The EIBIR two years on

Projects seek defined answers to vital medical questions

'There is no proof that some new procedures are better than the conventional ones or than clinical examination'

The European Research Institute for Biomedical Imaging (EIBIR) was founded two years ago. Its founder, Professor Gabriel Krestin, Head of Radiology at the Erasmus Medical Centre in Rotterdam in the Netherlands, and EIBIR founder, says the Institute has progressed considerably in that time, particularly due to the initial support of the European Society of Radiologists (ESR) and industry partners. ‘The first two-year agreement has now expired, and our partners in the industry are hoping to cut back their financial commitments step by step over the coming years,’ he told European Hospital recently. To stand on its own feet financially in 2010, the EIBIR has developed a business plan. We asked the professor to outline this and other EIBIR plans.
‘We filed, amongst other things, an application with the European Commission (EC),’ Prof Krestin explained. ‘We registered the project there and support was approved. The money enabled us to build up the EIBIR infrastructure and to attract other members. Meanwhile, there are now more than 240 European institutes participating in the EIBIR, enabling us to gather a lot of information about their research activities. The main objective here is to link members and so enable them to communicate and to develop joint projects.’
The EIBIR is also currently the managing partner of four projects – the first, ENCITE (European Network for Cell Imaging and Tracking Expertise) was registered by the EC under the title ‘Imaging for Cellular Therapy’. Among the hopes is that damaged cartilage can be repaired by stem cell implantation; other observation areas are the pancreas, brain and heart. ‘However, we have to know exactly where the cells need to be implanted and what happens to them — whether they grow, and so on. We make these processes visible with marked cells. The same procedure can be used for tumour cells to see how exactly they behave, or with myocardial cells to capture myocardial regeneration after heart attacks.’
At present this is restricted to animal testing, but the scientists hope that, towards the end of the project, first steps will be taken for testing in the hospital.
21 partners are involved in the ENCITE project, which has a budget of 12 million euros.
The second project is an image processing platform, which developed from several groups working together at the ECR. Now, this has also secured EU funding.
A further project focuses on the development of new contrast media for molecular imaging. ‘We are talking about the so-called smart-probes, i.e. contrast media that are only activated in the body or by interaction with certain cells or molecules respectively.’
‘The fourth project, Euro AIM – Assessment of Imaging in Medicine, deals with cost effectiveness and evidenced-based imaging, i.e. with the question which methods are better than others? Which indication requires the use of which procedure? What is cost effective? The problem is that we still have a tendency to use expensive diagnostic imaging systems without any proof that they are actually of use,’ he pointed out. As an example he gave some untargeted screening CT or MRI screening examinations. ‘We don’t do these in the Netherlands. They are not evidence-based and there is no proof that they have any benefits. Some German institutes even advertise in Dutch newspapers offering complete check-ups just across the border. I think what is being done there is irresponsible. If this was to be done in a respectable way it would have to be backed up by large, multi-centre clinical studies, to find out which particular risk groups would possibly benefit from screening. These studies cost a lot. We are currently trying to get an overview on which studies are being conducted in different countries via the Euro AIM. Virtual colonoscopy is one interesting example. Is it better than, worse than, or on a par with normal colonoscopy? Does it have to be repeated, say every two or five years? I can give you numerous examples of this type where we do something based on gut feeling, or where we think it is right, or because the images look good. However, there is no proof that these new procedures are better than the conventional ones, or than clinical examination.’

EIBIR participants
After the ESR initiated the EIBIR, it attracted more partners, he explained. ‘Initially it was the he European Representation of the Electronics industry (= European Coordination Committee of the Radiological, Electromedical and Healthcare IT Industry). Then the European Association of Nuclear medicine (EANM) i.e. the nuclear medics joined us, followed by the medical physicists (EFOMP, European Federation of Organisations of Medical Physics) and we are currently negotiating with the EORTC which represents clinical oncological research. And the cardiologists (ESC) are also interested. Many organisations that have expressed interest have had little to do with imaging, but imaging is becoming increasingly important in their studies. This is why they are on the look-out for a partner who can offer the necessary know-how. We hope that we will also get enquiries from this field and that we can participate in studies.
‘These enquiries show that we have made a name for ourselves; people are looking us up and want to work with us. We are perceived as a coordinating organisation that plans and implements projects on a national or European level.’
Professor Krestin then spoke of the European Strategy Forum on Research Infrastructures (ESFRI), which links representatives from the EU member states and decided which large medical equipment is needed for research. Based on the Lisbon Agenda the ESFRI has decided that billions of euros should be invested in the research infrastructure in the future. This funding, he pointed out, is to be distributed by the member states themselves. The ESFRI developed an initial “road-map”, which was updated last December. This new version lists 44 projects, ten in the life sciences. ‘Medical imaging research with its Euro BioImaging project is now in a good position to set up important new research centres in several countries,’ he said. ‘However, first the means for this have to be raised in the individual countries and this is where a national road map that lists imaging as an important development is helpful. However, my experience so far has sometimes been disappointing. I was at the German Federal Ministry of Education and Research and there were no concepts on the subject of biomedical imaging. They have not even thought about a road map for infrastructures. The German radiology colleagues were horrified when I told them about the state of play. It will take a lot of lobbying to get Germany involved.’
What other challenges does he foresee for the EIBIR in the future? Professor Krestin raised the subject of its aims and the necessary finance. ‘We have developed into a service provider in biomedical imaging. We want to bring people together and optimise research, and point towards certain directions. We can organise large projects, write applications and organise meetings. So far we have financed this with monies we’ve raised ourselves. In the future, we have to involve our members in financial responsibility to a larger extent if we want to be able to continue these services. Our objective must be to ensure that EIBIR membership becomes a recognised quality mark.’