2013 ISSUE 1 Newsletter

EFSUMB Newsletter

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

Winner of EUROSON 2012 Young Investigator Award

Dose-Dependent Artefact in the far Wall of the Carotid Artery with Dynamic Contrast Enhanced Ultrasound Introduction ▼▼

Dynamic contrast enhanced ultrasound (DCE-US) is an emerging technology to ­assess neovascularization in atherosclerosis. The aim of this study was to quantify a pseudo-enhancement phenomenon observed during DCE-US of the carotid in other studies.

Methods ▼▼

Ethical approval was obtained for this prospective case series and each patient gave written informed consent. 31 patients with 50–99 % internal carotid artery stenosis underwent DCE-US imaging of the carotid bifurcation using 2 ml of intravenous SonoVue™. In the final 10 patients, a further 1 ml bolus was administered after 15 minutes. Raw linear DICOM data was analysed offline. Regions of interest were drawn within the common carotid lumen and immediately adjacent in the near and far wall adventitia. Peak intensity was measured. In addition, an in vitro experiment, using a single channel flow phan-

Ankur Thapar (UK) BSc, MBBS, MRCS

tom was performed. SonoVue™ concentrations of 0.02, 0.1, 0.5, 1, and 2 ‰ were pumped into the tube. Regions of interest were drawn in a similar fashion and the peak intensity measured.

Results ▼▼

The carotid far wall was significantly more echogenic than the near wall at 2 ml (p < 0.0001, n = 31) and the far wall intensity rose synchronously with that of the lumen. The intensity difference was a factor of 4 at 1 ml and 12 at 2 ml. In vitro, the phantom demonstrated a similar pattern and magnitude of enhancement in an area without vasa vasorum.

Conclusion ▼▼

A dose-dependent, non-linear propaga­ tion artefact occurs in the far wall adventitia of the carotid artery, which should not be mistaken as a marker of plaque vulnerability.

Ankur Thapar is a year 1 vascular surgery trainee with an interest in novel ultrasound techniques for imaging the carotid artery and jugular vein. Ankur trained at Imperial College London and is currently completing his PhD in functional ultrasound imaging of vulnerable carotid plaque.

Recent Awards 2010

Royal College of Surgeons Mary Dunhill Fellowship

2010

Circulation Foundation Mary Davies Fellowship

2011

UK Venous Forum Travelling ­Fellowship

2011

London Surgical Symposium 1st Prize

2012

EUROSON Young Investigator Award EFSUMB

2012

Graham-Dixon Prize for Cardio­ vascular Surgery

All National Societies are reminded to submit their nomination for this year’s Young Investigator Award for a chance to win the coveted title and 1000 euro at EUROSON 2013, Stuttgart, Germany.

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

Fabio Piscaglia

Report of EFSUMB Activities in 2012 from EFSUMB President Fabio Piscaglia During last year activities have been actively running and the following are some of the most relevant topics: ▶▶For the first time the EUROSON meeting took place in Spain (Madrid). This was a successful event, with the conjunct participation of different speciality societies, together with the multidisciplinary Spanish society. ▶▶The CEUS non liver guidelines were published in the first 2012 issue of our official journal „Ultraschall in der ­Medizin / European Journal of Ultrasound“, dispatched to all EFSUMB members. At the end of the year the CEUS liver guidelines went e-pub. The latter were published simultanously in our journal and in the journal of the WFUMB, to represent the joint efforts of these two Federations to produce the document. ▶▶The preparation of Technological and Clinical Recommendations on the use of ultrasound Elastography has been ongoing during the whole year and is expected to be published online and subsequentely to appear in a printed version within 2013. Part 1 of the ­document will deal with the basics of ultrasound elastography, aimed at ­clarifying the different modalities ­currently on the market, which produce different types of elastography, including strain elastography and various shear wave modalities. Part 2 will present the current recommended ­clinical applications. This document will keep EFSUMB at the forefront of ultrasound worldwide, being the first guidelines released by a multidisciplinary ultrasound society. ▶▶The European Course Book was finally printed and is now available to be ordered. This book is, in the opinion of the EFSUMB officers, an outstanding production, with an extremely good quality / cost ratio, as it can be read for free from the EFSUMB website and but is also rather cheap to be purchased as a printed book with colour figures. ▶▶The EFSUMB website has been enriched constantly. The case of the month receives many thousand visits per month and is now translated in several languages. New cases from all EFSUMB members are welcome and can provide great visibility to the authors.

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▶▶EFSUMB has proposed a new term, Echoscopy, for bedside focused, clinically simple applications than can be carried out also with pocket size scanners. A more detailed EFSUMB posi­ tion on this topic, very relevant for everybody, but expecially for clinicians, is reported in this newsletter. ▶▶More information of EFSUMB activities to the individual national members is expected. To this aim EFSUMB has asked its delegates to inform all national members about EFSUMB activities in 2013 in their own national languages. ▶▶In 2012 the EFSUMB Education Committee approved 8 Euroson Schools in 5 countries, with a successful Elastography School held in Athens, Greece, for the first time and the year ended with the Hannover CEUS School which is now so popular the course is oversubscribed. The EPSC endorsed 11 courses from Peru to Romania, the ­latter offering an impressive 6 endorsed courses during the year. ▶▶Educational activities carried out within the EFSUMB mainframe are to be adequately recognized. Therefore EFSUMB decided to start releasing ­EFSUMB educational credits to acknowledge participation in its educa­ tional activities. Recognition of these ­credits by a national agency is not ­guaranteed and should be specifically ­verified (a universal recognition is in fact impossible on a European basis, given the different systems active in different countries, which are not ­mutually recognized).

▶▶Online education continues with the postgraduate web course which can be completed online to receive the ­EFSUMB CME certificate. ▶▶The Executive Bureau activities are carried out on a regular basis, thanks also to the support of Internet supported Conference Calls, which allow meetings on nearly a monthly basis with no additional cost. This modality is being experimented also by the ­EFSUMB Committees. ▶▶EFSUMB was represented at various meetings ECR, UEG Week, EASL and Dreilandertreffen in 2012 to promote our activities. ▶▶The Educational Portal hosts two e.Pub books which can be downloaded for free; Hepatic Elastography using Ultrasound Waves, edited by Prof Ioan ­Sporea and Dr Roxana Sirli and The Safe Use of Ultrasound in Medical ­Diagnosis, edited by Dr Gail ter Haar. ▶▶A position statement on safety of ­elastography has been released by the ECMUS Committee.

We look forward to working closely with our National Societies in 2013 to continue building the European ultrasound community.

EFSUMB Newsletter Dear Colleagues

EFSUMB Recently Joined in a Collaboration with the European Society of Radiology (ESR) Meetings between the two Societies have already been held in Vienna, both during the WFUMB / EFSUMB Congress and during the congress of ESR. The first combined scientific session will be at the ­Austria Center in Vienna, during the European Congress of Radiology (ECR) 2013.

It will be on Monday, March 11, 2013; 08:30–10:00; Room Z, and will be entitled: „Advances in diagnostic ultrasound: better results through cooperation” Introducing the EFSUMB: the world’s largest ultrasound Society

N. Gritzmann (Vienna / AT)

ESR / EFSUMB collaboration: a newly established platform for joint development of ultrasound in radiology and clinical specialties

L.E. Derchi (Genoa / IT)

Image fusion and intervention

T. Lorentzen (Herlev / DK)

The EFSUMB non-liver CEUS guidelines

F. Piscaglia (Bologna / IT)

The EFSUMB / WFUMB liver CEUS guidelines

M. Claudon (Vandoeuvreles-Nancy / FR)

During the meetings, discussions have been held on a variety of topics. Among them the problem of archiving ultrasound images and reports. From a survey held by the ESR, it has been shown that the ultrasound images (obtained either in radio­ logy or in clinical departments) are not always routinely saved in the hospital ­ PACS systems and that, within the same hospital, the reports of the ultrasound ­examinations are often recorded in a variety of archives. It has been recognized that it may be difficult to find resources to link all US equipment to the IT hospital system and to provide enough memory to store large amounts of data, especially if video clips need to be recorded. It has also been considered that there may be problems in planning a uniform and complete storage of the examinations’ reports, since ultrasound may be used in a large variety of

ways, from a stand-alone study to a simple and quick guide to a procedure or a physical exam. However, it has been agreed that availability of ultrasound images and reports for future reference is quite important in clinical practice and it has been decided that both Societies would recommend to their members to organize their ultrasonography workflow so that proper archiving of all examinations performed within each hospital would be regularly obtained.

The main aim of the collaboration between the two Societies is to further promote both clinical and radiological Ultrasound. In the following we want to suggest to our EFSUMB members the advantages of being an ESR member. The European Society of Radiology currently boasts 53,822 members in good standing from 195 countries. This makes the ESR one of the most important institutions in the field of radiology, aiming to promote ­radiology and highlight its importance in medicine worldwide.

Education & Training ▼▼

ESR offers a wide range of learning and training opportunities in accordance with its mission to promote diagnostic and interventional radiology and associated disciplines through pre and postgraduate education and research, and to formulate teaching and examination programmes to provide equivalent training for radiologists and other staff working in radiology departments in the relevant countries. ESR has an extensive homepage (http://www.myesr.org) where all the courses can be viewed. In this eLearning has a prominent place.

All ESR members have free and unlimited access to the online version of European Radiology, the official journal of ESR, which in 2010 has reached a Impact Factor of 3.594 and is Europe‘s no. 1 general radiological journal. The printed version of European Radiology can be purchased by ESR members for only an extra fee. A print subscription includes 12 monthly issues

and around 2,500 pages of scientific content.

Research ▼▼

Created in order to provide a Europe-wide base for joint research, EIBIR, the European Institute for Biomedical Imaging Research, aims to ensure the pooling of resources among members, to promote a culture of cooperation through networking activities. EIBIR thus wants to generate critical mass and help coordinate ­research into new instrumentation, methods, concepts and technologies.

Publications & Media ▼▼

Through its various publications in print as well as in electronic format, ESR provides its members and partners with valuable information about and insights into all aspects of radiology-related and society matters. Scientific publications include European Radiology, Insights into Imaging and ESR publications and statements and various ESR and ECR media.

EU Affairs ▼▼

The ESR is closely monitoring EU legisla­ tion and EU affairs with a potential impact on medical imaging and has started to successfully build relations with relevant EU institutions and EU consulting and public affairs agencies. The ESR needs to be acknowledged as a major stakeholder in EU health policies and involved in consultation processes for new legislative initiatives in this field. In order to achieve this, the ESR has adopted a pro-active approach and has recently established an EU Taskforce.

ECR ▼▼

The annual Congress takes place each year in the beginning of March in Vienna and as a member can be attended at a reduced fee.

Univ. Prof. Dr. Norbert Gritzmann Former President of EFSUMB Prof. Michael Bachmann Nielsen EFSUMB Publications Committee Chairman

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