2 new elastq imaging, real-time shear wave elastography, completes philips solution for liver assessment new: evolution 3.0 epiq ultrasound upgrade offers high-res purewave crystal transducer technology, shear wave elastography, contrast enhanced ultrasound, and image fusion. could you ask for more? released the epiq philips has evolution 3.0, an upgrade to its range of high-end ultrasound scan- ners – and a device that combines a number of innovative technolo- gies to improve image quality and processing. professor dirk-andré clevert, head of the interdisciplinary ultrasound centre at munich university hospital, explains what sets this new system apart from any competition. asked why the specific focus in development of the epiq-platform was liver imaging, he pointed out that the liver is the largest and central metabolic organ, with many pathological processes manifesting within it. ‘this applies primarily to tumour metastasisation but also to parenchymal changes other than liver cancer, such as fibrosis or cirrhosis. the liver is therefore an the confidence map captures areas with high (green) and low (red) measurement accuracy. shear waves cannot propagate through liquids, so the veins captured are coded red organ of great interest to all medical disciplines for oncological, inflam- matory, vascular and parenchymal questions.’ what does evolution 3.0 mean in this context? ‘the special feature is the combi- nation of different advanced ele- ments in one system: high resolu- tion purewave crystal technology, shear wave elastography technol- ogy (elastq imaging), contrast enhanced ultrasound (ceus) and image fusion. this covers all four mainstays of liver imaging. ‘the first is image quality, i.e. the b-mode image, which diagnosis hinges on, and for which we require high resolution transducers that can detect even the smallest, deep- lying lesions. newly developed data processing algorithms additionally ensure fast image reconstruction. ‘the second mainstay is contrast enhanced ultrasound, because only the use of contrast media enables us to fully utilise the diagnostic relevance of ultrasound images. the system offers high frequency trans- ducers, providing optimal resolution with sufficient depth of penetration, which can additionally be combined with contrast-enhanced ultrasound. ‘elastography is the third mainstay. elastq imaging is a colour coded, quantitative measuring system to evaluate tissue elasticity in real-time. rigidity measurements indicate the ct scan has detected a suspected liver lesion. good ct-ultrasound fusion imaging with definition of suspected, hyperechoic liver lesion increased vascularisation of this liver lesion cannot be defined in the colour coded duplex ultrasound scan shear wave elastography shows clearly increased liver stiffness, with the medium velocity of the shear wave propagation around 1.79 m/s, indicating cirrhosis. the colour gaps in the measurement box correspond with a hepatic vein and a branch of the portal vein potentially pathological changes not yet visible on the b-mode image, and whether the tissue is becom- ing softer or harder after treatment. image fusion is the fourth mainstay. this procedure can sonographically detect pathological changes seen on ct or mri scans and can substanti- ate a firm diagnosis.’ other medical device manufac- turers offer ultrasound/ct/mri image fusion. does epiq have unique capabilities? in the contrast-enhanced ultrasound examination the liver lesion shows a distinct wash-out after around 50 seconds, indicating a liver metastasis 3-d simulation includes haemodynamics moving centre stage in liver interventions new 3-d simulation models that include haemodynamics enable bet- ter treatment of hepatic tumours via radio-embolisation, according to eminent spanish radiologist josé ignacio bilbao jaureguizar report: mélisande rouger in radio-embolisation, an endovascu- lar technique currently used almost exclusively in liver cancer therapy, particles are liberated in the arte- rial flow of a vessel feeding hepatic tumours, to deploy the particles within the arterial tumoural net- work. interventional radiologists use a microcatheter through which they inject particles loaded with yttri- um-90, which emit radiation in a diameter between 2.5 and 11 mm for about 64 hours. crucially, the particles must be placed within the tumour, so that the total radiation goes only there. however, doing so remains a chal- lenging exercise, mainly due to the blood stream. depending on the arterial flow, areas of the tumour may receive more or less particles, according to josé ignacio bilbao jaureguizar, professor of radiology, head of inter- ventional radiology and consultant radiologist at university clinic of navarre in pamplona, spain. ‘this is one of the problems we have,’ he explained. ‘we use angiog- raphy and selective catheterisation techniques to homogenously distrib- ute the particles, but it all depends on blood flow in the end. so some areas will be treated appropriately, and others won’t – or not as much.’ because they needed to under- stand vascular flows better, bilbao’s department decided to team up with the university of navarre (un) school of engineering in neighbour- ing san sebastian, to help develop a computational simulation model based on the anatomy, to study all possible scenarios of particles distri- bution. (see: numerical investigation of liver radio-embolisation via com- putational … https://www.ncbi.nlm. nih.gov/pubmed/27751569). the simulation model takes into account all the available information, such as what kind of catheter will be used and its shape, or its distance from the next arterial bifurcation. ‘there are many parameters to factor in and countless scenarios in which particle distribution is not as homogenous as it should be,’ bilbao explained. ‘for example, if you place a catheter close to the bifurcation of two arteries that have the same calibre, you might wrongly assume that 50% of the particles would go left and 50% right. but blood stream is a complex physiological process, and a catheter, even if only a 1mm calibre, may interfere with it,’ he said. ‘you may also obtain different results if you place the tip of the catheter close or further to the bifur- cation, in a central or lateral position in the vessel, or if you liberate parti- cles at high or low speed.’ the un researchers came up with a large amount of possibilities and findings using and analysing real-sized 3-d models, according to bilbao, who compared particles dis- tribution to cars in highway traffic. ‘we are learning a tremendous set of things. simulation models enable us to test new catheters and see if they work, or not, understand how our equipment works, and issue appropriate user recommendations, among others. it opens up a lot of possibilities.’ radiology began to take an inter- est in haemodynamics study a few years ago, when a team in the usa showed the value of studying blood flow in prosthesis placing to correct aneurysms in the aorta (basciano ca. computational particle-haemo- dynamics analysis applied to an abdominal aortic aneurysm with thrombus and microsphere-targeting of liver tumours. phd thesis, north carolina state university, raleigh, nc, 2010.) anterior view of the patient-specific hepatic artery modelled by jorge aramburu montenegro in his thesis for computational simulations and a detail of the particle–haemodynamics in the vicinities of the injection studying smaller mobile vessels in the liver is just as interesting an option for radiologists, but they must learn to focus on functional imaging, bilbao believes. ‘we can’t work with morphological criteria alone any more; we need function. radiology is a wonderful morpho- logical technique and we’re particu- larly fond of studying microanatomy in depth. however we must get eh @ ecreuropean hospital vol 26 issue 1/17

4 seeking a quick route into healthcare management big firms forge a new partnership an alliance between siemens healthineers and ibm watson health aims to support service providers in the healthcare system, such as hos- pitals, health networks and other providers. a top-class technical solution consisting of three main components is to help ensure better treat- ment for many, at lower costs per head. ‘i believe we can make an important contribution towards evidence based medicine,’ says arthur kaindl, general manager for digital health services at siemens healthineers report: julia geulen enterprise performance manage- ment is one key component and can be compared with a storage archive. looking at a group of hospital patients, the management system is used to analyse classic perfor- mance indicators, such as average duration of patients’ stay, or the adherence to standard guidelines during treatment. the data required is networked between the different in-house it systems, consolidated and evaluated. it forms the basis for reimbursement of the services provided on the part of the health insurers and other operators and it can also be utilised to optimise pro- cesses and reduce costs. further component, looking at the individual a the i.e. watson care manager, comes into play when the issue is not the analysis of a defined group but the individual care of patients. example diabetes management: this platform consolidates and processes all avail- able patient data. this includes data from the hospital information sys- tem along with image and labora- tory data. based on this data, the system can then help doctors and nurses to choose the best treatment. the high added value of this solu- tion, and – unique on the market to date – the combination of all image, laboratory and pathology data, com- plemented by information from the patient file, is analysed in real-time. ‘the treatment path is available immediately after the image has been generated,’ kaindl points out. this is a big advantage during the diagnosis and treatment process, especially when there is an acute problem, such as a potential stroke. in view of the increasing number of chronically ill patients the extension of this solution to out-patient care is a declared objective. the plan is to network in the individual, vital data generated at home so that it can be integrated and analysed – to achieve better out-patient management. one vital requirement is adher- ence to the necessary data protec- tion regulations. siemens has a clear competitive advantage in this field because the company holds two certifications for a cloud-based net- working solution: uld for germany and europrise, which corresponds with the new european data protec- tion regulation. technical challenges several hurdles must be overcome during implementation of the solu- tion: quantitative analytics has not yet been sufficiently implemented in radiology, for instance. however, the prerequisite for clean data analysis is the supply of discrete data based on a structured, quantitative evalua- tion. although there appears to be a change in awareness, kaindl says, because it is recognised that the referring practitioners often do not have time to read pieces of prose, and because inconsistencies are also dangerous. a further requirement for effec- tive implementation is the clean networking of different it systems, with one to two dozen of these systems usually found per hospital. networking can easily and quickly be achieved with standard inter- faces. however, without these inter- faces the process is more time con- suming and sometimes also requires assistance from other it companies. nothing works without curation when data from the respective it systems has been aggregated it must be curated. kaindl: ‘this is a com- plex as well as unavoidable step to ensure we actually receive compa- rable data. curated data is a must.’ this process is carried out manually during development of the hospital database and takes a certain amount of time. it must be ensured that all information is input correctly into the data structure envisaged. this can often take several months. the actual analysis of the data can only be carried out afterwards. ‘otherwise there would be a dan- ger of “rubbish in, rubbish out’”, which must be avoided at all costs.’ initially, standard analytics is car- ried out with the help of known algorithms. after licencing, the data is later arthur kaindl msc phd is general manager of digital health services at siemens healthineers. he first worked for siemens after gaining his engineering diploma at friedrich-alexander university, erlangen-nuremberg (1988-95). in 2001 he received a phd in electrical engineering from leibniz university, hanover. following this, he held various magnetic resonance management roles and then, in 2005, was awarded an msc in ceramics engineering at alfred university, new york. specifically evaluated with the help of a new deep learning engine. jumping on the train siemens healthineers are looking for a quick route into healthcare management. ibm watson health is delivering important components. the newly established partnership is based on a distinct win-win situ- ation. ‘the respective strengths and domains ideally complement each other – ultimately also to the advan- tage of our customers,’ kaindl is convinced. there is optimism regarding compe- tition in this field. although google, for example, is trying to position itself with respective projects and the resulting predictive analytics, there appears to be a lot of distrust amongst consumers – particularly regarding healthcare data. devising structured reports european and usa radiology societies unite to validate reporting templates report john brosky structured reporting in radiology is easier to say than do. initially radi- ologists must agree on the structure of the report itself. then they need to agree on what to report. those two very different challenges help to explain why migration into the digital age of radiology reports is moving at ice age speed. ehealth and the expectation, according to emanuele neri md, chair of the informatics subcommittee for the european society of radiology (esr), is that templates for structured reports should be reviewed by diverse spe- cialty professional societies aiming to validate a format for each special- ised practice area. in 2013, the esr announced a collaborative initiative with the radiological society of north america (rsna) to accelerate the process of developing complemen- tary templates, and to open up that process for a wider participation by european national societies of radiology as well as specialist and subspecialist societies. in 2015, the esr and rsna signed a memorandum of understanding that includes the creation of a com- mon working group called the template library advisory panel (tlap) to serve as a bridge between the two societies to create and review proposed structured report- ing templates. the tlap wish that many esr subspecialties societies will step forward to collaborate, working through the open, online template library established by rsna to select and then validate clinical content and technical formatting for their respective practice areas. through the agreement, esr members have full access on the rsna website, and not only the abil- ity to download and review materi- als, but also to upload templates as a credential member. ‘we find ourselves at an interme- diate stage where the separate ele- ments, such a reporting templates for different specialised practices, are increasingly available but have not yet come together,’ said neri, who is also a member of the rsna informatics committee. ‘there are many subspecialty societies feder- ated by esr, whether abdominal, neural or cardiac,’ he pointed out. ‘and it becomes extremely impor- tant that each society with its exper- tise reviews and validates those templates created for a specific area of expertise, that they agree with it.’ templates by european professional societies and the subsequent publication of the template will mark a milestone, he said allowing the initiative to expand and advance toward adop- tion of templates. validation of neri outlined three strategies for the implementation that will unfold in parallel to this. first will be the promotion of templates by esr through its diverse activities, and targeted promotion by the specialty societies to its members. many of these societies are com- mitted to structured reporting, he said, citing as examples the european society of gastrointestinal and abdominal radiology, the european society of oncological imaging and the european society of medical imaging informatics. concurrently, there will be a pro- gressive integration by manufac- turers of validated templates into imaging equipment. ‘today when a hospital buys a ct scanner, the manufacturer has already pre-load- ed imaging protocols, which facili- tates the work for a clinician with validated, predefined parameters for an examination programmed into the console. pacs vendors can do the same with reporting templates, which will encourage and moti- vate radiologists to use appropriate reporting formats,’ neri believes. a third push toward wider imple- mentation will come through multi- disciplinary interactions, such as a radiologist participating on tumour review boards. ‘in these settings, the use of structured reporting is grow- ing because, with the reports, the radiologist improves communication with other clinicians asking for spe- cific information for tumour meas- urement or staging of the disease. in this oncology context a structured report provides specific information to respond to specific clinical ques- tions. and it is very effective.’ to widespread yet, there remain multiple chal- adop- lenges tion, some of which are uniquely european. ‘the difference from the united states is that different coun- tries in europe not only have dif- ferent healthcare payment systems,’ neri pointed out, ‘there is also a language issue, which is one of the major challenges we face for imple- mentation.’ here the advantage of struc- tured reporting is that it standard- ises reporting formats so that even where the language changes, the same information is presented in the same order. as a pan-european group, he said, esr can help diverse societies estab- lish structure, provide guidelines, and give direction. ‘still, reports must be translated,’ he added. ‘here’s where we find the challenge.’ beyond language there is the challenge of ontology, the terminol- ogy used to describe an imaging finding. ‘the risk is having a report with the correct structure, but with a wide variation in the terms. for this eh @ ecreuropean hospital vol 26 issue 1/17

6 age-appropriate disease? doesn’t exist 12-year population imaging study produces provocative insights what can we learn from population studies? according to gabriel krestin md phd there are things that we can un-learn, as well as learn, from population imaging studies. pox-100bt hyprid powered mobile x-ray system hyprid powered mobile x-ray system hybrid - device can be operated by hybrid internal battery or by external internal battery or by external power supply power supply powerful 5 kw and 100 ma powerful 5 kw and 100 ma ideological design for mobile application ideological design for mobile application smooth movement with dirigible wheels smooth movement with dirigible wheels folding and easy to transport folding and easy to transport 1417 wgc wireless most versatile dr (cid:31)at panel wireless most versatile dr (cid:31)at panel complete wireless digital radiography high-resolution image quality automatic exposure detection cassette size (15,4 mm ultra thin) suitable for mobile and stationary use stand: 35 | x1 medical econet gmbh im erlengrund 20 • d-46149 oberhausen tel.: +49 (0)208 / 377 890 - 0 • info@medical-econet.com fax: +49 (0)208 / 377 890 - 55 • www.medical-econet.com interview daniela zimmermann the chair of the department of radiol- ogy & nuclear medicine at erasmus university medical centre, krestin also leads the european population imaging infrastructure (epi2), an initiative of the dutch federation of university medical centres and erasmus university. population imaging is the large- scale application and analysis of medical images to find imaging bio- markers that enable the prediction and early diagnosis of diseases. the epi2 coordinates data acquisition at diverse locations and times and is a flagship node of the euro- bioimaging initiative, one of the large distributed life-sciences infra- structures on the european strategy forum for research infrastructures roadmap. pan-european participants include radiologists and research organisations from austria, finland, france germany, norway, sweden, and the united kingdom. at the garmisch mr 2017 symposium, held in january, krestin focused on brain imaging in the rotterdam scan study to challenge the widely held concept that there is an age-appropriate approach in medicine. ‘there is no such thing,’ he stated during our eh interview, defying this largely accepted idea in what he acknowledges is a provoca- tive talk. ‘in the past the term “age-appro- priate” has been used to relate a lot of alterations to the process of aging. the changes that we attributed to age are, in fact, caused by sympto- matic and sometimes pre-clinical or asymptomatic disease. aging is not a so-called normal process. there is no such thing as a normal aging of the brain. it is not normal that you lose or deteriorate in your brain effects of age, global white matter atrophy and white matter lesions on fractional anisotropy values of normal-appearing white matter. images are shown in the montreal neurological institute (mni) stereotactic space, with mni coordinates for axial levels (z) depicted for each column. the white matter skeleton (black) is projected onto the axial mr images. yellow-to-red colors represent normal-appearing white matter regions with reduced fractional anisotropy (fa) in relation to (a) increasing age, adjusted for sex only, (b) global white matter atrophy, adjusted for age, sex and white matter lesions, (c) white matter lesions, adjusted for age, sex and white matter atrophy and (d) increasing age, adjusted for sex, white matter atrophy and white matter lesions. with increasing age, multiple regions show significant decreases in fa (a). however, after adjustment for white matter atrophy and white matter lesions, only few regions remain (d). global white matter atrophy (b) relates to decreases in fa in the hippocampal region (z82), fornix (z90), corpus callosum (z90 to z108) and along the cingulate bundle (z119). in contrast, white matter lesion burden (c) is associated with reduced periventricular fa (z82 to z108). m.w. vernooij, m. de groot, a. van der lugt, m.a. ikram, g.p. krestin, a. hofman, w.j. niessen, m.m.b. breteler: white matter atrophy and lesion formation explain the loss of structural integrity of white matter in aging. neuroimage, volume 43, issue 3, 2008, 470–477. http://dx.doi.org/10.1016/j.neuroimage.2008.07.052 function with age, that the brain becomes senile. ‘what we see is the influence of many external factors, many risk factors, many related diseases, or perhaps of genetic predispositions. but it’s not necessarily the number of years you have lived that lead to these changes. ‘in population studies, when we started we were looking for very simple things, such as the different volumes of the brain across subjects of different ages. we were taught in medical school that, after ado- lescence, the number of neurons in new system helps physicians to choose suitable devices simpler mr-conditional cardiac device selection the promri configurator made by biotronik is an online tool that enables physicians to select from a series of mri requirements for a patient and subsequently generates a recommendation of all suitable mr-conditional cardiac device and lead combinations available in a particular country, thus helping phy- sicians to choose the most suitable mr-conditional cardiac systems for each patient. the firm’s many of implant- able cardiac devices are not only mr-conditional but also take advan- tage of the company’s award-win- ning mri autodetect functional- ity, biotronik reports. ‘this feature allows a device’s built-in sensor to detect an mr environment automati- cally (within a programmable win- dow of up to 14 days) and to switch the device to and from mri mode for the duration of an mri scan. this means that patients implanted with a cardiac device can receive optimal therapy for the maximum amount of time without requiring multiple visits to their physician for manual configuration for mri scans.’ its portfolio of mr-conditional devices and systems is extensive, so possible combinations for physicians eh @ ecreuropean hospital vol 26 issue 1/17

8 ‘very few people have a carbon hyper-polariser’ neuro-imaging: what radiologists can do today – and not yet dce-mri for biopsy planning from the extremely new, but not generally available, to the somewhat new… very avail- able and highly useful… walter kucharczyk outlines potentials and practicalities in advanced brain tumour imaging report: john brosky when the organisers of garmisch mr 2017 (22 january) wanted to hear about the newest developments in neuro radiology, they turned to walter kucharczyk md frcpc, one of the event’s most experienced pre- senters, having delivered lectures at this mri symposium since 1991. his experience also includes hav- ing served as the president of the international society of magnetic resonance in medicine (ismrm), the largest research and education group in the world devoted to developing and teaching magnetic resonance to doctors and scientists, and as previous professor and chair of the department of medical imaging at the university of toronto for sixtee- nyears. he is a renowned veteran lecturer with a decades-long record of international lectures. the faculty’s proposed title for the talk was terse, yet ambitious: ‘brain tumours: what is new?’ keep track of things! new: dvi-interface between accutron® hp-d and monitors improved workflow in angiography! improved security for the patient! the injector itself remains wireless and mobile! for philips & siemens angiography devices! contrast medium injectors and consumables for ct, mri and angiography hauptstrasse 255 · 66128 saarbruecken for more info: www.medtron.com courtesy of marco essig methods, that may not be extremely new, and what is truly new, but not readily available, is also complicated to analyse, and thus not particularly useful to most radiologists today,’ he explained. ‘i hope both parts of the lecture were of interest to the audi- ence – letting them know what all of them can do today and giving them a taste of what might be useful in the near future.’ after setting a context in reviewing the not-so-new, but well-proven tech- niques, kucharczyk advanced into more recent developments in tech- niques that are sufficiently available for everyone to use, and which are useful for a variety of applications, including diffusion weighted imag- ing, tractography, perfusion mri, and mr spectroscopy. among those attending his pres- entation, kucharczyk had predicted that, while many would be inter- ested in and aware of the very newest developments in neuroradi- ology, most practitioners would not have had access to such equipment and methods, so they would look for advanced, “somewhat-new” tech- niques that might not be the newest, but are available, are of proven value, and have stood the test of time. ‘for this reason, i divided the lecture into european_hospital_1-4_seite_hpd.qxp_anzeige 12.02.16 12:47 seite 1 two, between readily available, useful the very newest techniques are mostly performed in a research envi- ronment to investigate and help solve yet unsolved problems. but, they are not widely practiced because not every medical imaging centre has the hardware, software, cyclotron, combined mri-pet scanner, carbon hyper-polariser, or specialised per- sonnel to perform these techniques. ‘i don’t think we are there yet with many of the very newest things,’ he pointed out. the usefulness of the most read- ily available radiotracer, 18-fdg, to image brain tumours is limited, he said, because radiotracers based on glucose provide poor image contrast between the tumour and normal brain. brain tumours and healthy brain tissue both avidly take up the glucose. ‘as a result you need to go to other novel formulations of radiotracers, which are very expen- sive and have very short half lives,’ kucharczyk explained. ‘these neces- sitate having a cyclotron.’ similarly, hyper-polarised carbon species carry similar logistic and cost issues of requiring a very expensive carbon hyper-polariser, he added, ‘but they do enable the radiologist to study carbon-based metabolites, such as pyruvate, through its bio- chemical pathways and potentially assess the effectiveness of therapeu- tic drugs. but very few people in the new digital mobile x-ray systems for higher operator satisfaction mobiledart evolution mx7 series adds. ‘these help operators to work quickly in typical healthcare environments.’ digital mobile x-ray systems equipped with a flat panel detector (fpd) are used to examine patients dur- ing hospital rounds and for urgent cases in a&e and neonatal inten- sive care units (nicus). leading medical equipment manufacturer shimadzu (www.shimadzu-medical. eu) reports that its new mobiledart evolution mx7 digital mobile x-ray systems provide ultra-modern and extensive mobile digital radiograph- ic (dr) system functionality. ‘the mx7 series expands the level of support for medical person- nel involved in mobile imaging work. the system includes new software functions, an extremely operator-friendly design, and a built-in large 17-inch lcd monitor that increases resolution and also provides better visibility and touch- panel operability.’ storage and more other new features include storage space for smaller items as well as grooves in the console top side- walls, to maintain stability while placing a cover over the fpd unit, for example. ‘the mx7 still features the popular smooth and quiet drive system, the “all-free” button to freely position the unit with a single button, and the ability to display imag- es in about two seconds after exposure,’ shimadzu trusted performance the firm reports that, in a customer satisfaction survey by usa-based research firm klas, shimadzu mobiledart evolution was acknowl- edged as the 2016 “category leader” in digital x-ray mobile. ‘thus, mobiledart evolution can offer proven first-rate healthcare support.’ to date, shimadzu has sold over 3,000 digital mobile x-ray systems worldwide. ‘with the steady growth of digitalisation in clinical environ- ments, mobiledart is a globally well-known product appreciated by numerous customers in professional healthcare organizations,’ the manu- facturer reports. ‘the 3,000+ units have been installed in more than 60 countries.’ the mx7 features, an integrated power management function smart secure, which gives users a selec- tion of choices to create the best system for their clinical needs. based on superior communication between the main unit and dr system, this management function utilises the battery more effectively by minimising unnecessary power consumption. ‘in addition to a start- up time of about one minute for the dr system, the system also includes other new features designed to meet the needs of healthcare providers, such as a the mx7 digital mobile x-ray systems combine clinical feedback with highly advanced technologies to meet the highest operator requirements vegf 26.98 ng/mg vegf 13.68 ng/mg dce-mri for biopsy planning courtesy of marco essig eh @ ecreuropean hospital vol 26 issue 1/17

10 ecr 2017– eminent radiologist stresses adverse work issues radiologists suffer burnout and gender inequality in an exclusive interview with eh correspondent mélisande rouger, mauricio castillo president of the american roentgen ray society (arrs), spoke about the impact of dissatisfaction and gender dis- crimination in radiology, the focus of his wilhelm konrad roentgen honorary lecture at ecr 2017 burnout, dissatisfaction and gender inequality are recognised pheno- mena among physicians, and recent studies reveal they increasingly affect radiologists. ‘we’re hurting in these aspects,’ confirmed dr mauricio castillo, the jh scatliff distinguished professor and head of neuroradiol- ogy at university of north carolina, in chapel hill, usa. radiologists are among the best- paid physicians in the usa. in 2011 they earned more than any other specialty and ranked sixth in 2015. ‘we earn more than in 2011, but our salaries have not increased at the rate of other specialties. but we still do very well,’ castillo agreed. however, only around 50% of radiologists felt fairly compensat- ed and satisfied with their career choices, according to a study con- ducted among almost 20,000 physi- orities is to take care of our own, by making sure that people have appro- priate psychological help and achieve a life-work balance.’ to take care of its staff, unc has launched a three-year program, in which it will inject us$300,000. this is an essential step, castillo argued, as radiologists usually don’t receive help in their daily work and find themselves increasingly squeezed by finances. ‘we do a lot more studies than ever before, which has made our salaries go up, but also lead to burnout. radiology used to have fixed schedules similar to anaesthe- sia. now you can never leave,’ he said. ‘studies always have to be read, turnaround time has decreased and we are expected to have everything ready within minutes. we are teach- ing that to residents. getting that k c o t s r e t t u h s / s k o t s o d u t s © i cians by medscape in 2016. (http:// www.medscape.com/features/slide- show/compensation/2016/public/ overview#page=1) evidence collected over the past few years has also increasingly shown that radiologists are depressed. and worse, they suffer burnout. a 2015 study led by the mayo clinic showed that burnout affected over 39,000 physicians in the usa especially family doctors, urologists, physical medicine and rehabilitation specialists… as well as radiologists. ‘ten years ago, the proportion of radiologists seeking counselling was negligible. today this figure has increased by 400% and more radi- ologists are quitting their jobs for positions inside the industry,’ castillo pointed out. the neuroradiologist became alarmed after a study conducted at his university revealed how disheart- ened radiology residents felt. in a questionnaire sent to 504 residents about the issue of feeling extremely tired or burnout, those who said they were the most exhausted were the surgeons and radiologists. ‘i was surprised. but burnout has been on everybody’s mind, including the american college of radiology, which has taken a significant inter- est in this issue to ensure it is being properly tackled in medical schools,’ he said. ‘at unc, one of our top pri- turnaround time in less than one hour is compromising what is being learned, but it’s how we work nowa- days. we’re held accountable for how many studies were read within the 60 minutes threshold. it’s the same dur- ing the weekend, and this, of course, increases burnout.’ the profession’s inherent lack of contact with people also adds up to burnout and creates a sense of frustration. castillo believes these factors have led to a significant decrease in inter- est from medical students in radiolo- gy, an alarming fact as experts predict the profession will need 20% more radiologists by 2025 when the last baby boomers retire. radiology has become even more unpopular among women medical students. ‘radiology has one of the low- est percentages of women in medi- cine and that’s amazing when you think that 50-60% of all medical mauricio castillo md is the james h scatliff distinguished professor of radiology as well as chief and program director of neuroradiology at the university of north carolina in chapel hill, n. carolina. he is also the current president of the american roentgen ray society. dr castillo completed his radiology and neuroradiology training at the university of miami school of medicine, jackson memorial medical centre, and emory university school of medicine, affiliated hospitals in atlanta. his research interests include paediatric neuro-imaging, application of new imaging techniques and medical literature editing. within the latter, he has authored more than 640 articles and 25 books including the famous neuroradiology companion (now in fifth edition), a reference work covering the fundamentals of neuroradiology for residents, fellows and practitioners. students who are now graduating are women,’ castillo observed. in 2013- 14, radiology was not even in the top ten of entering in the pipeline women applicants, students and resi- dents, according to the association of american medical colleges (aamc). the unattractive, poor life/work bal- ance experienced in radiology is possibly one of the main reasons why women disregard radiology as a career choice, he suggested; but gender inequality in salary and career advancement may not be far behind. studies in this field show that women in medicine make an average 25-35% less than men for an equal position, and the number of women becoming full professors in medicine is small compared to the number of men. 38% of a medical faculty are women, and only 21% are full profes- sors and 16% are deans, according to the aamc. the usa has done the most research on this topic, but the problem is also very much present in europe and probably the rest of the world, and it should receive more attention from everyone, castillo believes. ‘in western europe and scandinavian countries the question of gender inequality seems a little less obvious than in the usa. however, when you speak to women in europe they feel that there’s inequality of gender in respect to free time, advance- ment within the career and between salaries, so this has become an issue there, too.’ * ecr 2017. 1-5 march. vienna, austria * arrs annual meeting. 30 april – 5 may. new orleans, usa. we are here! meet our friendly team at the society village. hall m. level o. so they can buy & sell medical equipment and parts, find a service partner, browse over 625,000 listings, and read healthcare business news online. register for free and join them.the world’s leading medical equipment marketplacewww.dotmed.comafghanistan 190, albania 380, algeria 313, american samoa 39, andorra 60, angola 44, anguilla 20, antarctica 16, antigua 4, antigua and barbuda 140, argentina 1542, armenia 202, aruba 39, australia 1685, austria 332, azerbaijan 133, bahamas 72, bahrain 95, bangladesh 271, barbados 32, belarus 81, belgium 442, belize 58, benin 55, bermuda 34, bhutan 24, bolivia 460, bonaire 2, bosnia and herzegovina 160, botswana 46, brazil 3068, british indian ocean territory 16, brunei darussalam 37, bulgaria 590, burkina faso 40, burundi 18, cambodia 112, cameroon 200, canada 4583, canary islands 2, cape verde 31, cape verde islands 1, caroline islands 2, côte d’ivoire 1, cayman islands 38, central african republic 495, chad 17, chile 708, china 4339, christmas island 10, cocos(keeling)island 1, colombia 1317, comoros 18, congo 7, congo, democratic republic of the 65, cook islands 17, costa rica 234, côte d’ivoire 139, croatia 191, cuba 33, curacao 4, cyprus 365, czech republic 196, denmark 252, djibouti 26, dominica 22, dominican republic 502, ecuador 620, egypt 1487, el salvador 247, equatorial guinea 28, eritrea 17, estonia 98, ethiopia 132, faeroe islands 1, falkland islands 1, faroe islands 1, fiji 34, finland 124, france 1034, french guiana 18, french polynesia 21, gabon 23, gambia 31, georgia 478, germany 1782, ghana 365, gibraltar 27, greece 915, greenland 23, grenada 25, guadeloupe 18, guam 71, guatemala 366, guinea 14, guinea-bissau 943, guyana 30, haiti 121, honduras 266, hong kong 383, hungary 367, iceland 49, india 7123, indonesia 1096, iran 1085, iraq 545, ireland 301, isle of man 1, israel 753, italy 1926, jamaica 158, japan 450, jordan 356, kazakhstan 123, kenya 327, kiribati 9, kuwait 162, kyrgyz republic 70, lao people’s democratic republic 30, latvia 118, lebanon 494, lesotho 20, liberia 19, libyan arab jamahiriya 247, liechtenstein 12, lithuania 123, luxembourg 38, macao 28, macedonia 218, madagascar 62, malawi 43, malaysia 692, maldives 33, mali 35, malta 56, marshall islands 23, martinique 22, mauritania 32, mauritius 66, mayotte 13, mexico 5172, micronesia 19, moldova 126, monaco 26, mongolia 144, montenegro 31, montserrat 9, morocco 426, mozambique 43, myanmar 65, namibia 35, nauru 15, nepal 127, netherlands 699, netherlands antilles 34, nevis 1, new caledonia 18, new zealand 271, nicaragua 168, niger 20, nigeria 1369, niue 12, norfolk island 21, northern mariana islands 32, north korea 15, norway 129, oman 88, pakistan 3289, palau 8, palestinian territory 8, panama 224, papua new guinea 42, paraguay 243, peru 865, philippines 1459, pitcairn island 1, poland 1111, portugal 461, puerto rico 740, qatar 83, reunion 16, romania 955, russia 1304, rwanda 40, saint barthelemy 2, saint helena 13, saint kitts 2, saint kitts and nevis 20, saint lucia 46, saint maarten 4, saint pierre and miquelon 11, saint vincent 1, saint vincent and the grenadines 21, samoa 13, san marino 12, sao tome and principe 2, saudi arabia 1025, senegal 101, serbia 348, serbia and montenegro 79, seychelles 19, sierra leone 31, singapore 392, slovakia 115, slovenia 115, solomon islands 13, somalia 40, south africa 684, south korea 674, spain 1056, sri lanka 160, sudan 212, suriname 50, swaziland 11, sweden 242, switzerland 293, syria 477, tahiti 2, taiwan 558, tajikistan 57, tanzania 159, thailand 422, timor-leste 18, togo 50, tokelau 4, tonga 13, trinidad and tobago 151, tunisia 120, turkey 1780, turkmenistan 20, turks and caicos islands 22, tuvalu 13, uganda 234, ukraine 895, united arab emirates 960, united kingdom 3660, uruguay 149, usa 130148, usvi 1, uzbekistan 137, vanuatu 17, venezuela 1187, vietnam 905, virgin islands (u.k.) 5, virgin islands (u.s.) 21, wallis and futuna islands 11, western sahara 1, western samoa 2, yemen 305, yugoslavia 112, zambia 80, zimbabwe 120.why are more than a quarter million health care professionals registered on dotmed?eh @ ecreuropean hospital vol 26 issue 1/17

12 whole breast ultrasound reveals minute cancers in minutes built for comfort; created for speed mark stribling is president and ceo of ivu imaging corporation. stribling introduced an innovative approach with sofia and set up his own start-up company in texas. partnering with hitachi ltd. in tokyo, japan, stribling could take sofia to the next level. the new sofia 3-d breast ultrasound system solves all the economic and logistic challenges associated with whole-breast ultrasound by using a full-field radial scanning method, the firm reports. the resulting throughput, efficiency, and patient comfort make sofia an ideal solution for women with dense breasts high-end combining hitachi’s arietta ultrasound with ivu imaging has resulted in the sofia 3-d whole breast ultrasound system. ‘by consistently finding cancers of five millimetres to one centime- tre early enough, we are likely to find they are localised to the breast and pre-metastatic,’ explained mark stribling, ceo of ivu imaging corporation. ‘that’s the goal, to find these occult cancers by surveying the (dense) breast quickly.’ it is understood that women with dense breast tissue face a four to six times greater risk of develop- ing breast cancer. ‘this is a high risk population, and all the litera- ture tells us that conventional mam- mography is going to miss these tumours for four women in every thousand examined,’ he added. speed up the process yet supplemental ultrasound exams performed manually to detect hid- den cancers are time-consuming, and a good outcome for a woman depends heavily on the experience of the operator handling the probe. to solve these clinical challenges, stribling introduced an innovative approach with sofia, an examination table that automates the examination and speeds up the process devel- oped in texas through his start-up company, ivu imaging corporation. partnering with hitachi ltd, in tokyo, japan, stribling could take sofia to the next level. in september 2016 he introduced 3-d radial acqui- sition of whole breast images using a long linear transducer (92mm width), which was then linked to the hitachi’s ‘noblus’ ultrasound system. following the latest development steps, sofia now also can be oper- ated in conjunction with hitachi’s premium performance arietta platforms. ‘the arietta platform is the game-changing breakthrough for 3-d whole-breast ultrasound,’ stribling pointed out. ‘hitachi ultra- sound now enables the sofia system to scan eight times faster than our first configuration, while at the same time tripling the resolution.’ a full bilateral exam requires just 10 minutes from the moment a patient enters the exam room until she leaves. as a result, clinics equipped with sofia can sched- ule more patients for supplemental imaging per day requiring no addi- tional consumables and no time- consuming pre-scan preparation. sofia does not require a room dedi- cated to whole-breast ultrasound. instead, the adjustable height table and the arietta platform create a new multi-use examination room for a wide variety of diagnostic ultra- sound exams or interventions. confirm findings sofia also offers women the most comfortable of any breast exam experience, the firm points out. they lie on a padded table and, unlike suffering the breast compres- sion involved in other devices, the breast is positioned in a recessed cone in the table and then, in a sin- gle automated radial sweep of only 30-seconds, a full image is acquired. ‘we can present a single breast volume to the radiologist, clearly showing breast structures in their natively-acquired radial plane along with the reconstructed coronal, sag- ittal, and oblique views if desired,’ stribling said. ‘the result is an aver- age interpretation time of about one minute per breast.’ the 900 images sofia captures are reconstructed into a 3-d volume that looks more like an mri image than a conventional ultrasound image, yet with the anatomical detail that ultra- sound can provide. ‘this view gives clinicians the ability to review the exam like a breast tomosynthesis or mri image that they are familiar with. in fact, all our customers who use mri for supplemental dense breast exams also use sofia for a second look to confirm findings, because of the number of false posi- tives in mri images,’ he added. the automated acquisition also assures consistent and reproduc- ible results, thereby eliminating the user-dependency of manual breast exams using traditional ultrasound. because the sofia is powered by the hitachi arietta platform pre- mium ultrasound system, it comes equipped with a host of powerful imaging capabilities. arietta family’s symphonic technology optimises data fidelity along the entire signal handling chain, from transducer to display monitor, the company point- ed out. the system also dynamically focuses at the pixel level, improving resolution and image uniformity. ‘anything arietta is capable of doing, the examining clinician can do with sofia,’ explained stribling, who added that hitachi engineers are already working with ivu imaging to bring an innovative capa- bility to sofia with automated eflow doppler scanning and mapping in 3-d. ‘hitachi’s eflow can depict very specific intra-nodular vascularity so that we will not only see abnor- mal anatomical structures but with the push of a button can provide functional information showing any abnormal vascularity, such as angio- genesis,’ stribling said. ‘this new functionality is not very far away. way forward: 3-d tomographic ultrasound report: mark nicholls it is collaboration could push vascular imaging to a new level. researchers from the university of manchester and ivs ltd (independent vascular services) – an independent uk company providing clinical servic- es and running vascular ultrasound departments for the nhs – is pair- ing mindray’s resona 7 with piur imaging’s tomographic ultrasound device to develop 3-d tomographic ultrasound (tus) to enhance vascular diagnosis. the collaboration is underpinned by a €2.6m european horizon 2020 grant, in a research initiative that charles mccollum, professor of surgery and head of the academic surgery unit in the institute of cardiovascular sciences at the university of manchester, believes will significantly enhance the imag- ing of carotid disease as the cause of stroke and advance monitoring and treatment of aortic aneurysms, as well as many other conditions. duplex ultrasound imaging, such as that achieved by resona 7, is already regarded by the team as the first line of investigation for arterial and venous disease throughout the body, apart from the heart and chest arteries. safe, pain-free and delivering high quality imaging, it avoids the disad- vantages of mr, which can over-esti- mate the severity of stenosis, or ct with the risk of ionising radiation and nephrotoxic x-ray contrast, professor mccollum explained. ‘for the investigation of carotid dis- ease, varicose veins, deep vein throm- bosis, peripheral arterial disease and arterial and venous malformations in the limbs, it can’t be bettered,’ he added. ‘for aortic aneurysm, ultra- sound is the way you make the diag- nosis. but what we are showing now with 3-d tomographic ultrasound with the piur imaging solution, is that it is the best way to measure the aneurysm; for surveillance and to detect endoleaks, or problems after endovascular aneurysm repair. ‘in my view the future is 3-d tomographic ultrasound. it will not be necessary for all applications of colour doppler, but for quality imag- ing that a surgeon can interpret, 3-d tomographic ultrasound will be the way forward.’ mccollum added that the 3-d tomographic approach will produce images that a surgeon can look at from every angle, as well as inside the artery, and images he/she can what is v-flow? mindray’s new ultrasound system, resona7, delivers a technology that dynamically visualises blood flow. called v-flow, it displays the fluidity with dynamic arrows indicating the flow process, rather than a series of static images, with both the magnitude and direction of the flow measurable at any location in the vessel, avoiding the inconvenience of angiography. the platform uses an extremely high frequency yet remains flexible due to the availability of arbitrary beamforming methods. consequently, multiple image lines are obtained after a single transmission. continuous doppler transmission can color displaymegapixeleh @ ecreuropean hospital vol 26 issue 1/17

l c i a e p s’ s 14 a r g r e h p d i o a r training in radiography and medical technology is mainly academic ecr significantly expands radiographers program cies. since 2004 they have been entitled to administer contrast media and, since 2012 they have also been able to administer radiopharmaceuti- cals. ‘dosage calculation has always been part of our duties. the applica- tion is obviously always carried out in agreement with doctors, with the degree of risk governing the intensi- ty of this cooperation. it is important that doctors are available in case of any incidents,’ explains rosenblattl. tencies when required,’ rosenblattl says. the law on higher medical- technical services (mtd) governs the profession; doctors are regulated by medical law. accordingly, in austria have extensive competen- radiographers austrian congress for radiologic technology advanced training by rtaustria 21.-22.4.2017 in salzburg/austria www.radiologietechnologen.at/ kongress2017 report: sylvia schulz the job title radiographer has a firm place in many european and non-european countries. the aca- demic training reflects the complex range of responsibilities the role entails. michaela rosenblattl m.ed, who heads the radiology degree course program at the university of applied sciences in wiener neustadt, vienna, reports on the austrian situation. as president of the austrian society of radiological technologists (rtaustria), a founder member of the european federation of radiographer societies (efrs), also presents a european perspec- tive. since 1960, austrian training for this profession used to require stu- dents to have passed their matura (equivalent to a-levels), rosenblattl explains. in those days, training centres were mostly affiliated to hospitals. the bologna process, a pan-european harmonisation of degree courses and degrees and trans-national academic reform, aim- ing to achieve international mobil- ity for students, accelerated further developments. in 2004 the title ‘radi- ographer’ was officially introduced (in austria) and, in 2005, training was integrated into the universities for applied sciences. the degree course is now available at seven of these universities across austria. radiology department assistants can perform less challenging radio- logical tasks, requiring fewer quali- fications. they work closely with radiographers and are only allowed to carry out certain procedures, such as bone density measurements and mammograms. radiographers are on a level with doctors. ‘doctors can avail themselves of our compe- what’s best for a radiographer: the clinic or industry? you can’t compare an apple with an orange usually radiographers work in a clinical environment, are specialised in ct, mr or ultrasound and take care of patients and their treatment. not so patrick doherty, siemens healthcare regional business manager, dublin undergraduate who worked in a university hospital for five years before switching to work within the healthcare industry. conclusion? ‘it’s a daily challenge,’ he confirms. in the ecr’s rising star session he describes ‘working in the industry’. earlier, he outlined his experiences for european hospital. report: marcel rasch asked why there no standardised education in radiographers for europe, siemens healthcare regional business manager patrick doherty pointed out that, for a start, countries use a different term for radiographers – e.g. radiological technicians. ‘in european countries the educational approach for radiographers and radi- ological technicians differ very con- siderably,’ he added. ‘there appears to be no established standard yet and indeed it seems to be difficult to agree on an educational standard. ‘i did my undergraduate degree in dublin – on a four-year under- graduate degree program – the only one in ireland for diagnostic radi- ography. ‘in the united kingdom there is a three-year undergraduate program, but this can vary based on content. and in other countries, such as the usa, where they call radiological technicians mtas, one undergoes an educational diploma in a particular area of a radiologi- training for radiographers is academically based in almost all european countries, rosenblattl points out. only germany and spain lag behind, with the latter now making amends. ‘i don’t understand why things should be so difficult in germany of all countries,’ she observes. in many non-european countries, including australia, train- ing is also organised on an aca- demic level. ‘this is even the case in nigeria, with an entire institute being managed by a radiographer.’ the academic training is demand- ing because the course includes physics, technology and it. but even those without a-levels can enrol, as long as they pass the additional examinations required. ‘the perme- ability of our education system is quite high and we put this principle into practice,’ rosenblattl explains. training also continues to be impor- tant once graduates have completed the course and work in the profes- sion, because radiology is a very innovative field, both from a medi- cal and a technological perspec- tive. ‘our organisation also offers its own programs to promote fur- ther training.’ more importantly, an exchange across national borders is cal department, for example gen- eral x-ray scanning, and this is what they do after examination, all day, every day – general x-ray scanning. whereas the undergraduate degree that i took was a broad-based degree, covering all the imaging modalities and topics, so that we were essen- tially able to go into the departments fully qualified. what opportunities are there when working in the industry? ‘‘when i started to work in the industry, i went into direct sales, for a local irish medical distributor, selling an array of products. that was real learning by doing and a quick immersion into the world of sales and being nimble and entrepre- neurial. it broadened my perspective because it was a hard challenge for this small distributor to compete in an environment where all the big companies, like ge, siemens, philips and the national big players as well, are placed. for me it was a big learn- ing curve, having gone from the clinical environment and essentially being a customer to now seeing the industrial view. ‘back to your question: typically radiographers who work for compa- nies such as siemens are specialised in a certain area. when the com- pany sells an mri scanner, for exam- ple, the radiologist or radiographer explains how to use it and how to interact with the system. that would be the first step of i would say 75 percent of radiographers going into industry. the advantage is that you start with a lot of the tasks you would have done in your clinical work rou- tine. from there you can develop into different areas.’ what are the benefits of working in the industry? ‘it’s a different approach. working in a hospital is a busy, hectic job with all the subjects you have to address from patient to paper work. working in the industry is a different chal- lenge. there are pros and cons in each role. ‘in the industry i miss, on one hand, the clinical interaction with patients but, on the other hand, it opened my eyes to the complexity of what the companies and the industry eh @ ecreuropean hospital vol 26 issue 1/17

16 l c i a e p s’ s r e h p a r g d i o a r radiographer calls for increased cooperation with radiologists by mélisande rouger the increased demand for imaging studies and workforce shortages have put strain on radiology ser- vices while technological advances enabled other medical disciplines to perform their own imaging examina- tions. to hold their ground, radiolo- gists and radiographers must work together and develop common strat- egies, an expert will argue during a dedicated professional challenges session organized by the european federation radiographers societies (efrs) and the european society of radiology (esr) at ecr 2017. of “workforce shortages, workload increase, workplace changes, new technologies and budget challeng- es put quality of medical imaging and radiology at risk,” dr. graciano paulo, professor of medical imaging & radiotherapy at coimbra health school in portugal, said. assessing opportunities and chal- lenges facing radiography and radiol- ogy has become mandatory because medical imaging is being taken over by other specialists, paulo, co-found- er of the efrs, explained. ing procedures has risen sharply over the past fifteen years, there is evidence of a shortage in the number of radiologists and radio- graphers. this can only mean that the imaging procedures are being fragmented and slowly being taken by others. cardiologists, orthope- dists and many other specialists now perform their own interventional procedures and imaging investiga- tions. technology is becoming more available, smaller and easier to use, so the boundaries of the profession are disappearing,” he said. many experts agree that radiolo- gists need to have more contact with patients and within the clinical team to secure their position. one solution would be to delegate part of their workload to radiogra- phers, paulo suggested. to work “training an advanced-practice radiographer in close co operation with a radiologist would enhance patient care and increase the visibility of the radiologist. the radiologist would have more time to do clinical work and interact with patients and his peers instead of sitting behind his/her screen filling reports,” he said. “while the number medical imag- in some countries like the uk, where the number exams is increas- ing every year, radiographers already fill in the imaging report for plain x-ray examinations and in close cooperation with the radiologist. the radiographer has a special position in the imaging chain, and this role could benefit both the patient and the radiologist, accord- ing to paulo. “the radiographers are gatekeep- ers to radiological equipment and act as real pivots between referrers, patients and radiologists. allowing and improving skill mix and joint guidance between the two profes- sions can give the radiologist more time to do clinical work and meet the patient,” he said. radiology, an increasingly desert- ed specialty, would become more attractive in return; similarly, more young people would decide to become radiographers if training included disease knowledge, paulo believes. together “if we manage to bring the two professions towards a new paradigm in the way we pro- vide service to the patient, this will increase professional satisfaction of both radiologists and radiographers and make both professions more attractive,” he said. radiographers education and training programs level across europe should be har- monized, and include a minimum european qualification framework (eqf) level 6 of knowledge, skills and competences (ksc) and a 240 ects program. some countries are currently lagging behind. “in spain, the radiographer pro- fession has one of the lowest quali- fications in the world. it’s not a university degree and training lasts only two years. almost everywhere else, radiographers must train four years (240 ects). many spanish radiographers are actually training in portugal to have their skills rec- ognized internationally. so we are currently working on convincing the spanish government of the neces- sity of training radiographers more appropriately,” he said. besides, imaging services need to use a common coding system across europe to make sure they are comparing the same type of data, regardless of the country or institu- tion. departments should also adopt workflow performance metrics, clini- cal indication oriented protocols, audit and accreditation systems, paulo recommended. graciano paulo is a full time professor of medical imaging & radiotherapy and vice president of ipc-escola superior de tecnologia da saúde in coimbra, portugal. he is a co-founder and past president of the european federation of radiographers societies (efrs). dr. paulo has a bachelor’s degree in radiography, a master’s degree in health economics, and a phd in health sciences. his main area of research is radiation protection. “with these pillars, we would be able to increase the visibility and recognition of radiology in health- care systems. but we can only do this together in europe,” he said. in the end, the future of medical imaging will depend on both pro- fessions’ capability of working as a team, based on roles and respon- sibilities, bearing in mind that the patient should be always in the center of the process, with a holistic approach, he added. “we should be proactive in finding a solution because when we want to be reactive, at that point, it will be too late.” pivotal role in patient care for radiographers by mark nicholls delivering consistent levels of educa- tion and training throughout europe remains an important challenge as radiographers play an increasingly pivotal role in patient care and patient safety. as the european congress of radiology in vienna prepares to hold a record number of sessions of for radiographers, including many focused on the evolving roles of radiographers, dr jonathan mcnulty, vice president of the european federation radiographer societies (efrs), believes that deliv- ering europe-wide levels of edu- cation, qualification and training for radiographers is critical in rais- ing standards of care, diagnostics, therapeutics and patient safety. he new promri® configurator checking safe mri access upfront with this unique online tool, you can configure a biotronik cardiac system suitable for mri access. www.promricheck.com acknowledged that, whilst radiog- raphers in europe are generally well educated, and often trained to masters or doctoral level, access to bachelor degree level training in some countries is still limited. continued, ‘but there’s a very good evidence base showing that when radiographers are used more effec- tively - when challenged and allowed to take more advanced roles - there can be improved patients outcomes as well, so there is a big benefit to the patient from better utilising the workforce across europe.’ ‘in europe, the quality of imaging services is generally good, how- ever, there are some discrepancies so an important body of work at european level is to try to work with radiographers, national socie- ties and education institutions to enhance the education and training of radiographers,’ mcnulty added. ecr 2017 has a strong educa- tion and scientific program for radiographers, including a number of sessions delivered with partner organisations and, this year, ecr is recognised as the official congress the efrs for medical imaging. there are sessions looking at pro- fessional challenges, patient safety and refresher courses across all spe- cialist areas of radiography. mcnulty, from the school of medicine at university college dublin, also stressed the importance of using the skills of radiographers to their full potential. ‘there remain issues in countries around europe where the knowledge and skills of radiographers are somewhat under- utilised at a time when there are huge opportunities for radiogra- phers to play a more significant role in medical imaging and radiology.’ however, while radiographers have been viewed as technicians in some nations, in others their role has advanced significantly with their increasing knowledge, experi- ence and responsibility with some working as advanced practitioners or the equivalent of consultant radi- ographers. ‘it’s not just about giving more opportunities to radiographers,’ he the european society of radiology and efrs have a memorandum of understanding as a blueprint for greater collaboration at a time that radiographers are playing these ever greater roles in radiology services. ‘radiographers are a key piece in the jigsaw, which makes for a modern state-of-the-art diagnostic or therapeutic service being provided by radiology departments,’ he said. ‘it is essential that radiographers are the experts in terms of the technology that is at the heart of a modern radiology department and radiographers have the key role to play in optimising the use of that technology. ‘an equally essential role - that people can often overlook - is that radiographers work closely with their patients. they interact with them on a daily basis and have an important role to play in patient care and patient safety in a modern imaging department. ‘if it is an imaging modality using ionising radiation, they make sure the radiation dose to the patient is minimised. from being seen as a technician, they need to be seen as the expert in that area who can really get the most out of the tech- nology and play that important role in patient care, patient management and in a safe way as well.’ what is also important, he added, is that radiographers – whether diagnostic or therapeutic radiog- raphers – must work to raise the identity and profile of their profes- sion among the public and other members of the health service.’ dr jonathan mcnulty is an assistant professor and head of subject, radiography, in the school of medicine, university college dublin, ireland where he oversees the bsc radiography programme along with over 20 postgraduate programmes and as a university fellow in teaching and academic development, he has led university-wide educational research projects. since 2014 he has sat on the board of the european federation of radiographer societies (efrs) and is currently vice-president of the efrs. having delivered more than 100 conference presentations and contributed to over 50 journal articles, he has held significant national and international research grants. his research interests include medical and healthcare education, optimisation and benefit-risk communication, neuroimaging and image perception. mcnulty said a team approach and closer collaboration with other health professionals remained important in terms of achieving patient safety and the best clinical outcomes. mcnulty is presenting a session, looking at the challenges in education and training and imple- menting the theory of patient safety into clinical practice. he said a challenge lay in achiev- ing agreement on the scope of patient safety within radiology. ‘a message i’d like to get across at ecr is to make people reflect more on what we are doing in our educational programmes, in clini- cal practice, and to identify patient safety-related deficits which may exist and what steps we might be able to take to try and address some of those areas.’ eh @ ecreuropean hospital vol 26 issue 1/17