ECR_2016

Tel. : +33 (0)4 77 47 81 60 www.stephanix.com contact@stephanix.com evidence dream Movix Series dream xtreme dream omniscop Series dream rad Series dream statif pro dream A complete range of digital solutions NEW NEW Visit us at booth 331 expo X2 eCR 2016 EUROPEAN HOSPITAL  Vol 25 Issue 1/16 24 EH @ ECR Geoffrey Rubin MD MBA is the George Geller Professor of Radiology and past Chair of the Duke University Department of Radiology in Durham, North Carolina, USA. A former President of the prestigious Fleischner Society his research interests focus on coupling cardiovascular and pulmonary CT and MRI with novel image processing techniques to detect, characterise, quantify and visualise structures as aids in diagnosis and treatment planning. Rethinking acute aortic syndromes Technological advances in CT imaging have sparked a veritable explosion of imaging data. Pushing against the rush of novel imaging findings there is, what Dr Geoffrey Rubin calls, the slow wave of adoption in medicine, the acceptance and agreement of the clinical community for new diagnos- tic assessments More than 10 years ago advances such as dual-energy and multispec- tral imaging arrived, offering new perspectives yet, Rubin points out, they continue to challenge medical imagers today. ‘Here, there is not so much a new method as one that has only very recently become practical to implement,’ he explained. As Co-President of the 9th Inter­ natio­ nales Symposium Mehrschicht CT und Aktualisierungskurs, Rubin presented a lecture on ‘CT Angiography of the Aorta’, which he hopes will ‘advance an understand- ing of how to fully interpret the images we are acquiring in the set- ting of acute aortic syndromes.’ Interviewed here, he outlines key points covered in his presentation at the International CT Symposium (20-23 January). ‘Acute aortic syndromes are an evolving construct,’ Rubin states. ‘These constructs have been bounc- ing around the consciousness of imagers for about 30 years yet, with the introduction of CT and, to a cer- tain extent, MR, we are beginning to understand them better than when they were initially described using conventional angiography. We have come to observe that the traditional descriptors are not really how we should be thinking about acute aor- tic syndromes.’ Can you provide an example? ‘The original description of intramu- ral haematoma (IMH) was stagnant blood in the wall of the aorta, but this description is identical to an aor- tic dissection where the false lumen does not communicate with the true lumen. IMH is a phenomenon that can be seen in all types of acute aortic syndromes. Identifying IMH is like saying you see a red car. The car being red may tell you something about the driver, but any car, BMW, Mercedes, Volkswagen can be red. ‘The presence of IMH is a sign of the severity of an abnormality. When we take IMH out of the list and are left with two pathological entities, aortic dissection (AD) and penetrat- ing atherosclerotic ulcers (PAU), then we have to add a third one that we have not talked about much, which is ruptured thoracic aortic aneurysm, an entity that causes acute aortic syndrome as well, though it has not been part of the traditional list. In a sense we go from a list that was three, where IMH was viewed as this specialised case of stagnant blood in the wall of the aorta, and we say instead, let’s pull that to the side. It’s an imaging finding we will see in AD, PAU, and the newly included rupturing aneurysm.’ Do those findings affect the clini- cal management of these patients? ‘That’s a good question. The clini- cal management is determined by more than just the identification of the pathological entity, but other issues about where it is located. In the case of aortic dissection, the patient may go immediately to the operating room, or the patient may be observed, or they may go to the cath lab for an intervention. There remains quite a lot of variation in treatment plans, and not a lot of sci- ence around the best therapy. ‘These designations are not suf- ficient unto themselves to direct management. What these designa- tions do is explain the underlying pathology, the underlying disease that caused this problem in the first place. These entities can be divided in terms of different sets of causes, though ultimately they converge toward a common final pathway, which is an aortic wall that is falling apart while trying to contain all the blood flow from the heart. And if the wall does fully break down, then it will be a catastrophic event for that patient. ‘We understand pretty well what we are seeing. What we are trying to do is much like looking at an auto- mobile that has been in an accident and trying to figure out how it got here. Was it caused by lots of little accidents, was it one big crash, was it a crash with another car, or did it fall off a cliff. This is what I will focus on, how it got there, which is a rich and complex subject, and less about what might be done about it. ‘Key for us is to make sure that whoever is going to treat the patient has a comprehensive understand- ing of what is wrong, what the scan shows is going on.’ Huge advances in computed tomography imaging, such as dual-energy and multispectral imaging still challenge today’s radiologists. These images in CT aorta angiography provide great definition of internal organs Next-generation CT aorta angiography challenges 30-year-old definitions, John Brosky reports EU job portal for refugee scientists The EU has launched a new web- site to support EU refugees and asylum seekers holding university degrees in applying for research positions in the 28 Member States of the European Union. Called Science4Refugees, the new initiative of the European Commission in Brussels is spe- cifically aimed at qualified sci- entists among the refugees in Europe. This online platform allows them to find out about job opportunities commensurate with their qualifications and pro- fessional experience, to submit short CVs and publication lists and to request application forms. The new EU online portal Science4Refugees is part of Euraxess, a pan-European plat- form for „Researchers in Motion“ in which 40 European coun- tries are currently participating with more than 500 Euraxess Service Centres. Here, profession- als offer personalised assistance to researchers and their fami- lies in matters such as moving house, finding accommodation, obtaining visas and work per- mits, language courses, schools for their children or social insur- ance issues. Euraxess offers this service free of charge. Tel. : +33 (0)477478160 www.stephanix.com contact@stephanix.com

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