Specialty in Europe

European Affairs

The UEMS house is located in the heart of Brussels EU quarter – a stone’s throw from the Parliament and the Commission – and the UEMS is naturally very active in political lobbying with EU Institutions, addressing the main challenges faced by European health sector, including standardisation of training, accreditation and practice. The European Union of Medical Specialists has indeed a long-term tradition in defending the interests of medical specialists, as it first convinced the European Commission that health care required a Directive establishing comparable high levels of medical training in the Member States. Further examples of EU-related policy statements are the UEMS Declarations on Quality (Trilogy): Policy on Continuing Professional Development (2001), Promoting Good Medical Care (2004), Ensuring the Quality of Medical Care (2007).

The UEMS is now working in close consultation with other European Medical Organisations (AEMH, CEOM, CPME, FEMS, EANA, PWG, UEMO) and many other scientific Non-Governmental organisations and patient associations.

In collaboration with ESR EU & International Affairs department, the Section of Radiology itself is deeply monitoring the European standards in Medical Training, competence-based training and assessment, Professional Qualifications directives, Cancer Prevention initiatives, Personalised Medicine & eHealth and the most relevant thematic networks and public consultations on the EC Health Policy Platform. In addition, the Section is actively engaged in the fields of education and post-graduate specialist training through the collaboration with the European Society of Radiology, the European Board of Radiology and the most important scientific societies.

The impact of Brexit on Radiology

A referendum was held on 23 June 2016 to decide whether the U.K. should leave or remain in the EU. Leave won by 51.9% to 48.1%. For the U.K. to leave the EU, it had to invoke Article 50 of the Lisbon Treaty, which gives the two sides two years to agree the terms of the split. Prime Minister Theresa May triggered this process on 29 March 2017, meaning the U.K. is scheduled to leave at 11 p.m. U.K. time on Friday, 29 March 2019. This date can be extended if all 28 EU members agree.

Professional consequences after post-Brexit vote

The chronic shortage of radiologists in UK National Health System is becoming dramatic  following the Brexit vote in June, Royal College of Radiologists (RCR) President Dr. Nicola Strickland said in several interviews last month – and the situation is getting worse. A third of UK radiologists already come from abroad and new recruitment campaigns have been launched in the past 6 months, without success. Fears generated by Brexit hurricane and potential visa restrictions led overseas consultants not to fill the vacancies, as uncertainty on British politics would made impossible to relocate with their families to the British Isles. Dr. Strickland added Health Secretary Jeremy Hunt’s proposal to train an additional 1,500 doctors each year will not possibly solve the problem, as only a small number of them will choose the radiology specialty and they won’t even come through the system until 2030.

According to a census released by the Royal College of Radiologists (RCR) on 10 September 2016, demand for imaging services increases, but the supply of radiologists does not, if we just consider that between 2012 and 2015, the consultant radiologist workforce in Scotland grew by 5%, but the number of CT and MRI scans rose by 55%. A key finding is that 99% of U.K. radiology departments could not already meet scan and x-ray reporting demands. Severe diseases as aggressive cancers may go undiagnosed and life-saving treatments become unavailable because of the shortage, while patients would be forced to seek for urgent treatment abroad.

After Prime Minister Theresa May´s decision to support a full and radical break from the EU, the British National Health System – NHS and the Royal College of Radiologists find themselves in a dramatic situation: while the Government has made clear it wants to allow current EU immigrants, a significant part of the the workforce, to remain after Brexit, almost nothing has been done in the last months to combat the increasing shortfall in radiologists, warns the President of the Royal College of Radiologists – Dr. Nicola Strickland. With controls on qualified immigration, recruiting a new generation of radiologists is becoming more and more difficult – Dr. Strickland added – and reliance on teleradiology could be the only solution. Among many other consequences, the European Medicines Agency (EMA) will probably relocate from its current headquarters in London, meaning Britain will lose a prestigious institution in the healthcare field and the power of influencing health policies. Furthermore, UK policymakers still need to decide if to secure a deal with EFTA and how to cope with the European Committee for Standardisation after rejecting the European Union and the related European Economic Area agreements. A complicated transition period in import-export of CE marks and standards, with a bad impact on imaging hardware and IT products in the UK market.

Radioisotope supply has been another significant concern with Brexit, especially with a planned move for the U.K. to leave the EU Euratom regulatory body in favor of its own Office of Nuclear Regulation.While facing Brexit negotiates, the Royal College of Radiology highlighted how most materials for PET/CT scanning are manufactured in the U.K., but the rest of the country’s radioisotope supply is still imported from Europe and other regions, thus creating a serious risk of future shortages if the UK leaves the Euratom treaty under Brexit.

In February 2018, Brexit negotiations were still going on in Brussels, while the health topics risk being forgotten, potentially delaying the availability of new medicines and imposing large costs on patients, hospitals and manufacturers. Healthcare is usually among the most important policy issues to voters at national elections but has largely been absent from the recent Article 50 talks between the EU and UK. That is despite the fact that the UK pharmaceutical industry is one of the country’s largest, with approximately €3 billion of medical devices imported to the UK from the EU-27, compared to exports of €2 billion. Pharma industry leaders have already warned that they face multi-million euro contingency costs, while some clinical trials on new medicines will be put on hold until they have greater certainty on what the UK’s relationship with the EU is likely to look like. Pharmaceutical companies face a multi-million euro bill in regulatory costs regardless of whether the UK reaches a ‘soft’ or ‘hard’ Brexit deal with the European Union.

The agreement on Phase One of the Brexit talks struck in December 2017 protects patients who have already started a treatment when the UK leaves the EU in March 2019, although a ‘hard Brexit’ would pose the greatest disruption for the European healthcare sector and patients, particularly if there is no mutual recognition agreement on clinical trials, batch testing and diagnostics. Patients could face a long delay for new drugs even if the UK swiftly agrees on a free trade deal with the EU, according to the Brexit Health Alliance, similarly to what happens in Switzerland, which starts receiving new drugs an estimated 157 days after the EU, despite having a series of bilateral trade agreements with it, also because drug companies tend to target their new products at the largest markets. Meanwhile, since Britons voted for Brexit in June 2016, the National Health Service – the country’s largest single employer – has been concerned that the health service, which is already facing a staffing shortfall, could be deprived of thousands of EU nationals after the UK leaves the single market at the end of 2020.

Nationals from other EU countries make up almost 10% of doctors in England’s hospital and community health services, and just over 7% of all nurses. However, last available data does not yet suggest that an exodus of EU health workers from the UK has taken place. Around 62,000 known EU nationals work in the NHS, accounting for 5.6% of the total workforce, a slight increase from 5.5% in early 2016. While it is still unclear whether the UK will continue to participate after Brexit in the European Reference Networks, on February 28, 2018 the Brexit Health Alliance, which consists of organisations from the NHS, medical research, industry, patients and public health organisations, warned about the consequences that a “bad Brexit” deal could have on patients with rare diseases. The report remarked the importance of the European Reference Networks (ERN), whose aim is to provide cross-border healthcare cooperation between European countries on treating rare and complex diseases. The European Commission has insisted that the ERNs are significant because almost 30 million patients across Europe suffer from rare diseases.

 

An interview with Dr. Nicola Strickland, President of the Royal College of Radiologists (RCR), on Brexit from ECR 2019:

https://www.auntminnieeurope.com/index.aspx?sec=rca&sub=ecr_2019&pag=dis&ItemID=617048

Healthcare in Europe

European Semester 2019: health priorities

The European Semester provides a framework for the coordination of economic policies across the European Union. It allows EU countries to discuss their economic and budget plans and monitor progress at specific times throughout the year. On June 05, 2019, the European Commission has presented the next steps in the 2019 cycle of the European Semester of economic policy coordination.

For what may concern the health care, reforms of the health systems are ongoing in several countries to ensure the accessibility of healthcare for all, while enhancing their cost effectiveness and sustainability. Member States should continue their efforts, giving priority to the careful design of comprehensive measures and to stepping up the adoption and implementation of health service delivery reforms. Further investment is often necessary to support and implement reforms in the health systems.

http://europa.eu/rapid/press-release_MEMO-19-2815_en.htm

 

EMSA statement on Conflicts of Interest in Medical Education Settings

The European Medical Students’ Association (EMSA) recently adopted the policy paper “Conflicts of Interest in Medical Education Settings” at the General Assembly in Heidelberg on 26/04/2019. Awareness of conflicts of interest in healthcare collaborations and education on how to handle them are essential for the professional and scientific integrity of future doctors. This is being widely neglected in European medical faculties. Therefore, EMSA calls on European medical faculties to: firstly, implement courses on how to deal with conflicts of interest and secondly, adopt a guideline regulating their own handling of conflicts of interest. Furthermore, EMSA calls on European Institutions and member states to raise public awareness for this topic, encourage medical schools to implement courses on the topic and allocate financial resources on training and research regarding conflicts of interest in healthcare. EMSA acknowledges the importance of handling conflicts of interest as part of medical education and commits itself to work on it.

Link to the statement:

https://emsa-europe.eu/wp-content/uploads/2019/05/Policy-Statement-Conflicts-of-Interest-in-Medical-Education-Settings-1.pdf

 

 

EMOs Statement on Prevention of communicable diseases through vaccination

European medical organisations reaffirm that the prevention of communicable diseases through vaccination is safe and very effective. Immunisation through vaccination is the best protection we have against serious, even deadly, diseases.

In recent years, vaccination coverage for children and adults has decreased in many European countries. Vaccine hesitancy has become one of the main challenges and reasons for low vaccine acceptance and uptake. The influence of diverse anti-vaccine groups spreading misleading and often false information has increased, especially on social media. In Poland, a draft law amending the legislation on communicable diseases has been prepared against medical advice, submitted to the Parliament as a citizens’ initiative and rejected only after a decisive protest from medical organisations, experts and public. This example shows that the risk of abolishing the obligation of preventive vaccinations and in due time exposure of many citizens to dangers of serious contagious diseases that are currently controlled by national vaccination programmes is real.

We believe that existing legislation in European countries should in no case be amended to weaken the role and scope of national vaccination programmes. Coordination and cooperation between different European countries should be strengthened to prevent communicable diseases that know no borders. Also, doctors, other healthcare professionals and their organisations are essential to deliver facts based on scientific evidence and increase public awareness about the benefits of immunisation. Our voice based on our professional knowledge and expertise should be listened to, and the facts based on sound science should be respected. European medical organisations call on governments and legislators to assure that vaccination programmes are supported in the best interest of European citizens.

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European Association of Senior Hospital Doctors(AEMH)
European Council of Medical Orders(CEOM)
Standing Committee of European Doctors(CPME)
European Working Group of Practitioners and Specialists in Free Practice(EANA)
European Junior Doctors Association(EJDA)
European Medical Students Association(EMSA)
European Federation of Salaried Doctors(FEMS)
European Union of General Practitioners(UEMO)
European Union of Medical Specialists(UEMS)

 

ECHI – European Core Health Indicators

 

The European Core Health Indicators (ECHI) are the result of a long-term cooperation between the EU Member States and the European Commission. Three ECHI projects (1998-2001, 2001-2004, 2005-2008) funded under the EU Health Programmes established the first lists of ECHI indicators, aiming to create a comparable source of health data at EU level. Definitions and data collection are now in place for nearly 60 out of 88 ECHI indicators. The indicators under development still need further refinement before being accessible in the ECHI data tool. ECHI indicators are grouped under five main chapters: Socio-economic situation, health status, health determinants, health services and health promotion.

A relevant example of health services is the distribution of Computer Tomography scanners and Magnetic Resonance Imaging units per 100.000 inhabitants. Indicators are at the crossroads of policy questions and data sets. They reflect a policy interest as well as a selected set of possibilities in terms of what can be calculated.

Medical Technologies (e.g. CT scanners and MR imaging units have been included in ECHI statistics: Medical technologies: MRI units and CT scanners (I)

 

Facts & Figures in Europe

 

European Quality of Life Survey

Nearly 37,000 people in 33 European countries (28 EU Member States and 5 candidate countries) have been interviewed in the last quarter of 2016 for the fourth wave of the European Quality of Life Survey. This overview report presents the findings for the EU Member States. It uses information from previous survey rounds, as well as other research, to look at trends in quality of life against a background of the changing social and economic profile of European societies. Ten years after the global economic crisis, it examines well-being and quality of life broadly, to include quality of society and public services. Each Member State exhibits certain strengths in particular aspects of well-being, but multiple disadvantages are still more pronounced in some societies than in others, in relation ; and in all countries significant social inequalities persist.

Download the report at the link below: https://www.eurofound.europa.eu/publications/report/2017/fourth-european-quality-of-life-survey-overview-report

On 21-22 June 2018 the new Joint Action Health Equity in Europe was launched in Luxembourg in the presence of the EU Commissioner Andriukaitis. Forty-nine participants from 25 EU Member States work together to address health inequalities and underlying social determinants of health across Europe. Under the coordination of the Italian Institute of Public Health, the Joint Action aims to achieve greater equity in health in Europe across all social groups while reducing the inter-country heterogeneity in tackling health inequalities.

European Observatory on Health Systems and Policies

The European Observatory on Health Systems and Policies supports and promotes evidence-based health policy-making through comprehensive and rigorous analysis of the dynamics of health care systems in Europe. The Observatory is a partnership that includes the Governments of Austria, Belgium, Finland, Ireland,  Norway, Slovenia, Sweden, Switzeland and the United Kingdom; the Veneto Region of Italy; the French National Union of Health Insurance Funds (UNCAM); the World Health Organization; the European Commission; the World Bank; the London School of Economics and Political Science (LSE; and the London School of Hygiene & Tropical Medicine (LSHTM). The partnership is hosted by the WHO Regional Office for Europe.

For further information: http://www.euro.who.int/en/about-us/partners/observatory/about-us

EU Health Policy Platform

 

The Health Policy Platform (HPP) has been presented in Brussels on December 05, 2016. More than 150 health interest groups already registered, an Agora space, 4 Thematic Networks (more to come), and 23 Networks of EC experts and stakeholder groups. HPP is used by other international organisations (e.g.: Steering Group of the WHO European Health Information Initiative). Registered users receive notifications about newly uploaded information. Moreover, DG SANTE has created an online resource centre in the Agora Library of the EU Health Policy Platform with a range of material on new care models and integrated care. The purpose is to offer a structured reference area – a “hub” – where care authorities and other interested stakeholders can find readily available knowledge and tools, to help them build their know-how and capacity to implement integrated care and new care models. This document has collected relevant material, grouped under the following categories: 1. Good Practices 2. Case Studies 3. Tools 4. Guidance for Designing and Implementing Integrated Care 5. Assessing Integrated Care 6. Contracting and Payment models for New Care Models 7. Financing Instruments and Mechanisms.

You can register to the Platform here: https://webgate.ec.europa.eu/hpf/

EU Expert Panels

1) The Expert Panel on effective ways of investing in health is an interdisciplinary and independent group established by the European Commission which could support the EU countries in delivering high quality care and making their health systems more effective, accessible and resilient. The Panel has adopted three opinions related to access to healthcare, innovative payment models for high-cost innovative medicines and performance of primary care.

  • The Opinion on innovative payment models for high-cost innovative medicines analyses how national pricing and reimbursement authorities could improve patients’ access to innovative medicines and foster innovation that matters whilst ensuring that health systems are financially sustainable. The Opinion sets out some broad principles to guide the definition of specific payment models, including greater price and cost transparency, looking at patent law and market exclusivity rules to promote and reward high-value innovations, and using methods to measure the social value of pharmaceutical products, e.g. in the context of Health Technology Assessment (HTA).
  • The Opinion on benchmarking access to healthcare in the EU responds to the request for quantitative and qualitative benchmarks to assess progress in reducing unmet need for healthcare. It is based on the data collected through the EU annual Survey of Income and Living Conditions (EU-SILC), drawing attention to evidence of relatively high rates of unmet healthcare needs in some EU countries. The Panel advised on how to identify the distribution of unmet needs and how to address challenges by mobilising resources at national and European level.
  • Finally, the Opinion on tools and methodologies for assessing the performance of primary care explores how to measure the performance of primary care. It takes account of the complex structure, modes of operating and services provision of primary care, and also of its outcomes, particularly in terms of relevance, equity, quality and financial sustainability. The Opinion translates multiple dimensions into comparative key indicators, and descriptive additional indicators, related to the 10 identified domains of primary care.

More information available on the EU Health Policy Platform: https://webgate.ec.europa.eu/hpf/item/item/8493

2) The European Commission’s Scientific Panel for Health (SPH) is a science-led group consisting of 27 experts based on the provisions of the Horizon 2020 Specific Programme that has been tasked with helping to achieve better health and wellbeing for all.

European Reference Networks (ERN)

 

 

Approximately 30 million European citizens are affected by rare diseases. They face major challenges in diagnosis, treatment and care of their rare and complex conditions. ERNs are virtual networks that use a bespoke IT platform and telemedicine tools to review patient cases. Where possible, they ensure that it is the information that travels, not the patient. With ERNs, patients with rare and complex conditions will be able to benefit from the best treatment and advice available in the EU for their specific condition. Their doctors will have access to a highly specialised pool of colleagues from all over Europe.

The driving forces behind the ERNs are healthcare providers and national health authorities. They show trust, take ownership and have the most active role in the development and functioning of the networks. The Commission’s role, as defined in the 2011 EU Directive on Patients’ Rights in Crossborder Healthcare, is to create the framework for the ERNs. The Commission also provides grants to support network coordinators and provides them with the technical networking facilities.

The 4th ERN Conference (Brussels, November 21-22, 2018) opened a new stage in the networks’ lifecycle, namely the deployment phase. After an intensive period of preparatory actions and awareness raising , the first 24 ERNs are operational.

Health Technology Assessment (HTA)

 

Health Technology Assessment (HTA) refers to the the systematic evaluation of properties, effects, and/or impacts of health technology. It is a multidisciplinary process to evaluate the social, economic, organizational and ethical issues of a health intervention or health technology. The main purpose of conducting an assessment is to inform a policy decision making.

HTA is a research-based tool to support decision-making in healthcare. HTA assesses the added value of new health technologies over existing ones, including medical devices anjd diagnostic tools. HTA is used with a view to improving the quality and efficiency of public health interventions and the sustainability of the entire healthcare system, involving both national and regional players. The European Commission has recently published an inception impact assessment for an initiative on HTA, planned for the fourth quarter of 2017 which will be preceded by a public stakeholder consultation due to be launched in late autumn 2016.

On 22 September 2016, DG SANTE met with EUCOMED and EDMA representatives, both members of MedTech Europe alliance in relation to the recent publication of the DG SANTE Inception Impact Assessment (IIA) on strengthening the EU cooperation on HTA (14 September). Representatives of the European Coordination Committee of the Radiological, Electromedical and Healthcare IT Industry, COCIR were also present as observers. The morning session, hosted by EUCOMED, focused on medical devices while the afternoon session, focused on in vitro diagnostics,  was introduced by EDMA. The objective of the meeting was primarily for the European Commission to present the initiative strengthening the EU cooperation on HTA and to explain the next steps including the imminent public consultation and recently launched studies; and for the medical technologies sectors to provide initial comments on the initiative.

The European Network for Health Technology Assessment currently focuses on a core model for HTA, consisting of nine domains:

  • definition of the health problem and current use of technology;
  • description and technical characteristics of the technology;
  • issues of safety; issues of clinical effectiveness; cost and economic evaluation;
  • ethical aspects; organisational aspects; patient and social aspects; and legal aspects.

The Commission has received some 250 replies to its public consultation on strengthening EU cooperation on Health Technology Assessment, 25% of which from citizens and 75% from stakeholders. Almost all respondents acknowledge the usefulness of HTA and 87% consider that EU cooperation on HTA should continue beyond 2020. Of those who support sustainable EU cooperation on HTA, many think the scope should include pharmaceuticals and consider that medical technologies should also be covered.

Health Technology Assessment: 87% of citizens and stakeholders support EU cooperation beyond 2020

The European Commission’s upcoming proposal on Health Technology Assessment which measure the added value of a medical equipment or device compared to existing ones – will focus on clinical aspects and leave member states free to decide on economic or ethical issues. Therefore, the Commission intends to reassure worried member states and aims at addressing the issue of having multiple national assessments for the same products, with subsequent lack of coordination. In the last years, the challenge posed to national healthcare budgets by the high prices of medicines and medical devices triggered a lot of political discussions and menaced the political values of equity of access and innovation. It is then in the common interest of all citizens that Member States rely more on each other, share information and have more tools at their disposal to help them take informed decisions when assessing the added value of innovative medicines, procedures and equipments.

A legislative proposal on strengthening the EU cooperation on HTA while assuring the principles of proportionality and subsidiarity is scheduled to be adopted by Commissioners on 31 January. HTA is a multidisciplinary process to assess the added value and effectiveness of a given health technology – for example medicine, medical devices, diagnostic tools or surgical procedures, over and above existing ones. The Commission hopes that HTA will be used by member states as a tool to ensure cost-effective, accessible and – most of all – sustainable health systems.

The scope and competences of an EU HTA have divided the member states with the countries that already have an HTA preferring a less centralised role while others wanting a strong mechanism. The EU presidency believes it is essential that the member states have sufficient time at their disposal to analyse the text, which will apparently require coordination between various authorities in each country. The Council recognised that EU cooperation on HTA can support the decision-making of Member States and asked the Commission to reflect about the future of this cooperation beyond 2020 when the current EUnetHTA Joint Action comes to an end. The European Parliament in its Report on EU options for improving access to medicines highlighted the potential of joint assessments for avoiding the duplication of efforts and the misallocation of resources across the EU and urged the Commission to propose legislation on a European system for HTA.

More information available at: http://ec.europa.eu/research/health/index.cfm

Digital Health

 

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. 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.

On 12th May 2017, the European Commission has published the mid-term review of the Digital Single Market (DSM) Strategy. Adopted in 2015, the DSM aims to make the EU’s single market freedoms “go digital” and boost growth and jobs in the EU.

  • The percentage of hospitals exchanging patient information electronically with other health care organisations within the same country ranges from 33% to 39%. Exchange with health and care providers in another EU country is only 4%.
  • 52% of citizens wish to have electronic access to their health records, but only 9% of hospitals in Europe allow citizens to access online their own patient records, even partially.
  • Faster diagnosis and more personalised treatment of rare and complex diseases can be achieved if scientific expertise and data are pooled across borders, significantly reducing the 5.6 years on average that it takes currently to diagnose a rare disease in Europe. An estimated 30-40 million Europeans are affected by rare and complex diseases.
  • Faster diagnosis of infectious diseases and more effective response can be achieved if scientific expertise and health data are pooled across borders.
  • Europe has the highest burden of chronic diseases which are responsible for 86% of all deaths and 77% of health and long-term care expenditure. But only 18% of European citizens have used online health and care services in the last 12 months.
  • By improving interaction between users and health care providers, mhealth can improve quality of services and better planning by healthcare systems. If widely adopted, annual savings in Europe resulting from use of mhealth applications are estimated at € 69 billion.

The White Paper on the Future of Europe – officially presented at the last eHealth week in Malta – notes that by 2030 Europe will be the oldest region in the world. Expenditure on health and long-term care has been increasing in all EU Member States, and is expected to rise even further as a consequence of an ageing population. Despite an increased spending in health and care, there has been a decline in the average healthy life years of citizens across the EU28. Therefore, enabling a better use of the digital technologies may improve the citizens’ health, and address the systemic challenges which our healthcare systems are facing.

 

mHealth

mHealth is referred to as “medical and public health practices supported by mobile devices”. Mobile devices can now be used to monitor, record, analyse, alerts and communicate health information to reach people and professionals remotely. It may deliver behavioural interventions to support individuals to start, reinforce or reduce specific health behaviours. mHealth has the potential to increase accessibility and to contribute to a more person-focused healthcare system, support shifts towards prevention, and improve system efficiency. It could also contribute to making access to healthcare more equitable.

Although the annual growth rate of the European general radiography market has stalled to a near standstill, mobile general radiography systems can be used in a wider variety of clinical settings, including emergency departments, intensive care units, and operating rooms, improving workflow efficiency and patient access to diagnostic imaging. More diversity in the design of mobile digital systems, particularly lightweight and compact systems, coupled with extended battery life, is increasing their versatility for bedside imaging. Hospitals have typically set as a top priority the digitialization of fixed rooms and the replacement , and there is still a sizeable stock of analog mobile systems in use. These will gradually be replaced with digital systems over the coming years. The cost for a digital replacement can typically be justified by the operational efficiency gains and reduced dose associated with digital mobile systems.

With an almost flat growth forecast for the general radiography market in Western Europe, the best opportunities for growth are now located in the East. The Eastern European DR market is – however – heavily influenced by the availability of EU development funds for healthcare projects and the recent announcements that EU funding is to be shifted away from Central and Eastern Europe to the countries worse hit by the financial crisis, (e.g. Spain and Greece), cast a shadow of doubt over the longer-term growth prospects for the region.

Link: http://eurohealthnet.eu/publication/making-link-mobile-health-mhealth

IC Health – Improving Digital Health Literacy in Europe

Citizens’ digital health literacy is now considered an essential element for successful eHealth deployment in Europe. However, citizens often do not have the necessary skills to find and evaluate online health information and apply their knowledge to make health decisions. Digitally health literate citizens are empowered to play a more active role in their health self management, resulting in improved prevention, adherence to a healthier lifestyle and better health outcomes.

IC-Health project will provide support for the improvement of digital health literacy in Europe; in particular, the project will design 35 open access online courses (MOOCs), in eight different national languages, for different population cohorts including for instance children, pregnant awomen, elderly and people affected by diabetes. The Platform is composed of different “rooms”, each one dedicated to a specific community of practice, divided per country. In addition, there is an extra room called ‘Europe’ devoted to the exchange of knowledge and information on digital health literacy at Eu level and to support the creation of a wider network of interest around the work of the IC-Health project.

To register, please visit: http://ichealthplatform.eu

 

 

Personalised Medicine

 

The Horizon 2020 Advisory Group has defined personalised medicine as “a medical model using characterization of individuals’ phenotypes and genotypes (e.g. molecular profiling, medical imaging, lifestyle data) for tailoring the right therapeutic strategy for the right person at the right time, and/or to determine the predisposition to disease and/or to deliver timely and targeted prevention“.

Personalised medicine does not only concern medicines or medicinal products. A better understanding of the biological mechanisms and environmental interactions that govern health and disease will impact the entire health care continuum, from health research to patient care.

The Directorate-General for Research and Innovation has released the Personalised Medicine Conference Report after the conference which took place in Brussels on June 1-2, 2016. This report addresses the broader policy perspective and challenges by showcasing both integrated healthcare models in Member States and business approaches which involve patients more directly in their healthcare. Attached, the Council´s Conclusions on Personalised Medicine for patients. Please find the full report in the attachments below. An International Consortium for Personalised Medicine (ICPerMed) was initiated during several workshops organised by the European Commission throughout 2016. ICPerMed aims to provide a flexible framework for cooperation between its member organisations.

For detailed information on the Personalised Medicine Agenda in the EU, please visit:

https://ec.europa.eu/research/health/index.cfm?pg=policy&policyname=personalised

 

In 2013, the European Commission Health & Food Safety Directorate-General (DG SANTE) published a staff working document (SWD) on the potential use of ‘–omics’ technologies in the research and development of personalised medicine, on recent developments in EU legislation concerning medical devices and on socioeconomic factors affecting the development of personalised medicine. The ESR – European Society of Radiology has released an ad-hoc statement on the topic.

Medical Devices

 

On May 25, 2016, the Dutch Presidency of the Council of the European Union and the European Parliament have reached a draft agreement on the medical devices and in vitro diagnostic medical devices regulations. This agreement comes after a four-year long legislative process initiated by the European Commission’s 2012 Proposal for a Regulation on medical devices and Proposal for a Regulation on in vitro diagnostic medical devices to replace the three existing medical devices directives. The Commission had considered a revision of the existing regulatory framework necessary to enhance the safety of medical devices while allowing patients to benefit from harmonised rules for timely and innovative health care solutions. Devices will in future become fully traceable and patients receiving implantable devices must be informed of the product’s key facts. Non-confidential information will be made available publicly through the central database European Databank on Medical Devices (Eudamed). Another consequence will be the adoption of tighter rules for the notified bodies that are responsible for assessing medical devices, ensuring they have available qualified personnel to conduct factory inspections. The new regulation will also hold manufacturers responsible for continuous follow-up on the quality and safety of devices placed on the market, mandating manufacturers to monitor and act promptly in case emergencies arise.

Among the reactions, Serge Bernasconi, CEO of MedTech stresses the importance of collecting necessary funds from public and private stakeholders (e.g. Governmental Health Agencies, Industry Representations) to fully implement the agreement, and confirms that industry bodies EDMA and Eucomed will actively support their members in the challenging transition towards a new, less bureaucratic regulation. The European Patients’ Forum (EPF) would have expected a closer involvement of patients, but still welcomes the agreement as a means to implement stricter controls on pre-market assessment and post-market surveillance of medical devices, resulting in better safety standards for patients.

The May 25 agreement still needs to be formally adopted by the Council and the Parliament to conclude the legislative process. It is also important to note the transition periods for the new rules, which will apply three years after publication of the medical devices regulation and five years after publication of the vitro diagnostic medical devices regulation. On April 5, 2017, the European Parliament finally adopted two new regulations imposing stricter rules on medical devices’ safety, which, in any case, will not enter into force before mid-2020. The regulations will be fully applicable in three years for medical devices and in five years for in vitro diagnostics.

The two new Regulations bring a number of improvements for medical and in-vitro devices:

  • Improve the quality, safety and reliability of medical devices: The new rules will impose tighter controls on high-risk devices such as implants, requiring a pool of experts to be consulted before placing the device on the market. Controls will also be tightened on clinical trials as well as on the bodies that can approve the marketing of medical devices. Medical devices such as breast or hip implants will be traceable and the post-market surveillance will be reinforced. In addition, the regulation will provide random inspections of producers’ facilities after devices have been placed on the market, as well as stricter controls on notified bodies, which will have to employ medically skilled people.
  • Strengthen transparency: The new regulations will make sure that vital information is easy to find for consumers. For instance, patients will receive an implant card with all the essential information, and a unique device identifier will be mandatory for every product so that it can be found in the new European database of medical devices (EUDAMED).
  • Enhance market surveillance: Once devices are available for use on the market, manufacturers will be obliged to collect data about their performance and EU countries will coordinate more closely in the field of market surveillance.

 

EPF statement for swift and effective implementation of the new EU Regulations on Medical Devices to improve safety and transparency

Patients with chronic conditions rely on medical devices to improve their health and quality of life. Patients have a fundamental right to expect that the devices they use are safe, after being authorised for use in the EU.

The European Patients’ Forum (EPF), an umbrella organisation of 72 patient organisations across the EU calls on the EU Member States, the European Commission and the industry to ensure a swift and effective implementation of the new, improved regulatory framework in a way that will ensure patients’ safety and a transparent regulatory framework. “The system should be fully transparent, with publication of all evidence on safety and quality, as well as public reporting of incidents for devices just as adverse drug reactions are reported”, says EPF’s Secretary General, Nicola Bedlington. “This is vital to restore the trust and confidence of patients and the public in the way medical devices are regulated in the EU”, she added.

As medical devices are produced and circulate all over the European Union, it is important to have common rules to ensure devices on the European market are safe and high quality. In April 2017, following several years of discussions, the EU adopted two new Regulations on medical devices, which replace the existing Directives. The new rules will apply from spring 2020 for medical devices and from spring 2022 forin vitro diagnostic devices.

Stronger safety requirements

The new Regulations will bring important changes for patients, one of which is stronger safety requirements. There are three stages which are crucial for patient safety: clinical investigation, when the device is tested; conformity assessment, when the safety and performance of the device is assessed; and vigilance, which is the ongoing monitoring of risks and incidents once the device is on the market. In our view patients should be empowered to play a role in each of these steps. In particular, patients’ expertise and experiences as users of medical devices needs to be used more effectively in safety monitoring – the long experience with pharmacovigilance has shown that patients’ reports add value and enable any problems to be spotted earlier.

Better information

The new EU Regulations promise better information to patients: an EU database on medical devices, EUDAMED, will be set up and it will be accessible to the public. Patients will be given information leaflets on their implanted devices. An important improvement is that for high-risk, “class III” medical devices, which include implantables, the manufacturer will need to provide a publicly available document summarising the device’s safety and clinical performance. The summary document will be an important source of information for patients and healthcare professionals, and should enable them to make more informed decisions.

The need for stronger controls

Given that a centralised system for approving devices was not going to be an option, EPF called for stronger controls on the notified bodies which approve devices in the EU, to ensure they would not be able to compete by lowering the quality of the assessment procedure and therefore risk patient safety. We believe it is vital that in future the Member States and Commission have control over the notified bodies, and that these are regularly evaluated. The capacity of notified bodies to deliver on the requirements of the Regulation must be ensured.

Patients engage in the implementation process

EPF and our members continue to engage in the implementation process of the EU Regulations. As a member of a sub-group of the Medical Devices Coordination Group, EPF has and will continue to prioritise patients’ safety and call for transparent, easily accessible safety information for patients and their organisations. We have developed materials for patient organisations to inform and enable them to participate in the implementation of the regulations and monitoring of their impact, and continue to work with our community to encourage patient participation at national level.

Patient safety is at the heart of our work for equitable access to high-quality, patient-centred healthcare. Patients across Europe deserve a regulatory system on medical devices that they can trust.

Cancer Prevention in the EU

 

Cancer is still the second leading cause of death in the EU and a major public health concern in terms of disease burden and economic and social cost. There is a constant need for a robust, well informed response to it in order to contribute to the prevention, early detection, and adequate treatment. While responsibility for the delivery of health services lies with the Member States, the European Union contributes to tackling cancer with awareness-raising, guidance and investment in research and fostering cooperation. In 2009, the Commission adopted the Communication on Action against Cancer: European Partnership and established the European Partnership for Action against Cancer (EPAAC). Building on the EPAAC, the Comprehensive Cancer Control joint action 2014 – 2017 (CANCON) aims to help reduce the cancer burden in the EU. It delivered a European Guide on Quality Improvement in Cancer Control. An expert group on cancer control has been established by the Commission in 2014, gathering representatives from EU, EEA and EFTA countries, but also patients´ and professional associations and IARC.

Developed in cooperation with WHO, the European Code against Cancer is a set of 12 recommendations as to how people can reduce their cancer risk: it has been constantly updated since 1987. On December 15, 2017 an important anniversary in the fight against cancer has been celebrated in Europe: 30 years ago the first edition of the European Code Against Cancer (ECAC) was published at a time when cancer awareness was almost insignificant. Nowadays, instead, awareness of cancer prevention is on the rise, as – according to a recent online survey by the Association of the European Cancer Leagues (ECL) – 82% of people understand that people can reduce their risk of getting cancer in the future by making changes to their lifestyle. This an increase on the result of the previous survey (performed in 2015*) when 78% of people believed cancer could be prevented through making lifestyle changes. Tobacco use remains the single biggest cause of chronic disease and avoidable death in the EU. Statistics on deaths in the EU from lung cancer, the cancer most associated with smoking, show that in 2015, there were 273 400 deaths from lung cancer alone, 273 400 too many. Somebody lost their child, parent, brother, sister or a friend. Lung cancer accounts for a fifth of all cancer-related deaths. On top of this, tobacco is also a major risk factor in many other forms of cancer, as well as other major diseases such as cardiovascular disease.

For more than 30 years since the first ‘Europe against cancer’ programme was launched, actions taken at EU level were implemented to extend and save lives. The Commission has been at the forefront of tackling risk factors, promoting screening to detect cancer early, and best practices to help EU countries improve the quality, effectiveness, resilience of health systems and to reduce inequalities in access to health services. Population-based cancer registries are the data providers that enable the monitoring of cancer frequency and collecting information on new cancer cases in well-defined populations. They are critical resources for the clinical and epidemiological investigation of cancer and for the planning and evaluation of cancer prevention and control programmes.

The European Cancer Information System (ECIS) application is a web-based tool conceived and developed by the JRC to report and disseminate cancer burden indicators at European level, on incidence, mortality and survival, from data submitted by around 150 European cancer registries. It provides added value by allowing regional and national comparisons of harmonised cancer indicators, quantifying the burden of cancers and following its trends and changes over time. It can help to understand the causes of certain types of cancer and compare best practices in prevention, diagnosis and treatment interventions.

 

Radiology presence within the EC Cancer Mission

The Cancer Mission is a high-level initiative, launched by the European Commission within the framework of the next Programme for Research & Innovation ‘Horizon Europe’, aimed at driving research on cancer in the EU. In August 2019, ESR 2nd Vice President, Prof. Regina Beets-Tan has been appointed as one of the Members of the Mission Board for Cancer, thus having the opportunity to represent the radiology community within this important body.

For further information:

https://ec.europa.eu/info/news/commission-announces-top-experts-shape-horizon-europe-missions-2019-jul-30_en

 

Initatives on Cancer Control

 

The EU funded cancer research schemes throughout the 7th Framework Programme for Research (2007 – 2013) and provided further support under Horizon 2020 (2014 – 2020), including research programmes into cancer progression to improve treatment and development of new therapies.

The Joint Action on Cancer Control‘s policy recommendations aim to improve the patient’s reintegration to employment and social life. The main messages of this work are: Cancer survivors’ follow-up, late effect management and tertiary prevention needs to be anticipated, personalized and implemented into care pathways, with active participation of survivors and relatives. Improvement of early detection of patients’ needs and their access to rehabilitation, psychosocial and palliative care services is required. An integrated and multi-professional care approach with a coordination of community care providers and services are needed to implement a survivorship care plan that enhances patient’s self-management and quality of life. For children, adolescents and young adult survivors, late health and psychosocial effects of cancer and its treatments need to be anticipated and addressed. More research in the area of survivorship is needed to provide data on late effects, as well as the impact and cost-effectiveness of supportive care, rehabilitation, palliative and psychosocial care interventions.

In February 2018, the European Cancer Information System (ECIS) website was launched on the occasion of World Cancer Day. It is a project supported by the Joint Research Centre (JRC), the European Commission’s in-house science and knowledge service, allowing experts and practitioners to explore geographical patterns and trends. The purpose of this web-application is to support research as well as public-health decision-making in the field of cancer and to serve as a point of reference and information for European citizens.

Link to ECIS: https://ecis.jrc.ec.europa.eu

EC special focus on Breast Cancer

 

The ECIBC – European Commission Initiative on Breast Cancer – is developing recommendations for breast cancer screening and diagnosis. Over the course of the next two years, approximately 90 evidenced-based recommendations regarding screening and diagnosis will be developed and published on this site as they become available. Supplemental recommendations will be developed and updated as new evidence and priorities emerge. Future recommendations will cover other aspects of breast cancer. In addition, on the ECIBC website, you can access information for the 35 countries participating to the initiative. Each Country profile shows breast cancer data, organisation of care, and engagement in ECIBC. The information will be regularly updated and translated into the official languages of their respective countries. Factsheets are saved in the Agora Library, under the Expert Group – Cancer control folder. Finally, the ECIBC Concept Document has been updated and is now published. The document describes ECIBC’s background, general goal, specific objectives and expected benefits and includes information on on-going activities

You can find here the list of recommendations: https://ecibc.jrc.ec.europa.eu/recommendations/

The MURAB project has the ambition to drastically improve precision and effectiveness of the biopsy gathering for cancer diagnostic operations. By reducing the usage of expensive Magnetic Resonance Imaging (MRI) to a minimum in the workflow and at the same time yield the same precision during samples targeting, a new workflow will be offered to the practice. Guided by a novel MRI-Ultrasound (US) registration, a robotically steered US transducer equipped with an acoustically transparent force sensing will autonomously scan the target area and optimally acquire volumetric and elastographic data. An innovative technique, called Tissue Active Slam (TAS), will be developed in the project to optimally register the intraoperational acquired volume to the preoperational MR image. Once that is done, the radiologist can select the target on the mixed image and the robot will steer the instrument to the exact desired pose by adapting the instruments orientation on the basis of real time US measurements.

Home

 

EU-funded IDentIFY project to better diagnose patients

 

An EU-funded multinational project lead by the University of Aberdeen (UK) seeks to massively boost the information that Magnetic Resonance Imaging (MRI) can deliver to doctors, helping them to better diagnose and treat cancer patients. The potential benefits apply to other severe medical conditions, including osteoarthritis.

Innovations developed by the project include developments in the scanner electronics, software and power supplies, better characterisation of environmental magnetic fields and their correction, improved image processing algorithms.

Link: http://ec.europa.eu/research/infocentre/article_en.cfm?id=/research/headlines/news/article_18_06_29_en.html?infocentre&item=Infocentre&artid=49379

Radiotherapy and Cancer care

Today, radiotherapy is a safe and highly effective cancer treatment, using ionising radiation, predominantly high-energy X-rays. Radiotherapy allows cancer specialists to precisely target and destroy tumour cells by delivering the most effective dose possible.
Radiotherapy is recommended as part of treatment for more than 50% of cancer patients. It can be used on its own, or to complement or enhance the effects of other treatments, for example to shrink or control a cancer before and after surgery.

There is evidence that 40% of all cancers cured are eliminated by radiotherapy, either alone or acting in combination with other types
of treatment. Radiotherapy also has a major role in alleviating symptoms and improving quality of life.

If, by 2035, every cancer patient who needs radiotherapy has access to it, almost one million more lives will be saved every year worldwide!

For further news, please read the ESTRO Cancer Foundation White Paper:

https://www.estro.org

Universal Healthcare – World Health Day

 

World Health Day is a chance to celebrate health and remind world leaders that everyone should be able to access the health care they need, when and where they need it.

Access to healthcare for all is one of the major achievements of post-Second World War Europe bringing to reality the idea that all human beings, rich or poor, should benefit from quality medical care without worry that their illness would bankrupt their family. As we celebrate World Health Day, we should feel a great deal of satisfaction for the progress made on our continent in protecting EU citizens’ health and in raising the overall life expectancy. As a cardiac surgeon, and having treated many patients, I have seen how important Universal Healthcare is, especially for the most vulnerable. I have also met many inspiring healthcare professionals, scientists, researchers and social workers who make Universal Healthcare a reality on everyday basis – it strikes pride in my heart to be part of this wonderful union.

But when it comes to health, an important lesson learned is that borders don’t matter in case of health crisis. That is why the EU has now set up a European Medical Corps to dispatch medical experts to tackle health emergencies such as epidemics or infectious diseasesboth inside and outside Europe. The EU is also a leading global donor for health initiatives to boost research and provide support to fight major diseases across the world. Through its international development funding for example, the EU has allocated over €475 million to the Global Fund to Fight AIDS, Tuberculosis and Malaria. The EU also provides around €200 million in humanitarian assistance every year to support health programmes that seek to limit mortality, disability and disease associated with humanitarian crises. That being said, there are still significant differences in life expectancy and exposure to health risks in the world as well as across the EU.  For example, premature mortality rates from chronic diseases are at least twice as high as the EU average in Bulgaria, Hungary and Latvia. Such inequalities are often related to social inequality and caused, in part, by disparities in access to high-quality care due to financial costs and the uneven geographical distribution of doctors within and across EU countries. This is why building a fair and socially equal Europe is a key priority for the European Commission. The European Pillar of Social Rights recently adopted aims to ensure access to social protection for all workers and self-employed individuals in the EU.

This is an important step towards delivering on our commitment to make healthcare accessible to all citizens – not only medical treatment, but also preventive care. Making sure that every single person in the EU has access to health care should be the priority for all national authorities. In this context the continued growth of European Reference Networks will also increase the cooperation across our health systems. These virtual networks facilitate access to specialised healthcare for patients suffering from rare and low prevalence complex diseases.

Although the success of making healthcare available to all ultimately rests with the Member States who are responsible for defining and organising their health policy, services and budget, the Commission will continue to offer guidance in order to decrease the health gaps among EU countries. Together we will be able to make sure that we are doing our utmost so that universal health care is delivered to all, here in the EU and around the world.

 

Education and Training

European Training Requirements

 

The UEMS contributed significantly to the improvement of Postgraduate Training through the development of European Curricula in each medical specialties as well as the elaboration of Training Standards. Back in 1994, in fact, the UEMS adopted its “Charter on Training of Medical Specialists” with an aim to outline the guiding principles for high level Medical Training. With five chapters being common to all specialties, this Charter provided a sixth chapter, known as “Chapter 6”, that each Specialist Section was to complete according to the specific needs of their discipline.

https://www.uems.eu/areas-of-expertise/postgraduate-training/european-standards-in-medical-training

This document – renamed European Training Requirements – aims to provide the basic training criteria for each specialty and should be regularly updated by UEMS Specialist Sections and European Boards to reflect scientific and medical progress.

The European Training Requirements for the specialty of Radiology – based on the revised European Training Curriculum prepared by the European Society of Radiology in collaboration with the Section – was originally approved by the UEMS Council in 2013. The curriculum is periodically amended and the last version has been revised in February 2018, endorsed by the Section on October 06, 2018 and by the UEMS Council on October 20, 2018.

This revised version of the Curriculum outlines a five-year training period consisting of Level I (fundamentals) over the first three years, followed by a more flexible Level II with potential special interest rotations during the last two years. Level III is dedicated to the subspecialisation path. Given the developments of the radiology profession, the Section and the ESR request that the name of the discipline be harmonised to “Radiology”. In order to keep pace with the increasing complexity of medical imaging and growing training needs, they also request that the minimum years of training laid down in the European Directives be increased from four to five years.

European Training Curriculum 2018: https://www.myesr.org/education/training-curricula

 

ETR Reviewing Committee

The ETR Reviewing Committee was established at the UEMS Council meeting in 2013 aiming to support UEMS Specialist Bodies that have produced ETRs to have a comprehensive peer review and possible amendments prior to an open discussion at the Council meeting. Members of UEMS ETR Review Committee are:

  • UEMS Secretary General
  • two of the UEMS Vice-Presidents
  • representatives of the 3 Groupings of the Sections
  • three representatives from the NMAs
  • administrator from UEMS office

The ETR submitted by the UEMS Sections & Boards for vote and adoption by UEMS Council should follow a precise timeframe:

  • first draft to be received by UEMS office no later than 2 months before the Council meeting
  • the draft will be distributed to the ETR Review Committee, NMAs and UEMS Sections & Boards for eventual comments
  • comments from the above mentioned bodies shall be received no later than 1 month before the Council meeting
  • the UEMS body submitting the ETR shall produce a final version of the document no later than 2 weeks before the Council meeting
  • the final document will be published 2 weeks before the Council meeting

European Examinations of the Section

The Section of Radiology is particularly engaged in the field of education and postgraduate specialist training.

 

EDiR – European Diploma in Radiology

The EDiR – European Diploma in Radiology – is an international benchmark for radiologists and is currently a unique and differential advantage over other candidates for a job or fellowship. Created in 2011, it serves the standardisation and accreditation of radiologists across European borders. The examination is open to radiologists and radiology residents in their fifth year of training in compliance with the requirements indicated below.

The EDiR exam consists of multiple response questions, short cases and the Clinically Oriented Reasoning Evaluation. Up to October 2018, 67% of the candidates were ESR Full Members (Europe) and 33% ESR Corresponding Members. Pass rate: 72%.

The application for the EDiR examination can be carried out individually or as a group through hospital heads of department or the corresponding national society.

EBIR – European Board of Interventional Radiology

Activated in 2010, the European Board of Interventional Radiology has obtained UEMS-CESMA recognition in March 2017. Supplemental to any other national qualifications, the EBIR also aims to facilitate the free movement of Interventional Radiologists across and beyond Europe.The EBIR is under the supervision of the CIRSE – Cardiovascular and Interventional Radiological Society of Europe, the ESR – European Society of Radiology – and the UEMS Division of Interventional Radiology. European Board of Interventional Radiology received CESMA appraisal in April 2017.

The 2nd edition of the Curriculum and Syllabus will serve as the basis for the EBIR Examination from March 2018. Preparatory courses for the EBIR are held regularly at the annual scientific meeting of CIRSE, at the European School of Interventional Radiology, the European Conference on Interventional Oncology and through the educational platform ESIRonline.

EBNR examinations

The Division of Neuroradiology collaborates with EBNR to offer EBNR exams in Neuroradiology (EDiNR), in Paediatric Neuroradiology (EDiPNR) & Spine interventional Neuroradiology (EDiSINR). EBNR examinations have received CESMA appraisal in September 2017.

More information at: http://www.ebnr.org

EDiR – European Diploma in Radiology

The EDiR is the European examination offered by EBR – European Board of Radiology and open to radiologists and radiology residents in their fifth year of training in compliance with the requirements. EDiR candidates must be certified radiologists or at least be in their fifth year of national radiology training at the time of the examination. In cases where the radiology training is less than five years, experience as a supervised staff radiologist will be considered. The total of training and supervised practical experience must be four years or more at the time of application.

It has been fully endorsed by the Section of Radiology and has received the appraisal from UEMS-CESMA in 2015. EDiR was recognised as a UEMS examination and examiners involved in EDiR will be granted 2 ECMECS per examination.

UEMS observer in EDiR Scientific Board: H. J. Lamb

UEMS representative in EDiR Standards Committee: M. Adriaensen

The EDiR is recognised as an equivalent of the Polish exit training examination, the first part of the Turkish board examination and the image interpretation part of the Finnish national examination. Moreover, in order to practice radiology in The Netherlands, trainees must either pass their national board examination or the EDiR. It has significant value in many other countries and it is expanding its role beyond Europe. A total of 3121 candidates have taken the examination until April 2019, with a pass rate of around 70%.

Structure:

The examination consists of three parts: Multiple Response Questions (MRQs), Short Cases (SCs) and the Clinically Oriented Reasoning Evaluation (CORE). The committees that form the EDiR Scientific Board follow a structured workflow to prepare each examination, ensuring an adequate peer review system for quality assurance.

Mission:

The EDiR reflects the content of the European Training Curriculum (ETC), which covers every aspect of radiology practice. As such, it is an accurate test of general knowledge of the specialty. An ever-increasing number of heads of department are encouraging their final year residents to take the examination. Taking the EDiR is therefore an excellent opportunity for radiologists to test their excellence and compare themselves to their colleagues overseas. Designed to facilitate professional mobility across different countries, the diploma is an asset for radiologists both in and outside Europe. Diploma holders will have an advantage if they are looking for a job. It’s a test of character. It proves that this person wants to compare him or herself to international competition. As Prof. Paul Parizel highlighted: “It proves that this person wants to compare him or herself to international competition.It shows that this person has that kind of energy, it’s more than just an extra line on their CV“.

The Diploma is becoming more and better known and overall more than 2,000 candidates have applied since 2011 (78% have passed), highlighting the solidity of the exam.

How to prepare for EDiR:

The EBR is investing in new resources and provided new tools for EDiR candidates, including the EDiR preparatory e-book, the EDiR app, and the EDiR blog.

  • The EDiR e-book is intended to be an instrument to help trainees prepare for the EDiR examination. The aim of this book is to provide a standardised study opportunity for radiology residents and facilitate preparation for the exam.
  • The EDiR app, a dynamic, interactive tool accessible anywhere and anytime, will contribute to building an EDiR community. It is an attractive, user-friendly application with many assets for up-dating knowledge, including mock examinations with self-assessment tests, MRQs, short cases, structured reports for CORE preparation, notifications, exam examples, etc.
  • The EDiR blog serves as a complement to EDiR preparation; in addition to the regular cases that EBR Blog readers are familiar with, it has been recently started a series of ‘Flashcard’ cases. The first two are emergency and neuroradiology cases. Other subspecialties will be successively included to teach candidates and guide them through analysis of useful images. In this way, they will be well prepared for the examination.

 

For further information, please contact diploma@myebr.org or visit the EBR website:

http://www.myebr.org/edir/certification-of-excellence/

CESMA – Council of European Specialist Medical Assessment

 

CESMA should become standard setting and accrediting body for all assessments conducted by or with participation of UEMS bodies, and also for other assessments” – Dr. Krajewski and Dr. Borman

CESMA – Council of European Specialist Medical Assessment was created by the UEMS in 2007 with an aim to provide recommendations and advice on the organisation of European examinations for medical specialists:

  • To promote harmonisation of European Board assessments
  • To provide guidelines to the Boards on the conduct of assessments
  • To encourage take up of Board assessments as a quality mark
  • To offer an alternative to National assessments, where appropriate

 

Through the Glasgow declaration in 2007, CESMA set the basis for harmonised standards at the European level with regard to European Specialty Examinations. To the present date, more than 30 European Examinations have been appraised, as marks of excellence in medical specialties. While the European Examinations organised under UEMS aegis are not to be considered as formal qualifications, their quality and renown have increased significantly over the past few years. As a result, some countries recognize European examinations as part of their national examination (more information available in a specific box dedicated to EDiR).

Link: https://www.uems.eu/areas-of-expertise/postgraduate-training/cesma

ETAP 2.0 – Be better. Be certified

 

The European Training Assessment Programme (ETAP) was established in 2001 as a joint initiative between the EAR (European Association of Radiology) and the UEMS/Radiology Section. In March 2017 it was agreed to shift the project to the EBR. The revised version – European Training Assessment Programme 2.0 (hereafter, ETAP 2.0) – is now an equally represented partnership project between the Section and the European Board of Radiology (EBR). The new ETAP 2.0 has been officially presented at the ESR Annual Leadership Meeting in Barcelona on November 18, 2017 and started its activities at ECR 2018.

The certification process is now performed virtually through the ETAP 2.0 platform, which enables an easy, objective and quick assessment.

Goals:

  • improve and harmonise the standards of radiology training in Europe.
  • provide institutions that offer postgraduate radiology education with objective assessment of their training programmes by external assessors nominated by the ESR.
  • develop assessment systems and guidelines for use by postgraduate education authorities at a national level.

The ETAP Working Group, which will become the ETAP 2.0 Scientific Committee after ECR 2018, comprises an equal number of EBR and UEMS members. Candidates from the EBR and the UEMS will take the position of scientific director on an alternating basis. Three EBR members and three UEMS members will also perform the role of assessor on a rotating basis (one lead assessor and co-assessor per assessed institution). A third junior assessor (European Junior Doctors and ESR Radiology Trainees Forum Subcommittee representatives) will perform an advisory role as residents or junior doctors supporting the assessors.

ETAP Scientific Committee:

Chair: D. Negru

Assessors/ Co-assessors (on a rotating basis):
EBR member: O. Dicle
EBR member: V. Koen
EBR member: L. Oleaga
EBR member: F.B. Pizzini
EBR member: P.K. Prassopoulos
UEMS member: H. Aronen
UEMS member: I. Battyáni
UEMS member: H. Helmberger
UEMS member: J.P. Joris
UEMS member: J. Kraft

Trainees organisations/advisory role:
P. Largo – ESR Radiology Trainees Forum Subcommittee
A. Montvila – European Junior Doctors

Collaborators/ Verification of information and documentation provided: Society Delegate to the ESR Education Cte. (from the country of the institution to be assessed) and UEMS National Delegate (from the country of the institution to be assessed).

ETAP 2.0 Phases and levels of certification

 

Phase 1: evaluation of the documentation. Centres interested in being assessed submit the application form to the ETAP office using the ETAP platform.The ETAP Scientific Committee verifies compliance with the eligibility criteria and the centre receives its access credentials for the platform. The centre and trainees complet etheir respective questionnaires and provide the necessary information

Phase 2: video and report. The centre sends a video of its facilities and equipment. No high-quality professional video is required. This verifies the information relating to the facilities and equipment required in the questionnaires, which are filled in by the head of training (report on equipment, including manufacturer, model, year, etc.).

Phase 3: online interviews. Online interviews with the people who fulfil the following functions (adapted to each institution according to their training department structure):

  • Head or a deputy head of the radiology department
  • Head of the education programme
  • One of the trainees’ tutors
  • One attending physician involved in the training programme or a deputy (involved in the training programme)
  • Trainee supervisor
  • At least two trainees (maximum of five, ideally one junior trainee and one senior trainee)

The final outcome of the certification of the relevant training departments is determined using a weighting system for the different areas of evaluation based on the material provided by the institution; namely the questionnaires and information provided by the head of training and the residents, the video of the institution facilities and equipment, and the online interviews.

Levels of certification:

  • Silver: the institution has training standards that ensure adequate training in accordance with the standards set out in the European Training Curriculum (ETC) and covers all aspects of education.
  • Gold: the institution provides a standard of training that is in accordance with the ETC, a subspecialisation programme and basic research training.
  • Platinum: the institution provides an advanced subspecialisation and research training programme and all imaging modalities are available.

CME-CPD & accreditation

 

Continuing Medical Education (CME) consists of educational activities which serve to maintain, develop, or increase the knowledge, skills, and professional performance and relationships that a physician uses to provide services for patients, the public, or the profession. Continuing Professional Development (CPD) is a structured approach to learning to help insure competence to practice, taking in knowledge, skills and practical experiences. It can be defined as the systematic maintenance, improvement and continuous acquisition or reinforcement of the lifelong knowledge, skills and competences of health professionals. (UEMS Glossary of Terms, 2013)

For the UEMS, CME-CPD is:

  • a clinical and professional duty
  • an ethical obligation
  • In the hands of the profession
  • Free from commercial influence
  • From graduation to retirement
  • Meaningful in professional life
  • Affordable
  • at national and European level

 

At EU-level, the role of CPD to help safeguard patient safety within the context of cross border mobility has been addressed in several legal instruments: e.g. Council Recommendation on Patient Safety, including the prevention and control of healthcare associated infections, Directive 2011/24/EU on patients’ rights in cross-border healthcare, and Directive 2013/55/EU on the recognition of professional qualifications. National Accreditation Authorities and UEMS Specialty Boards perform professional evaluation of CME-CPD activities through European CME credits (ECMEC). In order to facilitate the transfer of credits between European countries, 1 ECMEC equates to one hour of CME, with a maximum of 6 ECMECs for a day and 3 ECMECs for half a day.

Survey: the status of CME-CPD in Europe

 

Coming soon!

EACCME – European Accreditation Council for Continuing Medical Education

 

The UEMS established the European Accreditation Council for Continuing Medical Education (EACCME), in January 2000, with the aim of encouraging high standards in development, delivery and harmonization of continuing medical education. This was to be achieved through the international accreditation of CME events, and the establishment of a system for the international acceptance of CME points. Agreements in place with the American Medical Association (AMA) and the Royal College of Physicians and Surgeons of Canada (RCPSC) for mutual recognition of credits enhance the international status of EACCME. In April 2009 the UEMS-EACCME launched the accreditation of e-learning materials. By e-learning is meant the delivery of CME-CPD by methods including: recorded audio, recorded visual, recorded on Compact Disc (CD), recorded on Digital Versatile Disc (DVD), available on Personal Digital Assistant (PDA), available online via an educational website, or any mixture of the preceding. The UEMS-EACCME sets itself as the central link between the National Accreditation Authorities (NAAs), the UEMS Specialist Sections and Boards (S&Bs), the European Specialty Accreditation Boards (ESABs) and the Providers of CME activities.

EACCME 2.0

  • Application-review-accreditation: faster and more efficient
  • faster path for “Trusted Providers”
  • Brand new IT platform
  • Embrace state of the art educational events (e-platforms, e-libraries, apps)
  • Accreditation portfolio: new forms of CME-CPD activities
  • More emphasis on quality control of events
  • Recognition of professional qualifications
  • Embrace a broader spectrum of healthcare professionals

 

Towards EACCME 3.0!

Stay tuned!

 

For detailed information, please visit: https://www.uems.eu/uems-activities/accreditation/eaccme

 

ACI – Accreditation Council in Imaging

 

The European Board of Radiology is an organisation dedicated to the investigation, development and implementation of certification and accreditation activities and programmes, including examinations and other instruments of qualification/certification for general and sub-specialised physicians, programme evaluation and accreditation of continuing medical education activities, accreditation of training institutions and similar organisations, as well as monitoring and harmonising qualification and training standards in the field of radiology, imaging diagnosis in Europe. The specialist body of EBR, which is carrying out the proceeding of the accreditation in collaboration with the EACCME, is called Accreditation Council in Imaging (ACI).

ACI started its activities in January 2016 and now has a leading position in Europe and beyond. 530 applications have been received since January 2016.

The Section is an important link in the fruitful collaboration between the EACCME and the ACI: official agreements have been signed in 2015 and amended in 2016 and 2017. Today, radiology – together with oncology and cardiology – is one of the UEMS specialties with the largest number of applicants for event accreditation.

As part of the agreement, UEMS and EBR representatives lead ACI on alternate basis (biannual mandate). Since 04 March 2019, Prof. Miloš Lučić is the new ACI Scientific Director.

Representatives of the Section sit in the two ACI Scientific Committees. In particular: Prof. P. Ricci is the UEMS representative in Policy Committee, Prof. H. Aronen and Dr. R. Demuth in Reviewing Committee. According to ACI Rules of Procedure, mandate of ACI Committee members is now made biannual.

Since European accreditation systems differ not only from one another, but also with regard to their equivalence to ECMEC credits, in 2017 the ACI conducted the survey “Accreditation systems in Europe” in an attempt to collect relevant data on accreditation systems in Europe, and regarding significant preferences of the European radiological community on Continuing Medical Education (CME). Recognising the globally emerging generation shift not only in radiology, but also in the generation-dependent level of readiness to use current and future technologies in radiology and education, the ACI conducted a new survey in June 2018 on the future of Continuing Medical Education (CME) and Continuing Professional Development (CPD).

Given the fact that not only radiology, but our whole world, is becoming technology-oriented and technology-based, the ACI applied the generation scaling that is generally accepted in global social sciences terminology, dividing the generation distribution into various groups: the so-called Silent Generation/Traditionalists, born before 1946; Boomers/Baby Boomers, born between 1946 and 1964; Generation X, born between 1965 and 1980; Generation Y, also known as Millennials, born between 1981 and 1994 and Generation Z, born after 1994.

The overall results indicate that most respondents know how to earn CME credits (68.56%). However, it is evident that the best-informed radiology population are the older generation groups —Silent Generation/Traditionalists (80.95%), Boomers/Baby Boomers (78.73%) and Generation X (71.15%)— in comparison to Generation Y, with a much lower number of informed respondents (47.62%). It is also notable that in the same group the lack of knowledge about how to obtain CME credits, or the need for more information, is over 50% (52.38%). This unexpected fact is a cause for alarm, and should be understood as an immediate “call for action”, to inform younger generations of radiologists about how to earn CME credits.

With regard to CME credits obtained through attending Live Educational Events (LEEs) and E-Learning Materials (ELM), it appears that the great majority of radiologists and other radiology professionals, regardless of generation, are still earning the largest number of CME credits in a traditional way (LEEs), which includes congresses, seminars, courses and schools. We can see a slight shift among Generation Y respondents, together with a slight but observable increasing trend in earning more CME credits through ELM among the younger generation groups, indicating an easy and slow generational shift towards ELM.

ESR Education on demand

Please note that the current website will close on December 31, 2018.The new website of ESR – Education on Demand will be launched in spring 2019.

ESOR – European School of Radiology

 

The European School of Radiology (ESOR) is an institution, fulfilling the mission of the European Society of Radiology (ESR) in the field of education. One of its main goals is to assist in harmonising radiological education in Europe. With its wide range of activities ESOR additionally aims to raise standards in the field of scientific radiology, to extend and coordinate teaching resources worldwide and to help young radiologists to achieve the knowledge and skills to fulfil tomorrow’s requirements.

ESOR celebrates successful first Asklepios Course in Thailand (July 20-21, 2018). Following the success of this first course, the continuation of this ESOR programme in South-East Asia in 2019 was confirmed.

Link: http://esor.org/cms/website.php

 

Eurorad

 

Eurorad – a project of the European Society of Radiology – is the largest peer-reviewed databse for radiological case reports, containing more than 7.000 published cases and is continuously growing. Celebrating its 20th anniversary, the brand-new website of Eurorad includes a fast and efficient search engine, Editors Selection of cases, teaching cases with quiz questions and much more.

Eurorad website (on the left column) is free to access.

 

Survey: Interventional Neuroradiology in Europe

 

The current framework of Interventional and diagnostic Neuroradiology in Europe still presents significant differences in training and practice. In view of the preparation of the “European Training Requirements in Interventional Neuroradiology” – unanimously endorsed by the UEMS Council on April 13, 2019 – the Section of Radiology and the subspecialty Division of Neuroradiology have launched in September 2018 a survey on the situation of Neuroradiology training and Neuroendovascular practice in Europe. The survey has targeted radiology societies and national delegates from 31 UEMS member countries, belonging to the European Union, the European Economic Area and the Council of Europe.

The results of the inquiry have been summarised in the table and in the conceptual maps on the left column.

 

Edited by:

Dr. Francesca B. Pizzini – Secretary General, Division of Neuroradiology
Mr. Francesco Tanzi – Secretariat, Section of Radiology
Prof. Marek Sasiadek – President, Division of Neuroradiology
Prof. Paolo Ricci- President, Section of Radiology

 

 

 

 

Question 1 – Specialty school/Fellowship in Neuroradiology

 

□ Yes

□ No

□ N/A

□ Not answered

Question 4 – Neuroendovascular procedures performed by Interventional Radiologists

 

□ Yes

□ No

□ N/A

□ Not answered

 

Question 6 – INR Training required

 

□ Yes

□ No

□ N/A

□ Not answered

Practice

General Data Protection Regulation

 

On January 25, 2012, the European Parliament and the European Council have adopted a first draft proposal for the regulation of sensitive personal data with particular regard to their processing, movement or distribution. This had been done to address the uncertainty of a very fragmented legislative framework between 28 Member States and since the last concerning Directive had been adopted in 1995 (Directive 95/46/EC).

In the field of health care, this first proposal has provoked a massive request from medical professionals’ organisations, patients´ associations and industry representatives for a more balanced approach to the topic, allowing access to health data and statistics for research purposes. After prolonged discussions, a revised agreement on data protection has been adopted by the European Parliament in April 2016 and officially published in the EU Official Journal on May 04, 2016. This Regulation (EU – 2016/679) will apply from May 25, 2018, meaning that Member States still have two years to transpose the provisions of the directive into their national law. It is an essential step to strengthen citizens’ fundamental rights in the digital age and facilitate business by simplifying rules for companies in the Digital Single Market;

Main outcomes are:

  • Personal consent should be given by a clear affirmative act establishing a freely given, specific, informed and unambiguous indication of the data subject’s agreement to the processing of personal data, such as by a written statement or by electronic means.
  • Processing of personal data for archiving purposes in the public interest, scientific or historical research or statistical purposes should be subject to appropriate safeguards for the rights and freedoms of the data.
  • Right to data portability, including the health sector. Furthermore, the data subject will have the right to obtain any automated data which are processed using consent as the legal basis for processing in an easy-to-read format. This could mean hospitals and health and care providers being asked by patients to receive their electronic data in an appropriate format.
  • Establishment of an independent supervisory authority for processing personal data at national/regional level which should be provided with the financial and human resources, premises and infrastructure necessary for the effective performance of the tasks.
  • Genetic data should be defined as personal data relating to the genetic characteristics of a person which result from the analysis of a biological sample from the person in question, in particular chromosomal, deoxyribonucleic acid (DNA) or ribonucleic acid (RNA) analysis.
  • Data subject shall have the right to obtain from the controller the erasure of personal data concerning him/her without undue delay and any person has the right to have their personal data rectified or ‘the right to be forgotten’ but it still allowed the further retention of data when necessary in the public interest or in the exercise of official authority vested in the controller, for reasons of public interest in the area of public health, for archiving purposes in the public interest, or scientific and historical research purposes.
  • Children and consent – parental prior consent is required for use of an under 13 year old’s personal data. Member States are free to set their own rules for those aged 13-15. If they choose not to, parental consent is required for children under 16.
  • Data Protection Officer: organisations/companies above 250 employees must appoint a Data Protection Officer (DPO). This post can be shared with other organisations.
  • National data protection authorities, also called supervisory authorities will continue to exist to protect fundamental rights in relation to data processing and to facilitate the free flow of personal data within the Union. Some countries (e.g. Germany) can keep more than one supervisory authority, but one of them has to be nominated as the representative on the new European Data Protection.
  • Creation of the European Data Protection Board, which is established as a body of the Union with legal personality. The Board shall be composed of the head of one supervisory authority of each Member State and of the European Data Protection Supervisor and will ensure the consistent application of the Regulation, together with opinions, guidelines and best practices.
  • Introduction of levels of fine up to 4% of the annual worldwide turnover for companies who misuse personal data, abuse the rights of the data subject or fail to implement requirements of the Regulation.

To summarise, the new regulation provides a more balanced approach between protecting privacy and making sensitive data available for research projects, where grounds of public interest (e.g. public health purposes) allow it. The processing of personal data concerning health may still be necessary for reasons of public interest in the areas of public health, without consent of the data subject. This in the consideration of the fact that sensitive data could be used to:

  • better understand diseases and improve treatments
  • understand patterns and trends in public health
  • plan services that make the best of limited financial resources
  • monitor the safety of drugs and treatments
  • compare the quality of care provided in different states of the Union.

Once again, the new regime does not entirely rule out the relevance of national provisions. As stated in Recitals 8 and 10, in fact, the Regulation provides a margin of manoeuvre for Member States’ to restrict or specify its rules.

In addition to the EU legislative framework, the Organisation for Economic Cooperation and Development (OECD) establishes that “Informed consent has become the pillar for protecting individual’s autonomy where research involves human subjects.” In particular, the OECD data protection legislation grants patients (as data subjects) a number of rights once identifiable data are processed. The following are included:

  • to be aware of the processing of their data, its purposes, the identity of the data controller, the identity of the possible recipients of the data;
  • to have access to a copy of the information comprised in their personal data;
  • to object to processing;
  • to prevent processing for direct marketing;
  • to object to decisions being taken by automated means;
  • to have inaccurate personal data rectified, blocked, erased or destroyed;
  • to claim compensation for damages caused by a breach of the Privacy Directive.

Member States are allowed to apply more stringent rules to legitimize the data subject’s consent, through the provision of written consent or preventing consent from being the sole basis to authorize the generally prohibited processing of personal health data. The data subject may always revoke the given consent at any time and without justification. This will impede further processing, but not making past operations retrospectively unlawful. Consent must be a “freely given, specific and informed indication of the data subject’s wishes”. The Privacy Directive does not require the consent to be in written form.

  • Freely given consent: “Free” consent means a voluntary decision, by an individual in possession of all of his faculties, taken in the absence of coercion of any kind, be it social, financial, psychological or other. Furthermore, agreeing to undergo a certain medical treatment does not automatically furnish an explicit consent to the processing of personal data collected during such treatment.
  • Specific consent: “Specific” consent must relate to a well-defined, concrete situation in which the processing of medical data is envisaged.
  • Informed consent: “Informed” consent means consent by the data subject based upon an appreciation and understanding of the facts and implications of an action: The individual concerned must be given, in a clear and understandable manner, accurate and full information of all relevant issues (…) such as the nature of the data processed, purposes of the processing, the recipients of possible transfers, and the rights of the data subject. This includes also an awareness of the consequences of not consenting to the processing in question.
  • Consent withdrawal: The consent could be considered as the weakest way to process data as the data subject has a total control on it without any consideration on the “scientific interest” for the whole society. The withdraw of consent may occur damage to the data controller as it can invalidate all the research in some cases even when the data subject has no real or valid reason.

Link to EC Data Protection Regulation: https://ec.europa.eu/info/law/law-topic/data-protection_en

How does every EU country processes Health Data afther GDPR? The EU-funded AEGLE project has prepared several updated country reports:

http://www.aegle-uhealth.eu/en/aegle-in-your-country/the-campaign.html

 

Since the new rules will come into force on May 25, 2018, the ESR – European Society of Radiology has prepared a paper on The EU General Data Protection Regulation: what the radiologist should know includeing an overview of the most relevant legislation applicable to radiologists, a glossary and concrete examples of the impact of GDPR on clinical practice.

 

Regulation of Professions

EU Proportionality Directive on the regulation of professions

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 were 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.

In 2016, regulated professions accounted for about 22% of the European labour force, representing around 50 million citizens. As part of the value chain and their role as input to production processes as well as their output, services provided by professionals, such as engineers, architects, accountants, lawyers, are crucial to the functioning of the European economy more broadly and across sectors. Excessive regulatory barriers to professional entry have negative consequences for job creation, productivity, mobility and the consumer who is forced to pay higher prices by a less competitive market.

Professional activities are regulated by Member States at national, regional or sometimes at local level. Securing the modernisation of the regulated professions and in particular the review of reserves of activities and the cumulative impact of measures requires that proper proportionality analysis be carried out at national level.

The first European Commission´s proposal for a Proportionality Directive in the regulation of professions was presented on January 2017, and since then the co-legislators have moved at very different speeds: while the Council completed its negotiations in the adoption of a general ap-proach in May 2017, the European Parliament is still in the early stages of adopting its position and a decision is expected for the autumn.

The right to work in the sense of the freedom to pursue one’s chosen profession or to conduct a business is enshrined in the Charter of Fundamental Rights of the EU. The key benefits of the EU Single Market include the freedom of establishment and the freedom to provide services.

The proposal will introduce a general obligation for member states to carry out an ex-ante proportionality assessment before adopting new or modifying existing legislation restricting access to or the pursuit of regulated professions. It must be also considered that economic considerations can only partially affect the health professions, as patient safety and access to healthcare are equally important.

The first deliberations of the European Parliament have proposed more extensive changes to the draft Directive, including an exemption for health professions as included in the draft Report of the Commit-tee for Internal Market and Consumer Protection (IMCO) and in the draft Opinion of the Committee for Envi-ronment, Health and Food Safety (ENVI). Several health organisations have raised their voice concerned by the potential impact of the Directive on their practices: as an example, CPME, alongside other health stakeholders, in particular the Council of European Dentists (CED) and the Pharmaceutical Group of the European Union (PGEU), have highlighted the fundamental difference of conceptual approach to regulation demonstrated by the draft Directive in comparison to the rationale for regulating doctors and other health professions.

On 4 December 2017 the European Parliament’s IMCO committee took the vote on its position on the Proportionality Directive. On the crucial issue of the exemption of health professions from the Directive, the proposal was defeated (by 20 votes to 15). The European Parliament will therefore now go into negotiations with the Council without a clear mandate to exempt health professions. A special status could in any case be granted health professions, which may help to mitigate the Directive’s impact.

Link: http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=COM:2016:0822:FIN

Declaration of Geneva – The “Modern Hippocratic Oath”

 

The Declaration of Geneva is one of the World Medical Association’s (WMA) oldest policies adopted by the 2nd General Assembly in Geneva in 1947. It builds on the principles of the Hippocratic Oath, and is now known as its modern version.

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: https://www.wma.net/policies-post/wma-declaration-of-geneva/

Gender equity – Women in Radiology

 

Although important measures have been taken and radiology seems to be one of the few medical disciplines in which female and male academic physicians make the same salaries, incentives to combat gender bias in the radiology profession are still needed to encourage diversity and the inclusion of women among researchers, according to a recent study published on June 13 in Academic Radiology. While gender disparities in clinical practice have been deeply investigated in the last few years, but disparities in radiology research and publications have not been tracked as closely, according to the US team of NYU Langone Medical Center, who conducted the study. To investigate challenges to radiology research and publication for women in radiology, they sent an electronic survey to 280 members of the American Association for Women Radiologists in September and October of 2017. The researchers received 89 surveys, for a response rate of 31.8%. Of the survey respondents, 61.4% indicated they were interested in conducting radiology research and 60.2% stated their departments expected them to do so. However, 80.7% of respondents also noted that their departments expected them to conduct educational activities.

The authors also found the following:

  • 56.8% of survey respondents felt their research success was valued by their department.
  • 47.7% felt they received appropriate credit for their research.
  • 41.6% had ever had a female research mentor.
  • 23.9% believed that their department makes deliberate efforts to support women’s research.
  • 22.7% felt they received sufficient time for research.

Respondents listed family or child care issues, unconscious bias at the department or chair level, exclusion of women from research activities by male researchers, and concern about being perceived as “aggressive” as key barriers to conducting radiology research and stated that dedicated research time (40.4%), personal research mentors (23.6%), and earlier career training in research methodology (21.3%) were the most helpful factors for research success.

The findings suggest that a number of interventions are urgent to foster the research success of women radiologists, including dealing with conscious and unconscious bias among departmental and institutional leadership; establishing start-up and ongoing research time and access to department resources; putting work-life balance and child care policies in place; ensuring research tracks are available to both men and women in the department; and providing training in research methodology, negotiation skills, and leadership.

If you want to find out more on this topic, do not miss the following articles published on Aunt Minnie.

https://www.auntminnie.com/index.aspx?sec=sup&sub=imc&pag=dis&ItemID=121054

https://www.auntminnie.com/index.aspx?sec=rca&sub=rsna_2017&pag=dis&ItemID=119261

https://www.auntminnie.com/index.aspx?sec=rca&sub=rsna_2016&pag=dis&ItemID=116030

 

A comparative study with Nuclear Medicine

 

In the US and Canada, men still outnumber women in academic performances and leadership positions of nuclear medicine by almost 6-to-1, according to a recent study published in the January issue of the American Journal of Roentgenology. In particular, researchers found that men occupy 86% of the leadership ranks despite the genders having comparable research experience.

These results show the need for devising strategies to promote diversity in leadership roles and tackle gender disparity in academic and leadership positions across nuclear medicine specialists.

 

Nuclear medicine academic faculty members by gender (as of 2018):
 Position Male Female
Professor 35% 16%
Assistant professor 38% 67%
Associate professor 27% 17%

 

 

 

ECR 2019: Women in Focus – The Bigger Picture

 

A specific Women in Focus programme has been organised for ECR 2019, and several topics such as female leadership in the medical class and the generational progression of women in medicine have been analysed. A series of special, non-scientific sessions have celebrated female contributions to medicine, offering a platform for speakers to share their experiences, offer constructive advice and debate issues surrounding gender and healthcare. Intended to be educational as well as inspiring, Women in Focus explored and celebrated the crucial role that women play in healthcare, whilst offering advice and insights to those wishing to advance their caregiving skills and careers within this sector. As the programme was intended to be relevant and interesting to everyone, and not only to the radiological community,it was also open to the public.

Link: https://www.myesr.org/women-in-focus#paragraph_grid_14853

 

International Day of Radiology

 

On November 8, 2019 radiologists, radiographers, radiological technologists and professionals from related fields will celebrate the eighth International Day of Radiology (IDoR 2019) all over the world. Let’s celebrate together!

The International Day of Radiology is an annual event held with the aim of building greater awareness of the value that radiology contributes to safe patient care, and improving understanding of the vital role radiologists and radiological technologists play in the healthcare continuum.

This year´s theme is dedicated to Sports Imaging (Musculoskeletal Radiology). Musculoskeletal radiology is a fast-growing subspecialty of diagnostic radiology that plays an increasingly important part in the assessment and management of patients with a wide variety of injuries throughout the world.

https://www.internationaldayofradiology.com

Radiographers in Europe

 

EFRS & ESR Joint Paper on patient safety in medical imaging

This joint paper of the European Federation of Radiographer Societies and European Society of Radiology highlights the diverse areas that encompass patient safety in medical imaging, and the important roles of both radiographers and radiologists in this. The paper can be accessed at the link below:

https://www.sciencedirect.com/science/article/pii/S1078817419300094

 

EFRS Diploma in Radiography (Radiotherapy)

Based on a partnership between the European Board of Radiology (EBR) and the European Federation of Radiographer Societies (EFRS), a new examination sitting for the EFRS Diploma in Radiography (Radiotherapy) has been scheduled for June 10 2019, in London. The examination is open to fully qualified radiographers who have completed their radiography education and training. Candidates must be officially recognised to practice in their country.

For further information and application:

https://www.myebr.org/efrs-exam-introduction-2?utm_source=All+Staff&utm_campaign=2f0d28334b-EMAIL_CAMPAIGN_2019_03_26_04_22_COPY_01&utm_medium=email&utm_term=0_eebba0cdcc-2f0d28334b-84391317

 

ESR and ASRT to increase mutual collaboration on initiatives for radiographers

The European Society of Radiology (ESR) and the American Society of Radiologic Technologists (ASRT) have stepped up efforts to support radiographers together through a variety of different initiatives.

The ESR is increasing the membership benefits for North American radiologic technologists and offers radiographer a tailor-made Shape your Skills initiative for the continued professional development of radiographers. Successful applicants will be granted free ECR 2019 registration and a hotel accommodation voucher.

On the other hand, ASRT has also committed to supporting a number of American radiographers attending ECR 2019 which is also recognised as the official scientific meeting in medical imaging for radiographers by both the ESR and the European Federation of Radiographer Societies (EFRS).

 

New at ECR 2019 – FIRST European Diploma in Radiography

Based on a cooperation between the EBR – European Board of Radiology and the European Federation of Radiographer Societies (EFRS), it will be possible for radiological technologists to sit a European Diploma in Radiography for the first time at ECR 2019! Two different exams will be available: an examination in medical imaging (incluidng nuclear medicine) or the combined examination for medical imaging (including nuclear medicine) and radiotherapy.

The first European Diploma in Radiography exam was held at the European Congress of Radiology 2019 on February 27 in Vienna.

The examination is open to fully qualified radiographers who have completed their radiography education and training and are officially recognised to practice in their country.

More information on next events available at: https://www.myebr.org

 

Initiatives targeting Radiographers at ECR 2019

The European Congress of Radiology (ECR) 2019 has played host to not only radiologists, but also radiographers from across the world. The congress, which is the official annual scientific meeting in medical imaging for radiographers, recognised by both the European Federation of Radiographer Societies (EFRS) and the European Society of Radiology (ESR), has seen the largest and most comprehensive radiography programme to date, with a full line-up including several new events dedicated purely to radiographers.

Radiographers could attend the Cube 2.0 – an interactive educational hub dedicated to the captivating world of interventional radiology (IR). The Radiographers’ Lounge in the main congress centre has also been expanded, allowing space for 20 society booths, a “Voice of EPOS” stage and even more networking opportunities.

Radiographers could enjoy a packed programme including many Special Focus, Coffee and Talk and Professional Challenges sessions, an EFRS workshop and Refresher Courses, as well as exclusive EFRS meets Denmark and International Society of Radiographers & Radiological Technologists (ISRRT) meets Africa sessions. The congress has also been the occasion to host the ESR/EFRS Joint Radiographer Abstract Awards. A total number of 704 radiographer abstracts were submitted for ECR 2019, which represents a 14% increase on last year’s figures!

Patient Safety

ESR Patient Advisory Group

The ESR Patient Advisory Group (ESR-PAG) was established in 2013 to bring together patients, the public and imaging professionals in order to collectively address and leverage developments in the field of radiology. The ESR-PAG advocates for a patient-centred approach in the activities of the ESR with the aim of benefiting patients across Europe. The ESR is the first medical specialty to successfully launch a professional-patient body that gathers patient representatives from various disease-specific fields and the ESR-PAG will become a group of committed patient advocates aimed at strongly embedding the patient perspective within radiology in full collaboration with the ESR.

For complete information about ESR-PAG, please visit:

https://www.myesr.org/quality-safety/patient-information

 

 

HPP Thematic Network on Medical Training and Professional Development for Patient Safety

On the EU Health Policy Platform, a new thematic network has been created by the European Society of Radiology (ESR) to focus on:

  • how to promote evidence-based medicine through education;
  • how education and mutual recognition of qualifications can enhance mobility of health professionals;
  • the harmonisation of educational programmes and medical school curricula in the EU.

This thematic network seeks to explore the connection between education and professional development with enhanced patient safety. With the amount and quality of technological capabilities, scientific studies and available data increasing exponentially, it has become increasingly difficult for healthcare professionals to keep abreast of the latest developments, and to treat their patients according to the latest medical evidence. Creating a truly European healthcare labour force through university education and continuing medical education (CME-CPD) is therefore particularly important, yet many legal and political barriers remain for healthcare professionals that move to different countries.

In addition, the European Society of Radiology’s Patient Advisory Group (ESR-PAG) was established in 2013 to enhance the communication strategies with patient groups and organisations. The goal of the ESR-PAG is to bring together patients, the public, and imaging professionals in order to positively influence advances in the field of medical imaging to the benefit of patients in Europe. The last ECR 2017 in Vienna featured two well-attended sessions organised by the ESR-PAG which enjoyed high interest by the congress delegates and featured lively discussions between panellists and the audience.

Read more about ESR-PAG at: http://www.myesr.org/article/1067

Link to the EU Health Policy Platform: https://webgate.ec.europa.eu/hpf/

Radiation Protection

Joint IAEA and WHO Position Statement on the Bonn Call-for-Action

The International Conference on Radiation Protection in Medicine: Setting the Scene for the Next Decade held in 2012 in Bonn, Germany had the specific purpose of identifying urgent  issues arising in medical radiation protection. Participants from 77 different countries attended the Conference, whose main outcome has certainly been a proposal on incoming priorities regarding radiation protection in the next decade. This specific outcome has been called Bonn Call for Action.

Its aims are:

a) to strengthen the radiation protection of patients and health workers overall;
b) to attain the highest benefit with the least possible risk to all patients by the safe and appropriate use of ionizing radiation in medicine;
c) to aid the full integration of radiation protection into health care systems;
d) to help improve the benefit/risk-dialogue with patients and the public;
e) to enhance the safety and quality of radiological procedures in medicine.

Safety Standards for Radiation Protection

The Council of the European Union established directive 2013/59/Euratom, which sets basic safety standards for protection against the dangers arising from exposure to ionizing radiation. Member States had time until the 6 February 2018 to complete the process of transposition into their national regulations. Radiologists must be aware of some key elements, including the directive’s requirement that high-dose procedures such as CT or interventional radiology must be closely monitored, especially for procedures on children. The Directive laying down basic safety standards for protection against the dangers arising from exposure to ionising radiation introduced specific articles relating to two different areas:

  • Justification of medical exposures with respect to new types of practices and the interrelation with bio-medical research and early detection of diseases (art. 55 (2))
  • Accidental and unintended exposures of individuals subject to medical exposure focusing on specific requirements on notification and recording of significant events (art. 63 in conjunction with art. 96).

The directive clearly states any equipment used for interventional radiology and CT, as well as any new x-ray machine, must have a device or a feature informing the practitioner at the end of the procedure of relevant parameters for assessing the patient dose. The device or feature must also have the capacity to transfer this information to the record of the examination. Uniform basic safety standards are established for the protection of individuals subject to occupational exposures, besides the medical and public exposures against the dangers arising from ionising radiation.

Sources of ionising radiation can be processed radioactive materials, nuclear installations, natural radionuclides, x-ray machines and cosmic radiation. The Directive applies inter alia to the manufacture, production, processing, handling, disposal, use, storage, holding, transport of radioactive material and certain radiation emitting installations as well as the exposure of workers to radiation.

Link to EC Radiation Protection legislation: https://ec.europa.eu/energy/en/topics/nuclear-energy/radiation-protection

BSS Transposition Project

 

The BSS –  Basic Safety Standards – Directive (Council Directive 2013/59/Euratom) modernises European legislation on radiation protection by taking account of the latest scientific and technological progress to consolidate the existing Euratom radiation protection work into one single piece of legislation, merging five previous directives and upgrading a recommendation to become legally binding.

The new Directive entails substantial innovative requirements in several different areas, as the protection of patients in medical applications, improving the protection of workers, and enhancing the protection of the public from natural radiation sources. After entry into force of the Directive 2013/59/Euratom on 6th February 2014, which consolidated many different sets of legislation, Member States will have time until 6th February 2018 to bring into force the laws, regulations and administrative provisions necessary to comply with this Directive.

Thus, the European Commission approved a 15-month tender project in May 2016 to monitor the transposition of the BSS Directive into Member States’ national legislation and to support its implementation. This project was awarded to a consortium headed by the European Federation of Organisations for Medical Physics (EFOMP). Other participating organisations are the European Society of Radiology (ESR) and the European Federation of Radiographer Societies (EFRS).

Led by the Radiation Protection Subcommittee, the ESR – European Society of Radiology developed a summary of the BSS directive that includes the essentials for diagnostic radiolog and organised a meeting in Brussels, hosted by the European Commission on 24-25 January 2017.

Radiation Protection initiatives

EuroSafe Imaging

EuroSafe Imaging is the European Society of Radiology’s flagship initiative to promote quality and safety in medical imaging. The mission of EuroSafe Imaging is to support and strengthen medical radiation protection across Europe following a holistic, inclusive approach. The European Society of Radiology (ESR) has taken part in a wide number of EC projects in the area of medical radiation protection in cooperation with the European Federation of Organisations for Medical Physics (EFOMP), European Federation of Radiographer Societies (EFRS), Heads of the European Radiological Protection Competent Authorities (HERCA), European Association of Nuclear Medicine (EANM), European Society for Radiotherapy & Oncology (ESTRO), and subspecialty radiological societies, such as the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) and the European Paediatric Radiology Society (ESPR). The ESR has also worked with major international organisations like the European Commission, International Atomic Energy Agency (IAEA), World Health Organisation (WHO), United Nations Scientific Commission on the Effects of Atomic Radiation (UNSCEAR) and the International Commission on Radiological Protection (ICRP).

At ECR 2019, the EuroSafe Imaging campaign has celebrated its fifth anniversary. To date, the ESR’s EuroSafe Imaging campaign has attracted more than 51,500 ‘Friends’ supporting its activities, including dozens of institutional supporters around the world. The first EuroSafe Imaging Call for Action was published in 2014. It was updated in 2018, becoming a 13-point action plan for achieving EuroSafe Imaging’s objectives of promoting appropriateness in radiological imaging, maintaining radiation doses within diagnostic reference levels, promoting the use of up-to-date equipment, empowering patients, joining forces with various stakeholders, and contributing to a global safety culture in medical imaging.

The EuroSafe Imaging Stars initiative was launched in 2016 with the goal of establishing a worldwide network of imaging departments committed to best practice in radiation protection. To participate in this initiative, imaging facilities have to perform a simple self assessment according to a list of 21 criteria on the topics optimisation, justification, quality and safety, education, research, and regulatory compliance. After successful evaluation, applicant facilities are awarded a number of stars from one to five, depending on the criteria fulfilled.

EuroSafe Imaging is equally involved in EUCLID (European Study on Clinical DRLs) project. The 33-month European Commission tender project EUCLID will provide up-to-date clinical DRLs for the most important, from a radiological perspective, x-ray imaging tasks in Europe. The project is led by the European Society of Radiology and started in August 2017.

More information here: http://www.eurosafeimaging.org

 

EURAMED

The European Alliance for Medical Radiation Protection Research (EURAMED) is a consortium of associations involved in the application of ionising radiation and radiation protection standards in medicine, namely the European Association of Nuclear Medicine (EANM), the European Federation of Organisations for Medical Physics (EFOMP), the European Federation of Radiographer Societies (EFRS), the European Society of Radiology (ESR) and the European Society for Radiotherapy and Oncology (ESTRO).

The first edition of a strategic research agenda (SRA) for medical radiation protection has been published in July 2016.

Artificial Intelligence, Machine Learning and Virtual Reality

In late 2016, AI luminary – Prof. Geoffrey Hinton – was famously quoted as saying it was obvious ‘we should stop training radiologists’ because they’ll soon be replaced by AI. Although specific tasks can be done with software, AI has not delivered on all its early promise, according to many observers, and it is not replacing radiologists. Some radiologists, however, argue AI is launching its assault on radiologists.

The term Artificial Intelligence (AI) is applied when a device mimics cognitive functions, such as learning and problem solving. It refers to a field of computer science dedicated to the creation of systems performing tasks that usually require human intelligence. Machine learning (ML), a term introduced by Arthur Samuel in 1959 to describe a subfield of AI including approaches that allow computers to learn from data without being explicitly programmed, has been extensively applied to medical imaging. Among the techniques that fall under the ML umbrella, Deep learning (DL) has emerged as one of the most promising.

You can find a comprehensive framework on AI and ML definitions and applicability in the interesting paper – Artificial intelligence in medical imaging: threat or opportunity? Radiologists again at the forefront of innovation in medicine, appeared on European Radiology Experimental in 2018. Link: https://eurradiolexp.springeropen.com/articles/10.1186/s41747-018-0061-6

Although radiologists are not the only medical professionals to have their specialty modified by Artificial Intelligence, it is widely accepted that the radiological community is on the verge of a major revolution, and that AI will deeply affect the radiology specialty and the way clinical specialty and professional life have been conceived. While a good AI technology may potentially be helpful and valuable, bad or unethical use may be extremely dangerous, with proper regulation needed to ensure that software is used safely, ethically, and with appropriate protection of patient privacy. Patients, radiologists, and regulatory authorities must work together to prevent that from happening and a balance that provides security, privacy protection, and ethical use of sensitive information.

As Prof. H. Lamb – member of the Executive Bureau of the Section – thinks: “an important challenge for radiologists is to maintain a high level of quality, whereas the ever-increasing workload can be facilitated. To guarantee high quality radiological exams and reports, assistance from AI can be of great value. Pre-processing of radiological imaging and especially image quantification can help to substantially reduce time spent per read. We can thereby create more time for communicating results, for example, in multidisciplinary meetings and in direct contact with patients. Commercial imaging clinics show and explain results to their clients. In routine clinical settings, radiologists do not have enough time to communicate directly with patients. The application of AI may create more time to connect with patients, and present imaging results in an app, on a mobile phone, automatically” (ECR Today 2019, Artificial or intelligent radiologist?)

In the European Union (EU), the current regulatory framework for medical devices – including AI software – has been reformed by the new Medical Device Regulation (MDR) and the new In Vitro Diagnostic Medical Device Regulation (IVDR). The MDR will become effective on 26 May 2020 while the IVDR will apply as of 26 May 2022. The recent reform originated from the awareness that the existing directives, dating back to the 1990s, are no more appropriate to deal with new, evolving technologies.  On the other hand, the rise of AI generates several concerns relating to the way sensitive data are collected by the devices: as an example, data are threatened by cyberattacks addressed to those same bodies which collected them. Similar threats led the EU to adopt the General Data Protection Regulation (GDPR), which went into effect 24 May 2018, and the Cybersecurity Directive, which took effect on 10 May 2018. The extended territorial scope and wider rights for data subjects in the GDPR make the regulation more suitable to regulate AI, while the Cybersecurity Directive delineates requirements for EU member states that aim to prevent cyberattacks and to limit their effects.

“Among other provisions, member states are required to ensure that operators of essential services take appropriate measures to prevent and minimize the impact of incidents and to preserve service continuity (Articles 14(2) and 16(2)), and to ensure that supervisory authorities are notified of incidents without undue delay (Articles 14(3) and 16(3),”

 

Risks and criticalities of AI:

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.

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. 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 and giving effective proofs VR and AR can help save time and money and increase accuracy in diagnosis.

 

Assessing the impact of AI in radiology management:

“As the demand for time-consuming imaging services keeps on growing, radiology departments are increasingly vulnerable to staff shortages. Artificial intelligence (AI) can be a solution in many management scenarios, but leaders must address the enduring apprehension and define which tools are relevant when making the most of the new technology.”

Please find below the link to a very interesting interview on this topic with Prof. Christoph D. Becker collected at the ESR AI Premium Event in Barcelona (April 2019).

Link: https://ai.myesr.org/education/in-work-assessing-the-impact-of-ai-in-radiology-management/

 

An extraordinary competition between physicians and AI:

On June 30, 2018 in Beijing, an extraordinary radiology competition took place.  It was heralded by the CHAIN Cup, an event billed as “The World’s First Competition between Physicians and Artificial Intelligence in Neuroimaging”. A custom-built Artificial Intelligence (AI) system dubbed BioMind was pitted against a team of 15 specialist doctors, with experience in neuroimaging. The AI system, dubbed BioMind, was programmed to accurately diagnose brain tumours and predict hematoma expansion. ESR Past-President – Prof. Paul M. Parizel – was one of the two international jury members.

AI won, by a large margin, predicting the correct histological diagnosis in 196 out of 225 cases (87%) in just under 15 minutes, whereas the human specialist doctors got only 66% right in 30 minutes. In the second heat, a different team of doctors competed with BioMind in predicting expansion of intracerebral hematoma; and AI won again by a large margin (83% versus 63%).

It must be highlighted however that – when checking the answers – the humans seemed more apt to provide a specific diagnosis, but they were more frequently wrong especially for ‘rare’ tumours. In any case, the AI BioMind system was not only accurate but also very fast. It was able to finish the 225 cases in 15 minutes (averaging 4 seconds per case), whereas the team of 15 specialised radiologists was able to achieve an accuracy rate of 66% when diagnosing 15 brain tumours each, finishing the task in 30 minutes (2 minutes per case).

 

ESR event “Intelligence. Innovation. Imaging – The perfect vision of AI” highlighted the importance of AI:

With more than 5,800 registrations from 140 countries for live streaming and 230 attendees onsite, the European Society of Radiology’s (ESR) event, ‘Intelligence. Innovation. Imaging – The perfect vision of AI’, which took place in Barcelona on April 05-06, 2019, highlighted the importance that artificial intelligence (AI) is playing for radiologists around the world.

In particular, the ethical use of artificial intelligence (AI) in radiology has been explored in the course of event by Dr. Adrian Brady, who also gave a speech on privacy, data use agreements and data protection. “Data use agreements should also be updated regularly to reflect new uses as well as version control specifications, he said. It’s probably true, however, that exclusive-use data use agreements are contrary to the common good, as they may prevent a significant amount of useful patient radiology data from being used to develop other AI tools or utilized in other research”, Dr. Brady said.

For further information:

https://www.myesr.org/article/2519?utm_source=ESR+All+Staff+7&utm_campaign=7f50a476dd-EMAIL_CAMPAIGN_2019_04_08_11_01&utm_medium=email&utm_term=0_150e2eaac8-7f50a476dd-87033989

Events & Initiatives

 

ECR – Invest in the Youth: Support Programme for Trainees

 

Application for Invest in the Youth for ECR 2020 is open from July 1 to October 10, 2019.

The ‘Invest in the Youth’ programme supports 1,000 young professionals in training by giving them free registration for the ECR and an accommodation voucher. The ESR reserves the right to grant support at its sole discretion. For the selection of final recipients, various parameters will be considered, such as abstract submission and acceptance, geopolitical spread and previous inclusion in the programme. Notifications of acceptance or rejection will be sent via email by December 2019.

For more information:

https://www.myesr.org/supportprogrammes#paragraph_grid_17004

 

ESR Nicholas Gourtsoyiannis Teaching Fellowship

The European Radiology Private Foundation has initiated this Teaching Fellowship to honour Prof. Nicholas Gourtsoyiannis for his vision, untiring commitment and pivotal role in furthering education in radiology in Europe and abroad and to recognise his leadership within the European Congress of Radiology (ECR), the European Association of Radiology (EAR) and the European Society of Radiology (ESR). This Teaching Fellowship will be awarded annually starting in 2018. It is aimed at radiologists with clinical and academic experience who wish to enhance their teaching and training skills by delivering lectures and/or undertaking interactive workshops in a foreign environment.

Link: https://www.myesr.org/education/esr-nicholas-gourtsoyiannis-teaching-fellowship

Albert L. Baert Editorial Fellowship

This editorial fellowship programme aims to provide training in editorial skills, such as manuscript evaluation, manuscript editing, organisation of peer review, manuscript production and publishing, including electronic publication.

The eligible candidate must:

  • Be a certified radiologist or senior resident
  • Be an active member of the European Society of Radiology
  • Provide evidence of a record of scientific or clinical research
  • Work in the field of Radiology as proven by scientific presentations or publications

Candidates still in training or under the age of 35 are preferred.

Further information: https://www.myesr.org/publications/albert-l-baert-editorial-fellowship-2019

 

 

 

The Section of Radiology at ECR

 

Abstract Submission for ECR 2020 will be possible from July 1 until October 10!

The European Society of Radiology (ESR) – founded in 2005 – is the largest radiological society in the world. It is an apolitical, non-profit organisation, dedicated to promoting and coordinating the scientific, philanthropic, intellectual and professional activities of radiology in all European countries. The ESR now counts over 112,000 members worldwide!

The European Congress of Radiology is the world´s biggest radiological congress, annually held in Vienna and organised by the ESR. ECR 2019 hit a new record in participation: 30.259 total participants, which marks a rise of 6% compared to ECR 2018.

All ESR Connect clips produced during ECR 2019 are now available: https://esr-connect.meta-dcr.com/ecr2019/library

ECR 2020 will be held March 11 – 15, 2020 in Vienna, Austria Center, Bruno-Kreisky-Platz 1, 1220. The slogan for ECR 2020 will be: ‘A Clear Vision for Radiology’.

After the success of ECR 2019’s ‘Women in Focus’ programme, the ESR will once again organise an exclusive ‘in Focus’ event at the European Congress of Radiology. The programme, titled ‘Children in Focus’, will explore a broad range of health and social issues related specifically to children and young adults

Thanks to the generosity of the ESR, the Section of Radiology has been granted a dedicated booth in the International Village where to present the educational activities and European projects. Free registration to the Congress has been offered to the delegates of Section and internal Divisions.

For general information and scientific programme of ECR 2020: https://www.myesr.org/congress#paragraph_grid_12532

 

 

ESR-UEMS Joint Session at ECR 2020

The ESR-UEMS Joint Session is a special meeting annually held in Vienna, on the occasion of the European Congress of Radiology.

The Joint Session is the occasion for ESR and UEMS leaderships to present the many similarities and common strategies of the two organisations, in particular in the field of the defence of professional interests of radiologists and in the harmonisation of high-level radiology training in Europe.

The latest edition of the Joint Session has been dedicated to the topic: “Imaging Professionals within the EU. Radiologists without borders”  and was focused, among other things, on the concept and importance of advocacy at the level of the European Union. The two societies have worked closely together for a number of years now and strive to further strengthen their cooperation

The whole session has been recorded and available, after registration, on ESR website:

https://ecronline.myesr.org/ecr2019/index.php?p=recorddetail&rid=47cd5dd7-ddbf-4cc7-8f5b-7c50b2b31f5e&t=browsesessions

An interesting article – appeared on AuntMinnie – has been dedicated to the ESR-UEMS Joint Session – 2019:

ESR-UEMS Joint Session 20190320

 

The next ESR-UEMS Joint Session will be dedicated to the “Visibility of imaging professionals in the EU” and will take place on Thursday, March 12, 2020 (08:30-10:00).

 

 

 

Save the date

 

Meeting of IR Division: Barcelona, CIRSE Congress, CCIB, September 07, 2019

Meeting of NR Division: Rome, September 28, 2019

Meeting of the Section: Rome, September 28, 2019

UEMS Fall Council: London, BMA House, October 18-19, 2019

UEMS CESMA meeting: Tel Aviv – December 06-07, 2019

UEMS Advisory Council on CME-CPD: Brussels, 11 January 2020

UEMS Conference on CME-CPD: Seville, March 06-07, 2020

ECR 2020, “A Clear Vision for Radiology”: Vienna, March 11 – 15, 2020

UEMS Spring Council 2020: Brussels, April 24-25, 2020

UEMS Fall Council 2020: Limassol, October 16-17, 2020