in-depth analysis and the promotion of scientific debate between the speakers and their audience.

“The intensive care unit is a very special environment requiring special expertise from both the technicians and the radiologists working in a technically challenging situation. The patients are typically in very severe conditions, frequently unconscious, and almost always connected to life-support and monitoring equipment,” Prof. Palkó pointed out some of the difficulties of working in an ICU.

As a result of this, the majority of imaging examinations are performed on patients with limited ability to cooperate and often at the bedside. Reports are then typically written with insufficient clinical information, based on technically limited images, even though the need for accurate imaging material and radiological information is even greater than in standard clinical settings.

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As acknowledged in last year’s ESR white paper on the subject, the concept of personalised medicine (PM) is becoming an increasingly hot topic. The patient-centred principles of PM have the potential to take over as the dominant philosophy in clinical healthcare in the relatively near future, which would see the focus of the medical world gradually shifting away from the current system of ‘disease care’, towards an approach based on prediction and prevention. However, although most radiologists are aware of the idea of PM and rightly consider medical imaging to already be among the most personalised aspects of healthcare, there is perhaps a need for more awareness of the exact nature of this new paradigm, and specifically a need for recognition – from within and outside the discipline – of the role that medical imaging should play.

ESR President Prof. Gabriel P. Krestin will chair the Professional Challenges Session on personalised medicine

A Professional Challenges Session at ECR 2013, chaired by the ESR President, Prof. Gabriel Krestin, will aim to raise awareness of the core principles of PM and highlight the factors that radiologists will need to consider in order to adapt their approach to training, clinical practice and research.

“The whole idea of PM, and the role of imaging within it, is relevant to all of us,” said Krestin, from the Erasmus Medical Centre, Rotterdam, Netherlands. “It is a concept that will gain in importance in the coming years and it will have an increasing influence on the way we work as radiologists. I think many people have heard of PM, but certainly not everyone will have a sound conception of exactly what it is or its full implications for imaging and our daily practice. To be aware of this, and the possibilities that will probably multiply in the coming years, is very important.”

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