Loading ePaper
V o l . 3 5 I S S U E 0 1 / 2 6 • F e b r u a r y 2 0 2 6 T H E E U R O P E A N F O R U M F O R T H O S E I N T H E B U S I N E S S O F M A K I N G H E A L T H C A R E W O R K From observation to action The rise of agentic AI in pathology including EH@ECR Computational pathology is becoming increasingly impor- tant in helping deliver precision medicine to a wider range of patients. Experts at the European Congress of Pathology in Vienna discussed how algorithms can optimise laboratory workflows, generate stronger evidence for molecular tumour boards, and enhance clinical trial design. Pathologist Marie Brevet emphasised how computational algorithms can optimise workflow and generate clinical impact by integrating data across the entire pipeline rather than focusing on a single model. She also discussed near-future perspectives involving foundation models, multi- modal approaches, and the emerg- ing role of agentic AI. Brevet, who is founder and CEO of health innovation company Biwako, said use of Natural Language Processing (NLP) in pathology can digitise request forms and generate medical reports with AI as a virtual secretary for pathologists. Saving time, reducing errors Acknowledging that challenges re- main in how to integrate such mod- els into Laboratory Management Systems (LMS), she said that large language models (LLMs) will save pathologists time and decrease transcription errors. Within the con- text of workflow, computational algorithms can support case triage, balance workload and enable real- time tracking and monitoring of laboratory processes, detecting mis- matches and flagging errors with automated quality control. 'An example in dermatopatholo- gy is with the use of algorithms that not only predict the likelihood of melanoma or carcinoma but can also prioritise the most urgent cases,' she said. Advertisement Brevet also underlined how, in practice, a laboratory can automat- ically route melanocytic lesions to its local expert, ensuring faster and more accurate decision-making. Foundation models and agentic AI In molecular pathology, algorithms can prioritise cases most likely to benefit from targeted therapies and enrich the pool of patients for DNA or RNA sequencing. Meanwhile, foundation models are reshaping the field of pathology. Trained on vast and heterogeneous datasets, they are designed as pre-trained architectures that can be rapidly fine-tuned for multiple downstream tasks. 'The benefit,' explained Brevet, 'is that they do not begin every new task from scratch, which allows scalability and robustness.' While generative AI creates content, she described how agentic AI can go a step further and 'decide, act, and interact' with other systems – moving from 'observation to action' – such as drafting a medical report autonomously without hu - man request. 'Agentic AI can have a global view of a laboratory, identify where bot- tlenecks occur, and then observe, decide and execute the necessary actions to avoid them. While that may feel both intimidating and fas- cinating, agentic AI is closer than many imagine.' Multimodal data for molecular tumour boards Professor Olivier Michielin explained how a multimodal approach can deliver better, more specific information to molecular tumour boards (MTBs) and facili- tate precision medicine. Michielin, who is Head of the Department of Oncology and the Precision Oncology Service at Geneva University Hospital, discussed an www.healthcare-in-europe.com m o c . e b o d a . k c o t s – i h c i m a d a t © approach to integrate multiple data streams into a precision oncology programme that would see patients split into well-defined populations so they are 'exquisitely sensitive' to a given therapeutic intervention. In his presentation on 'The integra- tive/multimodal tumour board for improved precision medicine,' he said: 'This could lead to massive benefits for patients. It is still a bit of a dream…but we are getting there.' With data science at the core, the challenge is how to standardise data streams from clinical data, patient-reported outcomes, multi- omics, spatial omics, digital pathol- ogy and radiomics. While it is a long process, it could see infor- mation placed before experts on the MTB for precision oncology to decide on the best treatment option for a patient. Building on that, the data would be retained to enrich decision-making processes going forward. Spatial biomarkers and longitudinal data A significant step has been the creation of the Swiss Personalised Oncology (SPO) network across major hospitals and universities using structured data or NLP to extract information from medical records in diverse systems. 'We can extract data and follow patients longitudinally, which provides time-bound information that can be analysed with process mining technology and follow, for example, how patients are distrib- uting across treatment lines. 'We believe the spatial component of multiomics will be key – spatial biomarkers are indeed predictive of benefits of immunotherapy in mela- noma, lung, as well as other cancer types sensitive to immunotherapy.' Given the importance of the spatial component, his department has cre- ated a spatial workflow applicable on digitalised or physical slides. He showed an example of his fully digitalised approach with the devel- opment of a predictive image-based digital pathology biomarker for IO therapy response in metastatic mel- anoma. Building tools for interactive tumour boards A national omics network has been built in Switzerland to recruit 300 patients, with patients' treat- ment decided based on next-gen- eration sequencing programmes, spatial-omics, digital pathology and drug screening. He illustrated examples of how the approach may help improve treatment and deliver precision medicine therapies for patients. Michielin added: 'Being able to bring information to the molecular tumour board and discussing it interactively with the doctors and data scientists is essential. We are also building tools that allow us to view and interact with the data at the tumour board. 'We are convinced that the best use of these rich data and multidimen- sional datasets will allow us to raise the bar in therapy.' By Mark Nicholls Marie Brevet Professor Marie Brevet is a pathol- ogist and the founder and CEO of Biwako, a company supporting health innovation. She was Professor and Hospital Practitioner at the University Hospital of Lyon until 2020 and now works with Technipath, Synlab. Her expertise spans the molecular biology of tumours, biobanking, digital health and artificial intelligence. She is also a board member of the French Society of Pathology. Olivier Michielin Professor Olivier Michielin is Head of the Department of Oncology and Precision Oncology Service at Geneva University Hospital, Co-Director of the Swiss Cancer Centre Léman and Professor at the Swiss Federal Institute of Technology in Lausanne (EPFL). His research focuses on translational oncology and precision medicine. CONTENTS AI EH@ECR LABORATORY 1 2 8 www.healthcare-in-europe.com
2 E H @ E C R @ ECR 2026 AI and interdisciplinary imaging take centre stage in Vienna ECR 2026 to cast “Rays of Knowledge” on the future of radiology Few medical specialties evolve as rapidly as radiology. Continuous advances in imaging technology, the integration of artificial intel- ligence, and growing interdis- ciplinary collaboration demand that professionals stay at the forefront of knowledge. The European Congress of Radiology (ECR) 2026 in Vienna embraces this reality with its motto “Rays of Knowledge”. ‘This congress will provide a learn- ing experience that cannot be matched, offering true value to attendees wishing to expand their professional expertise and create unforgettable memories in the pro- cess,’ states Congress President Prof. Minerva Becker. ‘At ECR 2026, we want to encourage all par- ticipants to share and take away their own “Rays of Knowledge”, contributing to a forum of profes- sional and scientific exchange like no other.’ The congress imagery underscores this vision. ‘Our official congress poster features Athena, the Greek Goddess of knowledge, wisdom, and learning – a powerful symbol of Europe's deep-rooted tradition in the pursuit of truth and scien- tific discovery,’ Becker explains – whose own first name, inciden- tally, is the Roman equivalent of Athena. ‘Another fitting symbol is the owl, emblematic of vision and insight, reflecting the radiologist's ability to reveal what lies hidden to the ordinary eye. Just as the owl Minerva Becker Professor Minerva Becker is Head of the Imaging Unit of Head and Neck and Maxillofacial Radiology at the University Hospitals of Geneva and currently serves as President of the European Society of Radiology (ESR). Her clinical expertise and research focus on head and neck oncology, including hybrid and multiparametric imaging. She is the author of over 200 scientific publications and co-editor of Valvassori's Head and Neck Imaging. An enthusiastic educator with over 350 invited lectures worldwide, she is also Past-President of the European Society of Head and Neck Radiology (ESHNR). sees clearly through darkness, we in radiology detect what others cannot, sharpening the focus on diagnosis and patient care.’ Fresh eyes on imaging through the lens of pathology Artificial intelligence takes centre stage in the 2026 In Focus pro- gramme, themed “The Art of AI in Clinical Practice.” Sessions will explore how AI is democratising screening, enhancing communi- cation, and reshaping oncologic follow-up – while also addressing the ethical and regulatory dimen- sions of these developments. AI will also be among the key topics of the Plenary Lectures delivered by renowned speakers, along with liver disease and stroke. is Another highlight of the scien- tific programme the new course “Decoding the Diagnosis: Radiology Meets Pathology,” which pairs imaging findings with their pathologic counterparts. ‘It will be an inspiring way to see imaging with fresh eyes and elevate every- day practice,’ Becker notes. for Striving less conventional approach, the new “How We Do It” series breaks with established lecture formats, inviting presenters and attendees alike to share real- world clinical experiences. In the same vein, the “Out of the Box” lectures build bridges from radi- ology to art, history, and music – a reminder that inspiration and fresh perspectives often emerge from unexpected sources. These sessions invite attendees to step beyond the clinical routine and explore the cultural dimensions of their profession. As is ECR tradition, the congress also takes a look at how radiolo- gy is approached across featured partner countries – France, Japan, Switzerland, and the United States. A congress for the entire imaging community Becker emphasises the ECR's inclu- sive character: ‘ECR has long stood as more than a congress for radiol- ogists alone – it is a hub of diver- sity within the imaging and health- care community.’ This is reflect- ed in the new “Subspecialties on Stage” series. These sessions aim to showcase the beauty of select- ed subspecialties, highlight current topics, and discuss their activities advancing radiology and radiology education. The congress' interdisci- V I E N N A / 0 4 - 0 8 M A R C H plinary character is further under- lined by its long-standing partner- ship with the European Federation of Radiographer Societies (EFRS), making the congress a meeting point for the entire imaging community. The global appeal of the event is already evident: with over 9,700 abstracts submitted from 105 coun- tries, the congress has set a new record. ‘The exceptional number of abstracts submitted for ECR 2026 reflects the remarkable vitality and global engagement of the radiolo- gy community,’ Becker notes. ‘I want to extend my deep appre- ciation to everyone whose ener- gy and commitment have shaped this congress. Countless individ- uals have poured their passion into every detail’, the Congress President concludes. ‘Their dedica- tion has made ECR 2026 possible, and for that, I am sincerely grate- R S E © ful. I look forward to welcoming you all to Vienna, where we will unite radiologists, researchers and industry partners in our shared pursuit of excellence and grow under the bright light of “Rays of Knowledge”.’ EUROPEAN HOSPITAL Vol 35 Issue 01/26
E H @ E C R 3 Radiology workflow at RSNA 2025 Time-saving tactics for overburdened radiologists (without AI) Radiologists worldwide are fac- ing mounting workloads, with exam volumes rising and work- force numbers struggling to keep pace. At the RSNA 2025 annual meeting in Chicago, a dedicated session explored how departments can improve efficiency using tried-and-tested methods – without waiting for artificial intelligence to arrive. Within this decade, AI is expect- ed to become a landmark tech- nology for radiology departments, having an impact on the way radi- ologists work comparable to the introduction of CT, MRI, and PET scanners or PACS. Its widespread deployment in future years will aid the fewer per-capita radiologists who will be interpreting a larger volume of exams than today – a higher percentage of which will be of advanced imaging complexity. Radiologists today feel overbur- dened. What can be done now? The RSNA session, entitled 'Improving radiologist efficiency: what can you do while waiting for AI?', tackled this issue. It was a throwback ses- sion reminiscent of the 1990s, when Advertisement radiology departments were trying to manage conversion from a film- based department to the first clun- ky and cumbersome generations of PACS. Radiologists faced greater inefficiencies while trying to adapt to a new efficiency-promoting tech- nology. The recommendations in this session are as applicable as they were in the 1990s. It is just that two generations of radiologists may not think about them. Identifying what wastes radiologists’ time Inefficient department workflow is often a culprit, and classic rules to identify workflow inefficiency for any profession apply. From a qual- ity control standpoint, so also are: • Activities that do not add value • Activities that add value but are not efficiency-optimised • Tasks that could be automated • Tasks that could be performed by a non-radiologist James V. Rawson, MD, Vice Chair of Operations and Special Projects in Radiology at Beth Israel Deaconess Medical Center (BIDMC) in Boston, advises that his hospital's patient transfer policies had to be changed. Patients would not be admitted without the transferring hospital's CT images. With only a report, BIDMC had to repeat the exam, wasting both department scanning resources and radiologists' time. Internally, when dictating either a low-value exam report or an addendum, it is important to ask why. Much has been pub- lished about reducing the orders of low-value exams, using clini- cal decision support software or directly communicating with the ordering physician. With respect to report addendums – what is causing the need to prepare this? Is it the arrival of comparisons after report dictation? If so, what can be done to prevent the situation from happening again? Regularly evaluate data that can be automated, Dr Rawson advises. Auto-population of data and meas- urements is routine. Can other data measurements be added? Standardise as much as possible. He said that published studies have shown that standardised dic- tation macros of incidental find- ings management, for example, will be read more by ordering phy- sicians. Departments should rou- tinely determine if radiologists are performing tasks that others in the department could do. If so, opti- mise qualified staff to do these jobs. Finally, Dr Rawson asked: 'How much time do you spend with new radiologists? Do you throw them into the reading room with an unfamiliar PACS? Or do you train them, and if so, how thor- oughly?' An investment of one to three hours of familiarisation with a diagnostic workstation's software can pay huge dividends in an individual radiologist's workflow efficiency. constant review to maintain best practice protocols that standard- ise radiology services throughout the state. Marta E. Heilbrun, MD, Medical Director of Imaging Services, Quality and Patient Safety at Intermountain Healthcare, dis- cussed how this uniformity hap- pens for the hospitals and 143 clinics with 30,500 caregivers. 'We engage radiologist system leaders and their cross-group networks of section leaders to identify and maintain best practice protocols,' she said. 'We look to simplify processes, because that is how we gain efficiency.' Standardization across a multi-hospital network Developing best practice proto- cols for eight separate radiology practices serving 22 geographi- cally dispersed hospitals with 18 to 510 beds is the way that the Canyons Region of Intermountain Healthcare, a health system ser- vicing the entire state of Utah, efficiently operates. This is man- aged with a lot of education, communication, feedback, and Rollout of new and updated proto- cols is done with attention to detail, and incorporates a mechanism for direct feedback from radiologists, managers, and technologists. 'We provide the entire network with sup- portive resources and a formal pro- cess to accomplish the work. We set and promote expectations by work- ing with frontline technologists.' All locales have the same scanners and utilise the same protocols. Documentation is standardised. NEWTOM 7G NEXT GENERATION CONEBEAM CT www.newtom.it As of today NEWTOM 7G incorporates the Dual Energy (DE) system, elevating performance to new heights and revolutionising the way your practice operates. Dual Energy: patented NEWTOM technology The result of a continuous quest for patient well- being and ever-greater diagnostic precision, Dual Energy uses two different radiant energies to identify any pathologies with greater clarity and precision. Virtual Monochromatic Images Dual Energy technology mitigates beam- hardening artifacts. What’s more, being able to reconstruct monochromatic virtual images at different keVs improves soft tissue imaging quality and reduces metal artifacts. Lastly, Dual Energy CBCT provides a basis for tissue characterisation. Colour-coded images NEWTOM Dual Energy software enables users to perform semi-automatic tissue segmentation and apply colour codes, streamlining the differentiation of materials within the scanned area. This allows rapid and straightforward detection of potential pathologies. Blended image The new features enable weighted blending of high- and low-energy imaging. The resulting images combine the low noise, typical of high-energy acquisition, with the high contrast resolution of the low-energy image set. Featuring a large gantry aperture, the NEWTOM 7G is the most advanced CBCT device on the market. From in-depth detail to the big picture. AND THERE’S MORE TO COME! Stay tuned for groundbreaking updates on the technology at ECR 2026 | HALL X3 Stand 311
4 E H @ E C R Macros have been developed for every possible exam combination, to enable radiologists to incor- porate standard recommendations into their reports. Workloads are consolidated several times in a 24-hour day, so that expertise is always available. Flexible sched- uling is promoted for equitable work/life balance. Feedback and recommendations for improvement also have a schedule, with input from all involved carefully evaluat- ed. Changes are made for the good of the entire network. The workstation mouse: a help or a hindrance? Mouse efficiency matters. In a sin- gle shift, a mouse travels 1.37 miles with 10,778 total input actions, Shawn Lyo, MD, a neuroradiologist at the University of Pennsylvania in Philadelphia, told RSNA attendees. ‘Choosing the right mouse and developing healthy usage habits can significantly enhance produc- tivity and reduce strain. Eighty- seven percent of radiologists report musculoskeletal discomfort in a weekly basis,’ he said. How to choose the right mouse? The decision is personal. Noting that shape impacts grip comfort, different shapes may work best for different sized hands. Weight is important, because lighter mice can improve speed. A heavier mouse can dampen unintended motions. Scrolling speed? Programmable buttons? ‘A mouse is a central com- ponent of a diagnostic workstation. How you optimize depends on your personal ergonomics, task demands, and computing environ- ment. Optimising your mouse isn’t a luxury. It’s a practical investment in comfort, speed, and longevity,’ said Dr. Lyo. Reducing radiologist’s interruptions Radiologists get interrupted. Daily interruptions may number in the hundreds in busy reading rooms of academic hospitals, caused by clinicians visiting the reading room to ask questions, by telephone calls, and by pagers, text mes- saging and urgent emails. ‘At one point, we recorded interruptions every three minutes,’ said Prof. Alexander J. Towbin, MD, a pae- diatric radiologist and Associate Chief Medical Information Officer at Cincinnati Children’s Hospital in Ohio. Cincinnati Children’s radiology department was one of the first in the United States to create reading room assistant (RRA) positions. RRAs answer phone calls, answer general questions, communicate m o c . e b o d a - k c o t s – D t a w u n a P o J © critical results, and engage with reading room visitors and ‘direct traffic’. Radiologists enrol their profession- al private telephone numbers in a federal government registry to prevent scam and nuisance calls. Access to these telephone num- bers by hospital staff is severely restricted, forcing callers to direct inquiries to RRA. Phone ‘trees” are redesigned and improved for call- ers as needed, so that they expedi- tiously direct a caller to the person they ultimately needed to talk to. ‘We also evaluated workflow. RRA desks were relocated to the entrance of each reading room. With visitors having immediate access to RRAs when they enter a reading room, reading rooms have become quieter and less disruptive from a visual perspec- tive’. Stefanie Woodard, DO, a breast imager at the Heersink School of Medicine at the University of Alabama in Birmingham augment- ed Prof. Towbin’s remarks by dis- cussing the essentials of optimal reading room design. By Cynthia E. Keen Breast screening blind spot: Why transgender patients are falling through the cracks Transgender patients are large- ly invisible in breast cancer screening statistics – and many never receive an invitation to participate in screening pro- grammes. Guidelines exist, but awareness among referring phy- sicians remains low. Experts say radiology departments are best positioned to lead the change by creating inclusive environ- ments and actively reaching out to this underserved population. At the 2025 SBI Breast Imaging Symposium held in Colorado Springs, an expert outlined how imaging facilities can make a difference. Do transgender individuals need regular breast cancer screening? Yes, some do. How many trans- gender women and men have had a breast cancer screening examina- tion in the European Union? In the United Kingdom? In North America? What percent- age of transgender patients need annual screening, based on well-es- tablished guidelines? The answers are simple. Nobody knows. Even in countries with near ubiquitous electronic health records (EHR) at hospitals and clinics, statistics don’t exist. ‘This population is so under- served it is invisible,’ Prof. Avice O’Connell, MD, of the University of Rochester, US, and a radiologist affiliated with Strong Memorial Hospital and Highland Hospital, told attendees at the 2025 SBI Breast Imaging Symposium held in Colorado Springs, Colorado. The referral gap Transfeminine patients living in countries which have nation- al breast cancer screening pro- grammes may not receive invita- tions to participate because they are registered by their sex assigned at birth. Transmasculine individu- als who have genetic breast can- cer risk factors and/or cisgender female breast tissue, but who are correctly identified as transgender males in EHR data, may be also excluded from invitations to par- ticipate in a national breast cancer screening programme. It’s a somewhat similar situation in the United States, where physi- cians make the referrals for breast imaging exams. But based on anecdotal observation of the small numbers of transgender patients getting screened, it is question- able if the referring physicians do so. Data collection of mammograms performed on patients who identify themselves as transgender is not centralized and may not even be collected at imaging facilities where exams are being performed. In a world awash with data, information about breast cancer screening for and breast cancer developed by transgender patients is a series of not-even-guessable unknowns. Dr. O’Connell suggested that hos- pital radiology departments and freestanding imaging centres are best positioned to change this. But first they must change to attract transgender patients who may be turned off by entering a “women’s imaging centre” or by encountering clinical and support staff who do not know inclusionary language or comfortable interaction strategy. ‘If you use the wrong terminology, you will lose trust,’ she cautioned. ‘If patients feel comfortable, they will tell their friends who will start to come.’ Creating an inclusive environment Intake forms need to be gender neutral. Demographic data to be collected needs to include gender identity preference (male, female, or non-binary), as well as the sex assigned at birth. Patients should select the pronoun they relate to, and this preference should be used by radiology department staff. It is essential that imaging facilities project a welcoming, neutral envi- ronment rather than a convention- al feminine decor. This includes registration/check-in, colour of hospital gowns, changing areas, and screening and diagnostic wait- ing rooms. Signage in these areas needs to convey gender neutrality or inclusiveness. At least one clear- ly identified gender-neutral public restroom needs to be available. Patients who are transgender should be advised of breast cancer screening guidelines, regardless of the type of imaging exam they are having. Guidelines exist – but awareness is low Breast health and imaging experts from the American College of Radiology published ACR Appropriateness Criteria® (ACR) for Transgender Breast Cancer Screening in 2021.1 Guidelines with similar recommendations have also been published by a number of health organizations, including the World Professional Association of Transgender Health (WPATH),2 the University of California San Francisco (UCSF) Center of Excellence for Transgender Health, the Endocrine Society, and the American College of Obstetricians and Gynecologists. This is important because a recent study conducted by the Mayo Clinic in Rochester, Minnesota, of its primary care and internal med- icine physicians working at all Mayo Clinic locations, and those at the University of Michigan in Ann Arbor and the University of Texas - Medical Branch in Galveston, revealed that only 35% of the respondents were aware that breast cancer screening recommendations for transgender patients existed.3 Compounding this lack of aware- ness is concern by physicians about the accuracy and applicabili- ty of these guidelines because they reflect the best guess advice by experts, based on clinical analysis and studies of the data of cisgen- der women. Anna D’Angelo, MD, a consult- ant radiologist at the Foundation Polyclinic University A. Gemelli in Rome, Italy, and a member of the European Society of Breast Imaging (EUSOBI) Young Club Committee, told AuntMinnie Europe in an interview, that the EUSOBI is plan- ning to launch a survey among its members to collect data about the Avice M. O’Connell, MD Avice M. O’Connell, MD, is pro- fessor of Imaging Sciences at the University of Rochester, New York, US. She is a breast screening expert with UR Medicine Breast Imaging. She received her medical degree from Trinity College, Dublin, Ireland. With over 30 years of experience in breast imaging, she is actively involved in teaching and research, with a particu- lar focus on newer imaging modalities such as Cone-Beam Breast CT. transgender population to identify areas that need improvement.4. By Cynthia E. Keen References: 1. Expert Panel on Breast Imaging; Brown A, Lourenco AP, Niell BL, et al. “ACR Appropriateness Criteria® Transgender Breast Cancer Screening. J Am Coll Radiol. 2021;18(11S):S502-S515. 2. Coleman E, Radix AE, Bouman WP, et al. “Standards of Care for the health of transgender and gender diverse people, Version 8.” Int J Transgend Health; 2022;23(Suppl1):S1-S259. 3. Carroll EF, Woodard GA, St. Amand CM, et al. “Breast Cancer Screening Recommendations for Transgender and Gender Diverse Patients: A Knowledge and Familarity Assessment of Primary Care Practitioners.” J Community Health. 2023;48(5):889-897. 4. Rylands-Monk F. “Transgender breast emerges as a priority for radiology.” AuntMinnie Europe. October 20, 2025. EUROPEAN HOSPITAL Vol 35 Issue 01/26
E H @ E C R 5 JFR 2025: New developments in brain imaging for psychiatry Exploring new frontiers of the mind Psychiatrists and neuroimaging experts gathered to explore one of the last remaining frontiers in radiology – the human mind – at the annual meeting of the French Society of Radiology ( JFR) in Paris. The experts’ message was bold and humble: psychiatry is enter- ing a new era, powered by arti- ficial intelligence (AI) and brain imaging. But amid these changes, one truth remains constant – the patient must stay at the centre. From invisible suffering to visible patterns For decades, psychiatry has relied on words. Diagnosis has been rooted in interviews, intuition, and empathy – an encounter between two minds, one seeking to name what the other feels. But as Edouard Duchesnay, researcher at Neurospin in Saclay, explained, mental illness also leaves subtle, measurable marks in the brain’s structure. ‘A patient’s state of mind originates in the brain,’ he said. ‘So we can image it, and perhaps one day, predict its evolution.’ His team develops algorithms capable of identifying differences Advertisement of just two or three percent in brain tissue or white matter path- ways. These imperceptible irreg- ularities, when analyzed across large cohorts, can reveal patterns of vulnerability or resilience. The goal is not to replace psy- chiatry’s human gaze with cold mathematics, but to give it new tools: to understand who might be at risk, who might recover, and why. ‘Nothing predicts the future,’ Duchesnay said, ‘but data can help us see trajectories that words alone can’t describe.’ These models – built on thousands of MRI scans – can already antic- ipate the onset of psychosis or predict how a bipolar patient will respond to lithium years in ad- vance. It’s not magic, Duchesnay insists, but mathematics in the ser- vice of care. The promise and the paradox of prediction The ambition is clear: to move from reactive to predictive psychiatry – a discipline capable of detecting vul- nerability before crisis. ‘Imagine,’ Duchesnay said, ‘a fourteen-year- old who struggles silently. If brain imaging could show whether that adolescent’s neural development follows a trajectory toward resil- ience or psychosis, clinicians could act earlier, adapt care, and perhaps prevent suffering before it surfaces.’ Yet caution prevails. For him, AI in psychiatry is not clairvoy- ance – it’s pattern recognition, grounded in biology but guided by humility. Each dataset, no matter how vast, is only a reflection – a statistical echo of human com- plexity. That’s why, even in the heart of the algorithm, the art of interpretation remains indispen- sable. Psychiatry in transition: a new language of the brain While Duchesnay’s work repre- sents the technical frontier, the next challenge lies in translation – turning data into understanding, and understanding into care. That was the focus of a roundtable gath- ering four leading psychiatrists: Arnaud Cachia, Tomas Mastellari, Marion Plaze, and David Attali. Together, they explored how brain imaging can illuminate psychiatry without overshadowing it. For Marion Plaze, a psychiatrist at Sainte-Anne Hospital in Paris, imaging is reshaping how med- icine defines disorders such as depression or schizophrenia. These are no longer fixed categories, THE EYES TO YOUR RADIATION THERAPY SYSTEM Engineered for precision, reliability, and seamless integration Image-guided radiation therapy (IGRT) relies on precise imaging, both to create personalized treatment plans and to confi rm their accuracy. Dunlee has vast experience in manufacturing kV imaging components for radiation therapy and offers product bundles to enable precision when image quality and uptime matter most. The product bundle includes: X-ray tube: enabling the high-resolution imaging required for excellent soft tissue visibility and supporting excellent treatment for a wide variety of patients Flat Panel Detector & customized anti-scatter grids: Designed for large fi eld-of-view applications, high frame speed, and enhanced soft tissue visibility For long lifetime and great reliability, the Flat Panel Detector uses α-Si technology which is proven in MV environments and radiation-resistant compared to other technologies. Experience Dunlee‘s IGRT solutions at ECR 2026 - Hall X2, Booth #204 www.healthcare-in-europe.com but dynamic states within a spec- trum of neural and emotional activity. AI, she suggested, could refine these spectrums – allowing treatment to match each individu- al’s biology and rhythm. that David Attali, head of the psychiatry clinic at Paris University Hospital Group Psychiatry & Neuroscience, insisted technology’s real power lies in connecting data with dialogue. ‘Images give us an entry point, but they don’t replace the story the patient tells. The goal is to align both – what the scan reveals, and what the person lives.’ the temptation Between data and empathy Cachia, a professor of cognitive neu- roscience at Paris Cité University, warned of to turn psychiatry into a science of patterns rather than of people. ‘If we see only the image and not the individual,’ he said, ‘we risk losing what psychiatry was built upon – the encounter.’ The psychiatrists spoke of their patients not as data points, but as complex stories in motion. This blend of precision and compassion marked the tone of the entire ses- sion: an invitation to use AI not as a substitute for intuition, but as a mirror that sharpens it. The mind, illuminated In the end, both the researchers’ algorithms and the psychiatrists’ reflections converged toward a shared horizon – that of an inte- grated psychiatry, where technol- ogy supports empathy and science deepens understanding. AI, when used wisely, becomes not a machine of prediction, but an instrument of attention The brain, once a black box, is slowly opening to science. What it reveals is not only the anat- omy of disease, but the resilience of those who live within it, they concluded. By Mélisande Rouger Edouard Duchesnay is Affiliate Professor of machine learning at Université Evry Paris-Saclay in France. He is the leader of the “Signatures of brain disorders” team at NeuroSpin (CEA, Université Paris-Saclay), where he supervises the design of machine learning and statistical models to uncover neural signatures predictive of clinical trajectories in psychiatric disorders. scan and learn more at dunlee.com
6 E H @ E C R Support for clinicians beyond initial diagnosis Enhancing breast imaging with AI Artificial intelligence has a critical role to play in supporting clinicians beyond the initial breast cancer diagnosis. At the European Society of Breast Imaging (EUSOBI) annu- al scientific meeting in Aberdeen, Scotland, Professor Gerald Lip outlined how AI can enhance the performance of modalities such as ultrasound and MRI in supporting clinicians as they plan and deliver treatment for patients In his presentation, Professor Lip pointed to how AI can support lesion detection, characterisation and classification in ultrasound examinations. 'It also has a use in terms of reader education and improvement of specificity, but what is important in all AI imple- mentations is the easy integration into workflow to support efficien- cy and adoption,' said the Clinical Director of the North East of Scotland Breast Screening Service. He told delegates that AI research models with ultrasound are look- ing at tumour type prediction, pre- diction of neoadjuvant response, and prediction of the presence of axillary nodal metastases. Reducing over-investigation in young women An additional area of work in the UK is assessing whether AI can help avoid biopsy in ultrasound benign lesions in women under 35. 'We are actively looking at that in terms of where we can raise the age of not doing a biopsy for women with benign lesions because that is over-investigation and over-treat- ment, and this increases anxie- ty in a young female population,' Professor Lip explained. In the realm of contrast-enhanced mammography (CEM), he said more data is needed but there is potential to use AI, particularly with synthetic contrast agents. It is with MRI that Professor Lip believes there are important oppor- tunities with the integration of AI – such as with prediction of tumour response, risk assessment, breast cancer characterisation and seg- mentation tools based on radiom- ics. 'AI might be able to increase workflow and allow you to work more on complex and more inter- esting cases,' he told delegates. 'Again, they may also facilitate use of less contrast or even synthetic contrast agents.' He noted that his colleagues at the University of Aberdeen are con- ducting research on Field Cycling MRI imaging – a new type of MRI developed in Aberdeen using low-fields of MRI to better charac- terise breast cancer. 'We are see- ing good results with characterisa- tion of DCIS (ductal carcinoma in situ) and of use AI algorithms in post-processing,' he said. Pathology as the next growth area While breast pathology may be some years behind radiology, Professor Lip suggested it could be the next big growth area for investors in tech. 'It definitely has areas that will help a lot more because that is where pharmaceu- tical and oncology companies are looking at classification tools so that we can segment tumours, do mitotic counting, and prediction for response. AI has clear benefits for breast pathology,' he noted, adding that Whole Slide Imaging (WSI) currently takes up signif- icantly more data than standard radiology images. Workflow tools and future considerations Other aspects of AI that can sup- port breast radiologists include voice technology, dictation tools, auto scribing and chatbots – all of which can help with workflow and time saving. Key considerations, he said, include post market surveil- lance, strategies for dealing with new hardware and software, pro- curement, data bias and diversity, and ethical concerns. However, working with humans remains important in a world of GenAI and LLMs and the evolution Professor Gerald Lip is Clinical Director of the North East of Scotland Breast Screening Service and the Principal Investigator of the GEMINI prospective evaluation of mammog- raphy artificial intelligence. He is the current President of the British Society of Breast Radiology, and is the newly appointed Head of AI in Medicine at the University of Aberdeen Medical School, in line with his work in inte- grating artificial into healthcare. intelligence of foundational AI and multi-mode models. 'By linking pathology, MRI and radiology together and putting in AI adaptors and tools, we are going to start talking about predic- tion and personalisation of treat- ments,' Professor Lip continued. 'If we can enhance our technology with AI and not work in silos, we can work together to build a more patient centred and sophisticated future.' By Mark Nicholls Advertorial 94.7% of radiology professionals report musculoskeletal complaints – why patient transfer matters on the back and shoulders, avoids twisted postures and lowers peak physical loads. Fully MRI- compatible, it supports consistent transfer workflows across imaging modalities. www.febromed.de | vertrieb@febromed.de Source: Fernandes K et al. Radiographers’ musculoskeletal health in Western Switzerland. Work. 2023;74(4): 1527–1537. Radiology professionals face high physical demands in their daily work. A study conducted in Western Switzerland with 359 participants shows the extent of this burden: 94.7 % reported musculoskeletal complaints within the previous 12 months, and 67.7 % within the last seven days. In addition, 15.6 % had already been absent from work due to these conditions. The neck and lower back were most frequently affected (Fernandes et al., 2023). One of the most physically demand- ing tasks in daily routine is patient transfer onto positioning tables in CT, MRI and X-Ray. Unfavorable lifting and pulling movements, time pressure and repetitive man- ual handling can quickly lead to overload and injury. Improving ergonomics at this critical point is therefore essential. febromed addresses The get up® patient transfer aid from this challenge by supporting patients during standing up, repositioning and transfer. The swiveling handle allows patients to actively partic- ipate in the movement, reducing physical strain on radiology staff while improving safety and sta- bility. The get up® can be used as a hand- hold, standing aid and transfer aid in one system. It is available in ceiling-mounted, floor-mounted and wall-mounted versions, allow- ing integration into different room concepts. Defined swivel limits and locking mechanisms help prevent collisions with CT, MRI or X-Ray machines. By enabling stable, guided move- ment, the system reduces strain d e m o r b e f © 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: Wolfgang Behrends (WB) Phone: +49 (0) 9221 949-505 E-Mail: redaktion@european-hospital.com Germany: Cornelia Wels-Maug (CWM) Dr Christina Czeschik (CC) Great Britain: Mark Nicholls (MN) Spain: Mélisande Rouger (MR) USA: Cynthia E. Keen (CEK) Subscriptions Simone Sesselmann kundenservice@mgo-fachverlage.de Subscription rate 4 issues: 32 Euro, Single copy: 8 Euro. Publication frequency: quarterly 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 Founded by Heinz-Jürgen Witzke ISSN 0942-9085 Correspondents Austria: Michael Krassnitzer (MK) d e m o r b e f © Representatives Germany, Austria, Switzerland: Diana Thümmel Phone: +49 9221 949-407 E-Mail: d.thuemmel@mgo-fachverlage.de 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 35 Issue 01/26
E H @ E C R 7 From ablation to neuromodulation The new era of functional radiosurgery tial to increase response rate and minimize side effects,’ said Prof. Dr. Bredel. Connectomics explores how neurons in the brain are connected and interact with each other to produce behaviour and cognition. It provides an under- standing as to how individual neu- rons are connected to one another to form functional networks. ‘Functional MRI maps these chem- ical and electrical signal connec- tions. This, plus the use of Big Data, is enabling us to understand brain wiring differences in disease. With this knowledge, we can aim for highly personalised treatments, better diagnosis, and prediction of therapeutic response by identify- ing the exact fiber tracts to stim- ulate or modulate,’ observed Prof. Dr. Bredel. ‘We do frameless functional radio- surgery on a linear accelerator equipped with a multileaf collima- tor, an open thermoplastic mask for immobilization, and surface-im- aging for intra-fraction motion monitoring. The procedure takes 25 to 28 minutes. The majority of patients have a positive response in four to six months,’ he said. Exploring new frontiers of functional SRS Evan Thomas, MD, is founder and Chief Medical Officer of the nonprofit Renaissance Institute of Precision Oncology & Radiosurgery in Winter Park, Florida, began his presentation about cutting-edge functional brain radiosurgery treat- ments with an announcement: ‘There is a paradigm shift in the field of functional SRS. We are mov- ing from the history of simple ana- tomical target ablation to a future of sophisticated circuit-based neu- Advertisement romodulation. Dose evolution is being driven by major advances in connectomics and functional neu- roimaging.’ ‘These procedures are the most complex and ethically demand- ing, reserved for patients suffering from life-altering conditions that have been unresponsive to other types of treatments. Every case is rigorously vetted by a multidis- ciplinary panel of psychiatrists, interventional psychiatrists, neu- rosurgeons, neurologists, and a radiation medicine team,’ he said. ‘Our goal is not just to destroy tissue or lesions but to intelligent- ly and precisely modulate spe- cific dysfunctional networks,’ Dr. Thomas added. ‘The fundamental difference between the past and present is what lies in the science.’ There is a long history of func- tional brain radiosurgery treatment for extreme obsessive-compulsive disorder (OCD). The response rate is 50% to 65%, and up to 20% of patients have a complete remission. However, because benefits are not felt until six to 12 months following treatment, it is imperative to man- age patients’ expectations. The treatment of cancer pain can have remarkable and rapid results with terminally ill patients who have little time left, many of whom have widespread hormone-sensi- tive metastatic disease. Dr. Thomas advised that 60% to 75% of patients report significant pain relief within a week or less. ‘If a single treat- ment strategy is ineffective, we perform triple-target neuromodula- tion, a comprehensive multi-modal attack on intractable pain at three distinct neuroanatomical level. It is a very interesting approach with profound results,’ he said. Treatment for major depressive disorder is investigational, with reported response rate at 40% to 55%. Depression is very hetero- geneous. Dr. Thomas stated that the critical next step is to conduct larger clinical trials and identi- fy biomarkers. The challenge, he explained, is that optimal target and predictive biomarkers remain undefined. Advanced imaging with a 7 Tesla MRI scanner can show the abnor- mal internal structure of focal cor- tical dysplasia not visible on imag- es from lower strength scanners, a boon for patients with refractory epilepsy. The primary advantage of functional brain radiosurgery is preservation of neurocognition and treatment of lesions that are in difficult to surgically access loca- tions. Benefits are not experienced for six to twelve months, and toxic- ity is a risk. Ethical challenges and careful patient selection must be addressed. Still – ‘As we continue to merge the power of this minimally inva- sive approach with revolutionary insights from modern neurosci- ence, we're on the cusp of design- ing many entirely new therapies for conditions once considered untreatable,’ he concluded. Special report: Cynthia E. Keen References: 1. Goulet M, Masucci GL, Taussky D, et al. History and Development of Clinical Use of Functional Stereotaxy for Radiation Oncologists: From Its Origins to Its Current State. Curr. Oncol. 2025; 32(12): 656. 2. Song P, Zhang Y, Zha M, et al. The global prevalence of essential tremor, with emphasis on age and sex: a meta-analysis. J Glob Health. 2021;11:04028. Markus Bredel, MD, PhD Markus Bredel, MD, PhD, is Chairman and Sylvester Professor of Radiation Oncology of the Depart- ment of Radiation Oncology at the University of Miami’s Miller School of Medicine. He served as the Billy Grey Chair of Research of the National Brain Tumor Society (NBTS), chaired the Central Nervous System Tumors Program Subcommittee of the American Society of Clinical Oncology (ASCO), and was a member of the edi- torial board of The Lancet Oncology. Prof. Dr. Bredel focuses clinically and scientifically on CNS tumours and has a particular interest in advanced radiosurgery for brain metastases and movement disorders. is Evan Thomas, MD, founder and Chief Medical Officer of the Renaissance Institute of Precision Oncology & Radiosurgery in Winter Park, Florida, US. He serves on ASTRO’s Government Affairs Committee and chairs the Central Nervous System sub- committee for Benign Radiotherapy. Dr. Thomas has been a pioneer in the implementation of frameless, coneless linear accelerator-based radiosurgical treatment. He specializes in treating brain tumours, movement disorders, and cardiac arrhythmias using cut- ting-edge radiosurgical techniques. Functional brain radiosurgery is an application of stereotactic radiosurgery (SRS), represent- ing its newest clinical field. It is a precise, non-invasive medical technique using focused ionis- ing radiation to precisely target specific brain structures to mod- ulate brain function for neu- rological disorders, psychiatric conditions, or intractable pain. The technology offers “precision without incision”, the title of a Presidential Symposium on the topic at ASTRO 2025, the annual meeting of the American Society for Radiation Oncology held recently in San Francisco. Functional neurosurgery, a surgi- cal approach that involves precise targeting of anatomical structures to modify central nervous system circuits to effect changes with- in or outside the nervous sys- tem, provided the foundation for the evolution of functional brain radiosurgery. Swedish neurosur- geon Lars Leksell performed the first functional brain radiosurgery in 1967 using the Gamma Knife he designed. Fast forward to 2025....Functional brain radiosurgery is used today for trigeminal neuralgia, spheno- palatine neuralgia, chronic clus- ter headaches, essential tremor, Parkinson tremor, dystonia, can- cer pain, thalamic pain, obsessive compulsive disorder, and several types of epilepsy.1 Session pre- senter Markus Bredel, MD, PhD, Chairman and Sylvester Professor of Radiation Oncology of the Department of Radiation Oncology at the University of Miami’s Miller School of Medicine in Florida dis- cussed its use to treat movement disorders. Classical movement disorders and connectomics There are more than 20 types of involuntary tremor, with essential tremor being the most prevalent, at an estimated 25 million cases, followed by tremor-dominated Parkinson disease. Tremor affects 1.3% of the worldwide population, mostly in the upper extremities. It is associated with aging: it starts to afflict 5% to 6% of individuals with- in the age range of 50 to 65 years. Once tremor occurs, it progresses over time.2 ‘Tremor can be severely disabling and socially stigmatising. It is not a benign disease. When patients spill food and drink, they are often perceived as drunk. They may not be able to work or to perform daily life tasks,’ comment- ed Prof. Dr. Bredel. ‘Patients are candidates for refractory tremor treatment when conventional treat- ments don’t work. Approximately 75% in my practice do not want invasive surgery.’ The success rate of functional radiosurgery has been about 75% to 80%, due to individual variation. Stereotactic coordinates are based on average measurements in the human brain, and do not account for patient-specific white matter connectivity and functional location. ‘The new field of advanced con- nectomic targeting has the poten- www.healthcare-in-europe.com
8 Hospital hygiene L A B O R AT O RY Breaking chains of infection to combat antimicrobial resistance With antimicrobial resistance causing over 5 million deaths annually, rapid outbreak detec- tion is critical. A German lab demonstrates how FTIR spec- troscopy can transform hospital infection control. Efficient detection of infectious disease outbreaks within hospi- tal settings is a challenge that is becoming increasingly urgent given the growing number of anti- biotic-resistant bacteria. A recent study found that between 2010 and 2020 around 136 million cases of healthcare-associated antibiotic-re- sistant infections occurred globally each year1 and, in 2019 alone, the World Health Organization (WHO) reported over 5 million deaths associated with antimicrobial resistance.2 Rapid outbreak detec- tion is essential to break chains of infection early, reduce use of anti- biotics and prevent further spread of resistant bacteria. Surveillance frameworks should be built around proactive systems that can identify infections quickly and accurately to help contain outbreaks and ulti- mately protect vulnerable patients. Outbreak detection in Germany Despite an advanced national infection prevention and control (IPC) program reinforced by fed- eral law, annual healthcare-asso- ciated infection cases in Germany number between 400,000 and 600,000.3 In 2008, the German Federal Government set up the German Antimicrobial Resistance Strategy (Deutsche Antibiotika- Resistenzstrategie, or DART) with the aim of reducing further devel- opment and spread of antibiotic resistance. The strategy has since undergone various revisions and its latest iteration, DART 2030, was published in 2023. DART highlights infectious disease outbreak detection and contain- ment as an essential tool to combat the rise of antibiotic resistance. It calls for hospitals nationwide to adopt reliable surveillance sys- tems which can promptly diag- nose infections with a high level of accuracy, allowing targeted hygiene measures to be initiated as quickly as possible to help limit bacterial spread. FTIR spectroscopy for outbreak analysis Existing systems and workflows can be too slow and fragmented to provide the timely and action- able results required to detect and contain potential outbreaks. Many hospitals rely on traditional meth- ods, such as genomic sequencing, which lack the necessary speed. There is, therefore, a clear need for a more efficient method to confirm microbial outbreaks quickly in line with DART requirements. Fourier-transform infrared (FTIR) spectroscopy offers a new approach for efficient microbial outbreak analysis. It can be used to compare isolates and classify microorganism strains with high specificity. Results can then be vis- ualized in the form of cluster anal- yses (dendrograms) or 3D scatter plots, allowing scientists to identify relationships between isolates and outbreaks. In the case of a suspected out- break, the methods used by most hospitals typically require several days, by which point bacterial spread may already have occurred. FTIR spectroscopy can shorten this timeline considerably. By mapping the unique fingerprint of micro- organisms, FTIR spectroscopy can provide results within hours rather than days, enabling clinicians to implement effective treatment and containment strategies much more rapidly. Cluster analysis of resistant pathogens gram-nega- Multidrug-resistant tive pathogens, a leading cause of healthcare-associated infec- tions,4 can be particularly difficult to detect. Klebsiella pneumoniae (K. pneumoniae) is a gram-neg- ative bacterium that can cause lung inflammation in people with weakened immune systems. The European Centre for Disease Prevention and Control (ECDC) has recently reported the emer- gence of hypervirulent carbapen- em-resistant K. pneumoniae cases across Europe.5 In a recent investigation, research- ers at MVZ Labor Münster used FTIR spectroscopy to perform clus- ter analysis on resistant K. pneu- moniae isolates from eight patients to determine whether transmission had occurred. The isolates and a control strain were measured at least three times a day over three days. The resulting dendrogram analysis (see Figure 1) revealed five clusters, with four isolates (see cluster 1) and two isolates (see cluster 2) clustering together. As the isolates in cluster 1 are very closely related, there is a strong indication that transmission has occurred. In contrast, clusters 4 y n a m r e G , n e m e r B , G K . o C & H b m G s c i n o t l a D r e k u r B © Figure 1: Dendrogram with five clusters of eight K. pneumoniae strains (cluster 3 contains the “control strain”) created using FTIR spectroscopy on an IR Biotyper. and 5 consisted of only one isolate each, therefore ruling out trans- mission. The need for accelerated outbreak analysis As the threat of antimicrobial resistance continues to grow inter- nationally, a timely outbreak detec- tion and containment strategy is crucial. The speed and accuracy of FTIR spectroscopy has the poten- tial to transform outbreak con- trol. While this technology is more commonly found in research envi- ronments, its expansion into rou- tine hospital settings could provide clinicians with the rapid results required to implement effective hygiene measures, break chains of infection early and limit devel- opment of resistance – all critical points on the world’s healthcare agenda. 3. Activities at RKI. RKI. August 27, 2025. Accessed November 12, 2025. https://www.rki.de/EN/Topics/ Infectious-diseases/Antibiotic-resistance/Activities- at-RKI/activities-at-rki-node.html. 4. Macesic N, Uhlemann A-C, Peleg AY. Multidrug- resistant gram-negative bacterial infections. The Lancet. 2025;405(10474):257-272. doi:10.1016/ s0140-6736(24)02081-6. 5. Increase of hypervirulent carbapenem-resistant Klebsiella pneumoniae in the EU/EEA. European Centre for Disease Prevention and Control. February 14, 2024. Accessed November 12, 2025. https:// www.ecdc.europa.eu/en/news-events/increase- hypervirulent-carbapenem-resistant-klebsiella- pneumoniae-eueea. Authors: Kim Kahnau, Senior Medical Microbiologist, MVZ Labor Münster and Markus Meyer, Head of Business Unit Hygiene/Epidemiology, Bruker Microbiology & Infection Diagnostics References 1. Balasubramanian R, Van Boeckel TP, Carmeli Y, Cosgrove S, Laxminarayan R. Global incidence in hospital-associated infections resistant to antibiotics: An analysis of point prevalence surveys from 99 countries. PLOS Medicine. 2023;20(6). doi:10.1371/journal.pmed.1004178. 2. World Health Organization. "Key Facts and Figures on Health Care-Associated Infections and Antimicrobial Resistance." Accessed October 2, 2025. https://www.who.int/campaigns/world-hand- hygiene-day/key-facts-and-figures. m o c . e b o d a . k c o t s – e b o r c i M _ r D © EUROPEAN HOSPITAL Vol 35 Issue 01/26