ECR TODAY FRIDAY, MARCH 1 - European Society of Radiology
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FRIDAY, MARCH 1 ECR TODAY
AIX THEATRE EXPO X1 HALL
MODERATORS
Dr. Hugh Harvey and Dr. Wim Van Hecke
Friday, March 1
11:00–12:00
AI in 8 – industry pitches from Icometrix,
Envoy AI, Aidence, AGFA, Osimis
12:00–12:40
Dr. Liz O’Riordan: AI from a Patient’s Perspective
12:45 –13:00
Q&A with Dr. Liz O’Riordan & Dr. Hugh Harvey
13:30–14:30
AI in 8 – industry pitches from Smart Reporting, iCAD,
Contextflow, Oxipit, 12 Sigma Technologies
14:30 –15:30
AIX Panel: Implementing Artificial Intelligence in Clinical Care
Moderator: Dr. Wim Van Hecke
Saturday, March 2
11:00–12:00
AI in 8 – industry pitches from Densitas, Infervision, Nvidia, Incepto Medical, Subtle Medical
12:00–12:40
Dr. Filippo Pesapane & Dr. Marina Codari: AI Ethics and Regulation: an open issue
12:45 –13:00
Q&A with Dr. Filippo Pesapane, Dr. Marina Codari & Dr. Wim Van Hecke
13:30–14:30
AI in 8 – industry pitches
14:30 –15:30
AIX Panel: Where to next?
The Regulation of Radiological AI in Europe and Abroad
Moderator: Dr. Hugh Harvey
AIX PARTICIPANTS
AGFA Health | CareAidence | Aidoc | BioMind | Cercare Medical | contextflow | Combinostics
CorTechs Labs | Densitas | EnvoyAI | iCAD | icometrix | Incepto Medical | Infervision
Kheiron Medical | NVIDIA | Median Technologies | M*Modal | OnePacs | Osimis | Oxipit
Quantib | Quibim | Smart Reporting | 12 Sigma Technologies
THE AIX IS PROUDLY SUPPORTED BY CANON MEDICAL
ECR TODAY 2019 EUROPEAN CONGRESS OF RADIOLOGY
DAILY NEWS FROM EUROPE’S LEADING IMAGING MEETING | FRIDAY, MARCH 1, 2019
3 9 17 25
HIGHLIGHTS CLINICAL CORNER TECHNOLOGY & RESEARCH COMMUNITY NEWS
European-wide implementation Let AI do the boring part and Artificial intelligence takes centre stage at Education needs to include teaching
of clinical audits starts to gather boost structured reporting, ECR 2019’s technical exhibition how to think critically, says Editor-in-
momentum experts argue Chief of Insights into Imaging
BY VIVIENNE RAPER
IN
Interventional radiologists
L
E
A
T
RV N PH
E N TI O Y SI C S
respond to growing pressures
to minimise radiation risks
Interventional radiologists may be raising their risk of cancer due to a deficit of training
and awareness, but there are practical ways to reduce the risks, expert speakers will tell
ECR 2019 delegates at today’s joint session of the ESR and the European Federation of
Organisations for Medical Physics.
“It is not a statistically proven Medical University of Innsbruck, dures, especially in interventional
coincidence, but brain tumours Austria, noted that an increased radiology, it is important to address Joint Session of the ESR and EFOMP (European
have been seen in interventional number of radiation-induced skin this again,” he said. Federation of Organisations for Medical Physics)
cardiologists and radiologists,” said injuries have been observed since The effects of radiation expo-
Prof. Peter Vock, professor emeri- the year 2000, after a long period sure remain poorly understood, Friday, March 1, 08:30–10:00, Room G
tus at the University of Bern, Swit- when low-dose diagnostic proce- explained Vock. Until recently, the Medical imaging and emerging issues in occupational
zerland. “These tumours have been dures and improved radiation pro- statistics for radiation exposure radiation exposure
mostly on the left side of the brain tection made radiation-induced came from Japanese atomic bomb
and, if you know the architecture tissue injuries a non-issue for survivors and a few other stud- Moderators: M. Brambilla; Novara/IT
of an interventional unit, this is the radiologists. ies of humans, many of whom had W.R. Jaschke; Innsbruck/AT
side where you have higher expo- “Radiologists think the risks of received higher doses than radiolo-
»» Is fear of radiation-induced occupational cancer irrational?
sure when you do interventions.” radiology are exaggerated, and this gists receive at work.
P. Vock; Spiegel/CH
Prof. Werner Jaschke, chairman was true for a long time, but, with Common models of the biological
of the Department of Radiology, more and more high-dose proce- effects of radiation exposure, such »»Eye lens radiation dose and cataractogenesis
as the linear no-threshold (LNT) J. Damilakis; Iraklion/GR
model favoured by some interna- »»Occupational exposure from interventional radiology
tional bodies, make questionable procedures: how to measure it, how to reduce it
assumptions when they extrapo- W.R. Jaschke; Innsbruck/AT
late to effective doses below around »»Selection and usage of personal protective equipment in the
50 millisieverts (mSv), he contin- fluoroscopy and interventional radiology operating room
ued. To add to the complexity, the M. Brambilla; Novara/IT
randomly determined risk of radia-
tion-induced cancer varies by dose »»Panel discussion: Has the optimisation of occupational
rate, age at exposure, gender, indi- radiation exposure in radiology procedures reached a plateau?
vidual radiosensitivity, and the This session is part of the EuroSafe Imaging campaign.
location of the exposure. The lung,
thyroid, and breast, for example, are
more vulnerable than some other the United Kingdom, and the United might be more appropriate and,
parts of the body. States [INWORKS] BMJ, 2015 doi: if so, the radiation dose can be
Despite the uncertainties, Vock 10.1136/bmj.h5359). reduced – if not removed entirely.
said there is some evidence that “Fortunately, interventional Radiation exposure is higher
low doses of radiation can be harm- radiologists can reduce their expo- with complex procedures involv-
ful. For instance, a large study of sure by following the rules of best ing long fluoroscopy time and mul-
nuclear plant workers found an practice,” he noted. “If you use all tiple images or angiographic series,
increased rate of cancer deaths at those rules, you will have a small according to Jaschke. Radiologists
The neuroradiological-intervention suite at the Bern University Hospital in a mean cumulative dose of 21 mSv fraction of the exposure you can reduce the dose they receive
Switzerland. Occupational radiation protection in radiology nowadays is – in the range received by interven- would have without, and the risk is by, for example, switching from 16
most critical in fluoroscopy-guided intervention, where physical protective tional radiologists at work (Risk of minimised.” frames per second to a lower-frame
measures have to be integrated with sterile working conditions and the thera- cancer from occupational exposure The first rule is to question the
peutic need of short distance between the patient and the interventionalist. to ionising radiation: retrospective justification of the fluoroscopic
(Provided by Prof. Jan Gralla, Bern University Hospital) cohort study of workers in France, intervention. Other techniques continued on page 3
myESR.org #ECR2019
EUROPEAN DIPLOMA IN RADIOLOGY – QUESTION OF THE DAY
R
Y-MA CH
FRIDA
There is a new opportunity to
2
1
O da
to take the EDiR examinatio y
N n for
free next year at the ECR 202
0!
Q U E S TIO
N
The European Board of Radiology
will raffle amongst the winners a free
examination fee for the examination
Solve
poste the questi
that will take place within the ECR 2020
frame. ECR 2020 free registration will be
o
also included!
befor d at the EB n
e 13:3 R blog
Go to the EBR blog at blog.myebr.org to
find the EDiR Question of the Day, and
0h.
further interesting resources to prepare
for the examination.
t
The question righ ner
in
answer and the w at the
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will be announce oday.
ht
EBR blog at 14:00
BLOG.MYEBR.ORG
ECR TODAY | FRIDAY, MARCH 1, 2019 HIGHLIGHTS 3
continued from page 1 before they enter the angiography ogists keener to put their hands
suite and start the procedure,” he close to the x-ray beam and increas-
fluoroscopy mode. Another simple said. ing the dose to their hands and
way to reduce exposure is to take However, in some cases, it is patients, he said. Other companies
up a position as far as possible from impossible to avoid a high radia- supply shielded hats, which fail to
where radiation enters the patient. tion dose, such as in procedures provide effective protection of the
He also favours using a real-time involving catheterisation where brain due to radiation coming up
personal dosimeter to help check the radiologist has to remain close from below.
exposure after each procedure. This to the patient. In this case, it is Maintaining a balance between
can help radiologists optimise their important to choose the right per- protection and comfort is also
equipment and physical position sonal protective equipment, accord- important, Brambilla explained.
for future procedures. ing to Dr. Marco Brambilla, chair of Some companies, for example, sell
Jaschke would like radiation the Department of Medical Physics, heavy shielded equipment that is
safety to become as much of a ritual University Hospital of Novara, Italy. Ready for action: the interventional radiology suite at Heraklion University uncomfortable to wear for hours
as going through air safety checks “There are aprons, gloves, glasses, Hospital in Crete, Greece. (Provided by Prof. John Damilakis) at a time. Both he and Jaschke rec-
prior to a flight. “If you are an air- hats or masks, but not all of them ommend ceiling-mounted radia-
line pilot, when you go into the provide the same degree of protec- degree of protection this affords,” tion because they must be thin tion protection, which doesn’t put
cockpit, you run through certain tion, so the purpose of my talk is to he explained. enough to maintain the sensitiv- pressure on the body, but Brambilla
steps each time, and that’s what we explain to radiologists which equip- Protective gloves, for example, ity of the fingers. They give a false warns that some radiologists or car-
want to train our radiologists to do ment they should own and the only give limited radiation protec- sense of security, making radiol- diologists are not trained in its use.
BY VIVIENNE RAPER
European-wide implementation
A U DIT
of clinical audits starts
to gather momentum
Two surveys about the implementation of clinical audits across Europe will be the highlight
of today’s presentation by Dr. Adrian Brady, chairman of the ESR Quality, Safety and
Standards Committee. The results of the new research, which closed in December 2018, will
underline that many countries have yet to introduce important European legislation.
“In a lot of countries, the idea of In his talk, he will present results Clinical Audit Tool booklet, Espe- the International Atomic Energy future – prevent major and minor
audit being part of our lives as radi- from a survey of EuroSafe Imag- ranto, containing 17 templates and Authority’s official auditing scheme. errors, Schillebeeckx continued.
ologists is alien,” said Brady, a con- ing Star departments to show how other details to guide radiologists “We’ve run an algorithm to define “Whatever audit scheme we take,
sultant radiologist at Mercy Univer- many of them have implemented through audit in various situations. the key content identifiers for each we see similar errors recurring in
sity Hospital, Cork, Ireland. “But, as the new requirements. A further The first edition was originally pub- audit question, and then matched radiology, some where there could
well as needing to do it legislatively, survey of national societies aims lished in 2017, but a second edition those questions with the informa- be no harm to the patient, but we’ve
it’s a good idea for your department to discover how many European containing 13 additional templates tion most likely to address them,” also seen 10–15 major recurring
to evaluate whether it’s meeting a Union member states have imple- has been developed. explained Dr. Tom Van Herpe, sen- errors in every radiology depart-
reasonable standard.” mented nationwide structures to The 17 original templates, along ior researcher at Qaelum. ment we’ve audited in the past, and
Article 58a of the European Coun- support clinical audits. with the six new ones, cover activ- According to Nelly Ilcheva, head this worried us,” he said.
cil Basic Safety & Standards (BSS) Brady noted that 36 out of 47 ities that must be measured under of quality assurance and regula- The company is working with
Directive (2013/59/Euratom), which national societies and 68 out of 103 the directive. Most of this informa- tory assurance at Qaelum, the soft- pilot hospitals to clinically validate
lays down basic safety standards for EuroSafe Imaging Star departments tion relates to radiation exposure. ware has other benefits in addition the software, Ilcheva explained. The
protection against the dangers aris- had given feedback in response to Another seven templates cover to audit. The system can work on a team has already validated the data
ing from exposure to ionising radia- the surveys. “This is a really excel- audit topics relating to service pro- range of audit frameworks and eas- management part of the software,
tion, requires that radiology depart- lent response rate,” he said. vision and clinical practice. These ily convert between them. By mon- and will begin testing the compli-
ments perform clinical audits. The He will also explain how radiol- are not required to comply with itoring compliance, the system can ance and audit functions in due
emphasis is on each national gov- ogy departments can undertake legislation. help to detect, classify and – in the course.
ernment to put the directive into clinical audit. There’s no specificity In today’s session, Dr. Jan Schil-
practice, and clinical audits became in the directive about what depart- lebeeckx, a consultant and former
compulsory on February 6, 2018. ments need to be auditing, and it’s chief medical officer at Qaelum, a PIER Session (Professional Issues and Economics
According to Brady, clinical audit up to the individual department, he spinoff from the Leuven Catholic in Radiology)
isn’t a new thing in Europe, but the added. One department might run University in Belgium, will discuss
implementation has traditionally an audit on waiting times, while the company’s software tools for Friday, March 1, 10:30–12:00, Room N
varied between countries. “The U.K. another could look at radiation pro- clinical audits. He explains that the PIER @ ECR Session
and Ireland are a poster child for tection issues. idea for his talk came from his own
audit,” he said. “It’s a standard part To assist radiology depart- experience of auditing 44 hospitals (Jointly organised with the ESR Audit and Standards
of working life.” ments, the ESR has released a throughout Europe and the Middle Subcommittee)
East.
“We came to one common find- PI 2 Clinical audit: how to deal with the legal and professio-
ing: there’s a lot of information nal requirements
available in hospitals and radiology
Moderators: D.C. Howlett; Eastbourne/UK
departments, but the people on the
G. McGinty; New York, NY/US
ground don’t know where it is,” he
said. »»Chairperson’s introduction
Thanks to a government grant, D.C. Howlett; Eastbourne/UK
Qaelum began in 2013 to develop »»ESR’s concept and tools for clinical audit
software to help with clinical audit- K. Drinkwater; London/UK
ing processes. The company began
by collecting a large database of
»»Overview on adoption of BSS throughout Europe
multiple published documents,
A. Brady; Cork/IE
including good practice guidance, »»Peer review as key for quality improvement: the US experience
and then categorised and labelled G. McGinty; New York, NY/US
the information. »»Can newer IT-developments including artificial intelligence (AI)
Qaelum also created a large set of help to improve quality in radiology?
questions that could be used to run J. Schillebeeckx; Knokke/BE
In the CT department of a Belgian hospital, radiographers, nurses, and an audit. This was initially based
»»Panel discussion: Why should radiologists care about clinical
technicians undergo audit training. Shown on the left are Evgenia Boldyreva, on the Quality Assurance Audit
audit and peer review?
radiology technologist and head of training at Qaelum, Dr. Jan Schillebeeckx, for Diagnostic Radiology Improve-
and Dr. Tom Van Herpe. (Provided by Dr. Jan Schillebeeckx) ment and Learning (QUAADRIL), This session is part of the EuroSafe Imaging campaign.
myESR.org #ECR2019
4 HIGHLIGHTS ECR TODAY | FRIDAY, MARCH 1, 2019
BY AIDAN BOYD-THORPE AND MÉLISANDE ROUGER
Women at work must follow
their passions, Hricak says
age. While this is often the case, I HH: Things are changing. When I continuous, dynamic balancing act. ECRT: How would you encourage
also believe that leadership ambi- began my career, the image of a suc- Priorities will change not just over women to become leaders in their
tion may develop over time and that cessful leader or executive tended to years but, sometimes, from month to profession?
not all leaders start off with a leader- be that of a large man with a cigar month or week to week. HH: I encourage women to fol-
ship role in mind. If you are thinking and a rather autocratic style. Starting ECRT: Is it easier for women in low their passions. If what you want
about a leadership role, take opportu- with the new millennium, the image some countries to focus on their is to be a leader, then as a mentor, I
nities, and be prepared to take a risk of a leader changed, and it was very careers than in others? can help you by talking with you and,
if you are excited by a challenge that important that leaders looked fit and HH: I have friends both male and most importantly, being there for you
is presented, even if you do not know healthy. However, the style of lead- female from all around the world, to pick you up when things do not go
where it may lead. Be brave and trust ership tended to remain the same. and in my observation, the key ingre- well. I can show you where the chal-
in yourself. It was a change in form more than dients for success – perseverance, lenges may occur and help you avoid
ECRT: How do experienced radi- in function. Today’s understand- resilience, focus and courage – prevail difficulties; when you are down, your
ologists regard their younger ing of what a role model is in leader- everywhere. However, other ‘ingre- mentor needs to show you it is OK –
colleagues? ship continues to evolve. I do believe dients’ are not the same in every the storm will pass, and you will be
Prof. Hedvig Hricak, Chair of the De- HH: It very much varies from per- we are seeing a change in function country. Every policy and style has even better for it. At the same time,
partment of Radiology at Memorial son to person. It is often difficult for as well – emerging from idealisation to be adapted to local culture. Glo- it is important to respect and help
Sloan Kettering Cancer Center in women not just to ascend to leader- of an old, autocratic, ‘executive-suite’ balisation will influence circum- someone who wants to go part-time
New York, US, is the organiser of the ship but also to stay there, and some- style of leadership to a general appre- stances around the world and will so they can spend more time with
new ‘Women in Focus’ programme times we have a tendency to gener- ciation of leadership that is more help spread equality, but it will never their family. We need to respect and
taking place today at the Church. alise. There are many studies about transparent and inclusive, emphasis- make conditions the same across all celebrate choices.
difficult interpersonal relationships ing discussion and consensus-build- countries.
The ESR is celebrating women’s between women hampered by com- ing – leadership that appreciates
accomplishments in medicine with petitive rivalry and lack of trust. diversity and understands the power
the addition of a brand-new event, However, while there will always be of the internet and social media. Women in Focus – The Bigger Picture
the ‘Women in Focus’ sessions, to its women who are overly competitive Women may be more ‘attuned’ to
annual meeting, the ECR. With ses- with other women, there will also change, and my hope is that large Friday, March 1, 14:00–15:15, The Church
sions on female leadership, mentor- always be very nurturing women, numbers of women will become lead- WF 3 Women in challenging environments
ing and generational differences, who are excellent mentors to other ers and introduce greater apprecia-
Prof. Hedvig Hricak from New women. The same is true for men – tion for flexibility and life balance, »»Chairperson’s introduction
York, US, hopes the programme she it is just that men in leadership are not because no one else wants lead- R.G.H. Beets-Tan; Amsterdam/NL
will chair will help younger female not under the same scrutiny. There ership positions, but because more »»It’s the little things that matter
attendees to engage with and learn are many good indicators that the women are recognised as qualified to L. O’Riordan; Ipswich/UK
from experienced role models. new generation is much more gen- be leaders. »»Safe spaces for women in challenging environments: the
In an interview with ECR Today, der blind and does not see gender ECRT: What are the key factors example of Women Health Counselling Centres for refugee
she reflects on what it takes to be as a big issue. As the new genera- of a successful academic career in women and girls
a leader, how to balance work and tion grows older, I believe they will radiology? Ş. Bahar Özvariş; Ankara/TR
personal life, and other questions show greater respect for choices and HH: Success in academia requires
»»Panel discussion: Diversity in healthcare delivery
women often have to deal with greater approval of flexibility, regard- a willingness to work hard and often
Ş. Bahar Özvariş; Ankara/TR, E. Olasunkanmi Balogun; Lagos/
throughout their careers. less of gender. long hours. It also requires vision and
NG, R.G.H. Beets-Tan; Amsterdam/NL, D. Husseiny Salama; Cai-
ECR Today: What do successful ECRT: What is the traditional curiosity – a desire to always build
ro/EG, S.F. Khan; Islambad/PK, L. O’Riordan; Ipswich/UK
leaders have in common? image of a woman in a leading role? on your knowledge and, once you
Hedvig Hricak: Successful leaders HH: Women in leadership roles solve a problem, move straight on
share a few characteristics such as have traditionally been seen as to the next one. You must never rest Friday, March 1, 16:00–17:25, The Church
courage, focus, resilience and tenac- tough, driven and determined, and on your laurels; instead, you must WF 4 Leadership and mentorship
ity. Another is optimism: when there the image has not changed much. remember that you are only as good
is a challenge, some people despair However, as more women assume as your tomorrow. You should contin- »»Chairperson’s introduction
while others see an opportunity. leadership positions, they are serving uously reinvent yourself. J.E. Husband; London/UK
A successful leader seeks never to as role models, giving them opportu- ECRT: Working women often »»Is mentoring gender-specific?
waste a crisis. Furthermore, love for nities to shape new images of how have to balance their careers and G.P. Krestin; Rotterdam/NL
people, understanding of and respect women in leadership can be. Women families. Can you ever strike that »»The many facets of mentoring – how to find the right match?
for other people’s values, and the abil- leaders today can be themselves and balance? M. Abdel-Wahab; Vienna/AT
ity to motivate and inspire are char- combine a more traditional approach HH: We often say you can have it
»»Panel discussion: Reminiscence: remembering to pass forward
acteristics often seen in successful with feminism and caring. all, but it is difficult to have it all at
M. Abdel-Wahab; Vienna/AT, C. Beardmore; Guildford/UK, J.E.
leaders. ECRT: Fewer and fewer people the same time. You have to make
Husband; London/UK, V.P. Jackson; Tucson, AZ/US, G.P. Krestin;
ECRT: Are leaders born or is lead- are willing to take on leadership choices and have a strategy. There
Rotterdam/NL, G. McGinty; New York, NY/US
ership an acquired skill? roles. Could this be an opportunity will be a time when family has to
HH: Many believe that leaders for women to influence new leader- come first, and a time when your »»Closing remarks
are born and people exhibit leader- ship to meet current needs for flex- family has to understand that work H. Hricak; New York, NY/US
ship characteristics from an early ibility, etc.? will take most of your time. It is a J.E. Husband; London/UK
At this year’s ECR, explore and celebrate the
crucial role that women play in healthcare, as a
diverse range of speakers from across the medical
community tackle a range of issues related to gender,
leadership and professional growth.
Four unique interactive sessions
Live audience polling
Extended panel discussions
Special coffee breaks
Dedicated rooms for remote viewing The Church
Thursday, February 28
Friday, March 1
myESR.org/wif
IN MEMORIAM ALEXANDER R. MARGULIS
(1921-2018)
#ECR2019 myESR.org
ECR TODAY | FRIDAY, MARCH 1, 2019 HIGHLIGHTS 5
BY MÉLISANDE ROUGER
Potential of AI in hybrid
HY
G
B I
RI
N
D IM AG AI
imaging can only be realised
if integrated into workflow
The benefits of using artificial intelligence in hybrid imaging are real for decision support,
prediction and other applications. But imaging specialists must adopt a practical approach
for tools to be implemented in daily routine, and this can only happen if they are integrated
into the hospital’s major workflows, as experts will explain today during a session held by
the European Society for Hybrid, Molecular and Translational Imaging (ESHIMT).
There is a natural match between ual hybrid images but also from a what is yet to come, Leimgruber automated way possible, so that affect radiomics as well, and this
artificial intelligence (AI) and cohort of hybrid images of a patient believes. “It is easy to justify using people actually use or access the would not be in anybody’s inter-
hybrid imaging (HI), and a new field with a particular disease, which a these techniques as a way to decide, data. “Otherwise the old saying est,” he concluded.
of research has emerged to com- single doctor cannot define.” with the best of available scientific of ‘garbage in – garbage out’ will
bine both. HI merges parameters Furthermore, HI is closely con- knowledge, if there is something
from two imaging modalities into nected with pathology, and that needs to be done about a lung
a single exam and it generates a lot researchers increasingly view AI nodule or not. Although it is already
of information that is intrinsically as a tool to mediate between imag- a complex problem, it is a first step
multiparametric, and therefore ing and histopathology. Studies are towards more integrated radiomics
interesting to mine with AI. “We will already being conducted on com- or radiomics+,” he said.
benefit a great deal from AI,” said bining digital histopathology with More comprehensive radiom-
ESHIMT President, Prof. Thomas PET/MRI and generating prediction ics+ approaches are emerging that
Beyer from Vienna, Austria. models based on machine learning, put results into perspective in
HI brings together anatomical to differentiate between benign and response to therapy, dose evalua-
images with molecular imaging on malignant tumours in the prostate, tion, where and whether to biopsy,
a cellular level. PET/CT and PET/ without the need to do biopsy. “This etc. Researchers are not yet entirely
MR already provide the reader with is what we conceive AI and ML can sure, as radiomics publications usu-
much broader information than CT help us do, among other things,” ally tackle very specific issues with
alone, and multiparametric imaging Beyer said. quite a technical approach. There
comes to a climax with MRI, accord- Oncology, probably more than are many different tools but it is
ing to Beyer. “You have the ‘50 shades any other field, needs to integrate very hard to use them in a clinical
of grey’ of MRI and the molecular imaging data through radiomics setting when data is flowing in very
imaging capacities of PET. With HI, with proteomics, genomics, pathol- quickly, every day, in every hospi-
and PET/MRI in particular, radiolo- ogy, therapy and radiotherapy to tal. The question is how the medical
gists and nuclear medicine experts move towards personalised med- team is going to integrate them all.
will start leveraging dynamic imag- icine, according to Antoine Leim- The point of using radiomics is
ing modes, which is like watching a gruber, a nuclear medicine physi- to keep it simple, manageable and
lesion’s spatio-functional character- cian, radiologist and physicist from truly useful, Leimgruber explained.
istics over time,” he said. Vevey, Switzerland. “Radiomics can “If you have 200 tools and you have
But the more parameters are help radiologists and nuclear doc- to spend hours delineating lesions,
added to the observation of a tors by providing them access to then you are only going to improve
tumour, the more difficult it maximal information on disease. your scoring system by a few per-
becomes for an individual doctor to Radiomics is also an opportunity cent. This strategy is never going
make a judgement call on the phe- for the imaging community to step to go through the everyday clini-
notype of a disease. Machine learn- in and start advising networks of cal setting. Solutions must be inte-
ing, deep learning and other tech- physicians,” he said. grated into the major workflows in
niques could therefore be used as Most of the data that has been the hospital.”
a decision support mechanism for collected using radiomics so far A solid start would be to inte-
physicians who diagnose patients has been in lung cancer. Half of the grate simple and standardised The general scheme of machine learning approaches. The data serve as an
using hybrid modalities, Beyer sug- studies have focused on lesion char- data, which has been extracted input to explore and to build a decision-making model by the optimiser. A fit-
gested. “We want to use AI to extract acterisation – malignant or benign. from reproducible protocols, into ness measurement characterises the performance of the model. This scheme
more information from individ- These are just preliminary data for the hospital workflow in the most can symbolise a one-step or iterative process, depending on the given ML
approach. Of note, the three modules may have different relationships with
regards to the actual ML approach
ESHIMT Session (European Society for Hybrid, Molecular
and Translational Medical Imaging)
Friday, March 1, 08:30–10:00, Room M 1
ESHIMT 2 Artificial intelligence in hybrid imaging
Moderators: C.C. Cyran; Munich/DE
H.K. Hahn; Bremen/DE
»»Radiomics+: prediction model using convergent data
A. Leimgruber; Lausanne/CH
»»AI and Holomics: predicting the truth from hybrid imaging and
non-imaging data
I. Buvat; Orsay/FR
»»Sharing is caring: on the need for open research data
The 4V model of Big Data referring to Volume (data size), Velocity (speed of change), Variety (different sources and O. Ratib; Geneva/CH
formats of data), and Veracity (uncertainty in data). »»Panel discussion: AI in HI: incremental value or feeding the
data explosion?
Editor’s note: the two figures on this page are from Papp L, Spielvogel CP, Rausch I, Hacker M and Beyer T (2018)
Personalizing Medicine Through Hybrid Imaging and Medical Big Data Analysis. Analysis. Front. Phys. 6:51. doi: 10.3389/
fphy.2018.00051 © 2018 Papp, Spielvogel, Rausch, Hacker and Beyer, images used with permission of the authors.
myESR.org #ECR2019
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ECR TODAY | FRIDAY, MARCH 1, 2019 HIGHLIGHTS 7
BY MÉLISANDE ROUGER
Systemic effects in
O
NC IC C HE ST
OLO G
interventional oncology:
Holy Grail or Pandora’s Box?
S. Nahum Goldberg is full professor of radiology at Hadassah Hebrew University,
Jerusalem, Israel and visiting professor of radiology at Harvard Medical School, Boston, MA.
He is a worldwide expert in image-guided tumour therapy, a field he has helped pioneer
and continues to advance. He will share some of the latest results on the effects of these
therapies, both positive and negative, today during the Josef Lissner Honorary Lecture.
to ablation systems and techniques much larger responses that can Large data bioinformatics and ago he was involved in a partner-
now being used clinically more help to treat other tumours besides artificial intelligence search strate- ship with Prof. Luigi Solbiati from
than 100,000 times annually, things the one that is being targeted. Such gies will potentially serve that pur- Milan and Dr. Tito Livraghi from
have not always gone as planned, positive reactions, which can be pose, helping, for example, to collate Vimercate, Italy, two pioneering
according to Goldberg, who heads of assistance in the treatment of and analyse data from biobanks. Italian radiologists in the field of
the interventional oncology unit at metastatic cancer, occur under the Goldberg and his colleagues are image-guided tumour ablation.
Hadassah Medical Centre. so-called abscopal effect hypothe- exploring how to develop rational Around that time, he founded a
“Specifically, for much of the last sis, in which tumours shrink both methods of determining how much minimally invasive tumour thera-
two decades, we have argued that inside and outside the scope of data are needed to develop suffi- pies laboratory at Beth Israel Dea-
other benefits of these interven- localised treatment. cient clinical relevance. coness Medical Center in Boston,
tional oncologic therapies, includ- On the negative side, interven- “The million-dollar question will and about 15 years ago, he estab-
ing percutaneous tumour ablation tional therapies can activate or free be how to elegantly extract rele- lished an independent applied
and chemoembolisation, were focal pathways that can have harmful vant data, as opposed to the current radiology laboratory at Hadas-
and local, based upon our convic- effects, including tumour growth investigation methods, which are sah Medical Centre. In addition
tion that we were only affecting the increase. usually driven by individual inves- to helping to elucidate the mech-
tumour we were treating and not In his lecture today, Goldberg tigators and which, at some point, anisms behind tumour ablation,
the entire patient system. It turns will provide some of the initial data won’t be enough,” he concluded. ablation systems and techniques
Prof. S. Nahum Goldberg from Jeru- out, based on early case reports and regarding which molecular mecha- Goldberg has helped to develop designed in these laboratories are
salem will share some of the latest more solid evidence produced over nisms can have potential effects on the field of interventional oncol- now used clinically more than
results on the effects of image-guided the last five years or so, that this treatment, but above all, he wants ogy from scratch. Twenty years 100,000 times annually.
tumour therapy, during the Honor- premise is not always true,” said to increase awareness of the issue
ary Lecture today at 12:15. Goldberg. among the audience.
“Most of the damage occurs “It becomes incumbent on us to
Image-guided therapy and tran- where intended, but all kinds of better understand on a tumour- Josef Lissner Honorary Lecture
scatheter intervention work best pathways in the system are also by-tumour, organ-by-organ, abla-
on small tumours in the liver, kid- activated after an intervention. Just tion-method-by-ablation-method, Friday, March 1, 12:15–12:45, Room A
ney and several other organs, evi- like a sunburn that affects a local and patient-by-patient approach Systemic effects of image guided tumour therapy:
dence over the past two decades piece of skin can be accompanied which pathways we’re activating have we opened Pandora’s Box or found the Holy Grail?
has showed. That was the birth by a headache or fever, a systemic and how to accentuate the pos- S. Nahum Goldberg; Jerusalem/IL
of interventional oncology and it reaction can follow an interven- itive and cause immune effect,
held exciting promise for the (rad- tional oncologic procedure in some and reduce or eliminate the nega-
ical) improvement of cancer treat- patients and under certain circum- tive that you see from tumorigenic
ment. Based on that knowledge and stances. Depending on the type of effects,” he said. A dedicated interventional radiology (IR) programme will again be
promise, many researchers have tumour and its location, a series of The medical community must held at the ECR in the Cube, a new addition that attracted lots of del-
worked towards combining these both positive and negative systemic think of clever methodologies to egates last year. Spread across 700m² of floor space in the Meliá Hotel
procedures with more conventional effects can be unleashed,” he added. figure out which interventional Vienna, the Cube 2.0 will once more provide an engaging, hands-on
cancer therapies like chemotherapy These effects are rather variable therapy is going to give the best introduction to the fascinating world of IR, with four main themes, one
and radiation to increase the size and are currently hard to predict, results, and personalised medi- per congress day: peripheral IR, central IR, oncological IR and neuro-
and range of the population that but one thing is certain: there is a cine using biomarkers has a role logical IR. Friday, March 1 will feature five interactive sessions on onco-
can be treated. good side and a bad side – the Holy to play. However, we are still at an logical IR, with opportunities for participants to simulate oncological
One of the underlined premises Grail and Pandora’s Box, as Gold- early stage in terms of understand- interventions.
of interventional therapies is that berg put it. ing which biomarkers will predict The Cube is also cooperating with the European Federation of Radiog-
using imaging to guide a procedure On the positive side, interven- which patients are going to go along rapher Societies (EFRS) and radiographers are very welcome to take
is less invasive than using other tional procedures can incite an a given immune pathway or tumor- part. This ‘Silicon Valley’ of IR education is sure to make a big splash
methods like surgery. Despite this immune reaction in which the body igenic pathway. Much of this work at ECR 2019!
and other advantages that have led will identify the cancer and form remains to be done.
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interventional
radiology at the
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Open 8:30-17:30 The Cube offers a holistic, engaging
and hands-on introduction to
February 27 - March 2 IR, covering peripheral, central,
at the DC Tower, ECR City oncological and neurological
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teamwork and innovation.
For more information visit Interactive expert-led presentations,
a massive collection of simulators,
www.myESR.org/cube thousands of devices, virtual
anatomy and more await you at
‘the Silicon Valley of IR education’.
The Cube is located in the cuboid annex
of the DC Tower.ECR TODAY | FRIDAY, MARCH 1, 2019
CLINICAL CORNER 9
10 Radiology in Italy takes centre stage on
day three of ECR 2019 11 Don’t get caught out: beware the perils
of revealing data on social media 12 Optimising the management of
cancer-related pain
BY MÉLISANDE ROUGER
Let AI do the boring part and boost
AI
structured reporting, experts argue
Templates, CDE and open source frameworks are among the strategies developed on both
sides of the Atlantic to unleash the power of artificial intelligence in structured reporting.
task is appalling. AI can do image
analysis, and EMR and data analy-
sis,” he said.
At Massachusetts General Hos-
pital, Alkasab developed the com-
puter-assisted reporting and deci-
sion support (CAR/DS) framework,
which is an open authoring system
for point-of-care clinical decision
support tools integrated into the
radiologist’s reporting environment.
The solution works like a plug-in
that vendors can include in their
products and use in specific scenar-
Dr. Adrian Brady from Cork, Ireland, Prof. Peter Mildenberger from Mainz, Prof. Charles Kahn from Prof. Tarik Alkasab from Boston, US, ios that have been predefined by
Chair of the ESR Quality, Safety & Germany, chair of the ESR PIER Philadelphia, U.S., will speak will show how decision support and AI designers. The tool is semi-au-
Standards Committee, is co-chair of Subcommittee, will give an update about the concept of common data artificial intelligence can improve tomated SR, where radiologists are
this morning’s PIER Session. on developments for structured elements (CDE) for reporting. reporting in radiology. assisted in creating the structured
reporting. part of the report and the form has
been created for them.
Experts will present the latest entific research activity, according must abide by those definitions, to be storing in our database. This The framework was presented
tools available on the market and to Prof. Peter Mildenberger from guarantee there is a shared mean- data would become part of the for vendor competition at RSNA
highlight cooperative ways to make Mainz, Germany, who chairs the ing. To help radiologists get started, information that is available on our 2017 and interesting working
radiology reports more understand- ESR Professional Issues and Eco- the RSNA and ACR joined forces patients and we could use and mine tracks have been set in motion,
able to all clinicians, more pertinent nomics in Radiology (PIER) Subcom- a few years ago to create the plat- this data to make new discoveries such as modules for pulmonary
in healthcare and less boring to mittee. “If you have templates that form RadElement.org, where infor- and identify patterns to improve and liver lesions. It can be used
radiologists, today at the ECR. are consented to and used between mation on CDEs can be accessed healthcare,” he said. for all kinds of clinical settings to
Radiologists have been talking departments, you can group all the by both viewers and automated In the meantime, SR could be standardise report scenarios, for
about ways to improve the infor- data into one database to have more systems. made a lot easier when using deci- example, evaluating incidental
mation provided in their reports for power in your studies,” he said. For the kind of reporting cur- sion support and artificial intelli- findings like thyroid nodules, renal
quite some time. Although most of Interoperability between tem- rently done by radiologists, it might gence for data entry. Somewhere cysts and ovarian cysts, Alkasab
their colleagues still dictate their plates is an important aspect to be that only one or two features in the process of reporting, the suggested.
reports in free text, leading radiolo- work on and partnerships with are captured as CDEs. For example, radiologist still has to fill in some “The definition format and ref-
gists agree that this is not the way groups from other disciplines are when doing a CT scan for pulmo- fields and blanks, and turn that erence implementation software
to go for the future. appearing in Europe. In Germany, a nary embolism, there may be a CDE into a structured report either with are freely available, and we hope
“Free text can be difficult for a group working on CT of pancreatic that indicates whether an embo- language or data bullet points. This to empower individual radiolo-
referring physician to understand cancer has been formed between lism is absent, present or indetermi- task is, admittedly, boring, accord- gists, expert groups and vendors to
and, if a radiologist is not meticu- the German Radiological Society nate. “This could spare the patient ing to Prof. Tarik Alkasab from Bos- develop a robust ecosystem of CAR/
lous enough, key information may (DRG) and several other scientific having to undergo further exams,” ton, US. DS tools that can further improve
not be easy to identify,” said Dr. organisations to develop common Kahn said. “Nobody likes to do that. This idea the quality and efficiency of the
Adrian Brady from Cork, Ireland, research templates. This is an inter- In the future, many of the that you have these radiologists so patient care that our field provides,”
Chair of the ESR Quality, Safety & esting direction to explore, Milden- machine learning tools that are bright and specialised doing that he concluded.
Standards Committee. berger explained. “Having infor- currently being developed could
Using structured reporting (SR) mation that is relevant for other well capture the information and
templates to help radiologists fill colleagues from other disciplines identify features that radiologists
in their reports has emerged as an is the real path and a challenge for would not currently make a habit PIER Session (Professional Issues and Economics
interesting solution for simplify- the near future. Having a common of reporting. “Using CDEs could in Radiology)
ing the process. The idea is to have editorial board could be interesting help capture data about the patient
boxes in the reports, so that they all in this regard, and it is a solution we that has future value. In abdominal Friday, March 1, 08:30–10:00, Room N
follow the same structure. The only are considering,” he said. CT, measuring muscle mass in the PIER @ ECR Session
thing that changes is the informa- One key requirement for tem- abdominal wall has some prognos- (Jointly organised with the ESR eHealth Subcommittee)
tion in each structured section. “If plates to be useful is, obviously, that tic impact for patients if they later
PI 1 Reporting and communication today and tomorrow:
radiologists all use the same SR tem- they be developed to incorporate have cancer. That can be a prognos-
plates, it makes it much easier for all relevant elements, including tic factor for how well they will do
challenges to implement structured reporting (RS) and deal
physicians to understand results,” common data elements (CDE); data with their treatment, so this might with artificial intelligence (AI)
Brady said. that is generated during the pro- be interesting to measure,” Kahn »»Chairpersons’ introduction
In 2015, the ESR and RSNA signed cess of imaging, which has a shared said. A. Brady; Cork/IE
a Memorandum of Understanding definition. The same could be done when E. Neri; Pisa/IT
that includes the creation of a com- A CDE encompasses a well-de- quantifying the amount of subcu- »»Update on developments for structured reporting: Radreport
mon working group called the Tem- fined question as well as its allow- taneous fat versus intra-abdominal 2.0, TLAP, MRRT
plate Library Advisory Panel (TLAP), able answers, according to Prof. fat, which has a different distribu- P. Mildenberger; Mainz/DE
to create and review proposed SR Charles Kahn from Philadelphia, tion and is related to the genetic »»The concept of common data elements (CDE) for reporting
templates for specific diseases and PA/US, Chair of the RSNA Radiol- make-up and gene expression pro- C.E. Kahn; Philadelphia, PA/US
populations. Over a hundred tem- ogy Informatics Committee. “Com- file of the individual; measuring
»»Decision support and artificial intelligence (AI) to improve
plates have been validated so far, mon Data Elements ensure that the spleen size; and many other meas-
reporting in radiology
which are all available on the ESR information expressed is consistent urements that do not fall into the
T.K. Alkasab; Boston, MA/US
website. and carries the same meaning for reporting tasks but could enable
The TLAP is now advocating for all who use it,” he said. precision medicine tomorrow. »»Communication with referring physicians and patients: what is
templates to be used across differ- CDEs enforce the notion that “You could well imagine that relevant?
ent departments, to aggregate the everything is characterised and automated tools would be meas- J.M.L. Bosmans; Ghent/BE
data, especially for epidemiology, well defined. A coding scheme is uring these things and generating »»Panel discussion: How to use structured reporting and artificial
outcome research or any other sci- created to this end and every user this information, which we would intelligence in reporting
myESR.org #ECR201910 CLINICAL CORNER ECR TODAY | FRIDAY, MARCH 1, 2019
BY BECKY MCCALL
Radiology in Italy takes centre stage
on day three of ECR 2019
The future status and development of the radiological profession look set to come under
the microscope today during the eagerly anticipated ‘ESR meets Italy’ session. The major
challenges ahead, including artificial intelligence (AI) and machine learning, are to be
addressed by expert speakers.
community, having been active in tries, facilitates radiologists taking
healthcare policy and education for on roles that are carried out by
around 40 years. He contributed to technicians and radiographers else-
the development of national guide- where. There are 14,000 radiologists
lines for radiology practice, includ- in Italy, and given the country’s
ing the regulation of teleradiology, population of slightly over 60 mil-
and his influence and leadership lion, there is around one radiologist
have led to the establishment of per 4,300 people.
recent Italian laws on healthcare According to data from the
security, professional liability, and Organisation for Economic Co-op-
insurance reimbursement. eration and Development, Italian
In today’s presentation, ‘Radi- radiology runs more than 2,000 CT
ology in Italy’, of particular note and 1,715 MRI scanners, of which
and relevance will be his work only 30% are less than five years old.
with ‘Choosing Wisely’, which Bibbolino noted that a recent SIRM
aims to promote dialogue around survey found that approximately
avoiding unnecessary medical 120,000,000 x-ray, ultrasound, CT,
tests and treatments. The initia- MRI and interventional radiology
Dr. Corrado Bibbolino is a board tive is involved with the so-called examinations are performed in
member of the Italian branch of slow medicine movement, and Italy annually. Mostra Técnica: exhibitions held in Italy provide a shop window for new
Choosing Wisely. focuses on a thoughtful, deliberate “With all these examinations, equipment and services, including those for artificial intelligence and
approach to patient care. there is a problem with appropriate- machine learning.
“We feel that we have to be able “A radiologist should be near the ness and overdiagnosis. Some medi-
to drive AI and not be driven by it. patient, not only exist as an invisi- cal problems don’t need imaging; for ment. Also, rethinking the logistics There is a need to iron out dif-
The Italian way of thinking may ble figure,” said Bibbolino. “This is a example, MRI of the lumbar spine of emergency departments would ferences between regions, and to
help our community to fight to typical and defining feature of radi- isn’t always necessary,” he said. “In help make patient transfers eas- ensure the proper distribution of
ensure that AI does not supersede ology practice in Italy, which differs some countries, patients can wait ier, and we need to ensure that the resources nationally, he added.
the human elements of care,” Dr. distinctly from countries where for two to three months for imag- equipment is optimised for emer-
Corrado Bibbolino, head of the the radiologist and the patient are ing, but here in Italy, patients can gency patient care.”
Forensic and Ethical Section of the often located in separate rooms.” have MRI after a few days.”
Italian Society of Medical Radiol- Unlike some other European Also speaking during the same
ogy (SIRM), told ECR Today ahead countries, Italian radiologists session will be Dr. Vittorio Miele,
of ECR 2019. carry out ultrasound examina- head of imaging at the Careggi Uni- ESR meets Italy
He fears AI may take over the role tions themselves and report to the versity Hospital in Florence and
of the radiologist, and the personal patient immediately afterwards, he President Elect of SIRM 2019. He Friday, March 1, 10:30–12:00, Room A
aspects and skills may be lost. explained. In other parts of Europe, will discuss the Italian Emergency EM 2 From morphology to function
“Patients may think that they are sonographers or technicians carry Network. Requests for emergency
satisfied with AI, but it is not the out the ultrasound scan and often diagnostic and therapeutic services Presiding: L.E. Derchi; Genoa/IT
same as dealing with a real person a patient does not get to meet the are constantly growing, due to both R. Grassi; Naples/IT
– it’s not like an automatic ticket radiologist at all. “We feel it is impor- clinical and epidemiological factors,
»»Introduction: Radiology in Italy
machine in a railway station,” Bib- tant to be close to our patients, to and this is due to the increasing
C. Bibbolino; Rome/IT
bolino said. “Human characteristics understand their condition and deal amount of traumatic events and
like empathy and intuition are not directly with them, not through non-traumatic clinical emergencies. »»Italian emergency network
there. A computer might resolve intermediaries,” he emphasised. “There’s overcrowding of the emer- V. Miele; Florence/IT
a problem, but it cannot ask the Bibbolino went on to say that, in gency system because patients with »»Interlude: The sirens: myth or reality?
patient questions, feel the reaction, Italy, particular attention is paid to minor health problems attend due to R. Grassi; Naples/IT
look into the patient’s eyes and risk management for both patients a lack of immediate response in the »»Emergency interventional radiology: brain and body
think what the patient is thinking and staff. Thanks to legislation that non-emergency system,” he said. G. Carrafiello; Varese/IT
– these are things AI cannot do. came into effect in late 2017, called Miele pointed out that the major-
»»Interlude: The cyclops: myth or reality?
This is the difference between a the Gelli law, the safety of examina- ity of patients accessing emergency
R. Grassi; Naples/IT
human and a robot. AI is important tions, treatment and professional care have at least one diagnostic
but it is not a substitute for a real liability have become even more examination to determine the care »»La Radiologia Medica: the role of the journal in an international
radiologist.” important issues. path. “Twenty-four-hour radiology setting
Bibbolino is a long-standing The large number of radiologists staffing greatly influences the diag- A. Giovagnoni; Ancona/IT
member of the Italian radiology in Italy, compared with other coun- nostic performance of a depart- »»Panel discussion: How will the radiologists’ profession evolve?
COFFEE & TALK SESSIONS
Don’t miss this popular informal session format, featuring short lectures and
discussions, taking place in various stylish lounges:
Room Coffee & Talk 1 (2nd level, Foyer B, within the ESOR Lounge)
Room Coffee & Talk 2 (1st level, Foyer N, next to the EuroSafe Imaging Lounge) Stop by and contribute to the
Room Coffee & Talk 3 (entrance level, Foyer E) lively discussions while sipping
your coffee or tea.
TOPICS:
Artificial intelligence Management tips
EuroSafe Imaging Research & research fellowships
Radiation protection Virtual reality Details at
ESR iGuide Undergraduate radiology teaching
Publication tips Audit
ipp.myESR.org
Type of session: C
#ECR2019 myESR.orgECR TODAY | FRIDAY, MARCH 1, 2019 CLINICAL CORNER 11
BY VIVIENNE RAPER
Don’t get caught out: beware
the perils of revealing data
on social media
Sharing patient data on Facebook and WhatsApp involves a breach of European
data protection regulations and can have serious consequences, according to Dr. Erik
Ranschaert, President of the European Society of Medical Imaging Informatics (EuSoMII).
He aims to raise awareness of secure alternatives at today’s Special Focus session.
to train machine-learning tools. tattoos on CT scans of the skin, for
“It is necessary to ensure they are example. Ratib wonders how much
properly developed and hosted, and each patient should be informed
they reliably avoid the misuse of about what measures are being
data – we should concentrate the taken to protect the confidentiality
debate on that,” he said. of data.
Part of that debate is how to build “We have to tell them, we will do
patient confidence in an age of everything we can to keep your
widespread distrust of companies data anonymised, but there is
like Google and Facebook. Patients always a risk. If someone wants to
need to believe that radiological expend enough time and effort to
images given to researchers will find you, they will, but our respon-
be put to ethical use. He suggested sibility is to minimise that risk as
that future image banks might much as possible,” he said.
Sensitive features can be automatically detected and hidden by covering the be regulated by the ESR, RSNA or As for sharing those images, Ran-
face with a shapeless mask of pseudo-random noise. (Provided by N. Roduit, other reputable bodies. schaert wants to educate radiolo-
University Hospital of Geneva) Patients also need to know their gists and researchers about secure
images are properly anonymised, alternatives to public social media
and its exposure can have serious permits general consent, whereby he continued. “We know that with software, such as WhatsApp. More
consequences.” patients agree their data can be today’s facial recognition, it is easy secure apps include Tiger Connect,
His talk today will focus on the used for research, without specific for a computer to match a recon- Forward Health, Siilo and Medic
risks of radiologists using social information about the research structed image from a CT or MRI Bleep. These are GDPR-compliant,
media and messaging services. No studies that will use the data. The image of your head to an picture allowing encryption, data trans-
less than 40% of medical specialists insurance is that a specific study that you published on WhatsApp or parency, access control, audit con-
at a Dutch hospital have sent patient must be approved by an ethics the internet.” trol and anonymity, with formal
names and pictures via WhatsApp, committee. To avoid such risks, facial data arrangements for processing and
while a study by Google DeepMind Under general consent, images from medical images can be storage, he said. Images taken with
found that doctors use Snapchat to and related data are anonymised, blurred out, but this prevents stud- a dedicated messaging app, such
send scans to each other. but the patient still has rights, and ies on the nose, eyes or sinuses to as Siilo, can be securely stored on
A screenshot of a brain CT with “One of the main reasons is there can withdraw from future pro- be performed on such altered data. remote data servers with strict con-
haemorrhage, using the Siilo app. is a need for fast communication. It jects, Ratib added. To eliminate the Some data security experts rec- trolled access to authorised users.
It is possible to add arrows and is an easy way to efficiently share anonymous data, there must be a ommend removing all identifying Even if the smartphone is stolen,
manually erase some information medical data,” noted Ranschaert, secure code linking the data to the features, including blurring out the data can remain safe.
(blurring on the bottom). (Provided adding that a resident might want patient’s identity.
by Dr. Erik Ranschaert) to get a second opinion on a scan “It is complex to implement and
from an interventional radiologist, has a cost, and as we move towards
He recalls a story from 2013, and if the patient is in a life-threat- open data and imaging biobanks, Special Focus Session
when an assistant surgeon from ening situation, every second we need to discuss who will carry
the Sacred Heart Hospital in Lier, counts. the cost of data tracking and data Friday, March 1, 16:00–17:30, Room
Belgium, hit the news headlines for However, it is now important management to ensure proper SF 12 IT-security and GDPR
all the wrong reasons. The surgeon to consider the European Union’s security and compliance with data
Moderators: O. Ratib; Geneva/CH
posed with large metal cutting pli- General Data Protection Regula- protection regulations,” he said.
ers above a patient’s leg, explaining tion (GDPR). When radiologists There is also the question as to E. Kotter; Freiburg/DE
this was just a normal day in the share images, they must secure whether patients can give up their »»Chairperson’s introduction
orthopaedic operating room, and the explicit consent of the patient. rights and ‘donate’ their own data, E. Kotter; Freiburg/DE
posted the photos on Facebook. Moreover, Snapchat or WhatsApp which is legal in the U.S., where
“It was intended to be a joke, but don’t allow audit or access control patients can sell their data, but may »»Understanding the key points of GDPR
the Belgian board of physicians to images, and there is no guaran- be illegal under GDPR. He noted C.D. Becker; Geneva/CH
asked for an official investigation tee the data can be permanently that these problems must be over- »»Issues related to patient consent to allow access to the data
because he – and the hospital – deleted, he explained. come before radiologists can ben- O. Ratib; Geneva/CH
were identified,” said Ranschaert, Ensuring patient consent is also efit from big banks of images for
»»Security aspects when using mobile devices and/or social
adding that it would also have the topic of a talk by Prof. Osman research.
media
been relatively easy to identify Ratib, professor of Medical Imag- Ratib’s talk will largely focus on
E.R. Ranschaert; Tilburg/NL
the patient. “And this makes it ing at the University of Geneva in data security as radiologists estab-
quite dangerous: data is vulnerable Switzerland. He noted that GDPR lish large imaging biobanks needed »»Panel discussion: Data protection: benefit or burden?
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