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Vol 34 ISSUE 4/25 • November 2025 THE EUROPEAN FORUM FOR THOSE IN THE BUSINESS OF MAKING HEALTHCARE WORK Low-field imaging from Shanghai: engineering portable precision Moving MRI closer to the patient – one hand-pushed scanner at a time Can a full MRI scanner be shrunk to fit through a hospital door, moved by hand, and still produce diagnostic images – in- cluding 3D and DWI sequences? At the ESMRMB 2025 Congress in Marseille, Zhiyong Zhang, re- searcher at Shanghai Jiao Tong University, offered a detailed demonstration that the answer is yes – if you re-engineer every layer of the machine, from mag- nets to mobility. ‘Low-field MRI is not just a scaled- down version of high-field,’ he said. ‘It requires its own architec- ture, its own sequences, its own way of thinking.’ From heavy to hand-pulled Zhang’s team initially began by building a 0.25T scanner, but the machine weighed two tons. ‘That was too heavy for mobility,’ he ex- plained. So they redesigned a 0.21T version, integrating all RF and gradient electronics into a structure that fits into a portable housing. ‘Now, one person can move it. I can move it myself.’ The system has since been de- ployed in several teaching hospit- als, with five full units now oper- ating in Zhang’s lab. ‘We wanted something small, reproducible, and locally operable,’ he said. The structure also allows it to be mounted on a truck for mobile im- aging – another step toward decen- tralised MRI access. Image quality at low field: engineering, not magic ‘We show T1, T2, FLAIR, and 3D T2 images – all acquired on our sys- tem,’ Zhang said. ‘And none of it is AI-enhanced. This is raw imaging.’ But achieving those images required more than hardware. ‘Low field means low SNR,’ he said. ‘And that means every imperfection matters.’ 1. ELECTROMAGNETIC NOISE Many open-source or DIY MRI se- tups struggle with EMC (electrom- agnetic compatibility). Zhang’s team analysed normal frequency ranges of all commercial com- ponents, from power supplies to amplifiers, and built shielding and filters to isolate noise. ‘If your switching amplifier has harmonics close to your imaging bandwidth,’ he warned, ‘you’ll see artifacts – or no image at all.’ method using field probes that measure gradient fields directly in x, y, and z axes. ‘Image-based cor- rections take hours or days,’ he said. ‘With field probes, we can do it in a few minutes, and com- pensate for high-order eddy cur- rents in real time.’ The team also mapped and cor- rected for concomitant fields using Maxwell-based models – essential for clean DWI acquisitions at low field. Zhang broke down the system’s design into three challenges: hard- ware interference, sequence opti- misation, and image correction. 2. GRADIENT INSTABILITY To eliminate possible ghosting and geometric distortions, Zhang de- signed a correction real-time Continued on page 2 www.healthcare-in-europe.com
2 Continued from page 1: to 3. TEMPERATURE SENSITIVITY ‘Low-field systems are much more sensitive temperature drift,’ Zhang noted. To stabilise the cen- tral im- plemented monitoring and feed- back systems throughout the scan process. frequency, his team Sequence innovation for low field Zhang’s talk highlighted how se- quence engineering must be re- thought entirely for low-field en- vironments. The team developed multi-band FSE and EPI se- quences – typically used in high- field applications – and adapted them for their lower-power sys- tem. AI in imaging ‘In high field, multiband FSE is li- mited by SAR,’ he said. ‘At low field, you need less than 1kW to drive it – versus 16kW in high- field systems.’ Using quadratic phase increments, they improved echo stability and remarkably suppressed signal os- cillations, enabling longer ac- quisition windows. Combined with RF encoding techniques, this led to notably clearer contrasts and faster imaging – including re- markable full head scans in under 10 minutes. DWI at low field: the final frontier ‘Diffusion imaging is the hardest to achieve,’ Zhang admitted. ‘All open-source systems struggle with DWI.’ But after successive rounds of hardware filtering and se- quence optimisation, his team suc- ceeded trace- weighted DWI images with their EPI-based sequence. acquiring in ‘We’re not at the same resolution as 3T systems,’ he said. ‘But the clinical utility is there – and we’re improving every month.’ Design matters: MRI for humans, not just engineers The team also partnered with in- dustrial design students to adapt the machine to real-world environ- ments. The latest scanner model is less than 80 cm wide, making it small enough to fit in elevators or through hospital doors – a critical RADIOLOGY filtering, and sequence devel- opment. ‘Our work is collaborative, iter- ative, and grounded in engin- eering,’ he said. ‘And it’s driven by a clear question: how do we bring MRI closer to people, not just in power, but in practice?’ The answer, shown slide by slide in Marseille, is being built – one filtered amplifier, rephased se- quence, and hand-pushed scanner at a time. ■ Author: Mélisande Rouger threshold in many facilities. ‘We added force sensors and touch- based movement,’ Zhang said. ‘You push it, it moves; you pull, it fol- lows.’ For paediatric imaging, the design is even more intentional: rounded shapes, colourful surfaces, em- bedded screens, and accessories to hold iPads or toys during scans. ‘The goal is to create a space where children feel safe,’ he said. ‘Where parents can stay, and tech- nicians can interact.’ A growing team, a broader vision Zhang concluded by crediting his team – including several students who received awards for their work on multiband FSE, hardware AI successfully supports radiologists in breast cancer screening A Swedish hospital has success- fully deployed an AI reader to support breast cancer screening and free up radiologists’ time. The Capio Sankt Görans Hospi- tal in Stockholm traditionally used two radiologists to read breast scans, but has now pi- voted to using one radiologist and the AI technology. Head physician at the Department of Breast Radiology, Dr Karin Dem- brower, explained how the im- plementation had followed rigor- ous clinical trials and testing before deployment. Speaking to delegates at the Euro- pean Society of Breast Imaging an- nual scientific meeting, held in Aberdeen, Scotland, at the end of September in cooperation with the British Society of Breast Radiology, she said the deployment had im- proved workflow and eased work- load on radiologists who were pre- viously working evenings and weekends to tackle waiting list queues. Her presentation ‘Implementation of clinical Artificial Intelligence in breast radiology – who decides and how? was part of a session looking at ‘AI from gadget to gain in breast imaging’ with a series of expert speakers examining how the technology was supporting breast departments across Europe. radiology Clinical trial Dembrower specifically detailed how her hospital had made the transition to using AI in reading breast examinations. In Sweden all women aged 40–74 are invited for screening every sec- ond year. That sees 80,000 women invited a year to her site with 75–80% attendance. k c o t s k a e P - e b o d a . k c o t s © screening programme. But with a shortage of breast radiologists, the hospital wanted to see if AI could address the key challenges. The ScreenTrustCAD trial was launched in April 2021 to assess whether AI in mammography screening can replace one of two radiologists in a double-reading setting. It ran to June 2022 with 55,581 women participating. Good results Three strands saw: two radiologists reading scans, one radiologist with AI, and an AI-only track. The two radiologists recalled 1629 women; AI plus one reader re- called 1556; and AI-only recalled 50% of those (861). She said: ‘Two radiologists found 250 cancer cases, AI plus one reader found 261, and AI-only found 246. The advanced cancer cases of more than 2cm that were node positive were 77 for two readers, 81 for AI plus one reader, and 78 for AI-only. ‘These results were good and with a method better than the existing one, we started the process of im- plementing AI at our site.’ tems, and an ethical and legal framework, the system went live in June 2023. Task shifting Performance so far has seen the re- call rate fall by 26%, false positives decrease by 13%, an increase in the cancer detection rate among re- called woman of 55.5%, and the overall cancer detection showing a 12.2% rise. The change also saw task shifting with a greater focus on diagnosed women and no more waiting queues or out-of-hours working for radiologists. She also cited examples of women who had cancers picked up with a radiologist working alongside AI that may have been difficult to see with the human eye. Dembrower conceded there was initial scepticism among colleagues but with AI, her department now has ‘another tool to help us make the best decisions.’ Promoting curiosity For a successful implementation she said a hospital environment that has a culture of promoting curiosity and innovation is key. The standard of care for assessing screening mammograms tradition- ally saw two radiologists reading all mammograms, with 70% of all cancer cases detected within the That saw one reader replaced with AI in the mammography screening process. Having worked with rel- evant authorities and vendors to ensure robust and secure IT sys- ‘We were lucky that we could take AI from research to clinical prac- tice early and I think it is good to have researchers that are clinically active because it is easier to im- plement different projects,’ she said. The key question remains: who is responsible, who decides? ‘In this case, she said, ‘the radi- ologist is the lead and the decision maker.’ With the success of the Screen- TrustCad study with the AI plus one reader track, the focus is now shifting to the potential of the AI- only track. Evidence is short-term The session also heard from Pro- fessor Pascal Baltzer from the De- partment of Biomedical Imaging and Image-guided Therapy at Vien- na General Hospital who looked at AI in screening from the per- spective of the latest trials. He said a key factor in AI in screening was the shortage of radi- ologists and a rising workload, though he also notes that digitali- sation has allowed radiologists to be faster in reporting. He also pointed to a UK workforce census that indicated a 29% shortfall in radiology consultants at a time that imaging demand was growing by 8%. However, while AI has potential for improved cancer detection and workflow efficiency, he warned of a risk of “over-enthusiasm” and that robust evidence is needed. AI in screening He discussed a number of trials in- cluding a meta analysis comparing AI screening with radiologists, the MASAI and ScreenTrustCAD trials from Sweden, alongside studies from Denmark, Germany, Hungary and South Korea, comparing AI systems to radiologists’ perform- ance. In a summary of the evidence for AI in screening, he said it is regu- larly superior for cancer detection; that recall and false positives were stable or reduced; there is a signifi- cant workload reduction; but evi- dence is still short-term on interval cancers and overdiagnosis. Giving his final verdict, Baltzer told delegates: ‘AI is ready to assist, not yet intended to replace radiologists but the evidence supports use of AI in screening very clearly. legal clarity ‘The next step is the interval cancer data and is also needed but these are all processes where radiologists should be inte- grated as much as possible.’ ■ Author: Mark Nicholls Karin Dembrower Dr Karin Dembrower is the head physician at the Department of Breast Radiology, Capio Sankt Gör- ans Hospital in Stockholm and has been working as a dedicated breast radiologist since 2016. Her scientific work is focused on assessing how AI can be implemented to improve cancer detection and breast cancer risk estimation. Pascal Baltzer Pascal Baltzer is Professor for mag- netic resonance radiology at the Medical University of Vienna and has been a radiologist at the Department of Biomedical Imaging and Image- guided Therapy at MedUni Vienna since 2012. His scientific focus is on magnetic resonance imaging (MRI) and he is internationally-recognised for his work on breast, bladder and prostate imaging. EUROPEAN HOSPITAL Vol 34 Issue 4/25
RADIOLOGY Inclusive Diagnostics Shining a light on underserved populations in breast imaging 3 gender identity aligns with the sex assigned to them at birth. She focused on patients under- going feminising and masculinising gender-affirming and Gender-affirming Hormone Ther- apy (GAHT). surgery However, within that process, she said evidence of the breast cancer risk is limited. Major challenges There is also a lack of long-term follow-up, documentation of hor- mone exposure or lack of pros- pective studies, and the association between breast cancer risk and GAHT remains poorly understood. In terms of breast cancer screen- ing, she said challenges include people from these groups not par- ticipating in or being aware of screening or prevention pro- grammes; lack of trust of health- care professionals; and poor knowledge of screening guidelines among the transgender population and healthcare professionals. There was also evidence of a lack of training and education among healthcare providers. In conclusion, she said: ‘Radi- ologists must be familiar with the correct terminology and the types of gender-affirming processes; healthcare providers – both GPs and specialists – must be aware of the most current guidelines for the TGD population; the scientific so- cieties and individual research groups must collaborate to close gaps in research and education, re- ducing healthcare inequities; and LGBTQIA+ groups should be involved in research and educational activities.’ advocacy Transgender survey D’Angelo confirmed that EUSOBI was in the process of launching a survey on radiologists’ knowledge of in breast imaging. transgender populations Meanwhile, Dr Machteld Keupers from the University Hospital Leuven in Belgium, discussed how to perform paediatric breast im- aging, the most common benign and malignant breast lesions in children, and clinical management of paediatric breast masses. ■ Author. Mark Nicholls Nuala Healy Professor Nuala Healy is Chair of Radiology at RCSI University of Medicine and Health Sciences in Dublin where she leads the academic Department of Radiology while pro- viding patient care as a consultant radiologist at Beaumont Hospital. She is also the research lead for the British Society of Breast Radiology. Y u r g u i d e im a g i n g e c h n l g y a n d i n f rm a i c s i n E u r p e For more information, visit healthcare-in-europe.com s a d i n o e L - e b o d a . k c o t s © imaging Greater attention is needed in breast for patient groups who are often over- looked in healthcare. At a major breast imaging conference, ex- perts highlighted the scarcity of research on breast imaging for males, transgender individuals, young people, and other under- served populations. Speakers at the European Society of Breast Imaging (EUSOBI) an- nual scientific meeting, held in Aberdeen, Scotland in cooperation with the British Society of Breast Radiology, shared that collabor- ative efforts are underway to close these In a session breast imaging in specific populations, presenters discussed findings from a EUSOBI-supported survey of radiologists on practices in male breast imaging, plans for a similar survey focused on ap- proaches for transgender patients. information gaps. Professor Nuala Healy from the Beaumont Breast Centre in Dublin and the Royal College of Surgeons Ireland told the conference that there are currently no European guidelines for male breast imaging, with practitioners tending to follow the American College of Radiology (ACR) and Royal College of Radi- ologist guidelines. In giving an overview of male breast disease, she said only 5% of referrals to breast units are male but they generate a significant workload as about 75% of patients have some form of imaging. She said the majority of male breast disease is benign, ranging from lipoma to fat necrosis, gyne- www.healthcare-in-europe.com comastia and pseudo gynecom- astia, with male breast cancer ac- counting for just 1% of all breast cancers and 0.5% of all male cancers and generally presenting in older men. ‘Because male breast cancer is rare,’ she continued, ‘there are very few prospective or randomised controlled trials in terms of treat- ment or management, so most of what we do with males with breast cancer is extrapolated from female breast cancer. ‘But about 40% of male breast cancers present at stage 3 or 4 at diagnosis and because they present later they tend to have much worse outcomes.’ Risk factors include age, genetics with BRCA2 more common in male breast cancer than in female and anything which reduces testoste- rone or causes an increase in oes- trogen is a risk factor for male breast cancer. Survey response The EUSOBI survey on male breast cancer was sent to breast imagers across Europe and had 825 re- sponses, mostly from radiologists, across 34 countries. While the ACR and UK guidelines offer advice on use of ultrasound, mammograms or DBT (digital breast tomosynthesis) for men, sur- vey respondents indicated how they conducted imaging. Many were performing ultrasound for initial imaging in benign in- determinate palpable mass for men under 25 and mammogram or DBT for men over 50. For suspicious palpable masses, the vast majority of practitioners (82%) are performing ultrasound for under 25s and a combination of mammogram or DBT for over 50s. Gynecomastia imaging The survey also asked respondents what they did when faced with gynecomastia and pseudo gyne- comastia in the clinic. ‘In younger populations, it is ultra- sound and over 50 it is mammo- gram or DBT, while 72% of respon- dents said they did imaging for both unilateral and bilateral gyne- comastia.’ In summary, Healy said most radi- ologists are doing some form of imaging for gynecomastia, though 41% are not doing any form of im- aging for males considered at high risk of breast cancer and 13% do not perform follow up after a his- tory of breast cancer. ‘We need to do a lot more research in terms of male breast imaging and then develop some updated guidelines,’ she concluded. Breast cancer risk Anna D’Angelo from the Catholic University of the Sacred Heart in Rome Transgender Breast Imaging, emphasising the importance of using the correct ter- minologies with this patient group. discussed Transgender, she clarified, is an umbrella term for people whose gender identity does not align with the sex assigned to them at birth, while cisgender is people whose
4 Functional neuroradiology RADIOLOGY When music lights up the brain: insights from fMRI realize that what we feel intuitively as musicians – the coordination, the emotion, the inner singing – all have visible traces in the brain. Seeing it on an image makes it even more real.’ The composer’s mind: where thought becomes sound In a second phase, the duo studied improvisation. Composer and or- ganist Thierry Escaich was asked to create music inside the MRI, si- lently, without touching an in- strument. When he imagined a ba- roque fugue, the visual areas of his brain lit up – as if he were reading an invisible score. When he turned to romantic music, the emotional orbitofrontal cortex became dominant. And for contem- porary creation, it was the analyti- cal prefrontal zones – logic and planning – that took over. As Mellerio puts it, ‘Each musical style tells a different story in the brain. Bach’s architecture, Chopin’s emotion, Boulez’s mathematics – they all use different neural path- ways to express creativity.’ Music as a mirror of the mind For Anne-Isabelle de Parcevaux, this journey into neuroscience is more than an experiment – it’s a new way of hearing herself. ‘As musicians, we work so hard on technique that we sometimes for- get how complex our perception really is. Seeing the brain in action reminds us that music is not just an art – it’s a full-body experience, one that involves movement, mem- ory, emotion, and thought all at once.’ Their joint work, presented at JFR 2025, reveals not only how music transforms the brain, but also how curiosity – between two disciplin- es, two languages, two ways of seeing – can itself become a form of harmony. ■ Author: Mélisande Rouger References 1 Mellerio C, De Parcevaux AI, Charron S, Etevenon P, Oppenheim C: Functional MRI of a conductor in action; Journal of Radio- loneurology https://doi.org/ 10.1016/j.neurad.2023.01.002 2023; Charles Mellerio Charles Mellerio, PhD, is a neur- oradiologist at Paris University Hos- pital Group Psychiatry & Neuroscience and Northern Imaging Center in Paris, France. He trained as a radiologist at Claude Bernard Lyon 1 University and completed his PhD studies in neuroscience at Paris Cité University. Anne-Isabelle de Parcevaux Anne-Isabelle de Parcevaux is an organist at Eglise St Ignace in Paris and Cathédrale de Versailles in France. She is also a Master’s student in Neuroscience at Sorbonne Univer- sity and she graduated in arts medi- cine and music studies at the National Conservatory of Dance and Music and Saint-Maur-des-Fossés Conservatory in Paris. m o c . e b o d a . k c o t s – 1 n i 3 o g o l © At the JFR 2025 (Journées Fran- çaises de Radiologie), the annual meeting of the French Society of Radiology, an organist and a neuroradiologist came together to share a story that bridges two worlds rarely seen in dialogue – that of sound and that of images. One listens, the other looks. Yet both try to understand the same mystery: what happens in the human brain when music takes control? It all began, as many collaborations do, around a dinner table in Paris. Charles Mellerio, a neuroradio- logist specializing in functional im- aging, had recently been part of a TV documentary about conductor Alain Altinoglu. Curious to see what a maestro’s brain might look like while leading his orchestra, he had placed the conductor inside an MRI scanner and watched colours bloom across the screen – regions of sound, movement, emotion, and attention lighting up all at once. The findings would later be pub- lished in the Journal of Neur- oradiology.1 Months later, at that dinner, he met Anne-Isabelle de Parcevaux, a pro- fessional organist from Paris and Versailles, equally fascinated by neuroscience. As they talked, she helped him reinterpret those im- ages through the eyes – and the ears – of a musician. What had seemed like random activations suddenly made sense. A zone linked to the perception of the throat, for instance, turned out to be involved in inner singing – that silent melody many musicians “hear” as they play. When musicians become their own experiment From that exchange, a scientific ar- ticle was born. And from that, a collaboration. Together, Mellerio and de Parce- vaux began exploring the brains of various different musicians – vi- olinists, flutists, pianists, con- ductors, and singers – using func- tional MRI to capture what happens when they actively im- agine playing or listening to their own music. to non-musicians, The results were striking. Com- pared their brains lit up like symphonies – en- gaging not only auditory regions but also motor areas, emotional centers, and even the zones of lan- guage vision. As Charles Mellerio explains, ‘A professional musician doesn’t just hear music. Their brain anticipates it – it prepares the movement, the emotion, even the physical gesture of playing.’ and The hidden choreography of the brain Each musician’s brain revealed its signature. The violinist’s own motor cortex glowed stronger on the side controlling the left hand. The singer’s brain activated the areas for breath and articulation. The pianist’s visual-spatial regions were hyperactive, guiding her hands across an imagined key- board. Even when perfectly still inside the scanner, their brains were dancing. Anne-Isabelle smiles as she recalls these findings: ‘It’s fascinating to 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) Founded by Heinz-Jürgen Witzke ISSN 0942-9085 USA: Cynthia E. Keen (CEK) Correspondents Austria: Michael Krassnitzer (MK) Germany: Cornelia Wels-Maug (CWM) Dr Christina Czeschik (CC) Great Britain: Mark Nicholls (MN) Spain: Mélisande Rouger (MR) Subscriptions Simone Sesselmann kundenservice@mgo-fachverlage.de Subscription rate 4 issues: 32 Euro, Single copy: 8 Euro. Publication frequency: quarterly Representatives Germany, Austria, Switzerland: Diana Thümmel Phone: +49 9221 949-407 E-Mail: d.thuemmel@mgo-fachverlage.de Europe: Eric Jund Phone: +33 493 58 77 43 E-Mail: jund@european-hospital.com Taiwan: Charles Yang Phone: +886 4 232 236 33 E-Mail: medianet@ms13.hinet.net USA & Canada: Hanna Politis, Media International Phone: +1 301 869 66 10 E-Mail: hanna@media-intl.com All company, brand and product names in this publication are the property of their respective holders. Users must obtain per- mission from those holders before copying or using the owner’s trademarks, product and company names or logos. EUROPEAN HOSPITAL Vol 34 Issue 4/25
RADIOLOGY Magnetic resonance imaging reduces unnecessary biopsies MRI-first approach reshapes prostate cancer diagnostics resonance Magnetic imaging (MRI) holds great potential to spare men with suspected pros- tate cancer a painful biopsy. In our interview, Dr Peter Seiden- sticker, Head of Medical Affairs Radiology at Bayer, outlines how MRI could be implemented as a first-line diagnostic. EH: The PROKOMB study1 sug- gests MRI can serve as the first diagnostic step for suspected prostate cancer – where do you see the advantages of this ap- proach compared to the tradi- tional biopsy-first strategy? Dr Seidensticker: “According to some current analyses, the majority of biopsies conducted for prostate cancer diagnostics are unnecess- ary. Against this background, the PROKOMB study, which was con- ducted by the Charité and sup- ported by Bayer, demonstrates that utilizing MRI as the first diagnostic step in suspected prostate cancer can offer several advantages over the traditional biopsy-first ap- proach. “First and foremost, by identifying patients who do not show suspi- cious lesions on the scan, MRI can significantly reduce the need for unnecessary – and quite invasive – biopsies and avoid associated downsides, such as potential in- fections. Moreover, pre-biopsy MRI facilitates more precise, tar- geted biopsies in cases of clini- cally that require treatment, while minimiz- ing the risk of over-diagnosing in- dolent cancers.“ significant cancers What were the most striking findings of the study that sup- port changing clinical practice? “The core finding of the PRO- KOMB study showed that men with non-suspicious MRI can avoid biopsies without being at increased risk of clinically significant pros- tate cancer. To be precise, the study shows that an MRI-informed strat- egy could prevent biopsies in 41% of all men, and 86% of MRI- negative men over three years. “These findings are crucial in ad- vancing strategies and innovative approaches in prostate imaging and will benefit many patients. A significant impact of the PRO- KOMB study is the recent update to the respective German S3 guide- line on prostate cancer, which now cites the PROKOMB study. So, the study made an active contribution to new recommendations, reinfor- cing the importance of evidence- based practices in patient care. Against this background, we are very pleased to have supported this important study.“ www.healthcare-in-europe.com r e y a B © Dr Seidensticker Are there specific MRI protocols or sequences necessary for pros- tate cancer detection, and how standardized are these across different imaging centres? “Prostate MRI or better multi- parametric MRI of the Prostate (mpMRI) describes a series of stan- dard MRI sequences that are also used in other areas of the body. However, there are specifics requi- ring training for the technologists in order to plan and set up the scan, and for the radiologist reading Pros- tate MRIs is also still quite special- ized knowledge. Enhanced training, simplified scanners, and future AI integration will do their part in ad- vancing Prostate MRI further.“ What role do MRI contrast agents play in PCa diagnostics? How significant is cumulative ex- posure for patients who may need multiple MRIs over their lifetime? “Prostate MRI is poised to become a standard practice in evaluating prostate cancer, with around 600,000 procedures performed an- nually and a 5% growth rate. The gadolinium-based contrast agent used in these scans can help phys- icians distinguish cancerous tissue and facilitate diagnosis, staging, and monitoring. A next generation low dose, high relaxivity gadolin- ium-based contrast agent can be particularly beneficial for patients needing contrast- enhanced scans, as the gadolinium lifetime exposure is reduced, such as in cancer patients undergoing disease monitoring. Using the lo- west effective dose without com- promising diagnostic results is also the recommendation of health authorities and scientific guide- lines. This is why Bayer drives in- novation in this field with a new investigational low dose MRI contrast agent.“ multiple What are the main barriers to im- plementing an MRI-first diag- nostic pathway in routine prac- tice (cost, availability, expertise, or something else)? How could they be overcome? “Potential barriers such as costs, li- mited availability, e.g. in more rural areas, and a need for specialized expertise to interpret scans, could be overcome by training radi- ologists and technicians more ef- fectively, by developing simplified and standardized scan protocols, and by implementing future AI sol- utions supporting for example the reading of the images. All of these would have the potential to make MRI-first pathways more efficient and scalable. Additionally, changes to established clinical pathways may cause hesitation among practi- tioners to adopt new practices. Im- portant clinical insights, e.g. from the PROKOMB study, help con- tribute to a needed paradigm shift for the benefit of patients among practitioners.“ From a health economics per- spective, does the MRI-first ap- proach make sense when you factor in the costs of unnecess- ary biopsies and their com- plications? “This is subject for further investi- gation, but the MRI-first approach may offer cost-effective benefits, as the higher initial costs of MRI could possibly be balanced by helping to avoid unnecessary biopsies, and thus, potential com- plications like infections, minimiz- ing hospital stays, and lessening further care related to false posi- tives. Over time, this strategy could contribute to improved patient out- comes while also helping to lower overall healthcare cost.“ Please formulate a ‘take-home message’ about the impact of 5 r e y a B © MRI on prostate cancer diag- nostics. “Prostate cancer ranks as the sec- ond most common cancer in men and the fifth leading cause of cancer-related death worldwide. Adopting MRI as the initial diag- nostic tool can enhance the identi- fication of clinically significant cancers and improve diagnostic ac- curacy, but also has the potential to spare patients from unnecessary biopsies. This approach con- tributes to reducing patient anxiety and fostering more personalized care – ultimately leading to better outcomes for men facing prostate cancer.“ ■ Interviewer: Wolfgang Behrends 1 Hamm, CA, Asbach P, Pöhlmann A et al.: Oncological Safety of MRI-Informed Biopsy Decision-Making in Men With Suspected Prostate Oncology 2025;11;(2):145–153. doi:10.1001/jamaon- col.2024.5497 Cancer; JAMA Peter Seidensticker Dr. Peter Seidensticker is a board- certified radiologist with over 20 years of experience in the pharma- ceutical and medical device industry. He holds a doctorate in interven- tional radiology and currently serves as Head of Global Medical Affairs Radiology at Bayer. Dr. Seidensticker is recognized for building strong teams and driving impactful strat- egies to advance radiology practice worldwide.
6 ARTIFICIAL INTELLIGENCE AI: Security’s Double-Edged Sword Cyber Resilience in the Age of Artificial Intelligence (AI) new introduces intelligence Artificial is transforming healthcare, but it also cy- bersecurity risks that challenge IT teams. While AI streamlines diagnosis and workflow, cyber- criminals are the same technology to infiltrate hospital systems. Experts ad- dressed these emerging threats and strategies for resilience dur- ing the ‘Maximising What You Have for Cyber Resilience – Ask the Experts’ forum at HETT25 in London. leveraging s l l o h c i N k r a M © AI is a clear threat, particularly with deep faking with individuals potentially creating false personas to gain access or information. The cybersecurity panel. From left to right: Gary McAllister, Nasser Arif, Linda Kaye, Sam Cattell. the Chairing interactive open forum session, Gary McAllister, Chief Technology Officer (Health- care & Public Sector) for Dell Tech- nologies, said having the right level of checks to counter deep fakes is critical. He also warned of taking thins too lightly: ‘We know Deep Fake tech is being used for humour and en- tertainment at the moment but it is only a matter of time before it is used maliciously, so we need to be ahead of the curve.’ to combat Asked how these threats, potentially by using AI as a counter, the Digital Care Hub’s Technical Cyber Lead Sam Cattell acknowledged: ‘We seem to be one step behind and reacting to AI when we should be using AI and looking into the future.’ While AI can help combat deep fakes, he points to human behav- iour, awareness and strong pass- words as basic but effective steps. Deep Fake threat With increased risk from AI and Deep Fakes, London Northwest Healthcare Trust’s cyber security manager Nasser Arif said dialogue with vendors is important as many have specific tackle threats. tools to Cyberpsychology expert Professor Linda Kaye from Edge Hill Univer- sity in Lancashire suggested AI could be used in selection and re- cruitment processes, alongside psychometric tests. ‘As those tools draw on people’s online data and behaviour, we can understand a lot more accurately about people from their online be- haviour rather than the way they might respond to psychometric test,’ she said. AI, added Kaye, could have a role in better detecting where there might be potential dangers and threats in future employees be- haviors ‘before people are re- cruited rather than testing while in the organisation.’ Blameless culture Arif said it was important to re- member the tremendous pressure IT teams work under during a cyber attack. ‘With the number of incidents in- creasing, we should remember that cyber security and IT professionals are humans, so reach out to them and ask how they are doing.’ Kaye underlined the importance of pastoral and human support, par- ticularly for those who may have made a mistake leading to an inci- dent, while Cattel said a ‘blameless culture is absolutely vital.’ McAllister said business continuity plans that are more than an ‘inter- im response plan’ are crucial as major attacks can take a significant amount of time to recover from. Speaking of his experience with Synnova while at Guy’s and St Tho- mas’ Hospital which compromised healthcare in south London for sev- eral months, he said: ‘We often for- get that cyber incidents become crime scenes which require foren- sic investigation meaning you lose a lot of your infrastructure for a prolonged period of time.’ Cyber resilience Support for health organisations af- fected by cyber attack is available through the NHS Cyber Security Operations Centre (CSOC) and the CAF (Cyber Assessment Frame- work) to help organisations assess and improve their cyber security and resilience The value of PEN (penetration) testing was also discussed, with authorised simulated attacks to raise alertness and staff training and awareness of cyber attack, as well as audits and cyber security ‘health checks.’. ‘It goes back to making sure we are adapting with the times,’ explained Arif. ‘In the NHS we have regular penetration tests and must make sure we tailor those to the latest threats.’ Kaye, who pointed to employee at- titude and risk aversiveness assess- ment, added: ‘People might have technical skills and understand cy- bersecurity risks but if they do not have a positive attitude around im- plementing them, that is equally a risk.’ Funding concerns The issue of funding levels was raised and Cattel said increases were needed both in the public and in the private sector to up- grade technology in the face of in- creased cyber risk. However, Arif said investment re- quests should be honest, as exist- ing solutions often make new pur- chases unnecessary. ‘There are improvements you can make which cost nothing,’ he sug- gested. ‘Cyber awareness is a clas- sic example where there is a lot you can do with existing tools.’ That included bringing in equip- ment suppliers to look at up- grades, new tools, or ways of utilis- ing the technology. ‘You may find you are probably using the product the same way you were using it three years ago,’ he added, ‘but the threat landscape has completely changed in that time.’ ■ Author: Mark Nicholls Gary McAllister is Chief Technology Officer (Healthcare & Public Sector) for Dell Technologies. He previously worked in the NHS, including at Guy’s and St Thomas’ Hospital in London. Nasser Arif is cyber security man- ager for London Northwest Health- care Trust and Hillingdon Hospital Healthcare Trust, managing the cyber team and incident response and is passionate about the human element of cyber security. ECG-reading AI better detects severe heart attacks in emergency setting AI-based ECG interpretation de- tected more STEMIs and had fewer false positives. The study was published in JACC: Cardiov- ascular Interventions and simul- taneously presented at TCT 2025 in San Francisco. ST-segment elevation myocardial infarction (STEMI) is a severe type of heart attack where a major cor- onary artery is blocked, preventing blood flow to the heart muscle. Quickly restoring blood flow, or reperfusion, using percutaneous coronary intervention is the stan- dard of care; however, delays in achieving guideline- recommended time to reperfusion still persist, especially at hospitals and centers not specializing in PCI and in rural areas. Time to reperfu- sion longer than 90 minutes is as- sociated with threefold higher rates of mortality. the “AI-driven ECG interpretation can bring the best of both worlds – identify true heart attacks early while reducing unnecessary ac- tivations,” said Robert Herman, MD, PhD, lead author of the study and a cardiovascular researcher at Azorg Hospital in Aalst, Belgium. “Improving the accuracy of triage at the first medical contact can streamline emergency care, reduce fatigue and strain on clinical teams, and ensure that patients who truly need urgent intervention receive it without delay.” setting, In one of the first large, real-world evaluations of an AI–based ECG model for STEMI triage in the emergency researchers retrospectively looked at 1,032 pa- tients with suspected STEMI who triggered emergency reperfusion protocols. Data was from three geographically diverse primary PCI centers between January 2020 and May 2024. Each patient’s initial ECG underwent analysis by the STEMI AI ECG Model (Queen of Hearts) trained to detect acute cor- onary occlusion, including STEMI equivalents and differentiate from benign mimics. Angiography and biomarkers con- firmed that 601 (58%) were STEMIs and 431 (42%) were false positives. The AI ECG model did better than standard triage, detecting 553 of 601 confirmed STEMIs vs. 427 de- tected by standard triage on the in- itial ECG. AI ECG had a false positive rate of 7.9% vs. 41.8% for standard triage, representing a fivefold reduction. “These results indicate that AI- enhanced STEMI diagnosis at the first medical contact has the poten- tial to shorten time to treatment and reduce false activations,” said Timothy D. Henry, MD, FACC, sen- ior author of the study, The Carl and Edyth Lindner Family Distin- guished Chair in Clinical Research and Medical Director of The Carl and Edyth Lindner Center for Re- search and Education at The Christ Hospital in Cincinnati. “This tech- nology may be especially valuable in optimizing the transfer of STEMI patients from non-PCI centers to ensure timely and appropriate care.” In an accompanying editorial com- ment, Mohamad Alkhouli, MD, MBA, cardiologist at the Mayo Clinic, said the researchers should be “commended for developing an operational AI model aimed at ad- dressing one of the most complex and error-prone aspects of inter- ventional prac- cardiology tice—STEMI activation.” prospective However, he emphasized that the AI model employed in the study should be interpreted with caution, as it was originally developed to detect occluded arteries rather than STEMI and necessitates further validation across diverse patient populations. “The true challenge is not proof of accuracy alone, but readiness—to integrate, regulate, and interpret AI as a complement to human judg- ment, particularly in high-stakes, time-sensitive settings,” Alkhouli said. ■ clinical Source: American College of Cardiology EUROPEAN HOSPITAL Vol 34 Issue 4/25
ARTIFICIAL INTELLIGENCE 7 AI’s real-world impact AI Advances Risk Stratification in Breast Screening Artificial Intelligence is taking on an increasingly pivotal role in the risk stratification of women attending breast screening pro- grams. Beyond the identification of those at higher risk, AI is also proving valuable in predicting and assessing re- sponses to breast cancer diag- nosis and treatment. refining These dual applications of AI were explored during a dedicated session at the European Society of Breast Imaging’s annual scientific meeting, with the British Society of Breast Radiology in Aberdeen, Scotland, at the end of September. Under the theme ‘AI from gadget to gain in breast imaging,’ experts dis- cussed how advanced algorithms are helping clinicians more pre- cisely identify, stratify, and treat pa- tients, moving AI from a tech- nological novelty to a clinical necessity. Epidemiologist Dr Mikael Eriksson, who is an Assistant Professor in the Department of Medical Epidemiol- ogy and Biostatistics at the Karo- linska Institutet in Stockholm, fo- cussed on AI for risk stratification. He explained that traditional risk models have been around for a number of years and are good for calibration in that they identify the correct risk classes. However, he said they also have disadvantages in that they: have low uptake in the screening popu- lation and focus strongly on family history rather than general risk and lifetime risk. ‘As a result,’ he said, ‘they are not suitable for those developing inter- val cancers, have differential per- formances in ethnic subgroups, are difficult in practical terms to collect in the clinical settings and can rec- ord bias, meaning many risk as- sessments are performed with in- complete information.’ Supplemental screening He outlined work at his institution to expand risk assessment beyond primary prevention initiatives. Eriksson said: ‘We want to assess risk in a narrow clinical timeframe to identify women who could benefit from supplemental screen- ing, or shorter screening intervals, and at the same time reduce false positive predictions.’ the mammogram traditionally used infra- Using structure for breast cancer detection, the goal using AI is to develop a basis for risk prediction and classification with an outcome of supplemental screening or interval rates to high- light women that may have a worse prognosis and ‘ultimately address reduction in breast cancer mortal- ity.’ Detective work He gave an example of following women from 2014 who have a moderate risk and using advanced AI tools which flagged a higher risk in 2016, clearly showing those women who could benefit from a supplemental screening and may be clinically actionable, eventually with a diagnosis in 2021. the narrow With 15–45% of breast cancers diagnosed as interval cancers, he said time-window could significantly increase the chance of a cancer-finding, though with a few false-positive recalls. He said the AI model can ac- curately identify high risk, regard- less of mammographic density, and what intervals should be, and consistently per- form better than traditional risk models. follow-up the While there are confounding fac- tors, with ‘detective work’ needed to find those confounders to im- prove the AI-risk model perform- ance, an increasing number of AI models are now being validated in several screening settings with ‘very promising results.’ Clinical guidelines With a clinical trial using AI risk models to identify women for supplemental screening, he said the key will be identifying how many will be at high risk and what is the reduction of interval and ad- vanced cancers, but also factoring in the psychological effect that can come from risk assessments and how it affects women and screen- ing attendance. In summary, Eriksson said: ‘It is really excellent to use cancer screening infrastructure for risk as- sessment and we are trying to tar- get actionable tumours that could have benefit for earlier detection and care. ‘AI models are better than tradi- tional models for using density alone for precision screening but we are still lacking clinical guide- lines so this can go out to broader clinical use; that is a key next step to see the future potential that breast cancer screening.’ Golden opportunity Dr Ritse Mann from Radboud Uni- versity Medical Center in the Ne- therlands examined the role of AI for response prediction and diag- nosis. He said that AI using images may improve pCR (pathologic complete response) prediction over pre- diction based on clinical features alone ‘but the effect is modest’. regimens He further suggested that AI may aid in selection of less toxic thera- peutic for patients, though while acknowledging that presents a ‘golden opportunity’, he noted that very few studies have looked into it. ‘In the post-treatment setting, AI might help us to identify patients that do not need surgery and po- tentially those that do not need radiotherapy. It may also select high-risk populations with poorer prognosis for further intervention.’ However, he concluded: ‘Every- thing here is very much work in progress.’ ■ Author: Mark Nicholls Mikael Eriksson Dr Mikael Eriksson is an Assistant Professor in the Department of Medi- cal Epidemiology and Biostatistics at the Karolinska Institutet, Sweden. Driven by improving mammography screening to reduce breast cancer mortality, he specialises in develop- ing individualised risk assessment techniques for identifying women that have suboptimal benefit from screening. Dr Ritse Mann leads the clinical breast research at the radiology de- partment of the Radboudumc in The Netherlands with a focus on the evaluation and implementation of novel breast imaging techniques. He is an executive board member of the European Society of Breast Imaging (EUSOBI). Developing a breath test for lung cancer with biosensors and AI University of Texas at Dallas re- searchers have developed bio- sensor technology that when combined with artificial intelli- gence (AI) shows promise for de- tecting through breath analysis. lung cancer for biomarkers electrochemical biosensor The identifies eight volatile organic compounds (VOCs) that are poten- tial thoracic cancers, including lung and esop- hageal cancers. AI then analyzes the biochemical characteristics of the compounds to determine whether they match those linked to various thoracic cancers. “We built a screening tool that could allow physicians to catch the disease early, which improves outcomes,” said Dr. Shalini Prasad, professor and department head of bioengi- neering in the Erik Jonsson School of Engineering and Computer Science. “This technology offers a potentially affordable, quick, non- invasive breath analysis tool for cancer screening.” The project is a collaboration be- tween UT Dallas bioengineering and computer science researchers www.healthcare-in-europe.com s a l l a D t a s a x e T f o y t i s r e v i n U © A screen-printed electrochemical sensor. and a clinical research team from UT Southwestern Medical Center. The researchers described the tech- nology in the journal Sensing and Bio-Sensing Research. The device was tested on breath samples from 67 patients, includ- ing 30 with biopsy-confirmed tho- racic cancer. The device accurately identified the VOCs in 90% of the confirmed cancer cases. The inspiration for the device came about during the Covid-19 pan- demic. “There was a lot of interest at that time in noninvasive technol- ogies that could rapidly allow us to screen and isolate the spread of Covid,” said Prasad, corresponding author of the study and a Cecil H. and Ida Green Professor in Sys- tems Biology Science. “The use of breath became very attractive be- cause breath goes through our re- spiratory system and carries meta- bolites, which are indicators of disease.” Changes in metabolites in exhaled breath can occur early in disease onset. This emerging field of breathomics could allow health care providers to analyze VOCs in exhaled breath to diagnose dis- eases and monitor health con- ditions, Prasad said. AI is an im- portant component of the UT Dallas team’s device. “There is a huge amount of data provided by the breath,” Prasad said. “What is important? What is not? All this in- formation comes from the machine learning algorithm. That’s why the partnership with computer science is critical. How meaningfully you integrate AI into technology is im- portant.” Prasad approached Dr. Ovidiu Daescu, professor and department head of computer science, a Jons- son School Chair and a co-author of the study, to fine-tune the ma- chine learning models and validate the approach. “The breath profiling device and associated machine learning model have great poten- tial for making a difference in cancer detection while improving costs, assuming more cases are tested and validated over time in medical settings,” Daescu said. The researchers also partnered with Dr. Muhanned Abu-Hijleh, a professor of internal medicine in the division of pulmonary and criti- cal care medicine at UT Southwest- ern. “Lung cancer is the leading cause of cancer-related deaths in the U.S. and worldwide,” said Abu-Hijleh, an interventional pulmonologist who is also the medical director of respiratory therapy and director of the chronic obstructive pulmonary disease clinic and program. “Using minimally technologies like biomarkers and exhaled vol- atile-organic-compounds analysis can help in the early detection of thoracic malignancies with mini- mal burden on patients and the health care system, carrying less overall morbidity.” invasive Prasad said the team will continue working on the device, including seeking further clinical validation. “Eventually, this technology could be deployable in your primary care provider’s office,” she said. “So just as you go in for an annual physical and give an annual blood draw, you could do a breath test as well. Then the primary care provider could make recommendations to the patient if the indicators are elevated, such as a follow-up refer- ral.” Other UT Dallas contributors to the paper include first author Dr. An- irban Paul, bioengineering re- search scientist; Kordel France, computer science doctoral student; and Avi Bhatia, neuroscience sen- ior in the School of Behavioral and Brain Sciences. Other collaborators from UT Southwestern include clinical research assistant Ruby Thapa and Dr. Rhoda Annoh Gor- don, research programs manager in pulmonary and critical care medicine. ■ Source: University of Texas at Dallas
8 PATHOLOGY Opioid and alcohol-related disorders in healthcare Managing inpatients with substance abuse disorders The number of patients with substance abuse disorders who are admitted to hospitals as in- patients has been steadily in- creasing. (1) Hospitalists at- tending SHM Converge 2025, the annual meeting of the Society of Hospital Medicine (SHM) in Las Vegas this spring, were given practical advice on how to treat these patients. An estimated 6.1 million individ- uals in the United States have an opioid disorder, according to the 2022 National Survey on Drug Use and Health. (2) The US National In- stitute on Alcohol Abuse and Al- coholism reports that 28.9 million people aged 12 and older had alco- hol use disorder in 2023. (3) Patients admitted to a hospital emergency department with a drug or alcohol overdose are initially treated by emergency clinicians and emergency pharmacists. When any patient with substance abuse disorder becomes an inpatient, hospitalists have the responsibility of initiating medication protocols to reduce dependency. Opioid use disorder Anna-Maria South, MD, of the Divi- sion of Hospital Medicine at the University of Kentucky College of Medicine in Lexington, discussed the protocol used at her hospital and the importance of encouraging a Medications for Opioid Use Dis- order (MOUD) drug regimen to prevent opioid withdrawal. First, testing is needed. (4) The Clinical Opiate Withdrawal Scale (COWS) is an eleven-item tool administered by a clinician to rate common signs and symptoms of opioid withdrawal and monitor symptoms over time. Resultant scores help clinicians determine the stage or severity of opioid withdrawal and assess the level of physical dependence. A COWS score of 8 or greater is indicative of withdrawal symptoms. (5) is a Buprenorphine synthetic opioid, which as a partial agonist, can block withdrawal symptoms. It has low misuse potential and low toxicity. For patients experiencing opioid withdrawal with a COWS score of 8 or greater, Dr South recommends 4 mg of buprenorphine, with an ad- ditional 4 mg administered every 2–4 hours as needed for continued withdrawal symptoms, for a maxi- mum of 16 mg on Day 1. This protocol is repeated on Day 2, with a maximum dose of 16 mg per day, and on Day 3 onward with a maxi- mum dose of 24 mg per day. Opioid use disorder is usually suc- cessfully treated with a dose of 16 to 32 mg daily. A low dose (micro-dosing) regimen of buprenorphine may be ap- m u h p a t e m - e b o d a . k c o t s © propriate for patients who are cur- rently prescribed a full opioid agonist and elect not to wean or enter withdrawal, and for patients who use fentanyl regularly. The full agonist opioid is continued as pre- scribed. Buprenorphine is started at a very low dose, with the dose slowly increased daily for a week. This will very slowly displace the full opioid agonist. This regimen avoids the precipitated withdrawal caused by larger doses of bupre- norphine. Precipitated withdrawal recog- Precipitated withdrawal, nized by a sudden increase in the COWS score within 20–60 minutes after receiving buprenorphine, is a debilitating experience, marked by rapid onset of symptoms such as body aches, nausea, vomiting, diar- rhea, and abdominal cramps. Pa- tients who use opioids may be frightened, and if experiencing it, they may check out of the hospital before recommended discharge and may decline further bupre- norphine treatment. It is difficult to convince a patient who has gotten sick from buprenorphine once to take more of it. ‘Patients who have been using il- licit opioids and want to start bu- prenorphine for MOUD are good candidates for the low dose bupre- norphine protocol,’ commented Dr South. ‘To make sure the patient who does not have a prescribed opioid regimen but is taking a full agonist daily, I start by giving oxy- codone (20–25 mg every four hours) simultaneously with low doses of buprenorphine. The ob- jective is to prescribe a daily dose that will be enough to compensate for the opioid deficit by ad- ministering the full agonist to keep receptors satisfied, then slowly dis- placing them. If precipitated with- drawal starts to occur, treat the symptoms aggressively with 4 mg or 8 mg dose of buprenorphine every hour.’ If a patient needing MOUD is ad- mitted to a hospital for reasons which may not require a weeklong hospitalization, a three-day proto- col may be more appropriate. The full agonist is administered for the first two days in conjunction with buprenorphine, then discontinued on a third day with a frequent 24-hour dosing schedule of bupre- norphine. ‘Patients with an opioid use dis- order have as six times greater death risk than the general popu- lation. Those on a MOUD just have a two times greater risk. Hospital- ists play an important role in re- ducing death risk. They can test for transmittable diseases, prescribe naloxone, and provide information about resources. These include sources to obtain clean needles/ syringes, MOUD providers and free-of-charge primary care clinics,’ she said. Alcohol use disorder Patients admitted as inpatients who have with a potential alcohol use disorder may be identified using the Alcohol Use Disorders Identification Test – Consumption (AUDIT-C). (6) The Prediction of Alcohol Withdrawal Severity Scale (PAWSS) helps clinicians identify patients who may be at high risk for developing complicated alcohol withdrawal syndrome. This occurs when a patient has a score of 4 or higher. Keri Holmes-Maybank, MD, of the Medical University of South Caroli- na (MUSC) in Charleston, recom- mends that all hospitals establish treatment protocols. Over the past decade, phenobarbital has been used in hospital emergency depart- ments because it has a long half- life of 53 to 140 hours. But no stan- dardized or universal protocols have been established for inpa- tients. The American Society of Addiction Medicine (ASAM) recommends the administration of phenobarbital only for individuals experiencing severe alcohol withdrawal, who are at great risk for this, or who have a contraindication for benzodiaze- pine use. ASAM advises that it should only be used by clinicians experienced with its use, given its narrow therapeutic window and side effects. (7) Phenobarbital is associated with severe adverse reactions of the cardiovascular nervous system, events, nausea, vomiting, con- stipation, apnea, and hypotension. Hospitals should not administer it if staff is not available to closely monitor the patient. ‘The drug is a reasonable alter- native to benzodiazepine, es- pecially when your patient has challenging or refractory alcohol withdrawal or benzodiazepine- resistant alcohol withdrawal,’ said Dr Holmes-Maybank. ‘There is not enough data to say what the best protocol is. At MUSC, we ad- minister 260 mg followed by two doses of 130 mg.’ She advised that only about one percent of individuals in the US with alcohol use disorder are re- ceiving medication for alcohol use disorder (MAUD). Naltrexone is the drug of choice for treatment, or ac- amprosate if a patient has a con- traindication to naltrexone. The challenge for hospitalists is to get patients through their alcoholic withdrawals before starting a MAUD regimen. reduction, whether ‘Hospitalization is a reachable mo- ment for initiating MOUD and MAUD, and can help the patient to get connected with outpatient care. Harm for opioid drugs or alcohol, does not require total abstinence. Every quit attempt counts. It is a step toward recovery. Don’t give up’, she con- cluded. ■ Cynthia E. Keen Anna Maria South Anna Maria South, MD, is an ad- diction medicine physician and an Assistant Professor of Medicine at the University of Kentucky College of Medicine in Lexington. She is the chair for the Society of Hospital Medicine Substance Use Disorders Special Interest Group. Dr South is also the assistant director of the Health Equity and Advocacy Thread for the College of Medicine, an initi- ative to ensure that the medical school curriculum helps students to learn how to address health in- equities and to provide patient- centred care for patients from diverse backgrounds. Keri Holmes- Maybank Keri Holmes-Maybank, MD is a hospitalist and an Associate Profes- sor in the College of Medicine at the Medical University of South Carolina. She is core faculty for addiction medicine in the internal medicine residency program. Dr Homes-May- bank is involved with multiple national organizations serving as the vice chair for the Society of Hospital Medicine Substance Use Disorders Special Interest Group and Co-Direc- tor of the Academic Hospitalist Acad- emy References: 1. Suen LW, Makam AN, Snyder HR, et al. National Pevalence of Alcohol and Other Sub- stance Use Disorders Among Emergency De- partment Visits and Hospitalizations: NHAMCS 2014–2018. J Gen Intern Med. 2021. 13;37(10):2420–2428. doi:10.1007/s11606–021–07069-w. 2. U.S. Food and Drug Administration. In- formation about Medications for Opioid Use Disorder (MOULD). Internet accessed on https://www.fda.gov/drugs/information- drug-class/information-about-medications- opioid-use-disorder-moud. AND https://www. samhsa.gov/data/sites/default/files/reports/ rpt42731/2022-nsduh-nnr.pdf June 10, 2025. 3. National Institute on Alcohol Abuse and Alcoholism. Alcohol’s Effects on Health: Al- cohol Use Disorder (AUD) in the United States: Age Groups and Demographic Char- acteristics. September 2024. Internet accessed on June 10, 2025 https://www.niaaa.nih.gov/ alcohols-effects-health/alcohol-topics/alcohol- facts-and-statistics/alcohol-use-disorder-aud- united-states-age-groups-and-demographic- characteristics. 4. Holmes-Maybank K, South AM. ‘No Ad- diction Medicine Service? No Problem! Things You Need to Know to Care for Patients with Substance Abuse Disorders”. SHM Converge 2025, 23–25 April 2025.Las Vegas, NV. 5. National Institute on Drug Abuse (NIDA). Clinical Opiate Withdrawal Scale. September 2, 2015. Internet accessed on June 6, 2025 https://nida.nih.gov/sites/default/files/ ClinicalOpiateWithdrawalScale.pdf 6. Simon CB, McCabe CJ, Matson TE, et al. High test–retest reliability of the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) questionnaire completed by pri- mary care patients in routine care. Alcohol Clin Exp Res (Hoboken). 2024;48(2):302–8. 7. American Society of Addiction Medi- cine.The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management: Execu- tive Summary. 2020. p.18. EUROPEAN HOSPITAL Vol 34 Issue 4/25