European Society Of Radiology Research Articles

Dear Colleagues - EFSUMB Recently Joined in a Collaboration with the European Society of Radiology (ESR)

Meetings between the two Societies have already been held in Vienna, both during the WFUMB / EFSUMB Congress and during the congress of ESR. The first combined scientific session will be at the Austria Center in Vienna, during the European Congress of Radiology (ECR) 2013. It will be on Monday, March 11, 2013; 08:30–10:00; Room Z, and will be entitled:

EFOMP and EANM: joint recommendations for a curriculum for the education and training of physicists in nuclear medicine

Some of these barriers can be explained by the fact that there is no definition of the MP that is consistently recognised on a European level. This is somewhat surprising as there are well-known definitions issued by the scientific societies, for example the International Organization for Medical Physics (IOMP): Medical physicists are professionals with education and specialist training in the concepts and techniques of applying physics in medicine. Medical physicists work in clinical, academic or research institutions. Medical physicists working in the clinical environment are health professionals, with education and specialist training in the concepts and techniques of applying physics in medicine, competent to practice independently in one or more of the sub-fields (specialties) of medical physics. This rather clear definition has so far not found its way to documents issued by the European Union (EU) and the national regulatory authorities. In two directives stemming from the EURATOM treaty, the Commission has outlined roles for physicists working with radiation protection. The “MED directive” [2] addresses radiation protection of patients, carers and the public from medical exposures and defines somewhat vaguely a “medical physics expert” (MPE). Due to the lack of clarity, the implementation of this title varies considerably across Europe. The other directive, “the EU Basic Safety Standards (BSS) Directive” [3], concerned with radiation protection in general, had previously introduced another title for persons with a similar role (but outside the medical field): the “qualified expert”, in later documents also called “radiation protection expert”. Unfortunately, the roles defined in the two directives are not consistent and this still causes confusion and misunderstandings. Fortunately, a new directive (“Proposal for a Council Directive laying down basic safety standards for protection against the dangers arising from exposure to ionising radiation [COM(2012)242]”, http://ec.europa.eu/energy/nuclear/radiation_protection/doc/2012_com_242.pdf, dated 30.5.2012) is currently under revision. It is meant to replace the former two directives and will also provide a clearer definition for an MPE: “medical physics expert means an individual having the knowledge, training and experience to act or give advice on matters relating to radiation physics applied to medical exposure, whose competence to act is recognised by the competent authorities” (article 4, definition #40 in the draft document). Comparing the definitions provided by IOMP and the Commission it becomes clear that being an MPE (as defined in the directive) is an important role of an MP (as defined by IOMP). This is especially true in nuclear medicine, where most activities are related to the use of ionising radiation. However, the scope of work of an MP is considerably wider. Thus, an MPE should not per se be regarded as a senior and experienced MP—despite the expert in the acronym. On the other hand, being an MPE requires a high level of expertise with respect to application of ionising radiation—probably more expertise than the average MP would have. On this rather confusing background it seems more than logical that some sort of harmonisation would be helpful. This was a major motivation for the European Federation of Organisations for Medical Physics (EFOMP) and the European Association of Nuclear Medicine (EANM) to set out to collect and compose a modern curriculum specifically for the education and training of medical physicists in nuclear medicine. EFOMP (http://efomp.org) is the umbrella organisation for the national medical physics organisations and societies. One of the main objectives of EFOMP is the harmonisation and promotion of the best practice of medical physics in Europe. For this purpose, EFOMP issues policy statements on various topics, for example on the “Continuing Professional Development for the Medical Physicist”, describing the planned acquisition of qualifications required for professional practice throughout a working life. Likewise, the EANM—representing nuclear medicine in Europe—aims at advancing science and education in nuclear medicine for the benefit of public health. Physicists from both the Dosimetry Committee and the Physics Committee of the EANM joined EFOMP in the effort of composing the curriculum. Similar scientific collaborations were established by EFOMP with the European Society of Radiology (ESR) and the European Society for Radiotherapy and Oncology (ESTRO) for a curriculum in radiology [4] and radiation oncology [5], respectively.

President De Wispelaere short address: International Day of Radiology 08.11.2012

In 2011, under the coordination of the European Society of Radiology (ESR) all European national radiological societies decided to celebrate the anniversary of Wilhelm Conrad Rontgen’s death who first discovered x-rays in 1895. The role of radiology as a diagnostic and interventional procedure in medicine is undeniable, but its perception among the general public and among colleagues performing in other clinical disciplines still needs to be clarified.

Core curriculum for medical physicists in radiology. Recommendations from an EFOMP/ESR working group.

Some years ago it was decided that a European curriculum should be developed for medical physicists professionally engaged in the support of clinical diagnostic imaging departments. With this in mind, EFOMP (European Federation of Organisations for Medical Physics) in association with ESR (European Society of Radiology) nominated an expert working group. This curriculum is now to hand. The curriculum is intended to promote best patient care in radiology departments through the harmonization of education and training of medical physicists to a high standard in diagnostic radiology. It is recommended that a medical physicist working in a radiology department should have an advanced level of professional expertise in X-ray imaging, and additionally, depending on local availability, should acquire knowledge and competencies in overseeing ultrasound imaging, nuclear medicine, and MRI technology. By demonstrating training to a standardized curriculum, medical physicists throughout Europe will enhance their mobility, while maintaining local high standards of medical physics expertise. This document also provides the basis for improved implementation of articles in the European medical exposure directives related to the medical physics expert. The curriculum is divided into three main sections: The first deals with general competencies in the principles of medical physics. The second section describes specific knowledge and skills required for a medical physicist (medical physics expert) to operate clinically in a department of diagnostic radiology. The final section outlines research skills that are also considered to be necessary and appropriate competencies in a career as medical physicist.

Results of a survey by the European Society of Radiology (ESR): undergraduate radiology education in Europe—influences of a modern teaching approach

ObjectivesThe purpose of the present study is to determine in what way a conventional versus a modern medical curriculum influences teaching delivery in formal radiology education.MethodsA web-based questionnaire was distributed by the ESR to radiology teaching staff from 93 European teaching institutions.ResultsEarly exposure to radiology in pre-clinical years is typically reported in institutions with a modern curriculum. The average number of teaching hours related to radiology is similar in both curriculum types (60 h). Radiology in modern curricula is mainly taught by radiologists, radiology trainees (50%), radiographers (20%) or clinicians (17%). Mandatory clerkships are pertinent to modern curricula (55% vs. 41% conventional curriculum), which start in the first (13% vs. 4% conventional curriculum) or second year of the training (9% vs. 2% conventional curriculum). The common core in both curricula consists of radiology examinations, to work with radiology teaching files, to attend radiology conferences, and to participate in multidisciplinary meetings.ConclusionThe influence of a modern curriculum on the formal radiology teaching is visible in terms of earlier exposure to radiology, involvement of a wider range of staff grades and range of profession involved in teaching, and radiology clerkships with more active and integrated tasks.Main Message• This study looks at differences in the nature of formal radiology teaching.

Intraoperative radiation therapy: is it a standard now?

The question whether and for whom the gold standard of whole breast radiotherapy (WBRT) may be replaced by accelerated partial breast irradiation (APBI) is one of the most controversial issue in the adjuvant breast cancer setting. Among different APBI techniques, intraoperative radiation therapy (IORT) is particularly appealing to patients and physicians, because the procedure is fast, convenient, normal structures sparing and able to solve some clinical problems, like the integration with chemotherapy. Early findings from phase II and randomized phase III trials show the approach of APBI in selected patients at low risk for local recurrence is safe and well tolerated, but short follow-up creates some reservations. Since recurrences of breast cancer can occur after a considerably time delay, final assessment of APBI will only be valid after sufficient follow-up from prospective randomized trials with large patients number. Until then APBI should be considered experimental. Furthermore, many questions regarding the appropriate patient selection criteria, treatment volume and dose fractionation still exist. In the context of risk-adapted RT, the key to success is the proper selection of the patients. Both the American and European Society of Radiology and Oncology provided a consensus statement regarding patient selection criteria based on tumour and patient-related features. The 5-year results of the non-randomized ELIOT study from Milan, using 21 Gy-full dose, identified a group of patients who may be good candidates for the treatment. The stratification of patients according to clinical phenotype or by molecular class and a widespread use of preoperative breast magnetic resonance imaging might be better identify patients eligible for APBI.

Medical imaging in personalised medicine: a white paper of the research committee of the European Society of Radiology (ESR)

The future of medicine lies in early diagnosis and individually tailored treatments, a concept that has been designated ‘personalised medicine’ (PM), i.e. delivering the right treatment to the right patient at the right time. However, the value of medical imaging in PM is frequently underestimated, as many policy makers forget the all-important right location in the PM paradigm. Medical imaging has always been personalised as it provides individual assessment of the location and extent of an abnormality, and in the future it will prove fundamental to almost all aspects of PM. Stratification based on imaging biomarkers can help identify individuals suited for preventive intervention and can improve disease staging. In vivo visualisation of locoregional physiological, biochemical and biological processes using molecular imaging can detect diseases in pre-symptomatic phases or facilitate individualised drug delivery. Furthermore, imaging is essential to patient-tailored therapy planning, therapy monitoring and follow-up of disease progression, as well as targeting non-invasive or minimally invasive treatments, especially with the rise of theranostics. For PM to reach its full potential, medical imaging must be an integral part. Radiologists need to be prepared for this new paradigm as it will mean changes in training, in research and in clinical practice.

Undergraduate education in radiology. A white paper by the European Society of Radiology

Undergraduate education in radiology. A white paper by the European Society of Radiology

White paper on radiation protection by the European Society of Radiology

In the past decade, the medical effective dose per caput has increased in most European countries because of CT; it now ranges between 0.4 and 2 mSv/year. The biological impact of diagnostic imaging exposure is dominated by stochastic effects: based on the linear-no-threshold hypothesis, the risk of cancer induction is estimated to increase proportionally to organ dose, reaching around 0.5% at an effective dose of 100 mSv. The risk is higher the younger the age at the time of exposure, it is different for different organs, and women are more susceptible than men. Fluoroscopy-based imaging, above all intervention, may reach the dose threshold for deterministic effects, observed most often at the skin above around 3 Gy, and it is also the major source of occupational exposure in radiology. This white paper discusses the role of justification, evidence-based referral guidelines, optimization, diagnostic reference levels, clinical audits and quality assurance programs. The ESR strongly supports education and training of the medical staff involved in imaging by ionizing radiation. It disseminates information regarding radiation protection, takes initiatives, cooperates with partners and supports projects in justification as well as optimization. To reach these aims, the ESR cooperates with other organizations involved in radiation protection.

Clinical Audits: The European Society of Radiology Perspective

In October 2009, the European Commission published guidelines (Radiation Protection No 159) [ 1 European CommissionRadiation Protection No 159—European Commission guidelines on clinical audit for medical radiological practices (diagnostic radiology, nuclear medicine and radiotherapy). http://ec.europa.eu/energy/nuclear/radiation_protection/doc/publication/159.pdf Google Scholar ] on clinical audits for medical radiology, including diagnostic radiology, nuclear medicine, and radiotherapy to improve the implementation of article 6.4 of Council Directive 97/43/EURATOM, on the health protection of individuals against the dangers of ionizing radiation in relation to medical exposure [ 2 Council of the European UnionCouncil Directive 97/43/EURATOM. http://ec.europa.eu/energy/nuclear/radioprotection/doc/legislation/9743_en.pdf Google Scholar ]. In article 6.4 it stated that “clinical audits shall be carried out in accordance with national procedures.” However, there is wide variation in the understanding and implementation of clinical audits in Europe. The interpretation of the term audit and its differentiation from regulation, quality assurance, accreditation, and research also differ across Europe. In January 2010, the Audit and Standards Subcommittee of the European Society of Radiology (ESR) published a document on the ESR's perspective on clinical audits in an effort to define the scope of clinical audits in a way applicable across the European member states and radiologic organizations [ 3 European Society of RadiologyClinical audit—ESR perspective. Insights Imaging. 2010; 1: 21-26 Crossref PubMed Google Scholar ].

Usability of irreversible image compression in radiological imaging. A position paper by the European Society of Radiology (ESR)

Usability of irreversible image compression in radiological imaging. A position paper by the European Society of Radiology (ESR)

Good practice for radiological reporting. Guidelines from the European Society of Radiology (ESR).

The views of the European Society of Radiology concerning what constitutes a good radiological report are outlined in this article. Some pertinent literature is reviewed.

European Commission guidelines on clinical audit. Statement by the European Society of Radiology

European Commission guidelines on clinical audit. Statement by the European Society of Radiology

Poul Erik Andersen's radiological work on Osteochondrodysplasias and interventional radiology

Poul Erik Andersen is a Professor and Interventional Radiologist at the University of Southern Denmark, Odense and Odense University Hospital, Denmark. His innovative and expertise is primarily in vascular interventions where he has introduced and developed many procedures at Odense University Hospital. His significant experience and extensive scientific work has led to many posts in the Danish Society of Interventional Radiology, the European Society of Radiology and the Cardiovascular and Interventional Radiological Society of Europe, where he is a fellow and has passed the European Board of Interventional Radiology - The European qualification in Interventional Radiology.

Analysis of radiology education in undergraduate medical doctors training in Europe

Objectives The purpose of the present study is to describe how undergraduate radiology teaching is organized in Europe and to identify important characteristics of undergraduate radiology curriculum. Methods An electronic survey on undergraduate teaching was distributed by the European Society of Radiology (ESR) to 38 national delegates of the ESR Education Committee. Results The “classic type” of radiology teaching method is more frequent than the “modular type”. In 38% of medical training centres the first experience with radiology is in pre-clinical years. The students enrolled in the fourth medical year experience the largest involvement in radiology education. The total number of teaching hours (mean 89 h, median 76 h) varies across the countries and differs depending on the radiological topic (mean across all topics 14.8 h, median 13). Written tests and oral exams were the most frequently used examination modes. Clerkships are reported as a key part of training. Conclusion This first international comparative study of undergraduate radiological curriculum in Europe identifies a large number of differences in curriculum content and teaching methods throughout Europe. More research is needed to establish the radiological educational competences resulting from these differing curricula's to improve and to standardize the teaching according to (inter)national and institutional needs.

Multimodality imaging in Europe: a survey by the European Society of Radiology (ESR) and the European Association of Nuclear Medicine (EANM)

PurposeMultimodality imaging represents an area of rapid growth with important professional implications for both radiologists and nuclear medicine physicians throughout Europe. As a preliminary step for future action aimed at improving the quality and accessibility of PET-SPECT/CT multimodality imaging practice in Europe, the European Society of Radiology (ESR) and the European Association of Nuclear Medicine (EANM) performed a survey among the individual memberships of both societies to obtain information on the status of multimodality imaging in their facilities and their future visions on training for combined modalities.MethodsA questionnaire was forwarded to all individual members of ESR and EANM. The main subject matter of the questionnaire related to: (1) study performance, current procedures and current equipment, including its supervisory personnel at respondents’ individual facilities, and (2) vision of future practice, performance and the potential for combined interdisciplinary viewing and training for future professionals.ResultsThe reporting and the billing procedures of multimodality imaging studies are very heterogeneous in European countries. The majority of the members of both societies believe that the proportion of PET/CT conducted as a full diagnostic CT with contrast enhancement will increase over time. As expected, 18F-FDG is the most used PET tracer for clinical applications. The large majority of respondents were in favour of an interdisciplinary training programme, being developed on a European level together by ESR and EANM and the respective sections of the European Union of Medical Specialists.ConclusionThe results of this survey show that there is wide heterogeneity in the current practice of multimodality imaging in Europe. This situation may limit the full potential and integration of multimodality imaging within the clinical arena. There is a strong desire within both specialties for the development of interdisciplinary training to address some of these issues.

ESR position paper on ultrasound

This paper re-emphasises the important role of diagnostic ultrasound. It underlines the importance of ultrasound as a non-invasive imaging procedure which does not use ionising radiation. The paper also illustrates how ultrasound is often the cornerstone of the work up of the patient and the need for radiology departments to be able to offer expert ultrasound on a 24/7 basis. Some aspects related to turf battles and education are discussed. Finally the way in which these issues will be addressed by the European Society of Radiology is outlined.

Editorial: A new journal in radiology

It is a great pleasure to write the first editorial of a new journal! This marks a significant step in the development of the publications emanating from the European Society of Radiology. After 20 years the success of European Radiology now seems very well established. This is a huge triumph for, firstly, the late Professor Joseph Lissner (Founding Editor) and then the remarkable endeavours of Professor Albert Baert (Honorary Editor). To see a journal start form scratch and rapidly become one of the leading general radiology journals in the world in the space of 20 years is a remarkable feat. We all hope that Insights into Imaging will have a similar meteoric career.

Multimodality imaging in Europe: a survey by the European Association of Nuclear Medicine (EANM) and the European Society of Radiology (ESR)

Multimodality imaging represents an area of rapid growth with important professional implication for both nuclear medicine physicians and radiologists throughout Europe. As a preliminary step for future action aimed at improving the quality and accessibility of PET/SPECT/CT multimodality imaging practice in Europe, the European Association of Nuclear Medicine (EANM) and the European Society of Radiology (ESR) performed a survey among the individual membership of both societies to obtain information on the status of multimodality imaging in their facilities and their future visions on training for combined modalities. A questionnaire was forwarded to all individual members of the EANM and ESR. The main subject matter of the questionnaire related to: (1) study performance,current procedures, current equipment including its supervisory personnel at respondents' individual facilities and (2)vision of future practice, performance and the potential for combined interdisciplinary viewing and training for future professionals. The reporting and the billing procedures of multimodality imaging studies are very heterogeneous in European countries. The majority of the members of both societies believe that the proportion of PET/CT conducted as a full diagnostic CT with contrast enhancement will increase over time. As expected, (18)F-FDG is the most commonly used PET tracer for clinical applications. The large majority of respondents were in favour of an interdisciplinary training programme being developed on a European level together by the EANM and the ESR and the respective sections of the European Union of Medical Specialists. The results of this survey show that there is wide heterogeneity in the current practice of multimodality imaging in Europe. This situation may limit the full potential and integration of multimodality imaging within the clinical arena. There is a strong desire within both specialties for the development of interdisciplinary training to address some of these issues.

Development of molecular imaging in the European radiological community

The recent and concomitant advances in molecular biology and imaging for diagnosis and therapy will place in vivo imaging techniques at the centre of their clinical transfer. Before that, a wide range of multidisciplinary preclinical research is already taking place. The involvement of radiologists in this new field of imaging sciences is therefore absolutely mandatory during these two phases of development. Achievement of such objectives requires the refinement of strategy within the European radiological community and the European Society of Radiology (ESR) will have to drive a number of actions to stimulate the younger generation of radiologists and to facilitate their access to knowledge. For that purpose, a molecular imaging (MI) subcommittee of the ESR Research Committee based on a group of involved radiologists will be constituted to develop contacts with other constitutive committees and associated societies to provide proposals to our community.