Tough questions and tricky dilemmas abound in fast-moving world of trauma imaging

23 Pages·2017·10.7 MB·English

TODAY
ECR 2018
EUROPEAN CONGRESS OF RADIOLOGY
DAILY NEWS FROM EUROPE’S LEADING IMAGING MEETING | SUNDAY, MARCH 4, 2018
3 9 17 25
HIGHLIGHTS CLINICAL CORNER TECHNOLOGY & RESEARCH COMMUNITY NEWS
Chinese Society of Radiology Failure to diagnose abdominal Artificial intelligence brings fresh clinical Incoming ESR President Lorenzo
looks forward to increasing bleeds means bad outcome in possibilities and sense of renewal to digital Derchi looks forward to celebrating
international communication most cases x-ray sector an ECR milestone in 2019
BY KATRINA MEGGET
Tough questions and tricky
dilemmas abound in fast-moving
world of trauma imaging
Brink, radiologist at Radboud Uni- advise whether further imaging or perform trauma imaging eval-
versity Medical Centre, Nijmegen, is necessary. uation, noting that the diagnostic
the Netherlands. This represents a major challenge, approach of a trauma CT scan is
Polytrauma patients gener- especially when specific guidelines different to any other total body CT
ally undergo primary care accord- on how and who should be scanned scan, for instance.
ing to advanced trauma life are only partly available. For exam- “Should this be a dedicated emer-
support (ATLS), a training pro- ple, no general consensus crite- gency radiologist with both gen-
gramme for the management of ria exist for the justification and eral knowledge of all body parts,
acute trauma cases that provides a scanning protocol of whole-body and specific competencies in acute
solid framework and common lan- trauma CT, although some decision radiology? Or should every radiol-
guage based on treating what kills tools have been developed to guide ogist invest in trauma radiology
people first. Prior to this, however, the use of brain, chest and neck CT, experience and knowledge?” Brink
the radiologist has already been and a few good quality prospec- asked. “Are senior residents on-call
involved in the preparatory time- tive studies on this topic have been competent enough to perform
out procedure and briefing on conducted, she continued. Fur- trauma radiology without immedi-
the incoming polytrauma patient. thermore, there are significant and ate supervision by a radiologist? Is
This can provide the information specific questions around which ‘scan slicing’ (primary evaluation of
needed for the radiologist to decide patients should undergo CT angiog- different body regions by different
Members of the multidisciplinary trauma team assess a patient. when and how to perform imaging, raphy of the neck to exclude blunt radiological subspecialists) a good
Provided by Dr. Joost Peters. Copyright: Frank Muller / Zorg in Beeld. to determine which examinations carotid injury and whether radiolo- idea or does this interfere with ade-
are justified and which modalities gists should perform split bolus CT quate teamwork?”
Time is of the essence when it Advances in radiology have should not be used, and work out in all patients. Indeed, there was a further ques-
comes to a polytrauma patient, yet played an important role in the how the CT protocol should be tai- Brink plans to address some of tion about whether radiologists
numerous questions continue to management of polytrauma lored, she explained. these issues today, and she intends should position themselves in the
arise about how and who should patients – those with multiple and “The radiologist should take the to update ECR delegates on the trauma bay.
be scanned and for which condi- potentially lethal injuries, such as lead in deciding how that imag- most relevant guidelines on trauma “You could argue that the pres-
tions. For a close-knit multidiscipli- a combination of a pelvic ring frac- ing should be tailored to the spe- imaging, while other speakers from ence of a (resident) radiologist
nary trauma team, making the right ture with laceration of the blad- cific trauma patient, and the the multidisciplinary trauma team during the whole resuscitation
imaging decisions for patients with der or a haemothorax with blunt radiologist should quickly and will outline how to understand process is not efficient, and hard
severe injuries can be complex and aortic injury. But specific guide- appropriately communicate on which traumatic diagnoses are to implement in daily practice.
a matter of life and death. Trauma lines on imaging such patients are the most life-threatening imaging game changers.
specialists will share their experi- in short supply, creating a multi- diagnoses first,” noted Brink, add- She acknowledged there was an
ences at today’s session. tude of questions, said Dr. Monique ing that the radiologist should also issue around who should supervise continued on page 3
myESR.org #ECR2018
ECR TODAY | SUNDAY, MARCH 4, 2018 HIGHLIGHTS 3
continued from page 1 vey phase, speak the ‘common lan-
guage’ of ATLS, and realise that time Volume-rendered, thick slab reconstruction of a thoraco-abdominal
This can be compensated by plac- is of the essence. “To obtain optimal trauma CT scan of a polytrauma patient with (among other injuries)
MY THESIS
ing radiological workstations next communication and consequently a right-sided diaphragmatic rupture with herniation of the liver and the
to the emergency rooms and the good results, the fundamental gallbladder into the thoracic cavity, and dissection of the left renal artery.
CT scanner – but this still remains guidelines of ATLS must be familiar Image provided by Dr. Monique Brink.
a hospital-wide discussion on pri- to all involved in primary trauma
orities,” Brink said. “We believe care in the emergency department,
IN 3 MINUTES that the direct benefit of the pres- including the radiologist.”
ence of radiology in the trauma Peters also noted, perhaps con-
bay highly outweighs the cost in a troversially, that sometimes it is
level 1 trauma centre … The survival not possible to wait for scan find- Multidisciplinary Session
of trauma patients improves if the ings because the nature of the
trauma team collaborates closely life-threatening injuries may not Sunday, March 4, 08:30–10:00, Room M 4
and systematically.” allow for any delays. “It is some- MS 17 The polytrauma patient
Dr. Joost Peters, a consultant in times difficult to decide if you have
» Chairperson’s introduction
trauma surgery at the Radboud the time to obtain radiological
M. Brink; Nijmegen/NL
University Medical Centre and one information,” he said. “Sometimes
Visit our spectacular new location
of today’s multidisciplinary speak- the only right place (for the patient) » Guidelines and game changers: the radiologist’s perspective
SKY HIGH STAGE and join 240 daring ers, noted that radiologists were to be is in the operating room.” M. Brink; Nijmegen/NL
an essential link and valued team However, he believed that in the » The primary survey: talking ABC
colleagues presenting their scientifi c member when it came to poly- future, scanning would be faster J. Peters; Nijmegen/NL
trauma patients and emphasised and more detailed, greatly helping
theses in just three minutes! » The secondary survey: from head to toe
the need for communication. the trauma team when dealing with Brink spoke of improved scanning
M. Holla; Nijmegen/NL
From a trauma surgeon’s point a patient and providing answers to guidelines and patient selection,
of view, “it is essential that we com- many of the current questions. Fur- as well as rapid computer-aided or » The neuroradiologist’s perspective
municate regarding time manage- thermore, he also believed hybrid even automated diagnosis of inju- F.J.A. Meijer; Nijmegen/NL
ment and findings from scans,” operating rooms with more syn- ries in the future. » Multidisciplinary case presentation and discussion
he said, emphasising that radiolo- chronised interventions would
gists needed to be aware of the sur- become more common. Likewise,
BY KATHARINA MIEDZINSKA
Chinese Society of Radiology looks
forward to increasing international
communication and collaboration
A population of over 1.38 billion and 33 percent of all community cians and scientists in the broad patients with suspected insulino- the detection, prognosis, and treat-
people and a continually chang- hospitals have access to a picture field of radiology and to promote mas and other functional pancreatic ment evaluation of prostate cancer.
ing economy pose great challenges archiving and communication sys- the development of radiology in endocrine tumours. Last but not least, Prof. Zaiyi
to the healthcare system in China. tem (PACS).” China. It will therefore feature sig- Also in the session, Prof. Xiao- Liu from the Department of Radi-
This also affects the Chinese radi- Radiology plays an increasingly nificantly in Jin’s talk. Guang Li from the Centre of Min- ology at Guangdong General Hos-
ological system, which developed important role in the prevention Afterwards, five lectures will pro- imally Invasive Tumour Therapies pital in Guangzhou will speak
in quite a different way to those in and treatment of diseases in the vide insights into radiology practice at Beijing Hospital will report on about colorectal cancer and a
other countries. This will be one of country and has reached advanced in China today. Chinese experiences regarding the study presenting a radiomics nom-
the aspects covered in today’s ‘ESR global standards in certain fields. In Kicking off will be Prof. Fu-Hua interventional therapy for hepato- ogram incorporating the radiom-
meets China’ session. others however, it is still at a devel- Yan from the Department of Radi- cellular carcinoma. Prof. Xiao-Ying ics signature, CT-reported lymph
A look back at the history of radi- opmental stage. ology at Shanghai Jiao Tong Uni- Wang, chair of Radiology at Peking node status and clinical risk fac-
ology in China reveals that it has “To improve radiological services versity School of Medicine in China, University First Hospital, will then tors, which can be used to conven-
followed a long and winding road. in China, there is a lot more to be who will discuss multiparametric discuss the technique and clinical iently facilitate the preoperative
Prof. Zheng Yu Jin, Chair of the done in various areas, including the analysis in imaging liver disease. application of artificial intelligence individualised prediction of lymph
Radiology Department at Peking education of radiologists and tech- Chronic liver disease, especially in abdominal pelvic imaging, specif- node metastasis in patients with
Union Medical College Hospital, nicians, facilitation and optimisa- HBV/HCV-related cirrhosis and ically outlining its clinical value in colorectal cancer.
will illustrate this at the beginning tion of workflow, and the appro- hepatocellular carcinoma (HCC), is
of today’s session. “15 years ago, radi- priateness and efficiency of patient very common in the Chinese pop-
ologists were writing reports with care,” Jin explained. ulation. According to the popula- ESR meets Session
pens and viewing stacks of films Of particular importance are also tion-based cancer registration data
from the light box in a dark room, rural areas, as there is, for example, of the Chinese National Central Sunday, March 4, 10:30–12:00, Room B
while patients came to the techni- still a great difference in the radi- Cancer Registry, HCC is the third ESR meets China
cian with hand-written prescrip- ological equipment distribution most common cancer and the sec- EM 3 A glance of China through images
tions and registration information,” between urban and rural areas due ond most common cause of can-
he noted, adding that fortunately to economic conditions and differ- cer-related deaths. Multiparamet- Presiding: B. Hamm; Berlin/DE
in the meantime a new era has ences in the medical care system. ric imaging plays a vital role in the Z.Y. Jin; Beijing/CN
dawned for Chinese radiology. Generally speaking, in cities the non-invasive assessment of HCC, as
» Introduction
Over the last few years, there amount of radiological equipment well as HCC characterisation and
Z.Y. Jin; Beijing/CN
have been great advances in radi- is significantly larger than in rural surveillance. Yan’s talk will address
ology in China and Chinese radiol- and poor areas. topics such as imaging features » Interlude 1: Experience of Chinese traditional music
ogists have not only accumulated “It is our goal to improve the qual- of HCC as well as other common Group Performance
a lot of clinical experience, but also ity of medical service, especially in liver diseases in China, and famil- » Multiparametric analysis in imaging liver disease
TOPICS:
carried out some valuable research rural areas. Also, we will encourage iarise ECR delegates with the clini- F.-H. Yan; Shanghai/CN
in CT, MRI, ultrasound, angiog- private health and imaging centres, cal application of multiparametric
» Multimodality imaging for insulinoma detection
raphy, interventional radiology, and web based consulting services analysis in abdominal pathologies.
H.-D Xue; Beijing/CN
Oncologic imaging Musculoskeletal nuclear medicine, and other radio- in addition to the established pub- Prof. Hua-Dan Xue from the
» Interventional therapy for hepatocellular carcinoma: Chinese
Genitourinary Head and neck logical fields. lic health institutions. In future, Department of Radiology at Peking
experiences
Chest Abdominal and gastrointestinal There have also been significant we want to participate more inten- Union Medical College Hospital will
X.-G. Li; Beijing/CN
Cardiovascular Breast developments in terms of radiolog- sively in globalisation and welcome deal with multimodality imaging
Neuro Radiographers Details at ical equipment and its geograph- international communication and for the detection of insulinomas, the » Interlude 2: Experience of Chinese tea culture
ical distribution, as Jin explained collaboration,” Jin said. most common hyper-functioning Group Performance
Interventional radiology Paediatrics ipp.myESR.org
using some concrete examples: “CT A key role in this development pancreatic endocrine tumours, with » Application of artificial intelligence in prostate imaging
Type of session MyT3 machines per million of the popula- process falls to the Chinese Society a particular focus on the advantages X.-Y. Wang; Beijing/CN
tion has increased from 5.5 in 2007 of Radiology (CSR). Founded in 1937 of perfusion CT, multiparametric
» Radiomics nomogram to predict lymph node metastasis in
to 8.6 in 2010, and in 2015 a survey in Shanghai, the non-profit organi- MR and PET/CT with special tracers,
colorectal cancer
showed that approximately 50 per- sation aims to foster interdiscipli- as well as the potential clinical work-
Z. Liu; Guangzhou/CN
cent of all general public hospitals nary collaboration among physi- flow and decision tree for imaging
260x405 ECR Today.indd 2 09/02/18 11:12
myESR.org #ECR2018
ECR TODAY | SUNDAY, MARCH 4, 2018 HIGHLIGHTS 5
BY KATHARINA MIEDZINSKA
Image-guided interventions:
a key pillar in radiotherapy
Recent years have seen dramatic improvements in imaging technologies for radiotherapy,
as a panel of experts will highlight at ECR 2018. In today’s joint session of the ESR and
ESTRO (European Society of Radiotherapy and Oncology), speakers will provide an update
on the role modern imaging plays in radiotherapy planning and delivery, with an eye to the
advances on the horizon, aiming to inform both radiologists and radiation oncologists.
whilst the radiation beam is on. It
also offers good soft tissue defini-
tion, which can be used for the pur-
poses of adapting the radiotherapy
to changes in shape and position of
radiotherapy target tissue,” Harris
explained.
The combination of rapid imag-
ing and absence of ionising radia-
tion makes ultrasound highly suit-
able for estimating intrafraction
motion. In her presentation, Har-
ris plans to specifically outline the
use of ultrasound for interfraction
motion estimation of the uterus
for patients receiving radiotherapy
for gynaecological cancers and the
Central sagittal images from 3D ultrasound (top row) and cone beam CT use of 3D functional ultrasound to
(bottom row) of a single patient, acquired in the same session, during weeks monitor the response of tumours to
one and two of radiotherapy for cervical cancer. Notice how the uterus and radiation therapy, aiming to famil-
bladder vary considerably in shape and position on different days. Cone beam Image of a locally advanced rectal cancer case (cT3N2M0) treated with iarise attendees with clinical advan-
CT is the current gold standard image-guided radiotherapy technique for neoadjuvant chemoradiotherapy delivered with a MRI-Tri 60Co hybrid tages and modern perspectives of
gynaecological cancer, however, ultrasound is useful for helping to define the machine at the Gemelli Advanced Radiotherapy Center of the Fondazione ultrasound-based techniques.
boundary of the uterus which is hard to discriminate on cone beam CT. Policlinico Universitario ‘Agostino Gemelli’, Università Cattolica del Sacro Also in this session, Prof. Oliver
Provided by Dr. Emma Harris Cuore, Rome, Italy. First (left) and last (right) fraction of the treatment: Jäkel, from the Radiation Oncol-
clinical complete response has been achieved. ogy Department at the University
The use of ionising radiation for Universita Cattolica S. Cuore, Rome, Provided by Prof. Vincenzo Valentini Hospital Heidelberg, Germany, will
cancer treatment has undergone Italy, who will chair this session provide an insight into MR-LINAC
extraordinary development during together with Prof. Michael Fuchs- when asked what core message he performed with non-harmful ultra- technological advances while Prof.
the past decades. More than any jäger, head and chair of the Depart- would offer relating to the impact sound waves, a technique that has Minerva Becker, from the Depart-
other treatment modality, radio- ment of Radiology at the Medical of new imaging technologies for the potential to offer anatomical as ment of Diagnostic and Interven-
therapy relies heavily on medical University of Graz, Austria. radiotherapy. well as functional information. tional Radiology at the University
imaging to determine the extent Parallel technological advances, In the first session of today’s joint “Ultrasound can be used effec- Hospital Geneva, Switzerland, will
of disease and the spatial relation- which have revolutionised the ESR/ESTRO course, ECR delegates tively in the context of radiother- discuss multiparametric MR-PET
ship between the target region fields of radiology and radiation will learn about dual-energy CT, apy guidance. As a non-ionising for the differentiation of resid-
and neighbouring healthy tissue. oncology, are leading to radiation which offers the potential to ana- and real-time imaging modality, it ual disease and treatment-induced
An inherent goal of radiation ther- treatments with the potential for lyse material composition through is ideal for monitoring the motion inflammatory changes.
apy is to deliver enough dose to higher cure rates and less toxicity, image acquisition at two different of abdominal tissues continuously
the tumour to eradicate all cancer but also to accordingly greater com- energy levels. The use of dual-en-
cells or to palliate symptoms, while plexity and less margin for error. ergy in CT scanners is not a recent
avoiding normal tissue injuries. Therefore, to get the most out of idea and its use has gained increased
Imaging for cancer diagnosis, these latest technologies, there attention in radiology departments Joint Session of the ESR and ESTRO
staging, treatment planning, and must be close cooperation between over the last few years. Currently, (European Society for Radiotherapy and Oncology)
radiation targeting has been inte- radiologists and radiation oncolo- multiple new strategies for using
grated in many ways to improve the gists. The question, whether radia- dual-energy CT systems for the Sunday, March 4, 08:30–10:00, Room X
chance of this occurring, and the tion oncology and radiology will be entire chain of radiotherapy are New imaging approaches for radiotherapy
adaptation and integration of var- able to take advantage of each oth- being investigated, which make it
» Chairpersons’ introduction
ious imaging approaches into the er’s technological innovation, lies at an exciting development that may
V. Valentini; Rome/IT
process of cancer detection, diag- the centre of the panel discussion provide many benefits for radio-
M.H. Fuchsjäger; Graz/AT
nosis, and intervention is a medical in today’s course. therapy, as Patrick Wohlfahrt, MSc,
area that is undergoing rapid devel- “Times have changed; after all, from OncoRay, National Centre for » Dual-energy CT: what are the benefits for radiotherapy?
opment. In parallel to advances in the days are past when medical Radiation Research in Oncology in P. Wohlfahrt; Dresden/DE
radiation delivery, a large spectrum specialties were working on their Dresden, Germany, will illustrate. » Ultrasound imaging in radiotherapy:
of imaging strategies and technolo- own. There is no doubt that multi- Following his presentation, Dr. ‘old’ technology with new applications in RT?
gies has evolved. disciplinarity and cooperation have Emma Harris, from the Institute of E. Harris; Sutton/UK
“New imaging approaches for become more and more relevant. Cancer Research and Royal Mars-
» MR-LINAC technological advances and potential
radiotherapy are a very relevant Common growth comes from syn- den Hospital, London, UK, will
usability in clinical setting
and contemporary topic, as the ergy and communication between deal with the question of whether
O. Jäkel; Heidelberg/DE
newest imaging techniques, par- specialists. It will be increasingly an ‘old’ technology such as ultra-
ticularly hybrid approaches, are important for radiologists and radi- sound can offer new options for » Multiparametric MR/PET for differentiation of residual
gaining increasing importance in ation oncologists to understand applications in radiotherapy. Today, disease vs treatment-induced inflammatory changes
radiation oncology treatment plan- each other’s fields and to collab- the most commonly used forms of M. Becker; Geneva/CH
ning and delivery,” said Prof. Vin- orate closely, to be able to opti- image guidance are based on kilo- » Panel discussion: Will radiation oncology and radiology be able
cenzo Valentini, from the Radia- mise the gains from new imaging or megavolt x-ray imaging. How- to take advantage of each other’s technological innovation?
tion Oncology Department at the approaches,” Valentini emphasised ever, image guidance can also be
Visit the
Arts & Culture booth
in the entrance hall
myESR.org #ECR2018
ECR TODAY | SUNDAY, MARCH 4, 2018 HIGHLIGHTS 7
EuroSafe Imaging has launched its
Cardiovascular and Interventional Radiological Society of Europe
Call for Action 2018 at ECR 2018
ESIR 2018
An interview with EuroSafe Imaging Chair, Professor Guy Frija
ECR Today: The first Euro- 13 actions. So, what’s new? And establishment of clinical diagnos- GF: We are clearly supporting the
Safe Imaging Call for Action was what’s different? tic reference levels for paediatrics. implementation of the BSS by pro-
launched in 2014 to guide the GF: The general approach has not To support these activities, we initi- viding guidance and tools to imag-
objectives of EuroSafe Imaging. been changed. The EuroSafe Imag- ated a subgroup this past year that ing department staff to help them
Now a new version, the EuroSafe ing Call for Action is still commit- is dedicated to paediatric imaging. comply with the directive. In par-
Imaging Call for Action 2018, has ted to supporting the Bonn Call ECRT: Why does research play a ticular, we are developing imple-
been presented at the European for Action published by the Inter- key role in the Call for Action? mentation policies for imaging
Congress of Radiology 2018. Why national Atomic Energy Agency GF: The first Call for Action referring guidelines and supporting
European School of Inter ventional Radiology
is a new call needed? (IAEA) and co-sponsored by the launched in 2014 included the the development of the ESR clinical
Guy Frija: The first EuroSafe World Health Organization (WHO) action to collaborate with research audit tool. This audit tool will help
Imaging Call for Action happened in 2012. However, the actions have platforms and to develop a stra- staff comply with the new BSS and
shortly after the launch of the been updated and adjusted. The tegic research agenda for medical improve the quality of patient care.
EuroSafe Imaging campaign in 2014. Call for Action is now more focused radiation protection. We success- We are also disseminating the ESR
During the years, we, at EuroSafe on the clinical perspective of med- fully achieved this with the estab- iGuide in Europe, a clinical deci-
Imaging, have developed a wide ical imaging and radiation protec- lishment of the European Alliance sion support system, and have just
Clinical Procedure Training range of different activities to sup- tion and, in general, is more con- for Medical Radiation Protection launched a new working group at
port and strengthen medical radia- crete. In particular, the concept of Research (EURAMED) and the pub- the congress to support dissemina-
tion protection across Europe. This clinical diagnostic reference levels is lication of its first strategic research tion of the ESR iGuide. In addition,
approach has proven successful now reflected in the Call for Action, agenda in 2016. The new Call for various BSS educational activities
and our experiences and feedback which we strongly advocate and Action 2018 goes much further. We are underway, like the Tips & Tricks
Mechanical Thrombectomy in Acute Ischaemic Stroke
have shown that we are on the right promote. We also support the Euro- Prof. Guy Frija is Chair of the will support research in advanced material published on our website
track. However, these experiences pean Commission project EUCLID, EuroSafe Imaging Steering topics of radiation protection, such and the webinars we are co-organ-
Florence (IT), tba
and new developments also make which develops clinical diagnostic Committee and Co-Chair of the new as artificial intelligence and image ising with the IAEA Radiation Pro-
it necessary to adapt our approach reference levels for adults for x-ray International Society of Radiology quality, as well as facilitate the dis- tection of Patients Unit.
Local Host: F. Fanelli and thus the EuroSafe Imaging imaging tasks in Europe. In general, Quality and Safety Alliance. semination and translation of this ECRT: That sounds like the next
Steering Committee decided to this new Call for Action will better research into clinical practice. years will be very busy for Euro-
update the Call for Action to bet- facilitate the development and use GF: These coming years we plan ECRT: The new Basic Safety Safe Imaging. We wish you the
ter reflect the current challenges of management systems for dose to focus on the protection of chil- Standards (BSS) Directive had best for all endeavours and thank
Prostate Embolisation ahead. exposure collection and monitor- dren from radiation, as more guid- to be transposed by the member you for the interview.
ECRT: The first Call for Action ing, and the establishment of key ance for good and safe use of imag- states just before ECR 2018, in Feb-
was a 12-point action plan to quality indicators. ing for this vulnerable group is ruary 2018. How is EuroSafe Imag- Visit www.eurosafeimaging.org
Milan (IT), June 14-15, 2018
achieve EuroSafe Imaging’s objec- ECRT: What other actions will needed. Therefore, we advocate ing supporting imaging depart- for more information.
tives, whereas the EuroSafe Imag- EuroSafe Imaging focus on in the launching a new dedicated project ments with the compliance of the
Local Hosts: F.C. Carnevale & A.G. Rampoldi
ing Call for Action 2018 comprises coming year? in this area, in particular for the BSS?
Mastering Liquid Embolics
EUROSAFE IMAGING CALL FOR ACTION 2018
Zaragoza (ES), October 25-26, 2018
Local Hosts: J. Urbano & M.A. de Gregorio
1. Develop guidelines and implementation policies, 8. Establish a dialogue with industry regarding
and disseminate a Clinical Decision Support improvement of radiological equipment, the use
system (ESR iGuide) in Europe of up-to-date equipment (e.g. Dose Management
DVT/PE Thrombolysis and Thrombectomy
Systems) and the harmonisation of exposure
Dublin (IE), tba 2. Develop clinical diagnostic reference levels indicators
(DRLs) for adults and children
Local Hosts: M.J. Lee & G.J. O‘Sullivan
9. Strengthen the EuroSafe Imaging Stars network
3. Develop image quality assessment based on
of imaging centres that embody best practice
clinical indications
in radiation protection
DEB & cTACE in Primary and Secondary Liver Cancer
4. Promote dose management systems to
10. Organise radiation protection training courses
Villejuif (FR), December 13-14, 2018 establish DRLs at local level and beyond and develop e-learning material to promote
safety culture and raise awareness on radiation
Local Host: T. de Baère 5. Develop performance indicators for radiation
protection
protection management
11. Support research in advanced topics of radiation
6. Implement a clinical audit tool for imaging to
protection, e.g. artificial intelligence, as well as
improve the quality of patient care
facilitate the dissemination and translation of this
www.cirse.org/esir2018
7. Radiation protection of children: develop research into clinical practice
guidance for good and safe use of imaging,
12. Improve information to and communication with
and for effective communication
patients about radiological procedures, related
benefits and possible risks
13. Engage with stakeholders and collaborate with
related initiatives and regulatory authorities
C RSE
in Europe and beyond to contribute to a global
f o u n d a t i o n
safety culture in medical imaging
myESR.org #ECR2018
E S R M E E TS
A F R I C A
This morning ESR leadership will meet with
Leaders of African Radiology Societies.
The meeting was organised ahead of ESR
Meets Africa, scheduled to be a highlight of
next year’s ECR.
This is the first time so many African
representatives have met at the congress
and the meeting promises to be a fruitful
and energetic occasion.
Attendees will share knowledge and discuss
ways to improve collaboration in the field of
radiology between Europe and Africa.
In particular, discussions will focus on impro-
ving the delivery of radiological healthcare
throughout the African continent.
The meeting will mark the beginning of closer
relations and cooperation between European
and African radiologists.
myESR.org
ECR TODAY | SUNDAY, MARCH 4, 2018
CORNER
CLINICAL
9
Time is brain: optimising the Case-Based Diagnosis Training 2018: New treatment strategies give hope to
11 12 15
management of acute ischaemic stroke normal variant or disease? patients with musculoskeletal tumours
BY FRANCES RYLANDS-MONK
Failure to diagnose abdominal bleeds
means bad outcome in most cases
In vascular abdominal emergencies, patient status can degenerate quickly, so time is of the
essence. CT is pivotal for fast and appropriate triage of patients and selection of the best
treatment strategy. But what if the really important signs and symptoms are small and
hidden? New technologies are helping to provide the answers.
Figure 1: Ruptured abdominal aortic aneurysm before and after stentgraft implantation.
Provided by Dr. Krzysztof Pyra.
If a radiologist fails to diagnose abdominal and retroperitoneal is 8 to 10 years, it will be another
abdominal bleeding or large vessel organs and structures in 3D. Fur- decade before we can expect to see
thrombosis, then poor outcome is thermore, modern scanners allow DECT routinely applied in acute
almost inevitable, so patients should low-dose CTA of the whole abdo- abdominal emergencies.”
be sent straight to contrast-enhanced men with high diagnostic yield. In vascular abdominal emer- Figure 2: Ruptured abdominal aortic aneurysm: classical surgery vs
CT angiography (CTA), according to Sinitsyn’s talk will in part focus gencies, dual-phase (arterial and percutaneous stentgraft implantation under fluoroscopy guidance.
Prof. Valentin Sinitsyn, head of radi- on the use of dual-energy CT venous) low-dose enhanced CT, Provided by Dr. Krzysztof Pyra.
ology at the Federal Centre for Reha- (DECT) for such emergency vascu- followed by fast review to decide
bilitation and Treatment in Moscow, lar cases. The technique increases if extra imaging is necessary, Conversely, cases of acute bleed- ogist to determine their suitability
and past President of the ECR. conspicuity of iodine extravasation remained the protocol of choice. ing may be missed because the rate for minimally invasive procedures.
“Radiologists should report the and intravascular thrombi, and the Without enhancement, very small of bleeding is low or the bleeding When considering repair options
direct signs of acute bleeding or radiologist often can skip non-en- leaks are hard to detect, so biphasic has stopped, resulting in percep- for abdominal vascular emergen-
thrombosis, presence of vascular hanced scans and perform only a enhanced CT is a ‘must’ for these tual errors whereby small amounts cies, each case requires a tailored
ruptures, dissections or lacerations, single contrast-enhanced acquisi- tiny leaks and thrombosis. Using of iodine are missed. Radiologists approach, with the patient’s over-
aneurysms and pseudoaneurysms, tion with reconstruction of virtual DECT, a single arterial-phase CT should be aware of the differentials all health taken into considera-
blood clots and haematomas,” he non-contrast images. may be sufficient, Sinitsyn added. and check for bleeding as opposed tion, along with the specific, often
told ECR Today ahead of the con- “DECT can yield qualitative infor- Despite CT’s manifold advan- to just inflammation or distention. life-threatening injury.
gress, adding that they also should mation similar to MRI and reveal tages, radiologists should be aware Furthermore, hyperdense content In his presentation today, Pyra
check for signs of total or regional small quantities of iodine in tiny of the potential pitfalls of the inside bowel loops might mask will cover the most frequent find-
organ ischaemia (hypoperfusion, blood leaks in the soft tissue. There is modality in vascular emergen- acute blood clots, he warned. ings and their different treatment
oedema, or necrosis) associated no difference for the patient in terms cies; for instance, enhancement of “Detecting bleeding is difficult options. Traumatic arterial injuries
with bleeding or thrombosis. of time, compared to non-enhanced bowel mucosa or vascular tumours within the bowel due to the radiolog- often present in CT as contrast blush
For detection of acute continuous scans, but it is only available on new may be misinterpreted as acute ical signs associated with presence areas of high density. In the majority
bleeding, CT is equal to traditional generation scanners, less than 1% of bleeding, while poor opacifica- of food. DECT can help to determine of cases, transvascular embolisation
catheter angiography and pro- all existing CT machines,” he noted. tion of arteries or veins may look if the hyperdense content is due to of the injured vessel may be the
vides additional information about “Given that the lifespan of a machine like thrombosis. iodine, calcium or other types of method of choice, and is superior to
material,” Sinitsyn said. the classic surgical approach.
At today’s session, speakers will dis- He thinks retroperitoneal hae-
cuss the shift in diagnostic approach matoma adjacent to an abdominal
toward ultrasound and CT, the latter aortic aneurysm is the most com-
noted for speedy coverage of large mon imaging finding indicative of
anatomical areas, and reliable results aneurysm rupture. Endovascular
are relatively independent of opera- aneurysm repair (EVAR) has become
tor and patient preparation. an established technique for the
ECR delegates will hear how sug- treatment of many infrarenal aortic
gestions made by radiologists carry aneurysms. Less invasive than open
considerable implications for patient surgical repair, EVAR is associated
management. Dr. Krzysztof Pyra, with better outcomes, according to
consultant radiologist in the depart- Pyra (see Figures 1 and 2).
ment of interventional radiology and The interventional radiologist’s
neuroradiology at the University remit also rests on the repair of
Hospital of Lublin, Poland, today will
Figure 3: Yakes Type IIIa arteriovenous malformation: multiple arteriovenous fistula into the wall of a single outflow address which patients need consul-
aneurysmal vein – before and one year after embolisation. Provided by Dr. Krzysztof Pyra. tation with an interventional radiol- continued on page 10
myESR.org #ECR2018
10 CLINICAL CORNER ECR TODAY | SUNDAY, MARCH 4, 2018 ECR TODAY | SUNDAY, MARCH 4, 2018 CLINICAL CORNER 1111
to the vital abdominal organs,” will let you propose treatments to BY KATHARINA MIEDZINSKA
he said. the referrer, but also directly to the
Rare findings, like arteriovenous patient – the person often omitted in Time is brain: optimising
malformations, are extremely chal- the decision-making process,” he said.
lenging and require accurate diag-
nosis and appropriate treatment,
especially if they are high-flow and/ Special Focus Session
or extensive lesions. Embolisation the management of acute
with coils and 98% ethanol is just Sunday, March 4, 08:30–10:00, Room L 8
one of the many existing treatment SF 17b Abdominal emergencies: friends and enemies
possibilities (see Figure 3).
» Chairperson’s introduction
On the left is contrast-enhanced axial CT scan of the abdomen in a patient “The radiology curriculum should
I. Arkhipova; Moscow/RU ischaemic stroke
with suspected rupture of abdominal aortic aneurysm. Leakage of blood put much more emphasis on
from the aorta (centre) is not obvious. On the right is the corresponding expanding clinical knowledge, so » Abdominal vascular emergencies: no time to lose
dual-energy CT scan (iodine map). Concentration of iodine corresponds to that radiologists become even bet- V.E. Sinitsyn; Moscow/RU
gradations of the re-colour scale. White arrow indicates high concentration ter partners in the decision-making » When to call the interventional radiologist and when to call the
of iodine (yellow-green areas inside the blue non-enhancing tissues) in the process on the patient’s pathway. surgeon?
blood leaking into the para-aortic tissues from the small contained aortic The diagnostician may – or even K.K. Pyra; Lublin/PL In today’s State of the Art Symposium on interventional treatment of stroke, ECR delegates
wall rupture (later confirmed in surgery). Provided by Prof. Valentin Sinitsyn. should – advise on implement-
» Closed loop obstruction: a challenging diagnosis
ing minimally invasive therapeu-
M. Zins; Paris/FR will get the chance to acquaint themselves with challenges in the treatment of acute
continued from page 9 tracks along the media, forming a tic methods in particular cases,”
second blood-filled channel within Pyra said. » Expected and unexpected emergencies of abdominal viscera:
ischaemic stroke and to learn about current imaging modalities and the important role
other relatively common pathol- the wall. Furthermore, knowledge of these radiology before surgery?
ogies; acute aortic dissection, “It is the interventional radiolo- novel therapies is growing among C. Stoupis; Männedorf/CH
of endovascular techniques in the management of affected patients.
for example, occurs when blood gist’s task to identify and dilate the patients, who may wish to participate » Life teaches us case by case
enters the medial layer of the true lumen, exclude the entry tear actively in choosing their treatment. M.-L. Riibak; Tallinn/EE
aortic wall through a tear or pen- by implanting a stent graft and, if “Having in-depth knowledge about
» Panel discussion: Every imaging sign could matter!
etrating ulcer in the intima and necessary, provide blood inflow interventional procedures not only brain areas, as well as other things, “Endovascular strategies for
need to be considered in the deci- tandem stroke cases result in
sion-making process. In practice, this improved outcomes. Recent stud-
is the most difficult question to be ies have shown the great benefit of
BY ELINA SAMARA AND ANNALISA TRIANNI
answered, needing more advanced endovascular treatment in these
imaging techniques such as perfu- patients, comparable with the treat-
Patient specific dosimetry: sion and multi-phase cross-sectional ment effect in patients who have
vascular imaging,” he said. an intracranial occlusion without
Furthermore, optimal clinical cir- cervical carotid pathology. There-
cumstances during and after the fore, current guidelines recommend
procedure are essential to ensure thrombectomy of the intracranial
a farewell refresher course A B C the best outcome for ischaemic occlusion for patients with these
stroke patients. Hence, in his pres- tandem lesions,” said van Zwam.
A 70-year-old female with acute aphasia and right hemiplegia was referred for endovascular stroke therapy. entation, van der Zijden also plans Up to now, different endovascular
Angiography in lateral view with injection of the left internal carotid artery (A) confirmed the diagnosis of a carotid to pay special attention to cur- approaches have been proposed for
tip occlusion (arrow). The thrombus was removed subsequently by using a combination of a stent retriever and rent indications for endovascular cervical lesions, including carotid
an aspiration catheter (B), sandwiching the thrombus in this way between stent and distal access catheter. The treatment, supportive care during stenting in the acute phase (before
Biological effects induced by exposure to radiation demonstrated the need for accurate
angiogram post-thrombectomy (C) shows a successful recanalisation with no visible perfusion deficits (TICI 3 grade). an endovascular procedure, and or after thrombectomy), PTA only, or
Provided by Dr. Thijs van der Zijden post-thrombectomy medical treat- conservative treatment in the acute
dosimetry during the early days of x-ray use in medicine. Since the 1950s, scientific interest
ment, including anticoagulation phase followed by delayed stenting
Starting the session off will be vessel occlusion. “In recent years, in order to avoid futile recanalisation and anti-aggregation treatment or delayed carotid endarterectomy.
has also turned to the estimation of risks of radiation-induced cancer and genetic effects.
Dr. Thijs van der Zijden, from the mechanical thrombectomy has and prevent additional harm. and blood pressure control. However, as there is yet no evi-
department of radiology at the mostly been performed with stent Especially the size of the vessel Today’s session will be chaired by dence for optimal management,
Various dosimetric quantities have been used in diagnostic radiology and sometimes there
Antwerp University Hospital, Bel- retrievers, but due to current devel- occlusion is of vital importance,” he Dr. Pedro Vilela, from the Hospital no clear guidelines for the manage-
gium, who plans to familiarise ECR opments and the clinical experience, added. “In most cases of large vessel Garcia de Orta, Almada, Portugal. ment of the extracranial carotid
is confusion because the same term is used for different quantities.
delegates with current approaches other techniques such as thrombus occlusions, the thrombus is located Vilela and van der Zijden will be pathology exist.
in the endovascular treatment of aspiration have emerged as effective in the distal part of the internal joined by Dr. Wim van Zwam, from “The use of acute artery stenting
stroke. During the last years, vari- treatment tools as well,” he said. carotid artery and/or in the proximal the Maastricht University Medical and intracranial thrombectomy
Dosimetry requires the use of spe- to be performed to estimate the organs. With the advancement of easily determined using physical Elina Samara is Medical Physicist ous endovascular approaches have Today, endovascular therapy is middle cerebral artery. These cases Centre, Netherlands, who plans to enables high recanalisation rates,
cialised instrumentation and meth- risks and proceed correctly. technology, new tomographic phan- dosimeters such as thermolumines- at the Valais Hospital, Switzerland; been developed for the treatment considered the standard treatment are, apart from basilar artery occlu- specifically address the endovascu- but the required antiplatelet ther-
odology along with the knowledge Although doses from diagnos- toms have been developed from com- cent dosimeters, but organ doses she will chair the refresher course. of patients with acute ischaemic for acute ischaemic stroke in the sions, the best indication for the lar management of acute ischaemic apy after stenting increases the risk
to interpret results and apply it in tic radiological examinations are puted tomography or other images demand extended calculations, usu- Annalisa Trianni is Medical stroke. Endovascular thrombec- setting of large vessel occlusion, use of a mechanical thrombectomy. stroke with tandem lesions. of haemorrhage. Therefore, further
clinical situations. Today’s refresher relatively small and do not usually obtained from individuals, and now ally using Monte Carlo simulations. Physicist at Udine University tomy presents many benefits over as it improves the functional out- However, due to ongoing technical In 20 to 30 percent of patients with data are needed to optimise the
course will provide essential infor- approach thresholds for tissue reac- offer more realistic modelling of All these methods are progres- Hospital, Italy; she is Chair of the the endovascular application of come in patients with severe stroke improvements of thrombectomy acute ischaemic stroke due to a large management of patients with acute
mation about the purpose and meth- tions, severe skin injuries have been human anatomy. Today, phantoms sively enabling more accurate esti- ECR 2018 Physics in Radiology pharmacologic fibrinolytic agents. due to an occlusion of the internal devices combined with progressive vessel occlusion of the anterior circu- ischaemic stroke with tandem
ods of specific patient dose assess- documented for interventional may also represent the paediatric mations of individual patient doses. Subcommittee. Mechanical thrombectomy devices carotid artery or proximal middle practical and scientific insights, lation, a concomitant ipsilateral cer- lesions,” van Zwam explained.
ment, as well as the technology used. procedures. Skin dose mapping is patient, obese patients and pregnant There is no doubt that patient spe- work more quickly, attaining recan- cerebral artery, provided that the smaller vessel occlusions, such as M2 vical internal carotid artery stenosis Last but not least, Dr. Juan
Patients with chronic diseases, needed during these kinds of pro- women, for instance. cific dosimetry has an enormous alisation within a span of a few procedure starts within six hours or even M3 cortical segments of the or (pseudo-) occlusion is present. Macho, from the Hospital Clinic
such as inflammatory bowel disease cedures to avoid tissue effects, and Secondly, each modality has its amount to offer in clinical practice. minutes. They are linked with lesser from symptom onset. middle cerebral, are coming closer These so-called tandem lesions pres- de Barcelona, Spain, will, among
or coronary artery disease, some- accurate knowledge of maximum own technical specificities and intracerebral and systemic haemor- However, provision of this treat- and closer within our reach for end- ent a particular treatment challenge, other topics, discuss literature data
times need to undergo radiographic skin dose is essential for patient patient exposure differs. The x-ray rhage likelihood and are more effi- ment requires expertise, as van der ovascular treatment as well.” as they are difficult to manage end- regarding the incidence and treat-
examinations for their entire lives. management after the procedure. source rotates around the patient cient in the treatment of large clot Zijden underlined: “Although very Also, the clinical appropriateness ovascularly and known to respond ment of distal arterial occlusions
Moreover, paediatric patients Patient specific dosimetry is there- during a CT examination irradiat- Refresher Course: Physics in Medical Imaging volumes in proximal vessels. fast procedure times with impressive of the particular technique is essen- poorly to intravenous administra- as well as potential indications for
with positive outcome and long fore paramount for the estimation ing a large region of the body, while According to van der Zijden, end- recanalisation rates can be achieved tial, according to van der Zijden. tion of tissue plasminogen activator endovascular treatment beyond
life expectancy undergo repeated of doses and risks for both stochas- in mammography it is mainly the Sunday, March 4, 08:30–10:00, Room G ovascular thrombectomy has clearly by using stent retrievers and throm- “Questions concerning the size of the (t-PA). They typically have a worse the proximal arterial occlusion and
examinations for diseases such as tic effects and tissue reactions. patient’s breast which is exposed RC 1713 Patient-specific dosimetry demonstrated its benefit for the bus aspiration, it is still of utmost potentially salvageable volume of prognosis than an intracranial lesion the six-hour time window recom-
lymphoma, Crown disease or bleed- The question is: how can we use to radiation. In plain radiography, primary treatment of patients with importance to select the correct brain at risk for infarction compared alone and clinical outcome is poor if mended in most of the guidelines.
» Chairperson’s introduction
ing disorders. While little informa- basic quantities such as kerma to the x-ray source is fixed and the acute ischaemic stroke from large patients for endovascular treatment to the size of the already infarcted not treated endovascularly.
E. Samara; Sion/CH
tion on cancer risks from repeated determine meaningful organ doses? x-ray beam is projected through
examinations is available, head and Firstly, patient characteristics, such the patient’s body exposing one » A. Breast imaging dosimetry State of the Art Symposium
neck CT scans were shown to be sig- as age, sex, height and weight, need well-defined part of the body to I. Sechopoulos; Nijmegen/NL
nificantly associated with increased to be taken into consideration. For radiation. In contrast, during a » B. Patient dosimetry in CT and CBCT Sunday, March 4, 08:30–10:00, Room F1
risk of cataract. Pregnant women this purpose, phantoms simulating fluoroscopy-guided procedure, the S. Edyvean; London/UK SA 17 Interventional treatment of stroke: a game changer
may need to undergo radiological the human body can be used to eval- x-ray source moves around the
» C. Patient dose in fluoroscopy and interventional » Chairperson’s introduction
examinations. Sometimes, they uate the organ doses resulting from patient and the radiation dose is
A. Trianni; Udine/IT P. Vilela; Almada/PT
even discover they are pregnancy radiation exposure. Initially, these distributed to a large area.
as a result of a radiological proce- phantoms were based on mathemat- Lastly, the technique to calcu- » Panel discussion: The future of patient-specific dosimetry » Stroke, endovascular treatment: current approaches
dure. In these cases, specific dose ical expressions that described the late the dose needs to be deter- T. van der Zijden; Antwerp/BE
This session is part of the EuroSafe Imaging campaign.
estimations for the conceptus need shape and position of idealised body mined. Skin dose can be relatively » Stroke, endovascular treatment: tandem lesions and acute
phase stenting
A B C W. van Zwam; Maastricht/NL
» Stroke, endovascular treatment: beyond proximal occlusion
and six-hour time window
VISIT THE Images of a 47-year-old male with a so-called ‘wake-up stroke’. The stenosis was passed and the MCA occlusion was
J. Macho; Barcelona/ES
opened with a stent retriever. The extracranial stenosis was not treated in the acute setting, but it was later treated by
» Panel discussion: Stroke, endovascular treatment:
endarterectomy. The patient did perfectly well (mRS 0 after 3 months). Images show the intracranial occlusion of the
ECR ONLINE & EPOS LOUNGE right middle cerebral artery (MCA) (A), the stenosis of the extracranial right internal carotid artery (B), and the right new horizons
middle cerebral artery after thrombectomy (C).
Provided by Dr. Wim van Zwam
ON THE 1ST LEVEL!
#ECR2018 myESR.org myESR.org #ECR2018
12 CLINICAL CORNER ECR TODAY | SUNDAY, MARCH 4, 2018 ECR TODAY | SUNDAY, MARCH 4, 2018 CLINICAL CORNER 1133
BY SORAYA ROBINSON
discovering new marker patterns, from thousands of disease and Until then, a number of hurdles and possibly automated curation Assoc.Prof. Dipl.-Ing. Dr. Georg
and rendering those patterns use- treatment histories, and models must be overcome along the way. of such data. Algorithms will have Langs is head of the Computational
Case-Based Diagnosis Training ful. We will have powerful compu- that translate these observations Research communities that advance to identify prognostic feature pat- Imaging Research Lab at the
tational models that will enable a into an accurate prognosis. machine learning, and medical dis- terns in complex imaging data, and Department of Biomedical Imaging
more accurate prediction of individ- As we become able to detect and ciplines such as radiology, must robust models will need to be able and Image-guided Therapy, Medical
ual disease course, and which will quantify complex but subtle patterns collaborate closely, learning to trig- to predict, simulate and assess the University of Vienna.
forecast a response to treatment in observations at an earlier stage, ger algorithmic methodology from certainty of their output at the same Assoc. Prof. Dr. Helmut Prosch is
2018: normal variant or disease? from observations such as imag- diagnostic categories might change. clinical questions, and to ask new time. While these challenges are sig- section chief of thoracic imaging
ing data and disease history. These Through an understanding of the clinical questions whose answers nificant, an increasingly joint effort at the Department of Biomedical
models will enable the selection of link between distributed signatures will be rendered actionable by by researchers across varying fields Imaging and Image-guided
personalised treatment strategies and prognosis, we will discover novel computational algorithms. We will renders the solution to such chal- Therapy, Medical University
more effectively based on an assess- disease and response phenotypes, need to find methods to deal with lenges plausible, and the future of of Vienna.
may be so common that experienced Dr. Soraya Robinson works as a organising the CBDT sessions since ment of each patient in light of an which, in turn, will contribute toward heterogeneous multi-modal data, medical imaging might change more
practitioners require only a single general radiologist in a diagnostic 2014. unprecedented scale of evidence research for novel treatments. and find the means for the efficient rapidly than we expect right now.
look to make the correct diagnosis, centre in Vienna. She has been
others will be quite a bit trickier – but
a mystery than can be solved with
the right approach. Case-Based Diagnosis Training Sessions
BY LAJOS R. KOZÁK
Since it may be difficult to focus for
long stretches with so much thinking Sunday, March 4, 13:00–14:00, Room E1
and memorising going on, we have CB 1 Case-Based Diagnosis Training – Part 1 Optimising pre-surgical fMRI
again organised an interlude pres-
entation for between the two blocks Moderators: K.M. Friedrich; Vienna/AT
of case presentations for variety. S. Robinson; Vienna/AT
A B
With the help of the images that radi-
» Liver
ologists from all over the world have language mapping for personalised
L. Martí-Bonmatí; Valencia/ES
Figures 1A and 1B: transverse and coronal contrast enhanced chest CT sent us, Dr. Wolfgang Drahanowsky
» Neuro
showing persistent left superior vena cava and absence of right superior from Vienna will give his talk in his
D. Prayer; Vienna/AT
vena cava in a 65-year-old man with follow-up after gastric cancer. usual entertaining style. This year we
have chosen normal variants as the » Maxillofacial
therapy planning
topic of interest. Some are easy to rec- S. Robinson; Vienna/AT
ognise such as persistent left sided » Musculoskeletal
superior vena cava with absence on F. Kainberger; Vienna/AT
the right side (Figures 1A and 1B).
» Genitourinary
Others are less easily recognisable
M. Toepker; Vienna/AT
unless you have encountered them
Intrinsic connectivity networks of the brain may be the key to fine tune paradigms
before, such as an accessory planta-
ris muscle (Figures 2A and 2B). Our Sunday, March 4, 14:00–14:30, Room E1
knowledge of embryological devel- CB Case-Based Diagnosis Training – Interlude
opment will be refreshed in order to » Normal variant or disease? Blood oxygenation-level depend- sion. By the same token, interpa-
understand what happens when the ent functional MRI (fMRI) became tient differences were compatible
process is arrested at a certain stage W. Drahanowsky; Vienna/AT an important tool in the pre-surgi- with previous neuropsychology.
A B
or starts to head in the wrong direc- cal evaluation of patients with epi- Based on our results, we con-
tion. The aim of this presentation is Sunday, March 4, 14:30–15:30, Room E1 lepsy, brain tumours and other such clude that fMRI-based inference
Figure 2: (A) coronal T1-weighted MRI, (B) transverse fat suppressed to familiarise you with an array of CB 2 Case-Based Diagnosis Training – Part 2 conditions. The main goal of fMRI as reflected in the labelling results
pd-sequence of a 16-year-old girl with an accessory plantaris muscle (arrows). normal variants which should not be mapping is establishing the spatial we obtained may on the one hand
misdiagnosed as abnormality requir- Moderators: K.M. Friedrich; Vienna/AT relationship between the lesion and be used to evaluate the paradigms
For the fifth time in a row the subspecialties. Just as in daily prac- ing further imaging, invasive diag- S. Robinson; Vienna/AT eloquent areas, e.g. language areas that were made use of themselves,
ECR will draw to a close with the tice, you will be provided with clinical nostic procedures or treatment. On like Broca and Wernicke, the pri- to gain a better insight into their
» Head and neck
popular Case-Based Diagnosis Train- information and a couple of pathog- the other hand, we should recognise mary sensory-motor cortex, visual advantages and possible disadvan-
C. Czerny; Vienna/AT
ing on Sunday afternoon. No mat- nomonic images. Then you will get when developmental disorders have areas, etc. Optimally, a task which tages for pre-surgical evaluation.
» Chest
ter whether you are an ambitious ample time to come up with the clinical significance, and we could be activates the eloquent area near On the other hand, these net-
H. Prosch; Vienna/AT
researcher or a general radiologist, answers to multiple questions. the first to advise the patient. the lesion is used. However, there work-based approaches may also
employed in a hospital or a diagnos- Each case will be analysed by one A winner will be chosen from the » Spine is no general consensus on the be advantageous on the individual
tic centre, at the beginning of your of our ten renowned subspecialists best submissions of normal variants. K.M. Friedrich; Vienna/AT optimal paradigms, or on the best level for fine-tuning mapping para-
career or you already have decades of and you will be able to confirm your So make sure you are there when this » Gastrointestinal practices of processing and eval- digms for specific symptoms, lesion
experience, there is sure to be some- diagnosis or pick up tips and tricks to year’s award is handed out, and join W. Schima; Vienna/AT uation. Recently, there have been loci and/or specific sub-functions
thing for you at this session. help you decide between various dif- us to analyse interesting cases, which promising initiatives for stand- selected using neuropsychologi-
» Breast
You will be confronted with 20 ferential diagnostic entities by going may well be similar to the ones wait- ardisation, like the one developed cal evaluation, thus personalising
M.H. Fuchsjäger; Graz/AT
different cases from 10 radiological for the most probable option. Some ing for you when you return home! by the Epilepsy Working group paradigm optimisation and
of the European Society of therapy planning.
Neuroradiology’s Diagnostic Neu-
roradiology Committee. Lajos R. Kozák, MD, PhD is an
BY GEORG LANGS UND HELMUT PROSCH
Consensus recommendations assistant professor of the MR
would make pre-surgical evalua- Research Centre at Semmelweis
Promises and hurdles in the tion comparable across centres, University, Budapest, Hungary.
but they would per se neither elim-
inate the inherent limitations of Our open source, open access ICN_Atlas toolbox is designed to quantify individual fMRI activation patterns within Further reading:
the task-activation approach itself, intrinsic connectivity networks, also known as resting-state networks. Given a whole-brain activation map, a set Smith et al., PNAS (2009)
nor facilitate a better personalised of metrics is calculated describing different aspects of involvement for each such network, thus describing the 106(31):13040-45
collaborative future of machine approach. Indeed, the task-activa- involvement of the relevant cognitive processes during performance of the given task. Laird, J Cogn Neurosci (2011)
tion approach is inherently limited, 23(12):4022-37
as (1) some of the activated areas on the correspondence between tion patterns in the framework of were the highest weighted labels Ray, Front Neurosci (2013) 7:237
may not be necessary for perform- ICNs and task-related fMRI acti- ICNs. Given any whole-brain acti- for picture naming while ‘Percep- Kozák et al., NeuroImage (2017)
ing the given task, (2) a given task vations one can argue that net- vation map, ICN_Atlas outputs the tion.Audition’, ‘Passive Listening’ 163C:319-341
learning and medical imaging
may not activate all areas neces- work-based approaches may also be involvement of each ICN, making and ‘Pitch Monitor/Discrimination’ ICN_Atlas is available at https://
sary for performing the task, and valuable for fine-tuning mapping the contribution of different cogni- were those for word/non-word deci- nitrc.org/projects/icn_atlas
(3) the level of activation seen in paradigms in a neuropsychologi- tive processes to the performance
a given task may not be related to cally meaningful way using infer- of the given task deducible. For this
the performance level observed in ence based on ICNs. study, we implemented a labelling Scientific Session: Neuro
Machine learning is a rapidly images (supervised learning). Alter- ment and implementation of novel take over the job of radiologists. the given task. These limitations As proof of concept we re-eval- scheme in ICN_Atlas using the
evolving research field that is natively, there are approaches in treatment strategies as well as the However, this is likely the wrong may be mitigated by considering uated fMRI language mapping metadata matrices of Laird and Sunday, March 4, 14:00–15:30, Room M 5
drawing increased attention in which dedicated algorithms are individualised, effective and early question. There is no doubt that, the whole brain activation pattern results of 40 consecutive patients Ray, i.e. matrices containing numer- SS 1911b Quantitative imaging techniques
medical imaging. A number of cur- able to identify patterns without delivery of care and preventive 20 years from now, the job of radi- using a network-based approach scanned using picture naming, ical weights representing the con-
rent publications have reported human supervision (unsupervised medicine. ologists will look very different. instead of focusing on a given synonym matching, speech com- nection between cognitive/behav- Moderators: O. Fösleitner; Vienna/AT
promising developments in com- learning). In both approaches, large Linking research in machine Yet, the prime impact of machine eloquent area. prehension, and word/non-word ioural domains/paradigms and I. Tsougos; Larissa/GR
puter-aided diagnosis tools using numbers of images are needed to learning and medicine will act as a learning will not be in replacing, Intrinsic connectivity networks decision tasks in 2016–2017 in the ICN activations.
» Optimising pre-surgical fMRI language mapping using
machine-learning. Machine learn- train and test the algorithms. These powerful driver in this endeavour. but rather enabling radiologists to (ICNs) described using resting-state MR Research Centre, Semmelweis The four evaluated paradigms
knowledge derived from intrinsic connectivity brain networks
ing in radiology aims to train com- images can be obtained from clini- This collaboration is the key to cre- use more powerful prediction mod- fMRI (hence their other name: University, Budapest, Hungary. trigger somewhat different mecha-
for personalised therapy planning
puters to recognise patterns in med- cal routine examinations, such as ating better models to predict dis- els and rely on more comprehen- resting-state networks) are good We used our recently published nisms of language processing and
L.R. Kozák1, G. Gyebnár1, A.G. Szabo1, A.L. van Graan2,3, P. Barsi1,
ical images, enabling quantification computed tomography or magnetic ease course and risk in individual sive patterns that are informative candidates for network-based open source, open access analysis production. This was reflected in
L. Lemieux2,3, G. Rudas1; 1Budapest/HU, 2London/UK,
of disease extent and prediction of resonance imaging, which capture patients, to forecast the response for individual disease course and approaches, as they are consistent toolbox, ICN_Atlas, designed to the labelling results, e.g. ‘Perception.
3Chalfont St. Peter/UK
disease course with greater preci- characteristics ranging from struc- to a growing landscape of possible treatment outcome. The radiolo- across individuals. Moreover, based quantify individual fMRI activa- Vision.Shape’ and ‘Naming (Overt)’
sion than that achievable by the ture or function to metabolism. treatments, to deliver early preven- gist’s role will be to develop such
human eye. Image-derived predic- The computational analysis of tion, and to make possible the opti- diagnostic paradigms and to inte-
tion models can further be opti- imaging data using machine learn- mal care of each individual. grate these paradigms with overall
mised by the addition of clinical ing is about to fundamentally The increasing use of comput- patient characteristics.
and laboratory data. change our ability to understand Automatically identified disease er-assisted diagnosis software in The primary role of machine
A computer can be trained to disease, risk and treatment. It will patterns in a high-resolution lung CT radiology also engenders the fear learning will not be automation,
recognise patterns, with annotated serve as the basis for the develop- (Hofmanninger, Prosch, Langs) that such software will eventually but improving individual care by
#ECR2018 myESR.org myESR.org #ECR2018
14 CLINICAL CORNER ECR TODAY | SUNDAY, MARCH 4, 2018 ECR TODAY | SUNDAY, MARCH 4, 2018 CLINICAL CORNER 1155
BY ALESSIA VAROTTO BY KATHARINA MIEDZINSKA
Volumetric histogram-based New treatment strategies
analysis of SUV and ADC values give hope to patients with
for the assessment of paediatric musculoskeletal tumours
sarcoma at staging
In today’s Special Focus Session, experts will provide an update on imaging modalities,
treatment strategies and therapy monitoring in patients with musculoskeletal tumours,
aiming to raise awareness of how multimodality imaging can influence therapeutic
In the last few years there have been many studies which have evaluated the diagnostic
balancing between tumour control and quality of life.
performance of PET/MRI in oncological imaging, including paediatric oncological imaging.
This very innovative hybrid technique allows the simultaneous acquisition of metabolic
“During the follow-up, we ana-
lysed the timing of LR and distant
and anatomic information with a high soft tissue contrast resolution and a low dose
metastasis (DM), concluding that
in patients with localised STS after
radiation exposure. Another benefit is the option of adding various specific sequences like
curative surgery, rates of LR and
DM are highly non-constant over
diffusion weighted imaging (DWI), which can provide information about the cellularity of
time and strongly modified by
tumour characteristics. These find-
neoplastic lesions.
ings contradict a ‘one-size-fits-all’
aftercare policy and support the
concept of a time and risk-adapted
ric soft tissue sarcomas. Indeed, strategy for personalised post-sur-
we obtained a significant negative gical follow-up,” he explained.
correlation between the ADC and At present, patients are mainly
SUV mean, median and skewness being advised based on local expe-
values and a significant positive rience, but not always on evidence.
correlation between the ADC and Ewing sarcoma, previous resections of the right femur and lumbar spine. On PET/CT the metastasis in the left humerus is FDG positive, but the Allowing individualised treatment
SUV kurtosis values – both for the Ewing mets on this whole body MR metastases are visible on T1-weighted and metastasis in the right cranial vault is FDG-negative and only seen on the plans, this app might change that,
entire examined population and diffusion images in the left humerus, left femur, and right cranial vault. corresponding CT scan. The metastasis in the left femur is invisible on the according to van de Sande.
for rhabdomyosarcoma alone. This PET/CT scan. Note increased FDG uptake in left leg and foot secondary to “Radiology will help to further
evidence demonstrates that SUV Musculoskeletal tumours are a ious available treatment options, muscle activity. Provided by Prof. Johan Bloem. enhance the model in regard to
and ADC values correlate when the rare and diverse group; therefore, a in future, the aim is to better tailor tumour location, size and, in the
overall distribution of their val- wide range of tumours and tumour- treatment goals to the patient’s respond to treatment. Combining depending on the dynamic assess- future due to PET and dynamic
ues in the whole tumour is taken like conditions may be encountered needs. Imaging plays a key role in this information with patient char- ment of a patient’s prognosis. MRI, also biological behaviour. Also,
into account. when patients undergo radiologi- establishing the diagnosis, determin- acteristics allows us to make treat- During this session, van de Sande follow-up scans will be added to
Although these results need to be cal examinations. Because of the ing prognosis, selecting treatment ment decisions together with the plans to familiarise ECR delegates the model, helping to individualise
confirmed on a larger population, advent of new chemotherapeutic strategies, monitoring the treatment patient and to balance advantages with a multicentre analysis and the follow-up protocol in order to
they already suggest the necessity drugs and treatment regimens, and, effect, and detecting recurrence. and disadvantages of different the dynamically predictive Person- minimise hospital visits and anxi-
for a multifaceted approach for as a result of advances in imaging “However, until now only med- treatment strategies,” he said. alised Sarcoma Care model (PER- ety, and to maximise the screening
accurate investigation of tumours and surgical techniques, the prog- ical judgement, which is based The impact of treatment choices SARC), which supports shared deci- yield,” he concluded.
like sarcomas. We strongly believe nosis of patients with musculoskel- on imaging, has been used to set on survival chances and quality of sion-making in high-grade extremity Bloem and van de Sande will be
that this innovative approach will etal tumours has improved over the therapeutic goals, while a patient’s life will also be a central theme of soft-tissue sarcomas (STS). The joined by Prof. Marc-André Weber,
have a strong clinical impact, since last years, as Prof. Johan Bloem, needs and lifestyle were hardly the presentation of Dr. Michiel van model considers treatment modali- from the University Medical Centre
this type of analysis may provide from the department of radiology taken into account. Now, potential de Sande, from the department of ties, including applied radiotherapy Rostock, Germany, and Dr. Chris-
useful information not only in the at the Leiden University Medical benefits to the patient in relation orthopaedic surgery at the Leiden and achieved surgical margins, and tina Messiou, from the Royal Mars-
assessment of sarcomas at staging. Center, Netherlands, and chair of to potential difficulties, which arise University Medical Center, who, predicts overall survival as well as den NHS Trust, London, United
It may also have important impli- this session, will illustrate. in the course of the disease, such among other things, plans to dis- the probability of local recurrence Kingdom, who will discuss multi-
cations concerning the response “Diagnostic tests in combination as co-morbidities of treatment, cuss options that allow providing (LR) at three, five, and ten years. modality imaging in the treatment
to the therapy; allowing the eval- with systemic and focal therapy are complications, and loss of func- better individualised treatment To this end, an app was developed of bone and soft tissue sarcoma.
uation of post-treatment changes used to reach curative or palliative tion, as well as individual needs are strategies and strategies for per- to assist in shared decision making
in tumour characteristics in terms goals. The progress made in diag- becoming increasingly important. sonalised post-surgical follow-up. in clinical practice.
of functional and metabolic infor- nostic tests, treatment strategies, This is essential, as, for example, “Knowing if the sarcoma will return
mation. Our research group is and understanding the biologic a 19-year-old male, who spends remains the basic patient paradigm
therefore devoting great efforts to behaviour of tumours increases our most of the time in front of a PC, in cancer treatment and follow-up.
promoting this project, which is options to serve our patients,” he has completely different needs to All currently available prediction Special Focus Session
expected to further highlight the emphasised. a 50-year-old marathon runner,” models for sarcoma are applicable
revolutionary role of PET/MR in However, there is also another Bloem explained. only at the time of baseline, such Sunday, March 4, 08:30–10:00, Room N
oncologic imaging. side to the coin, as these develop- “Age has always been an impor- as at the time of diagnosis or sur- SF 17a New treatments for musculoskeletal tumours
ments increase therapy-related tant parameter when evaluating gery. Updated patient information
» Chairperson’s introduction: What is changing?
Dr. Alessia Varotto is a radiology morbidity, diagnostic test-related musculoskeletal tumours, however, during the follow-up and changing
J.L. Bloem; Leiden/NL
resident at the Radiology Section anxiety, follow-up invasive proce- against the background of an aging covariate effects over time may
A 9-year-old boy with a Ewing sarcoma of the left fibula (orange arrow in A, B and C) demonstrating restricted diffusion on the ADC map (A) and pathologic of the Department of Medicine – dures and costs. population and major differences change the prognosis. However, » New treatment paradigms in orthopaedic oncology
uptake at PET (B). Fused PET/MR image of the same lesion in C. Volumetric representation of the tumour (D), used for histogram analysis. (Copyright: DIMED at University of “The current challenge is to use in regard to lifestyles, it is no longer this is not taken into account in M.A.J. van de Sande; Leiden/NL
Radiology Sections and Nuclear Medicine Unit, Department of Medicine – DIMED, Padova University, Italy) Padova, Italy. our diagnostic and therapeutic sufficient,” he added. currently available models,” van de » Multimodality imaging in treating and monitoring
means to increase not only survival Bloem plans to specifically out- Sande explained. bone sarcoma
chances, but to also preserve qual- line the demand for new treatment The concept of dynamic pre- M.-A. Weber; Rostock/DE
Assuming that a lesion with high and that a ROI-based approach now no similar evidence has been the histogram analysis can pro- ity of remaining life, while involving concepts. “The combination of diction allows the inclusion of
» Multimodality imaging in treatment and surveillance
cellularity lesion may also have a is apparently insufficient when produced with respect to paediatric vide a better insight into paediat- the patient’s opinion into decision morphological and especially func- updated information on the status
of soft tissue sarcoma
high metabolism, several studies it comes to reflecting these sarcomas. making processes,” Bloem noted. tional imaging with MR and PET/ of the disease, patient character-
C. Messiou; London/UK
have tried to evaluate if there is a complex structures. The aim of our study was there- As medical treatment is becom- CT provides detailed information istics and imaging results during
correlation between regions-of-in- It has been demonstrated fore to use histogram-based anal- My Thesis in 3 Minutes ing more individualised due to a on the phenotype of the tumour. the follow-up, which can be used » Panel discussion: Increasing quality of life in sarcoma patients
terest (ROI)-based DWI (i.e. primar- recently that histogram-based anal- ysis to evaluate the relationship better understanding of tumour Thus, it is possible to better predict to provide better individualised without decreasing survival. What is needed from an imaging
ily using apparent diffusion coef- ysis which collects SUV and ADC between simultaneously acquired Sunday, March 4, 10:30–12:00, Sky High Stage pathophysiology in relation to var- how the tumour will behave and treatment and follow-up options perspective to allow and support this?
ficient (ADC)min and ADCmean values from the entire volume of ADC and SUV values collected MY 18 Paediatric
values) and PET values (i.e. using a neoplastic lesion enables better from paediatric patients affected
standardised uptake (SUV)mean assessment of the complex heter- by sarcomas examined at staging Moderators: M. Haliloglu; Ankara/TR
and SUVmax values) in tumours. ogeneity of tumours and evaluates by [18F]-FDG PET/MR (fully inte- P. Toma; Rome/IT
Controversial results have subse- more accurately the relationship grated system). Our preliminary
» Volumetric histogram-based analysis of SUV and ADC
quently been published demon- between their metabolic activity results presented at ECR 2018, while
values for the assessment of paediatric sarcomas at staging:
strating that neoplastic lesions and cell-density. For instance, very derived from a very small popu-
preliminary results of a PET/MR study
have different characteristics and encouraging results for sarcomas lation (ten patients; five affected
A. Varotto1, G. Orsatti1, F. Crimi1, D. Cecchin1, P. Zucchetta1,
behaviours, probably due to their in adults have been obtained, but by rhabdomyosarcoma), are very
M. Weber2, R. Stramare1, C. Giraudo1; 1Padua/IT, 2Vienna/AT
highly heterogeneous architecture, to the best of our knowledge until promising and demonstrate that
#ECR2018 myESR.org myESR.org #ECR2018
16 CLINICAL CORNER ECR TODAY | SUNDAY, MARCH 4, 2018
BY MAGALY ZAPPA
Does MR imaging help to
evaluate intestinal fibrosis?
Results with a murine model
of radiation-induced colitis
biomarkers of inflammation in ysis (inflammation and fibrosis) discrimination of the two groups
humans have been determined by of the resection pieces. Fat-sup- (and, particularly, combinations
several studies with correlations to pressed T2- and T1-weighted, dif- including perfusion) and confirm
resected specimens and are consist- fusion-weighted, magnetisation the significance of a multiparamet-
ent. On the other hand, the recog- transfer and perfusion using ric approach.
nition of MR signs correlated with ASL technique 7T MR imaging The next considerations are now
fibrosis showed discordant results was performed. to test these sequences to evaluate
in available studies. The main diffi- All sequences showed significant antifibrotic treatments currently
culty in identifying these possible differences between irradiated and under development and to trans-
imaging biomarkers of fibrosis is control rats and between inflamma- pose these sequences to patients
Images from an irradiated rat from the mixed group (transmural fibrosis), the individualisation from inflam- tion and mixed groups. Sequences to evaluate intestinal fibrosis and
showing layered thickened bowel wall. (A) Axial fat suppressed T2-weighted mation within a stenosis since it with the best AUC to differentiate improve patients’ management.
images; (B) Axial fat suppressed T1-weighted image; (C) Axial magnetisation is now well known that inflamma- the two groups were T2-weighted
transfer map image. Images provided by Beaujon Hospital tion and fibrosis coexist. For this, intensity, diffusion, and magneti- Magaly Zappa, MD, PhD is a
the development and evaluation of sation transfer. These sequences radiologist at Beaujon Hospital,
Crohn’s disease is a chronic formation which are the main indi- new MRI sequences require the use are particularly interesting in com- APHP in Paris, France.
inflammatory bowel disease char- cations for surgery. The current of animal models of fibrosis. binations, which allow a better
acterised by transmural bowel wall challenge of therapeutic research is In our study, we evaluated MR
inflammation with recurring peri- to limit the aggravation of parietal sequences to distinguish inflamma-
ods of exacerbation and remission damage related to inflammation, tion from fibrosis using an original Scientific Session: Abdominal and Gastrointestinal
of inflammation. Almost all cur- to improve mucosal healing and to model of radiation-induced colitis
rently used treatments are effective develop anti-fibrotic treatments. To with a single-dose radiation of 27 Gy Sunday, March 4, 14:00–15:30, Room X
in their anti-inflammatory action test the efficacy of these potential of gamma irradiation delivered by a SS 1901c Inflammatory bowel disease: what next?
and give good results on the remis- treatments as well as to evaluate cobalt 60 source through a window
sion of relapses and the reduction fibrosis in bowel stenosis in order centred on the colorectal region. We Moderators: S. Kinner; Essen/DE
of inflammatory lesions. to select patients, it becomes neces- included a ‘control’ group of 10 rats, N.N.
However, it’s well known that sary to have reliable biomarkers of an ‘inflammation’ group of 24 rats
» 7 T MR imaging for fibrosis evaluation in a radiation-induced
when inflammation becomes intestinal fibrosis. (with inflammation and submu-
murine model of colitis
chronic, it drives excessive produc- Beyond disease mapping and cosal fibrosis) and a ‘mixed’ group
M. Zappa1, S. Doblas2, D. Cazals-Hatem1, F. Milliat3, P. Garteiser2,
tion of the extracellular matrix the search for complications, MRI of 39 rats (with inflammation and
M. David1, V. Vilgrain1, B. Van Beers1, E. Ogier-Denis2; 1Clichy/FR,
which leads to fibrosis, causing has taken a central place in the transmural fibrosis). MR data were
2Paris/FR, 3Fontenay-aux-Roses/FR
luminal narrowing and stricture evaluation of inflammation. MR compared with a histological anal-
BY LUÍS PEDRO VIEIRA RIBEIRO
Evaluation of burnout
syndrome in radiographers
As radiographers face a wide can culminate in suicide. The devel- approach and levels of prevention. This research is one more con- presentations within the radiogra-
range of psychosocial stress fac- opment of addictions has also been Preventive approaches to be consid- tribution to the knowledge about pher programme, but this specific
tors in hospital environments, they associated with burnout. Common ered are both modifications in the burnout syndrome among radiog- presentation entitled ‘Evaluation of
are at a high risk of developing somatic symptoms are headaches, working environment (prevention raphers, especially because younger burnout syndrome in radiographers’
burnout syndrome. gastro-intestinal disorders or car- of circumstances) and also improve- radiographers present such high will be held today at 14:00 in Room
Burnout is defined as a psy- dio-vascular disturbances. ments in the individual’s ability to levels of burnout. It is necessary to K, and we will be very grateful if you
chological syndrome of chronic For radiographers, similar to other cope with stress (behavioural pre- fight the causes of burnout in order could attend and make contribu-
exhaustion, cynicism, and inefficacy, health professionals, being in the ventive measures). According to to not compromise the healthcare tions. We hope to see you there!
and is experienced as a prolonged ‘front line’ of patient care can be the World Health Organization, the service they provide.
response to chronic stressors in the more or less stressful depending on levels of prevention can be divided We would like to invite you to Luís Pedro Vieira Ribeiro is Head
workplace, which in turn may affect the individual and the clinical con- into primary preventive measures come to our session and to find out of the Medical Imaging and
hospital outcomes such as the qual- text. The risk of burnout is influ- (avoidance/removal of factors that more about the lines of research in Radiotherapy Department at the
ity and safety of provided care. This enced somewhat by the extent of the make the illness), secondary meas- our department (e.g. we are expand- University of Algarve, Portugal.
issue is very important since radiog- stress factors and deficits in personal ures (early recognition-intervention ing and applying this work to the He would like to thank his co-
raphers are present at the first con- resources, but mostly by social sup- of manifest disease), and tertiary radiotherapy and nuclear medicine authors from the same department,
tact with the patient, especially in an port systems and coping strategies. measures (coping with the conse- fields), so please don’t miss our pres- V.R. Luiz, A.F.C.L. Abrantes,
emergency, where it is necessary to In our research, to assess the level quences of disease-rehabilitation entations at the Radiographers Ses- K.B. Azevedo, R.P.P. Almeida, S.
be fast, effective and efficient. of burnout, we used the Maslach and relapse prophylaxis). The con- sions. Our department has several Rodrigues, and N.F. Pinto.
The symptoms of burnout are Burnout Inventory, introduced in cepts for behavioural preventive
usually multidimensional with 1981 (Maslach & Jackson), which is measures presented in the literature
several psychiatric, psychosomatic, widely used in the diagnosis of this focus on primary prevention and Scientific Session: Radiographers
somatic and social disorders. The syndrome. It is a self-assessment belong to the ‘domain’ of psychology.
main psychiatric symptoms are, questionnaire consisting of 22 items A high number of radiographers Sunday, March 4, 14:00–15:30, Room K
in addition to chronic fatigue and to evaluate emotional exhaustion, experience occupational burnout. SS 1914 Professional issues in radiography
continuous exhaustion, above depersonalisation and reduced per- Most of them report as causes the
all described as ‘mental dysfunc- sonal accomplishment. pressure to complete patient lists Moderators: S.O. Schönberg; Mannheim/DE
tion’. This includes concentration In the healthcare context, imple- and the fact that they can only N.H. Woznitza; London/UK
and memory disturbances, a lack menting measures to prevent spend such a short amount of time
» Evaluation of burnout syndrome in radiographers
of drive and personality changes. burnout is extremely important. with each patient. The number
V.R. Luiz, L.P.V. Ribeiro, A.F. Abrantes, K.B. Azevedo, R.P. Almeida,
Severe disturbances are anxiety Burnout syndrome can be differen- of weekly working hours is also a
S. Rodrigues, N.F. Pinto; Faro/PT
and depressive disturbances, which tiated according to the preventive major issue.
#ECR2018 myESR.org