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Vol 34 ISSUE 1/25 • February 2025 THE EUROPEAN FORUM FOR THOSE IN THE BUSINESS OF MAKING HEALTHCARE WORK Pioneering women in medical imaging informatics: Katherine P. Andriole From the cradle of digitization to the dawn of AI in radiology Including EH@ECR The Society for Imaging In- formatics in Medicine (SIIM) has done more than any other pro- fessional society to promote the digital conversion of medical im- aging from X-ray film and 35 mm slides. The pioneering re- search of its members over the past 40+ years transformed timely access to radiology exams and created a sea change for radiology department operations and how data from imaging could be analysed. Although a mostly male dominated field, women did and are increasingly making important contributions in the technology. SIIM is pro- ducing a “Women in Informatics” webinar series, launching it with a profile of Katherine P. An- driole, Ph.D., a leading expert and one of the first women to enter the field. Andriole is lauded by numerous medical societies and organizations for her many technical accomplish- ments, and for her leadership role to promote medical imaging in- formatics. She was instrumental in helping design, build, and im- plement one of the first pre- commercial hospital Picture Archi- ving and Communication Systems (PACS). She is now focusing on the use of artificial intelligence (AI) systems in medical informatics. An- driole has authored or co-authored more than 160 peer-review journal articles. European Hospital talked with An- driole about the evolution of medi- cal imaging informatics, experi- ences she has had, and her advice to those – both women and men – who want to enter the field. The impact of timing: starting a ca- reer at the dawn of a revolutionary era in radiology Andriole points out that the ubi- quity of digital medical imaging didn’t happen overnight. It is the result of the collective efforts of an international group of radiologists, engineers, scientists, medical device and software prod- uct in- formation technology specialists, and medical physicists to develop methods to extract, organize, share, and utilise data and images from digital modalities. developers, medical computer Medical imaging informatics has evolved over decades, eventually becoming a subspecialty of radiol- ogy. It has crucial role in exchang- www.healthcare-in-europe.com . D . h P , e l o i r d n A . P e n i r e h t a K f o y s e t r u o C © ICU and ER PACS viewing workstations ing and utilizing medical images within complex information sys- tems. By combining information science, computer science, and healthcare, informatics optimize the acquisition storage, retrieval, and utilization of healthcare in- formation, enhancing accessibility and quality. None of this existed when Andriole entered college. Her parents, both healthcare professionals, and es- pecially her mother, were influen- tial in stimulating interest in math and physics as applied to biology and medicine, and in showing what a powerful, determined woman could achieve. Andriole earned a Ph.D. in electrical engin- eering and medicine at Yale Uni- versity, with an emphasis on classi- cal machine learning and image processing. ‘My initial work with imaging de- vices was to manually measure ca- rotid arteries seen on CT scans,’ she said. ‘At the time, no efficient means existed to acquire digital data directly from CT images. This was a different era. MRI was relatively new, PET was a novel toy, radiology reporting was dictated to a tape recorder and manually tran- scribed to paper records, and exam scheduling was done by phone.’ A chance encounter at a medical conference with H.K. Bernie Huang, D.Sc., a leading PACS pion- eer, led to a fellowship in radiology to work on research in digital im- aging and PACS development, first at University of California, Los An- geles (UCLA), and subsequently at the University of California, San Francisco (UCSF). EH: You have experienced some seismic changes in radiology. What had the greatest impact How did you adjust to change Andriole: ‘In my opinion, the estab- lishment of the DICOM standards and systems integration of RIS/ PACS/HIS were foundational el- ements. With these, capabilities and functionality soared. Con- tinuous improvements in comput- ing power and network capabil- ities, plus dramatic reduction in the cost of digital storage also had a huge impact. ‘The DICOM standards enabled us to extract accurate data in an orderly manner from any vendor’s proprietary imaging scanner or PACS, enabling interoperability. An image interchangeability DICOM demonstration among technical ex- hibition vendors at the 1995 RSNA annual meeting was a monumental event. ‘Image storage has evolved from a walk-in refrigerator sized magneto optical disk storage system holding a maximum of 1 terabyte of data to laptop computers with that capac- ity and accessibility to cloud stor- age. The improvements in network data transfer, combined with dra- matic cost reduction of trans- mitting data, were game changing. The technologies became afford- able and adoptable.’ ‘I was a member of a multi-special- ty team at UCLA and UCSF whose goal was creating a sea change using technology innovations to improve radiology. I had brilliant, supportive mentors. The late Theo C. Pilkington, Ph.D., a pioneer of biomedical engineering, taught me how to approach projects with many unknowns. He ingrained the mandate that if you are going to do anything, you need to understand the fundamentals of a science or technology and its impact. ‘Huang insisted that his PACS team embed itself prominently in the clinical environment to understand what tools are needed, how they will impact workflow, and what benefit they will have. What makes a tool useable and compelling, im- proving upon an older method of doing something or introducing something totally novel but poten- tially beneficial What char- acteristics of a tool or a process cause a user to like or to hate it ’ You are a RSNA 2022 Gold Medal recipient for rendering ‘remark- able service to the science of radiology’. What do you think your greatest contributions are to medical imaging in your ca- reer as a medical informaticist It requires IT experience, and ‘What I have achieved has been as a member of a team. Informatics is teamwork. team science, clinical domain experi- ence, im- plementation science. The teams I have worked with demonstrated how to develop innovative benefi- cial constructively working with all the players, in- cluding vendors, convivially and having fun. technology ‘I am proud of the work we did to be among the first to acquire data from computed radiography (CR) scanners and to show that CR- generated data could be used even though spatial resolutions were challenged. CR scanners were de- signed at the time to transmit data only to X-ray film printers. We had to do reverse engineering using ACR/NEMA standards and then DICOM standards. ‘I also am proud of developing simple, easy-to-use interfaces for PACS viewing-only workstations for ICU, neonatal ICU ward, and Emergency Department physicians. And with David E. Avrin, M.D., Ph.D.,of UCSF for developing soft- ware for automated image pre- fetching of relevant prior exams to a PACS diagnostic workstation cache for comparison with a new exam being interpreted. These both were revolutionary at the time.’ Is medical imaging informatics a good career choice for women What is your advice for entering this specialty Katherine P. Andriole Katherine P. Andriole, PhD, is the Director of Academic Research and Education of the Mass General Brigham AI Office, formerly the MGH & BWH Center for Clinical Data Science (CCDS). She is currently an Associate Professor of Radiology at Harvard Medical School, Brigham and Women’s Hospital. ‘Most definitely. There will be a growing need for medical imaging informaticists, especially as AI tools become commonplace aids to radiologists. Someone has to vali- date their need and monitor their use and performance. People who are inquisitive and who like to solve problems enter this field with many different backgrounds. ‘I encourage anyone interested in the field to attend society meetings such as SIIM25, in person. I can’t emphasize this enough. It’s where you meet the pioneers and leaders, make connections, and can ask questions. Proactively network with end users and with vendors. I also recommend the National Im- aging Informatics Course, an ac- celerated this specialty. It’s a five day long deep dive into the field. Tuition schol- arships are available from its SIIM and RSNA sponsors.’ ■ introduction to Article: Cynthia E. Keen CONTENTS RADIOLOGY EH@ECR HEALTH IT PATHOLOGY ONCOLOGY AI 1 2 4 5 9 12 www.healthcare-in-europe.com
2 EH@ECR @ ECR 2025 ECR 2025: Welcome to Planet Radiology! Congress preview ements such as the all-new “Ask Me Anything” sessions. In these sessions, participants can directly engage with leading experts in their respective fields, who will share in-depth knowledge through a short lecture followed by an open discussion. How to fix the world (as a radiologist) Another notable addition to ECR is a format called “Imagers Fixing the World” (Room O2 and the In Focus Lounge on Level 1), which will showcase impact of radi- ologists worldwide: ‘From provid- the ing teleservices in conflict zones and bringing ultrasound to the re- motest regions to harnessing the power of AI and driving radiology’s green transition, Imagers Fixing the World will celebrate the people and projects that are advancing global health equity and planetary sustainability for the future,’ the or- ganisers say. Following congress tradition, ECR 2025 features several partner coun- tries: During the “ESR Meets” sessions, attendees will learn how radiology is practiced in Morocco, Brazil, the UK and the Baltic coun- tries. Working on the finishing touches for this year’s event, Prof. Rockall says: ‘I want to express my sincere appreciation to everyone who has worked and continues to work so tirelessly in making ECR 2025 a reality. The dedication and passion of so many, often behind the scenes, has shaped this con- gress into something truly special. I greatly look forward to welcom- ing you to Vienna, where we will explore “Planet Radiology” to- gether.’ ■ Andrea Rockall Professor Andrea Rockall is the Clinical Chair of Radiology at Imperi- al College London and President of the European Society of Radiology. She is also the Congress President for this year‘s European Congress of Radiology (ECR). Her work focuses on genitourinary cancer research and machine learning in radiology, earn- ing her the BIR/Mayneord Memorial Award for her contributions to the field. Science, sustainability, and so- ciety – these are the three cor- nerstones of this year’s Euro- pean Congress of Radiology (ECR) in Vienna, Austria. Follow- ing the motto “Planet Radiol- ogy”, the congress focuses on the environmental impact of diag- nostic imaging while exploring ways to advance equitable global healthcare access. Congress President Prof. Andrea Rockall provides a preview on the up- coming event, discussing high- light sessions and new formats – and how radiologists can con- tribute to fixing our planet. As radiologists from around the world have come to expect from ECR, this year’s scientific pro- gramme is again packed with in- sightful sessions from high-profile speakers. During its five-day run- time (Feb 26-Mar 2), the congress will explore cutting-edge advances in radiology, provide an overview of the latest and most exciting find- ings from clinical trials, and dem- onstrate how innovative interdisci- plinary approaches bring new benefits for patient care. Visitors will also be sure to get their fair share of eye candy during the opening ceremony on the first day of the congress, auspiciously titled “Wonder”. In view of the extensive and distin- guished programme, Prof. Rockall is confident that the congress will be a truly one-of-a-kind experience for all congress attendees: ‘With the theme “Planet Radiology”, ECR 2025 will take the concept of planetary health and explore its key parts, including global sustain- ability, healthcare equity and scien- tific innovation.’ Striving to make the event more environmentally-friendly than ever, the organisers have introduced new ways to weave sustainability into the DNA of ECR. Prof. Rockall emphasizes: ‘As climate impacts grow, radiologists are positioned to be leaders in adopting greener practices and sustainable health- care models. As such, you can ex- pect educational sessions dedi- cated to this critical issue. These are supported by a number of green im- plemented at ECR 2025, including the offer of discounted rail travel to reduce attendees’ carbon foot- prints.’ initiatives we have like the ECR 2025 brings back popular fa- vourites inter- pretation quiz, open forums and the AI Theatre (Room D2 on level –2), while introducing fresh el- image R C E © EUROPEAN HOSPITAL Vol 34 Issue 1/25
EH@ECR 3 Imaging modality comparison presented at RSNA 2024 Photon-counting CT advances identification of pancreatic cystic lesions Pancreatic cystic lesions – indi- cating an increased risk of pan- creatic cancer – are an occasional incidental finding in routine computed tomography (CT) ab- dominal imaging. New research suggests that the superior image quality of photon-counting CT (PCCT) can help detect more of these lesions. At the RSNA an- nual meeting, an expert outlined the benefits and limitations of the imaging technique for early detection. Patients with pancreatic cysts may be at increased risk for pancreatic cancer. Therefore, an MRI scan with intravenous contrast for fol- low-up of incidental cystic lesions is usually performed, and guide- lines recommend follow-up CT im- aging on an ongoing basis. The lesions are only identified as incidental findings in fewer than 3% of routine abdominal CT scans performed, compared to up to 44.7% in MRI examinations. Recent research at multiple academic centres explores the effect of im- proved CT image quality on detec- tion rates for pancreatic cystic lesions. 1 the Researchers at the University of Freiburg evaluated image quality and diagnostic accuracy of PCCT compared to conventional energy-integrating detector CT (EID-CT), with MRI serving as the reference standard. They reported at a RSNA 2024 scientific session that PCCT does improve detection and delineation, particularly for smaller cystic lesions. Additional benefits significantly lower radiation exposure while producing higher image quality and generating higher diagnostic confidence by readers. 2 included Improved differentiation Principal investigator Stephan Rau, MD, and colleagues’ database in- cluded 106 consecutive patients with a median age of 62.7 years, who had a portal venous ab- dominal PCCT, an EID-CT, and a multi-parametric abdominal MRI performed within a six-month peri- od. A total of 46 simple cystic lesions were confirmed on MRI: 14 greater than 10 mm, and 27 be- tween 5 mm to 9.99 mm in size. The researchers assessed diag- nostic accuracy, and qualitative and quantitative image accuracy. Dr Rau reported image quality, lesion conspicuity, and diagnostic confidence were rated superior for PCCT vs. EID-CT on 5-point Likert scales by three independent radi- ologists in a blinded reading. Sen- sitivity for the detection of cystic www.healthcare-in-europe.com lesions was significantly higher for PCCT for all lesion categories: 76.8% vs 59.4% overall, 86.4% vs 71.6% for lesions 5 mm to 9.99 mm in size, 90.5% vs. 83.3% for lesions equal or greater than 10 mm. Photon-counting CT also provided better material decomposition, re- sulting in higher cystic paren- chyma contrast. case, water-like ‘From my point of view, this is the most interesting finding of the study,’ Dr Rau commented. ‘It shows that PCCT provides better evaluation of cysts components, in this fluids. Thereby, a new possibility for fu- ture studies on differentiation of cystic lesions based on their at- tenuation/material decomposition could be feasible and should be evaluated.’ Complimenting MRI, not replacing it ‘The University of Freiburg has al- ready integrated PCCT technology for clinical applications, including abdominal imaging,’ Dr Rau told European Hospital. ‘The results of the study underline its value in im- proving diagnostic workflows for detecting pancreatic cystic lesions, especially in routine scenarios or where MRI access is restricted. Adoption for broader use in the specific context of pancreatic cystic lesions detection will likely depend on further advancements, includ- ing multispectral imaging capabil- ities for lesion characterisation.’ Asked about the potential of PCCT as an appropriate substitute for MRI, Dr Rau advised, ’MRI remains the reference standard, particularly due to its superior contrast resol- ution and ability to characterise cystic lesions in greater detail, such as distinguishing malignant from benign features. MRI’s unmatched soft tissue contrast, especially on T2-weighted sequences and dif- fusion weighted imaging, is critical for pancreatic cystic lesion evaluation.’ comprehensive He added, ‘MRI remains indispens- able for follow-up imaging or cases with non-conclusive CT findings. And it does not use ionizing radi- ation.’ Dr Rau believes that PCCT, with its higher image quality and lower radiation dose, demonstrates great promise as a complimentary tool to MRI. ‘It may even be a sub- stitute on scenarios where MRI availability is limited, or patients are contraindicated for MRI,’ he said. Diagnostic boon, but a burden on workload But while PCCT’s higher sensitivity for detecting small pancreatic lesions is a significant advantage, this technology has brought a new challenge: what should radiologists do about these increasingly com- mon incidental findings Dr Rau explains that current guide- lines, based on conventional CT technology, recommend follow-up imaging for all pancreatic cystic lesions. ‘This approach may im- pose a substantial burden on healthcare systems without clear evidence of benefit. Balancing early detection with the cost and practicality of follow up care is an important consideration for future research and policy discussions.’ ■ Author: Cynthia E. Keen Stephan Rau Stephan Rau, MD, is a radiologist specializing in computed to- mography at the Clinic for Diagnostic and Interventional Radiology at the University of Freiburg, Germany. He has conducted extensive research in the diagnostic capabilities of photon- counting detector CT technology. His clinical research includes PCCT im- aging of cystic renal lesions, the spine, head and neck scans in pa- tients with dental hardware, multiple myeloma, and of patients with metal artefacts. References: 1 Dane B, Kim J, Qian K, et al. Pancreatic cystic prevalence and detection with photon counting CT versus conventional energy in- tegrating detector CT. Eur J Radiol. 2024;175:111437. doi: 10.1016/j.ejrad.2024.111437 2. Rau S, Stein T, Rau A, et al. Detection of cystic lesions of the pancreas: Imge quality and diagnostic accuracy of photon-counting detector conventional energy-integrating de- tector CT |T1-SSG09–01. 2024 RSNA Meeting Central. Accessed online 26 January 2025. https://reg.meeting.rsna.org/flow/rsna/ rsna24/AttendeePortalRSNA2024/page/ sessioncatalogap/session/ 1719441285462001hlC8 INTELLIGENT DATA MANAGEMENT INTEGRATED PROCESS SUPPORT NEXUS / VNA ...80 % faster workflow! Archiving of medical and administrative data in one system Standardized integration for simplified networking Workflow engine for cross- departmental processes MDD class IIb viewer with diagnostic capability and comfort functions GDPR-compliant data management with intelligent deletion process Are you ready for the next generation of data archiving? Then get in touch with us now at: sales@nexus-chili.com www.nexus-chili.com
4 HEALTH IT Digital solutions for healthcare Telemedicine as a lifesaver structures. overcome outdated ‘Telemedicine services must be ad- equately funded, and existing legal hurdles must be dismantled.‘ Flexible handling of financing mechanisms Currently, certain telemedicine ser- vices cannot be billed like their analog counterparts. Gaß stated, ‘This hinders the integration of digital solutions.‘ A flexible hand- ling of existing financing mech- anisms, such as case-based pay- ments, could provide relief without injecting additional funds into the system. Moreover, a shift in mind- set is required that shifts the focus from technical details to medical quality. ‘Telemedicine should not only be perceived as a technical addition but as an integral part of modern medical care. This change in awareness must also be reflected in political and regulatory deci- sions to promote the acceptance and use of digital medicine,‘ Marx added. The goal is a con- nected healthcare system that breaks down barriers, increases efficiency, and ensures quality. Marx and Gaß emphasized that it‘s not about investing more money, as many often believe. ‘It‘s more about making these new forms of treatment permissible and billable within existing volumes.‘ Stroke care served as an example again: If a regional stroke unit consults tele- medicine expertise from a neur- ological center, the treatment can- not be billed. To act economically, the patient would have to be trans- ported to a clinic and treated there, although the treatment could have been provided telemedically. ‘It must become possible for us to bring telemedicine expertise to the patient and receive part of the case payment for this service,‘ Marx clarified. He is not aiming to de- sign an additional billing system but rather to handle the existing funds more flexibly. How the medicine of the future can already be implemented today was demonstrated by the company Clinomic with its digital platform for intensive care medicine ‘Mona.‘ The integrated solution acquires, analyzes, and visualizes patient and operational data. Experts can be digitally consulted to review a case together with colleagues. Mona thus enables interdisciplin- ary consultations with internal and external special- ists for optimal intensive care. ‘This is a breakthrough in the care of critically ill people,‘ Marx finds, and concludes by emphasizing: ‘If we do not fully utilize the possibil- ities of digital medicine, we will not be able to overcome the chal- lenges we face in patient care.‘ ■ telemedicine Author: Sonja Buske Using VR glasses, external doctors can participate in the discussion of a shared patient case via the digital platform „Mona.“ © Sonja Buske notion that good care can only be provided on-site. Another key as- pect is the future use of data in pa- tient care. Electronic patient rec- ords, combined with AI-supported analysis, could help refine diag- noses and target telemedicine in- terventions more accurately. This improve care would not only but also allow for a more effective use of scarce resources. However, according to Gaß, politi- cal and structural changes are needed to realize these advances. He appealed to those responsible to create innovation spaces and The future of healthcare requires rethinking and innovative ap- proaches. Given demographic changes, increasing care needs, and a growing shortage of skil- led workers, the integration of digital solutions is essential, as Dr. Gerald Gaß, Chairman of the German Hospital Federation, and Prof. Gernot Marx, Chairman of the German Society for Telemedi- cine, emphasized during the special exhibition „Hospital of the Future“ at MEDICA in Düs- seldorf. Both associations are therefore calling for a stronger use of telemedicine in hospitals in a joint position paper. ‘Telemedicine offers promising op- portunities to enhance the quality of patient care and create equal liv- ing conditions—especially in rural areas, which are often affected by care shortages,‘ said Marx. He cited stroke care as an example, which can be ensured in remote areas thanks con- nections. ‘Experts from specialized centers are digitally involved in the treatment. This reduces transfers to major care centers and enables local care, even for complex diag- noses,‘ explained Marx. He thus advocates moving away from the telemedicine to Dr. Gerald Gaß (left), Chairman of the German Hospital Federation, and Prof. Gernot Marx, Chairman of the German Society for Telemedicine, advocate for the increased use of telemedicine. © Sonja Buske Publisher mgo fachverlage GmbH & Co. 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PATHOLOGY 5 Research presented at Spanish cardiology congress New data on heart attack puts pressure on governments to promote social justice increased tension in the body that is similar to the mechanism of stress. ‘The cold causes stress and this reaction increases tension of the arteries as they tend to close,’ he explained. The phenomenon, called snow attacks, is a well- referenced risk factor of myoc- ardiopathies. the issue continental to demonstrate.’ Another classic trigger for cardiov- ascular events is the association with respiratory infections, but there used to be a problem of stat- istical analysis differentiating be- tween cold and flu, he explained. ‘In our climates, flu and cold go together,’ he said. ‘Determining relative con- tribution of one and the other – whether it is the flu or the cold that influences the risk – was an im- portant García-Lledó and his team have shown that both influenza and cold are independent risk factors in trig- gering myocardial infarction. In ad- dition, they have observed that pol- lution factors, some of which tend to cluster with cold temperatures, also present a risk for heart at- tack. ‘Cold, flu and carbon mon- oxide act as independent as- sociates in the risk of suffering a heart attack. All three have a pa- thophysiological explanation,’ he said. © Vaccination and fairer health policies An efficient strategy to decrease those risk factors is to get vacci- nated against the flu, a vaccination lations with higher unemployment rates and lower income. These is- sues have to do with social policy, and are also relevant for the clini- cian, in order to promote vacci- nation against influenza.’ ■ Author: Mélisande Rouger Alberto García-Lledó Alberto García-Lledó is Head of the cardiology service at the Príncipe de Asturias hospital in Madrid, Spain. He is also an associate professor of cardiology at Alcalá de Henares Uni- versity near Madrid. His special inter- ests are general cardiology and epidemiology. that also protects against other car- diovascular events such as stroke. ‘We have evidence that of all re- spiratory infections, the influenza virus is the one that is most cor- related with cardiovascular ac- cidents,’ he said. ‘The flu vaccine has been around for many years, and we have a lot of experience and published work on its efficacy. In the general population, the vac- cine reduces the risk of myocardial infarction and the risk of stroke.’ Vaccination in Spain is among the best in Western Europe, third only to the UK and Portugal’s that is close to or exceeding 60%, the tar- get set by the WHO. The importance of social justice The new vaccine against the Re- spiratory Syncytial Virus (RSV) could also prove efficient on popu- lation risk. ‘All respiratory viruses and pneumococcus have an in- fluence,’ said García-Lledó. ‘Any in- fection increases the risk of heart attack and stroke because it pro- duces inflammation of atheros- clerosis plaques.’ The most relevant part of the study, however, is how it could help implement health policies that reduce both pollution and energy poverty, García-Lledó believes. ‘We will have to support the reduction of pollution and the promotion of social justice, so that the less wealthy have access to heating,’ he said. ‘We are working to incentivize social assistance, because the risk of heart attack is higher in popu- m o c . e b o d a . k c o t s – m i y i d o y © there was no increase in the risk of suffering from a heart attack.’ low With temperatures, vaso- constriction occurs to avoid cool- ing the inside of the body. Adrenal- ine is secreted, and the skin is left with less blood to keep it warm in- side the body. The process creates NEWTOM 7G NEXT GENERATION CONE-BEAM CT www.newtom.it NewTom CBCT imaging now draws on fresh energy. As of today NewTom 7G incorporates the Dual Energy (DE) system, elevating performance to new heights and revolutionising the way your practice operates. Dual Energy: patented NewTom technology The result of a continuous quest for patient well-being and ever-greater diagnostic precision, Dual Energy uses two different radiant energies to identify any pathologies with greater clarity and precision. Virtual Monochromatic Images Dual Energy technology mitigates beam-hardening artifacts. What’s more, being able to reconstruct monochromatic virtual images at different keVs improves soft tissue imaging quality and reduces metal artifacts. Lastly, Dual Energy CBCT provides a basis for tissue characterisation. Colour-coded images NewTom Dual Energy software enables users to perform semi-automatic tissue segmentation and apply colour codes, streamlining the differentiation of materials within the scanned area. This allows rapid and straightforward detection of potential pathologies. Blended image The new features enable weighted blending of high- and low-energy imaging. The resulting images combine the low noise, typical of high-energy acquisition, with the high contrast resolution of the low-energy image set. Featuring a large gantry aperture, the NewTom 7G is the most advanced CBCT device on the market. From in-depth detail to the big picture. Stay tuned for groundbreaking updates on the technology at ECR 2025 | HALL X3 Stand 312 AND THERE’S MORE TO COME! Environmental factors such as low temperatures and carbon monoxide levels in the air have long been underestimated as risk factors for triggering a heart attack. At the Spanish Car- diology Congress (SEC24) in Oc- tober in Bilbao, an expert pres- ented new research results, which offer insights on the dis- ease causes and put pressure on policy makers to reduce pollu- tion and promote equal access to energy. The data, which was acquired in a retrospective study, sheds light on population risk factors that are often disregarded, according to main author Prof. Alberto García- Lledó, Head of the cardiology ser- vice at the Príncipe de Asturias hospital in Madrid. ‘In infarction, we usually think of individual fac- tors such as cholesterol or work that affect an individual, but there are also environmental factors that affect society,’ he said. ‘These vari- ables are those that periodically in- crease the risk of infarction when certain diseases come along, such as the flu in autumn.’ Shattering a myth García-Lledó’s team has observed heart events in the Madrid region to identify the environmental fac- tors that can influence the risk of suffering from a heart attack. The researchers found that fewer heart attacks occur in August than in No- vember, thereby contradicting a longtime belief related to heat waves. ‘Temperature has an in- fluence, but heat waves are not as- sociated with infarction,’ he said. ‘In Madrid, the colder it gets, the higher the risk. With heat waves, we were able to demonstrate that www.healthcare-in-europe.com
6 Digital pathology discussion panel PATHOLOGY The AI tools pathologists want and need into clinical practice is regulatory, which is very tricky to navigate, as well as having the constant requirement to produce return on investment.’ New approaches to reimbursement needed In terms of improving diagnostic accuracy, Moore said greater ac- ceptance of novel biomarkers for computational pathology will be essential but rather than simply being a multi-industry response, a ‘societal response’ is also required with wider public and govern- mental acceptance of AI. All panellists agreed that demon- strating return on investment (RoI) is a major hurdle, and with relatively few laboratories that are digitised, reimbursement remains fragmented. Bodén favoured a longer-term perspective towards reimbursement and hopes to see health systems become more data driven to provide a better under- standing. Sadimin said the main circumstances where it has been easier to show a RoI with AI in pa- thology is whenever pathologist shortages arise, or they are required to work in remote lo- cations. As for showing benefits to an organisation, she said: ‘That is more challenging and very much depends on who you ask and people’s levels of experience and comfort with AI.’ The issue of bias and ethics in AI use in pathology was raised, with concerns over reliable ground truth but also dogged by a lack of in- stitutions using the approach. Sadimin added: ‘We need to get as many institutes as possible using it and across sites with different demographics.’ Slow take-up seen as a major hurdle The future of AI tools in pathology hinges on a few key factors, the pa- nellists concluded: A major con- cern remained the limited take-up of the technology. ‘With only 4–5% of hospitals in the US currently digital, without digital slides, we are not going to have AI,’ Linder pointed out the importance of wider adoption globally. Bodén suggested a need for more AI use on assisting with reporting as well as improved search func- tionality to reduce the need for outside data sources. Moore said: ‘There are so many biomarkers in the pipeline, that digital pathology biomarker assessment is coming and there is going to be more than one biomarker on one slide, so multiplex too. The sooner we can embrace that the better. Tumour volume is going down because of early detection programmes, so with less tumour, we will need more biomarkers.’ ■ Author: Mark Nicholls Anna Bodén Anna Bodén is Chief of AI govern- ance at the Region Ostergotland and clinical pathologist at the Depart- ment of Clinical Pathology and De- partment of Biomedical and Clinical Sciences at Linköping University in Sweden. She is co-lead of the Euro- pean project Bigpicture on AI-driven digital pathology, has spearheaded digital pathology in her department and aims to integrate AI into clinical practice. Nina Linder Nina Linder is a Guest Professor of Medical Diagnostic Artificial Intelli- gence at the Department of Women’s and Children’s Health, Uppsala Uni- versity, Sweden, and a researcher at the Institute for Molecular Medicine (FIMM) at the University of Helsinki in Finland. Her research focus is on the development of novel AI-based solutions for cancer and infectious disease diagnostics. Luiza Moore is a practising consul- tant pathologist in Cambridge and Senior Director of Clinical Diag- nostics, Global Oncology Diagnostics, AstraZeneca. In her current role she works with multiple franchises to co- ordinate delivery of diagnostic sol- utions and leads efforts to maximize biomarker adoption and facilitate de- centralised molecular testing. Evita Sadimin Evita Sadimin is Chief of the Divi- sion of Pathology Informatics and Data Science at the Department of Pathology, City of Hope National Medical Center, in California and an Associate Professor of Pathology. Her clinical work focuses on urologic on- cology pathology. EUROPEAN HOSPITAL Vol 34 Issue 1/25 Linder, Moore, Bodén and Sadimin at the DPAI © Mark Nicholls The evolving role of AI tools in digital pathology was explored at an open discussion during the annual Digital Pathology and AI Congress in London with a high- level panel of practitioners look- ing at current and future tech- nology options. The panel of pathologists, scientists and aca- demics assessed the tools they currently use, and those they would like to see available in the future as AI plays an increasing role in pathology. The experts also looked at how the adoption of AI into clinical practice is reimbursed and whether digital pathology its promise. is delivering on Taking part in the discussion was Professor Evita Sadimin, Chief of the Division of Pathology In- formatics and Data Science at the City of Hope National Medical Center in California; Dr Anna Bodén, Chief of AI governance at the Region Ostergotland and clini- cal pathologist at the Department of Clinical Pathology and Depart- ment of Biomedical and Clinical Sciences at Linköping University in Sweden; Consultant Pathologist Luiza Moore, Senior Director of Clinical Diagnostics with As- traZeneca; and Professor Nina Linder, Guest Professor of Medical Diagnostic Artificial Intelligence at the Department of Women’s and Children’s Health, Uppsala Univer- sity, Sweden. Challenging beginnings The panellists highlighted what they consider the most current promising use of AI. Exclusively digal nw! Sign up for our newsletter to receive the latest digital issues for FREE, straight to your inbox! SUBSCRIBE NOW! healthcare-in-europe.com/de/ newsletter/ the supporting This included delivering diag- nostics to patients in remote lo- cations, intro- duction of new biomarkers and improved medical screening. How- ever, all acknowledged the im- plementation of AI into practice and workflows has had challenges. Looking back to when her depart- ment began to introduce digital pa- thology, Bodén believes having more structured data from the out- set would have made im- plementation easier. Linden added that establishing good ground rules was an ongoing problem as she believes end points are still not good enough to train algorithms. While ‘fantastic tools’ are becoming available, Moore stated: ‘We are very conscious of how this is going to fit into individual real-world labs and with interoperability and we are looking at ways to deploy AI that minimises disruption.’ Sadim- in, who offered a US perspective, said: ‘For us, the number one chal- lenge of introducing AI algorithms
PATHOLOGY 7 Promising, but in need of further validation Implementation challenges of blood biomarkers for Alzheimer’s disease and validated in clinical trials with patient cohorts of non-Hispanic Caucasian people, who have few health-related comorbidities, and who live in developed economies in countries north of the Equator. Research is starting to reveal that co-morbidities, such as chronic kidney disease, hypertension, his- tory of cancer and/or cardiac ar- rest, diabetes, and some pre- scription drugs, can each impact biomarker concentrations in the blood. and reference intervals that per- form reliably across all patient groups.’ BBB tests in current clinical use are making diagnoses and AD monitoring more precise, and are facilitating AD research through better selection of patient cohorts for clinical trials. Still, it is going to take years before BBB testing can reach the lofty but much needed goal of stemming the epidemic of AD. ■ Author: Cynthia E. Keen References: 1 Kwon HS, Yu H-J, Koh S-H. Revolutionizing Alzheimer‘s Diagnosis and Management: The Dawn of Biomarker-Based Precision Medi- cine. Disord. 2024;23(4):188–201. doi.org/10.12779/dnd.2024.23.4.188. Neurocogn Dement 2 Schöll M, Verberk IMW, del Campo M, et al. Biomarkers of Neurodegeneration 2: Chal- lenges in the practical implementation of blood biomarkers for Alzheimer’s disease. Lancet Healthy Longev. 2024:S:100630. doi.org/10.1016/j.lanhl.2024.07.013. 3 Hampel H, Hu Y, Cummings J, et al. Blood- based biomarkers for Alzheimer’s disease: Current state and future use in a trans- formed global healthcare landscape. Neuron. 2023;111(18):2781–2799. doi: 10.1016/j.neuron.2023.05.017. 4 McGlinchey E, Duran-Aniotz C, Akinyemi R, et al. Biomarkers of Neurodegeneration 5: Biomarkers of neurodegeneration across the Global South. Lancet Healthy Longev. 2024 Oct;5(10):100616. doi: 10.1016/S2666–7568(24)00132–6. Alzheimer’s BBB research of the di- verse ethnic, genetic, cultural and demographic factors, and socioeco- nomic different populations of Af- rica, South Asia, Central America and South America has just begun, and is sparse compared to research in Europe, North America, China, Korea ap- proximately 60% of people living with dementia are estimated to be from low-income and middle- income countries in these under- researched areas.4 Japan. Yet, and This is a massive and complex challenge. ‘The unavailability of re- liable reference intervals for highly diverse populations could lead to the misinterpretation of laboratory test results and contribute to mis- diagnosis and inappropriate clini- cal intervention in a diverse real- world greater heterogeneity among individuals,’ writes Schöll and his multi-national team of co-authors. setting with Harald Hampel, MD, PhD, Chief Medical Officer and Senior Vice President, Neurology from Japan- based pharmaceutical company Eisai, and co-authors are more blunt: ‘While the performance of BBBs in highly selective popu- lations provides initial information, a broader understanding of how these biomarkers behave within the global community at large is needed to provide clinical guid- ance. It is imperative to conduct rigorous validation studies in more representative, real-world popu- lations determine which measures perform most con- sistently and to establish cutoffs to Advertisement m o c . e b o d a . k c o t s – r u t r A © Blood-based biomarker (BBB) tests may represent the best weapon to combat the soaring rates of Alzheimer’s disease (AD) throughout the world. Existing clinically validated tests are cur- rently deployed to facilitate diag- nosis, to monitor disease and ef- fectiveness of to quantify progression, and to de- termine if a patient is appropri- ate for treatment or participation in a clinical trial. treatments, Historically, diagnosis of AD has been based on clinical observa- tions and apparent symptoms, and, for those with access and the funds to pay, lumbar spinal puncture for a cerebrospinal fluid (CSF) test or for a PET imaging scan. With the proliferation of BBB tests in clinical development, and with increasing levels of accuracy at- tained, they are expected to be- come a global tool to fight this most common of dementias. How- ever, there are many challenges to be overcome yet, both with the tests themselves and with their clinical implementation. Test equipment challenges The most accurate tests today use mass spectroscopy, which outper- form immune-based methods of measuring plasma in accuracy and reliability. Korean researchers from Hanyang University College of Medicine in Seoul conducted an in- depth review of current methodol- ogies used in published research to measure Amyloid-beta (Aβ) plas- ma. They discovered ‘considerable variance in the diagnostic efficacy of plasma Aβ, contingent upon the measurement em- techniques www.healthcare-in-europe.com Ionization-mass ployed. spec- troscopy exhibited superior per- formance, while single molecule array (SIMOA) technology did not yield comparable results,’ wrote lead author Hyuk Sung Kwon, MD, PhD.1 Mass spectrometry-based assays require specific expertise and in- frastructure, are time consuming, and yield lower throughput with immunoassays. The equipment is expensive and not available in many hospital and clinic labora- tories.2 However, immune-based methods are currently used for CSF analysis. In addition to immunoassays pro- ducing less accurate results of BBB tests they are also subject to batch- to-batch variation, antibody repro- ducibility, and potential cross- reactivity. They offer automated processing, lower cost, and can de- liver rapid turnaround time for point-of-care testing capability. And equipment is in the lab. These fac- tors make a strong case for the de- velopment of BBB tests specifically designed for immunoassays. Standardisation challenges Another challenge relates to col- lecting viable samples for process- ing in remote or low-economy geo- graphic areas with inadequate laboratory infrastructure. Expan- sion of testing capability of more robust samples, such as dried blood spot, could help resolve such issues. pected to make BBB testing more accessible throughout the world, standardisation for blood biom- arker measurements is imperative. Reproducible, accurate, and con- sistent results are essential. The Global Biomarker Standardization Consortium of the Alzheimer’s As- sociation has been overseeing this critical issue as well as the devel- opment of certified reference ma- terial. Both tasks are enormous in scope and scale, but essential for wide- spread global adoption. Prof. Michel Schöll, Ph.D., of the University of Gothenburg and the Wallenberg Centre for Molecular and Translational Medicine, and colleagues, write: ‘Standardisation challenges will vary greatly de- pending on the blood biomarker and analytic approaches used for its measurement.’ They add, ‘True standardisation will require the derival and validation of cutoffs that are translatable between me- thodological approaches for re- spective blood biomarkers.’ Standardisation reference values are made more complex by the fact that the requirements for the diag- nostic performance of a biomarker are determined by the BBB test’s context of use. As an example, a test to “rule in” AD needs a higher specificity cut point to minimise false positives, whereas a “rule out” test needs a high sensitivity cut point, to minimize false negatives.3 When multiple tests are available from multiple vendors, the cost of blood biomarker analysis is ex- pected to drop. While this is ex- Challenges of population ethnic diversity, medical comorbidities, and confounding factors Most BBB tests have been tested
8 PATHOLOGY Detection of neurodegenerative condition Developing blood biomarkers to diagnose Alzheimer’s to enter There is no known cure for Alz- heimer’s disease (AD), although prescription drug-based treat- ments that can slow AD progres- sion in some patients are start- ing clinical use. Biomarkers, quantifiable char- acteristics of biological pro- cesses or pathological con- ditions, are making it possible to help identify and measure the presence and extent of AD and its degenerative progression. A blood plasma biomarker test re- ceived international media at- tention in July 2024 when results of a large clinical trial showed it to be 91% accurate in diagnosing AD in patients who had been clinically evaluated and diagnosed, com- pared to 73% by dementia special- ists and 61% by primary care phys- icians. The study involved 17 primary care centres in Sweden treating 1,213 patients over 65 years old experi- encing symptoms ranging from subjective cognitive decline to de- mentia. Half had pathologically confirmed AD.1 secondary and The significance of this research becomes clear in light of experts predicting that in 2025, 10 million people will develop AD. Leading organisation Alzheimer’s Disease International (ADI) further esti- mates that the disease will escalate from 55 million cases worldwide to 78 million by 2030 and more than 139 million cases by 2050.2 Benefits for diagnostics and research When blood biomarker tests for AD do become clinically available, unlike the current testing methods of expensive positron electron to- mography (PET) imaging scans and invasive lumbar spine punc- ture for a cerebrospinal fluid test, they will offer many advantages. These are expected to be wide- spread availability, low cost, easy acquisition from patients, and ac- curate laboratory analysis. But they are not going to be a commonplace screening tool soon. Many clinical research challenges await. Sebastian Palmqvist, MD, PhD, Associate Professor in the Clinical Memory Research Unit at Lund University and principal in- vestigator of the Swedish study, ad- vised during a JAMA Medical News podcast that the test is not a stand- alone diagnostic AD test, but rather something that should accompany the standard clinical evaluation. However, he emphasized that ‚you need biomarker tools to accurately identify AD, because the clinical symptoms aren‘t specific for that disease and can be caused by many other ideologies.3 The development of blood biom- arker tests will greatly aid drug- related clinical trials. In a review on this topic, lead author Tharick A. Pascoal, MD, PhD, an Associate Professor of Psychiatry and Neurol- ogy at the University of Pittsburgh, along with an international team of co-authors, state that ‚the import- ance of biomarkers in drug devel- opment is growing exponentially‘ and that they ‚are expected to serve a wide range of contexts of use in clinical trials focusing on AD and other dementias.‘ 4 ‚The lack of biomarkers for popu- lation selection [of early clinical trials targeting Amyloid-beta] has raised the possibility that their negative results could be because other brain pathologies, unaffected by the drugs being studied, were causing symptoms in many partici- pants,‘ they write. ‚Furthermore, the lack of biomarkers to track therapeutic response has raised questions about whether drugs reach their targets and produce the expected biological effects. The lessons learned from these clinical trials have highlighted that it is im- perative to use biomarkers for more informative drug devel- opment in the field of AD.‘ Categories and complexities Blood biomarkers for AD do not have a single category, but three. The first class includes biomarkers associated with the presence of beta-Amyloid plaques and p-tau tangles, both of which are classic pathological hallmarks. The second class is associated with neuronal loss, neurodegeneration, or syn- aptic degeneration. The third class includes processes to neuroinflammation related to glial cells. related The US Food and Drug Adminis- tration and National Institutes of Health created a Biomarker Work- ing Group in 2016, which defined and established nine types of biomarkers. These are categorized in diagnostic, predictive, prog- nostic, response, monitoring, and safety categories.5 Diagnostic biomarkers are most publicly associated with blood susceptibility, laboratory tests being used in clini- cal trials and in development. Better diagnostics lead to increased need for care Assuming that blood biomarker tests become clinically approved and low in cost, what then Com- menting about the accuracy of the blood plasma test used in the Swedish clinical trial in a JAMA edi- torial, dementia specialist phys- icians the United States point out the need for a significant increase in nurse practitioners, nurses, and care navigators.6 from Australia and Lead author Stephen Salloway, MD, of the Departments of Psychiatry and Neurology of Warren Alpert Medical School of Brown Univer- sity in Providence, Rhode Island, and co-authors write, ‚Advances in the diagnosis and treatment of Alz- heimer disease will require import- ant changes to care models. It will not be possible to provide high- quality dementia care in a new molecular era within the already overburdened practice settings without providing additional re- sources and staffing.’ This by itself is a huge challenge, and is not being achieved to effec- tively deal with the needs of today’s AD patients and their care- givers, even though an estimated $1.3 trillion is being spent, accord- ing to ADI. ■ Author: Cynthia E. Keen Sebastian Palmqvist, MD, PhD is Associate Professor in the Clinical Memory Research Unit at Lund Uni- versity. He also is a Consultant Neur- ologist at Skåne University Hospital in Malmö, Sweden. Palmqvist is prin- cipal investigator of ADetect, a 24 month long AD detection study launched in January 2024, and a re- search participant in Lund University ongoing EDAP (early prognostics of Alzheimer’s disease) project. References: 1 Palmqvist S, Tideman P, Mattsson-Carlgren N, et al. Blood Biomarkers to Detect Alz- heimer Disease in Primary Care and Second- ary Care. JAMA. 2024:332(15):1245–1257. doi:10.1001/jama.2024.13855. 2 ‚Dementia statistics‘. Last accessed from Alzheimer’s Disease International website on 22 January 2025. https://www.alzint.org/ about/dementia-facts-figures/dementia- statistics. 3 Highlights from the Alzheimer’s Association International Conference. JAMA Podcast – August 16, 2024. JN Learning – AMA Hub. Last 2025. https://edhub.ama-assn.org/jn-learning/ audio-player/18904877 resultClick=3 accessed January 10 4 Pascoal TA, Aguzzoli CS, Lussier FZ, et al. Insights into the use of biomarkers in clinical trials in Alzheimer’s disease. EBioMedicine. 2024 Oct;108:105322. doi: 10.1016/j.ebiom.2024.105322. 5 BEST (Biomarkers, EndpointS, and other Tools) Resource [Internet]. Last accessed 24 January 2025. https://www.ncbi.nlm.nih.gov/ books/NBK338449. 6 Salloway S, Rowe C, Burns JM. Are Blood Tests for Alzheimer Disease Ready for Prime Time 2024;332(15):1240–1241. doi:10.1001/jama.2024.12814. JAMA. New approach to detecting Alzheimer‘s Dr Bernard Megli, clinical coor- dinator of the study, said: “The vas- cular system and the brain work to- gether to ensure that the brain receives sufficient energy. In fact, the brain needs as much as 20% of the body’s overall energy con- sumption despite contributing only about 2% of the body’s weight.” The “neurovascular unit” (NVU) consists of vasculature connected via brain cells called astrocytes to neurons and ensures that this co- operation is successful. To assess the function of the NVU, re- searchers combined non-invasive measurements of brain blood flow and electrical activity with novel analysis methods developed by Lancaster’s Nonlinear and Biomedi- cal Physics group. They measured the brain’s electrical activity and oxygenation using electrical and optical probes on the scalp while an (ECG) measured heart rate, and a belt wrapped around the participant’s chest measured breathing. Simulta- electrocardiogram neously measuring blood oxyge- nation, brain electrical activity, res- piration and electric activity of the heart let the researchers capture physiological rhythms and their imperfect timings. Efficient func- tioning of the brain depends on how well all these rhythms are or- chestrated. To assess the efficiency of the NVU, both the strength and the coordination of these rhythms were assessed by computing their “power” and “phase coherence” using mathematical algorithms. Researchers found that the median respiration rate was approximately 13 breaths per minute for the con- trol group, and approximately 17 breaths per minute for the Alz- heimer’s group. Professor Stef- anovska said: “Quite unexpectedly, we also detected that the respir- atory frequency at rest is sig- nificantly higher in subjects with Alzheimer‘s disease. This is an in- teresting discovery – in my opinion a revolutionary one – that may open a whole new world in the s g n i n n e J l l i J © Researchers combined non-invasive measurements of brain blood flow and electrical activity with novel analysis methods Research led by Lancaster Uni- versity has revealed clear evi- dence that changes in the or- chestration of brain oxygenation dynamics and neuronal function in Alzheimer’s disease contribute to the neurodegeneration. The study “Neurovascular phase coherence is altered in Alzheimer’s Disease” is published in Brain Communications. The lead author is Aneta Stefanovska with Juliane Bjerkan, Gemma Lancaster, Peter McClintock and Trevor Crawford from Lancaster University and Bernard Megli and Jan Kobal from the University of Ljubljana Medical Centre in Slovenia. Professor Stef- anovska said: “Alzheimer‘s can be hypothesised as being a result of the brain not being appropriately nourished via the blood vessels (vascular system).” an likely reflects study of the Alzheimer‘s disease. It most in- flammation, maybe in the brain, that once detected can probably be treated and severe states of Alz- heimer‘s might be prevented in the future.” disease.” Dr Megli said: “With disappointing results from protein-focused drug trials, the vasculature and neur- ovascular unit are promising tar- gets for future treatments of Alz- heimer’s Professor Stefanovska said: “We show clear results of our approach and how can be detected Alzheimer‘s simply, noninvasively, and in- expensively. The method has a great potential, and we are discuss- ing possibilities to create a spin-out or start-up company to proceed with it. Of course, more research is needed.” ■ Source: Lancaster University EUROPEAN HOSPITAL Vol 34 Issue 1/25
ONCOLOGY Freezing cancer cells 9 Cryoablation: A treatment option for low-risk early-stage breast cancer patients lumpectomy Cryoablation, the destruction of malignant cancer cells by freez- ing them, is increasingly becom- ing an alternative to having con- ventional for patients diagnosed with early- stage, localised, low-risk breast cancer. Findings from numerous recent clinical trials show that cancer recurrence rates are very to low and are comparable breast surgery (BCS). conservation Unlike in BCS, however, no breast tissue is removed, and scarring is minimal. The procedure is per- formed in outpatient hospital radi- ology departments, with local an- aesthesia and ultrasound or MRI guidance, taking less than an hour. Patients experience little dis- comfort and can resume normal ac- tivities within a day or two. Mild-to-moderate adverse effects for patients having the procedure include bruising, localised edema, freeze-related skin burns, rash, bleeding from needle insertion, local hematoma, tenderness, pruri- tis and rash. They resolve rapidly without complications or long-term residual effects. is most effective ‘Cryoablation when treating small lesions with- out extensive intraductal com- ponent,’ say Lauren M. Kopicky, MD, a breast surgeon at Cleveland Clinic and Debra A. Pratt, MD, Medical Director of breast services of the Moll Cancer Center of Fair- view Hospital in Ohio.1 They cau- tion that breast cryoablation is ap- propriate only for select patients, and is currently authorized by the US Food and Drug Administration (FDA) only in clinical trials. Ac- cording to cryoablation technology developer IceCure Medical, the technique is approved for use in Europe for breast cancer and fi- broadenomas (benign breast tu- mours) for over two decades and is considered a well-tolerated out- patient procedure. Promising trial results Much awaited five-year outcomes of the ICE3 Trial, initially presented at the 2024 American Society of Breast Surgeons (ASBrS) Annual Meeting, may spur FDA approval.2 This is the first and largest-to-date prospective, multi-centre clinical trial of breast cryoablation for breast cancer. One hundred ninety- four women, ages 55 to 94, receiv- ed cryoablation treatment at 19 hospitals, with imaging follow-up only and no subsequent tumour excision for 194 patients. None had lymph node involvement. Almost 80% of participants received ad- juvant treatment, predominantly treatment.3 (63.9%) Seven patients (3.7%) experienced cancer recurrence. Two patients (1%) developed distant metastasis and died. endocrine www.healthcare-in-europe.com ) 0 . 4 Y B C C ( 4 2 0 2 s r e c n a C ; H n a w d A , U r e l b ü K , J t d l e f l e i B , J T l g o V © © 59-year-old female patient with cancer in the left breast. The Cryoablation was performed with two 9 min freeze cycles with a 9-min passive thaw cycle in between. (A) Pre-Ablation contrast-enhanced T1-weighted MR images. Tumour localized in left lo- wer lateral quadrant. (B) The cryoprobe is inserted in the lesion during the CT-guided ablation procedure. (C) First post-ablation images, 24 h after ablation. The ablation zone can be seen in the contrast-enhanced T1-weighted MR images. (D) Ablation zone in the 3-month post follow-up MR-images. (E) Ablation zone in the 6-month post follow-up MR-images. (F) Ablation zone in the 9-month post follow-up MR-images. The patient showed a complete remission and had a survival time of 16 months starting at the date of ablation until last contact. Richard E. Fine Richard E. Fine, MD, is a breast sur- geon at the Margaret West Compre- hensive Breast Center in Germantown, Tennessee. He has the distinction of being one of the first surgeons in the United States to per- form image-guided breast biopsies and has extensive experience in new breast biopsy methods. Dr Fine is a past president and Chairman of the Board of the American Society of Breast Surgeons. Prof. Thomas J. Vogl, MD, PhD, an interventional radiologist, is Director of the Clinic of Radiology and Nu- clear Medicine at University Hospital Frankfurt, Germany, specializes in in- terventional oncology and vascular procedures. He also is Professor for X-ray Diagnostics of the Goethe Uni- versity Frankfurt am Main. Dr Vogl’s research has resulted in worldwide optimisation of imaging procedures and surgical methods. He was in- volved extensively in the evaluation of contrast agents and developed an angiography robot with the ability to deliver high-resolution diagnostic im- ages from inside the body to detect previously undiscovered tumours. Patients had a planning CT-scan prior to cryoablation to locate an appropriate incision point and plan the trajectory of the cyroprobe shaft. Breast MRI scans were per- formed 24-hours post-treatment. If any residual contrast-enhanced tu- mour tissue was seen at ablation margins, another cryoablation pro- cedure was performed to ensure complete ablation of the tumour. Principal investigator Prof. Thomas J. Vogl, MD, PhD, Director of the Clinic of Radiology and Nuclear Medicine, and colleagues advise that they selected CT-guidance in- stead of ultrasound guidance for the ablation procedure to enable an exact visualisation of the cryro- probe, the malignant tumour, and the ice ball in all dimensions and to ensure a sufficient safety dis- tance to adjacent structures. References: 1. Kopicky LM, Pratt DA. Cryoablation and Breast Disease. Curr. Breast Cancer Rep. 2024. 16:279–287. https://doi.org/10.1007/s12609–024–00561–2 2. Fine R, Gilmore R, Dietz J, et al. Cryoab- lation without Excision for Early-stage Breast Cancer: ICE3 Trial 5-year Follow-up on Ipsi- lateral Breast Tumor Recurrence. Scientific session 176458, 25th ASBrS Annual Meeting. April 2024. https://doi.org/10.1245/s10434–024–16181–0 3. Fine RE, Gilmore RC, Tomkovich KR, et al. Cryoablation Without Excision for Early- Stage Breast Cancer: ICE3 Trial 5-Year Fol- low-Up on Ipsilateral Breast Tumor Recur- rence. Ann Surg Oncol. Published online 16 September 2024. https://doi.org/10.1245/s10434–024–16181–0 4. Vogl TJ, Bielfeldt J, Kübler U, et al. CT- Guided Percutaneous Cryoablation of Breast Cancer: A Single-Center Experience. Cancers. 2024 16, 2373. https://doi.org/10.3390/cancers16132373 it is cost-effective, They say that the advantages of using a liquid-nitrogen system are that time- efficient for both patient and clini- cians, and has a notably better cos- metic outcome. It does not require specific security measures, because liquid nitrogen is not stored in a pressurised container. The dis- advantage is that the procedure takes considerably than either microwave radio- frequency ablation procedures. ■ longer or Principal investigator Richard E. Fine, MD, of the West Cancer Center and Research Institute in Germantown, Tennessee, reported that at 54 months, the overall ipsi- lateral breast tumour recurrence (IBTR) rate was 3.7%, 3.2% for pa- tients who subsequently received endocrine surgery. This gives a five-year IBTR survival rate of 4.3% and 3.7%, respectively. Five years following treatment, 100% of pa- tients and physicians were very sat- isfied with cosmetic results: a nor- mal-looking breast with a small scar from the cryoablation needle. CT-guided cryoablation for curative intent and metastatic local tumour control In Germany, cryoablation is being used to treat patients with localised recurrence, auxiliary node involve- ment, and metastasis. Researchers at University Hospital Frankfurt re- port their treatment of 56 tumours in 45 patients using liquid-nitrogen based CT-guided cryoablation in Cancers.4 The study cohort consisted of breast cancer patients who did not want to undergo surgery or who had unresectable tumours who underwent cryoablation between May 2019 to May 2023. They ranged in age from 31 to 86 years. Thirteen with newly diagnosed breast cancer and 11 with breast cancer recurrence were treated with curative intent. Twenty-one with metastases were treated for local tumour control. All patients completed the treatment, and none experienced any complications. Author: Cynthia E. Keen ProSense Cryoablation System. © IceCure.
10 ONCOLOGY Hyperbaric oxygen therapy to reduce toxic effects HBOT shows promise after breast cancer oxygen radiotherapy therapy Hyperbaric (HBOT) treatments could offer relief to breast cancer patients who experience late toxicities following treat- ment. To date, the handful of completed clinical trials only produced inconclusive or contra- dictory results. Therefore, results from the latest trial, named HONEY (Effect of Hyperbaric Oxygen Therapy on Breast Cancer Patients with Late Radi- ation Toxicity), were anxiously awaited. However, re- searchers’ insights, published in JAMA Oncology, also do not pro- vide much definitive evidence of HBOT’s benefit. 1,2 the hundred eighty-eight (19.1%) pa- tients out of 2,029 survey re- sponders (who had been partici- pants in a previous breast cancer clinical trial) reported they were experiencing these late toxic ef- fects. A total of 189 were eligible to participate in the HONEY trial. invited researchers 125 The women to receive 30 to 40 HBOT sessions 120 minutes in duration over a period of six to eight con- secutive weeks. Eighty-five women declined the treatment, with 70 saying that the time commitment required to participate was too great. An additional 61 were se- lected as the control group. ulty of Medicine in Jerusalem, write: ‘We now have modest evi- dence to justify the use of HBOT in treating the chronic morbidities as- sociated with breast irradiation. […] In terms of the next steps, ad- equately powered randomized, sham-controlled, double-blind trials will be necessary to truly de- termine the benefit of HBOT.’ 2 Breast cancer-related HBOT clinical trials in progress Two clinical trials are currently underway in Asia to evaluate how HBOT may toxicities caused by radiotherapy to treat breast cancer. reduce conditions, HBOT provides 100% oxygen for inhalation inside a pressurized treatment chamber. The therapy is used to treat a large variety of medical including toxicities caused by cancer treat- ments, by increasing the amount of oxygen that the blood can carry throughout the body and by de- livering oxygen-rich plasma to hy- poxic can help strengthen immune responsiveness and encourage new collagen de- position and endothelial cell formation. 3 tissue. This The HONEY trial A multi-institutional team in the Netherlands conducted the hospi- tal-based randomised clinical trial to assess the effectiveness of HBOT to reduce or eliminate moderate or severe breast, chest wall, and/or shoulder pain in combination with edema, fibrosis, or movement re- striction 12 months or longer fol- lowing breast irradiation. Three Ultimately, only 31 women com- pleted the HBOT treatment, which consisted of breathing 100% oxygen through an oxygen mask during four intervals of 20 minutes at an atmospheric pressure of 2.5 ATA (or bar). Principal investigator Prof. Helena M Verkooijen, MD, PhD and colleagues evaluated these patients at baseline and at three- and six-months post-treat- ment. They report that in follow up, moderate to severe pain was not statistically different between the HBOT group (50%) and the control group (62%). However, the HBOT treatment participants ex- perienced a significant reduction in fibrosis. In an accompanying editorial, Dr Ezra Hahn of the Princess Margaret Cancer Centre in Toronto, Prof. Dr Aron Popovtzer of the Hadassah University Medical Center in Jeru- salem, and Prof. Dr Benjamin W. Corn of the Hebrew University Fac- South Korean researchers at the Ilsan Medical Center, a Cha woman’s hospital in Goyang-si near Seoul, are conducting a clini- cal trial to determine the efficacy and safety of HBOT to prevent radiation dermatitis. Patients re- ceiving adjuvant radiotherapy fol- lowing breast conservation surgery for localized invasive breast cancer are either randomized to receive HBOT three times a week after completing five fractional radio- therapy treatments (for 60 Gy total) or to receive standard education in dermal care. Principal investigator Assistant Professor Jee Young Lee advises the study, which started November 2023, is measur- ing the incidence and severity of radiation dermatitis in each group, as well as evaluate any self- described quality of im- provements. 4 that life A large randomized clinical trial of nearly 400 breast cancer patients receiving treatment at Guangdong References: 1. van der Molen DR, Batenburg MCT, Maarse W, et al. Hyperbaric Oxygen Therapy and Late Local Toxic Effects in Patients With Irradiated Breast Cancer: A Randomized Clinical Trial. JAMA Oncol. 2024 Apr 1;10(4):464–474. doi: 10.1001/jamaoncol.2023.6776. 2. Hahn E, Popovtzer A, Corn BW. Hyper- baric Oxygen Therapy for Management of Late Radiation Toxicity – A Honey of a Trial JAMA Oncol. 2024 Apr 1;10(4):437–438. doi: 10.1001/jama. 3. Sethuraman KN, Smolin R, Henry S. Is There a Place for Hyperbaric Oxygen Ther- apy Adv Surg. 2022 Sep;56(1):169–204. doi: 10.1016/j.yasu.2022.02.011. 4. Efficacy and Safety of Hyperbaric Oxygen Therapy for Radiation Dermatitis in Patients with Localized Breast Cancer (HBOT). Clini calTrials.gov ID NCT06158347. https://clinicaltrials.gov/study/ NCT06158347 cond=cancer&term=Hyper- baric Oxygen Therapy&intr=radiation ther- apy&page=2&rank=14. 5. Hyperbaric Oxygen in the Prevention of Radiation Pneumonitis. ClinicalTrials.gov ID NCT05189496. https://clinicaltrials.gov/study/ NCT05189496 cond=cancer&term=Hyper- baric Oxygen Therapy&intr=radiation ther- apy&aggFilters=status:rec&rank=1 in Provincial People’s Hospital Guangzhou, China, is evaluating if HBOT treatments can prevent radi- ation pneumonitis caused by chemotherapy and radiotherapy. Radiotherapy can cause radiation lung injury, leading to pulmonary fibrosis. 5 the secretion of thereby ‘Hyperbaric oxygen can improve the tissue after radiation by pro- moting the function of vascular en- dothelial cells and fibroblasts, and reducing in- flammatory factors, in- hibiting the process of fibrosis and fiber atrophy after radiotherapy, and promoting tissue repair. There- fore, it has the potential value of treating chronic radiation injury,’ explains principal investigator Prof. Kun Wang, MD, PhD. therapy Half of the patients are receiving standard-of-care treatment. The other half are receiving 30–40 hy- perbaric oxygen treat- ments immediately after the end of radiotherapy. Researchers will evaluate the incidence of radiation pneumonitis 12 months following completion of treatment for both patient cohorts, and the type and severity of symptoms among both groups of patients who develop radiation pneumonitis. ■ Author: Cynthia E. Keen New approach to crack persister tumour cells Cancer therapies do not always succeed in eliminating tumour cells. Some of these cells enter a state of senescence—a latent, non-dividing state that is gen- erally irreversible. Others, however, enter a state known as ‚persister,‘ where dor- mancy is temporary and reversible. This state allows the cells to begin growing again after the treatment has ended, leading to cancer recur- rence. A team led by Dr. Manuel Serrano at the Institute for Research in Bio- medicine (IRB) Barcelona has dis- covered a key strategy through which these persister cells evade the immune response and resist cancer treatments. Specifically, the study reveals that persister cells block the genes responsible for in- flammation through an epigenetic mechanism that acts as a ‚molecu- lar lock,‘ preventing these genes from becoming activated and alert- ing the immune system. This lock stops the immune system from de- tecting and eliminating these cells, allowing them to resist treatment. 5 2 0 2 h c r a e s e R r e c n a C , . l a t e M a v e h c t a v o K , L t r a h c i R , V i n o p m a R © Graphical abstract of the new research This contrasts with senescent cells, which are highly inflammatory and use different mechanisms to evade the immune response. “This epigenetic silencing is a weakness of persister cells and could be leveraged to design new therapeutic approaches,” says Dr. Serrano, head of the study and cur- rently working at Altos Labs (Cam- bridge, UK). The study, first-authored by Dr. Val- entina Ramponi, has been pub- lished in the journal Cancer Re- search. In addition to identifying this mechanism, the study shows that inhibiting the epigenetic mech- anism could unlock inflammatory genes and compromise the viabil- ity of persister cells, thus paving the way for the development of new therapies. “The goal is to be able to develop drugs that selec- tively target persister cells and the effect of con- strengthen ventional treatments,” concludes Dr. Ramponi, now a postdoctoral researcher at the AIRC Institute of Molecular Oncology. This discovery marks a step for- ward in the fight against resistance to cancer treatment. By targeting persister cells, the likelihood of re- lapse could be reduced, thus im- proving patient prognosis. This study has been done in col- laboration with the Rovira i Virgili University, the Queen Mary Univer- sity of London, the CIBER de Dia- betes y Enfermedades Metabólicas Asociadas (CIBERDEM), the AIRC Institute of Molecular Oncology, and Altos Labs’ Cambridge Institute of Science. The study was funded by the European Research Council (ERC), the Spanish Association Against Cancer, the European Mol- ecular Organization (EMBO), and the Barcelona In- stitute of Science and Technology (BIST). ■ Biology Source: Institute for Research in Bio- medicine Barcelona EUROPEAN HOSPITAL Vol 34 Issue 1/25
ONCOLOGY 11 San Antonio Breast Cancer Symposium (SABCS) Young women and breast cancer: research in focus (SABCS) At the San Antonio Breast Cancer Symposium in De- cember, three experts presented new approaches and study re- sults for the treatment of breast cancer in young women. In her lecture, Camila dos Santos explained that the development of the mammary glands is strongly controlled by hormones that pro- mote cell growth and cell division. ‘During pregnancy, there are sig- nificant structural and functional changes in the breast, such as the expansion of cells and the produc- tion of new proteins to prepare for milk production,’ said the Associate Professor at Cold Spring Harbor Laboratory, New York. ‘These hormonal influences not only change the growth pattern of epithelial cells but also affect the collagen structure of the breast and its alignment, as shown by micro- scopic techniques such as collagen that staining.’ She emphasized pregnancies epigenetic changes that permanently affect the gene expression of breast cells. ‘Early pregnancies can reduce the risk of breast cancer by 30–40%, depending on the subtype and genetic mutations. This protective effect often into post- leave lasts menopausal age,’ explained dos Santos. Using mouse models, it was shown that pregnancies promote cell aging, which inhibits tumour development. It was also dis- covered that pregnancy affects the immune system by infiltrating cer- tain types of T cells that can alter the tissue environment of the breast and inhibit tumour growth. Urinary tract infections promote tu- mour growth The systemic effects of urinary tract infections (UTIs) on the breast are still relatively unknown. They lead to a systemic inflammatory reaction and increased collagen de- position in the breast. In mouse models, it was found that UTIs cause hyperplasia of the mammary gland ducts and changes in cell be- haviour. These changes can ac- celerate tumour growth in geneti- cally models. ‘Pregnancy and systemic factors such as infections can influence breast development and breast cancer risk in multiple ways. These findings could lead to the devel- opment of preventive therapies that modulate the immune system or influence epigenetic changes to reduce breast cancer risks,’ sum- marized the expert. susceptible Suppression of ovarian function In her presentation, Prudence Francis looked at various ap- proaches to suppressing ovarian function in premenopausal women with early breast cancer. The medi- cal oncologist breast cancer clini- cian-researcher at Peter MacCallum Cancer, Melbourne, Australia, pointed out that ovarian function can be reversibly suppressed by GnRH agonists, which is par- ticularly suitable for young women to avoid permanent menopause. ‘Alternatively, surgical menopause is an option for women close to the natural menopausal age,’ said the expert. that indicate Monitoring estradiol levels is also important to ensuring effective suppression of ovarian function. ‘In clinical practice, this is often not done routinely unless specific symptoms sup- pression is inadequate. However, studies show that younger women, women without chemotherapy, and those with higher BMI are at in- creased risk of not achieving per- sistent suppression,’ Francis ex- plained. Ovarian suppression is particularly indicated in premeno- pausal women with a high risk of recurrence, for example in very young women or those who are to through cognitive chosocial health: ‘Younger patients often suffer from higher levels of psychological stress. The fear of re- lapse is widespread, but can be re- duced inter- ventions,’ the expert made clear, emphasizing the importance of couples therapy to improve coping strategies. Problems such as insom- nia could be successfully treated with a combination of cognitive be- havioural therapy and light ther- apy. Finally, Sheng discussed support programmes for young adults. These should cover a broad spec- trum, from psychosocial support and fertility counselling to the treatment of menopausal symp- toms. im- plementation of such programmes is hampered by limited financial and human resources,’ she criti- cized. ■ ‘However, the Report: Sonja Buske be treated with an aromatase in- hibitor. For premenopausal women with estrogen receptor-negative breast cancer, ovarian suppression is increasingly being discussed as a means of reducing the risk of pre- mature menopause. ‘Although there is no oncological benefit in this group, the quality of life and health of women could be im- proved by avoiding premature menopause,’ the expert made clear. Aftercare and treatment: a multidis- ciplinary approach Dr Jenni Sheng addressed the vari- ous aspects of follow-up care and treatment for young women with breast cancer in her presentation. The Assistant Professor in the De- partment of Oncology at the Johns Hopkins University School of Medicine, Baltimore, emphasized that a multidisciplinary approach is necessary to optimize survival and quality of life, as this patient group is often underrepresented in studies. ‘There is a particular focus on fertility and family planning, in- cluding the importance of early fer- tility preservation discussions. Studies show that pregnancy after breast cancer does not worsen dis- ease-free survival or overall sur- vival,’ said Sheng. Another key point of her presentation was psy- Replicating tumours to assess cancer immunotherapy efficacy The Micro Immune Response On chip (MIRO) allows tumours and their environment to be rep- licated in order to understand their im- munotherapy-based treatments. response to The device, which has already been successfully tested on breast cancer samples, could be key to developing new treatments and de- termining the most appropriate therapy for each patient in a per- sonalized way. The work, pub- lished in Nature Communications, is the result of a collaboration be- tween the Institute for Bioengi- neering of Catalonia and the Re- search Institute of the Hospital del Mar. The MIRO device makes it possible to fill a gap in the creation of treat- ments against cancer cells. Many developments offer promising re- sults in the laboratory, in vitro and in mouse models, but they do not work as well when transferred to humans. “MIRO enables to recreate not only the tumour, but its en- vironment and the interaction they have with the cells of the immune system. This relationship is vital for the success of immunotherapy- based treatments which, despite www.healthcare-in-europe.com C E B I © Representative image of MIRO co-culture on day 10 their curative potential, currently only work in between 20 and 40% of patients” explains Dr Anna La- bernadie, who designed the micro- fluidic system during at IBEC and now leads the Cell Behavior and Tissue Bioengineering laboratory at the Príncipe Felipe Research Center (CIPF) in Valencia. The researchers who have devel- oped this technology have already tested it with breast cancer samples known as HER2-positive. This type of cancer cell has very high levels of the HER2 protein, which promotes tumour growth, but at the same time, can be treated with therapies that spe- cifically target this protein. rapid antibody The tests carried out have made it possible to verify the importance of the environment surrounding breast tumours in protecting them from the most common treatment in this type of cancer, the mono- clonal trastuzumab. “Thanks to MIRO, we have been able to track the immune cells, see how they lose speed, movement, as they approach the tumour, which makes the treatment not work. They encounter a barrier formed by the tumour environment and become blocked”, explains Dr Alexandre Calon, head of the Translational Research Laboratory in Tumour Microenvironment at the Hospital del Mar Research In- stitute. The MIRO device, which has al- ready been tested with other types of solid tumours, such as lung or colon tumours, is manufactured using microfluidic techniques. These techniques allow fluids and cells to be manipulated on a very small scale. MIRO includes cell cul- tures of different types, separated into compartments in order to di- rect and observe their evolution. This model, the first of its kind cre- ated with these techniques, makes it possible to recreate and study in the immune detail interaction between cancer cells, their connective tissue and responses. “This model allows us to directly test the treatments that would be used with patients,” explains Dr Xavier Tre- pat, ICREA research professor at IBEC, where he leads the Inte- grative Cell and Tissue Dynamics group, and member of the Univer- sity of Barcelona (UB). The device’s ability to analyse the functioning of different treatments, the emergence of possible resis- tance and even identify new biom- arkers individually for each pa- tient, represents a great advance in the design and personalisation of immunotherapy treatments in on- cology. In this sense, Dr Joan Al- banell, head of the Medical Oncol- ogy Service at Hospital del Mar and director of the Cancer Research Program at his research institute, pointed out that “MIRO is an inno- vative preclinical model that can help improve the success rate and efficacy of new strategies with im- munotherapy once we transfer them to clinical trials”. As for future work, IBEC, ICREA and Hospital del Mar Research In- stitute have already filed a joint patent application for MIRO’s tech- nology. “Our goal is to transfer this technology to the pharmaceutical industry and hospitals to be able to apply it to patients,” explains Dr Anna Labernadie. The study described is part of Alice Perucca’s PhD thesis at IBEC. Her work focuses on investigating the role of the immunocompetent eco- system in cancer progression. The work also included the col- laboration of the Institute for Re- search in Biomedicine (IRB Barce- lona), the University of Barcelona (UB), the Bioengineering, Bio- materials and Nanomedicine Net- working Biomedical Research Centre (CIBER-BBN), Pompeu Fabra University and the Oncology Networking Biomedical Research Centre (CIBERONC-ISCIII); and has received partial funding from the “la Caixa” Foundation. ■ Source: Institute for Bioengineering of Catalonia
12 AI From chatbot to medical assistant Generative AI: prompt solutions for healthcare cess highly sensitive data, which calls for a thorough analysis of benefits and potential risks, Weiss pointed out. ‘We should not blindly push for implementation when the side-effects are unclear,’ he con- cluded. The aforementioned US companies were of course also at the tradefair, to present their generative AI sol- utions. Notably, Hadas Bitram, Partner General Manager, Health AI at Microsoft Health & Life Sciences, addressed the issue of re- sponsible use of medical AI at the Medica Innovation Forum. She highlighted safeguards in the com- pany’s own products against AI hallucinations and omissions. For example, the LLM gives reference to the sources a given information is based on, to enable validation and provide clinical context. ‘Still, there should always be an account- able medical professional in the loop,’ Bitram said. The expert also highlighted “AI lit- eracy” as a crucial skill for future clinicians: ‘The work of medical professionals will become increas- ingly sophisticated,’ she predicted. Assessing and using the right AI tools, interpreting their results and making the right calls based on their input will therefore be essen- tial. AI may not replace doctors, she concluded, but doctors who use AI will replace those who don’t. ■ Author: Wolfgang Behrends Baked-in bias of Computation, Prof Dr Reinhard Heckel pointed to insufficient data as a major cause for underperforming AI models. Rare conditions are by na- ture underrepresented in most da- tasets, and variations in image quality may increase existing mis- interpretations, the expert from the Technical University of Munich’s School In- formation and Technology said, ad- ding that inclusion of diverse data could mitigate some of these is- sues. However, some technologies have biases deeply embedded into their functionality, he explained. For example, some imaging moda- lities are optimized for lighter skin tones, which inherently leads to su- perior results in these patients. ‘This is a social issue,’ Antweiler said, pointing out the need to es- tablish groups that should be es- pecially protected from this kind of bias. m o c . e b o d a . k c o t s – v i l a z i l e © tent brought about one of the tech- nology’s major issues: results that look plausible at first glance but may turn out to be inaccurate or even completely made up by the algorithm – a phenomenon that has gained notoriety as AI “halluci- nations”. Since these fabricated findings can- not always reliably be excluded, safeguards should be established, suggested Antweiler. For example, different AI models could be run- ning independently on the same task to reveal inconsistencies. Also, human operators should always be aware of the possibility of such er- rors. ‘However, we should not for- get that humans also “hallucinate” – we make mistakes, and we tend to be less critical about them than we are about AI hallucinations,’ the expert cautioned. ‘Therefore, we should establish fair comparisons, to not vilify this powerful tech- nology.’ regarding further note were Of the IT requirements of generative AI, es- pecially computing power. More general models are often considerably more demand- ing, barring their use for solutions that need to be locally based to en- sure data security. In these cases, smaller, more specific AI models should be implemented, the ex- perts agreed. Need for “AI literacy” among medical professionals Despite the current shortcomings of generative AI models, many ex- perts consider their clinical adap- tation to be almost inevitable. Heckel noted that US-based com- panies are especially adept at translating AI models to market- able products, while European developers tend to have more high-end models, but are more cautious in their implementation. In medical settings, an AI may pro- Anyone who has exchanged a few lines of dialogue with a large language model (LLM), will probably agree that generative AI is an impressive new breed of technology. Beyond their use as chatbots, LLMs show great po- tential in addressing some of the most urgent in healthcare. At the Medica trade- fair in Düsseldorf, several expert sessions were dedicated to the topic of generative AI, its poten- tial medical applications and cur- rent caveats. challenges The above fact that almost every- one has tried their hands at interac- tion with a chatbot is testament to what some experts believe to be a key benefit of the technology: ‘LLMs are a game changer in that they make generative AI approach- able for more people, not just data scientists,’ explained Dr Bertram Weiss during a discussion at the Medica Health IT Forum. ‘This is because you can talk to them using normal language instead of code,’ the Pharma Lead from Berlin-based AI developer Merantix Momentum added. It is this high level of accessibility that could help hospitals offload a number of basic, but time-consum- ing tasks, such as appointment scheduling, or patient case docu- mentation. For example, generative AI has shown promising results in transcribing doctor’s notes into structured co- panellist Dario Antweiler from the Fraunhofer Institute for Intelligent Analysis and Information Systems IAIS. Even though results still need to be checked by a human, ‘this takes away hours of daily work from medical professionals,’ the ex- pert pointed out. formats, said Everyone hallucinates sometimes Pointing out the need for human validation of the AI-generated con- AI keeps an eye on health AI Using a pioneering artificial in- telligence platform, Flinders Uni- versity researchers have as- sessed whether a cardiac AI tool trialled in South Australian hos- pitals actually has the potential to assist doctors and nurses to rapidly diagnose heart issues in emergency departments. “AI is becoming more common in healthcare, but it doesn’t always fit in smoothly with the vital work of our doctors and nurses,” says Flinders University’s Dr Maria Ale- jandra Pinero de Plaza. “We need to confirm these systems are trust- worthy and work consistently for everyone, ensuring they are able to support medical teams rather than slowing them down.” Developed by Dr Pinero de Plaza and her team, PROLIFERATE_AI is a human-centred evaluation tool that uses artificial intelligence alongside researcher analysis to as- sess how well AI tools work in hos- pitals. “In order to understand if the AI systems are viable, we look at how easy they are to use, how well doctors and nurses adopt them, and how they impact patient care,” says Dr Pinero de Plaza, a re- search fellow in Flinders’ Caring Futures Institute. “It’s not just about making AI accurate; it’s about making sure it’s easy to understand, adaptable, and genu- inely helpful for doctors and pa- tients when it matters most.” Published in the International Jour- nal of Medical Informatics, the study used PROLIFERATE_AI to as- sess the RAPIDx AI tool; designed to help emergency doctors quickly and accurately diagnose cardiac conditions by rapidly analysing clinical and biochemical data. With chest pain one of the most common reasons for ED visits, the South Australian health system has been part of an NHMRC-funded trial being run across 12 hospitals in metropolitan and rural South Australia, which is currently ana- lysing its 12-month patient out- comes. Before and during the trial, the PROLIFERATE researchers evaluated the tool, with medical and nursing staff at the participat- ing hospitals being provided the opportunity to share their insights on interacting with the RAPIDx AI tool. The results showed that while ex- perienced clinicians, such as ED consultants and registrars, demon- strated high comprehension and residents and engagement with the RAPIDx AI tool, less experienced users, in- cluding interns, faced usability challenges. Regis- tered nurses also reported strong emotional engagement with the tool, recognising its potential to en- hance patient safety by reducing diagnostic uncertainty. “What sets PROLIFERATE_AI apart is its abil- ity to provide actionable insights,” says Dr Pinero de Plaza. “Rather than focusing solely on technical performance, we evaluate AI tools based on real-world usability and clinician trust, ensuring that these technologies are not just innovative but also practical and accessible.” While the research demonstrated consultants and registrars bene- fited most from using RAPIDx AI, the study also highlighted the need for targeted training and workflow- aligned adoption rates among new users. interfaces improve to “Our goal is to create AI solutions that empower doctors and nurses, not replace them,” says Dr Pinero de Plaza. “Technology alone cannot solve the complexities of emerg- ency care. We need AI systems that work seamlessly with clinicians, support decision-making under pressure, and integrate smoothly into existing workflows. We are committed to enhancing our AI tools to ensure they are instinc- tively user-friendly and to develop customised training programs that meet the diverse needs of health- care professionals and others.” ■ Source: Flinders University EUROPEAN HOSPITAL Vol 34 Issue 1/25