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Top 5 Radiology trends from the last European Congress of Radiology



1 - Stunning increase in AI applicability


As the previous edition, even ECR 2018 featured a very significant increase in Artificial Intelligence (AI) applications and AI-oriented educational content. Industry experts - in particular - emphasized AI's potential for improving the efficiency and productivity of radiologists, enabling them to deal with an increasing workload. AI may also free up radiologists to get more involved in patient care, working even more closely with clinicians. Many speakers believe that taking on a higher-profile role in the clinical care team will benefit patients and also ensure the survival of the specialty. Initial concern that AI would soon replace radiologists can persist, but it has largely given way to excitement over the technology's promise for enhancing radiology and augmenting radiologists, not displacing them. Furthermore, AI can prescreen imaging studies to highlight urgent cases for radiologists to review and provide decision support to radiologists during the interpretation process. AI can also help detect and characterize disease, such as differentiating lung nodules on CT scans, and may lead to new radiology indications, such as estimating stroke onset or predicting patient survival.

2 - Radiology profession should anticipate change


If they do not want to be replaced by robots, however, radiologists should always anticipate trends and changes in technology instead of fight them. AI - for instance - is going to help radiologists use some biomarkers - for example background parenchymal enhancement - to be better, to be predictive, and to prognosticate better for patients. Part of the reason why radiologists won't be replaced is due to their role in using these biomarkers, which folds into genetic sequencing. The information gives radiologists a sense of who's at high risk for certain diseases and also the treatment required for certain tumours. The same concerns on the future of the radiology profession have been raised in the US at the annual meeting of the American Institute of Ultrasound in Medicine (AIUM). According to some predictions, in fact, web-based AI and CAD will be reading all x-rays, CT scans, and MRI studies within five to 10 years and a study from 2017 found that a computer programme for diagnosing wrist, hand, and ankle fractures was 83% accurate after learning from a sample of more than 250,000 x-rays (Acta Orthopedica, July 6, 2017). Radiologists could face the risk of being almost entirely replaced by machines, or become an integral member of healthcare team, with less productivitiy but increased accuracy and accessibility.


3 - The gadolinium controversy


In 2017, the European Medicines Agency (EMA) recommended that four gadolinium-based contrast agents (GBCAs) for MRI scans be pulled off the market due to concerns about gadolinium remaining in the body years after scans occur. The agents affected included some of the most widely used contrast products in medical imaging. But it was apparent at ECR 2018 that the matter has not been resolved. The U.S. Food and Drug Administration has taken a very different view on the safety of GBCAs, and there is no sign of a consensus being reached between the U.S. and European regulators, It must be added many studies into gadolinium retention are now underway, but it could take a further decade or even more before the publication of reliable safety data. Until then, nothing is going to be resolved fast, and radiologists will have to reassure patients and answer their queries as well as they can.


4 - Performing MRI without gadolinium


Given the controversy mentioned above, an increasing number of researchers are investigating the diagnostic quality of images without media. Several ECR 2018 presentations showed and subsequently recommended that clinicians consider omitting the use of a GBCA for certain follow-up MRI scans when a primary diagnosis already has been established. The potential clinical applications range from the breast and the head and neck to the inner ear and some pediatric exams. MRI is further expanding its utility into neurology with applications for mild cognitive impairment, dementia, and Alzheimer's disease, although many neuroradiologists feel uncomfortable using advanced imaging, structured reports, or visual rating scales to diagnose neurological disorders, in part because they perceive the tools as time-consuming or they are simply not available.


5 - Brexit concerns


As confirmed by ESR President - Prof. Hamm - Brexit poses no threat to the ESR, but an opportunity to prove that science is beyond politics and does not know borders. Meanwhile, London has already lost the European Medicines Agency to Amsterdam, and U.K. researchers will be hit hard by the loss of EU funding, while some of the country's best medical minds are likely to be lost to North America and Australia. Dr. Nicola Strickland - President of the Royal College of Radiologists - stated during the ECR that there is a strong risk of U.K. radiology being marginalized within the ESR because the country will no longer be regarded as "truly European". By the start of ECR 2019, the whole framework will become much more certain, but in the meantime, important open questions remain: for instance, what guarantees can be made to EU nationals working in the U.K.? Or, will the U.K. leave the European Atomic Energy Community (Euratom), thereby risking the future supply of radioisotopes and endangering patients?


Read the complete article on Aunt Minnie Europe:









The ESR Clinical Audit booklet Esperanto


Healthcare organisations are accountable for continually improving the quality of their services. Clinical audits are a powerful tool to grant high quality of patient care, experience and outcome. They consist of measuring a clinical outcome or procedure against defined standards in order to identify differences between current practice and the given standards. If the standard is not achieved, reasons for this are explored, changes are implemented based on the results and a re-audit is carried out to ensure improvement (audit cycle). Audit carried out within departments ('internal' or clinical audit) can also provide evidence to prepare and support departments that are also undergoing 'external' audit which generally equates with inspection by a regulatory authority.


Carrying out clinical audit in accordance with national requirements became mandatory within the European Union from February 2018 as a result of implementation of the updated Basic Safety and Standards Directive. The updated BSS Directive (COUNCIL DIRECTIVE 2013/59/EURATOM) has major implications for European practice in several areas, including documented justification processes for radiation exposure, and dose optimisation. In addition, it requires that 'clinical audits are carried out in accordance with national procedures'.


The ESR cooperates with EU institutions and the Heads of the European Radiation Protection Competent Authorities (HERCA) to ensure that clinical audit is applied properly to improve quality of patient care in Europe, but also to understand the regulators' perspective for its efforts regarding audit. For this reason, the ESR Clinical Audit Tool is designed to facilitate the development of local clinical audit across the spectrum of the services provided by clinical radiology. It provides an outline of the principles of clinical audit combined with a library of templates for audit in a variety of situations, as well as a compendium of useful resources. The Esperanto booklet was named after the most successful constructed language in the world - Esperanto - and offers an overview of the ESR Clinical Audit initiative.


You can find the ESR Clinical Audit booklet in the attachment below.






At ECR 2018, it´s time to welcome the machines and eHealth



Use of artificial intelligence (AI) in image transformation and detecting abnormalities is dramatically increasing, as a specific New Horizons session confirmed during the last ECR - European Congress of Radiology in Vienna. AI can now improve performance in detecting and classify abnormal findings, such as lung nodules or cardiomegaly, and make it possible to create preliminary reports which radiologists can check before the main reading.


Imaging transformation and reconstruction methods are other promising fields and the main contribution of deep laerning will be imaging transformation and full automation of imaging processing, so that quantitative lesions are ready before radiologists read the images. However, one of the main difficulties in applying AI and deep learning to medical imaging remains the absence of standardised protocols among manufacturers and when using data from clinical studies, facing the risk big data evolve into dumb data.


At the ECR session, held on March 01, 2018 under the title - The Machines are coming: how will they change our future? - Prof. C. Schlett from Harward School of Public Health explained how to perform data mining and overcome difficulties, commenting: these data only make sense  if we combine imaging with clinical outcomes. Not everyone has digital health records today; that would be perfect to extract meaningful data. But you can also get your data from a non-standardised clinical setting.


Young radiologists seem extremely concerned with the possibility of losing their jobs because of the machines: however, Prof. J.B. Seo, from the Korean Asan Institute for Life Sciences in Seoul, replied: I don´t think we will lose our jobs in ten years´ time, but after that if deep learning has improved our performance by 4 or 5 times, then maybe we need to arrange our roles". This repositioning seems unavoidable, but making AI truly useful needs time and radiologists will probably have a lot of work in the analysis of the given lesions and matching them with clinical data.


Still, the implementation of AI in healthcare requires addressing crucial ethical challenges such as the potential for unethical or cheating algorithms, algorithms trained with incomplete or biased data, a lack of understanding of the limitations or extent of algorithms, and even the effect of AI on the fundamental fiduciary relationship between physicians and patients, i.e. privacy concerns. AI algorithms could be designed to perform in unethical ways -- as evidenced in nonhealthcare examples such as Uber's Greyball algorithm for predicting which potential passengers might be undercover law-enforcement officers. Algorithms can also be developed to cheat, such as when Volkswagen's algorithm enabled vehicles to pass emission tests by reducing nitrogen oxide emissions during tests.


Similarly, developers of AI for healthcare applications may have values that are not always aligned with the clinical values: there may be temptation, for example, to guide systems toward clinical actions that would improve quality metrics but not necessarily patient care. Or these algorithms may be able to skew data provided for public evaluation when being reviewed by potential hospital regulators. Furthermore, It is possible to program clinical decision-support systems in a manner that would generate increased profits for their designers or purchasers, such as by recommending tests, drugs, or devices in which they hold a stake, or by altering referral patterns.


Another relevant issue is the danger of self-fulfilling prophecies. The underlying data used to train an algorithm can be incomplete or biased, and the functioning algorithm may then reflect these biases. On the other hand, it's also possible that machine learning, when properly deployed, could help resolve disparities in healthcare delivery if algorithms could be built to compensate for known biases or identify areas of needed research.


It is therefore extremely important machine-learning systems are built to reflect the ethical standards that have alwasy guided healthcare actors in their daily practice. A key step will be determining how to ensure that they are -- whether by means of policy enactment, programming approaches, task-force work, or a combination of these strategies.


Finally, a specific sessiono of ECR 2018 has been dedicted to eHealth in radiology: policies, practices, pitfalls, potential. As illustrated by the ESR moderator, Prof. K. Riklund, eHealth is a priority topic in which the ESR is actively engaged, having been a member of the European Commission's eHealth Stakeholder Group since 2012. A white paper on teleradiology has been published on insight into imaging and an online survey was conducted in 2012. Recently, HIMSS Europe and the ESR launched the Digital Imaging Adoption Model (DIAM) as a benchmarking programme to guide the adoption of IT supported processes in radiology departments. The model is designed to identify potential gaps in infrastructure and workflow, to monitor technological progress, to enable benchmarking with peer organisations and to provide a roadmap for strategic and operational planning as well as investment decisions.


The adoption of eHealth systems has already revolutionised radiologists' daily routine and, with big data and artificial intelligence, but the next revolution appears to be just around the corner. In cooperation with the American College of Radiology and National Decision Support Company, the ESR has developed the clinical decision support system, ESR iGuide. Using the ESR's referral guidelines based on the ACR Appropriateness Criteria, ESR iGuide can be integrated into CPOE systems to provide actionable, evidence-based guidance to help referrers select the most appropriate imaging test at the point of patient care. In addition, the ESR has been working in cooperation with the Radiological Society of North America (RSNA) on a joint structured reporting initiative. The first step in this cooperation is the creation of structured reporting templates for a template library to cover clinical scenarios suitable for structured reporting. To facilitate the adoption of these templates in practice, the ESR is exploring cooperation with PACS and voice recognition systems. Moreover, the ESR's eHealth and Informatics Subcommittee is publishing a paper on structured reporting in radiology, setting out the ESR's conceptual approach.


Link (registration required):









Radiologists to interact with patients on virtual video consultation


Radiologists are being told they need to interact more with patients - especially before exams or procedures - but this is easier said than done due to many financial, and socio-cultural barriers or to time constraints.

However, in a study presented at RSNA 2017, a group of US researchers from Massachusetts General Hospital illustrate their positive experience with a virtual video consultation model that enabled radiologists to consult with patients without even leaving the reading room. Both patients and primary care physicians expressed satisfaction with the consultations, saying they improved the patient experience and helped them better understand their medical condition. It must be added ror the past decade, that hospital has had an active telehealth program in which physicians from a variety of medical specialties consult with patients in their homes over desktop and tablet computers using Virtual Visit software developed by the hospital itself.


One big advantage of the video consultations over in-person discussions is that it's possible to scale up the project without affecting radiologist productivity too much -- a key consideration for radiologists whose worth is measured by the number of relative value units (RVUs) they produce.


To read the complete article, please visit:







The wonder of 3D-printed models & Virtual Reality

A group of researchers from Imperial College London have developed a 3D printing technique to produce structures that mimic the properties of the softest tissues in the body. These structures may serve as templates for tissue regeneration and to create full human organs. A major challenge in this field is replicating the extreme softness and hollow shape of delicate organs such as the brain and lungs. Cryogenics is the novel aspect of this technology - it uses the phase change between liquid and solid to trigger polymerization and create super soft objects that can hold their shape.

But 3D-printed models could be used for a plethora of different scopes, as recently demonstrated by a Swiss team from University Hospital of Basel, who have been able to generate replicas of stenotic vessels by filling in 3D-printed scaffolds with silicone rubber and at a more affordable price than most other currently available methods. Their technique, which was presented at the RSNA 2017 meeting in Chicago, involves using a fused filament fabrication 3D printer and silicone molding to reproduce the 3D-printed stenosis models.

As the complexity of interventional radiological procedures continues to grow, numerous training protocols for operations have already been established, but most of these practices rely on anatomic phantoms that are generally expensive and rarely tailored to individual patients. A popular alternative to training with phantoms is to use 3D-printed models, which have been estimated to figure among the most disruptive medical technologies together with cloud computing and robotics.

The Swiss team first segmented CT scans of stenotic vessels and used open source 3D modeling software to design a generic stenosis model adapted for angiography simulation based on the scans. They then printed out a negative form of the design with a fused filament fabrication 3D printer to be used as a scaffold for the final model realised made of silicone. Thus, the resulting generic vascular stenosis model allowed the researchers to simulate angiography at a much lower cost (estimated at 8.15 euros) than using typical anatomic phantoms that can cost hundreds of euros. Following the same technique, the researchers subsequently created a different 3D-printed vasculature model based on a CT scan of the forearm, which radiographers/technologists could use to train for vascular access management.


For more information, please visit AuntMinnie´s website:



Virtual Reality, on the contrary, has already a long history of applicability in radiology, although it is still far from mainstream market adoption. Anyway, the idea of performing advanced visualization and complex image analysis for diagnosis in an open 3D space, with all the tools and functionalities available at the touch of a virtual button or voice commands, seem incredibly attractive to physicians today, much more than two decades ago, when Virtual Reality was implemented.


Furthermore, with basic technology requirements far more accessible today in terms of costs, use of Virtual Reality (VR) and Augmented Reality (AR) in healthcare and clinical settings is starting to gain traction. However, other barriers must be overcome: for instance, policymakers and government agencies need to define the ground rules for clinical use and reimbursement; and end-users of the technology need to work closely with the industry to help develop it to fit the needs and customs of real-world clinics.


As an intermediate step, AR for surgical applications and image-guided therapy, which layers 3D images from scanners, segmentations, and measurements on top of the patient directly in the interventional suite, could be  adopted in the mainstream.


Despite VR being very interesting for healthcare applications, quite a few hurdles need to be overcome from the business point of view, as:

  • reduceing the psychological barrier by increasing exposure in and around the healthcare segment.
  • increasing the user-friendliness of VR and AR applications, and developing them in association with physicians and radiologist to directly target their needs and reduce the implementation burden.
  • giving effective proofs VR and AR can help save time and money and increase accuracy in diagnosis.

For further information on Virtual Reality applicability by the health industry, please visit:






Imaging data support innovation


Imaging data are a valuable source of information and may offer more than just providing a timely diagnosis. In particular, data generated by imaging could prove revolutionary in artificial intelligence and quality control. For instance, by comparing MRI tumor stage with the pathology report after surgery, structured reporting systems can allow automatic assessment of accuracy in MRI. Furthermore, specialists can take data from structured reports to use as annotations when training algorithms.


Structured data, vital for optimizing both diagnostics and retrospective analysis, can be accessed in a few mouse clicks. However, relatively few imaging professionals attempt structured reporting, opting instead for free text, in part because vendors so far have failed to develop tools and platforms that would make structured reporting widely available and easy to implement.


A pilot reporting platform developed at Mainz (Germany) will now herald a new era of structured reporting and have an impact on daily reporting practice. It is thought to be the first reporting platform that is fully compliant with Integrating the Healthcare Enterprise's specifications for Management of Radiology Report Templates (IHE MRT).


Read the full article on Aunt Minnie Europe:







ESR to build radiology expertise on the island of Palau


The ESR - European Society of Radiology joined the International Atomic Energy Agency's (IAEA) national workshop on improving radiology clinical and ancillary services on the small island of Palau by sending a radiology expert to offer training and infrastructural advice.  The joint mission is a result of the IAEA-ESR practical agreement on cooperation in the area of diagnostic imaging signed in early 2017.


The national workshop, which took place on Palau in early November, is part of an IAEA project, which aims to improve the quality of radiology services and the ESR was approached to send an expert on its own expenses to train local radiologists, radiographers and referring physicians on basic imaging, radiation protection and awareness. As it is one of the ESR's leading principles to serve the healthcare needs of the public through the support of science, teaching and research and the quality of service in the field of radiology, the invitation to support the mission was accepted immediately.


The joint workshop took place at the Belau National Hospital, which is the only hospital on the island and serves the 20,000 inhabitants of Palau. At present, the radiology department is small and currently consists of eight radiographers and nurses but no radiologist. Diagnostic tasks are done via limited teleradiology services.


Please, read the full story on ESR website:







Radiology in Israel -- Experience from the Land of Innovation at RSNA 2017



The current situation of medical imaging in Israel has been presented by Dr. Jacob Sosna - President of the Israel Radiological Association (ISRA) at the last edition of RSNA in Chicago.


With a population of 8.5 million of mixed ancestry distributed on a very small surface, Israel nowadays counts 5 medical schools and a total of 450 radiologists, many of them trained abroad, especially in North America and in their original countries of origin (e.g. former USSR republics). Health and innovation are both top priorities in Israel, as healthcare expenditures were around 7.3% of gross national product in 2014, compared with the average of 9.3% in Organization for Economic Cooperation and Development (OECD) countries.


Most radiologists work in hospitals and clinics in the public sector, and all have board certification. Undergraduate medical training lasts 6 years, a residency in radiology lasts 5 years and radiology residency programmes are comparable to their Western European and North American models. The academic syllabus is revised every five years. The clinical rotation comprises internal medicine, surgery, or pediatrics, or any combination, while the basic research element must include a written research plan and a scientific report or publication.


Artificial Intelligence and technological applications are widespread in the country, and there has been an exponential growth of visual data over the past decade, with algorithms emerging as a way to categorize this vast amount of data. Finally, Artificial Neural Networks (ANNs) are deep-learning algorithms that are loosely based on the hypothesis of how biological neural networks operate. A key concept of ANNs is backpropagation, in which data are entered into the network and an output is produced.


For more information, please visit AuntMinnie Europe website:







Reinventing radiology at RSNA 2017


Radiologists must remain open to innovation and try to reinvent their specialty each day, according to the President of RSNA, Dr. Richard Ehman who - at the Annual Congress of Chicago - gave a speech on innovation and technological advancements to provide patients with access to radiology´s highest capabilities.

Radiology is permeated with innovation, as pioneers conducted early clinical studies using most recent discoveries of their age to improve the quality of patient service, and due to the fact it takes less time in radiology for a discovery to become part of practice than in other forms of medicine.




RSNA attendees concluded that in order to remain relevant in the future, radiologists should seek out their role in elucidating the multidimensional network that makes up biomedicine and manage the tension between complexity and precision, which involves accurately tracking the evolution of disease. With this goal in mind, they should continue being key pillars in improving the quality of healthcare through imaging, including building a global standard for aggregating all clinical imaging data and collaborate with scientists.


Full article available at:










WMA Declaration of Geneva - The Physician's Pledge


The following Declaration has been adopted by the 2nd General Assembly of the World Medical Association (WMA) Geneva, September 1948 and amended by the 68th WMA General Assembly, Chicago, October 2017.



As a Member of the Medical Profession:

I SOLEMNLY PLEDGE to dedicate my life to the service of humanity;

THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;

I WILL RESPECT the autonomy and dignity of my patient;

I WILL MAINTAIN the utmost respect for human life;

I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;

I WILL RESPECT the secrets that are confided in me, even after the patient has died;

I WILL PRACTISE my profession with conscience and dignity and in accordance with good medical practice;

I WILL FOSTER the honour and noble traditions of the medical profession;

I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due;

I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare;

I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard;

I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;

I MAKE THESE PROMISES solemnly, freely, and upon my honour.



For further information:









Swiss study to reveal global differences in radiation dose for CT scanning


A Swiss study published on the American Journal of Roentgenology and coordinated by Dr. Sebastian Schindera from Kantonsspital Aarau discovered that there are substantial differences around the world in the amount of radiation dose being used for CT scans. Researchers used radiation dose tracking software to compare the dose used in CT scanning by radiology departments from select US and European medical institutions, founding out that there can be wide variation in radiation dose, including sites belonging to the same health network. As an example, CT dose levels measured at California hospitals were up to 240% higher than the dose used at the University Hospital of Basel, in Switzerland.


The study could help standardize and reduce CT dose without compromising diagnostic confidence, ensuring that patients are scanned in a standardized manner, institutions are optimizing their performance, and benchmarks for dose are being set at the national and international levels. Radiology departments around the world have been attempting to establish diagnostic reference levels for radiation dose, and in many locations, these standards have helped to reduce CT radiation doses, although sizable disparities in CT dose persist.


For further information:







The effectiveness of mobile mammography programmes


Mobile units dedicated to breast screening are an innovative solution which is moving in the right direction, according to a recent study published online September 5 in the American Journal of Roentgenology (AJR). The use of mobile mammography screening units alongside traditional stationary sites has increased as facilities try to address issues that prevent underserved women from getting screened, such as transportation, access, and cost barriers.


By detecting some well-known disparities among patients (race, education, socioeconomic status, age and location), targeted interventions could in fact be developed to increase mammography screening rates, with a focus on the traditional US underserved populations.

In addition, the research team found significant differences in patient behaviors between those using the cancer centres versus the mobile mammography units, for instance there is a significant link between location and health insurance status, with more uninsured patients using the mobile van.

The Medical University of South Carolina - a pioneer in this field - uses a 40-ft van to provide breast cancer screening, prevention education, and health counseling for women who have difficulty accessing healthcare or are at higher risk of breast cancer. More than 2,000 free or low-cost mammography screening exams are conducted in the van each year, with service offered almost on a daily basis in Charleston county. The mobile unit's staff includes a patient navigator whose role is crucial for making mobile mammography a success among women who are vulnerable to being lost to follow-up.


Patients using the mobile mammography unit exhibit a higher recall rate, which may align with the overall patient population's lack of adherence to screening mammography guidelines and lack of prior mammography examinations for comparison. However, the significantly lower adherence to recall recommendations in patients using the mammography unit may be because of difficulties in access to the breast imaging center because patients must go to the cancer center for follow-up.

Find out more at:



or visit the website of the AJR:







Radiation protection in veterinary medicine



HERCA is a voluntary association in which the Heads of Radiation Protection Authorities from 32 European countries work together in order to identify common issues and propose practical solutions on topics covered by provisions of the EURATOM Treaty.


In the fall of 2012, the subject of radiation protection in veterinary medicine was raised during the meeting of the HERCA Board. Based on an further investigation, it was noticed that there was an increasing use of more complex imaging procedures (interventional radiology, CT, diagnostic nuclear medicine) and of different radio-therapeutic modalities (metabolic radiotherapy, tele-therapy, sealed sources), which may imply greater risks of exposure of humans to ionizing radiation.




Therefore, education and training of veterinary professionals has been considered crucial in order to keep the exposure of the different humans (as well as of the animals) involved to a minimum. Also, the specific education and training needs, strongly depend on the type of technique or sources that are being used by the veterinary radiologist.


In order to elaborate some indications to the different member countries to develop local requirements for education and training, HERCA has developed guidelines on radiation protection education and training of veterinary professionals. The outcomes are divided into two levels: a basic one for all professionals, and a second additional level, specific to the used technique and this for both the veterinary doctors as for the veterinary assistants/radiographers.


HERCA guidelines are available here:







Imaging, Precision Medicine and the role of screening in cancer prevention: a comparison of US and Norwegian studies


The Precision Medicine Initiative, which former President Obama announced during his State of the Union address in January 2015, wias intended to "pioneer a new model of patient-powered research that promises to accelerate biomedical discoveries and provide clinicians with new tools, knowledge, and therapies to select which treatments will work best for which patients."

The major concern in precision medicine is finding an appropriate therapy, thus requiring  US radiologists to completely change their point of view and focus on the implications for choosing the optimal therapy. For an effective treatment to be considered precise, its efficacy must be correlated with validated biomarkers to distinguish the responder from the non-responder. And because imaging can be done repeatedly, radiologists must also assess a patient's response to current therapy across serial studies.


As a consequence, the success of the Precision Medicine Initiative could apply to cancer prevention, requiring from doctors a clear understanding of each patient's tumoral heterogeneity and individual situation.


The researchers - in fact -  found that certain tumor characteristics formed a signature that was able to capture intra-tumor heterogeneity and could predict how the tumor would react in individual patients.


These data suggest that radiomics identifies a general prognostic phenotype existing in both lung and head and neck cancer," the authors wrote, and This may have a clinical impact as imaging is routinely used in clinical practice, providing an unprecedented opportunity to improve decision support in cancer treatment at low cost."


The incoming future will probably bring further progress in radiomics and imaging genomics will depend upon a certain degree of good cooperation between radiologists, oncologists, biologists and scientists.


Meanwhile, good news come from a Norwegian recent study on the trend of mortality rates for prostate and breast cancers in the Nordic region, which have declined by between 22% in Finland for prostate cancer and 32% for breast cancer in Norway since the 1990s. The drop seems not driven by changes in risk factors but rather by improvements in cancer detection and management, and in particular by favorable contributions from treatment in addition to mammography screening and increased Prostate-specific antigen testing.


Randomized studies and evaluations of the potential effects of mammography screening and PSA testing concluded approximately 20% to 30% disease-specific mortality reductions for both diseases, with higher estimates of overdiagnosis for prostate cancer than for breast cancer, according to the authors.


Concurrent and continuous increases in both breast and prostate cancer incidence rates, fully supports the notion the major proportion of the decline in mortality is not driven by changes in risk factors, like alcohol consumption, but in early detection and effective treatment.

Find more information below:


Precision Medicine:



Cancer prevention in Nordic countries:






The unknown price of Imaging Procedures


US patients would like to know how much an imaging procedure will cost, but healthcare pricing discussions happen in less than half of patient-physician encounters, according to a recent review published in the American Journal of Roentgenology.


In many cases, in fact, doctors and trainees don't even know the accurate costs of imaging tests themselves, while patients may have trouble formulating their financial concerns. To further complicate matters, even if patients find pricing information online, it may not give them an accurate picture of the cost-to-benefit ratio of an exam and on the effective quality of the imaging center. In particular, some physicians are concerned that if patients know the cost of imaging exams, this can mislead them and cause them to select lower-priced providers who might, for example, have older equipment or be less convenient.


Elective medical imaging is most commonly performed in the outpatient setting. As such, radiologists should recognize that patients may frequently consider imaging examinations as shoppable -- and should expect patients to seek price information, the authors of the review noted. More than half of patients are interested in obtaining price information -- particularly regarding out-of-pocket spending -- before they receive medical services, and about a fifth report that they compare price information before obtaining care.


Yet despite the fact that patients want to know how much their healthcare will cost, it's still rare for physicians and patients to discuss the issue: Patients say these kinds of conversations happen in only 14% of encounters with physicians, while physicians say they happen 44% of the time.


Therefore, radiologists should be asked to become aware of what their services cost, and to be able to direct patients to resources that will help them make informed decisions, like a rationale for each exam they recommend.


Find out more on Aunt Minnie:








How safe is MR imaging for patients with cardiovascular implantable electronic devices?


An increasing number of patients - many of which MR conditional - are being treated with cardiovascular implantable electronic devices (CIEDs), and an estimated 75% of patients with CIEDs will have an indication requiring MRI during their lifetime. Despite that, there is a clear lack of literature on the safe scanning of MR conditional CIEDs, as the article in the link below will highlight.


Fortunately, almost all hazards related to CIEDs in MR environments are due to the presence of ferromagnetic content and there are now two main ways to reduce magnetic field interaction. Firstly, through the minimization of ferromagnetic content of the generator and leads, thus limiting the choice of material which should be conductive, durable and biocompatible. The second method is to prevent the ferromagnetic content from interacting with the magnetic field, which can be achieved by using a lower magnetic field strength or by modification of the lead design. MRI-compatible leads can be identified by their vendor-specific identifier which will be covered in a separate section.


Read the entire abstract on Insights into Imaging, via the link below:







Social and education disparities still influence Breast Cancer screening


A recent Swiss study conducted on the population epidemiology unit at Geneva University Hospitals demonstrated how breast cancer screening programmes are still heavily influenced by social disparities.


According to the results, women from low income and education background remain frequently unscreened, although the overall number of screened women rose. Additional interventions besides organised screening are therefore necessary to combat the existence of a socioeconomic status-related gap in mammography screening.















Mean age












Swiss nationality



1,016 (68.8%)



1,898 (85.5%)



1,083 (73.3%)




Year of survey:



412 (27.7%)



439 (19.7%)



242 (16.3%)






379 (25.6%)



455 (20.4%)



267 (18.0)






443 (29.9%)



577 (25.8%)



428 (28.9%)






127 (8.6%)



370 (16.6%)



237 (16.0%)






119 (8.0%)



392 (17.6%)



307 (20.7%)



Never had mammogram



239 (16.2%)



275 (12.3%)



128 (8.6%)




The proportion of unscreened women decreased with increasing educational level, from 16.2% in those with primary education to 8.6% in those with tertiary education, while the proportion of unscreened women decreased from 30.5% in 1992-1995 to 3.6% in 2011-2014.








Special Report on 3D Printing, Virtual Reality and Artificial Intelligence in Radiology practice

(updated February 2018)



The U.K. National Health Service (NHS) has welcomed the use of 3D printing, modeling software and digital design of surgical prostheses to support the daily routine of reconstructive surgery and maxillofacial trauma units. Until now, British prosthetists and surgeons have been learning digital 3D design on the job, but the time has come for trained technicians - as biomedical 3D specialists - to be involved in the screenwork.


Necessary data come from CT scans using the innovative Belgian software Mimics. which allows to visualise the relevant structure in 3D and change the onscreen thresholds to pick out areas of interest on the CT scan such as soft or bony tissue.


Printed prosthetics also can be used in pediatric cases of microtia - for instance, a child who is missing an ear from birth can receive a 3D-printed artificial ear, thus avoiding surgical reconstruction, a difficult procedure due to the shortage of experts worldwide and the number of operations required. When there is no intact or healthy side to a part, a scan from another similar patient could be even used for creating the CAD images needed for 3D printing.Clinical trials have shown that 3D printing is capable of shortening the amount of time patients spend in the operating room -  a major concern of radiologists.

While the era of prosthetic 3D printing is slowly advancing all across Europe and gaining more territory in how it can be used in surgery,  the next step could be the seeding of these printed structures with stem cells to be implanted in patients, leading to unique tailored solutions for those with cancer, congenital abnormalities, and severe trauma patients. Anyway, the high cost associated with 3D printing and the lack of self-education in using these new technologies are the main barriers to bringing it into everyday clinical practice.


Read the full article at:



On the other side of the Atlantic, Dr. Jesse Courtier from the University of California confirmed in an interview on AuntMinnie website that a tremendous increase in both augmented and virtual reality (AR/VR) applications in the field of diagnostic imaging has been recorded. This is due in part to rapid advances in computer processing capabilities that now allow the type of real-time rendering that would not have been possible just a decade ago. The possibilities of moving from 2D representations to true 3D patient-specific holographic models are extremely useful to American surgeons, as the anatomy represented in a 3D way is much more realistic and closer to what they actually encounter when in the operating room. The possibilities of superimposing patient-specific 3D medical objects onto a real-world background have generated new ideas for patient and trainee education, presurgical planning, and even intraoperative use.


However, there are also negative issues related to virtual reality: today's regulation does not specifically stipulate cybersecurity standards at all, and there is no harmonized approach or requirement beyond general confidentiality and security of data. A new regulation -- the General Data Protection Regulation (GDPR) -- coming into force in Europe in 2018 focuses on patient confidentiality, while the new Medical Devices Regulation (MDR) -- set to be enforced in 2020 -- will go some way to address this.


Radiologists have necessarily to adapt to faster workflows and retrain their minds from reading images on printed film to scrolling through stacks of hundreds of images in a few minutes. At a time when our future as a specialty is being questioned due to the advent of technological advances such as artificial intelligence, radiologists are realising they must work diligently to stay at the forefront of technical innovation - Dr. Courtier added!


In January 2018, the most recent statistics and industry researches showed that approximately one in four US hospital radiology departments has either just adopted machine learning or has been using artificial intelligence, with nearly two-thirds of respondents who plan to use machine learning in the future targeting lung studies and chest x-rays, while breast imaging was still the most prominent application.


To view the full article:





Teleradiology is currently one of the most promising areas related to the technological developments of the radiology specialty. In UK, one of the first European countries to have applied teleradiology, providers even have key advantages over the conventional NHS service in terms of working hours, and they can step in to help out when staffing levels fall short of requirements. If a radiology department suddenly finds there is a shortage of staff, for instance, it can send the images electronically to a teleradiology service that has the ability to connect with the NHS reporting system and return results directly to the hospital. This way, providers can be ready Most teleradiologists in the U.K. are NHS radiologists who take on extra work from home, but some have left the NHS and work full-time in teleradiology, Wilson said. There is an argument that the teleradiology service uses the same radiologists who would have been doing the same work in the NHS so it does not alter the overall workforce issues, he said. But it does bring some people back into service who wouldn't be working otherwise, either due to home arrangements, small children, being retired, or because they live abroad.to handle emergencies in the middle of the night if need be.

Anyway, most teleradiologists in the U.K. are simply radiologists who take on extra work from home, only a few have left the NHS and work full-time in teleradiology. During night shifts, for instance, mistakes can happen due to fatigue or being interrupted. There is also an argument that the teleradiology service uses the same radiologists who would have been doing the same work in the NHS so not altering the overall workforce issues. But it does bring some people back into service who wouldn't be working otherwise, either due to home arrangements, small children, being retired, or because they live abroad.

One idea which has been suggested is that NHS hospital groups should create their own teleradiology system, although that solution would be extremely expensive, as the group would require an IT department to interface with all the different systems that vary by hospital.


Read more about teleradiology in the UK on Aunt Minnie:





Control over Patient Data


The last meeting of the European Society of Medical Imaging Informatics (EuSoMII) held in Rotterdam on November 2017 has been the occasion for an interesting debate on the control of patient data in the era of AI based radiology.


From a technological point of view - in spite of several control options allowed by national legislations - it is almost impossible to control every algorithm used in the deep learning space. Sensitive data included in these algorithms can face the risk of being distributed and made circulating across different countries without general public even being aware. Furthermore, although data ownership should be linked to control, this can be a delicate area when the owner voluntarily relinquishes control to some other organisations or entities. This can happen for instance when collected health data is sent into the cloud either by the healthcare provider or the patient himself.


In 2017 machines are already controlling part of the health data, pointing to automatic routines for computer-aided detection and diagnosis, including cancer. Humans and computers will probably share joint responsibility, each controlling part of the data, depending on its purpose, which, in an ideal scenario, should be determined in advance. Such data management and control will increasingly become part of the daily work of all European radiologists.


Find other information on Patient Data here:








Feeble early morning CT productivity in Europe´s imaging departments


A recent internal study conducted by researchers  of the University Hospital of South Manchester (UHSM) in the U.K. found there is very low CT productivity in this large hospital, but simple simple changes in staffing and workflow practices can lead to major improvements, a lesson that could be useful for many other leading university hospitals across Europe.


For the two CT systems in the acute radiology department of the University Hospital of South Manchester (UHSM) in the U.K., researchers collected data retrospectively from the RIS and PACS for every day in June 2016, including weekends.


Even though the machines were scheduled to operate for nine hours a day from 8 a.m., the average number of scans between 8 a.m. and 9 a.m. was 1.6 during weekdays, compared with an average of 5.7 per hour between 9 a.m. and 5 p.m. without mentioning the fact productivity can fall dramatically on Friday. About 93% of patients were scanned within 30 minutes of arriving in the department. Most inpatients arrived in the department after 8:20 a.m., while many outpatients arrived before 8:20 a.m., despite the majority of appointment times being arranged for after 8:20 a.m. The arrival time of accident and emergency patients varied, the research team reported.


Among the resasons of this phenomenon, researchers include:


- Quality control checks were performed at 8 a.m. daily on both scanners, meaning staff weren't ready to start scanning until 8:15 a.m.

- Few patients were in the department before 8:20 a.m. Most inpatients do not arrive in the department before 8:20 a.m., perhaps due to difficulties transferring patients from the ward during busy handover times for nurses and porters.

- Most outpatient appointments were booked after 8:30 a.m.

- There were variations in the number of accident and emergency patients and urgent inpatient scans required per day, as well as arrival time in the department. Elective in- and outpatient appointments can be managed to ensure a minimum number of patients in the department at the start of the day, they pointed out.

- Other unpredictable factors not recorded in the RIS contributing to delays included technical problems with scanners, patients requiring interpreters, and difficult venous cannulation.


Find out more at:





ACR Strategies to optimize radiation dose in CT exams


Concerns about radiation exposure and the risks connected to imaging exams have gained visibility among US patients and healthcare providers, the American College of Radiologists (ACR) recently announced.

CT exams, in particular, are coming under investigation due to the potential risks associated with cumulative exposure, although the benefits could far outweigh the moderate risks.

To enhance patient safety, radiologists and medical physicists have made a commitment that radiation doses should be as low as reasonably achievable (ALARA) -- without compromising the imaging quality required for diagnosis.

At this purpose, the ACR has implemented 8 strategies to optimise the risk-benefit ratio and deliver better patient care:


- Strategy 1: Educate your stakeholders about radiation safety principles


- Strategy 2: Compare your patient doses with national benchmarks to improve practice


- Strategy 3: Emphasize appropriate imaging to ensure each patient has the right exam for the clinical condition and to minimize unnecessary, potential radiation risk


- Strategy 4: Take a more proactive approach to radiation safety


- Strategy 5: Leverage the accreditation process to learn how to balance good quality with the right dose


- Strategy 6: Ensure your CT equipment meets XR-29 standards to avoid reimbursement cuts


- Strategy 7: Communicate health benefits and potential radiation risks of imaging to patients and their referrers


- Strategy 8: Utilize all available resources to help you optimize dose while maintaining quality


Please, read the entire article at:





HERCA Position Paper on Accidental and Unintended Medical Exposures


On 12th May 2017, on the occasion of the 19th meeting of HERCA which brings together the Heads of European Radiological protection Competent Authorities, a Position Paper on "Accidental and Unintended Medical Exposures" has been aproved.

While use of medical radiation is in general conducted to the highest standards of safety, there are still occasions when accidental and unintended medical exposures occur and Member States are required to put in place a regulatory system to address such exposures. Council Directive 2013/59/Euratom Directive identifies that different requirements are necessary to respond to:

- all medical exposures involving or potentially involving accidental or unintended medical exposures - where analysis and record keeping is appropriate

- clinically significant unintended or accidental exposures - where the patient or others and professional staff associated with the care of the patient should be informed

- significant events as defined by the competent authority - where reporting to the competent authority is required and that mechanisms should be in place to share information regarding significant events.


HERCA Position Paper which includes the outcomes of previous surveys conducted amongst its members - focuses on the roles of professional bodies and competent authorities with regard to significant events and other exposures. The paper postulates that different approaches are required for events involving diagnostic and radiotherapeutic exposures.


Link: http://www.herca.org/herca_news.asp?newsID=62





How social networks could help radiologists


For a long time, radiologists have been less visible and active on social networks and virtual media compared to other medical specialists as surgeons. This was also due to the fact radiologists also have less contact with real patients in real life.

Fortunately, the situation is rapidly changing and radiologists now often use social networks as Facebook or Twitter to communicate with colleagues and patients, sharing links to relevant published or in-press articles and exchange experience on their hospital or private practice routine.

But virtual media, in particular Twitter - whose rapidity seems to specifically fit the busy daily routine of medical specialists - could be useful to convey messages of gender equality, diversity and respect, as well as public awareness on major medical battles, as cancer prevention and healthy lifestyles.

Although the European radiological community seems to be less active on Twitter than their counterparts in the U.S, social media have been the protagonists of all the biggest radiological global events, from the American Roentgen Ray Society (ARRS), to the American College of Radiology (ACR) meetings and to the ECR.


Read the full potential of social media for radiology professionals at:






French private radiologists to launch NIML project


The French National Union of Private Radiologists (FNMR) - headed by Dr. Jean-Philippe Masson - has launched a new independent medical imaging project labelled NIML (nouvelle imagerie médicale libérale) aiming at facing old and new difficulties experienced by French radiologists.

Among other issues, it targets the removal from French internal legislation of article 99, which imposes a reduction in the tariff for technical acts for CT and MRI. It also aims to re-establish the code Z supplement, a reimbursement policy recently abolished.

A definitive scheme will be launchedby the Union during the national radiology congress, (Journées Francophones de Radiologie, JFR), in mid-October 2017. The proposal includes the following points:

Increase of MRI units from 12 to 20 per million inhabitants, in line with the European average

- Implementation of permanent local breast cancer screening services

- Preservation of a national imaging network that promotes local care and services in proximity to patients

- Promotion of interventional imaging

- Encouragement and support for information sharing between the public and private imaging sector

- Quality teleradiology based on the Teleradiology Charter

- Wider implementation of quality assurance, ultrasound quality control, and x-ray dose listed in patient health records

- Flexibility of departmental budgets, and reinvestment of savings back into imaging

- Removal of screening acts from imaging's budget


To read more about NIML, please read the full article at:






The problem of unnecessary scans


It has been estimated that 20% to 40% of imaging scans may be unnecessary, according to a recent study conducted in the prestigious Johns Hopkins Hospital of Baltimore. But unnecessary imaging is not just a US concern, as in several other countries radiologists fail to check the validity of CT and MRI scan requests and often ignore appropriateness criteria. In addition, the radiology faculty at Johns Hopkins was surveyed to identify the modalities and specialties that were in the greatest need of utilization improvement. For instance, nuclear medicine clinicians noted utilization issues with PET/CT for paraneoplastic workups for suspected cancer and there have been suggestions to investigate chest x-ray use on admission and for patients in the intensive care unit, body CT and ultrasound scans performed on the same patient, inpatient ultrasound for acute kidney injuries, and CT for acute pancreatitis from body imagers.


To read the full article, please visit:








DBT surpasses FFDM in identifying breast cancer


Digital breast tomosynthesis (DBT) is doing better than Full-field digital mammography (FFDM) in the identification of breast cancer, according to a new study conducted in Germany by a pool of researchers from the Charité -- Universitätsmedizin in Berlin. The German team found the first device tops the latter in detecting the closest tumor margin and has higher sensitivity for assessing margin status.

The authors realised that this significant improvement in closest margin identification by DBT can be mainly attributed to the better delineation of tumor margins and elimination of possible tissue overlapping over parts of the lesions.


To read the full article, please visit:






The importance of Imaging for US Precision Medicine future plans


In 2015, under Obama Presidency, a first important initiative to support Precision Medicine through the contribution of imaging was realised with a massive campaign of federal investments. Two years later, imaging is becoming even more vital to Precision Medicine, as the primary method for observing the unexplored regions of the genome and helping understand the phenotype of the patient.

Moreover, imaging is critical to the POP - Precision Oncology Program, which maintains a public data set that describes the types of cancers, cancer mutations, stages and treatments that can be used to foster cutting-edge therapies and fight against cancer.


Read more on this topic at:





US Radiologists are in high demand


For the first time since 2007, radiologists have landed back in the Top Ten of search assignments for U.S. physicians by the notable recruiting firm Merritt Hawkins, as employment conditions and average salary in the specialty continue to improve.
The specialty's return could be due to an increase in diagnostic imaging procedures, a more limited pool of candidates, and the proliferation of teleradiology services. An improving economy after the 2008 Financial Crisis, a very high percentage of radiologists older than 55 and an American ageing population are further important factors to be considered.

Find out more at:





Misconceptions still persist on radiologist´s daily routine



A recent study recently presented at the last American College of Radiology meeting demonstrated how many misconceptions still persist among patients about the daily duties of a radiologist´s busy workday. A radiologists is often perceived by hospital patients as a commodity rather than a doctor - Dr. Allison Lippert, who led the study - jokes about.


"One of the most important ways for us not to end up in that situation is to have patients who understand and advocate for us. If they don't understand the basics of being a radiologist, how can we expect them to appreciate what we do?" - she added.


Since the advent of PACS, radiologists - with the sole partial exception of interventional radiologists - are becoming even more invisible to patients compared to other specialists, with whom human interaction is frequent. The difference between radiologists, technologists and nurses is often misperceived, as is the inner organisation of the specialty and the role of subspecialties.


Consequently, educational campaigns have been promoted by radiologists in several US hospitals, with the aim of raising awareness on the daily routine of radiologists and their precious role to save patients' lives.


To this purpose, radiologists have found multimedia platforms and social networks to be allies for educating patients about radiology procedures commonly performed in hospitals. A research group led by Dr. Andrew Rosenkrantz of NYU Langone Medical Center analysed the effects of Youtube videos created by imaging facilities, and demonstrated there was still space for improvement.


"Almost 90% of American patients use online resources to research health conditions, diagnosis, and treatment" - Dr. Rosenkrantz commented - and "Online video sharing, rather than traditional static web pages, can be particularly helpful by depicting the examination process in real-time, including interactions with the radiologist and office staff." Yet, many videos fail to mention some core issues as the role of radiologists in comparison with other specialists, the risks of radiation exposure and other safety issues.


Find more on this topic at:







How do radiologists write their reports?

While patients have increasing access to their radiology reports, those with little or no medical literacy may find it challenging to understand the content, as medical documents are greatly mismatched with the level of patient literacy. Making medical reports comprehensible to patients is then critical to achieve the aims of open access to medical information, according to some US researchers.

Previous studies have found that many medical documents and educational materials are written at college level or above. However, the U.S. Census indicates that the average adult reads at the seventh- to ninth-grade level.

Researchers initially hypothesized that writing styles could be objectively evaluated using a measure that takes into account the length of the report and the reader's grade level. The radiologists also received their own readability scores on the two ultrasound cases they had reported, as well as a summary of how one radiologist's writing style compared to another's, according to the group.

The researchers concluded that despite the high level of reading complexity of ultrasound reports, the empirical evidence suggests a challenging but viable pathway for radiologists to improve their writing style.


Read the full article here:








3D Printing plays crucial role in American Radiology


The year 2017 seems to be a period of increasing expansion of 3-D printing in US radiology as in many other medical specialties, as the clinic 3-D printing plays three major roles: surgical planning, patient-specific simulations and education.


3-D printing is an adopted term for the design and generation of physical medical models that traces its roots to the 1980s, when Chuck Hull patented a stereolithography apparatus. Other pioneers like husband and wife team S. Scott and Lisa Crump and Andy Christensen advanced the field through the 1990s.


But it was only over the past decade that radiologists began working closely with surgeons to tap into the technology's potential. In 2008, for example, pre-surgical 3-D models played a central role in helping Mayo Clinic surgeons prepare for the separation of two conjoined twins. Education, in particular, has been significantly improved when three-dimensional models started helping learners and patients to understand diagnoses and potential interventions.


Once focused on non-medical domains, 3-D printing is now becoming integrated into medical care, and implantable, patient-specific printed tissue will soon start to appear, with bioprinting - the printing of models with human cells - is on the horizon.


Read more on the RSNA website:







German Bundestag to pass the first Radiological Protection Act


An EU directive on radiological protection standards has been applied to all the Member States since 2013, but EU directives cannot always be incorporated in an automatic way into national legislation on a one-for-one basis.

In Germany, the Federal Cabinet referred the bill to the Bundestag (the lower house of the Parliament) for consultation in February 2017 and the law is expected to be passed by August 2017, altough it will probably come into force not before January 2018.

The key changes of the new regulation will certainly be the introduction of individual screening, compulsory overdose notification, and the involvement of medical physics experts in X-ray diagnostics.

On the other hand, compulsory overdose reporting could place an additional burden on individual practices and clinics. In the future, medical physicists will have to be available to carry out improvements in the fields of CT and interventions, which is a major challenge, as we need to train a sufficient number of young specialists over the coming years. The introduction of the new 20-mSv annual limit for the lens of the eye will also cause significant problems and expense for some intervention departments.






US researchers examined Gender-based harassment in Radiology


US Researchers from Johns Hopkins University found that 10% of radiologists - including trainees - have experienced sexual harassment at least once in their professional life -- with women making up almost a quarter of these victims. Although women were more likely to witness and experience sexual harassment, they were less likely to report it.
Recent studies have also shown that harassers usually find in their gender, race, and class positions power that 'justifies' their abusive behavior.
Radiology does not seem immune to the problem of gender-based harassment, although
the overall rate remains low, compared to other medical specialties.

Find out more at:




Will Artificial Intelligence replace Chinese radiologists?


In China - a country which has already experienced a severe shortage of radiologists - a young start-up company - Infervision - is using intelligent software algorithms to support human physicians by helping them read images faster and highlight abnormalities in exams.


The algorithms are meant to improve the efficiency of radiologists by eliminating many of their highly repetitive tasks, said CEO Mr. Chen Kuan - but the near future could see a complete replacement of humans, including the next phase of the diagnosis, as detect the likelihood of malignancy when it comes to examine an abnormal result. In addition to developing AI models that can classify abnormalities, Infervision is also developing models for other body areas, such as the brain and stomach.


Read the full article here:





A 2020 future roadmap for Dutch radiologists


The Dutch Radiological Society of the Netherlands has started to design a strategic vision for the future role of Dutch radiologists.

One of the main challenges to face - explains Prof. Hildo J. Lamb - member-at-large of the Radiology Section and board member of the Radiological Society of the Netherlands is to maintain a high-quality, value-based and patient-centered approach while managing an ever-increasing workload.

To be able to cover the entire clinical imaging spectrum, close collaboration between radiologists, colleagues from different specialties and even non medical professionals (e.g. scientists, engineers) will be extremely important, as well as patient engagement.

"We have to shift our role from report generator to imaging consultant as part of a diagnosis-treatment team (...) avoiding the situation where the radiologist becomes a commodity like a digital doctor." - Prof. Lamb added.


Read the full article - originally published on ECR Today - at:





High-deductible health plans to heavily affect US radiologists


In the USA, before the days of Affordable Care Act (the so-called Obamacare), insurance schemes were often based on indemnity coverage that reimbursed patients for their medical bills and physicians had to wait long for their payment.


But, with the advent of managed care contracting where physicians were paid directly by the insurance company, patient balance collections mostly disappeared. Today the pendulum is swinging back in the opposite direction, requiring practices to once again face the need to collect significant balances from patients.


Hospital-based radiologists are among the most affected professionals, because they often have no direct contact with the patient at the time of service, which is the best time to start the collection process. In addition, many patients use imaging services only occasionally and therefore are not as committed to paying their radiologist as they might otherwise be about their primary care doctor whom they see more often. Therefore, radiologists can set up a process that promotes the two-way sharing of patient demographic and insurance coverage information, which is critical to the success of both parties in collecting the full amount due.


Unlike their hospital colleagues, radiologists in imaging centers have at least the opportunity for their own staff to interact with patients to avoid many of the challenges presented by high-deductible health plans. Aware that they will be responsible for some portion of the payment, patients today are searching for the best balance between price and quality.


When it's not possible to determine the amount due at the time of service, some practices are using a credit card reserve system and then the charge is put through once the balance is known. Many credit card processors will allow the cardholder to place a cap on the amount a vendor can charge to their account.


To conclude, high-deductible health plans will not end soon and force US radiologists to new challenges in collecting the appropriate fees for their services, whether performed in the hospital or the imaging center. Interaction with the patient is still the best course of action to reach an understanding of the cost of service and the process expected for collection.


Read the full article on:






TueRad, an e-learning strategy for Radiology


Trainees and medical students of Tübingen University (Germany) can now experience radiology digitally through the TueRad eLearning platform, supported by the German Society of Radiology for its future high-potential. The idea allows them working on case studies with all the functionality of a PACS workstation, and view high-resolution images with no clues or markings, unlike traditional textbooks.

Furthermore, TueRad has the big advantage of being supported by a leading professional association that supervised the whole technology side.

For further information, please contact the German Society of Radiology:


Deutsche Röntgengesellschaft e.V.

Ms. Nina Keil
Mail: keil@drg.de




French scientists create micro X-ray detector


French scientists have developed a tiny x-ray detector at the tip of an optical fiber. By combining a nano-optical antenna (NOA) with indirect detection methods, the team has thus invented a device that is only a few tens of microns in diameter. It could therefore have useful applications in medical endoscopy dosimetry.

At present, the quantity of x-rays detected is dependent upon the size of the scintillator and the resulting photons are emitted in all directions. Therefore, a small scintillator produces very few photons and the likelihood of them emitting in the direction of the camera is low.

The compact nature of the device means it could be incorporated into endoscopy techniques and hopefully used to measure radiation exposure from inside the body during radiotherapy cancer treatment.


Read the entire article here:




US practitioners recommend Breast Screening starting at age 40


Most US doctors have recently recommended women to start breast cancer screening at age 40, according to a recent survey on breast cancer screening published in JAMA Internal Medicine. American practitioners strongly believe in the power of early mammography programmes to save lives, said Dr. Jay Baker, vice president of the Society of Breast Imaging (SBI). The American College of Radiology (ACR) and the SBI, along with other major breast imaging groups and  American Cancer Society (ACS) also agree that women should be informed of the fact that some may be recalled for additional mammograms or ultrasounds, which may obviously cause some anxiety to patients.


Read more about this topic on the ACR website:






US Radiologists among the highest-paid doctors!


American Radiologists ranked sixth on a survey of physician salaries produced by Medscape, with an average annual salary of $ 396.000 preceded by Orthopedists ($ 489.000), Plastic Surgeons ($ 440.000), Cardiologists ($ 410.000), Urologists ($ 400.000) and Otolaryngologists ($ 398.000).


Full data for all the medical specialties are available on Medscape website:







Italian Screening Programmes report 30% drop in Breast Cancer


An Italian breast cancer screening study conducted on more than 400,000 women of different regions of the Peninsula found that screening attendance is associated with a reduction of nearly 30% for cancers of higher stages. Women in regional screening programs were followed for breast cancer incidence over 13 years. The investigators obtained individual data on exposure to screening and correlated this with total and stage-specific breast cancer incidence. Socioeconomic status and prescreening incidence data were also used to assess the presence of self-selection bias.


To confirm that the observed association was not a spurious one, the same team conducted a prospective cohort study of 413,447 Italian women who were invited to participate in regional screening programs. They determined the women's exposure to screening using individual data and correlated it with total and stage-specific breast cancer incidence (European Journal of Cancer, April 2017, Vol. 75, pp. 109-116).


Read the full results of the study at:





ECR 2018 and the future trends of radiology


The incoming ESR and ECR President, Prof. Bernd Hamm spoke with ECR Today  regarding his future challenge next year. Dr. Hamm - who was President in 2015 - talked about his ideas for next year´s congress, whose motto will be "Diverse and United".

Prof. Hamm explained that Radiology is such a diverse specialty - ranging from more and more refined diagnostic options to image-guided minimally invasive treatment options - that, despite these different and interesting facets and subspecialties, radiologists should see themselves as a community and join forces to strengthen our specialty in the best interest of our patients.

Since the ECR has now gained a worldwide reputation for tackling new challenges, despite the fact not all radiologists can come to Vienna each year, the remote sessions will be further increased. "For 2018 - explained Prof. Hamm - we are planning to use ECR Live to offer a special service to our colleagues in China: It is intended to select around 500 presentations to be translated into Mandarin Chinese for the radiological community in China. I am very eager to see how we can realize this and what the feedback will be. This is important for getting more colleagues interested in our society and promoting international cooperation. At the same time, it makes the ECR more visible around the world."

More attention will be also paid to radiographers and to the current hot topics in radiology: big data, artificial intelligence, and radiomics.

At the same time, the ESR Meets sessions aim to provide a special opportunity to the invited countries' radiological community to present topics that are of special interests: special guests of ECR 2018 will be China, Portugal and Switzerland (national symbols as an Alpine flower, a stringed musical instrument and a dragon also figure on ECR 2018 logo).




Cultural diversity and multiculturalism are becoming a distinctive mark of ECR: this will  be reflected in the idea to make available a selection of presentations in Chinese via ECR Live or through the establishment of joint sessions with the radiological Societies of North America and even Oceania.

Read the full article on Aunt Minnie Europe:




COCIR warns against unsafe and obsolescent Medical Imaging Technology


COCIR Secretary General, Ms. Nicole Denjoy urged healthcare providers to replace outdated equipment to improve patient safety in Europe, as obsolescent devices could bring to serious consequences, with a quarter of the European CT installations no longer capable of being upgraded with the latest technological safety measures. Technological obsolescence - warned Denjoy - has been a consequance of the financial crisis of 2007, but Public-Private partnerships and resources made available from the European Fund for Strategic Investments could be used to combat this deterioration in quality.

The benefits to patient safety are irrefutable and not only limited to better quality imaging, but to the fact the radiation dose required to generate images continues to fall in the last generation of CT installations.


Read more here:




Radiologists struggle with defending their territory


Tenacious "battles" to protect their specialty are nothing new for radiologists, as external specialties (e.g. neurology or cardiology) often try to acquire practices once reserved for radiologists, explains Dr. Christian Loewe from Vienna Medical University at ECR 2017.

"We need a clear analysis of the specialty's strengths and weaknesses, and to keep in mind that we're radiologists first," he said. "Turf battles, both outside radiology and inside it, only weaken us."

Dr. Loewe offered eight proactive measures radiologists can take to ensure they are in their rightful place in the healthcare continuum:

  1. Be one step ahead. Radiologists must continue to expand the limits of the specialty, looking for new techniques and therapies.
  2. Be available. After introducing or developing a new technique, exam, or treatment, make it available in rapid time.
  3. Be accessible. "We have to shift from diagnostic radiology to clinical radiology, and take the lead as advocates for our patients: this will help us avoid being replaced by machines."
  4. Be well-trained. "Our training and education is the basis of our success"
  5. Be subspecialized. The imaging field has become too big for general radiology to cover everything. So subspecialization is key to radiology's success, tough the subspecialization is still an addition!
  6. Be together. Radiology needs to stay together rather than fragment into other specialties.
  7. Be transparent. "Document what radiology contributes to the healthcare enterprise and what it means for patients, and then share it with referring colleagues and hospital administrators".
  8. Be focused. The patient should be at the center of radiologists' interest. "Patients are first".

Read the full article here: http://www.auntminnie.com/index.aspx?sec=rca&sub=ecr_2017&pag=dis&itemId=116797





Artificial Intelligence to replace radiologists soon? (updated September 2017)


Radiologists can heave a sigh of relief as robots are unlikely to replace them soon, but a new wave of artificial intelligence androids could take on many of their most repetitive and time-consuming routine tasks soon, while human doctors could focus on advanced and value-based activities. In most countries, radiology seems to be evolving from a traditional medical specialty towards an advanced discipline rich in machine-learning techniques and computer-aided detection products.

Furthermore, there is increasing interest in the field of quantitative imaging - known as radiomics - which requires accurate measurements of imaging biomarkers as indications of disease characteristics. When done manually by a radiologist, this is a time-consuming and often inaccurate activity, while Artificial Intelligence could transform it in a certainly more efficient and accurate tool.

This topic and many more are explored in the Signify Research report, "Machine Learning in Medical Imaging -- 2017 Edition."


Read the full article here: http://www.auntminnieeurope.com/index.aspx?sec=sup&sub=pac&pag=dis&ItemID=613990


According to a recent estimate conducted by McKinsey - the worldwide famous consulting firm - automation of healthcare can result in a saving of approximately 7% of the total costs and therefore it is mostly cherished by corporate, local and national healthcare systems, insurance companies, large hospital networks, and contract research organizations.

In particolar, the work of technologists/radiographers is gradually becoming more standardized, and at higher risk for automation, with an estimated potential of up to 60% to substitute human functions by computer algorithms.

Critics complain there is an excess of digital information and that health policies are still insufficient to respond the specific demands on safe transmission of patient data and the evaluation of diagnostic algorithms.

Other professional just think that - after a period of initial turmoil - disruptive innovations like AI will improve the quality of healthcare and allow physicians to focus more on direct patient relationship and teamwork. Impending U.S. Food and Drug Administration (FDA) approval of first AI-powered diagnostic algorithms will speed up the changes.






Radiologist, one of the best jobs in America!

According to a recent survey published by CNN, radiologist would be considered at n. 45 on the list of top 100 careers in the US, while an average salary of $316,000 would make it the second highest-paid career on the list. Factors that figured into the survey included how meaningful or stressful a job is, as well as how difficult it is to get started in the profession. Anyway, it should be noted the situation in Europe could be quite different and that gender disparities on salaries or stress self-evaluation could negatively affect the radiologists class in EU member states.


Radiology practice

Read more at:






Brexit negotiates and continuity of Medical Profession - UEMS position (Last update: October 2017)


Please find attached below a letter signed by UEMS President to support the continuity of patient care and high-quality standards for the medical profession in the framework of Brexit negotiates.


Please find below in the attachments the discourse of Prof. Andrew Rowland - British NMA representative to the UEMS - delivered at the Fall Council 2017 (Brussels, 20-21 October, 2017).


"Whatever the outcome of the negotiations, some form of regulatory cooperation between the UK and our European partners will continue. If France and Canada can work to coordinate accelerated recognition of professional qualifications across the Atlantic Ocean, then surely the UK and our European friends won't let the 33km of the English Channel stand in our way. (...) The British Medical Association will continue to do everything reasonably possible that we can to work within the UEMS to ensure we have the highest possible standards of medical training across Europe".


Prof. Andrew Rowland

Head of the UK Delegation to the European Union of Medical Specialists






e-Health & Big Data in European healthcare systems



The introduction of digital technology in EU national healthcare systems is now reality: the spread of ICT tools have finally enabled a new frontier in big-data storage that will have a tremendous impact on the national healthcare systems.

For that reason, the new EC report on Big Data & Healthcare recommends the creation of a unified platform (EHRO - Electronic Health Records Organisation) where patients and physicians can access, modify and (eventually) delete data, including sensitive information.

This paper recommends the creation of a European wide connected Electronic

The creation of the EHRO aims at overcoming past challenges faced by member states as the collection of patients' data, its ownership, and processing, including privacy issues.

By sharing personal health information on EU level, patients wishing to receive treatments abroad, will still be able to receive appropriate care and avoid unnecessary medical fees and administrative burdens (e.g. avoidance of duplicate medical tests). On the other hand, practitioners will have a comprehensive view of the patient's medical background, enabling them to offer the most appropriate and rapid treatment.

If individuals will be given the chance to give an informed consent to share their data, this will result in a less problematic approach than making use of data extracted from other sources (e.g. social media, surveys...): eHealth stakeholders, however, should continue to carefully consider ePrivacy and security issues when it comes to discuss their future strategies.


EU Parliament


Serious risk of infection from ultrasound probes inadequate safety procedures


A survey from the European Society of Radiology - ESR sent to 22.000 members in September 2015 has highlighted how about 29% of practitioners do not disinfect ultrasound probes or use inadequate safety measurers during their routine radiological procedures. It is then strongly advisable raising further awareness and good practices amongst radiologists to combat the risk of severe infections - Dr. Christiane Nyhsen, former British delegate to the UEMS/Radiology Section - reported during an AuntMinnie interview.

Please, read the full text here:




Europe´s Looming Radiology Capacity Challenge - A comparative study  by C. Silvestrin


TMC - the largest European Provider of Teleradiology services - has released a report on the current Radiologists Shortage in Europe through comparative analysis.

For further information and your downloadable copy of the report, please visit: https://www.telemedicineclinic.com/blog/european-capacity-challenge/



European Congress of Radiology to become annual meeting for radiographers

In view of an intensified collaboration with the European Federation of Radiographer Societies (EFRS), the European Society of Radiology (ESR) has decided to enhance its annual meeting with the aim of making it the essential European meeting for radiographers too and the expanded scientific programme reflects this development: nine Refresher Courses, two Professional Challenges sessions (both about different aspects of the significance of teamwork between radiologists and radiographers), and one Special Focus session about the role of radiographers in paediatric imaging constitute the core of this programme.

A dedicated Pros & Cons session on ultrasound service, and the EFRS Workshop, organised by the European Federation of Radiographer Societies and dealing with authorship and reviewing, will add to the diversity of the sessions on offer. The 'EFRS meets' session, which has been a regular part of the congress for the last four years, will feature Belgium as its guest country at ECR 2017, with the Association des Professionnels en Imagerie Médicale and the Vereniging Medisch Beeldvormers presenting radiographers' achievements in their home country.


The ESR's well-established 'Rising Stars' programme, which has aimed to reach trainee radiographers from the very beginning, has added the EFRS Radiographers' Basic Session to its programme. The Voice of EPOS, the ECR's platform for poster authors to present their work in moderated poster sessions, will also offer a separate session for radiographers for the first time.


ECR 2017 will take place March 1-5, 2017 in Vienna.

For further info, please contact:

ESR Press Office - Phone: + 43 1 533 40 64-545, press@myESR.org






Recognition of qualifications for Health Professionals


On December 19 2011, the European Commission first published a proposal for a revision of the previous Professional Qualifications Directive based on the outcome of the various consultation processes. On October 9, the European Parliament adopted the proposed legislation, which was followed by the adoption of the agreed text by the Council on November 15, 2013.


The main elements of the directive are the following:


Alert mechanism - Competent authorities of member states will have to proactively alert the authorities of other member states about professionals who are no longer entitled to practice their profession due to disciplinary actions or criminal conviction, through a specific alert mechanism.

Language assessment - Competent authorities will be enabled to assess the language competence of professionals after recognition but before providing access to the profession.

Continuous medical development and education for health professionals - Member states are to promote the continuous professional development of professionals who benefit from the automatic recognition of their professional qualification. This will apply to medical specialists, general practitioners, pharmacists and nurses.

Harmonisation of minimum training requirements - Revised minimum training requirements for some of the healthcare professions, updating of the minimum training requirements for these sectors as well as a requirement for member states to encourage continuing professional education and training.

• Provision of CME and continuing training.

European Professional Card (EPC) for interested professions: an ad-hoc focus group has already been established to implement the professional card

No partial access for health professionals who benefit from automatic recognition, or for other professionals if there are public health or patient safety implications.




Medical Devices industry to target China as the market of the future



China is about to become one of the most "hungry" markets for medical devices, AuntMinnie contributor Owen Tang recently wrote in the new report, China Medical Device Industry Yearbook - 2016.

Yet, the tumultuous growth in the Chinese medical device market is estimated to slow to a significant rate of 15% in the next decade, Tang said, based on long-term tracking and analysis of policies and guidelines, healthcare resources and medical services, as well as population and disease rates.


With a natural population growth rate of 4.96%, and around 10.5% of people older than age 65, Chinese population is rapidly ageing and facing an increase in chronical diseases.

As a consequence, China's healthcare expenses have continued to grow in recent years and reached RMB 4 trillion ($593 billion) in 2015, 6% of China's total gross domestic product, while annual healthcare expenses per person were RMB 2,952 ($438). There are nearly 1 million healthcare institutions in China and the total number of Chinese hospitals increased from 19,712 in 2008 to 27,226 in 2015, mainly due to the growth of private hospitals, which increased from 5,403 facilities in 2008 to 14,049 sites in 2015, a CAGR of 14. 6%.

The total number of patient visits in China in the first half of 2016 reached 3.85 billion, a growth of 2.3% over the corresponding period of 2015. Patient visits to public hospitals and private hospitals reached 1.38 billion and 190 million, respectively, representing growth of 4.6% and 18.5% over the period, respectively.


China has been one of the most important medical device markets in the world for many multinational companies, including imaging vendors, while imaging scanners, in vitro diagnostics, cardiovascular devices, and orthopedics are the main segments in the Chinese medical device market, which together accounted for more than 60% of the total market size.






Saudi Arabia & UAE: the place to be for low radiation Cardiac CT


Saudi Arabia and the United Arab Emirates are in the process to become one of the most advanced hubs in the world for the implementation of dose-reduction techniques for coronary CT angiography, recently stated Dr. Mouaz Al Mallah, Head of the Cardiac Imaging unit at the King Abdulaziz Cardiac Center in Riyadh capital city.


The King Abdulaziz Cardiac Center opened in 1999 but in 2010, the center underwent a major refurbishment and now provides dedicated facilities for cardiac disease management, outpatient facilities, and cutting-edge scientific facilities. The complex aims to provide quality cardiac care to a rapidly growing population (35% of the Saudi Arabian population is under 25 years old).

Together with several other colleagues, Dr. Al Mallah presented their findings at the last congress of the European Society of Radiology in August 2016. The researchers included data collected from 2.919 patients without known coronary artery disease (CAD) from four centers who underwent CCTA to rule out disease between January 2006 and December 2015.


Among the other minor centers involved in the study were the Prince Sultan Cardiac Center in Qassim (Saudi Arabia), and the cardiology department of Zayed Military Hospital in Abu Dhabi.













pdfBig Data in Healthcare report.pdf
pdfThe ESR Clinical Audit booklet Esperanto.pdf

Last updated: Tuesday, March 27, 2018