2007-Issue01

1

EFSUMB Newsletter European Federation of Societies for Ultrasound in Medicine and Biology

Editorial

This Annual issue of the Newsletter gives those involved with the organisation of EFSUMB the opportunity to inform all the members of EFSUMB of how the Federation has been managing itself and the money they contribute to it over the past 12 months. Whilst the other issues of the Newsletter are available to those who subscribe to the EJU and also available online at the Federation website, I suspect that

Executive Bureau 2006–2007 President: DH Evans (UK) President Elect: N Gritzmann (Austria) Past-President: K Jäger (Switzerland) Honorary Secretary: L Greiner (Germany) Honorary Treasurer: P Pavlica (Italy)

ECMUS – European Committee for Medical Ultrasound Safety Chairman: G ter Haar (UK) Members: P Arbeille (France) M Delius (Germany) C Kollmann (Austria) R Laurini (Norway) M Levene (UK) K Marsál (Sweden) Ex-officio: DH Evans (UK)

Education an Professional Standards Committee Chairman: D Lindsell (UK) Members: OH Gilja (Norway) C Nolsøe (Denmark)

for many this is the only opportunity they take to learn about what is going on. The other contributors to the Newsletter all give there own slant on how the Federation is developing. Financially obviously things are on a firm footing although this is no reason for complacency. The Journal continues to increase its number of subscribers as well as its impact factor which amply justifies the bold move to merge the EJU title with Ultraschall in der Medizin. The Education and Professional standards committee, having developed its initial minimum training standards document continues to supplement that and look to further involvement in education, particularly taking on the greater role in organisation of the very successful Euroson Schools.

I Sporea (Romania) H Strunk (Germany) Co-opted: Y Ville (France) Ex-officio: N Gritzmann (Austria)

Publications Committee Chairman: DW Pilling (UK) Members: M Bachmann Nielsen (Denmark) C Dietrich (Germany) F Drudi (Italy) J Pirhonen (Norway) Ex-officio: L Greiner (Germany)

EFSUMB Newsletter Editor: DW Pilling (UK)

Secretariat Mrs G Stanford EFSUMB General Secretary Carpenters Court 4a Lewes Road, Bromley, Kent BR1 2RN UK, Tel: +44 208 402 8973,Fax: +0208 402 9344, Email: efsumb@efsumb.org, website: www.efsumb.org

I hope you all take the opportunity to be informed about what the Federation is doing and in particular informing all those involved in ultrasound as a clinical tool to be aware what the Federation can do for them and how it can help.

Dr David Pilling Editor EFSUMB Newsletter

Contents Editorial ......................... .......................67 EFSUMB Officers and Committees .................. .......................67 President's Report....... .......................67 -Update Guidelines for the Use of Contrast Agents in Ultrasound ... .......67 Honorary Secretary's Report . ..........67 Honorary Treasurer's Report . ..........67 Report from EFSUMB Education and Professional Standards Committee ................................. ..........67 Minimum Training Requirements for the Practice of Medical Ultrasound in Europe:........................................ ..........67 - Appendix 9: Endoscopic Ultrasound in Gastroenterology....................................67 Report from EFSUMB Publications Committee .......................................... ..........67 Report from EFSUMB (Safety Committee) ECMUS ................... .......................67 - New Clinical Safety Statement 2006............. .......................67 - Souvenir Scanning Statement 2006............. .......................67 Report from Ultraschall in der Medizin/ European Journal of Ultrasound.....67 Young Investigator Award 2006 .....67 EUROSON School: ........ .......................67 - Report from Short Course on Abdominal Ultrasound in Tropical Medicine, Pavia Italy ................................. .......................67 - Future Euroson Schools ....................67 19th EUROSON – 31st Dreiländertreffen – 24–27 October 2007, Leipzig – Germany......................... .......................67 British Medical Ultrasound Society Annual Scientific Meeting Manchester December 2006 ............ .......................67 SonoWorld .................... .......................67 Diary Dates 2007.......... .......................67 Ultraschall in Med 2007; 28

3

which include the preparation of DVD based material and the intention to arrange EUROSON Schools to provide targeted training.

President's Report The past year has been a busy one for EFSUMB culminating in a very successful 'EUROSON' meeting held in Bologna, Italy, between 15th and 19th September 2006.

The meeting attracted 1,797 participants from 41 countries, and was thoroughly enjoyed by the participants because of the

strength of the scientific programme, the excellent social events and of course the venue.

Several important events took place in conjunction with the meeting. Firstly a group of experts from throughout Europe met to discuss an updated version on the 2004 EFSUMB ultrasonic contrast agent guidelines. The original guidelines (which can be downloaded from the EFSUMB web-site) were published in the August 2004 edition of Ultraschall in der Medizin / European Journal of Ultrasound. It has been agreed to update the guidelines and to add additional sections on the use of contrast agents in the pancreas, the kidney, urinary reflux, trauma, and transcranial applications. The expert group will meet again in Rotterdam in January 2007 to finalise the revision.

A second meeting was that between the WFUMB Executive Council and the EFSUMB Executive Bureau, where a number of areas of common interest, particularly relating to education, were discussed. It is hoped to form a closer working relationship between the two organisations to the mutual benefit of both.

Thirdly the EFSUMB Board of Directors held their Annual meeting to receive an update on the Federation's activities and take a number of important decisions. The Board endorsed two new statements from the Safety Committee, one an update of the 'Clinical Safety Statement for Diagnostic Ultrasound' and the second the 'Statement on the use of Diagnostic Ultrasound for Producing Souvenir Images or Recordings in Pregnancy' both of which can be

Ultraschall in Med 2007; 28

found on the web-site. The board also heard of the excellent progress being made by the Education Committee and of the publication of the EFSUMB Minimum Training Recommendations for Practice of Medical Ultrasound, and of further syllabi under development. We also heard of new initiatives to provide training to help individuals fulfil the recommendations,

Another important task of the Board of Directors is to choose the site for future EUROSON meetings, and this year five separate countries bid for the 2010 meeting, which was won by the Danish bid for Copenhagen. This means the venues for the next five EUROSON meetings are now decided with Leipzig, Germany in 2007, Timisoara, Romania in 2008, Edinburgh, Scotland in 2009, and Vienna, Austria in 2011 in conjunction with WFUMB. I look forward to meeting many of the EFSUMB members at our next EUROSON meeting in Leipzig from 24th–27th October 2007.

Prof David Evans EFSUMB President

Guidelines for the use of Contrast Agents in Ultrasound – Update Many of you will be aware that in January of 2004 EFSUMB held a meeting of experts in Rotterdam to formulate guidelines for the use of ultrasonic contrast agents in the liver. These were subsequently published in the August 2004 edition of Ultraschall in der Medizin/European Journal of Ultrasound (EJU), and have also been published in French and Chinese. To our knowledge there have also been at least 20.000 reprints produced in English and 5.000 in Chinese. These guidelines are freely available from our website at www.efsumb.org.

Time has moved on, and it is now the belief of EFSUMB, and the group of experts that developed the original guidelines, that the recommendations should be revisited and expanded to include applica-

David Evans EFSUMB President

tions in the kidney, in reflux, in the pancreas, and in the cerebral circulation. In order to achieve this EFSUMB have set up two further meetings of experts (generously sponsored by manufacturers of both contrast agents and ultrasound equipment). The first meeting was held in Bologna in September 2006 just prior to the EUROSON meeting, and some of the preliminary deliberations of the expert group were presented at that EUROSON meeting. The second meeting was held at the end of January 2007 in Rotterdam, immediately following the European Symposium on Ultrasound Contrast Imaging.

It is expected that the updated guidelines will be published well before the end of 2007 in EJU and possibly in other relevant journals. The guidelines will of course also be published on the EFSUMB web-site.

4

Honorary Secretary's Report ciety; and point 23, defining the maximum liability in case of a financial loss.

Bylaw number 7 "Regulations for the organisation of an ultrasound teaching course of the EUROSON School" and Bylaw number 9, Education and Professional Standards Committee reflect the change in responsibility of accrediting the Euroson School from the Executive Bureau to the Education Committee. All the new updated bylaws can be examined at the EFSUMB website: www.efsumb.org.

The year gone – from 1.1.2006 to 31.12.2006 – was again an eventful and rich year for the growing EFSUMB community. Under the presidency of David Evans, the Executive Bureau was busy with all correspondence and other paper-, email-, and phone work, and various meetings comprising one to two days. In addition, the EUROSON congress – as a joint congress with the Italian Society – was the traditional scenario for the Board of Director's meeting with bids for the EUROSON congress in 2010 – which in the end was won by the Danish Society for the wonderful city of Copenhagen, with the competition of Nice, Athens, Jerusalem and Istanbul. Congratulations to Denmark again, and we now welcome for bids for 2012!

The year 2011 will be dedicated to another central event in global ultrasound congress activities: the WFUMB World Congress for 2011 – now held every two years, too – will be held in Vienna. This decision was made at the superb World Congress of Ultrasound in Seoul ("A better World with Ultrasound") – congratulations to Austria, and to Europe. The next World congress of WFUMB in 2009 will be held in Sydney.

Some changes in the bylaws had been decided by the Board of Directors and became effective in 2006. The most significant change is probably the reduction of the period of office for all EFSUMB officers from three to two years. Other bylaw changes referred to Bylaw number 1 "Regulations for Organising An Euroson Congress" point 11b, where it was agreed to reduce the percentage of the financial surplus due to EFSUMB by the member so-

Certificates of membership were produced and are now available – each year – on request for each member (distribution by the national society bureaux/secretaries once the membership fees have been paid). The certificates are considered to be another attractive sign of being a member of the European Federation of Societies for Ultrasound in Medicine and Biology, the biggest community of multidisciplinary ultrasound societies from a total of 28 nations comprising now (January 2007) a total of 19671 members.

really fruitful and progressive activities for the EFSUMB delegates. For the first time, it was possible to grant continuous medical education credit points in cooperation with other European authorities.

After a successful and active 2006, we are looking forward to the events of 2007, starting with an update on contrast enhanced ultrasonography at Rotterdam on 26 January and further highlights such as the EUROSON/Dreiländertreffen at Leipzig in late October.

Finally, it is simply true that all societies and federations can only be as good as the total of their members – so again, all our EFSUMB members are kindly asked to contribute both at a national level and on the European scene in clinical and in research ultrasonography.

Prof Lucas Greiner EFSUMB Honorary Secretary

Membership Status at 31 January 2007 Country

Number of Members

Austria

853

The official Journal of our Federation – The European Journal of Ultrasound/ Ultraschall in der Medizin – further increased its impact factor to now considerable 1.7, thus underlining with its number of subscribers – more than 12,000 – and six issues per year – a leading role in interdisciplinary ultrasound scientific research and communication.

Belgium

241

Bulgaria

135

Croatia

62

Czech Rep

37

Denmark

689

Finland

450

France

291

Germany

6564

Greece

285

Hungary

48

The EUROSON congress at Bologna from 15 – 19th September 2006 – together with our Italian friends – again demonstrated with some 2000 participants a lively development of both scientific and clinically applied ultrasonography, with a remarkable industrial exhibition. EFSUMB was represented with the traditional lectures dedicated to the EUROSON lecture, the Therese Planiol, the DEGUM lecture, the Hans Henrik Holm lecture, the Young Investigator's award won by M.E. Frijlink on the topic of " Harmonic Intravascular Ultrasound". Moreover, special sessions were routinely held with the EFSUMB Industrial Board and by the EFSUMB committees on safety, publication, education and professional standards – altogether

Israel

101

Italy

1872

Latvia

158

Macedonia

11

Netherlands

65

Norway

246

Poland

1200

Portugal

70

Romania

422

Russia

152

Slovac Rep

40

Slovenia

128

Spain

177

Sweden

115

Switzerland

2649

Turkey

197

UK

2413

TOTAL

19671

Ultraschall in Med 2007; 28

5

EFSUMB Budget for the Year 2007 (in â‚Ź)

Honorary Treasurer's Report One of the main goals of the Society in the next few years is to prepare revised Guidelines on Contrast media in Ultrasound and this activity needs funds coming from EFSUMB and some industry sponsorship.

There has been a first meeting in Bologna in September 2006, and the next one in Rotterdam in January 2007, and we have a provisional cost of 9,000.00 Euro in 2007.

The EFSUMB economy is in good health and has reached stable financial ground.

The former Honorary Treasurer, Niels Juul, has left last year a very good financial result, with an evident surplus and the Society has now adequate reserves to provide support to different educational and training activities in the interests of the members of the national societies. The surplus is 15,966 Pounds (22,352 Euros).

The main income is from subscription fees of more than 19000 members belonging to European countries. For this reason I invite all the executive bodies of National Societies to stimulate their societies to increase the number of active members, so that we can pass the 20,000 member mark in 2007.

This economic surplus will help us in future to support the activities of the Education and Publications Committees activities.

The expenditure in 2005 is related to EFSUMB office expenses in London, where the General Secretary is efficiently doing a very hard job. The other main costs are the subscription to WFUMB, publishing the EFSUMB Newsletter, the expenses for the meetings of the Executive Bureau and different Committees, although we are trying to contain the costs as much as possible.

The Budget for the year 2007 is reported in Euro because this currency is used in the majority of European countries. We hope to have an increased membership fee income. Some other income will come from Euroson schools and Euroson congresses, but these will be only minor income because the organizing costs are increasing.

As you can see the 2007 budget makes no provision for a surplus, but we must be aware that EFSUMB is now a big organization and the costs of the many activities are growing. The Federation has maintained a low membership fee, increasing or sponsoring many new activities in different countries, but this has been possible thanks to the increase number of members in the last years.

Income Membership fee (19568 x 8 â‚Ź)

â‚Ź

EUROSON SCHOOLS and

â‚Ź

CONGRESSES Bank deposit interests

â‚Ź 800.00

Totoal Income

â‚Ź 159,844.00

Expenditure WFUMB fee (19568 x 1.5 $)

â‚Ź 25,438.40

â‚Ź1.30 Newsletter

â‚Ź 27,000.00

Meetings, Executive Bureau

â‚Ź 17,000.00

Meetings, Committees

â‚Ź 29,400.00

Prizes etc

â‚Ź 1,000.00

Website

â‚Ź 1,000.00

Wages

â‚Ź 28,000.00

Printing, postage, stationery

â‚Ź 1,200.00

Auditors

â‚Ź 2,500.00

Office expenses

â‚Ź 13,000.00

Computer equipment

â‚Ź 1,500.00

Bank charges

â‚Ź 1,000.00

Depreciation

â‚Ź 1,000.00

Printing ID certificates

â‚Ź 1,500.00

Provisional sponsorship Contrast

â‚Ź 9,305.60

agents meeting in Bologna 2006

Dr Pietro Pavlica FSUMB Honorary Treasurer

Total Expenditure

â‚Ź 159,844.00

Trading and profit and loss account in ÂŁSterling Year ended 31 Decemer 2005 Income Subscriptions

ÂŁ

Euroson Schools

ÂŁ

Euroson 2005 Congress surplus

ÂŁ

EJU subscriptions

ÂŁ

Deposit account interest

ÂŁ ÂŁ

Expenditure Subscription WFUMB

ÂŁ

Publishing EFSUMB newsletter

ÂŁ

EJU subscription

ÂŁ

Meeting and Travelling expenses of all committees

ÂŁ

Prizes

ÂŁ

Website

ÂŁ

Wages

ÂŁ

Printing, postage and stationery

ÂŁ

Auditors remuneration

ÂŁ

Office services

ÂŁ

Bank charges

ÂŁ

Depreciation: Plant and machinery

ÂŁ

Fixtures and fitting

ÂŁ

Computer equipment

ÂŁ ÂŁ

Operating profit/-loss

ÂŁ

Gain on exchange ***

ÂŁ

Excess of income over expenditure

ÂŁ

***The exchange gain has arisen due to movements in the exchange rate over the 2005 accounting year and as such, when euro account balances are translated into sterling (EFSUMB being required to state their finances in sterling as they are a UK charity), there is a "paper" gain on those balances. This also affects the dollar payment to WFUMB.

Ultraschall in Med 2007; 28

6

Report from EFSUMB Education & Professional Standards Committee 3 This committee will be responsible in future for organising the EFSUMB session at Euroson Congresses

Minimum Training Recommendations 5

Meetings 5 The committee has met twice during the course of the last year in December 2005 and April 2006. The next meeting is scheduled for January 2007

Review of Bylaw No.9 5 The committee has reviewed its compliance with the Bylaw and has confirmed compliance with the majority. Point 11.5 refers to advice on methods of accreditation to practise ultrasound in different specialty areas. It is felt that limited progress can be made in this area because of the different laws and regulatory bodies in different member societies' countries.

Point 11.6 (advice on minimum technical specifications for equipment) and 11.7 (advice on quality control processes) require further work and a 'Task & Finish' group has been set up under the chairmanship of Professor Yves Ville to do this.

The Bylaws no. 7 (Regulations for the organisation of an ultrasound teaching course of the Euroson School) and Bylaw no. 9 (Education and Professional Standards Committee) have also been changed so that: 3 Applications to run Euroson Schools will now be submitted to the Education & Professional Standards committee for approval and once approved a member of this committee will work with the organisers of the School

Syllabuses and competence assessment sheets for ultrasound practice in obstetrics, gynaecology, gastroenterology, nephro-urology, breast and vascular disease have been available on the EFSUMB website since September 2005 and were published in the EFSUMB Newsletter that accompanied the February 2006 edition of the European Journal of Ultrasound. It has been agreed that these are dynamic recommendations and where appropriate will be updated and modified from time to time on the website. Experts are currently reviewing these first six syllabuses. In addition specialist ultrasound societies in Europe are being asked for their comments. Following this the recommendations will be submitted to UEMS asking for their endorsement.

The Chairman has written to all member societies asking for comments on the EFSUMB recommendations, how they compare with national guidelines, whether competence assessment is undertaken in each country, whether further syllabuses would be helpful and whether member societies see the need for formal accreditation of ultrasound training in their respective countries. Written or verbal replies have been received from 11 of the 27 member societies. If more replies are received then a summary of these will be submitted for publication in the Newsletter The committee is now developing further syllabuses on: 3 Endoscopic Ultrasound – published in this Newsletter and on the EFSUMB website. EFSUMB is grateful to Prof Odd Helge Gilja, Prof. Svein Ødegaard and Dr. Lars Birger Nesje for preparing these guidelines.

3 Ultrasound Contrast Agents – to await the review of the current EFSUMB guidelines by the EFSUMB group responsible for this 3 Cranial Ultrasound in Infants 3 Focused Emergency Ultrasound 3 Critical/Intensive Care Ultrasound 3 Musculoskeletal Ultrasound 3 Thoracic Ultrasound

Other Proposed Work of the Committee 5 3 Developing DVDs/CDs based on the minimum training recommendations and Euroson Schools 3 Greater involvement in Euroson Schools in terms of support for their organisation as well as suggestions for faculty members and topics (eg contrast agents, emergency and intensive care ultrasound, musculosketal ultrasound, 3D/4D ultrasound and obstetric ultrasound – 1st trimester, heart, brain) 3 The development of pre and post course/school multiple choice questions to assess the effectiveness of the course and the acquired knowledge of participants 3 The development of educational material on the website if this adds value to the educational material currently available on other websites 3 The development of an education and professional standards session at each Euroson Congress. Suggestions for future congresses include: above only or above and below knee scanning for DVT, medico-legal aspects of ultrasound practice, characterisation of focal liver lesions using ultrasound contrast agents compared to CT and MRI, an overview of the EFSUMB ultrasound contrast agent guidelines when they have been updated, 'the way I do it' sessions, level 3/state of the art lectures, cardiac ultrasound, documentation and image recording requirements, 'second read' ultrasound, controversies in ultrasound.

Dr David Lindsell Chairman EFSUMB Education and Professional Standards Committee

Ultraschall in Med 2007; 28

7

EFSUMB Minimum Training Requirements for the Practice of Medical Ultrasound in Europe Appendix 9: Endoscopic Ultrasound in Gastroenterology This curriculum is intended for clinicians who perform endoscopic ultrasonography (EUS) in gastroenterology. It includes standards for theoretical knowledge and practical skills. It is mandatory to be experienced in GI endoscopy, and Level 1 competence should be obtained by anyone performing EUS unsupervised.

Compared to transabdominal US, EUS is even more dependent on continuous site orientation and image interpretation during the examination.

Level 1 5

Sectional EUS anatomy

The EUS operator needs to be trained in all aspects of GI endoscopy. For required level 1 skills in general ultrasonography, see Appendix 2.

3 Portal venous system and spleen: portal hypertension, thrombosis, splenomegaly 3 Kidneys and Adrenal glands: Tumours, hydronephrosis 3 Anus and Rectum: Tumours, inflammatory bowel disease, fistulas, defecation disorders 3 Colon: Tumours, inflammatory bowel disease, lymphomas 3 Other structures: abnormal lymph nodes and masses, aneurysms, thromboses, ascites

Competence to be acquired

The GI wall

It is recommended that the trainee performs 1–3 examinations under supervision per week and that a total of at least 100 examinations are undertaken. EUS may be performed with different EUS-systems, and ideally training should include the use of transendoscopic miniprobes and linear and/or radial echoendoscopes. Continuous individual assessment of the trainee's competence and skills is important.

3 Examinations should include the full range of pathological conditions listed below 3 A log book listing the types of examinations undertaken should be kept 3 Training should be supervised by a level 2 practitioner 3 Trainees should attend EUS courses and read appropriate literature 3 It is recommended that a medical practitioner performing level 1 EUS should continue to perform at least 30-50 EUS examinations each year and attend EUS meetings.

3 The competence assessment sheet will determine in which area the trainee can practice independently

Knowledge base Physics and Technology, EUS Techniques and Administration EUS requires that the operator combines the knowledge and experience of GI endoscopy and ultrasonography (US). Although the principles of imaging are the same as with transabdominal US it is also mandatory to train specifically in interpreting the images acquired with intraluminal, high-frequency US transducers.

Ultraschall in Med 2007; 28

3 General GI wall structure 3 Oesophagus 3 Mediastinum (Lymph nodes, trachea and bronchi, aorta, heart, pleura) 3 Stomach 3 Duodenum 3 Liver 3 Pancreas 3 Gallbladder 3 Biliary system 3 Portal venous system and spleen 3 Kidneys and Adrenal glands 3 Other structures (vessels and lymph nodes) 3 Anus and Rectum 3 Colon

Pathology in relation to EUS 3 The GI wall: Thickness and number of wall layers, subepithelial and intramural benign and malignant tumours with relation to wall layers, normal and abnormal vascular structures 3 Oesophagus: Wall layers, cardia, achalasia, oesophageal tumours, varices 3 Mediastinum: abnormal lymph nodes, tumours, cysts, aneurysms, pleural fluid 3 Stomach: abnormal wall layers, tumours, cysts, ulcers, vascular disorders, lymphomas, linitis plastica 3 Duodenum: Tumours, ulcers 3 Liver: Benign and malignant tumours, cysts, dilated bile ducts, vascular structures 3 Pancreas: Tumours, pancreatitis, calcification, cysts, duct changes 3 Gallbladder and biliary system: Stones, tumours , inflammation, level and cause of obstruction

To be able to: 3 Recognise the normal and abnormal GI wall and wall layers 3 Recognise intramural tumours and their structure with relation to wall layers and extension into the surrounding tissues.

3 Evaluate the size of ulcers

Oesophagus To be able to: 3 Perform a thorough EUS examination of the wall of the oesophagus at different levels 3 Recognise normal anatomy and variants 3 Recognise abnormal wall and wall layers 3 Recognise tumours (cancer, leiomyomas, gastrointestinal stromal tumour (GIST),with origin, structure and extension 3 Recognise abnormal vessels

Mediastinum To be able to: 3 Recognise normal mediastinal structures and organs (heart, aorta, pleura, azygos vein, pulmonary vessels, trachea and bronchi, lymph nodes 3 Evaluate abnormal structures, oesophageal cancer TN-staging, other tumours, enlarged lymph nodes, aneurysms, varices

Stomach and Duodenum To be able to: 3 Recognise the normal and abnormal gastric and duodenal wall

Ultraschall in Med 2007; 28

_____________________

Administration

____________________ ____________________ ____________________

x Abnormal wall layers

x Tumours

x Abnormal vessels

____________________ ____________________ ____________________

x Enlarged lymph nodes

x Aneurysms

x Varices

____________________ ____________________ ____________________ ____________________ ____________________

x Normal and abnormal wall layers

x Cancer Staging (TNM)

x Other tumours

x Ulcers

x Varices

x Normal anatomy & variants

____________________ ____________________ ____________________

x Normal & abnormal texture

x Focal lesions

x Normal & abnormal vasculature

____________

____________

____________

x Tumors within left adrenal gland

x Tumors & Hydronephrosis of kidneys

x EUS examination of kidneys and left adrenal gland ____________

____________________

x Normal anatomy & variants

Kidneys & Left Adrenal Gland

x Thrombosis & tumour ingrowth into portal venous system

x Focal splenic lesions

x Normal anatomy & variants

x EUS examination of spleen & portal venous system

Liver

____________

____________

____________

____________

____________

____________

Portal venous system & spleen

____________________

x Normal anatomy & variants

____________________

____________________

____________________

____________________

____________________

____________________

____________________

____________________

____________________

x Distinguish between common bile duct & portal vein

____________________

x EUS examination of stomach & duodenum ____________

____________________

x Tumours of papilla of Vater

Stomach and Duodenum

____________________

____________________ ____________________

x Bile duct dilatation

x Abnormalities of gall bladder wall & lumen

____________________

____________________

____________________

____________________

____________________

____________________

____________________

Trainer Signature

____________________

____________________

Trainer Signature

x Bile duct stones & tumours

____________

____________

____________

x Normal anatomy & variants

x EUS examination of gallbladder & biliary system

____________________

x Oesophageal cancer staging (TN) ____________

____________________

x Normal mediastinal structures & variants ____________

Gallbladder & Biliary System

x Pancreatic duct dilatatrion & stones

x Pancreatitis

x Pancreatic tumours and staging

Mediastinum

____________

____________

____________

x Normal pancreatic anatomy & variants

x EUS examination of pancreas

____________

____________________

x Normal oesophageal anatomy & variants

____________

____________________

x EUS examination of oesophagus

Pathology in relation to EUS

Sectional EUS anatomy

Pancreas

Date

____________

____________

____________

Date

Trainer

Oesophagus

To be competent to perform/diagnose etc the following: Trainer Signature

_____________________

EUS Techniques

Competencies/Skills to be acquired Level 1

_____________________

Trainer Signature

Physics and technology

Core Knowledge Base – Level 1

Trainee

APPENDIX 9: Gastroenterological Endosonographic Training Competency Assessment Sheet

____________

____________

____________

____________

____________

____________

____________

____________

____________

____________

____________

____________

____________

____________

____________

____________

____________

____________

____________

____________

Date

_

____________

_

____________

Date

8

9

3 Evaluate tumours, TN-staging of gastric cancer, leiomyomas, GIST, 3 Recognise intra- and perimural extent and structure of ulcers 3 Recognise lymphomas, linitis plastica, varices

Liver

Kidneys and Adrenal glands To be able to: 3 Recognise tumours and cysts in the kidneys, hydronephrosis, structural changes 3 Recognise the left adrenal gland and detect lesions eg tumours within it

pervision and training for these procedures should be undertaken by someone who has achieved level 3 competence in EUS and has had at least 2 years experience at that level 3 The trainee should be able to perform intraductal ultrasonography (IDUS).

EUS anatomy To be able to: 3 Recognise normal and abnormal liver texture 3 Recognise focal lesions 3 Recognise normal and abnormal hepatic and portal venous anatomy

Pancreas To be able to: 3 Perform a thorough examination of the pancreas 3 Recognise solid and cystic tumours 3 Perform staging of cancer 3 Recognise structural changes seen in pancreatitis 3 Recognise pancreatic duct dilatation and pancreatic duct stones

Anus and rectum To be able to: 3 Evaluate benign and malignant tumours and inflammatory bowel disease 3 Perform staging of malignant tumours 3 Recognise fistulas and abscesses 3 Recognise perirectal organs (uterus, vagina, urinary bladder)

Colon To be able to: 3 Evaluate benign and malignant tumours and inflammatory bowel disease 3 Perform staging of malignant tumours 3 Recognise pericolic organs (small bowel, major vessels, gallbladder, liver)

Gallbladder and biliary system

Other structures

To be able to: 3 Perform a thorough evaluation of the gallbladder and biliary system 3 Recognise normal ultrasonic anatomy of the gallbladder and biliary system and its frequent normal variants 3 Recognise abnormalities of the gallbladder wall and lumen (stones, sludge, tumours) 3 Be able to assess bile duct dilatation at intra hepatic and extra hepatic levels 3 Detect small bile duct stones and tumours 3 Detect and stage tumours of the papilla of Vater 3 Distinguish between a dilated common bile duct and the portal vein

To be able to: 3 Recognise abnormal lymph nodes and masses 3 Recognise aneurysms and thromboses 3 Recognise ascites and fluid collections 3 Identify the coeliac axis

Portal venous system and spleen To be able to: 3 Evaluate the spleen and recognise focal lesions 3 Evaluate the portal vein and its diameter, the confluence between the splenic vein, superior mesenteric vein and the portal vein and follow the splenic vein into the hilum of the spleen 3 Evaluate thrombosis and possible tumour ingrowth into these veins

Level 2 5 Knowledge base 3 Competencies will have been gained during training for level 1 practice and then refined during a period of practice, which will involve at least one year of experience with a minimum of two EUS examinations per week 3 A further 300 examinations should have been undertaken in order to encompass the full range of conditions and procedures as listed below 3 Supervision and training should be undertaken by someone who has achieved level 2 competence in EUS and has had at least 2 years experience at that level 3 The trainee should be competent to accept referrals from level 1 practioners 3 The trainee should be able to perform EUS-guided interventions (biopsies from tumours and lymph nodes, plexus neurolysis, cystogastric drainage). Su-

Detailed understanding of gastrointestinal, mediastinal, peritoneal, omental, vascular and retroperitoneal anatomy is required

Pathology in relation to EUS 3 An understanding of disease processes which affect the mediastinum, peritoneal cavity, its mesenteries, ligaments and compartments 3 An understanding of the pathways of spread of mediastinal, intraperitoneal and retroperitoneal disease 3 An understanding of the role of ultrasound contrast agents in differentiating between benign and malignant lesions 3 An understanding of the role of sonoelastography

Competence to be aquired To be able to: 3 Perform a comprehensive EUS examination of the GI-wall, mediastinum and abdominal organs that can be imaged

by EUS-systems (radial- and linear echoendoscopes and miniprobes) 3 Identify GI tumours 3 Perform staging of oesophageal, gastric, rectal and colonic cancer 3 Differentiate between solid tumours, cysts and vascular structures 3 Recognise dilated biliary and pancreatic ducts and identify the cause and level of obstruction 3 Recognise small biliary and pancreatic stones in non-dilated ducts 3 Recognise and localise small endocrine tumours in the pancreas 3 Recognise parenchymal and duct changes in patients with pancreatitis 3 Recognise and evaluate subepithelial and intramural tumours with respect to layer of origin 3 Perform spectral, colour and power Doppler EUS 3 Recognise vascular disorders, aneurysms, thromboses, varices and vascular malformations

Ultraschall in Med 2007; 28

Ultraschall in Med 2007; 28

____________________ ____________________ ____________________ ____________________ ____________________ ____________________

x Tumours

x Inflammatory bowel disease

x Fistulas abscesses

x Cancer staging (TNM) with rectal probes

x Perirectal organs

____________________ ____________________ ____________________ ____________________ ____________________

x Normal anatomy & variants

x Tumours

x Inflammatory bowel disease

x Staging of malignant tumours

x Pericolic organs

____________________ ____________________ ____________________

x Aneurysms & thromboses

x Ascites & thromboses

x Ascites & other fluid collections

_____________________ _____________________ _____________________ _____________________

x Small endocrine tumours in the pancreas

x Perform spectral, colour and power Doppler

x Intra & extramural extent of ulcers

x Intraductal ultrasound

____________________ ____________________ ____________________ ____________________

x Fine needle aspiration biopsy

x Tru-cut biopsy

x Neurolysis

x Cyst drainage

Interventional EUS

_____________________

Trainer Signature

x EUS examination using radial & linear

As for Level 1 plus:

To be competent to perform/diagnose etc the following:

Competencies/Skills to be acquired at Level 2

Trainee

x Coeliac axis ____________________ APPENDIX 9: Gastroenterological Endosonographic Training Competency Asessment Sheet

____________________

x Abnormal lymph nodes & other masses

Other structures

____________________

x EUS examination of colon

Colon

____________________

x Normal anatomy & variants

Trainer Signature

x EUS examination of anus & rectum

Anus & Rectum

Trainee

APPENDIX 9: Gastroenterological Endosonographic Training Competency Assessment Sheet

____________

____________

____________

____________

____________

____________

____________

____________

____________

Date

____________

____________

____________

____________

____________

____________

____________

____________

____________

____________

____________

____________

____________

____________

____________

____________

____________

____________

Date

Trainer

Trainer

10

11

3 Evaluate the layers of the GI wall and identify changes in the wall and individual layers to diagnose lymphomas, linitis plastica, inflammatory bowel disease 3 Evaluate the intra- and extramural extent of ulcers 3 Perform EUS guided intervention, fineneedle and tru-cut biopsies, neurolysis, cyst drainage 3 Perform IDUS which requires endoscopic experience at ERCP level

Level 3 5

Maintenance of skills 5 Having been assessed as competent to practice there will be a need for continued professional medical education and maintenance of practical skills.

Practitioners should: 3 include EUS in their ongoing continued medical education 3 audit their practice 3 participate in multidisciplinary meetings 3 keep up to date with relevant literature

A level 3 practitioner is likely to spend the majority of time undertaking gastrointestinal endoscopy, diagnostic and therapeutic GI endosonography, teaching, research and development and will be an "expert" in this area.

Frequently transabdominal US will also be undertaken

Report from EFSUMB Publications Committee The website continues to evolve with relatively minor changes. It was decided not to make further major investment in this at the moment although this will inevitably be required in the next few years.

The Publications Committee has met twice during 2006. The first meeting which was held at Heathrow Airport London was the first at which the full new committee was able to get together. We had a lengthy update on the recent developments in the European Journal of Ultrasound particularly with online submission. The Journal has been looking at a number of ways of improving the format of the Journal to further improve the impact factor which continues to rise slowly.

A number of initiatives were discussed to encourage societies to subscribe en bloc to the Journal including personal approaches to the Presidents of the societies.

The second meeting of the committee during the Euroson congress in Bologna in September noted the new lay out of the European Journal with CME papers at the commencement of each issue. There was a lengthy discussion about whether the organisers of future Euroson Congresses should be encouraged to include a years subscription to the Journal as part of the registration fee. It was suggested this might commence with the Romanian Congress in 2008. There were further discussions about the content of the Newsletter. As well as each member of the Publications Committee volunteering to submit one article a year which has already commenced, it was agreed to encourage commentaries and technical notes from all member of EFSUMB which would be appropriate for the Newsletter.

Dr David Pilling Chairman EFSUMB Publication Committee

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Report from EFSUMB (Safety Committee) ECMUS

As you can see below, the Safety Committee has worked hard to produce two new statements: a 2006 Clinical Safety statement and one about the production of souvenir images or recording during pregnancy. The appearance of high street boutiques in which an expectant couple can obtain a souvenir (keepsake) 3D video recording has caused some concern, and ECMUS felt that it was important that EFSUMB should publish its stance on this. The new clinical statement includes clauses about 3D and 4D imaging for the first time, and has an expanded section about the use of contrast agents.

The membership of the Safety Committee has undergone some changes during 2006. Tony Whittingham (UK) has retired as its Chairman, and he must be thanked for all his hard work on this committee, the new statements would not have appeared without his efforts. Gail ter Haar (UK) has taken over as the Chair and we must also welcome Christian Kollmann (Austria) as a second new member. The other members are Phillipe Arbeille (France), Michael Delius (Germany), Ricardo Laurini (Norway), Malcolm Levene (UK) and Karel Marsal (Sweden).

ECMUS exists to serve the EFSUMB membership. If there is any area for concern or topic that could benefit from clarification please do not hesitate to let us know.

Prof Gail ter Haar Chairman EFSUMB (Safety Committee) ECMUS

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European Committee of Medical Ultrasound Safety (ECMUS) This document is the 2006 revision of the EFSUMB Clinical Safety Statement. A Safety Statement has been published by EFSUMB annually since 1994. The text is deliberately brief, and gives a concise overview of safety in the use of diagnostic ultrasound. The 2006 Statement is the fourth revision of the Statement, the previous revisions being those published in 1998, 2002 and 2003.

Clinical Safety Statement for Diagnostic Ultrasound 5 Diagnostic ultrasound has been widely used in clinical medicine for many years with no proven deleterious effects. However, if used imprudently, diagnostic ultrasound could be capable of producing harmful effects. The range of clinical applications is becoming wider, the number of patients undergoing ultrasound examinations is increasing and new techniques with higher acoustic output levels are being introduced. It is therefore essential to maintain vigilance to ensure the continued safe use of ultrasound.

Ultrasound examinations should only be performed by competent personnel who are trained and updated in safety matters.

Ultrasound produces heating, pressure changes and mechanical disturbances in tissue.

Diagnostic levels of ultrasound can produce temperature rises that are hazardous to sensitive organs and the embryo/fetus.

Biological effects of non-thermal origin have been reported in animals but, to date, no such effects have been demonstrated in humans, except when a microbubble contrast agent is present.

The Thermal index (TI) is an on-screen guide to the user of the potential for tissue heating.

The Mechanical index (MI) is an on-screen guide of the likelihood and magnitude of nonthermal effects. Users should regularly check both indices while scanning and should adjust the machine controls to

keep them as low as reasonably achievable (ALARA principle) without compromising the diagnostic value of the examination. Where low values cannot be achieved, examination times should kept as short as possible. Guidelines issued by several ultrasound societies are available.

Some modes are more likely than others to produce significant acoustic outputs and, when using these modes, particular care should be taken to regularly check the TI and MI indices. Spectral pulse wave Doppler and Doppler imaging modes (colour flow imaging and power Doppler imaging) in particular can produce more tissue heating and hence higher TI values, as can B-mode techniques involving coded transmissions. Tissue harmonic imaging mode can sometimes involve higher MI values.

3D (three dimensional) imaging does not introduce any additional safety considerations, particularly if there are significant pauses during scanning to study or manipulate the reconstructed images. However, 4D scanning (real-time 3D) involves continuous exposure and users should guard against the temptation to prolong examination times unduly in an effort to improve the recorded image sequence beyond that which is necessary for diagnostic purposes.

Ultrasound exposure during pregnancy 5 The embryo/fetus in early pregnancy is known to be particularly sensitive. In view of this and the fact that there is very little information currently available regarding possible subtle biological effects of diagnostic levels of ultrasound on the developing human embryo or fetus, care should be taken to limit the exposure time and the Thermal and Mechanical Indices to the minimum commensurate with an acceptable clinical assessment.

Temperature rises are likely to be greatest at bone surfaces and adjacent soft tissues.

With increasing mineralisation of fetal bones, the possibility of heating sensitive

tissues such as brain and spinal cord increases. Extra vigilance is advised when scanning such critical fetal structures, at any stage in pregnancy.

Based on scientific evidence of ultrasound-induced biological effects to date, there is no reason to withhold diagnostic scanning during pregnancy, provided it is medically indicated and is used prudently by fully trained operators. This includes routine scanning of pregnant women.

The power levels used for fetal heart rate monitoring (cardiotocography – CTG) are sufficiently low that the use of this modality is not contra-indicated on safety grounds, even when it is to be used for extended periods.

Safety considerations for other sensitive organs 5 Particular care should be taken to reduce the risk of thermal and non-thermal effects during investigations of the eye and when carrying out neonatal cardiac and cranial investigations.

Ultrasound contrast agents (UCA) 5 These usually take the form of stable gas filled microbubbles, which can potentially produce cavitation or microstreaming, the risk of which increases with MI value.

Data from small animal models suggest that microvascular damage or rupture is possible. Caution should be considered for the use of UCA in tissues where damage to microvasculature could have serious clinical implications, such as in the brain, the eye, and the neonate. As in all diagnostic ultrasound procedures, the MI and TI values should be continually checked and kept as low as possible.

It is possible to induce premature ventricular contractions in contrast enhanced echocardiography when using high MI and end-systolic triggering. Users should take appropriate precautions in these circumstances.

The use of contrast agents should be avoided 24 hours prior to extra-corporeal shock wave therapy Ultraschall in Med 2007; 28

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Statement on the Use of Diagnostic Ultrasound for Producing Souvenir Images or Recordings in Pregnancy Developments in real-time three dimensional ultrasonic imaging have led to parents asking for souvenir (keepsake) video recordings of the fetus, sometimes at several stages during the pregnancy. An area of concern is the growth of services designed to provide such images and recordings without any diagnostic element to the scan. Often, such services are unable to provide counselling or offer guidance if signs of a fetal abnormality are unexpectedly revealed. Apart from such services, there many instances of diagnostic scans being prolonged in order to provide such recordings.

Recommendations 5

Very little information is currently available regarding possible subtle biological effects of diagnostic levels of ultrasound on the developing human embryo or fetus, and the possibility of developmental effects in the brain cannot be ruled out.

There is evidence that diagnostic levels of ultrasound can influence development of the brain in small animals, although it is not possible to extrapolate this finding to the human situation. A balance must always be maintained between diagnostic benefit and risk to the patient. Therefore, it is difficult to justify souvenir or keepsake scanning that has no diagnostic benefit.

Attention is drawn to the recommendation of the EFSUMB Clinical Safety Statement for Diagnostic Ultrasound that ultrasound examinations should be performed only by competent personnel who are trained and updated in ultrasound safety matters.

1. Ultrasound scans should not be performed solely for producing souvenir images or recordings of a fetus or embryo.

2. The production of souvenir images or recordings for the parents to keep is reasonable if they are produced during a diagnostic scan, provided that this does not require the ultrasound exposure to be greater in time or magnitude (as indicated by the displayed MI and TI) than that necessary to produce the required diagnostic information.

Report on Ultraschall in der Medizin/European Journal of Ultrasound (UiM/EJU) in 2006 When given an opportunity to talk about something I care about – like the UiM/EJU – this usually ends up going on forever and ever, so I had to promise to keep it short.

In short, the year 2006 was another good year for our journal. For an extended short version please read on.

As the EFSUMB appointed co-editor of the UiM/EJU I have been asked to write a report on the journal for this newsletter.

Ultraschall in Med 2007; 28

Electronic manuscript submission was introduced March 1 immediately resulting in an increase in submitted manuscripts.

This of course means greater competition

for the journal pages with a positive effect on the long-term quality of the journal and hopefully also the impact factor. On the negative side is that also some papers with potential merits must be turned down. From an editor's point of view the electronic submission system is a great improvement. It is easy to keep track of the submissions and all the documents relating to each manuscript. All correspondence is now performed electronically and this really speeds up the reviewing process. On this occasion I would like to thank everyone involved in the process, the contributors, the reviewers, my friends and co-editors and the Thieme group. It is a combination of effort that gives us the journal you are holding in your hands today.

As two of my co-editors, K. Seitz and G. Judmaier, reported in issue 05-2006 there has been a further increase in the percentage of English language papers.

The majority of original articles and case reports are now in English. Editorials and CME-articles are always bilingual.

The Impact Factor of UiM/EJU for 2005 again showed an increase, and it is now 1.708. This was good news not only for those directly involved in the journal but also to all the contributors as well as our European ultrasound community. The Ultraschall in der Medizin/European Journal of Ultrasound – the official journal of EFSUMB – is now also the official journal of 9 national ultrasound societies (the German, Swiss, Austrian, Norwegian, Danish, Latvian, Flemish, Macedonian and Croatian). Hopefully even more societies will join in the coming years.

CME articles started appearing in issue 5 in 2006 and will be in every issue. The two CME articles in 2006 were about "Sonographic evaluation of acute appendicitis" and "Ultrasound of venous thrombosis of the leg", something that should be of interest to most of our members. The CME articles scheduled for 2007 will be equally interesting and exciting and they are something extra to look forward to in each new issue of our European Journal.

Michael Bachmann Nielsen Co-editor of the UiM/EJU

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EFSUMB Young Investigator's Award 2006 Each year, each member society of EFSUMB is invited to nominate a member of their society to present a paper in the Young Investigator's Award session of the EUROSON Congress. Applicants must be under 35 years of age at the opening date of the Congress, and must be a paid up member of the nominating society. The member society must agree to sponsor their candidate for the cost of their travel and accommodation expenses, and the organising committee of the conference offer the candidates free registration at the meeting. One or two prizes of â‚Ź1.000 are awarded to the candidates, judged by an ad-hoc committee to be best in terms

First Prize 5 CV Martijn E. Frijlink Martijn E. Frijlink was born in Gravenhage, the Netherlands in 1976. He received his M.Sc. degree in electrical engineering from the University of Technology, Delft, Netherlands in 2001. In September 2006 he completed his Ph.D. dissertation on the topic of "Harmonic Intravascular Ultrasound" at the Biomedical Engineering department of the Thoraxcenter at the Erasmus Medical Center in Rotterdam, Netherlands. From February 2007 he will be with the Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. His current research interests include transducer development and high-frequency harmonic imaging.

Abstract Title: Harmonic Intravascular Ultrasound Authors: M.E. Frijlink1, D.E. Goertz1,2, D. Tempel1, H.J. Vos1,2,3, A. Gisolf3, R. Krams1, N. de Jong1,2 and A.F.W. van der Steen1,2 1Erasmus MC, Rotterdam, the Netherlands, 2Inter University Cardiology Institute of the Netherlands, the Netherlands, 3Delft University of Technology

Bologna 2006

of scientific content and quality of presentation. This year entries were received from 5 national societies (Denmark, Italy, Norway, Netherlands, UK), and as always the quality of the presentations was excellent. The winner on this occasion was Martijn Frijlink from the Netherlands with his outstanding presentation on 'Harmonic Intravascular Ultrasound'. I would like to encourage all societies to consider nominating one of their outstanding young members for the 2007 competition to be held in Leipzig in October of this year. I would also commend attendance at the Young Investigators session to the membership in general; for me it is one of the highlights of the meeting.

Prof David Evans EFSUMB President

Aims: Intravascular ultrasound (IVUS) is an important imaging technique for therapy guidance, clinical research, and the detection and evaluation of atherosclerotic lesions. In Echocardiography, at conventional diagnostic frequencies (<10 MHz), second harmonic imaging has been shown to suppress unwanted tissue image artifacts and enhance contrast agent detection. Therefore, we investigated the potential of Harmonic Intravascular Ultrasound (HIVUS) to improve tissue image quality. Furthermore we investigated the harmonic detection of microbubble contrast agents in the vasa vasorum, the microvascular network supplying large vessel walls. Despite the increasing recognition of the key role that vasa vasorum play in plaque progression and vulnerability to rupture, there is currently no clinically available tool to detect them in the coronary arteries.

Materials and Methods: A prototype HIVUS imaging system, including a custommade single-element IVUS catheter with a dual-frequency response was developed to transmit at a fundamental frequency of 20 MHz (F20) to obtain second harmonic signals at 40 MHz (H40) in pulse-echo mode. The performance of Tissue Harmonic Imaging (THI) was studied in vivo by situating the IVUS catheter in atherosclerotic abdominal rabbit aortas (n = 4) and transmitting high-pressure F20 pulses.

The feasibility of harmonic detection of a modified clinically approved contrast agent (Definityâ&#x201E;˘, Bristol-Myer Squibb Medical Imaging, MA, USA) with HIVUS in vivo was studied using the same set up and proximally releasing a bolus of contrast agent through a second delivery catheter. Presence and location of microvasculature was post mortem validated against histology and microCT. Results: Cross-sectional images of rabbit aortas as acquired in H40 mode with the dual-frequency catheter in vivo demonstrated an increased image quality as compared to F20 mode. HIVUS results at 40 MHz showed reduced sheath artifacts and high-resolution images with a good signal-to-noise ratio while maintaining penetration depth. For the in vivo contrast experiments, HIVUS enabled the detection and visualization of contrast agent within the main aortic lumen and within adventitial microvessels following the bolus release of contrast. Histology and microCT revealed presence of these microvessels in the adventitia. They were not detected using fundamental IVUS imaging.

Conclusions: The potential of Harmonic IVUS to improve tissue image quality has been shown in vivo using a prototype HIVUS system. These results also demonstrate the feasibility of contrast harmonic IVUS as a new technique for vasa vasorum imaging, which has potential to be a unique tool for assessing rupture prone coronary plaques.

Acknowledgement: this project was funded by the Dutch Technology Foundation (STW)

Ultraschall in Med 2007; 28

EUROSON School

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Report on Short Course on Abdominal Ultrasound in Tropical Medicine 5 Division of Infectious and Tropical Diseases, University of Pavia, IRCCS S.Matteo Hospital Foundation – Pavia, Italy, April 2006 The course was organized with 20 hours hands-on sessions and 20 hours lectures.

Hands-on was supervised by Drs. Brunetti and Debernardis, the latter acting also as a tutor.

Lectures included basic abdominal sonographic anatomy and the use of ultrasound in ascariasis, abdominal abscess (amoebic, bacterial, fungal), cystic echinococcosis, schistosomiasis, and filiariasis, fasciolosis, fluke infections, AIDS, tuberculosis. Specific lectures were devoted to teaching ultrasound in tropical countries and the use of ultrasound in prevalence studies of parasitic diseases.

Faculty included experts in ultrasound from Italy, Switzerland, UK, Germany and the West Indies. There were 8 participants from Italy, Ghana, Norway, United Kingdom, United States and Switzerland. Ultrasound experience of attendees varied from experienced practitioner to beginner.

Applications were received from several African countries, namely Congo and Cameroon, but those applicants could not find money to fund their travels so they had to withdraw. In this respect, we were lucky to have two scholarships covering the tuition fee made available by SIUMB (Italian Society of Ultrasound in Medicine and Biology); they were awarded to two

Ultraschall in Med 2007; 28

physicians from Ghana. Funds to cover tuition fees for more participants to the course that will be held next year (2007) will be raised in order to facilitate participation from tropical countries.

The course was well received and colleagues from different countries (Burkina Faso and USA) have already signalled their interest and will apply to the next course (April 30–May 4, 2007).

Of note, this course is the only one available on this important subject, and has so far received co-sponsorship (non-financial) from World Health Organization and from the American Society of Tropical Medicine and Hygiene.

Dr Enrico Brunetti The Course Director

Future EUROSON SchoolS 5 18–19 May 2007 Thoracic-, Neck- and Abdominal Ultrasound University Hospital Košice, Slovakia. Contact PD Dr. med. Jan Tuma, Seilerweg 1, CH 8610 Uster, Switzerland, Email: Jan.Tuma@hin.ch, PD Dr. Milan Kuchta, LF UPJŠ v Košiciach, trieda snp c. 1, Košice, Slovakia, Email: kuchta@lf.upjs.sk

31 May–1 June 2007 Guidelines in Gastroenterological Ultrasound, Craiova, Romania. Contact: secretariat SRUMB: www.srumb.ro

20

British Medical Ultrasound Society Annual Scientific Meeting Manchester December 2006 As usual the British Medical Ultrasound Society held its Annual Scientific Meeting just before Christmas. This was the 3rd successive meeting in Manchester so that delegates were very familiar with the venue. Whilst the format of the meeting over 3 days and with 3 and sometimes 4 parallel sessions has been established for a number of years, the content of the meeting has evolved steadily with far fewer proffered papers than perhaps 10 years ago but more invited speakers. The reasons for this are clear in that less workers are submitting high quality proffered papers, probably due to diminishing availability of resources in the UK for ultrasound research. The quality of the meeting has however continued to improve, attracting many high profile speakers from all areas of ultrasound to contribute. The meeting therefore continues to provide a very valuable update in recent advances in ultrasound for all those involved in the field.

Involvement with groups of clinicians who use ultrasound as a working tool has also helped to improve the meeting and encourage those for whom ultrasound is a relatively small part of their working life to learn more about it. There is no doubt that the parallel extensive industrial exhibition helps to attract these people to view the technology as well as the clinical applications.

Amongst the highlights this year were debates on the subject of "Can the NHS continue to afford the 20 week fetal anomaly scan" and the very controversial subject of the training of non imaging specialists to undertake ultrasound. These two debates both involved the audience voting both before the debate and afterwards and were very lively. Amazingly the second debate on training resulted in an exactly even vote for each side.

Perhaps the most interesting and innovative session was the one entitled "Ultrasound in Unusual Places" involving a lecture from a Royal Navy Radiologist involved in the war in Iraq, a speaker from NASA talking about ultrasound in space and the use of ultrasound on the international space station and finally a talk about ultrasound at the zoo from an ultrasound specialist from Berlin Zoo.

The social events met a very high standard although the evening at the Hard Rock CafĂŠ reached new heights in the audible sound levels produced by a band such that any form of communication between delegates ceased as soon as the band started.

This was however more than made up for by the Annual Dinner in Manchester Town Hall which was again of the highest quality with a Disco which even this reviewer found sufficiently attractive to encourage him to take to the floor.

Next year the Society moves back to Harrogate again for a change of scenery. As before the Society is always very welcoming to delegates from all parts of the world and those who have not been before would find the science and educational value of the meeting very high. I know I am very biased but having been to big international ultrasound meetings on three Continents this year, I can say that undoubtedly BMUS can compete very favourably with all these meetings in terms of quality of educational value and socially is also as attractive as any.

Dr David Pilling Editor EFSUMB Newsletter

SonoWorld is Dedicated to Linking the Global Ultrasound Community Recent expansion plans include regional sites SonoWorld (www.sonoworld.com) is the leading ultrasound education website dedicated to improving the quality of life around the world. Evolving from a small start-up a few years ago to a global resource, the site now has over 2.5 million visitors a year.

Dedicated visionary individuals with a desire to help are behind the efforts, sharing their expertise and knowledge for educating ultrasound professionals both in developing and developed countries.

SonoWorld is currently expanding with the launch of regional portals and a new specialty site (SonoWorld Echo).

Since SonoWorld's debut in 2001, the global physician and sonographer communities have expanded their ultrasound knowledge through this free online tool dedicated to communicating all aspects of the profession on an international platform. "I saw there was a need, in both developed and developing countries, for web-based education," said Barry B. Goldberg, MD, chairman of SonoWorld's medical advisory board. "Even in the most remote parts of the world, computers are available."

Dr. Goldberg emphasized that SonoWorld's advisory board is comprised of leaders from every section of the ultrasound profession who bring their expertise to this voluntary position.

Those who log onto SonoWorld find that in just one click they can be transported to the latest ultrasound news, peer-written and reviewed clinical articles as well as technology and product updates. Other content includes textbook chapters and interesting case studies. The result is that clinicians, sonographers and key industry professionals connect for learning and training while also raising their ultrasound awareness level and moving this medical imaging specialty forward.

"The idea is to provide help for those looking to learn or even purchase equipment or need ergonomic or other information; anything related to the ultrasound community," said Dr. Goldberg who has in his professional career spent decades traveling around the world educating physicians and sonographers.

International societies have recognized the benefits of participating in the global SonoWorld community and are contributors of articles and other content. As part of the "Contributing Organizations" pro-

Ultraschall in Med 2007; 28

21

gram, journal articles are provided courtesy of the sponsoring societies and selected by the editors of the journals they produce. The sharing of these selected articles on SonoWorld provides the contributing journals with exposure to potential subscribers in the global marketplace. A growing number of highly prestigious societies have signed on to partner with SonoWorld, including: the World Federation for Ultrasound in Medicine and Biology (WFUMB), the European Federation for Ultrasound in Medicine and Biology (EFUMB), the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), the Australasian Society for Ultrasound in Medicine (ASUM), the American Institute of Ultrasound in Medicine (AIUM) and the Society of Radiologists in Ultrasound (SRU).

practice guidelines native to the country or region, local events and professional society information.

May 16–19, 2007 3 88th German Radiology Congress 2007

The first of the deducted "regional" sites up and running is SonoWorld Europe (www.sonoworldeurope.com) which is in English and under the medical direction of Professor David Cosgrove from London, England. The second regional site is SonoWorld Latin America (www.sonoworldLA.com) which recently launched in both Spanish and Portuguese under the medical direction of Professor Giovanni Cerri from Brazil and Leandro Fernandez, MD from Venezuela. The third planned regional site is SonoWorld India under the medical direction of Professor Mukund Joshi from Mumbai, India. More regional sites are on their way.

May 18–19, 2007 3 EUROSON School Course

At the 92nd Scientific Assembly and Annual Meeting of the Radiological Society of North America held in Chicago November 26 through December 1, 2006, SonoWorld showcased a new echocardiography site. The link is found within www.sonoworld.com which features general ultrasound, vascular and Ob/Gyn materials.

Once live, each of the autonomous sites works closely with the regional ultrasound societies in the development of educational and informational content.

The groups work in tandem to best serve the needs of ultrasound practitioners in the region while providing direct access to the entire collection of SonoWorld educational materials.

The next expansion is dedicated to shaping SonoWorld to meet the needs of individual countries; additions include incorporating all the core educational materials and integrating regionalized information in local languages, such as specific

"We have taken information to the world, and the world is using it," Dr. Goldberg said. "All of this material should prove useful in raising the level of patient care by increasing ultrasound knowledge."

Diary Dates 2007 March 9–13, 2007 3 ECR 07 – European Congress of Radiology, Vienna, Austria. Contact: ECR office, Neutorgasse 9/2, AT-1010 Vienna, Austria, Tel; +43 1 533 40 64 - 0, Fax: +43 1 533 40 64 - 448, website: www.ecr.org

March 15–18 , 2007 3 2007 AIUM Annual Convention, Marriott Marquis Hotel, New York City, New York.

Website: www.aium.org

March 26–30, 2007 3 Advanced course in gynecological ultrasound, Malmö University Hospital, Malmö, Sweden. Contact: Prof Lil Valentin, email: lil.valentin@med.lu.se) or marianne.persson@med.lu.se

April 13–15, 2007 3 The 66th Annual Meeting of Japan Radiological Society (JRS). Yokohama, Japan. E-mail: jrs2007@radiol.med.osaka-u.ac.jp

Ultraschall in Med 2007; 28

(Deutscher Röntgenkongress), Berlin, Germany. Website: www.drg.de

Thoracic, Neck and Abdominal Ultrasound – University Hospital, Košice, Slovak Republic.

Contact: PD Dr. med. Jan Tuma, Seilerweg 1, CH 8610 Uster, Switzerland. Email: Jan.Tuma@hin.ch , PD Dr. Milan Kuchta, LF UPJŠ v Košiciach, trieda snp c. 1, Košice, Slovakia, Email: kuchta@lf.upjs.sk

May 31–1 June 2007 3 EUROSON School Course Guidelines in Gastroenterological Ultrasound. University of Medicine and Pharmacy of Craiova, Craiova, Romania. Contact: Secretariat: University of Medicine and Pharmacy of Craiova, Petru Rares Street, No.2-4, 200379 Craiova, Romania, Tel-fax: +40.251.419615,+40.251.426688, Email: vemd1@yahoo.com, Website: http:// eco2007.craiova.ro

June 1–2, 2007 3 ESSR 2007 – 14th annual Meeting of the European society of Musculoskeletal Radiology, Izmir, Turkey. Website: www.essr.org/

June 3–7, 2007 3 50th annual Meeting of the Society for Paediatric Radiology (ESPR). Website: www.espr.org

June 11–13, 2007 3 UKRC 2007 – UK Radiological Congress at Manchester, United Kingdom. Website: www.ukrc.org.uk/

September 21–22, 2007 3 9th Seminar of the European Society of Contraception, "From abortion to contraception", Bucharest, Romania. Contact: European Society of Contraception, Mrs. Nancy Habils, Opalfeneweg 3, 1740 Ternat, Belgium. Tel: +32 2 582 08 52, +32 2 582 55 15, email: congress@contraception-esc.com, esccentraloffice@contraception-esc.com

October 7–11, 2007 3 17th World Congress on Ultrasound in ObsteApril 15–20, 2007 3 ESUR 2007 (14th Annual symposium of the European Society of Urogenital Radiology ) Bonita Springs, Florida, USA. Website: www.esur.org

April 26–29, 2007 3 First Arab Radiologgy Congress at Dead Sea, Jordan. Further information: Tel.: 9627955 24038, Fax: 9623 6582 5888, email: hiari53@ hotmail.com. Website: www.isradiology.org/

May 6–11, 2007 3 107th American Roentgen Ray Society Annual Meeting, Orlando, Florida, USA. Website: www.arrs.org

May 9–12, 2007 3 18th Nordic Congress of Radiography and 57th Nordic Radiological Congress, Malmo, Sweden. Website: www.nordiccongress.org

trics and Gynecology (ISUOG), Florence, Italy.

Contact Congress Secretariat: Tel: +44(0) 20 7471 9955 Fax: +44(0) 20 7471 9959, Email: congress@isuog.org Website www.isuog2007.com

October 24–27, 2007 3 EUROSON ULTRASCHALL 2007, 19th EUROSON CONGRESS – 31st Dreiländertreffen, Congress Center Leipzig, Germany. Contact: INTERPLAN, Email: euroson@interplan.de, Tel: +49 / 89 / 54 82 34 - 0, Fax: +49 / 89 / 54 82 34 - 42. Website: www.euroson2007.de

April 30 –3 May 2008 3 10th Congress of the European Society of Contraception, "Non-contraceptive impact of contraception and family planning", Prague, Czech Republic. Contact/Information: European Society of Contraception, Mr. Peter Erard, Opalfeneweg 3, 1740 Ternat. Tel. +32 2 582 08 52, Fax. +32 2 582 55 15. Email: congress@contraception-esc.com; esccentraloffice@contraception-esc.com, Website: www.contraception-esc.com/