ECR 2016 Press Conference

Dose reduction techniques in paediatric CT: from A to Z

myESR — Wed, 02 Mar 2016 10:01:32 +0000

Dose reduction techniques in paediatric CT: from A to Z myESR Wed, 03/02/2016 - 11:01

Optimised low dose CT protocols: the half slice thickness approach.

Wednesday, March 2, 2016 (ECR) – Computed tomography (CT) is an essential imaging modality that can be used to solve many clinical problems. Moreover, it is available all over the globe and in many areas even on a 24/7 basis. Over the last ten years much has been done to lower the radiation doses used in CT through technical innovations and the application of protocols based on the ALARA (As Low As Reasonably Achievable) principle. But the optimisation of CT protocols still offers a lot of potential.

“Optimisation of protocols represents a complex task and every year tons of papers are released with several suggestions,” said Prof. Erich Sorantin of the Division of Paediatric Radiology at Graz Medical University, Austria, at the ECR 2016 press conference. In theory, the optimisation process should be easy to do, should not involve a lot of staff and of course no additional hardware should be needed. Based on his longstanding experience in the clinical field and teaching countless workshops on CT protocol generation, Sorantin has come up with a new method, called the half slice thickness approach.

The theory behind it is quite simple and exploits the inverse relationship between image noise, one of the major image quality determinants, and dose. To obtain the same image quality at half slice thickness, a double dose would be needed. To achieve a dose reduction, the process is reversed: after a particular study and patient discharge, radiographers reconstruct the study with half slice thickness and radiologists check image quality – if the diagnostic quality is still appropriate then 100% excess dose is used. Therefore, for the next study the initial dose is reduced by 20% and this process should be repeated until the image quality is no longer diagnostically acceptable. The half slice thickness approach is easy to do and involves only radiologists and radiographers, no hardware investments are needed – making it a good starting point for dose optimisation.

For paediatric CT, the optimisation process is more difficult to do, since many anatomical, physiological, and metabolic differences have to be worked into the parameter settings. Moreover, children are more sensitive to radiation than adults. There is scientific evidence that lower CT doses are used for children in dedicated paediatric radiology centres. Therefore, children should undergo CT where optimised protocols are available and where the clinical consequences of the study can be carried out, he recommended.
***

Erich Sorantin: Professor and Acting Head of the Division of Paediatric Radiology, Department of Radiology, Medical University Graz, Austria

Thursday, March 3, 16:00–17:30, Room D2

SF 8d CT radiation dose optimisation: are we doing enough?

Chairmen’s introduction
I.M. Björkman-Burtscher (Lund/SE) and C. Malamateniou (London/UK)
CT radiation dose optimisation: what has been achieved so far?
J. Santos; Coimbra/PT
Dose reduction techniques in paediatric CT: from A to Z
E. Sorantin; Graz/AT
Challenges and opportunities in CT dose optimisation: what can we do in the future?
S.J. Foley; Dublin/IE
Panel discussion: What are the suggested priorities and actions for CT dose optimisation?

The significance of hybrid imaging today

myESR — Wed, 02 Mar 2016 12:32:58 +0000

The significance of hybrid imaging today myESR Wed, 03/02/2016 - 13:32

Wednesday, March 2, 2016 (ECR) – Hybrid imaging with PET/CT and PET/MR is becoming increasingly crucial in the routine staging of oncologic disease, treatment planning, early treatment evaluation, and follow up. With ECR 2016 President, Professor Katrine Riklund, being licensed in both radiology and nuclear medicine, it is easy to guess, that one of the key aspects of the ECR 2016 programme will be hybrid imaging.

The combination of molecular, biochemical, and structural information that hybrid imaging has to offer is more useful than the information provided by each technique on its own, and can help to optimise the management of cancer patients, particularly those suffering from solid cancers and lymphoma, explained Riklund, assistant head of the department of radiation sciences, chief physician of the nuclear medicine department and director of the medical school at Umeå University.

Radiotracers are crucial for PET, since the tracer defines which function, receptor or biochemical process is being measured. The protocols used for CT and MRI define the quality and type of information gained by these modalities. In hybrid imaging it is therefore of utmost importance to both select the correct tracers as well as to optimise the examining protocol for each disease.

“To underline the importance of hybrid imaging, the ESR Executive Council decided in May 2015 to establish the European Society of Hybrid Medical Imaging (ESHI) as a subspecialty society under the umbrella of the European Society of Radiology (ESR). The society has been created with the aim of improving training in hybrid imaging so that its practitioners can make the best use of PET/CT and PET/MR for the benefit of patients,” said Riklund.

The focus is on ensuring the optimal use of hybrid imaging to provide the best patient care, and to establish a collaborative relationship between radiology and nuclear medicine. It is important to take advantage of both structural and molecular information in each examination and with continuous education most hybrid examinations should be read by only a single specialist in the future.

The society welcomes all physicians, scientists and professionals with an interest in hybrid medical imaging. ESHI will be officially inaugurated at the ECR 2016.

The founding Board of ESHI is as follows:
Katrine Riklund, Umeå/SE – President
Osman Ratib, Geneva/CH – Vice President
Thomas Beyer, Vienna/AT – Treasurer
Gerald Antoch, Düsseldorf/DE
Andrea Laghi, Rome/IT
Ex officio: President of the European Society of Molecular and Functional Imaging in Radiology (ESMOFIR) – Olivier Clément, Paris/FR
***

Katrine Riklund: Deputy head of the department of radiation sciences and director of the medical school at Umeå University; Radiologist and nuclear medicine specialist at Umeå University Hospital, Sweden; ECR 2016 Congress President

Sunday, March 6, 08:30–10:00, Room C

Joint Session of the ESR and ESHI (European Society for Hybrid Medical Imaging) Medical hybrid imaging
Chairpersons: K. Riklund (Umea/SE) and L. Donoso Bach (Barcelona/ES)

Introduction
L. Donoso Bach; Barcelona/ES
The aims of the new society
K. Riklund; Umea/SE
Training of hybrid physicians
G. Antoch; Düsseldorf/DE
The beauty of physics in hybrid imaging
T. Beyer; Vienna/AT
Functional hybrid imaging: 1+1 = 3?
O. Clément; Paris/FR
Practical challenges of hybrid imaging in clinical practice
O. Ratib; Geneva/CH
Discussion

From personalised to precision imaging: impact on clinical practice

myESR — Wed, 02 Mar 2016 12:30:54 +0000

From personalised to precision imaging: impact on clinical practice myESR Wed, 03/02/2016 - 13:30

Wednesday, March 2, 2016 (ECR) – Personalised medicine describes the concept of delivering the right treatment to the right patient at the right time. Personalised medicine is about the customisation of healthcare, with decisions and practices being tailored to the individual patient by use of genetic or other information, said Prof. Gabriel P. Krestin, Chairman of the Department of Radiology at Erasmus MC, University Medical Center Rotterdam, the Netherlands, ahead of the ECR 2016 press conference.

“It implies the prospect of devising a different management strategy for each individual patient. In this respect, medical imaging has always been personalised, as it provides individual assessment of the location and extent of an abnormality, whether the alteration is a disease, a malformation, or an injury,” he said.

Precision medicine, or stratification medicine, revolves around the idea that the consideration of individual characteristics – molecular and otherwise – can improve medical research and practice. Precision medicine should, therefore, integrate multiple biomarkers, based on clinical, behavioural, genomic, electrophysiological, and imaging measurements. In this context, medical imaging is intrinsically enabling precision medicine as a wide variety of new imaging techniques and methods produce important biological information about physiology, organ function, biochemistry, metabolism, molecular biology and functional genomics. These new methods combine the ability to measure and quantify biological processes with the ability to localise the measured entities into a high-quality anatomical image providing a new class of versatile and useful biomarkers. The addition of genomic data allows new correlations to be made between cellular genomics and tissue-scale imaging.

Making medicine more personalised and precise will entail increasing emphasis on, and precision in, diagnostics. Diagnoses however, depend on multiple components that include not only imaging, but also clinical observation, pathology, laboratory tests, and genomic tests. “To date, there is too little coordination between the medical specialties responsible for ordering and performing these tests, nor is there enough consideration as to the optimal order of tests. What is required is a new concept of integrated diagnostics: the convergence of imaging, pathology and laboratory tests with advanced information technology,” said Krestin.
***

Gabriel P. Krestin: Professor and Chairman of the Radiology Department at Erasmus Medical Centre Rotterdam, Netherlands; EIBIR Scientific Director

Thursday, March 3, 08:30–10:00, Studio 2016

PC 5 Personalised radiology: myth or reality?

Chairman’s introduction
C.J. Herold; Vienna/AT
Personalised imaging in practice: a myth?
F.J. Gilbert; Cambridge/UK
Personalised imaging and standardised protocols: a contradiction?
S.O. Schönberg; Mannheim/DE
En route to personalised imaging: the role of multidisciplinary conferences
J.A. Verschakelen; Leuven/BE
From personalised to precision imaging: impact on clinical practise
G.P. Krestin; Rotterdam/NL
Panel discussion: How to enhance personalised radiology in clinical routine

Epidemiology and current trends in obesity

myESR — Wed, 02 Mar 2016 12:28:48 +0000

Epidemiology and current trends in obesity myESR Wed, 03/02/2016 - 13:28

Wednesday, March 2, 2016 (ECR) – Obesity is a disease that has reached epidemic proportions around the world and affects nearly all medical disciplines. Professor Nick Finer, honorary consultant endocrinologist and bariatric physician at University College Hospital, London, will discuss how the worldwide prevalence of obesity – defined as a body mass index (weight/height² ) above 30kg/m² – has doubled between 1980 and 2008 and how modern imaging methods can be of help.

“In many ‘westernised’ countries such as the UK, Australia, Canada and the USA, more than one in three adults are obese. Children are getting fatter earlier and earlier in life too. While the mechanisms of obesity relate to energy balance: i.e. energy consumed from what we eat and drink, versus energy expended at rest and in physical activity, the causes are more complex,” Finer explains.

Obesity is strongly heritable; mutations or variations appear in many genes involved in body weight regulatory pathways, and can either result in severe childhood onset obesity – around 5% of those presenting under the age of five – or predispose to weight gain and obesity later in life. These genes can of course only drive and increase the risk of developing obesity in an environment that makes it easy to over-consume calorific foods and to remain inactive. Obesity is developing at ever earlier ages, which increases the lifetime exposure to its risks. Few organ systems are exempt from the deleterious effects of excess adiposity. Damage is increasingly linked to the secretion of hormones and chemicals from fat tissue (adipocytokines) that produce low grade inflammation locally and systemically. Type 2 diabetes, non-alcoholic fatty liver disease, cardiovascular and cancer risk, and obstructive sleep apnoea are all closely linked to obesity and the metabolic syndrome.

During the past 20 years, bariatric surgery has become an increasingly popular form of treatment for morbid obesity. The most common bariatric procedures performed include laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and laparoscopic sleeve gastrectomy. Fluoroscopic upper gastrointestinal examinations and abdominal computed tomography (CT) are the major imaging tests used to evaluate patients after these various forms of bariatric surgery.

Obesity also affects medical imaging, simply due to the size of patients. Imaging equipment can be too small and sufficient imaging quality can be very hard to obtain in morbidly obese patients, especially when it comes to ultrasound.

“Obesity is now responsible for about five per cent of all deaths worldwide and the costs of obesity to society are huge. A recent report from the McKinsey organisation concluded that ‘obesity is one of the top three global social burdens generated by human beings’, equivalent in cost to smoking, or armed violence, war and terrorism. They estimated that the annual global direct economic impact and investment to mitigate obesity in 2012 amounted to £2 trillion or 3% of global GDP,” said Finer.

Body Mass Index, while useful for population studies, is not an accurate measure of total body fat, nor does it give information about fat distribution. The methodological short-comings of epidemiological studies that have suggested modest overweight may be protective, may account for the so-called ‘obesity paradox’ theory, which suggests that obese people with chronic diseases have a better chance of survival than normal-weight individuals do. “The increasing use of imaging techniques such as DXA, CT and MRI may help to resolve these issues”, said Finer.
***

Nicholas Finer: Honorary Clinical Professor, National Centre for Cardiovascular Prevention and Outcomes, University College London Institute of Cardiovascular Science; Honorary Consultant Endocrinologist and Bariatric Physician, UCLH Centre for Weight Loss, Metabolic and Endocrine Surgery, London, United Kingdom

Thursday, March 3, 16:00–17:30, Room D1

SF 8c Imaging in obesity

Chairman’s introduction
S. Lee; Manchester/UK
Epidemiology and current trends in obesity
N. Finer; London/UK
Fat quantification and advanced body composition assessment using MRI
O. Dahlqvist Leinhard; Linkoping/SE
Imaging of modern surgical procedures and their complications
M. Rengo; Latina/IT
Is there a role for bariatric embolisation in the treatment of the obese patient?
C. Weiss; Baltimore, MD/US
Panel discussion: How best to manage obesity and its implications on the radiology department

ESR’s strategic research interests

myESR — Wed, 02 Mar 2016 09:57:09 +0000

ESR’s strategic research interests myESR Wed, 03/02/2016 - 10:57

ESR steps up collaboration in medical radiation protection and imaging biobanks.

Wednesday, March 2, 2016 (ECR) – Medical radiation protection, imaging biomarkers, and biobanks, have been the subject of intense focus on the part of the European Society of Radiology and its committees over the past year, said Professor Luis Donoso Bach, ESR President and director of the Diagnostic Imaging Department of the Hospital Clínic of the University of Barcelona, Spain.

The European Society of Radiology (ESR) and other medical associations – the European Federation of Radiographer Societies (EFRS), the European Federation of Organisations in Medical Physics (EFOMP), the European Association of Nuclear Medicine (EANM), and the European Society for Radiotherapy and Oncology (ESTRO) – have been working to develop a strategic research agenda (SRA) for medical radiation protection, as this field has been underrepresented and fragmented to date. In addition to giving greater visibility to medical radiation protection in the research community, the aim is to also to influence the EU research programme Horizon 2020 by proposing research priorities within its area of expertise.

“The first version of the SRA for medical radiation protection has been reviewed and approved by all medical societies involved. The final version, which will be published soon, will be the first time that the medical community has reached a consensus on a joint approach. This unity will help to ensure greater visibility in radiation protection research and opportunities for funding in future research programmes, which represents a major success for the medical community,” said Prof. Donoso.

The ESR has recently also become a member of MELODI, the Multidisciplinary European Low-Dose Initiative, an organisation promoting low-dose radiation protection research. The ESR’s prior cooperation with MELODI had been governed by a memorandum of understanding signed in 2014, but the ESR’s acceptance as a MELODI member by its General Assembly on November 9 allows the ESR to become an integral, long-term partner in shaping the European radiation protection research landscape, which represents a milestone in the society’s long history of promoting radiation protection.

After publishing its white paper on biobanks last August and bringing together all ESR activities concerning imaging biomarkers under the EIBALL umbrella (European Imaging Biomarkers Alliance), the ESR has taken another major step towards establishing a European biobank concept for medical imaging by starting an official collaboration with the Biobanking and Biomolecular Resources Research Infrastructures – European Research Infrastructure Consortium (BBMRI-ERIC).

“The ESR is particularly pleased with this collaboration with BBMRI-ERIC, which will facilitate development in the integration of imaging data with biobank databases. The main goals of this collaboration are to promote the importance and visibility of imaging biobanks, to coordinate efforts to establish a European imaging biobank infrastructure and to ensure its linking to existing biobanks,” Prof. Donoso is looking forward to the collaboration.
***

Luis Donoso Bach: Director of the Diagnostic Imaging Department of the Hospital Clínic of the University of Barcelona, Spain; Executive Director of the UDIAT Diagnostic Centre, Health Corporation Parc Taulí; ESR President

Wednesday, March 2, 08:30–10:00, Room L8

EuroSafe Imaging Session 1
Moderator: L. Rainford; Dublin/IE

Developing a strategic research agenda for medical radiation protection: a chance for advancing research in radiology
W. Stiller; Heidelberg/DE
Do iodinated contrast media enhance DNA damage after exposure to ionising radiation?
G. Frija; Paris/FR
Dose reduction in modern digital plain-radiography on the basis of indication-specific, standardised quality criteria
D. Spira; Heidelberg/DE
Paediatric imaging: are risks of ionising radiation exposure established?
H. Ducou le Pointe; Paris/FR

This session is part of the EuroSafe Imaging campaign

Thursday, March 3, 16:00–17:30, Room F1

PC 8b An introduction to European Imaging Biomarkers Alliance (EIBALL)

Chairman’s introduction
P.M. Parizel; Antwerp/BE
EIBALL and its mission
S. Trattnig; Vienna/AT
The potential role of EIBALL for EORTC multicentre trials
Y. Liu; Brussels/BE
The organisational role of EIBIR in EIBALL
V. Vilgrain; Clichy/FR
Imaging biomarker development for EIBALL by subspecialty societies
K. Nikolaou; Tübingen/DE
Panel discussion: What is the role of EIBALL now and in the future?

Friday, March 4, 08:30–10:00, Studio 2016

PC 9a Biobanks meet imaging
Moderators: E.Neri (Pisa/IT) and M.Pasterk (Graz/AT)

How does Biobanking and BioMolecular resource Research Infrastructur – European Research Infrastructure Consortium (BBMRI-ERIC) work?
J.-E. Litton; Graz/AT
Patient rights: data overprotection?
M.T. Mayrhofer; Graz/AT
What is the difference between a PACS and a clinical bank of radiological images?
A. van der Lugt; Rotterdam/NL
Population-based cohort biobanks: accessing large European prospective cohorts through the biobanking infrastructure BBMRI – large prospective cohorts (LPC)
O. Törnwall; Graz/AT
Population-based cohort: image banks
F. Bamberg; Tübingen/DE
What are ontologies?
B.Gibaud; Rennes/FR