EH 5_2015

Integrated infusion pump! Wireless & 3-Tesla-capable! Innovation – Made in Germany! STRESScan be so relaxing. The specialist for Stress-MRI! Contrast medium injectors and consumables for CT, MRI and angiography Hauptstr. 255 D-66128 Saarbruecken www.medtron.com Accutron® MR3! EUORPEAN_HOSPITAL_1-4_Seite_MR3.qxp_Layout 1 06.10.15 15:53 Seite 1 EUROPEAN HOSPITAL  Vol 24 Issue 5/15 14 RADIOLOGY Work in progress CT procedures in oncologyOver the last few years CT scan- ner manufacturers have introduced numerous hardware and software innovations to the market. CT diag- nostics benefit from this unbroken trend towards ever faster scanning and from the new reconstruction procedures that require a signifi- cantly smaller signal to generate clear images. The lower radiation dose, smaller amounts of contrast media needed and reduced tube voltage all help to make the exami- nation less invasive – resulting in an increased use of the procedure. But the progress in CT technol- ogy has not yet reached the end by far. ‘It’s more like a work in pro- gress,’ observes Professor Christian Stroszczynski, director of the Institute for Diagnostic Radiology at the Regensburg University Hospital. One important development is hybrid imaging. Hybrid scanners, i.e. equipment that can generate both morphological (CT or MRI) and functional (PET) data during one examination, produce merged image data records, which provide complementary information. These procedures have distinctive advan- tages and deliver a more precise diagnosis than the individual pro- cedures separately, particularly for whole body examinations of cancer patients. PET scanning can often detect primary tumours and metastases clearly, whilst CT and MRI facilitate an anatomically accu- rate localisation of these lesions. Stroszczysnki points to the growing importance of another new proce- dure, which he summarises with the term fusion. The combination of CT- or MRI images respectively with ultrasound is likely to become of great significance for clinical prac- tice. The procedure involves feeding the CT and MRI image data records into the ultrasound scanner via a USB stick and then overlaying the ultrasound images accurately over the CT- and MRI images.’ This has several advantages, specifi- cally in oncology. It allows improved comparability for process monitor- ing. An example: If a doctors check the size of a metastasis after two weeks they can compare the cur- rent ultrasound scans with the old CT scans. Process control is carried out with ultrasound, reducing both radiation exposure and cost. This can also make treatment easier, for hepatocellular carcinoma, for instance. During contrast with a CT or MRI scan the lesion will be only visible to the doctor for a short time. ‘I carry out a scan and see a lesion. If I’m then asked to puncture the lesion there is no benefit to seeing it at the contrast agent stage. By the time I’ll have positioned the needle the lesion will no longer be visible. However, now I can take these CT data records and feed them into the ultrasound scanner and then use ultrasound to locate and punc- ture the lesion based on the data records,’ the specialist explains. One big challenge in oncology is assessing if and how a patient responds to treatment. The most important factor is clearly tumour size, but conventional measuring procedures are not precise enough. Further development of volu- metric procedures for precise and reproducible tumour measuring in all organs is therefore an important step. The opportunities provided by imaging, such as perfusion imaging, also play an important part here. However, this procedure initially had to be simplified. For mobile organs, such as the liver, the images have to be produced in the same layer within a period of 40 seconds to measure perfusion; but, nobody can hold their breath for 40 seconds, which means there have always been technical problems with elimi- nating respiratory motion artefacts.’ When you are particularly unlucky the metastasis, or tumour, will liter- ally slip off the image. Now we have the opportunity to make volume perfusion CTs simple. Thanks to further developments in multi-slice CT, we can now image the entire liver and determine the perfusion,’ Stroszczynski continues. ‘We now have special drugs which help to impair or block tumour perfusion, resulting in it dying off. When you want to see how patients respond to this medication volume perfusion, CT is a good instrument that can be used at an early stage to help with treatment decisions.’ LI-RADS (Liver Imaging Reporting and Data System) is a further inno- vation. It is hoped that, by using standardised assessments in oncol- ogy that can also be internationally compared, the system will standard- ise reporting and data collection. Stroszczynski uses a practical exam- ple to explain this: ‘Some doctors talk about massive tumours, others will describe the same tumours as large. It’s therefore important to agree on size specifications. This structured reporting is currently in vogue and is likely to become more and more integrated into the diag- nosis process.’ Christian Stroszczynski has held the chair of Radiology and been Director of the Institute for Diagnostic Radiology at the University Hospital of Regensburg (UKR) since October 2010. Prior to this he was Assistant Director and Senior Consultant at the Institute for Diagnostic Radiology at the Carl Gustav Carus University Hospital in Dresden for four years. The core areas of his work are image guided diagnosis and treat- ment procedures for liver disease, cancer and vascular medicine In perfusion studies, dynamic CT facilitates differentiated imaging of perfusion parameters, such as blood volume, mean transit time and time-to-peak imaging Hybrid imaging of CT and contrast enhanced ultrasound provides new options for clinical application European paediatric imaging issues take central stage The International Day of Radiology Paediatric imaging will be in the spotlight on 8th November, as celebrations for the International Day of Radiology (IDoR) aim to raise public awareness on the role radiology plays in detecting and treating diseases in children, Mélisande Rouger reports Whilst the International Day of Radiology initiative will inform patients and families about what they can expect when visiting a radiology department and help to relieve anxiety regarding what will happen to their little ones, it will also highlight critical issues within the field and how radiology depart- ment personnel and equipment allo- cation varies across Europe. Paediatric radiologists, subspecial- ists recognised as such only in a few countries worldwide, are a rela- tively rare species within some areas of Europe; actually they’re almost endangered in some countries, according to Dr Catherine Owens, President of the European Society of Paediatric Radiology (ESPR). ‘There’s a dramatic lack of paediatric radiologists across the EU, especially in Eastern Europe,’ she explains, ‘but more recently within countries like France and Germany, who are going through a real crisis.’ Membership of the ESPR, a well- established society, is a good barom- eter to assess interest for the disci- pline on the continent. The UK has a healthy number of ESPR members, but there are still unfilled paediatric radiology posts in the country. The situation is much worse in Eastern Europe and huge countries such as Russia. Many of these countries have a very young population, yet few trained specialists, of whom even fewer are ESPR society members. The society now has very few members from France, where, ironi- cally, the ESPR dug its roots half a century ago, when Professor Jacques  Lefèbvre initiated the  first international meeting of the spe- cialty in Paris. Today’s French radiologists view paediatric radiology as not as lucra- tive as other subspecialties, with punitive daily schedules and on call arrangements, all exacerbated by staffing shortages. Dealing with children is more time consuming than general adult radiology, espe- cially in areas such as paediatric MR, where sedation and anaesthesia are required to engage the child’s cooperation during the examination. There is increasing difficulty with the economic and financial compen- sation for these procedures being limited. ‘In some countries, adult radiologists earn more money than paediatric radiologists and have more opportunity for private prac- tice. Therefore, paediatric radiology can be sometimes considered less Continued on page 16 EUORPEAN_HOSPITAL_1-4_Seite_MR3.qxp_Layout 106.10.1515:53 Seite 1

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