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Vol 34 ISSUE 3/25 • September 2025 THE EUROPEAN FORUM FOR THOSE IN THE BUSINESS OF MAKING HEALTHCARE WORK Technology applications Medical 3D printing: from niche to mainstream at least medical affinity. Close col- laboration between these fields is essential to make sure that the technology fits within the estab- lished clinical workflows and struc- tures.’ Quality management is an- other important aspect, he adds: ‘3D printing effectively means that the hospital is creating medical de- vices, and this needs to be done in a way that is safe and in com- pliance with medical regulations.’ Last, but not least, successful im- plementation of the technology hinges on integration into funding and reimbursement structures, the experts point out. For one, estab- lishing a 3D printing lab can be a significant investment, De Boodt points out. ‘Often, this is achieved using research grants and seed funding. However, after this initial period, hospitals are usually ex- pected to cover for the running costs themselves. ‘The added value is in many ways very obvious, but it does not always translate in how hospitals manage their billing,’ Peters says. While it may be simple to submit a CT scan into the system for reimbursement, this option is often absent for procedures invol- ving 3D printing. ‘I think this is a bit of a missed opportunity.’ There- fore, departments utilizing the technology should make sure to raise awareness about how it pro- vides cost savings and find ways to integrate it into established re- imbursement structures. Beyond printing: advancing personalization with AI and VR Looking ahead, Peters sees ar- tificial intelligence as a key tech- nology to complement and ad- vance 3D printing and planning: ‘AI will certainly accelerate the process of creating personalized solutions for patients,’ he predicts. It enables automation of certain steps during the planning phase, which lowers the learning curve for new users and streamlines the finalization of designs, reducing both manual work and costs. ‘AI addresses some of the greatest challenges in personalization,’ De Boodt says. ‘Certain applications, which were just not viable before – due to time constraints, design limitations or financial aspects – suddenly become realistic options.’ This in turn increases the appeal of 3D technology within a hospital’s business structure, potentially serv- ing as a catalyst, the expert argues. He also sees great promise in vir- tual and augmented reality (VR/ AR) technologies, although their time has not come quite yet: ‘There is a lot of innovation happening at the time, but actual usage in the clinical practice is still relatively li- mited, mainly due to hardware limitations. The true value of this technology will become apparent once we find technically realistic applications as navigation tools during procedures.’ Despite the many people who al- ready benefitted from the use of 3D technology, Peters sees a wealth of yet-untapped potential: ‘There are so many more people that would be better off with a per- sonalized approach,’ Peters ex- plains. ‘As we have seen during the presentations, many patients who were treated with conventional methods could have a fundament- ally different life. And of course, we hope to play a major role in that development, like we have been doing over the past few dec- ades. We really want to be at the forefront of that innovation that will drive that acceptance towards the future.’ ■ Article: Wolfgang Behrends Koen Peters Koen Peters is Executive Vice Presi- dent Medical at Materialise and a member of the company’s Executive Committee. Since January 2025, he has overseen global Operations, R&D, Sales, and Marketing for the Medical Unit, focusing on sustain- able growth and performance. An alumnus and external PhD researcher at Tilburg University, Koen is a re- markable data scientist. CONTENTS HEALTH IT AI WOMEN‘S HEALTH RADIOLOGY MANAGEMENT PATHOLOGY 1 2 3 8 9 10 www.healthcare-in-europe.com s d n e r h e B / E i H © the greater calls. ‘This was still a far cry from the personalized healthcare we know today – but the benefits were already obvious: Ultimately, every person is different, and the better a medical product fits their individ- ual anatomy, the chance of achieving a positive out- come.’ It was already at this early stage that the importance of 3D visualisation software became ap- parent, De Boodt adds: ‘Seeing how a personalized device fits within a patient, and planning the necessary cuts in advance can greatly contribute to shortening surgery times and reduce com- plication rates.’ The rocky, but rewarding road to clinical implementation While personalized 3D technology saw its first applications in com- plex cases, it has now become common, especially in orthopaedic and cranio-maxillofacial procedur- es. The improving accessibility of the software has been a key con- tributor to this development, Peters says. ‘With a growing awareness about the benefits of this kind of personalized approach, many in- stitutions have started adopting the technology.’ Since the advent of the technology, Materialise has devel- oped around 600,000 patient spe- cific guides and implants, the ex- pert estimates. Including cases where patient scans were analyzed with its software, this number rises to about 10 million. As became clear during the 3D printing forum’s presentations however, implementation is not al- ways straightforward. ‘One major challenge is finding the right staff,’ explained De Boodt: ‘An important starting point is having an engineer with good medical knowledge or Cranio-maxillofacial plates have been among the first medical implants to benefit from 3D printing technology at scale. From personalized medical guides and implants to advanced surgical planning solutions: 3D printing and visualization has grown considerably over the past years and is already making a significant impact in health- care. AI, cloud, and virtual reality technologies show promise to further advance the number of applications. However, many hospitals find it challenging to implement these technologies into their established clinical workflows and structures. At the 3D Printing in Hospitals Forum in Leuven, Belgium, hosted by Materialise, we spoke with Koen Peters, Executive Vice President Medical, and Sebastian de Boodt, Business Line Director Medical Software, about the potential for growth and barriers that need to be overcome for more patients to benefit from this technology. Orthopaedics was the first medical specialty to utilize 3D printing at scale, starting with customized guides for knee implants, Peters re- Next Step Teleradiologie Auf dem Weg zur Telemedizin- plattform der Zukunft! Seit Jahren ist die Teleradiologie ein fester Bestandteil der digitalen Gesundheitsversorgung. Doch wir sehen mehr: Das Potenzial für eine skalierbare, förderfähige Telemedizinplattform, die sektorenübergreifend funktioniert und zukunftssicher aufgestellt ist. NEXUS / CHILI GmbH Friedrich-Ebert-Str. 2 69221 Dossenheim Tel. +49 6221 1807 910 sales@nexus-chili.com www.nexus-chili.com www.healthcare-in-europe.com
2 Medical Taiwan 2025 ARTIFICIAL INTELLIGENCE Accelerating the journey of medical AI company’s CMO Jack Huang ex- plained, patients simply speak into a wearable device such as a smart ring, and the AI provides pre- liminary health assessments in 38 languages across twelve medical specialties. The system can assist in booking an appointment with a doctor based on the symptoms de- scribed recorded con- versation, and can also generate a record for the doctor to use. the in The company envisions “Dr. AI” to become an all-round companion for patients on their medical path- way. ‘For example, when you scan a prescription, it turns into a phar- macist,’ Huang said, providing easy-to-understand information on the prescribed drugs, helping with medical terminology and decipher- ing instructions in small font sizes. ‘The system is not designed to re- place doctors,’ the CMO em- phasized, but to serve as an intelli- gent assistant, handling routine tasks so doctors can focus on com- plex patient care. Regenerative solutions and digital twins The field of regenerative medicine was also well-represented at Medi- cal Taiwan. Notably, Acro Biomedi- cal showcased its “ABCcolla” col- lagen ophthalmic matrix for corneal transplants, as well as up- coming solutions for alopecia. ‘Our vision is to address the global shortage of transplantable tissues and organs,.’ said Dr DJ Hsieh, the company’s Chairman and CEO. Present with one of the largest booths at the event, BenQ Group led the showcase with 13 affiliated brands – including BenQ Materials Corporation – and presented a comprehensive range of healthcare solutions covering prevention and beyond. From AI-powered imaging evaluation systems and “digital twin” platforms for health data analysis to consumables such as professional hygiene materials, dis- infectants, protective garments, wound care solutions and mobile dialysis systems, the company pro- vided an overview over their exten- sive product portfolio, attracting a great number of visitors. Hiwin Healthcare presented an AI- enhanced robotic gait training sys- tem for rehabilitation. The device monitors the patient’s movement to generate a personalized training regimen. ‘The algorithm detects whether the patient is performing the correct movement, and adjust the programme accordingly,’ ex- plained the company’s Senior Gen- eral manager Sophie Lin. ‘This way, the optimal level of exercise is pro- vided.’ The system is already used in 21 hospitals across Taiwan. Smart medical devices to address medical staff shortage A staple of any Medical Taiwan event, the Smart Medical Pavilion was home to high-tech ap- plications. The special zones gave manufacturers opportunity to ex- hibit their combined solutions in a context resembling actual clinical configurations. Notable examples include a setup consisting of a smart surgical table and OR light- ing from BenQ, complementing a robotic system for precision neur- osurgery from Eped. When commercially available AI tools do not fit the specific needs of a hospital, institutions may try to create customized algorithms for themselves. To facilitate this effort, QOCA aim from Quanta Computer Inc. provides a medical cloud plat- form, which covers the entire pro- cess from AI development to clini- cal application. The solution is web-based and user-friendly, but since the data is hosted in the hos- pital’s internal network to address data privacy concerns. Medical Taiwan 2025 provided tes- tament to AI in healthcare moving beyond proof-of-concept to prac- tical reality. After witnessing three days of medical devices, health technology and care solutions, the show’s organizers and exhibitors looked back on another successful iteration of Medical Taiwan, and forward towards the show’s return in 2026. ■ Article: Wolfgang Behrends s d n e r h e B g n a g f l o W © Enhancing patient comfort was in the spotlight at the booth of Ya Hai International. The company show- cased a wide range of medical products, including advanced mat- tress toppings, sensor mats for no- nintrusive patient position moni- toring, and smart bed lighting systems. Further, highly custom- izable care lifters, patient transfer solutions and gait trainers were presented, designed to reduce the workload of care staff and adapt the systems to the individual needs of each patient, the exhibitors pointed out. Generative AI to assist pre-consultation With the first wave of medical AI tools entering the market, the next iteration is not far behind. AI-based large (LLM), popularized by ChatGPT, are show- ing particular promise. Pioneering this approach, Taiwanese company Intowell Biomedical, presented “Dr. AI”, an LLM-based platform for medical pre-consultation. As the language models “Dr. AI”, an LLM-based platform for medical pre-consultation. ©Wolfgang Behrends Scan for the extensive article on the Healthcare in Europe website. EUROPEAN HOSPITAL Vol 34 Issue 3/25 for Medical Taiwan has long been a showcase cutting-edge healthcare solutions, but this year marked a pivotal moment. Visitors of the latest edition of the medical, health and care expo in Taipei witnessed a par- ticularly noticeable step forward: the definitive transition of medi- cal AI from promising research to actual clinical practice. Organ- ized by the Taiwan External Trade Development Council (TAITRA), the show featured more than 300 Taiwanese and in- ternational companies, ready to pioneer this new chapter in medical technology. ‘AI is not the future – it is already here.’ With this statement, TAITRA Chairman James C.F. Huang made it clear just how far the technology has come in healthcare within the last few years. Unlike previous years that highlighted AI‘s poten- tial, Medical Taiwan 2025 demon- strated working solutions already transforming patient care. To get ready for this paradigm shift, the TAITRA Chairman invited his audi- ence to enter a ‘profound dialogue about the future of health’ – an in- vitation that was eagerly accepted by the attending companies, who took the opportunity to present their market-ready solutions, from AI-assisted X-ray diagnostics of conditions like lung cancer, to hos- pital ward management support systems. According to the organ- izers, 15,000 visitors attended this year’s show, reflecting the immense interest in the presented healthcare topics and solutions. Shift from treatment to prevention With advances in medical tech- nology, the industry is placing a greater emphasis on prevention. GKT‘s Winback radiofrequency this pre- systems exemplified ventive approach, targeting pain reduction and tissue regeneration before conditions worsen. apnea, dysphagia, Focusing on the potential of digi- talization, the telemedicine and smart medical devices pavilion was home to promising solutions such as the LinguaFlex system from TMU startup FlexMed, which uses gamification to encourage tongue muscle training, to treat obstructive sleep and speech impairments. Another uni- versity startup, DMolution, pres- ented a data-driven approach to diabetic foot care. Their AI- supported system evaluates in- formation gathered by a sensor to early detect patterns of impaired circulation in the feet due to dia- betes, preventing permanent da- mage. With advances in medical tech- nology, the industry is placing a greater emphasis on prevention. GKT‘s Winback radiofrequency systems exemplified this pre- ventive approach, targeting pain reduction and tissue regeneration before conditions worsen. apnea, dysphagia, Focusing on the potential of digi- talization, the telemedicine and smart medical devices pavilion was home to promising solutions such as the LinguaFlex system from TMU startup FlexMed, which uses gamification to encourage tongue muscle training to treat obstructive sleep and speech impairments. Another uni- versity startup, DMolution, pres- ented a data-driven approach to diabetic foot care. Their AI- supported system evaluates in- formation gathered by a sensor to early detect patterns of impaired circulation in the feet due to dia- betes, preventing risk of hospitali- sation and permanent damage.
WOMEN´S HEALTH 3 Risk stratification initiatives in Europe and UK Future breast imaging: a date with density e n i c i d e M e r u t a N , . l a t e M i e h k r o S Y, u i L , M m i l a S © ) 0 . 4 Y B C C ( 4 2 0 2 Cancers detected by supplemental MRI after negative mammography: a) A 13-mm large BI-RADS 4 finding on MRI that corresponded to a 13-mm large invasive cancer as diagnosed in the surgical specimen. b) A 9-mm large BI-RADS 4 finding on MRI that corresponded to an 8-mm invasive cancer and 14-mm ductal cancer in situ. c) Three su- spicious lesions within a total area of 60 mm, BI-RADS 5 finding on MRI, that corresponded to a 50-mm multifocal invasive lobular cancer. d) Two suspicious lesions, the lar- gest 13 mm, BI-RADS 3 on MRI, which corresponded to a 10-mm invasive lobular cancer with 85-mm extent including ductal cancer in situ. Because the AI tool only selected 6.9% of over 59,300 women, Dr Strand and colleagues state that the cost per cancer detected with supplemental MRI is four times more efficient than conventional mammography. Additionally, it is comparable to the cost of screen- ing mammography for this very high-risk population. In a future study, the researchers will investi- gate if an additional review of mammograms flagged as high risk by the AI tool will yield an in- creased cancer detection rate. Appeal for a more personalised approach Prof. Pijnappel predicts that breast cancer risk stratification by tradi- tional density measurement is going to become less important, and that AI tools have great poten- tial to identify at-risk women. ‚Not every woman with dense breast tis- sue will develop cancer. And you know that breast cancer occurs in women with average tissue density and fatty breasts. Women at low risk may only need mammograms at four- or five-year intervals. This may offset the cost of offering exams to high-risk women. Breast cancer screening should become more personalised, not the “one size fits all” frequency of today,‘ he concluded. ■ annually Author: Cynthia E. Keen screening mammogram, and who would benefit from a supplemental breast MRI exam. The AI tool as- sesses mammographic breast den- sity, potential masking, suspicious cancer signs, and other risk factors. investigator The AI tool analysed data of 1,211 women to whom it had assigned high risk scores to mammography exams performed at Karolinska. Principal Fredrik Strand, MD, PhD, advised that the cancer detection rate of partici- pants who had a supplemental MRI was 64.4 cancerous lesions per 1,000 exams, according to a report published in Nature Medicine. as having About 60% women in Europe en- rolled in a national breast cancer screening programme who have a screening mammogram can feel reasonably confident that radiologists will be able to diag- nose early-stage breast cancer. But what about the 30% cat- egorised dense breasts, and the10% who have extremely dense breasts? At the 2025 SBI (Society of Breast Im- aging) Breast Imaging Sym- posium in Colorado Springs, USA, Prof. Ruud Pijnap- pel, MD, PhD, discussed current clinical trials addressing breast screening of dense-breasted women. held For these women, detecting early- stage breast cancer on mammo- graphic images can be challenging. They may need additional types of breast imaging, but which tech- nologies are most effective? Clini- cal trials in Europe are underway to determine the most beneficial and most cost-effective screening methods for high-risk women. They are needed to convince gov- ernments to fund supplemental breast imaging to screen for cancer in women at average risk with dense breast tissue. Pijnappel, Professor of Breast Radi- ology at the University Medical Centre (UMC) Utrecht, the Nether- lands, and chief executive officer of the Dutch Expert Centre for Screening in Nijmegen, started off with a transatlantic overview: ‚Re- search in Europe on this subject differs slightly from that being undertaken in the United States,‘ he said. ‚One imaging methodol- ogy does not fit all, and protocols for more personalised screening are needed. Research in Europe is especially focussed on risk profil- ing so that interval cancer rates can be reduced, and to make screening frequency and modality based on www.healthcare-in-europe.com an individual woman’s risk assess- ment.’ It on clinical involves Between impressive evidence and financial challenges The trial DENSE over (NCT01315015) 40,000 women ages 50 to 75 with extremely dense breasts living in the Netherlands who had normal screening mam- results mography. is evaluating if supplemental breast MRI can mini- mize interval cancers in a two-year screening round. Participants were randomly assigned in a 1:4 ratio. For the MRI group, the interval-cancer rate was 0.83 per 1000 screenings compared to 5.06 per 1000 in the mam- mography-only group in the first round. the number of ‚This solid scientific evidence was impressive, but costs and breast MRI scanner availability made this very difficult for EU countries to implement,’ explained Prof. Pijnap- pel. ‘Only Estonia adopted supple- mental MRI screening for ex- tremely dense breasted women to its national screening programme protocol. So, three clinical trials in- vestigating individual screening optimisation were initiated.’ Ongoing clinical trials Launched in November 2024, the DENSE 2 (NCT06636370) is enrol- ling 36,000 women aged 49–72 with density D category to deter- mine if either contrast-enhanced mammography (CEM) or an ab- breviated breast MRI (AB-MRI) exam supplementing a “normal re- sults” at mammography performed at UMC Utrecht are more effective in reducing interval cancers than mammography alone. CEM is less costly and easier to implement than a conventional breast MRI. Secondary outcomes of the study include cancer detection rates and false positive rates. This trial in- cludes two screening rounds and is expected to conclude in April 2029. In the United Kingdom, mam- mography breast cancer screening is offered to women ages 50 to 75 every three years. The Breast Screening-Risk Adaptive Imaging for Density (BRAID) randomised clinical trial (NCT04097366), led by Prof. Fiona J. Gilbert, MD, of the University of Cambridge, recruited 9,361 women with C and D dense breast categories who have had a normal screening mammogram at one of 10 locations. Participants were randomised to a control group without supplemental test- ing, or to receive a CEM, an AB- MRI scan, or automated whole breast ultrasound (ABUS). The first supplemental exams were perform- ed within six months of the screen- ing mammography. Begun in 2019, the primary endpoint of the study is to measure both the primary and interval cancer detection rate over 42 months, recall and biopsy rates, tumour size, and grade of cancer. Prof. Pijnappel explained that the interim results presented at ECR 2025 revealed that 85 cancers were diagnosed with supplemental screening: 73 invasive cancers and 12 ductal carcinomas in situ (DCIS). The cancer detection rate was 19.2 per 1000 examinations for CEM, 17.4% for AB-MRI, and 4.2% for ABUS. The invasive tumour size identified by AB-MRI and CEM was half the size of those found with ABUS. The ScreenTrustMR (NCT04832594) prospective clinical trial being con- ducted at Karolinska University Hospital in Stockholm, Sweden, is evaluating the ability of an AI tool (AISmartDensity) identify women with the highest probabil- ity of having a delay in cancer de- false negative tection from a to Make safe rapid decisions with evidence-based tools In today’s fast-paced clinical environments, delivering the best patient care at the point of need is crucial. This webinar explores how health professionals can access evidence-based information using MedicinesComplete to make informed decisions that improve patient safety and outcomes. Watch now The Royal Pharmaceutical Society’s Knowledge Business PharmaceuticalPress.com
4 Respiratory health Pulmonary embolism in pregnancy: diagnostic pathways under scrutiny WOMEN´S HEALTH Radiation safety and legal framework CTPA, when optimized, typically exposes the fetus to less than 1 mGy – well below the 100 mGy threshold for teratogenic risk. Dose parameters such as the dose-length product (DLP) and computed to- mography dose index (CTDI) must be recorded in the radiology re- port. In France, these figures must also be communicated to the IRSN if the fetus is in the scan field. m o c . e b o d a . k c o t s – i k z t i l u a K n a i t s a b e S © ism and eliminates the need for thoracic imaging,’ Dehaene said. In the absence of clear DVT find- ings, either CTPA or ventilation/ perfusion (V/Q) scintigraphy may be used depending on local expert- ise and radiographic results. Scinti- graphy is preferred when chest X-ray is normal; otherwise, CTPA is recommended. CTPA optimization for pregnancy ‚Pregnancy increases cardiac out- put by up to 50%, creating specific imaging challenges,’ Dehaene stated. Protocols must be adapted to reduce fetal exposure while en- suring diagnostic quality. Scanning should cover only from the aortic arch to the diaphr- agmatic dome, omitting apical re- gions. Contrast injection should use 120 mL of iodinated agent at 4–6 mL/s, with a concentration of 350–360 mg iodine/mL. Bolus tracking is triggered in the pul- monary artery, with thresholds be- tween 120 and 150 HU. ‘A simple breath-hold – not deep inspiration – is preferred to limit motion ar- tefacts,’ she advised. pregnancy. There is no established con- traindication for iodinated contrast during Although potential fetal thyroid risks are often cited, no evidence of clinical hypothyroidism has been demon- strated. teams may monitor thyroid function as a pre- caution,’ Dehaene stated. Regard- ing breastfeeding, only a few agents require temporary inter- ruption, and usually no longer than four hours. ‘Paediatric To support diagnostic accuracy, clinicians now rely on structured algorithms. The two most refer- enced models were developed in 2019 by the European cardiology and respiratory societies and the Artemis group. Both integrate pre- test clinical scoring, D-dimer as- sessment, and imaging protocols. Adapting clinical probability tools The European approach proposes a modified Geneva score adapted for pregnant patients. Criteria in- clude age, recent immobilization or surgery, unilateral leg pain, history of PE or DVT, haemoptysis, leg swelling or tenderness, and tachyc- ardia. A score above seven indi- cates high clinical probability. In combination, D-dimer levels help stratify risk. ‘If D-dimers are low and clinical suspicion is low, PE can be safely ruled out without imaging,’ Dehaene explained. However, the test’s performance decreases in the third trimester due to physiologic D-dimer elevation. A prospective study involving 141 pregnant women validated this al- gorithm, though it showed better performance when supplemented with venous compression ultra- sound and CT pulmonary an- giography (CTPA). Imaging: structured and stepwise When further workup is needed, a chest X-ray is typically performed first, to rule out alternative diag- noses. If signs of deep vein throm- bosis (DVT) are present, lower limb Doppler ultrasound is indi- cated. ‘A positive Doppler result confirms venous thromboembol- Pulmonary embolism (PE) re- mains one of the leading causes of maternal mortality. At the French Thoracic Society Spring Days in May, Dr Aurélie De- haene, radiologist at European Hospital in Marseille, France, re- viewed diagnostic strategies for suspected PE during pregnancy, with a focus on clinical al- gorithms and optimized imaging protocols. increase gestation ‘Venous thromboembolic disease is common in pregnancy and peaks during the postpartum period,’ she said. ‚Physiological changes as- sociated with sig- nificantly the risk of thrombosis.’ These include vascular compression due to uterine en- largement, hormone-induced va- sodilation, and hypercoagulability – elements that align with Vir- chow’s triad: endothelial injury, sta- sis, and a pro-thrombotic state. Additional pregnancy-related fac- tors such as preeclampsia, in vitro fertilization, postpartum haem- orrhage, or caesarean section further increase this risk, alongside general risk factors like obesity, smoking, and advanced maternal age. Clinical overlap and diagnostic hesitation The overlap of PE symptoms with normal pregnancy complaints com- plicates clinical evaluation. ‘Dysp- nea and peripheral oedema are common and non-specific,’ De- haene said. This contributes to diagnostic uncertainty and reluc- tance to prescribe radiation-based imaging, despite the severity. Yet both underdiagnosis and over- treatment carry significant risks. ‘Missing a PE is dangerous, but so is unnecessarily anticoagulating a patient,’ she warned. r e g u o R e d n a s i l é M © Dr Aurélie Dehaene during her presentation. for ‘The fetal dose is often negligible, particularly thoracic exams where the uterus is outside the field,’ Dehaene said. radiation ‘Nevertheless, safety regulations and informed consent procedures must be strictly fol- lowed.’ radiation Role of scintigraphy and diagnostic limits Scintigraphy remains an acceptable alternative when chest radiograph is normal, offering diagnostic per- formance comparable to CTPA. However, it lacks the ability to identify alternative diagnoses and may also be inconclusive in some cases. CT, in contrast, provides broader diagnostic coverage and allows for evaluation of embolic burden. ‘Still, artefacts and suboptimal contrast enhancement can reduce image quality,’ she acknowledged. Optimizing safety and certainty Clear protocols, tailored imaging, and adherence to legal require- ments are key to ensuring safe and effective diagnosis of PE in preg- nant patients. For Dehaene, the message is clear: ‘Know the al- gorithms, justify the indication, adapt the protocol, and document everything.’ By aligning clinical vigilance with technical precision, radiologists play a central role in improving maternal outcomes in suspected PE. The stakes are high – but with informed strategy, risks can be con- trolled. ■ Author: Mélisande Rouger EUROPEAN HOSPITAL Vol 34 Issue 3/25
WOMEN´S HEALTH 5 Hospitalists explore diagnostic and therapeutic adjustments Dual challenge: Managing critical care of the pregnant inpatient remarked. The National Vital Stat- istics System recorded 18.6 deaths per 100,000 live births in 2023. This is an improvement from 2020, when 23.8 deaths occurred, ac- cording to the US Centers for Dis- ease Control and Prevention (CDC). By comparison for that year, the most recent for com- parative multinational statistics, the next highest rate in comparable European industrialised countries were much lower, with the highest being France, at 8.7 deaths. Factors in US mortality range from pre- existing conditions (e.g., obesity, hypertension), and unhealthy life- style (e.g., alcohol, smoking, illegal drug use), to pregnancy and birth related complications, including pre-eclampsia, gestational dia- betes, peripartum hemorrhage, and venous thromboembolism (VTE). 2017–2019 CDC data reveal that 66% of pregnancy-related deaths occur in the postpartum period: 22% during pregnancy, 13% on the day of delivery, 12% one-to-six days postpartum, and 30% from 43 to 365 days. In many countries, in- cluding the US, there is a shortage of primary care physicians to pro- vide after-birth medical treatment. Considering extensive changes Because fetal well-being depends upon maternal well-being, the pregnant body works harder to meet the needs of the developing fetoplacental unit. Hospitalists must consider the normal physi- ologic changes in pregnancy and determine if changes in the patient are pathologic. ‚It’s important to think what a diagnosis might be if a patient was not pregnant,‘ she said. ‚Then consider how preg- nancy physiology impacts these disorders.‘ Pulmonary changes include the in- crease in the angles of a rib, changes in arterial blood gas measurements, lower esophageal sphincter tone, increases in upper airway edema, increased Mal- lampati score which predicts ease of intubation, increased risk for as- piration, decreased gastric empty- ing, and increased intra-abdominal pressure. Kidneys hyper-filter during preg- nancy. Renal blood flow increases by 50%. Creatinine clearance in- creases to levels of 120–160 ml/ min, and levels of serum creatinine are decreased to 0.4 to 0.7 mg/dl. Changes in the cardiovascular sys- tem include an up to 30% to 50% increase in cardiac output, poten- tially worsening pre-existing car- diac comorbidities. Compression of the aorta can result in hypotension. Total blood volume increases by 25% to 40%, and plasma volume by 40% to 50%. Pregnant patients are at greater risk of coagulation, caus- ing anaemia. Elevation of the dia- phragm and uterus enlargement contributes to the risk of hypoxia. All pregnant patients also become insulin resistant. ‘Hospitalists need to consider what tests and imaging exams they order for a non-pregnant patient,‘ Dr Bi- lodeau advised. ‘Can these diag- nostic investigations be done safely in pregnancy, or is there another way by which to obtain the in- formation needed? Are the lab tests changed by physiologic changes? Assess the risk of either not doing the work-up or delaying it until after delivery.‘ Advice on radiation and medication Although radiation dose exposure to the fetus should be avoided, if possible, there is no clinical evi- dence of adverse effects from doses of less than 0.05 Gy, said Dr Bilodeau. Almost all commonly used diagnostic imaging using radiation involves exposure well below 0.01 Gy. Imaging for pul- monary embolism is both safe and accurate, including a V/Q scan, a chest X-ray, and a chest CT if necessary. that gadolinium contrast agent should not be used. She warned ‘Make certain that a patient who is about to deliver has not received prophylactic dose anticoagulant medication within 12 hours, or therapeutic dose anticoagulant medication within 24 hours of undergoing regional anaesthesia. The patient needs to be eligible for regional epidural or spinal anaes- thesia if needed during delivery,‘ she advised. Additionally, medications should be ordered only if they are ap- proved for pregnant patients and patients who are breastfeeding. Any medication risks should be discussed with patients in the con- text of risks that could occur if a patient does not take the pre- scription drug. ‘Don’t trust the medication list on a patient’s hospital chart,‘ Dr Bilo- deau said. ‘Ask the patient if she is or has been taking “recreational drugs”. Ask about over-the-counter medications and supplements, es- pecially herbal supplements, in- cluding dosage and frequency of use. The patient may not realize that any of these could impact test- ing and treatment.‘ Lactation and breastfeeding: ‘Don’t assume anything’ ‘Lactation periods are also sensi- tive. Medications are more likely to be transferred into breast milk dur- ing the first to fourth day of lac- tation. Some women breastfeed their children for two years or more. Don’t assume anything,‘ she said. ‘Finally, help a patient realize that her own health is most important,‘ Dr Bilodeau counselled. ‘Patients will ask what risk they have. Make time to explain this in understand- able terms. Advise that in any natu- ral pregnancy, there is a 3% to 5% risk of congenital anomalies.’ ■ Author: Cynthia E. Keen k c o t s i m u k i m - e b o d a . k c o t s © tient and family that are both gen- eral and fetal risk-related. They also need to be knowledgeable about how physiologic changes im- pact laboratory results and pre- scription medications. Speaking at SHM Converge, Court- ney Bilodeau, MD, Associate Pro- fessor of Medicine and Clinical Educator in Obstetric Medicine and Breastfeeding Medicine at the Warren Alpert Medical School of Brown University in Providence, Rhode Island, stated that essential qualities include: • Clinical expertise and knowledge • Diagnosing and treating a wide range of medical conditions • Staying updated on current medical advancements and • Problem-solving critical thinking • Strong interpersonal communi- cation and teamwork skills; and • Empathy and compassion. Considering that this is the 21st century, the maternal death rate in the United States is shocking, she safe treatment providing Hospitalists face a dual chal- lenge when a critically ill preg- nant patient is admitted to a hos- pital: and effective for both mother and fetus. Pregnancy causes physiologic changes as well as anatomical ones, which complicates the assessment and medical management of preg- nant women. At the annual meet- ing of the Society of Hospital Medicine (SHM) in Las Vegas, an expert discussed why hospital- ists must draw on a variety of skills when treating pregnant in- patients. causes Pregnancy physiologic changes as well as anatomical ones, which complicates the as- sessment and medical management of pregnant women. Hospitalists must play a critical role verifying the accuracy of in- formation, such as the compre- hensiveness of patient-provided drug lists, analyzing the possible impact on pregnancy of lifestyle and pre-existing conditions, and answering questions posed by pa- clinical Publisher mgo fachverlage GmbH & Co. KG E.-C.-Baumann-Str. 5 95326 Kulmbach/Germany Phone +49 (0) 9221 949-311 Fax +49 (0) 9221 949-377 Managing Directors: Eva-Maria Bauch, Stephan Behrens Editor and Production Manager: Tim Hofmann (TH) Phone: +49 (0) 9221 949-176 E-Mail: redaktion@european-hospital.com Editor: Wolfgang Behrends (WB) www.healthcare-in-europe.com Founded by Heinz-Jürgen Witzke ISSN 0942-9085 USA: Cynthia E. 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6 WOMEN´S HEALTH Digital support for the women’s health agenda Bridging the gender health gap Karen Kirkham, Claire Riley, Misbah Mahmood and Tulsi Patel (left to right) at the Digital Maturity Forum Keynote Session s l l o h c i N k r a M © Digital technology is being har- nessed to support the women’s health agenda in the UK and ad- dress issues of equity and access to healthcare through a range of innovative initiatives. Delegates to the HETT (Healthcare Ex- cellence Through Technology) North conference in Manchester heard how digital is being lever- aged to support women’s health Hubs – which tailor care to meet women’s needs while helping re- duce pressure on secondary care – and midwifery services. The keynote session was chaired by Karen Kirkham, partner and Chief Medical Officer from the pro- fessional services network Deloitte, who opened by highlighting the definition of health equity as a ‘fair and just opportunity of everyone to achieve their full health potential’ that includes social, emotional, physical and non-medical social determinants of health. A former GP with a strong interest in women’s health, Kirkham also pointed to a recent Deloitte report, which highlighted four tenets for improving health: 1. helping organisations under- stand what health equity is; 2. how to break the barriers to im- prove health equity, particularly through data; 3. how to embed health equity in every organisation with use of data, analytics, digital inclusion and workforce training, and; 4. how to close the health equity gap. What women want (in healthcare) Following up, Claire Riley, Chief Corporate Services Officer for the NHS North East and North Cum- bria Integrated Care Board (ICB), detailed how her region in the north of England had invested in women’s health hubs and surveyed 5000 women on what their prior- ities are. ‘We can look at the data and also look at what services women are accessing,’ she said, ‘but we don’t always ask women what they want. We wanted to make sure that the patient voice was at the heart of our plans going forward. If we are going to make a sustained difference to how women access services and the care they receive, we need to start with what they want.’ The expert pointed out the import- ance of acquiring data on depriva- tion, ethnicity, and economic ac- tivity was pivotal in offering a holistic approach to women’s care. Women’s health hubs – which were established under the Women’s Health Strategy for England – are having a major impact by offering appointments covering 3–5 issues, rather than one appointment for one area of care, she added. ‘We are starting to see real benefits of that joined up care focused on women’s health to the point where we are now extending some of those services in our hubs to in- clude diagnostics.’ Unmet demand for mental health support With the majority of women’s health funding still going into a hospital environment, Riley added that data can identify where the in- vestment needs to be spent in the community. She said that data can identify gaps in service and where improvements can be made by as- sessing health trends alongside pa- tient feedback. Links to the NHS app enable medics to provide more person- alized treatment pathways. How- ever, the expert added that those who are not yet able to access the technology should be supported as ‘any technology that is activating individuals to take control of their own health and wellbeing has to be a positive.’ Still, she remained concerned that while tech com- panies are heavily promoting sol- utions in areas such as fertility or menopause, a similar focus on mental health is absent. ‘But that is an area that women are accessing services for,’ she said, explaining that anxiety and depression are among the conditions associated with the most GP consultations, only surpassed by urinary tract in- fections. Help patients take ownership of their condition The audience also heard from Mis- bah Mahmood, Deputy Chief Mid- wifery Information officer at Leeds Teaching Hospital NHS Trust, who outlined how the electronic patient record (EPR) has standardised col- lection of data and led to the cre- ation of a health inequalities dash- board. In an example, she said: ‘The platform tells us that 50% of women who give birth at Leeds are from a deprived background and that 10% are gestational diabetic.’ That data, she continued, enabled her team to offer relevant and timely interventions and support. online self-referral to maternity ser- vices had enabled information cap- ture and the ability to identify and see women with the greater needs sooner. Generational shift Tulsi Patel, Director of Product at women‘s health technology com- pany Hertility, emphasized that data forms the cornerstone of their operations. She highlighted that 600,000 women have completed the company‘s online health as- sessments, which generate GP- ready reports on women‘s health conditions, facilitating expedited referrals when necessary. Noting a ‘generational shift’ in technology and wearables, she pointed out a trend towards higher prioritization of healthcare in general and women engaging ‘sooner in their healthcare journey’. Patel em- phasized the importance of user- friendliness of health technology and emphasized the role of con- sumer input to achieve this. The panel also expressed concern about the levels of inappropriate and inaccurate information being offered on social media channels and the need to support families that cannot afford technology to benefit their health. ■ Author: Mark Nicholls Mahmood explained how tech- nology had been harnessed in ma- ternity services in Leeds by having online notes on a web-based sys- tem that women can access as well as health information. In areas such as blood pressure monitoring or diabetes, she said it helped women understand and take ownership of their condition and make changes. The number of women accessing on- line notes is monitored and where gaps are identified, teams can reach communities. Mahmood said the introduction of lifestyle out to Misbah Mahmood Misbah Mahmood is Deputy Chief Midwifery Information officer at Leeds Teaching Hospital NHS Trust, and has been a qualified midwife for 10 years. She has led several projects across maternity services, including an end-to-end electronic patient rec- ord and secure online notes portal. She is a member of the Digital Mid- wives Expert Reference Group. Tulsi Patel Tulsi Patel is Director of Product at Hertility where she leads the Product Management and Design operation, which is spearheading the future of reproductive healthcare by pioneer- ing diagnostic testing, and providing data-driven and advanced insights into all aspects of women‘s health. Karen Kirkham Karen Kirkham is a partner and the Chief Medical Officer at Deloitte and a member of the HETT Steering Com- mittee. She previously worked as a GP in south of England with an inter- est in women’s health. Her areas of interest are healthcare operations and consultancy. Claire Riley Claire Riley is Chief Corporate Ser- vices Officer for North East and North Cumbria Integrated Care Board (ICB) and Executive Lead for Women’s Health, Research and Inno- vation. She was previously the Executive Director of Communi- cations and Corporate Affairs at Northumbria Healthcare NHS Foun- dation Trust. EUROPEAN HOSPITAL Vol 34 Issue 3/25
WOMEN´S HEALTH AI-powered prediction 7 Machine learning identifies cardiotoxicity risk in breast cancer patients toxicity. He suggested this ‘may be due to the ability to potentially use information from the whole heart with the ML algorithm to risk strat- ify patients, as opposed to single chamber information as we do tra- ditionally.’ The expert outlined potential clini- cal benefits of identifying at-risk patients before treatment begins: ‘This would provide opportunities for clinicians to cater their cancer therapies to minimize risk or to add cardioprotective medications or to modify the surveillance strat- egies to pick up early cardiac dys- function during cancer therapy,’ he said. ‘If patients at risk for cardiotoxicity can be identified even before cancer therapy, preventive strat- egies can be instituted to reduce the risk of cardiotoxicity. This will reduce the chance of the patient subsequently developing heart fail- ure or having their life saving cancer therapy interrupted.’ Transforming risk stratification The next step, according to Dr Tha- vendiranathan, is validation of findings in larger cohorts and to consider applying similar methods to more readily available imaging tests in patients with cancers, such as echocardiography. He expressed hope that further re- search could potentially lead to a baseline test for use prior to cancer therapy that may identify patients at risk of developing cardiotoxicity. ‘This has the potential to transform the way that we risk stratify pa- tients as current techniques are not very effective and hopefully, by early treatment, have an impact on the cardiovascular prognosis and overall survival of these patients,’ Dr Thavendiranathan concluded. The session at ESC Cardio- Oncology 2025 also included pres- entations on non-uniform cardio- vascular risks of tyrosine kinase in- hibitors, left atrial strain in multiple myeloma patients undergoing car- filzomib therapy, cardiovascular adverse events with cdk4/6 in- hibitors, cardiac function following anti-BCMA CAR-T therapy, and car- diovascular safety of modern radio- therapy in breast cancer. ■ techniques Dr Paaladinesh Thavendiranathan Dr Paaladinesh Thavendiranathan is a cardiologist at the Toronto Gen- eral Hospital University Health Net- work, and a Professor of Medicine at the University of Toronto, Canada. With a background in advanced car- diovascular imaging and an inter- national expert in the field of cardio-oncology, his research is in the use of advanced cardiac imaging techniques for detection and man- agement of cardiac toxicity. He is Di- rector of the Ted Rogers Program in Cardiotoxicity Prevention which fo- cuses on cardiac toxicity from sys- temic therapies including cancer therapy. i k z t i l u a K n a i t s a b e S - e b o d a . k c o t s © Researchers have developed a machine learning algorithm that uses cardiac MRI images to help identify breast cancer patients who may be at risk of cardiot- oxicity during cancer treatment. The research, led by cardiologist Dr Thavendir- anathan from Toronto General Hospital University Health Net- work, was presented at the Euro- pean Society of Cardiology‘s Car- dio-Oncology Conference in Florence in June. Paaladinesh Dr Thavendiranathan, who is also a Professor of Medicine at the Uni- versity of Toronto, explained that current techniques for risk stratifi- cation ‘are not very effective.’ Promising study performance The Canadian study aimed to de- termine if deep learning (DL) ap- proaches using CMR cine images pre or early during cancer therapy can predict CTRCD better than clinical risk scores or conventional quantified imaging measures. cardiac The study addressed the challenge of predicting cancer therapy- related dysfunction (CTRCD), which the researchers noted “remains a challenge.“ Ac- cording to the research paper, clinical risk models and con- ventional cardiac magnetic reson- ance (CMR) analysis ‘are limited’ in predicting HER2+ targeted therapy (HER2-TT) CTRCD risk. Women with early-stage HER2+ breast cancer receiving sequential anthracyclines and trastuzumab from three prospective studies were included. Patients were seen pre- and post-anthracycline and se- quentially during treatment with repeated cardiac imaging (echoc- ardiography and CMR) to create various machine learning models to predict CTRCD. risk factors, ‘This model performed better than clinical echoc- ardiography measures, and tradi- tional cardiac MRI measures or biomarkers,’ Dr Thavendiranathan said. ‘When we validated our find- ings in a separate cohort, the model continued to perform well.’ Using information from the whole heart The research concluded that ‘in women with breast cancer receiv- ing anthracyclines and HER2-TT, a DL model using CMR short axis cine images pre-anthracycline had higher discrimination for future CTRCD than clinical and con- ventional imaging quantification models.’ Dr Thavendiranathan‘s key finding was that a machine learning al- gorithm applied to a single set of cardiac MRI images could identify patients at high risk of cardio- EIS shows promise to advance cancer cell monitoring A new study unveils a method to non-invasively monitor cell spa- tiotemporal dynamics involved in cancer progression in a real- time and label-free manner, which can provide new insights for cancer diagnosis and treat- ment. that measures The new methodology combines the use of micro-electrode arrays, electrical impedance spectroscopy (EIS) the char- acteristics of tissue surrounding the sensor, and predictive al- gorithms. The use of predictive al- gorithms allows for faster pre- diction, better resilience to noise, and recognition of complex data patterns when compared to tradi- tional EIS analysis approaches. This new methodology is believed to be the first-ever use of EIS to en- able quantitative real-time monitor- ing of cell spatiotemporal dy- namics, or cell changes over time. (LadHyX) In the study, the team at École Polytechnique’s Hydrodynamics Laboratory leveraged Sensome’s technology and exposed it to normal and cancerous breast epithelial cells, where it was able to accurately predict the spatiot- emporal evolution of cell density, cell substrate coverage, mean cell diameter, and cell type in agree- ment with microscopy findings. It also enabled real-time tracking of spatial heterogeneities in breast cancer cell growth and the com- petition between normal and can- cerous cells based on the EIS measurements alone. “This technology has the potential to obviate the need for microscopy imaging in cancer cell monitoring in various settings and significantly advance our understanding of cancer cell behavior and inter- actions,” said co-author Abdul Ba- rakat, CNRS Director of Research and Professor at École Polytech- nique. “Assessing how cells organ- ize in space and time is essential to elucidating cancer progression. Live-cell fluorescence microscopy is the predominant method for tracking these dynamics today but is often limited by cytotoxicity in- duced by the fluorescent dyes, by cellular photo-damage during ex- tended periods of microscopic im- aging, and by restrictions in optical access in the case of opaque clini- cal samples. This methodology using Sensome’s technology dem- onstrates a non-invasive, label-free method enabling long-term moni- toring of cancer-related cellular spatiotemporal dynamics with minimal disruption of natural cel- lular processes.” “This study shows that the propri- etary signal processing and ma- chine learning algorithms involved in our technology can empower a method to successfully monitor www.healthcare-in-europe.com cancer cell differentiation and evol- ution over time,” said Franz Boz- sak, CEO and co-founder of Sen- some. “This breakthrough is the first step in exploring the use of our tissue-sensing technology in monitoring cancer-related phe- nomena, such as tumor growth. It complements the work we are cur- rently lung cancer—where in-situ cancer de- tection is crucial—which is one of several applications where we are applying our mastery of electrical impedence spectroscopy to novel uses in medicine.” doing in Source: École Polytechnique – Institut Polytechnique de Paris
8 RADIOLOGY Utilizing new strengths, fixing old weaknesses Ultrasound update for organ imaging personal contact with the patient. Studies have shown that this not only creates a more pleasant at- mosphere during the examination, but also improves the quality of the diagnosis6, she emphasised. ‘This is where we really have a big ad- vantage over other cross-sectional imaging techniques – and this should not be underestimated,’ she concluded. ■ Author: Wolfgang Behrends ) 0 . 4 Y B C C ( 4 2 0 2 s t r o p e R c i f i t n e i c S , W i L , K g n a W , L g n a Y : Illustration of multiple septations in a pleural effusion on ultrasound. Has organ imaging using ultra- sound arrived at the same level as cross-sectional imaging? At the annual conference of the German Society for Internal Medicine (DGIM), PD Dr Corinna Trenker presented new tech- nological developments and their diagnostic significance. Despite numerous innovations such as multiparametric proto- cols and AI support, she made it clear that the human factor re- mains one of the greatest strengths of sonography over other modalities. The examination of neck and soft tissue as well as organs in the near- field – testicles, thyroid or breast – has traditionally been one of the strong suits of ultrasound, reported the expert from the Clinic for Hae- matology, Oncology and Immu- nology at Marburg University Hos- pital: image resolution of up to 0.1 to 0.2 milli- metres, sonography simply ex- ceeds the resolution of CT and lateral ‘With a MRI.’ This is also reflected in the S3 guidelines – ultrasound is the method of choice for both tes- ticular cancer and the detection of thyroid masses. Even though the results of lymph node detection are consistently convincing, the technique has not yet been included in the guide- lines, Dr Trenker summarised. Nevertheless, she said that multi- parametric imaging using elas- tography and contrast-enhanced ultrasound (CEUS) is an exciting new tool for assessing lymph node hardening and vascularisation1 – ‘however, this is not relevant for the primary assessment of malig- nancy,’ the expert added. into play: In thoracic examinations, another advantage of ultrasound imaging comes ‘Sonography clearly has the edge because exam- inations can be performed in real- time,’ explained Dr Trenker. Par- ticularly when assessing thoracic wall infiltration in bronchial carci- also nomas, ‘the decisive factor is the respiratory-dependent fixation of the tumour, and here the sensitivity and specificity of ultrasound is clearly superior to CT imaging.’2 Ultrasound the method of choice for the detection and differentiation of pleural effu- sions in 2025. ‘Not only can pleural effusions of just a few millilitres be detected, but they can also be dif- ferentiated more accurately,’ said the expert.3 remains AI opens new possibilities When it comes to deeper anatomi- cal structures, ultrasound quickly reaches its limits, and the physical limitations of air-filled structures remain unchanged, Dr Trenker pointed out. The high level of examiner dependency also con- tinues to be an issue – but this could change in the future: New publications suggest, for example, that artificial (AI) could support the traditionally de- manding screening for hepatocel- (HCC).4 Con- lular carcinoma intelligence m o r f d e t p a d a sidering the growing issue of staff shortages, which also affects ex- perienced sonographers, this is a promising development, the expert pointed out – even if there are still a lot of unsolved questions regard- ing data protection. Dr Trenker illustrated the amazing diagnostic potential of AI in ultra- sound by looking at a recent meta- analysis from China: here, re- searchers used AI to analyse the sonograms of more than 11,000 breast cancer patients – and, based on this alone, predicted their HER2 receptor status with a high degree of accuracy.5 ‘This is a little hard to grasp, but, at least in initial studies, it is possible. I believe that many more applications in this field will emerge in the future.’ Patient contact: not just ‘nice to have’ Despite the general enthusiasm for technological progress, the expert reminded her audience of one of the key advantages of ultrasound: References: 1Künzel J, Brandenstein M, Zeman F et al.: Multiparametric Ultrasound of Cervical Lymph Node Metastases in Head and Neck Cancer for Planning Non-Surgical Therapy; Diagnostics https://doi. org/10.3390/diagnostics12081842 (Basel) 2022; 2Bandi V, Lunn W, Ernst E et al.: Ultrasound vs. CT in detecting chest wall invasion by tumor: a prospective study; Chest 2008; https://doi.org/10.1378/chest.07–1656 3Yang L, Wang K, Li W, Liu D: Chest ultra- sound is better than CT in identifying sep- tated effusion of patients with pleural dis- ease; 2024; https://doi. org/10.1038/s41598–024–62807–4 Scientific Reports 4Stefanini B, Giamperoli A, Terzi E, Piscaglia F: Artificial intelligence in Ultrasound: Pearls and pitfalls in 2024; Ultraschall in der Medi- zin https://doi. org/10.1055/a-2368–9201 2024; 5Fu Y, Zhou J, Li J.: Diagnostic performance of ultrasound-based artificial intelligence for predicting key molecular markers in breast cancer: A systematic review and meta- analysis; PLoS One 2024; https://doi. org/10.1371/journal.pone.0303669 6Gutzeit A, Sartoretti E, Reisinger C et al.: Di- rect communication between radiologists and patients improves the quality of imaging reports; 2021; https://doi. org/10.1007/s00330–021–07933–7 Radiology European Quantum mechanics to remove noise from medical images The math describing how par- ticles move in space can apply to stray pixels, removing noise from images. Medical imaging methods such as ultrasound and magnetic reson- ance imaging (MRI) are often af- fected by background noise, which can introduce blurring and obscure fine anatomical details in the im- ages. For clinicians who depend on medical images, background noise is a fundamental problem in mak- ing accurate diagnoses. Methods for denoising have been developed with some success, but they struggle with the complexity of noise patterns in medical images and require manual tuning of par- ameters, adding complexity to the denoising process. To solve the denoising problem, some researchers have drawn in- spiration from quantum mech- anics, which describes how matter and energy behave at the atomic scale. Their studies draw an interesting analogy between how particles vibrate and how pixel in- tensity spreads out in images and causes noise. Until now, none of these attempts directly applied the full-scale mathematics of quantum mechanics to image denoising. In a paper in AIP Advances, by AIP Publishing, researchers from Mass- achusetts General Hospital, Har- vard Medical School, Weill Cornell Medicine, GE HealthCare, and Uni- versité de Toulouse took translat- ing the particle-pixel analogy to the next level. “While quantum localization is a well-established phenomenon in physical materials, our key inno- vation was conceptualizing it for noisy images — translating the physics literally, not just meta- phorically,” author Amirreza Has- hemi said. “This foundational anal- ogy didn’t exist before. We’re the first to formalize it.” A central concept in the math de- scribing matter and energy, localiz- ation is used to explain how par- ticles vibrate in a space. Vibrations that stay confined are considered localized, while vibrations that spread out are diffused. Similarly, pixel intensity, or brightness, in a clear image can be considered lo- calized, while noisy patterns in an image can be considered diffused. The authors apply the same mathe- matics that describes the localiz- ation of particle vibrations in the surrounding physical space to de- cipher the localization of pixel in- tensity in images. In this way, they can separate the noise-free “signal” of the anatomical structures in the image from the visual noise of stray pixels. “The main aspect was developing an algorithm that auto- matically separates the localized (signal) and nonlocalized (noise) components of pixels in an image by exploiting their distinct be- haviors,” Hashemi said. The researchers’ direct application of the physics and mathematics of particles also eliminated the need to manually fine-tune parameters in denoising algorithms, which Hashemi said is a major hindrance in traditional approaches. “Our method leverages physics-driven principles, like localization and dif- fusive dynamics, which inherently separate noise from signal without expensive optimization,” Hashemi said. “The algorithm just works by design, avoiding brute-force com- putations.” Their method has applications not only in medical image denoising, but across quantum computing, too. “Our physics-driven frame- work com- putational primitives of quantum systems, offering a potential per- formance advantage as quantum computing scales.” ■ aligns with the Source: American Institute of Physics EUROPEAN HOSPITAL Vol 34 Issue 3/25
MANAGEMENT 9 SHM meeting explores complexities of doctor-patient communication “Very rarely a chance of heart attack or death” – Wait, what? Hospitalists frequently discuss the risks associated with tests, treatments, and/or surgical pro- cedures with their patients. A session on the meaning of risk to patients and how to effec- tively communicate risk was dis- cussed at SHM Converge 2025, the annual meeting of the So- ciety of Hospitalist Medicine held in Las Vegas in April. 1 ‘We work with our colleagues to conduct detailed assessments of risk for a specific patient to deter- mine the level of risk to proceed as well as the level of risk not to do so,’ said co-presenter Jeffrey L. Greenwald, MD, of the Medicine Consult Service Team of Mass- achusetts General Hospital in Bos- ton. ‘We discuss risk with our pa- tients and assume that the patient understands what we are talking about. But do they? And does this change the outcome? Almost never. The patient goes to surgery regard- less, yet shared decision making between patient and physician(s) should be central to this process.’ Co-presenter Douglas E. Wright, MD, PhD, director of Mass Gen- eral’s Medicine Consult Services, said he was jolted into awareness of the ambiguity of meaning of risk statements when he was reviewing a consent form for a cardiac stress test he was about to take while sit- ting in an empty waiting room at 6 am. The risks that could occur from taking the test included the state- ment: “very rarely a chance of heart attack or death”. What pre- cisely did this mean? The tech- nician did not know, and Dr Wright had the test without incidence. Interpretations may vary Dr Wright and Dr Greenwald sub- sequently discussed the incident and pondered how a patient would interpret the phrase “slight risk of complications” versus “10% risk of complications”. Researching the subject, they discovered that there is no easy answer. People individ- ually define risk differently. Pre- conceived notions, shared experi- ences, society influences, emotional states, and cultural and They suggest that doctors should: • recognize that information pro- vided about risk of tests, treat- ments, or procedures may be misunderstood and that the pa- tient may become very emo- tional. • determine their patient’s under- standing of the medical situ- ation. Identify their goals and priorities, specifically what they are hoping for and what they are worried about, such as prior ex- perience with similar situations. Identify if there are language, lit- eracy, or numeracy issues and assume that these are present unless proven otherwise. • not impose their own beliefs, preferences, and biases on the patient. • select a combination of lan- guage, visual representations, and numerics (such as per- centage) that they think will best convey their message in a way that the patient will understand. • ask the patient to explain in their own words what they (the doc- tor) said. • document the content of their in- teraction with the patient. situations where ‘In clinical specialists have differing opinions about a patient’s risk, be diplo- matic yet frank if you are put in the position of a mediator,’ Dr Green- wald advised. are ‘Hospitalists generalists. Specialists may be experts in their field, but they may not have evalu- ated the “bigger picture” with re- spect to totality of the patient’s clinical record. That is our job,’ he commented. When European Hospital asked Dr Greenwald what he personally ex- perienced at Massachusetts Gen- eral Hospital, a prestigious aca- demic research hospital, he advised that most patients accept the risk information as presented. ‘I think that receptivity of risk in- formation is based on the knowl- edge and trust of the physicians,’ he said. Co-author Benjamin P. Geisler, MD, a Doctoral Research m o c . e b o d a . k c o t s - a i d e m . r e b i e r h c s r e t e p © for some, innumeracy, make inter- pretation of even the most care- fully crafted description of a spe- cific medical risk assessment difficult and unpredictable. As an example, they cited a study presented at the 2019 Annual Con- gress of the Association of An- esthetists conducted at Sheffield Teaching Hospital NHS Trust in the United Kingdom. It evaluated how 57 clinicians and 290 patients inter- preted ex- pressions of risk relating to the oc- currence of a major peri-operative complication. 2 seven probability Not only was there a wide vari- ation among all participants, but patients tended to assign a much higher risk probability than clini- cians meant. The study also con- firmed the influence of education and the ability to understand nu- meric probability when assessing risk. Other research studies pub- lished in peer-review journals re- veal that risk assessment inter- pretation is highly individualized. Dos and Don’ts Because of these and other data, the presenters recommend that hospitalists prepare in advance for a meeting with a patient and/or family. Fellow at the Department of Health Management and Health Econ- omics at the University of Oslo, Norway, comments, ‘I definitely think that the issue exists in other countries too. Language and cul- ture undoubtedly have an impact on these discussions. The clinician- patient relationship may be dif- ferent on where you are in the world, say Scandinavia or Russia. Risk assessment discussions in Eu- rope may have an even greater technical detail than in the US or alternatively, be discussed only very briefly with the authority and recommendations of the physician unquestioned.’ The presenters concluded with this tongue-in-cheek comment. ‘In sum- mation, what do you tell your pa- tients? “You’ll be fine. Probably.” ■ Author: Cynthia E. Keen References: 1. Greenwald JL, Wright DE. “You’ll Be Fine. Probably.” Communicating Risk in Medicine. Presentation at SHM Converge 2025, 23–25 April 2025. Las Vegas, NV. 2. Wiles MD, Duffy A, Neill K. “The numeri- cal translation of verbal probability ex- pressions by patients and clinicians in the context of peri-operative risk communi- cation.” Anaesthesia. 2020 Jan;75 Suppl 1:e39-e45. doi: 10.1111/anae.14871. Jeffrey Greenwald Jeffrey L. Greenwald, MD, is a teaching hospitalist and a member of the Core Educator Faculty of the De- partment of Medicine at Massachu- setts General Hospital (MGH) and is an Associate Professor of Medicine at Harvard Medical School. Having served as the lead physician for Mass General Brigham’s High Performance Medicine Team on Readmissions, Dr Greenwald works with the MGH Readmissions Care Redesign Com- mittee, and was a principal developer of a novel readmission risk indicator currently used by MGH. He also works on the hospital’s Palliative Care Continuum Project, whose goal is to expand primary palliative care skills and education to clinicians. Douglas E. Wright, MD, PhD, is a teaching hospitalist and a member of the Core Educator Faculty of the De- partment of Medicine at Massachu- setts General Hospital (MGH) and is an Associate Professor of Medicine at Harvard Medical School. He serves on the MGH Medicine Consult Team. Having served as the lead physician for Mass General Brigham’s High Per- formance Medicine Team on Read- missions, Dr Greenwald works with the MGH Readmissions Care Rede- sign Committee, and was a principal developer of a novel readmission risk indicator currently used by MGH. He also works on the hospital’s Palli- ative Care Continuum Project, whose goal is to expand palliative care skills and education to clinicians. Ben Geisler Benjamin P. Geisler, MD, is cur- rently a Doctoral Research Fellow at the Department of Health Manage- ment and Health Economics at the University of Oslo. He practices hos- pitalist medicine at Massachusetts General Hospital, and is particularly interested in cardiovascular diseases, antimicrobial prescribing, rare dis- eases, and diagnostic dilemmas across medical sub-specialties. Dr Geisler is also a health services re- search, decision-analytic modeler, and health economist. 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10 PATHOLOGY Blood-based biomarkers under scrutiny BBB testing for universal Alzheimer’s screening? It’s complicated Amyloid plaques in Alzheimer‘s disease (BBB) Laboratory tests using blood- based biomarkers to identify the presence or risk of Alzheimer‘s disease (AD) in the brain are proliferating, offering the unprecedented opportunity for global population screening. Do these tests represent the next type of universally recom- mended screening tests, like pap smears for cervical cancer or feces analysis test kits for colon cancer? Experts curb the high expectations for this type of diagnostic tool. They argue that it is going to take years before AD BBB tests become a mainstream health-wellness test commodity, designed to identify people at risk a decade or more be- fore they develop AD cognitive de- cline. Clinical hurdles that need to be ad- dressed include: • population-representative clini- cal validation trials • a significant amount of clinical research to understand and quantify the impact of other dis- eases, medications, and com- binations thereof on levels of brain AD biomarkers • establishment of validated cut- offs and reference levels for all races and ethnicities • extensive training of medical professionals, particularly pri- mary care physicians, physician assistants, nurse- practitioners, in the accurate in- terpretation of test results, in the counselling of patients at risk, and in patient monitoring and support protocols. and Ethical issues abound, including the question of whether a patient and/or family will benefit from knowing the test results or will be hurt by them. Government legis- lation is needed to protect a testee from discriminatory action that could be life-damaging. Limited diagnostic significance Current BBB tests that identify the presence and level of Amyloid-beta plaques and tau tangles in the brain which are symptomatic of AD are not definitive diagnoses of the disease. They are not recom- mended as standalone diagnostic tools. Rather, they are intended to supplement a clinical diagnosis made by a physician of patients presenting with symptomatic or subjective cognitive decline. They may be a precursor to an invasive lumbar puncture test of cerebrospi- nal fluid (CFS) or an expensive PET scan. BBB tests also qualify AD diagnosed patients with early-stage cognitive decline for regulatory-ap- proved disease modifying ther- apies (DMT) or clinical trials. Many BBB clinical trials testing for AD have used patient cohorts who were predominantly non-Hispanic Caucasians. As an example, the TRAILBLAZER-ALZ 2 study of don- anemab, an FDA-cleared drug which significantly slowed clinical progression of AD in individuals with low/medium tau, included only 5.8% Hispanic, 4.1%, Black and 1.0% Asian patients in its 1,736 patient cohort. 1 What this means for both sympto- matic and asymptomatic people of colour is that the specific findings of this clinical trial may not be as applicable to them. Until more in- clusionary trials are completed, there is no way of definitively knowing. secondary care settings in the United States. She and her col- leagues express concern about the ability and confidence level of health care professionals who are not a dementia specialist inter- preting BBB test results. 2,3 Physicians must be able to con- sider positive and negative pre- dictive values of a test with vali- dated reference standards. But this may not be as easy as it seems, es- pecially if BBB tests adopt a two- cut-off approach. What should a physician do if a patient’s test re- sults fall between the two? Chronic kidney disease, stroke, obesity and cardiac disease have been found to influence AD BBBs. Prof. Mielke and colleagues point out that failure to consider the im- pact of any of these comorbidities when interpreting BBB levels may result in misdiagnosis. Additionally, no established guidelines exist for interpreting BBB tests in patients with multiple chronic conditions. Another factor to consider are medications which might impact test results. A clinical study con- ducted at the Institute of Neur- oscience and Physiology of the Sahlgrenska Academy at the Uni- versity of Gothenburg, in Mölndal, Sweden, that a pre- scription drug used for treating heart increased plasma Amyloid-beta concentrations by approximately 30%, while another drug for the same purpose had no impact. 4 revealed failure Challenges of non-specialist physician interpretation and follow-up Prof. Michelle M. Mielke, PhD, of the Department of Epidemiology and Prevention of Wake Forest Uni- versity School of Medicine in Win- ston-Salem, NC, is the co-lead of a BBB Workgroup of the Global CEO Initiative on Alzheimer’s Disease, tasked with providing actionable recommendations im- plementing BBBs in primary and on Global resources are seriously con- strained treating patients with cog- nitive decline, wither AD or other types of dementia. What health professional resources will be for patients exhibiting needed early cognitive decline but are functional if BBB testing for AD is positive? What types of assistance are needed? Do protocols exist to follow this patient? What if the pa- tient does not have access or re- m o c . e b o d a . k c o t s - r u t r A © sources to receive and pay for AD disease modifying therapies? Will stress generate other medical con- ditions that require treatment? Benefit to patient? An essential question for a phys- ician to consider is the benefit a BBB AD test will have for a patient, or not. Would a patient in their 60’s with no symptoms of cognitive im- pairment but with a family history of AD benefit? Because the AD pa- thologies of Amyloid-beta and tau accumulate in the brain years be- fore AD symptoms manifest them- selves, and because some individ- uals will never develop cognitive decline in spite of significant AD pathology accumulations, would a test be more harmful emotionally than beneficial as a warning of a possible debilitative illness? Would it be better for patients at presumed high risk be more moti- vated to make lifestyle changes to deal with sleep disorders or medi- cal conditions that are associated with AD development, instead of having the test? Would positive test results lead to discrimination impacting quality of life? Would a still cognitive individ- ual have a driver’s license revoked or denied? Would an application for a life insurance policy be re- jected or would premiums of an existing one increase? And in coun- tries like the United States with an independent insurance payor model, would premiums soar as to become prohibitive? Legislation could prevent these from happening, but scenarios have im- governments plemented legal protections? health any Lawrence VandeVrede, MD, PhD, an Assistant Professor of Neur- ology at the Memory and Aging Center of the University of Cali- fornia-San Francisco, and a core team member of Prof. Mielke’s group, is deeply concerned about the questions. He writes, ‘Until there is evidence that biomarker testing improves the outcomes of cognitively unimpaired patients, biomarker testing of these individ- uals outside of research studies or clinical trials likely has more risks than benefits.’5 ■ Author: Cynthia E. Keen References: 1. Sims JR, Zimmer JA, Evans CD, et al. Don- anemab in Early Symptomatic Alzheimer Dis- ease: The TRAILBLAZER-ALZ 2 Randomized Clinical Trial. JAMA. 2023;330(6):512–527. doi: 10.1001/jama.2023.13239. 2. Mielke MM, Fowler NR. Alzheimer disease blood biomarkers: considerations for popu- Neurol. lation-level 2024;20(8):495–504. doi: 10.1038/s41582–024–00989–1. use. Nat Rev for 3. Mielke MM, Anderson, Ashford JW, et al. Considerations im- plementation of blood-based biomarkers of Alzheimer’s disease. Alzheimers Dement. 2024;20(11):8209–8215. doi: 10.1002/alz.14150 widespread 4. 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. 5. VandeVrede L, Schindler SE. Clinical use of biomarkers in the era of Alzheimer’s disease treatments. Dement. 2025;21(1):e14201. doi: 10.1002/alz.14201. Alzheimers Lawren VandeVrede, MD, PhD, is an Assistant Professor of Neurology at the University of California-UCSF and is a researcher and clinician at its Memory and Aging Center at the Weill Institute for Neurosciences. His clinical and research interests are in advancing the care of patients with neurodegenerative disorders, either through development of novel thera- peutics or increasing understanding of the disease process. Dr. VandeV- rede serves on the core team of the Global CEO Initiative on Alzheimer’s Disease BBB Workgroup. Michelle M. Mielke, PhD, is Profes- sor of Epidemiology and Prevention and Professor of Gerontology and Geriatric Medicine at Wake Forest University School of Medicine in Win- ston-Salem, NC. In addition, she is Chair of the Department of Epidemi- ology and Prevention. She works as a translational epidemiologist to ident- ify fluid and neuroimaging biom- arkers for the diagnosis, prediction and/or progression of neurodegener- ative diseases. Dr Mielke is a co- leader of BBB Workgroup 2 of the Global CEO Initiative on Alzheimer’s Disease, which is tasked with provid- ing actionable recommendations on implementing BBBs in primary and secondary care settings in the United States. EUROPEAN HOSPITAL Vol 34 Issue 3/25