ECR TODAY WEDNESDAY, FEBRUARY 27 - European Society of Radiology
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WEDNESDAY, FEBRUARY 27 ECR TODAY
GRAND OPENING
ECR 2019
OPENING WORDS
Lorenzo E. Derchi; Genoa, Italy
ESR President
PRESENTATION OF ESR HONORARY MEMBERSHIP
Michael G. Kawooya; Kampala, Uganda
Federico G. Lubinus; Bucaramanga, Colombia
Vijay M. Rao; Philadelphia, USA
PRESENTATION OF ESR GOLD MEDALS
Anna-Maria Belli; London, UK
Luis Donoso Bach; Barcelona, Spain
Valentin E. Sinitsyn; Moscow, Russia
KEY LECTURE: BUILDING PUBLICS
Sir David Adjaye; London, UK
LIVE CONCERT
Dorretta Carter
Vienna Arts Orchestra, conductor Alex Johansson
Neue Wiener Stimmen, choir
Wiener Sängerknaben, choir
Conceptual Artist, Director, Stage & Video Designer
Amra Bergman
Musical Director
Erich Hofmann
ECR TODAY 2019 EUROPEAN CONGRESS OF RADIOLOGY
DAILY NEWS FROM EUROPE’S LEADING IMAGING MEETING | WEDNESDAY, FEBRUARY 27, 2019
2 9 17 25
HIGHLIGHTS CLINICAL CORNER TECHNOLOGY & RESEARCH COMMUNITY NEWS
Welcoming all radiographers to Imaging biomarkers start to ECR 2019 sees digital x-ray manufacturers Leading interventional radiologist
ECR 2019 come of age in early detection focus on workflow and efficiency receives ESR Gold Medal
of cancer
BY LORENZO E. DERCHI, ESR PRESIDENT
Welcome to ECR 2019!
Welcome to the 25th ECR in Vienna!
Thanks for coming to be a part of ‘the bigger picture’!
ECR 2019 marks an important selected posters could be explained part in ‘the bigger picture’ has been
anniversary. This will be the 25th in person by their authors. Last demonstrated by the record num-
ECR congress held in Vienna since year, the ‘MyT3’ presentations, ber of high-quality abstracts we
1991: a great achievement! Those the lounge meetings of ‘Coffee & received. I have to deeply thank
who have been coming here since Talk’ and the hands-on approach the many colleagues who have
the beginning will find a meeting to interventional radiology of ‘the submitted the results of their stud-
that has become bigger over the Cube’ were introduced. All these ies for consideration at the meet-
years, now including not only the session formats have proved suc- ing. We have tried to increase the
Austria Center, but also many of the cessful and will be continued, and number of scientific sessions in
buildings surrounding it. even expanded, this year. Further- order to accommodate the major-
It is a true ‘congress city’, which more, an additional new session ity of them and give the chance of
has grown to accommodate the type will be launched, not only for active participation to as many as
increasing numbers of delegates ECR delegates, but also open to any- possible.
from all over the world. Those one who is interested in joining in. A high number of abstracts
who are here for the first time will The ‘Women in Focus’ initiative will has been received from the ‘ESR
discover a congress with a wide explore the challenges encountered meets’ countries. These will be
range of opportunities to learn by women in our field and in other Italy, my home country, Pakistan,
about the different aspects of our medical and medical-related pro- and the whole African continent.
specialty, with sessions suited to fessions. It will open a debate over The ‘ESR meets’ initiative provides
all, from beginners to advanced gender parity in our profession and the chance to get to know our col-
professionals. will try to present role models to leagues from these places better
Over the years, the ECR has pro- whom the ever-increasing number and, when meeting radiologic socie-
vided radiologists with a European of women entering into radiology ties from other continents, to learn
platform for the presentation of can relate. how these colleagues work and live,
research and debate and has been The 25th ECR in Vienna can be to strengthen relationships and to
the key to the creation of a commu- considered as a chance to reflect create friendships with them. This
nity of people working together and on the journey of European radi- year, for the first time, we will meet
advancing in science and education ology through the past years and many radiologists from Africa. We
together. This has been the result as a starting point for the future. will try to understand what the
of the efforts of 24 Congress Pres- This is why it has been called ‘the European Society of Radiology
idents and Programme Planning bigger picture’. The concept is can do for them and, at the same ESR President Prof. Lorenzo E. Derchi is Head of the Department of Radiology
Committees who, with the help of reflected in the educational pro- time, what we can learn from their at the University of Genoa, Italy.
the well-structured and dedicated gramme, in which basic sessions experience.
efforts of the ESR Scientific Pro- for students and a state-of-the- Three well-known leaders in dif-
gramme Department, have worked art programme for residents and ferent fields of radiology will hold image-guided tumour therapy: to the submitters of the best radiog-
as if they were in a relay team, pass- young radiologists sit side-by-side this year’s Honorary Lectures. have we opened Pandora’s Box or rapher abstracts.
ing the baton from one to the next with discussions on the future of Prof. Paul S. Sidhu’s lecture is enti- found the Holy Grail?’ If you cannot come to Vienna
and ensuring continuity of aims our discipline. The impact of arti- tled ‘Contrast-enhanced US in pae- The European Congress of Radi- (someone has to remain home and
and good results over the years. ficial intelligence on our work, diatrics: ready for clinical practice?’ ology will see not only radiolo- do the tough work), you can watch
The ECR has always been a cre- the new diagnostic horizons pro- and will address a technique that gists taking part, but also delegates ECR Online! Almost all sessions will
ative meeting. It started with a vided by liquid biopsy, the need is not widely used and whose ben- working in all allied sciences. There be broadcast live for you to watch
‘classical’ structure, made up of to increase the visibility of radiol- efits are not yet fully explored. Prof. will be a number of educational and from home. Furthermore, they will
refresher courses, scientific pres- ogy and to develop respectful and Regina Beets-Tan will discuss the scientific sessions specifically dedi- be recorded and made available
entations and posters, and, over the fruitful relationships with patients new frontiers of oncologic imaging cated to radiographers. The Euro- to watch on demand later (often
years, has incorporated various new in everyday clinical practice, and in her lecture ‘Oncologic imaging: pean Federation of Radiographer as soon as the same evening). You
ways for contributors to present the challenges that medical doc- a new beginning has just begun’. Societies (EFRS) has made the ECR can even use ECR Online here in
scientific work. The first big inno- tors have to meet in dealing with Finally, Prof. S. Nahum Goldberg its flagship meeting and this year Vienna, to watch presentations you
vation was in 2003, with the intro- humanitarian emergencies, are will explore the extent of the poten- there has been a larger number of were not able to attend. There will
duction of the electronic posters of only a few of the important topics tially beneficial and harmful sys- abstracts submitted by radiogra- be ample lounges where you can get
EPOS. Then, in 2016, came the new we will discuss. temic effects of ‘focal’ interven- phers than ever before. Once again,
session format ‘the Voice of EPOS’ The willingness of the radiolog- tional oncologic radiology by asking the ESR/EFRS Joint Radiographer
in which the scientific message of ical community to play an active the question ‘Systemic effects of Abstract Awards will be presented continued on page 2
myESR.org #ECR2019
2 HIGHLIGHTS ECR TODAY | WEDNESDAY, FEBRUARY 27, 2019
continued from page 1 tions at the end of the presenta- our science and way of practice with tions that are not only professional ence and care. We have all worked
tions, talk with other colleagues, colleagues of other nations; to grow but have become, for many, per- to achieve the harmonisation of
some rest and take the opportunity liaise, and socialise. The annual ECR and learn how to provide a better sonal bonds of respect and friend- radiological teaching, practice and
to see those sessions you could not is THE place where the European service to our patients. We can find ship. Over the 24 ECRs held in the research in Europe. There is still a
quite squeeze into your schedule. community of all radiology profes- here an international horizon for past years, we have contributed to lot to do. May ‘the bigger picture’ of
Above all, everyone will take the sionals meets. We all come here to our research through the creation creating a community of radiol- this 25th congress in Vienna be the
opportunity to discuss, ask ques- increase our knowledge; to compare of links among people and institu- ogists advancing together in sci- starting point for further unity.
BY JONATHAN MCNULTY, EFRS PRESIDENT
Welcoming all radiographers
to ECR 2019
Radiographers have long been involved in the European Congress of Radiology (ECR),
and the European Federation of Radiographer Societies (EFRS) has had responsibility for
developing the radiographers’ sessions since ECR 2012. However, it is only in recent years
that the ECR has become the official scientific congress of the EFRS, and the European
Society of Radiology (ESR), for medical imaging radiographers.
Over the past eight congresses, versity Hospital, Iceland, who are this area. The radiographers’ Voice promises to be another fantastic
the radiographers’ programme has the co-chairs of the 2019 radiogra- of EPOS stage will also be located social event for radiographers on
grown considerably, as has the par- phers’ scientific subcommittee, and in the lounge area, as will a num- Thursday, February 28, where Pro-
ticipation of radiographers. A total to their team for an excellent edu- ber of research studies, requiring fessor Derchi and I look forward to
of 2,177 radiographers and radiog- cational and scientific programme. your participation, which will take hosting over 500 radiographers on
raphy students, from 75 countries, Aside from the above sessions, we place in the EFRS Radiographers’ the night.
attended ECR 2018 and we look for- also look forward to the radiogra- Research Hub (Room 2.96). The The EFRS represents over
ward to welcoming even more to phers’ Voice of EPOS sessions, the Radiographers’ Lounge will thus be 100,000 radiographers and over
ECR 2019, which has now become involvement of radiographers in a a great meeting place and, together 8,000 radiography students, across
one of the largest international series of sessions at the Cube 2.0 with the rest of the EFRS Executive 35 countries, through 40 national
gatherings of radiographers. (a special programme dedicated to Board, I look forward to meeting societies, along with 60 universi-
In 2018, a total of 22 refresher interventional radiology), and the you in this area and seeing you at ties within our Educational Wing.
courses, professional challenges EFRS Educational Wing annual the radiographers’ sessions. The EFRS is proud to collaborate
sessions, special focus sessions, meeting and our student session. Following the launch of the with the ESR on what has become
joint sessions, Rising Stars sessions, At ECR 2019, Room C on the 2nd ESR/EFRS Radiographer Awards the biggest and best programme
MyT3 sessions, and scientific ses- level will become the new venue and the Radiographers’ Evening for radiographers. We look for- Dr. Jonathan McNulty is Associate
sions made up the radiographers’ for most of the sessions in the radi- last year, both initiatives will con- ward to continuing our work with Professor and Associate Dean of
programme. For ECR 2019, this will ographers’ programme. The Radi- tinue for ECR 2019. I look forward the ESR to grow the radiographers’ Graduate Studies at University
rise to 28 sessions, which will truly ographers’ Lounge has also been to jointly presenting, with the con- programme along with the partic- College Dublin School of Medicine in
offer something for everyone. A spe- relocated to Foyer C (outside Room gress president Professor Lorenzo ipation of radiographers and radi- Dublin, Ireland, and President of the
cial word of thanks must go to Dr. C). In this area, the EFRS and ESR E. Derchi, the Best Radiographer ography students from around the European Federation of Radiogra-
Andrew England from the Univer- will welcome 20 national radiogra- Paper Abstract awards, the Magna world. pher Societies.
sity of Salford, UK, and a member of phers’ societies, along with some Cum Laude Radiographer Poster On behalf of the EFRS and the
the EFRS Educational Wing Man- educational institutions, who are awards, and the Best Radiography ESR, we hope that you have a great
agement Team, and Dr. Maríanna members of the EFRS Educational Student Abstract award during congress and look forward to meet-
Garðarsdóttir from Landspitali Uni- Wing, who will all have booths in the ECR. Do not miss out on what ing with you over the coming days.
W E LC O M E TO E C R C I T Y 2 0 1 9
4
1 Austria Center Vienna (ACV) 5 The Church
Main Congress Building Women in Focus
Registration Scientific Sessions
Grand Opening
1
Scientific Sessions 6 DC Box
ESR Connect Studio 3
2 M Building
International Village (National
Society Booths)
7 Tech Gate 2
Scientific Sessions Scientific Sessions
Meeting Rooms Rising Stars Lounge
Guerbet Patient Pathway and
Educational Programme
3 Expo 5
Technical Exhibition 8
AIX - Artificial Intelligence DC Tower
Exhibition & Theatre Interventional Radiology at 6
the Cube 2.0
Escape Room
4 Saturn Tower 7
Sky High Stage: CTiR and MyT3 Sessions 8
#ECR2019 myESR.org
ECR TODAY | WEDNESDAY, FEBRUARY 27, 2019 HIGHLIGHTS 3
BY MÉLISANDE ROUGER
Spotlight on radiology in Uganda
idency and we were overwhelmed MGK: Diffusion of ultrasound tic and treatment kits are scarce. how to adopt and adapt European
with work. Doctors were not willing in this setting has been explosive. Machines may be old with poor res- advances.
to undertake radiology residency, This may be due to the fact that we olution. Patients living in remote My first experience with the ECR
fearing that radiologists didn’t earn are starved of high-tech cross-sec- areas can’t access or afford the was in 1993 when I first attended
much. Equipment was scanty and tional imaging like CT and MRI, much-needed services. the meeting. Several of my col-
often malfunctioning. Many of and ultrasound has been termed ECRT: You helped found AFRO- leagues during my fellowship at
these challenges still exist today, but by others as the ‘poor man’s CT and SAFE.rad, a campaign for radia- the Eberhard Karls University in
to a lesser extent. Radiology is bet- MRI’. In Uganda, one finds an ultra- tion safety in Africa, a few years Tübingen, Germany, encouraged
ter understood and its role is now sound machine in almost every cor- ago. What are the first results? me to attend. At the end of the con-
evident. The number or radiologists ner of the small and major towns MGK: One major outcome is gress, as I boarded a plane to Brus-
has increased to almost 70. This year and cities. It is feared that many increased radiation safety aware- sels in which the then ESR Presi-
alone, 20 doctors took up radiology of these machines are manned ness by radiation workers, medi- dent, Prof Albert L Baert, also sat,
residency. The number and range of by untrained practitioners, but in cal workers and the public. There I said to myself we should also
equipment has also increased. fact many are manned by sonog- is a rising interest in the formu- form a similar society and con-
ECRT: Are there any regional raphers. In sub-Saharan Africa, lation of dose or diagnostic refer- gress in my country and in Africa.
Professor Michael G. Kawooya’s trends in radiology in Africa? Uganda can boast of having the ence levels (DRLs) and the use of The idea of USOFARI and PACORI,
contributions to improving bilateral MGK: The same challenges facing highest throughput of sonogra- clinical referral guidelines. There is the Ugandan and African societies
cooperation between Africa and radiology in Uganda bedevil most phers from our training institu- increased research in radiation pro- and congresses of radiology, began
Europe will be rewarded today as he of Africa, but North Africa, which tions. Sadly, some of these Ugan- tection. Collaboration and network- to form in my mind. As soon as I
receives ESR Honorary Membership. is largely Arabic, and South Africa, dan ultrasound graduates have ing among African countries and arrived in Uganda, I got together
which is wealthier, face fewer chal- been ‘brain-drained’ to Europe and with international organisations with colleagues and we decided to
lenges. In these parts of Africa, other regions. Ultrasound has been and campaign-platforms is grow- create these societies.
Michael Grace Kawooya is a Pro- radiology has flourished more com- maximally exploited in investiga- ing. The cause of these trends could Thereafter, I attended the ECR
fessor of Radiology at the Ernest pared to Central, East, and West tion of all parts of the body includ- also be multifactorial and not only for a few years and then ceased
Cook Ultrasound Research and Africa. The radiologist-to-popula- ing brain, chest, cardiovascular sys- AFROSAFE.rad. until 2013. Ever since then, I have
Education Institute and Profes- tion ratio is approximately 1:67,000 tem, musculoskeletal and others, ECRT: How is artificial intelli- attended the meeting every year. I
sor Emeritus at the Makerere in Egypt, 1:1,600,000 in Uganda and 1: whereas in developed countries one gence being implemented in radio- like the congress because I acquire
University College of Health Sci- 8,000,000 in Malawi. The more afflu- may use CT or MRI. logical practice in Africa? new knowledge and improve my
ences in Kampala, Uganda. He ent regions have higher numbers ECRT: What about the use of MGK: There is a budding inter- skills. I present at least one EPOS
has done much for the develop- and range as well as sophistication ultrasound in imaging tropical est in artificial intelligence (AI). In poster a year and that motivates
ment of radiology in his coun- of imaging equipment. They have diseases? Uganda, we are fortunate to have me. The EuroSafe Campaign, which
try and the rest of Africa, but says more radiology training institu- MGK: In diseases like bilharzia, an artificial intelligence laboratory I became familiar with at the ECR,
efforts must continue to increase tions and undertake more research. ultrasound plays a key role in epi- in the Main University of Makerere has been very inspiring and moti-
the number of radiologists and ECRT: Your research interest is demiological studies and is appli- and one student attempted a study vating, and was key in founding
range of equipment, and to raise ultrasound. Which new develop- cable in the diagnosis and ultra- on AI and breast cancer. Our ultra- AFROSAFE.rad.
awareness of radiation safety. ments do you use in daily practice? sound-guided therapy of hydatid sound training institute ECUREI I enjoy catching up with old
Kawooya believes Africa can learn MGK: In Uganda, we have disease (echinococcus), which con- has written up and submitted a pro- friends and making new friends.
a lot from European advances. His embarked on some of these devel- sists of aspiration of the liver cyst posal on AI in prostate cancer to an This coming year will be a very
contributions to improving bilat- opments, especially in the appli- and alcohol injection to kill the international funder. One major exciting year. I have always asked
eral cooperation will be rewarded cation of ultrasound in non-tradi- parasites. international search engine has myself when the ESR would meet
today as he receives ESR Honorary tional areas like anaesthesia, point In HIV/AIDS, ultrasound is valu- shown keen interest in supporting Africa, and it is happening this year!
Membership. of care, emergency medicine, mus- able in demonstrating abdominal the institute in undertaking proj- Africa can share its radiology chal-
ECR Today: How much has culoskeletal and nerves, oncology morbidity and co-morbidity, espe- ects in AI beneficial to Africa and lenges, victories, joys, culture and
radiology advanced in Uganda? and interventional radiology. cially tuberculosis, and is used to we are writing up concepts in this dreams with the rest of the world,
Michael Grace Kawooya: Back Other new, interesting devel- guide diagnostic procedures for regard. further cementing our friendship
in the late 1980s, radiology was very opments include the application obtaining tissue specimens, cells ECRT: What is your relationship and collaboration. And of course
new to medical practice in Uganda, of contrast agents elastography, and exudates. with European radiology and the I eagerly anticipate receiving the
and its contribution to healthcare machine learning and artificial The disease burden for some of ECR? highly esteemed ESR Honorary
was not well understood. It was not intelligence to ultrasound. these conditions is high and out- MGK: European radiology is very Membership.
given priority and was underfunded. ECRT: What has been your expe- weighs available resources equip- advanced in all areas. Much of what
There were only two radiologists in rience with ultrasound in a low-re- ment and trained manpower. is done in Europe is applicable to
the country when I finished my res- source setting? Resources for purchasing diagnos- Africa and we are glad to learn
BY MÉLISANDE ROUGER
Keep ultrasound close and generate
added value, Lubinus advises
Professor Federico G. Lubinus is full professor of radiology and director
of the radiology residency programme at the autonomous university
of Bucaramanga (UNAB) in Colombia. He is one of the leaders in South
American radiology and he believes that bringing back ultrasound to the
heart of radiological practice is key to the future growth of the specialty.
His efforts will be acknowledged today as he receives ESR Honorary
Membership.
to the rest of the world and a num- gists wondering about the role of the eties of South America to develop ficult to standardise programmes
Professor Federico G. Lubinus, who ber of regional trends, Lubinus specialty in the near future,” he said. and advance educational issues in and perform appropriate evalua-
will receive ESR Honorary Member- explained. “Big workloads, turf bat- But radiology practice in the con- the region. “Training is dependent tion of knowledge,” said Lubinus.
ship at today’s Grand Opening, is tles with other medical specialties, tinent is uneven and a major differ- on the regulations of each country. Lubinus is also director of the
one of the leaders in South American and challenges imposed by teleradi- ence concerns radiology training, There is great diversity both in the scientific committee of the Asoci-
radiology. ology and artificial intelligence are according to Lubinus, who cur- number of years of study required ación Colombiana de Radiología
some of the many difficulties we rently heads the Latin American to be a specialist and in the mini-
When it comes to radiology, South have to deal with, not only as radio- Educational Forum, a group that mum requirements demanded in
America has very similar challenges logical societies but also as radiolo- brings together radiological soci- each country, which makes it dif- continued on page 4
myESR.org #ECR2019
4 HIGHLIGHTS ECR TODAY | WEDNESDAY, FEBRUARY 27, 2019
continued from page 3 proper radiology legislation to regu- image-guided procedures and for “Current medical practice value, either by being part of expert
late practice and protect both radi- dynamic studies, which require an requires greater commitment in committees for decision-making or
(ACR), a society he served twice ologists and patients from illegal expert in ultrasound for examina- making diagnosis and forces us as image specialists who perform all
as president. Under his aegis, the exercise of the profession. This leg- tion performance,” he said. to be more accurate regarding the kinds of image-guided procedures
ACR worked to have a standardised islation has made it possible to pre- Furthermore, ultrasound diagnos- information that we include in the that do not need an interventional
training programme, a tool that is vent general practitioners and radi- tic and guidance procedures offer patient’s clinical history,” he said. radiologist to be involved, such as
now recognised by the Colombian ology technicians from performing the best strategy to deal with the The imaging departments of biopsies, drainages or guided infil-
ministry of education as the basis ultrasound, in addition to limit- challenges imposed by teleradiology large hospitals have had to adapt trations,” he said.
for evaluation and certification of ing the use of diagnostic images by and artificial intelligence (AI). “Any over time to meet a growing Lubinus, who has attended the
radiology graduates, and radiolo- other specialties only to their area radiologist who is willing to keep demand for image-guided diagnosis ECR for the last four years, particu-
gists who have received their certi- of expertise. his or her job in the hospital needs and treatment services in an envi- larly appreciates the creativity of
fication abroad. Keeping ultrasound as a major to become irreplaceable by perform- ronment that requires greater use the meeting, especially regarding
For the past four years, the Latin component of radiology is of major ing high quality ultrasound-guided of radiology services. Most radiolo- new ways to attract more radiolo-
American Education Forum has relevance to protecting the radiol- procedures and by getting directly gists, however, still perform image gists and make the congress more
also engaged in developing a stand- ogist’s current role as the expert in involved in the management of the interpretation without major inter- enjoyable to participants.
ardised academic residency pro- diagnostic imaging, according to patient,” he added. action with the patient or the refer- “I am very excited to see this new
gramme as a reference instrument Lubinus. “This is the area of radi- Radiology has become a cen- ring doctor. edition of the ECR, not only because
for the validation of qualifications ology that has been left behind by tral specialty in healthcare due to Being a good radiologist or an I am part of this ‘bigger picture’ pro-
of Latin American radiologists, to most radiologists, mainly in the the significant technological and expert in just one area of the spe- posed for the congress, but also
improve the much needed certifica- United States and in a large part IT advances made in the field. This cialty is no longer sustainable, Lubi- because of all the changes in tech-
tion and recertification in radiology. of Europe. They have given ultra- new positioning means that radiol- nus believes. nology and radiology practice that
Colombia is the only country in sound the role of purely a screening ogists must assume an increasingly “The challenge is to ensure that we see ahead of us,” he concluded.
Latin America, and one of the few method, forgetting its true value as clinical role and improve their per- radiologists and residents adapt to
countries in the world, that has a a real-time method for carrying out formance in imaging diagnostics. the new model and generate added
BY MÉLISANDE ROUGER
RSNA past president calls for more
international cooperation
Vijay M. Rao, MD, FACR is the David C. Levin Professor and Chair of the department of
radiology at Thomas Jefferson University. She is also senior vice-president of Enterprise
Radiology, Jefferson Health, and the immediate past president of the Radiological Society
of North America. As she receives ESR Honorary Membership today, she looks back on 30
years of work in a field she describes as globally united.
Radiology continues to evolve members of the patient’s health- champion of women in radiology, also the wide differences in access
from anatomic to more physiologic care team,” she said. working to provide opportunities to resources in healthcare,” she said.
and functional assessment of dis- The move toward value-based for networking and career devel- Global collaborations fostered
ease processes, with more precise imaging continues to be the biggest opment, increasing the visibility by the RSNA under her presidency,
quantification and minimally inva- trend in the US, where emphasis is of women in radiology, and most notably through RSNA Spotlight
sive therapeutic options. placed on volume when structur- importantly, supporting mentor- courses, have been particularly grat-
Rapid technological advances ing radiology practice. “Policymak- ing programmes. ifying for her. “These collaborations
have led to tremendous growth ers lack understanding of imaging’s “I would like to see more women with our international colleagues
in radiology along with associ- contribution to patient care and pursue such positions, but my have been extremely rewarding.
ated costs. But the digital age has the extent of services that radiolo- advice to both women and men Through an international exchange
introduced a number of previ- gists provide. That is why we have would be to seek out mentors, net- of ideas, we are able to join forces
ously non-existent opportunities begun the necessary transition to a work with your colleagues, join a with our colleagues throughout the
to transform radiology practice, value-based model of care, where society like the RSNA or the ESR world, so that our specialty contin-
using tools powered by informatics radiologists are actively consulting and find ways to volunteer. Seek ues to thrive.”
and machine learning (ML). “Radi- with patients and their referring out opportunities to interact with She attended the ECR for the
ologists should explore ways to uti- physicians as part of the health- your colleagues in other parts of first time in 2018 and was very
Professor Vijay M. Rao from Phila- lise these technological advances care team,” she explained. the world. It is these experiences impressed by the expansive con-
delphia, immediate past president of to add value and reduce waste in In research, she singled out that help us to grow and gain the gress and international scale. “I
the RSNA, will receive ESR Honorary healthcare,” she said. papers on gene therapy for can- insights and knowledge we need to really enjoyed the opportunity to
Membership today during the Grand Artificial intelligence (AI) and cer, resting state fMRI studies of become strong leaders,” she said. learn more about the ESR Meets
Opening. ML applications are valuable tools brain networks, PET radiotracers, Prof. Rao graduated from All countries, especially the cultural
that make radiologists more effec- biomarkers in lung cancer imaging, India Institute of Medical Sciences, presentations. I was struck by the
Radiology has come a long way tive and increase their contribu- and the explosion of deep learning India’s premier medical school, in common issues that unite radiolo-
from the days of plain film hyp- tions to personalised and precision applications. But radiologists “have New Delhi in 1973. She then com- gists across the globe, and found it
ocycloidal tomography in head medicine. “AI can assist radiolo- only begun to scratch the surface pleted her radiology residency in beneficial to share challenges and
and neck imaging, a subspecialty gists at a time when we are chal- of what artificial intelligence and 1978 at Thomas Jefferson Univer- possible solutions with interna-
to which Prof. Rao has dedicated lenged to provide imaging services machine learning can do,” she said. sity Hospital and has remained on tional colleagues,” she said.
most of her career. Technological that are faster, safer and afforda- Prof. Rao is the first female the faculty ever since. Her experi- She hopes the ESR will continue
innovations such as ultrasound, ble, as well as information that is chair of a clinical department at ence of two different cultures has its international programmes with
CT, MRI and PET have revolution- quantitative and precise. These Thomas Jefferson University, a enabled her to understand radiol- other societies, to provide its mem-
ised the field, allowing for earlier new technologies will improve past president of the American ogy on a more global scale. bers with learning opportunities
diagnosis and greater insights into workflows in our daily prac- Association for Women Radiolo- “Exposure to both cultures has and global perspectives on the
the pathophysiology of a host of tice, freeing up time for us to bet- gists, and immediate past presi- given me an appreciation of both issues that affect their practices.
diseases and conditions. ter position ourselves as integral dent of the RSNA. She has been a global advances in radiology and
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ECR TODAY | WEDNESDAY, FEBRUARY 27, 2019 HIGHLIGHTS 5
BY ANDREW ENGLAND
Radiographers’ sessions continue
RA
S
D
R
IO E
G R A PH
to expand at ECR 2019
The ECR is the official annual scientific meeting for radiographers in Europe, recognised by
both the European Federation of Radiographer Societies (EFRS) and the European Society
of Radiology (ESR). Continuing the tradition established by previous ECRs, there will, once
again, be a strong, up-to-date and comprehensive radiographers’ programme.
phers’ Lounge will be available out- EFRS will once again host its own out the congress, again with a spe- ity, with sessions on CT, MRI, dose
side of Room C as a break-out area ‘EFRS Meets’ session for radiogra- cial focus for radiographers. These optimisation, professional issues
and also as an important focal spot phers, in conjunction with repre- cover areas including #ECR2019: and mammography, to name but
for radiographers to meet, relax and sentatives of the Danish Society of social media in radiology (today, a few. A dedicated session on radi-
network. Alongside the Radiogra- Radiographers, Radiograf Rådet, 16:00–17:00), clinical audit across ography education will appeal to
phers’ Lounge will be the Radiog- during the EFRS meets Denmark Europe and paediatric radiation attending academics as well as
raphers’ Voice of EPOS Stage and session (Friday, 14:00–15:30). We look protection. A professional chal- those with an interest in training
booths from a range of radiogra- forward to hearing about the radi- lenges session has been developed, and education. The Voice of EPOS
phers’ societies. This will provide ography profession in Denmark which focuses on the very impor- sessions will also continue at ECR
further opportunities for radiogra- and sharing experiences. The EFRS tant issue of radiographer ‘burnout 2019 and will provide selected radi-
phers to engage and network with will also co-host a joint session with or bore-out’ (Saturday, 08:30–10:00). ographers with an opportunity to
their colleagues from around the the European Organisation for There will be two further special summarise their electronic post-
world. The EFRS will be located in Research and Treatment of Cancer focus sessions, the 3D printing lab ers verbally in four to five minutes.
this area together with the new on radiographers being at the heart from bench to bedside (Thursday, This initiative provides a massive
EFRS Radiographers’ Research of cancer treatment and research 16:00–17:30) and clinical simulation opportunity for radiographers to
Hub. For the first time, this will (Thursday, 16:00–17:30). Following and its role in radiography educa- develop presenting skills and dis-
Andrew England, PhD, is a Senior facilitate the collection of data on from this there will be a fur- tion (Friday, 08:30–10:00). seminate their research. There will
Lecturer at the University of Salford, for a number of radiographer-led ther joint session between the ESR/ Following the success of the ses- be a EuroSafe Imaging session on
United Kingdom, and Co-Chair of the research projects. EFRS on patient safety in medical sions for radiographers within the improving radiation protection in
Radiographers’ Scientific Subcom- A number of traditions will con- imaging (Saturday, 16:00–17:30). This Rising Stars programme in 2017 medical imaging for low and mid-
mittee for ECR 2019. tinue from ECR 2018, including session on patient safety is a suit- and 2018, these sessions have been dle-income countries (Friday, 16:00–
the Radiographer Awards which able adjunct to the recent publica- continued. Five sessions aimed 17:30). For radiographers with an
In recent years, we have seen will be presented by the EFRS and tion of a joint ESR/EFRS statement at radiography students and new interest in interventional radiol-
record-breaking growth in the ESR Presidents on Thursday at on the same topic. There will be an graduates have been planned and ogy (IR), the Cube 2.0 at ECR 2019
attendance of radiographers at the 11am. These awards will again rec- ISRRT meets Africa session with include topics such as radiography is an ideal opportunity. The Cube is
ECR. ECR 2019 will continue to grow ognise the winners of the best sci- a focus on radiographers offering research, radiation protection, a dynamic educational space ded-
and follow this trend with further entific paper/poster and student imaging services in Africa (Friday, career planning, the future of icated to the field of IR. Four days
increases in the presence and vis- abstracts. There will also be the sec- 16:00–17:30). radiology and clinical dilemmas. of IR-specific activities have been
ibility of radiographers. To accom- ond ‘bigger’ ECR Radiographers’ The radiographers’ Refresher Don’t forget you can also catch planned with radiologists, radiog-
modate the growing demand, a Social Evening, co-hosted by the Course programme will commence up with any sessions you missed raphers and nurses in mind. Ses-
number of additional sessions spe- presidents of the EFRS and ESR. with a session on forensic imag- via ECR Online – as sessions are all sions are designed to be immersive
cifically targeted at radiographers This will take place on Friday, with ing (today, 08:30–10:00). This ses- recorded for both live and on-de- and hands-on, covering peripheral,
have been introduced into the sci- a visit to a local Viennese vineyard, sion will provide insights into the mand viewing! central, oncological and neurologi-
entific programme. As a result, the and provide a further opportu- role of radiographers in forensic With the record number of cal IR.
new ECR 2019 radiographers pro- nity for networking and socialising. imaging and will help to highlight abstract submissions this year, the Finally, there are plenty of other
gramme yet again promises to be Demand is likely to be high and I the associated challenges. A fur- scientific sessions are once again sessions throughout the entire
world-leading and spectacular. would encourage all radiographers ther four Refresher Courses are packed with a very interesting and congress with either radiographer
New to ECR 2019 is the hosting to try and secure tickets early. planned, including sessions on the diverse range of research topics. involvement or interest.
of radiographer sessions in Room C The EFRS will again host a num- topics of hybrid imaging, radiog- The quality of submissions remains On behalf of the ECR 2019 Radi-
(Level 2), which will serve as a hub ber of interesting sessions. The first raphy audit and quality manage- high and at ECR 2019 there will be 11 ographers’ Scientific Subcommit-
for radiographers to meet and net- will be a dedicated EFRS Workshop ment, breast imaging and ultra- proffered paper scientific sessions. tee and the EFRS, we hope that you
work during the congress. Similar on ‘growing radiography research’ sound. A number of Coffee & Talk Abstracts have been arranged pre- have a very enjoyable and reward-
to previous years, the Radiogra- (Saturday, 14:00–15:30). Secondly, the sessions will take place through- dominantly according to modal- ing congress.
The Artificial Intelligence
Exhibition (AIX)
Making its grand debut at ECR 2019, the AIX brings the hottest topic
in radiology to the heart of the technical exhibition.
Whether you’re exploring AI for the first time, researching it, or just
want to chat about the future over a free juice at Algorithms Bar,
the AIX is a must visit at ECR 2019!
The AIX is located in the X1 hall.
For more details, and the full
AIX Theatre programme, visit
www.myESR.org/ai
myESR.org #ECR2019
ET2019
EUROPEAN CONFERENCE ON EMBOLOTHERAPY
EARLY BIR
FEES UNTI
MARCH 21
D
L
!
EMBOLOTHERAPY
The latest addition to the CIRSE conference family
focusing exclusively on a key area of interventional radiology:
embolisation in all its applications.
June 26-29 | Valencia | Spain
M A S T E R I N G E M B O L I S AT I O N
Some highlights from the ET 2019 programme
Special Topic Sessions
Examining the current evidence on new or controversial developments
in embolotherapy.
Technical Focus Sessions
Highlighting the latest trends in specific embolic materials, delivery
systems and advanced guiding modalities.
Case Remedy Sessions
Featuring case discussions including therapy options, technical aspects,
outcome and follow-up.
Morbidity and Mortality Conferences
Looking at the “bad days” as well as the “good days” in the angiosuite.
www.ETconference.org
Cardiovascular and Interventional Radiological Society of Europe C RSE
ECR TODAY | WEDNESDAY, FEBRUARY 27, 2019 HIGHLIGHTS 7
BY VIVIENNE RAPER
Italians make effective use of
O
NC IC C HE ST
OLO G
multidisciplinary team approach
to combat lung cancer
Multidisciplinary care and personalised medicine
have developed hand-in-hand over the last few years.
At today’s session, five Italian specialists in lung
cancer will be looking to the future and discussing
how developing the right strategy can make a
substantial difference in diagnosing and managing
lung cancer.
Dr. Anna Rita Larici, an assistant “Nothing can be done in a proper algorithms, with more sub-stages
professor of radiology at the Agos- way in the diagnostic and therapeu- being added. Although this makes
tino Gemelli University Hospital in tic fields without the co-operation the radiologist’s job harder, the ben-
Rome, is an enthusiastic advocate of of different specialists, such as the efits to clinicians include knowing
multidisciplinary care for lung can- oncologist, pulmonologist, patholo- when not to intervene.
cer patients. She recalls a case from gist, radiologist, radiotherapist and He gave the example of a 67-year- Regular meetings of the multidisciplinary lung cancer team play an essential
earlier this year in which a patient surgeon,” she noted. old female smoker with chronic role in determining an appropriate care plan at the Agostino Gemelli Univer-
was referred to her hospital after Multidisciplinary teams are com- obstructive pulmonary disease sity Hospital in Rome. (Provided by Dr. Anna Rita Larici)
multiple investigations elsewhere. mon in Italian university hospitals, (COPD) and a non-solid 1.5cm lesion
“He underwent several diagnos- according to Larici, although they of the upper lung. Improved imag-
tic tests, including CT and PET/ are less widespread in small periph- ing criteria and a multidisciplinary
CT scans, and invasive procedures, eral hospitals. They improve clini- view of the patient allow the weigh-
notably transthoracic biopsy and cal decision-making by bringing spe- ing up of surgery risk in patients A B
endobronchial ultrasound biopsy, cialists together in the same room with multiple co-morbidities. This
before it was demonstrated that to discuss cases. In her hospital, the could lead to the patient’s tumour
his lung lesion was not cancer, but team analyses patient information being managed conservatively
pneumonia,” she explained. and comes to a joint clinical decision. unless a solid component appears,
Larici, who is president of the “We start from images,” she said. avoiding an unnecessary lobectomy,
College of Thoracic Radiology of “Imaging is the core of the meeting. he said.
the Italian Society of Medical and The expert chest radiologist puts The treatment guidelines have
Interventional Radiology (SIRM), forward the diagnostic hypothe- changed in response to personal-
believes the patient didn’t receive sis in the case of an indeterminate ised medicine, with suggestions
correct management. “He under- lung lesion, taking into consider- on alternative treatments after
went several ‘non-useful’ investiga- ation imaging characteristics and the tumour becomes resistant to
tions because he wasn’t dealt with, available clinical data, or defines initial therapy. According to Silva,
from the beginning, in a multidisci- the clinical stage or re-stage after the faster new drugs are devel-
plinary context,” she said. treatment of a known lung cancer, oped, the more options clinicians
Lung cancer remains a leading and the further management of the have to combat drug-resistant
cause of mortality worldwide and patient mainly depends on these tumours, and the longer patients
is responsible for more than 2 mil- evaluations.” may survive.
lion cases and more than 1.75 mil- Personalised medicine has come With patients moving through
lion deaths each year, according to hand-in-hand with multidiscipli- a succession of treatments, can- Multidisciplinary team meetings at the Agostino Gemelli University Hospital
recent data from the World Health nary teamwork, Novello explained. cer no longer progresses in a sys- are always well attended. (Provided by Dr. Anna Rita Larici)
Organization (WHO). Physicians have access to a wider tematic predictable way, explained
“Diagnosis and therapeutic man- range of treatment options, includ- Novello. Instead, there may be
agement of patients with lung can- ing drugs that may only benefit a progression at one or two disease
cer is a challenging topic and the certain percentage of patients. sites, despite an overall improve- Multidisciplinary Session
overall death rate hasn’t signifi- “With personalised medicine, the ment in the patient’s condition.
cantly improved for several dec- overall survival rate is increased in Radiological imaging may need Wednesday, February 27, 08:30–10:00, Room K
ades,” said Larici. “But nowadays we a substantial proportion of patients to be interpreted differently and MS 1 Lung cancer team
have new possibilities to customise with lung cancer,” said Dr. Mario treatment targeted to individual
care for these patients”. Silva, assistant professor in radiol- metastases. »»Chairperson’s introduction
This inspired her to agree to mod- ogy at the Department of Diagnos- In his talk, Silva will also briefly A.R. Larici; Rome/IT
erate today’s session, which will focus tic Imaging, University of Parma, discuss new technologies to »»Imaging and staging
on the different roles in a multidisci- and researcher in Lung Cancer improve staging. Spectral CT, which M. Silva; Parma/IT
plinary team, with talks from experts Screening at the National Cancer relies on advanced scanner tech- »»Role of the pathologist: making the most of the sample
in imaging, pathology, oncology, and Institute of Milan. nology, can detect abnormalities in G. Rossi; Ravenna/IT
surgery. Among them is Prof. Silvia Silva will be talking about can- the distribution of contrast agent
»»Role of the oncologist: personalising the treatment
Novello, professor of medical oncol- cer staging using the 8th edition of in the neoplastic tissue to better
S. Novello; Orbassano/IT
ogy at the University of Turin, Italy. the TNM Classification of Malig- pinpoint the tumour’s evolution.
She too is convinced that current and nant Tumours. He explained that He believes it may develop into an »»What the surgeon needs to know
future developments in lung can- personalised medicine and tech- alternative to PET, the current ref- U. Pastorino; Milan/IT
cer treatment are due to the work of nological development have led to erence standard for non-invasive »»Multidisciplinary case presentation and discussion
multidisciplinary teams. an increased complexity of staging lung cancer staging. A.R. Larici; Rome/IT
CLINICAL TRIALS Watch and listen to the results
at the SKY HIGH STAGE
IN RADIOLOGY
Wednesday to Friday
10:30 – 12:00
STRAIGHT FROM THE RESEARCH CENTRE …
… TO THE WORLD’S MOST INNOVATIVE IMAGING MEETING
Vienna
myESR.org #ECR2019
8 HIGHLIGHTS ECR TODAY | WEDNESDAY, FEBRUARY 27, 2019
BY PADDY GILLIGAN AND DAVID LURIE
ECR 2019: medical physics
PH
Y SI C S
& the bigger picture
For those of us involved in developing the physics programme over recent years, it is
heartening to see the enormous progress in innovation, concepts and patient experience
reported at the European Congress of Radiology.
This has come about through 2018 International Day of Radiol- of workshops, joint sessions and
a team effort by researchers, edu- ogy publication in which many physics sessions, as well as the very
cators, scientists, radiologists and members of the Physics in Med- welcome participation of the ESR
radiographers, which is becoming ical Imaging subcommittee were in EFOMP events throughout the
stronger year-on-year through col- involved. As always, radiation dose year. These included the European
laboration between the European optimisation features strongly in School for Medical Physics Experts
Federation of Organisations for the EuroSafe Imaging sessions and (ESMPE) on Computed Tomogra-
Medical Physics (EFOMP), the Euro- the new Coffee & Talk programme phy held in Prague in January 2018
pean Federation of Radiographer will also have a strong physics and the 2nd European Congress of
Societies (EFRS) and the ESR. presence. Medical Physics (ECMP) which took
This year the theme of ‘The Bigger In 2019, there are seven exciting place in August 2018 in Copenha-
Picture’ strikes a great resonance physics in medical imaging scien- gen, via a joint EFOMP-ESR scien-
with the next stage in optimis- tific sessions presenting research tific session.
ing radiology for patient experi- on ‘Image quality and optimisation In addition, many other initia-
ence and safety improvement. This in CT’ (SS 113), ‘CT scanning: cardio- tives have already been planned for
is reflected in the exciting physics vascular, calcium, and iodine’ (SS the coming year, which will rein-
programme for this year’s congress, 213), ‘Radiation dose optimisation force not only the collaboration
which looks at the process of maxi- in CT’ (SS 613), ‘MRI: safety, phan- between EFOMP and the ESR but
mising benefit for patients, tailored toms and quantification’ (SS 313), also the relationships between the
to clinical need and image quality ‘Innovations in imaging: machine two communities of radiologists
rather than focusing on one param- learning, quality and new tech- and medical physicists, and radiog-
eter alone, such as radiation dose. niques’ (SS 413), ‘Radiation protec- raphers through EFRS, for the ulti-
This year’s programme includes tion technology and management’ mate benefit of patients.
a number of hot topics, with one (SS 513) and ‘Breast imaging phys- Vienna being such a beauti-
Special Focus session covering the ics’ (SS 713). ful, hospitable city, the members
emerging (and rapidly expand- Our always-popular education of the physics subcommittee are
ing) field of 3D printing in medical programme for 2019 combines also striking the balance between
imaging and another devoted to the accessible and highly-informa- work and play for 2019. As part of
up-and-coming use of 7T MRI scan- tive refresher courses on the fun- ‘The Bigger Picture’ we are hosting
ning in clinical practice, which her- damentals of MRI, image quality a social event for physicists attend-
alds a new frontier for diagnostic assessment in radiological optimi- ing the congress, on Thursday, Feb-
imaging. The physics programme sation, through to dose manage- ruary 28, from 7–9 pm at a city cen-
also reflects recent advances in the ment in paediatric CT scanning. tre venue. For the first time, the
use of big data and artificial intel- While it may be a challenge to get EFOMP booth in the international
ligence, with this year’s EFOMP up early on Sunday morning, fol- village will have an EFOMP rep-
Workshop featuring two sessions lowing the annual ECR Party, nev- resentative present. There will be
on extracting clinical information ertheless, those who do so will cer- a chance to meet up with some Examples of T1-weighted contrast-enhanced 7T MRI data.
from large data sets, where the tainly be rewarded by attending of the subcommittee members at (A) Spotted sharpnose puffer, Canthigaster punctatissima (SIO 61-225, SL 57
quest is challenging but the poten- the refresher course on iterative the congress to exchange ideas. mm). Pulse sequence parameters include: FA = 15°, TR = 22.814 ms, TE = 11.322
tial benefits are huge. In addition, reconstruction in CT, which proved Details for these events are listed ms, slice thickness = 100 µm, slice matrix = 354×780×210, resolution = 100 µm3,
the role of imaging in the era of liq- very popular and was rated highly on the EFOMP website and social averages = 5. (B) Blind legged torpedo, Typhlonarke aysoni (SIO 61-149, SL 92
uid biopsy is covered by a New Hori- at ECR 2018. media feeds. mm). Pulse sequence parameters include: FA = 15°, TR = 23 ms, TE = 11.222 ms,
zons session devoted to that topic. During 2018 many joint ini- slice thickness = 100 µm, slice matrix = 550×830×180, resolution = 100 µm3, av-
Methods to quantify iodine and tiatives have further strength- erages = 3. Numbered labels indicate a selection of readily visible anatomical
calcium using CT feature strongly ened the already excellent collab- structures in these slices.
in the sessions that have been pre- oration between EFOMP and the Image taken from © Berquist RM, Gledhill KM, Peterson MW, Doan AH, Baxter
pared for ECR 2019. These tech- ESR. These include the continuing GT, Yopak KE, et al. (2012) The Digital Fish Library: Using MRI to Digitize,
niques are particularly useful in involvement of EFOMP at the ECR Database, and Document the Morphological Diversity of Fish. PLoS ONE 7(4):
cardiac imaging, the theme of the through the planning and delivery e34499. https://doi.org/10.1371/journal.pone.0034499
ECR 2019 Physics in Medical Imaging:
Refresher Courses (RC), New Horizons Sessions (NH), Special Focus Sessions (SF)
and Workshops
Wednesday, February 27
NH 1: The role of imaging in the era of liquid biopsy
RC 113: Patient-specific dosimetry
RC 413: Striking the balance: image quality assessment in radiological optimisation
Thursday, February 28:
EFOMP 1 & 2: Big data and the big picture: deep learning in optimisation of medical imaging
SF 5a: 7 Tesla MR goes clinical
SF 8f: The 3D printing lab from bench to bedside
Friday, March 1:
David Lurie is Professor of Bio- Paddy Gilligan is Associate Professor ESR/EFOMP: Medical imaging and emerging issues in occupational radiation exposure
medical Physics at the University at University College Dublin and
of Aberdeen, UK, where he heads a Chief Medical Physicist at Mater Saturday, March 2:
group researching MRI technology. Private Hospital Dublin, Ireland. He RC 1313: Dose management in paediatric radiology
He chaired the ECR 2017 Physics in is chair of the ECR 2019 Physics in Ra- RC 1513: Demystifying MRI: things you always wanted to know
Radiology Subcommittee and was a diology Subcommittee, a member of
member of the Programme Planning the ESR radiation safety committee, Sunday, March 3:
Committee for ECRs 2018 and 2019. and sits on a number of regulatory RC 1713: Dose reduction and image quality implications of iterative image reconstruction in CT
Prof. Lurie is Vice Chair of EFOMP’s and professional bodies in Ireland,
Communications and Publications including the National Radiation
Committee. Safety Committee.
#ECR2019 myESR.orgECR TODAY | WEDNESDAY, FEBRUARY 27, 2019
CLINICAL CORNER 9
Integration, impact and end user Keep aware of artefacts to improve MRI illuminates typical and
10 friendliness are key for AI use in
medical imaging
11 outcome in hybrid imaging 12 specific features of neurological
conditions
BY BECKY MCCALL
Imaging biomarkers start to come
O
NC IC PH
OLO G Y SI C S
of age in early detection of cancer
Biomarkers, in combination with liquid biopsy and
pathology, can help to optimise cancer detection and
characterisation in the years ahead, and they now
form an integral part of a diagnostic approach that
aims to integrate diverse data from imaging, pathology,
and liquid biopsy/laboratory medicine, ECR 2019
delegates will learn at today’s New Horizons session.
“There’s a movement now that standardised, and this limits their machines and operators, according T2-TSE Gdce-T1w
says diagnosis is optimised by application at present. Quantifica- to Schlemmer, whose team is work-
the integration of all three,” Prof. tion of lesion perfusion over time is ing towards improving this.
Heinz-Peter Schlemmer, director a case in point. Turning to some of the newer
of the department of radiology “Tumours are usually hyper-per- imaging methods, he mentioned
and co-ordinator of the imaging fused with neovascularisation, and that chemical exchange saturation
and radio-oncology research at the this can be detected very early, long transfer (CEST) imaging is showing
German Cancer Research Centre before the tumour size shrinks,” he promise because it allows for the
(DKFZ), Heidelberg, Germany, told said, adding that there are different measurement of protein content in
ECR Today. “For a long time, we’ve methods for measuring perfusion the tumour.
been seeking quantitative data by MRI. “Change in protein content is
from imaging that lets us detect a Other functional biomarkers that important. We don’t fully under-
cancer early and determine tumour are typical cancer hallmarks include stand the biological significance
aggressiveness, local infiltration, diffusion-weighted imaging (DWI) of this, but we have seen mean-
and metastatic pattern and to plan with MRI, which looks at cell den- ingful changes, particularly in
and monitor therapies.” sity and composition of the extra- brain tumours,” he noted. “We’ve
Combining liquid biopsy and cellular matrix. DWI is an estab- also seen a genetic mutation that
imaging looks set to improve lished technique in the diagnosis of results in a measureable difference
future surveillance by detecting prostate cancer, and is starting to be in protein content. We hope that NOEAREX APTAREX
subclinical disease earlier, and ulti- used in melanoma too. in time we will use CEST for other
mately will deliver better outcomes, Schlemmer explained that can- applications.”
according to Prof. Vicky Goh, chair cer drugs and radiotherapy have There are various further new A patient with newly diagnosed glioblastoma underwent relaxation-
of clinical cancer imaging at King’s an impact on cell density because imaging biomarkers. One tech- compensated chemical exchange saturation transfer (CEST) imaging at
College Hospital and a consultant as the cells die, so the extracel- nique, for example, is MR finger- 7.0 Tesla. The protein-weighted CEST contrasts by means of amide proton
radiologist at Guy’s and St Thomas’ lular space widens. The effect is printing, which involves sequences transfer (APT) and nuclear Overhauser effect (NOE). MRI shows distinct
Hospital in London. seen on MRI early in treatment. that randomly acquire data and alterations of protein concentrations in the tumour area. While APT signals
“By accurately quantifying dis- With chemotherapy, these diffu- the output is correlated with a bio- are markedly increased, NOE mediated CEST effects drop in the tumour
ease burden and localising disease sion changes can happen within a logical biomarker. “We don’t fully area. The endogenous CEST contrasts have recently proven high potential
sites, it is possible currently to couple of hours of starting therapy, understand how it works but it as novel MR biomarkers to non-invasively assess tumour characteristics and
improve patient selection for fur- and they are a powerful indicator does,” he commented. prognosis. See: Paech D, Windschuh J, Oberhollenzer J et al (2018) Assessing
ther therapy,” she said. “Targeted measuring the depth of tumour Looking ahead, Schlemmer the predictability of IDH mutation and MGMT methylation status in glioma
molecular imaging will have an cells. turned to artificial intelligence and patients using relaxation-compensated multi-pool CEST MRI at 7.0 Tesla.
increasing role, particularly as dis- Referring to the overarching post-processing as used in imag- Neuro-Oncology:noy073-noy073; and Regnery S, Adeberg S, Dreher C et al
ease is detected earlier and its bur- aims of using imaging biomark- ing. “We can use deep learning (2018) Chemical exchange saturation transfer MRI serves as predictor of early
den is reduced.” ers, he said that it was important for extracting information out of progression in glioblastoma patients. Oncotarget 9:28772-28783. (Provided by
In the era of liquid biopsy, there to both detect tumours in the first images that are not visible to the Prof. Heinz-Peter Schlemmer)
will still be an important role for instance but also to determine if a eye, not even to a highly trained
imaging and a need for greater tumour is responding to therapy. radiologist,” he said. “Deep-learn-
sensitivity. In this respect, Goh “Different mass lesions seen on ing can pick up on this in a useful
stressed the need for more sensitive morphological images do not indi- quantitative way that provides
imaging. This morning, she plans to cate the malignant potential of the information that is easily transfer-
explain how cancer surveillance lesion. But with diffusion imag- able between hospitals.” New Horizons Session
aims to detect disease progression ing, we can see increased cellular He described a deep-learning
at an early enough stage for further density in the mass lesion, and in method for detecting breast can- Wednesday, February 27, 08:30–10:00, Room F2
definitive treatment to be a success. addition, with dynamic contrast cers that he and his colleagues NH 1 The role of imaging in the era of liquid biopsy
Turning to his main interest, perfusion imaging we can see neo- have tested. After carrying out
Schlemmer noted that so far in vascularisation, providing a strong DWI in a screening population, the »»Chairperson’s introduction
clinical studies morphology acts as indication that this mass lesion data were read by a deep-learning D. Regge; Turin/IT
a biomarker quantifying tumour belongs to a malignant tumour,” programme and then read by a »»Liquid biopsy in perspective: colorectal cancer as a model
size. During therapy, it can show he explained, adding that diffusion radiologist. system
whether the tumour is regressing, and perfusion are known biologi- “We found that a computer can A. Bardelli; Turin/IT
progressing or is stable, thus indi- cal cancer hallmarks, reflected by evaluate the data as well as an »»New imaging tools for cancer detection and characterisation
cating whether or not a treatment imaging biomarkers. experienced, well-trained radiol- H.-P. Schlemmer; Heidelberg/DE
is effective. These are the most important ogist can, so even though there is
»»Is there still a role for imaging surveillance? And when?
There are numerous other bio- radiological biomarkers in clini- no gain in knowledge, a less experi-
V.J. Goh; London/UK
markers associated with tumours, cal use. Although these biomark- enced radiologist could use the pro-
many of which are functional, and ers have been available for a few cess and the quality of reading and »»Combining molecular and imaging metrics in cancer
these can be quantified with MRI. years, radiologists still struggle reporting can be increased,” said (radiogenomics)
He pointed out that certain func- to use them effectively in clinical Schlemmer, adding that his team K. Pinker-Domenig; Vienna/AT
tional biomarkers are readily avail- trials because there has been no has also used deep learning with »»Panel discussion: Will liquid biopsy be a game changer for
able, but they have not yet been standardisation between different prostate cancer. radiologists?
myESR.org #ECR2019You can also read
