2013 ISSUE 6 Newsletter

EFSUMB Newsletter

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

Impressions of Euroson 2013 Meeting in Stuttgart, Germany Just finishing my residency in radiology and becoming a fresh radiologist it was very exciting for me when I got the invitation to attend the EUROSON 2013 and the Dreiländertreffen in Stuttgart, Germany.

Before that attending many years in a row the ECR in Vienna and many local congresses in Slovenia and neighbouring countries, such as Slovenian-Hungarian-Croatian congress or Alpe-Adria meeting, this was my first time to attend such a specialized congress, dedicated specially to ultra­sound and its use in different clinical settings and imaging algorithms.

With ‚the use of ultrasound in different clinical settings‘ I mean the ever increasing use of ultrasound in the emergency room, at the patients bedside or even in the operating theatre. At the exhibition a poster titled ”Intraoperative use of a wireless ultrasound device – a first clinical report“ from Zenk J came to my attention, where the operating head and neck surgeon used the new wireless transducers in the operating room with great success.

Portability and ease of use is a great benefit for the investigator, specially when using it in the emergency setting as a tool of POCUS (point of care ultrasound) or in the operating room, being an interventional radiologist or a surgeon.

During the congress I mostly attended refresher courses in vascular and pediatric ultrasound. There was one course called ”Das unklare Bein“ where besides the pathology of the veins and arteries also the pathology of the musculoskeletal system was discussed. A very experienced ortho-

pedic surgeon Norbert Hien listed an extensive array of pathologies in the leg and showed us that every pain and complaint in the leg can be explained, you just have to know your line of work. In the same section Elmar Mertiny described the importance of a good clinical exam and D-dimer value before doing the ultrasound examination in searching for deep venous thrombosis. Truly you have to know what to search for and what to expect.

Another interesting session was about ultrasound of the lung titled ”Bildgebung der Lunge“. At this point let me say that I was very happy to notice that my German professor from high school did a great job and I was able to follow the German lectures from Dreiländertreffen with no problems at all.

As expected imaging of the lung in case of pneumonia, a study presented by Angelica Riessig, can be very usefull or even straightforward, special caution was advised in the case of the so called fluidobronchogram, where a possible obstructing lesion could be the cause of pneumonia. At the contrast agents part of the session I was surprised that the presenter Christian Görg did not use much of CEUS (contrast enhanced ultrasound) in case of benign thoracic wall lesions but more so in case of lung consolidations, where the dual blood supply of the lung with great temporal resolution of the CEUS helps a great deal in differentiating different kinds of lesions.

In the pediatric sections I was specially interested in the role of CEUS in different clinical settings, where Doris Franke with

Primož Caf, MD, Radiologist, Member of Slovene Society for Ultrasonics

the lecture titled ”CEUS in der Pädiatrie“ offered a great insight in what CEUS actually is, how it works and where we can use it, be it in the setting of trauma, tumors or inflammatory disease. At the same section Michael Riccabona lectured about the interventions in the child, presenting practical tips how to perform the procedures and which drugs to avoid, specially in renal interventions. At the end of the session Prof. Riccabona, a very respected friend of Slovene pediatric radiologists, opened the discussion of allergic reactions in the CEUS examinations, presenting few reported cases of allergic reactions in the use of CEUS and predicting that new reports of allergic reactions will arise, also in the off label use of CEUS in cistoureterography in children.

Indeed, the use of CEUS is expanding.

Once being reserved only for the hepatic lesions, the last few years encouraging results arise also from the extrahepatic use of CEUS. In the section Update on current extrahepatic indications of CEUS I was

EFSUMB Lynne Rudd 28 Portland Place, London W1B 1LY, United Kingdom Tel: +44 (0) 20 7099 7140 Email: efsumb@efsumb.org

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EFSUMB Newsletter very much surprised by a great deal of information one gets when one uses CEUS in solid lesions of the gallblader or when one wants to differentiate an adenocarcinoma from a neuroendocrine tumor in the pancreas, for example. Even further extrahepatic indications for the use of CEUS were presented at the Bracco symposium. The chairman Fabio Piscaglia made a great summary of all three lectures at the end and said that we should use CEUS whenever possible, be it in the assessment of kidney function, lymph nodes or in monitoring of liver interventions.

As far as the industry is concerned, I did not have much time to visit different manufacturers to test all the machines, but I took time to visit the Ultrasound learning centre. Performing doppler ultrasound for a few years by now, I had a lot of questions and doubts, so I attended the abdominal session �Focus on Doppler examination for portal hypertension and renal artery stenosis“ with Theresa Fontanilla. She did a great job, answering all of my questions; I heard she also gave two wonderful lectures on doppler ultrasound and CEUS in liver transplantation and ARFI shear wave elastography as my colleagues reported.

Although in every imaging modality the specialists and investigators show great enthusiasm and never ending determination to get new insights into disease processes, I never felt such passion and even joy radiating from the specialists, presenting their insights into ultrasound as in this Ultraschall and Euroson 2013 meeting in Stuttgart, Germany.

The author received a sponsored registration for EUROSON 2013.

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Following the elections at the General Assembly at EUROSON 2013 the composition of the Committees is as follows Executive Bureau (ExB) ▼▼

Christoph F. Dietrich

Odd Helge Gilja

Fabio Piscaglia

Prof Christoph F. Dietrich (President) Prof Odd Helge Gilja (President Elect) Dr Fabio Piscaglia (Past President) Dr Hans-Rudolf Schwarzenberg (Honorary Secretary)

Hans-Rudolf Schwarzenberg

Paul Sidhu

Prof Paul Sidhu (Honorary Treasurer)

General Secretary ▼▼ Lynne Rudd

Lynne Rudd

ECMUS (Safety Committee) ▼▼

Gail ter Haar, UK, Chair Christian Kollman, Austria, Secretary Klaus Jenderka, Germany Kjell Salvesen, Norway Carla Serra, Italy Nico de Jong, Netherlands

Gail ter Haar

Education& Professional Standards Committee (EPSC) ▼▼

Vito Cantisani, Italy, Chair Dieter Nürnberg, Germany, Secretary Helmut Prosch, Austria Andreas Serra, Switzerland Eugenio Cerezo, Spain Hilde Berner Hammer, Norway (co-opted) Radu Badea, Romania (co-opted) Adnan Kabaalioglu, Turkey (co-opted)

Vito Cantisani

Publications Committee ▼▼

Michael Bachmann Nielsen, Denmark, Chair (EJU Editor) Adrian Saftoiu (EFSUMB Newsletter Editor) Caroline Ewertsen, Denmark Andreas Schuler, Germany Paul Sidhu, United Kingdom Nikolas Papantoniou, Greece (co-opted) Maija Razina, Latvia (co-opted)

Michael Bachmann Nielsen

Adrian Saftoiu

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EFSUMB Newsletter An edited version of the presentation given at EUROSON 2013, Stuttgart

English phrases that should be avoided in manuscripts – but are often not Ten tips from an Editor of Ultraschall in der Medizin – European Journal of Ultrasound 1. For articles written in English remember the Campaign for ‘plain English’ Charming and quaint language is redundant – Henceforth, Thus, Hence Before – The Dietary Guidelines for Americans recommends a half hour or more of moderate physical activity on most days, preferably every day.

The activity can include brisk walking, calisthenics, home care, gardening, moderate sports exercise, and dancing.

After – Do at least 30 minutes of exercise, like brisk walking, most days of the week.

2. No forbidden words or expressions should be used but the article should be well written and consistent with the core material assessed But beware of double meanings.

3. The flow of the article should be apparent Each sentence should lead to the next and each paragraph is self contained.

4. To produce a learned and structure article avoid words that may introduce bias ‘Puffery’ (Peacock terms) Words that are used to promote the subject without imparting or summarizing verifiable information, for example, Acclaimed, Outstanding, Leading, Renowned, Remarkable, Prestigious, Landmark, World-class ‘We have demonstrated the potential of this technique that could alter radiological practice to the benefit of patient care. ’Do not make unprovable proclamations about the importance of your work; stick to the facts and attributions to demonstrate their importance and let the reader decide.

5. Avoid unsupported attributions ‘Weasel words’ are vague attributions, where a statement is dressed with authority with appearance of support but denies the reader the source of the viewpoint. This disguises a biased view for example, Many workers believe, It is accepted opinion, Research

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has shown, It is widely accepted, Experts agree Claims should be attributed.

6. Avoid expressions of doubt ‘Doubting’ words are words that imply that a given point is inaccurate for example, Supposed, Apparent, Purported, So-called.

Punctuation may also be incorrectly used to imply that the author is distancing themselves from a common interpretation.

7. Avoid clichés and idioms in favour of direct and literal expressions For example, Take the plunge, At the end of the day, Tip of the iceberg, We kept our focus, A good rule of thumb, At the cutting edge, Draw the Line Before – We kept our focus, and at the end of the day, with a wind in our sails, and luck on our side, we pulled out all the stops, drew the line and finished in the nick of time.

After – The study was completed in the required time.

8. Relative time references The preference is to be more specific

with statements, vague time periods are not useful for example, Recently, Lately, Currently, Presently, To date, Formerly 9. Editorializing The need to highlight something as particularly significant or certain should maintain an impartial tone.

Notably, Interestingly, It should be noted, Actually, Clearly, Without doubt, Essentially 10. Abbreviations Explain each abbreviation before using the term and do not litter your manuscript with abbreviations.

Do not invent abbreviations, use established abbreviations.

And finally to summarise

▶▶Think carefully as you write, do not use ‘jargon’ ▶▶Write in plain English, longer sentences are not better ▶▶Avoid self aggrandisement ▶▶Stick to the facts, do not embellish the work ▶▶Avoid clichés and ‘invented’ abbreviations ▶▶Get someone else to read the manuscript – they will pick out the ‘clangers’ Prof Paul S. Sidhu King’s College London, UK

Forthcoming Euroson Schools visit www.efsumb.org for more Schools and Endorsed Courses

EFSUMB Newsletter

Contribution to the Newsletter Hosting eBooks on our website has been introduced a few years ago and includes the EFSUMB Course Book on Ultrasound (ECB), among others which have also been published in a printed format and the online EFSUMB Course Book Student Edition (ECBSE) which has been launched at EUROSON 2013 in Stuttgart. The ECB has been published on the new Educational Portal (http://www.efsumb-portal.org/ ep). Additionally, examination technique videos are available [www.efsumb.org] [http://www.efsumb-portal.org/ep/category.php?id=152]. Most importantly, eBook information can be updated and this is important in what is one of the most rapidly advancing fields of medicine.

This multidisciplinary ECB is intended to complement and advance the educational purposes of EFSUMB in a modern way, and will integrate the extensive experience of European authors and ultrasound teachers into clinical courses, also providing accreditation. The ECB is aiming at illustrating and supporting the EFSUMB course system and the well established EUROSON Schools. In addition, the ECB incorporates the minimum training recommendations for the practice of medical ultrasound published by EFSUMB. Up to now 26 chapters have been introduced and are available online.

1. Chapter Introduction, 2. Chapter US of the Liver, 3. Chapter Estimation of Liver Stiffness, 4. Chapter Liver Transplantation, 5. Chapter US of the biliary system 6. Chapter Pancreas, 7. Chapter Transabdominal US of the gastrointestinal tract, 8. Chapter Functional US of the gastrointestinal l tract, 9. Chapter Genitourinary US, 10. Chapter US of the scrotum, 11. Chapter Nephrology, transplantation and shunts,

12. Chapter US of the adrenals 13. Chapter Thyroid US, 14. Chapter Sonography of the salivary glands and soft tissue lesions of the neck, 15. Chapter Chest sonography, 16. Chapter Introduction to US in vascular disease and introduction, 17. Chapter Doppler US of the aorta, inferior vena cava and visceral arteries, 18. Chapter Doppler US of renal vessels, 19. Chapter US of peripheral veins, 20. Chapter US evaluation of cerebrovascular obstructive diseases, 21. Chapter US in peripheral arterial disease, 22. Chapter Interventional US, 23. Chapter Technical Quality Evaluation of diagnostic US systems, 24. Chapter Sonopsychology, 25. Chapter US in tropical diseases, 26. Chapter US in tropical medicine. Human Immunodeficiency Virus (HIV) Infection The course book is devoted to the interdisciplinary approach of the multinational societies of EFSUMB. Therefore, additional disciplines will be introduced in the near future. There are new chapters which are under preparation including an introduction into echocardiography, ultrasound of the musculoskeletal system, and endoscopic ultrasound.

As already mentioned, a version of the ECB should be made accessible for students, hence the ECBSE. EFSUMB is of the opinion that it is very important that medical students are trained in the principles of diagnostic ultrasound. Ultrasound can be a highly valuable tool not just in diagnostics but also in enabling students to understand anatomy and physiology. EF-

SUMB will promote a uniform education for all medical students. Therefore, compared to the ECB, the ECBSE offers less detail. Examination technique videos are necessary for students and the aim is to produce a version by 2014 considering these criteria. The first chapters of the ECBSE are already available on the EFSUMB website and an electronic version of the book is under consideration, such as a DVD, or USB stick or even an app so that the ‘book’ could be offered at the lowest possible price, be easily mailed to those who would like a permanent version and be easily transferable to congresses or educational institutions. Chapters that are already published, or almost ready, include examination technique, “knobology”, liver, biliary tract, spleen, neck, pancreas, gastrointestinal tract, FAST, Echoscopy: Clinical investigation with US. The ECB and ECBSE are hosted on the Educational Portal of the website under the icon ECB and ECBSE, respectively. Videos are embedded in the chapters with an additional first chapter (Ch 00) listing the videos for quick reference to the procedure, without the need to search through the text. For bulk printed book purchases or for any further information please contact efsumb@efsumb.org Dietrich CF, Gilja OH, Sidhu P, Schwarzenbach H, Piscaglia F Corresponding author: Prof. Dr. med. Christoph F. Dietrich EFSUMB President Med. Klinik 2 Caritas-Krankenhaus Bad Mergentheim Uhlandstr. 7 97980 Bad Mergentheim Tel.: (+) 49 - 7931 – 58 – 2201 Fax: (+) 49 - 7931 – 58 – 2290 Email: christoph.dietrich@ckbm.de

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