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Taking care of your X-ray imaging neeDS “can i really use a mobile c-arm for cardiac applications?” With our specially developed heart program, powerful generators and flat-panel technology our C-arms provide best results in the most demanding procedures. “How can i gain intraoperative confidence in spinal procedures?” Ziehm Vision RFD 3D helps avoid revision surgeries. With an edge length of 16cm it offers a 3D dataset to confirm the correct implant position in just 3 minutes. A new level of image quality you would not expect from a mobile C-arm. Find out more: www.ziehm.com Zie-1541-Anzeige_European-Hospital_rz.indd 1 12.10.15 18:02 www.healthcare-in-europe.com 15RADIOLOGY One in six men will develop prostate cancer Mr. Prostate’s MRI dream: ‘Yes, we scan!’One in six men will develop prostate cancer. This disease is the second leading cause of cancer death among men in the USA as well as the EU. Definite diagnosis, at an early stage, is vital for survival and early treatment minimises the risk of adverse effects, such as incontinence, erectile dysfunction, or impotence. While there is no preventive screening there is a ray of hope. With his team, Jelle Barentsz, Professor of Radiology and Head of the Prostate MRI Reference Centre of Radboudumc, has established new MRI techniques that can quickly confirm or dismiss suspected aggressive prostate cancer as well as accurately determine the aggressiveness of the disease and stage it Report: Sascha Keutel Latest studies show that many patients with mild forms of prostate cancer (known as indolent carci- noma) appear to undergo excessive treatment, a consequence of inad- equate staging before therapy with the commonly used diagnostic tools. This current diagnostic work-up has several disadvantages. Patients with an elevated prostate-specific antigen (PSA) levels usually undergo a tran- srectal ultrasound (TRUS)-guided biopsy, which typically involves sampling tissue from twelve (some- times six or as many as 24) points in the prostate, in accordance with an established pattern. However, the probability of detecting a carcinoma using this method is only about 50 percent, since ultrasound shows the prostate itself but often does not reveal the position of a carcinoma. In other words, many painful tests establish results that are often inac- curate creating stress and physical inconvenience for the patient with- out providing diagnostic safety. Improved accuracy Therefore, leading urologists are calling for a non-invasive and reli- able method to detect or rule out prostate carcinomas. MRI has been shown to be the most promising method. The new technology is known as mpMRI, which stands for multi-parametric MRI – because it uses several parameters. mpMRI enables physicians to probe tissue parameters such as cellular density (with diffusion-weighted imaging) in addition to depicting the ana- tomical features and vascularity. It significantly improves accuracy of diagnosis and has the potential to save men pain, discomfort and infection. The latest clinical data suggest a sensitivity of more than 89 percent, which means a patient with a negative MRI result does not need to undergo any further biopsy. Therefore it is currently the most reliable procedure available to con- firm and stage a prostate carcinoma or to rule it out. Economic viewpoint However, there is a problem: This technique is not yet widely avail- able. As it is considered very time consuming and demanding it tends to be restricted to centres of excel- lence. Due to the complexity of the images and the data volume that needs to be processed, evaluating the results is a very complex task for the treating physician, and the results are often difficult to interpret for the referring urologist. Barentsz disappointedly confirms: ‘Ignorance, legislation and cost accounting mean that a mpMRI is not the first option in the case of suspected prostate cancer.’ Nonetheless the expert points out that even ‘From an economic viewpoint the new MRI techniques are also favourable: they clearly lower the costs of diagnosis and treatment throughout the entire course of care, and improve the quality of life.’ For example: SEEit, a new pros- tate MRI solution by Siemens, makes this examination as com- fortable as possible: powerful coil technology (Body 60 and Tim 4G) and unique applications (RESOLVE) allow a non-invasive examination in less than ten minutes. Mr. Prostate’s dream Barentsz, who has often been called ‘Mr. Prostate’, advocates for the future a general screening pro- gramme for men above a certain age, questions: ‘If this is done for breast cancer which afflicts 1 in 7 women, then why isn’t it done for prostate cancer, where 1 in 6 men is affected? Why don’t we have a “man- nography” yet?’ MRI scans could radically change the diagnosis and treatment of pros- tate cancer and halve the number of unnecessary biopsies. ‘My dream is that MRI screening becomes stand- ard practice if somebody comes to his or her GP with an elevated PSA level,’ he explains. However, the introduction of new medical services always depends on decisions by the national healthcare authorities. Barentsz has a clear opinion about the use of prostate MRI: ‘I hope that we – government, health insurers, specialists, GPs and patients – will increasingly be able to work together to give men with suspected prostate cancer the ben- efits of a modern MRI scan. Yes we scan!’ Jelle Barentsz is Professor of Radiology and Head the Prostate MRI Reference Centre of the Radiology and Nuclear Medicine of the Radboud University Medical Centre in The Netherlands. He received his medical degree from Utrecht University in 1980 and his doctorate in 1990 for his research on MRI of the bladder.As an internationally recognised expert and renowned speaker he has been awarded many international prizes, inter alia in 2008 the Koningin Wilhelmina Research Prize: an award of two million euros for his research into using MRI for the diagnosis and treatment of prostate cancer. Recently, he was also knighted for the societal impact of his work New Body 60 coil for optimised coverage of the pelvis and improved signal ©www.siemens.com/press Non-invasive 3-D morphology imaging of the prostate in 4:58 minutes Non-invasive diffusion-weighted imaging of the prostate in 4:20 minutes Catherine M Owens MD is a Consultant Radiologist and Reader at the University College London (UCL) and Consultant Paediatric Radiologist at Great Ormond Street Hospital for Children (GOSH), where she has worked since 1996. Her specialist interests are cardio-respiratory radiology, radiology in cystic fibrosis, computed tomography and radiology in immune-compromised patients. In 2008, she was appointed as UCL Reader and has written more than a hundred peer- reviewed articles and over 20 chapters focusing on cardiothoracic CT, radiation protection in CT and radiology in the immune-compromised patients and in cystic fibrosis. The radiologist has lectured at over 150 national and international congresses and supervised higher degrees and diplomas, acting as liaison/host for the European School of Radiology fellowships. Dr Owens is also current President of the European Society of Paediatric Radiology. Zie-1541-Anzeige_European-Hospital_rz.indd 112.10.1518:02

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