ECR Today spoke with the new ESR/ECR President, Prof. Paul M. Parizel, from Antwerp, Belgium, to learn about this new position, his visions for the society and his ideas for next year’s congress.

Prof. Paul M. Parizel, chairman of Antwerp University Hospital’s department of radiology and full professor of radiology at the University of Antwerp’s faculty of medicine, is the incoming ESR/ECR President.

ECR Today: You are the first officer of the European Society of Radiology to take on the new position of combined ESR/ECR President. Could you please briefly explain to our readers how this change came about and what it means? What are your main tasks and responsibilities in this position?
Paul M. Parizel: It is a great honour, and also a huge responsibility, to assume this new position of combined ESR/ECR President. The ESR is one of the most important and prestigious international scientific societies, with more than 63,000 members throughout the world. The ECR is well established as the foremost congress in radiology in Europe. Until a few years ago, nominations and elections for the ‘cursus honorum’ of the ECR and ESR were made independently of each other. This implies that we have had brilliant presidents of our society, who never became president of the congress, and vice versa. As both the society and the congress were getting bigger, and more mature, it was decided to re-evaluate and retune the strategic plan and to change the statutes so that appointments were fully integrated, instead of running on parallel tracks, as was previously the case. Bringing the congress and the society under one and the same leadership umbrella is an efficient way to better utilise our resources (human, political and financial). I am convinced that this will improve communication with our members, enhance our international standing and facilitate relationships with other societies and with the industry.
This combined ESR/ECR presidency is certainly a daunting task, and I admit that I am a little bit nervous. On the other hand, I can rely on the work of my predecessors and especially on the creative input and unflagging energy of my friends and colleagues of the Board of Directors, the Executive Council, the statutory committees, subcommittees, working groups, and, last but not least, the experience, professionalism and efficiency of the ESR staff. Our society is healthy, both politically and financially, and we are steering a stable and steady course.

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The graph below shows the ages of speakers at ECR 2013. While the most common age of scientific paper presenters was 30, the most common age among educational speakers was 50.

Your ECR future is bright: today’s presenters, tomorrow’s teachers …

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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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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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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The optimisation and justification of procedures is vital when using CT as an imaging modality; particularly on children, who are more sensitive to ionising radiation than adults. Therefore, it is crucial that all those who use CT understand the physics behind the equipment and ultimately use this understanding to minimise the potential risks while maximising the potential benefits to each individual patient. Patients should also be informed of the risks and benefits of undergoing a CT scan. World-renowned experts will explain these issues in detail during a Special Focus Session at ECR 2013.

“Not all radiologists and technicians are aware of the latest dose reduction strategies. Some are not necessarily so well-informed and perhaps do not realise how important this is. We believe that it is a question of trying to get everybody to a certain level of knowledge and expertise,” said Dr. Catherine Owens, paediatric radiologist and CT unit lead at Great Ormond Street Children’s Hospital in London, U.K.

Fig. 1

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Heart disease affects a very large number of people worldwide, and the consequences can be serious and even lethal. Here, and perhaps more than in many other areas of medicine, imaging has helped to improve treatment and prevention. It does so by detecting the disease at an early stage, sometimes even before its emergence, especially in patients at risk of ischaemic heart disease.

Today, diagnosing cardiac patients has become routine for many radiologists. However, some of them may not know of recent developments in this field and they may need to refresh their knowledge. A panel of experts will update both general and specialised radiologists with the latest information available on cardiac imaging, during the dedicated Mini Course ‘Organs from A to Z: Heart’ at ECR 2013. After an introduction to heart anatomy and the main imaging protocols, the course will focus on valvular diseases and cardiomyopathies; two pathologies commonly encountered in radiology practices.

Figure 1:
A) Example of a dilated cardiomyopathy (DCM). Cine-MR images in four-chamber view (left) and short-axis view (right) at end-diastole show significant dilatation of the LV cavity. Ejection fraction was <35% in this patient. (RA = right atrium; LA = left atrium; RV = right ventricle; LV = left ventricle)
B) Example of an asymmetrical, apical hypertrophic cardiomyopathy (HCM). Cine-MR images in a four-chamber (left) and two-chamber view (right) in systole show a markedly thickened left ventricular myocardium predominantly of the apex, as compared with the basal segments (RV = right ventricle; LV = left ventricle).

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The brain remains undoubtedly one of the most mysterious organs of the human body. Magnetic resonance imaging has helped to unveil some of its secrets, and major advances have been made in understanding how the brain functions. Recent developments with resting fMRI (rfMRI) and diffusion MRI (dMRI) indicate that scientists are beginning to see beyond the brain: they have actually started to visualise the human mind. This new information is particularly relevant for understanding complex processes such as dementia, autism and depression. It is also proving increasingly central to the diagnosis of comas and chronic disorders of consciousness.

Leading researchers will discuss where the latest advances have led them and what the future will bring in a dedicated New Horizons Session during ECR 2013. FMRI has been used for over twenty years to visualise changes in brain activity by comparing a task versus a control task, and showing and quantifying how much brain activity is involved in the process. The recent addition of rfMRI enables researchers to track networks that are randomly active. A patient lying in a scanner with no particular task to perform will usually start thinking about the trivialities of the day and go from one thought to the other (“Did I close the door before I left? What am I doing here?” etc.). Neuroresearchers can track this mind mumbling with complex mathematics and extract information from what they call the default mode network.

Fig. 1: Differences in functional connectivity from rfMRI between autistic patients and age- and gender matched controls: the major disconnection is between the cerebellum and frontal language areas.

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