guest post by Dr. Rowland Illing, Affidea Chief Medical Officer

The healthcare industry as a whole has become increasingly sub-specialised, some would say fragmented. Many more healthcare professionals are involved in each patient’s care than in the past and this has both advantages and disadvantages. Amidst the complexity, there is a risk of losing focus on the patient. As with all advanced healthcare practices, the trend in radiology will, or at the very least should, tend towards a patient-centred approach to care provision. Coordinating such a vast system of referral, diagnosis, treatment and recovery therapy is a complex job in itself. The personal touch is all too easily forgotten. Services are delivered in a way that fits the system, rather than with actual patient needs.

The human factor in providing healthcare services

The challenge for the future will not be in advancing technology even further, that progress is well under way. Rather the challenge is to re-orientate today’s healthcare around the patient and develop treatments, therapies and processes that provide a holistic solution to their given healthcare needs.

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Dear Friends,

Today we are presenting a PA chest of a 28-year-old woman with fever and pain in the right hemithorax. What do you see? Check the images below, leave your thoughts in the comments section, and come back on Friday for the answer.

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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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Survey results show that the radiologist’s availability to clinical colleagues is an important part of the imaging service. So how do you balance that availability and your regular workflow? We want to hear your thoughts below.

In 2011, Lindsay et al. published the results of a survey aimed at assessing what factors affected satisfaction with radiology services amongst referring clinicians (1). The survey was conducted shortly after implementation of a PACS system across three hospitals, and focused mainly on the changes created by improved communication between radiology and other hospital departments. Overall, respondents had a positive opinion of the impact of PACS installation, with the majority feeling it decreased the reporting times and ameliorated the working pattern for medical staff. Furthermore, there were a number of indicators showing that direct access to the radiological images did not decrease the importance of the radiology reports. On the contrary, the higher the experience of the referring clinicians, the higher the perceived value of this part of the radiologists’ work.
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A recent article in the New England Journal of Medicine raises some very interesting questions about the future of imaging service provision. Who are we as radiologists, and where do we want to go? Are we running “imaging factories” or “clinical imaging services”? We would like to hear what you think in the comments section at the bottom of this article.

Are modern radiologists just cogs in an image production machine?

Dr. Saurabh Jha is a radiologist working in the Department of Radiology at the Hospital of the University of Pennsylvania, Philadelphia. Before that, he had a professional life as a surgical trainee on this side of the pond, in England. In a paper entitled From imaging gatekeeper to service provider – a transatlantic journey
(N Engl J Med 2013:369:5-7) he underlines the differences between the way he perceived radiologists when he worked in Europe as a surgeon and the way he practices radiology in the USA. English radiologists were gatekeepers: that is, they provided imaging studies only when they were really appropriate and necessary according to their clinical judgement. American radiologists are service providers; that is they perform and read the examinations requested according to the referring physicians’s clinical judgement.

“Evaluation of radiological services in the USA is based on the volume of examinations and turnaround time; the higher the number of studies, the better it is for the department.”

Dr. Jha explains that this difference is mostly related to the fact that imaging was a scarce commodity when he was working for the British National Health Service while, on the contrary, there is abundance of CT scanners, MRI machines, and technologists in the United States. Another explanation is that evaluation of radiological services in the USA is based on the volume of examinations and turnaround time. In such a case, the higher the number of studies, the better it is for the department.
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The winners of the TMC Radiology Quality Award 2014 from the Silkeborg Clinic (Denmark) with members of the jury at ECR 2014. Left to right: Lluís Donoso Bach (jury), Annette Meyer Balle, Jarl Jakobsen (jury), Rikke Aarhus, Peter Mildenberger (jury), Agnete Hedemann Nielsen, Hans Billing (jury), Susanne Skovlund Petersen, Ian McCall (jury)

The European Congress of Radiology always includes many presentations, but not many of them involve a cheque for €10,000. Last year, at ECR 2014, that was exactly what was presented to Agnete Hedemann Nielsen, Annette Meyer Balle, Susanne Skovlund Petersen and Rikke Aarhus of the Silkeborg Clinic in Denmark, winners of the inaugural TMC Radiology Quality Award.

The award, which is still open for submissions this year until December 31, is open to professional individuals or groups working in European radiology departments and is given by Telemedicine Clinic, the leading European provider of teleradiology services, to promote radiology-related quality initiatives in Europe.
With such a substantial prize on offer, last year’s award attracted some remarkable entries, but the one from Silkeborg most impressed the international jury. The Danish team introduced a process to improve the quality of diagnosis of minor stroke within their hospital, which was previously meeting national standards in 70% of cases. The systems they implemented had an immediate impact, raising that figure to 90% within two weeks and ultimately leading to reduced length of stay, reduced time of diagnosis, faster initiation of treatment, and improved diagnostic accuracy. You can read more about the winning project, as well as the second and third placed entries, here.

So, if you have been involved in a project that has had a positive impact on radiological quality, check out the submission categories and put in for the award. You have nothing to lose, but a possible €10,000 to gain!

Dear friends,

Showing post-operative radiographs of a 34-year-old male. Muppet saw the films without clinical information and was completely lost.

Can you interpret the findings and shame Muppet into early retirement? Check out the images below, post your thoughts and possible diagnoses in the comments section, and come back next Tuesday for the answer!

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