bir annual congress 2014
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BIR ANNUAL CONGRESS 2014Venue: Royal College of General Practitioners
CPD: 8 Credits (per day)
22–23OCTOBER
2014
BAYER HEALTHCARE HAS PROVIDEDSPONSORSHIP FOR THE COST OF THE
EXHIBITION STAND ONLY AT THIS MEETING.
PYCKO SCIENTIFIC LTD
Your AlternativeTo The Obvious
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More information available soon at www.bir.org.uk
• Room1Primers for the non-specialistsSessionorganisedbyDrDavid
Wilson,ConsultantInterventional
MSKradiologist,OxfordUniversity
HospitalsNHSTrust
• Room2Radiation protectionSessionorganisedbyMrAndy
Rogers,HeadofRadiationPhysics,
NottinghamUniversityHospitals
NHSTrust
Save the date
• Room1Clinical hybrid imaging in oncologySessionorganisedbyDrGopinathGnanasegaran,ConsultantPhysicianinNuclearMedicine,StThomas’Hospital
• Room2Musculoskeletal imagingSessionorganisedbyDrRichardWakefield,ConsultantinRheumatology,StJames’sUniversityHospital
Essentials for the radiology traineeSessionorganisedbyDrHardiMadani,RadiologyRegistrar,RoyalFreeLondonHospitalandDrAusamiAbbas,CardiothoracicRadiologyPostCCTFellow,UniversityHospitalAlberta
Day 2Day 1
BIR ANNUAL CONGRESS 20154–5 NOVEMBER
LONDON
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WelcomeandthankyouforcomingtotheBritishInstituteofRadiologyAnnualCongress2014.Thistwo-dayeventpromisesafascinatinginsightintovarioustopics,includinginfectious diseases, cardiovascular imaging, pulmonary diseases,MSK, neuroimagingandGIradiology.
Wehopethatbytheendofthecongress,youwillhavenotonlylearnttechnicalinformationthatwillhelpwithyourdailyactivities,butalsomanyotherinterestinghistoricalaspects,whichmaytriggernewresearchideasoneachofthosesubjects.
Wehave the fantastic additionof ePosters this year,whichwill bedisplayedon thescreensinthefoyer,wherestudents,traineesandconsultantswillbeshowcasingtheircurrentresearch.Pleasetakethetimetoviewtheseandasktheauthor(s)questions;thetimetableofscheduledtalksisinyourconferencepack.
ThefirstBIRCongressdatesbackto1897.Ifyouareinterestedinfindingoutwhatwasdiscussedattheveryfirstcongressandthosethereafter,theBIRhistorystand(inthefoyer)willrevealall.
Weareextremelygratefultoalloursponsorsforsupportingthiseventandwehopeyouwillvisittheirexhibitionstandstofindoutmoreabouttheservicestheyoffer.
Finally,I,theorganisingcommitteeandtheBIRwishyouaveryenjoyableandeducationalexperienceattheBIRAnnualCongress2014.
DrKlausIrionClinicalLead,DepartmentofRadiology,LiverpoolHeartandChestHospitalBIRAnnualCongressDirector2014
We are most grateful to
for supporting this conference
PYCKO SCIENTIFIC LTD
Your AlternativeTo The Obvious
BAYER HEALTHCARE HAS PROVIDEDSPONSORSHIP FOR THE COST OF THE
EXHIBITION STAND ONLY AT THIS MEETING.
Save the date
Day 2
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Programme DAY 1: Wednesday 22 October
ROOM 1: Imaging in infection
08:30 Registration and refreshments
09:00 Welcome and introductionChair: DrKlausIrion,ClinicalLead,DepartmentofRadiology, LiverpoolHeartandChestHospital BIRAnnualCongressDirector2014
09:05 A journey through the history of tuberculosis ProfessorBertieSquire,ProfessorofClinicalTropicalMedicine, Director,LSTMCentreforAppliedHealthResearchandDelivery
09:50 Thoracic tuberculosis DrAlexandreMancano,ConsultantChestRadiologist, PublicHealthSystemofBrasilia-DF,Brazil
10:20 Abdominal tuberculosis DrElizabethJoekes,ConsultantRadiologist, RoyalLiverpoolUniversityHospitaland DrTomHeller,ConsultantinInternalMedicineandInfectiousDiseases, KlinikumPerlach,Munich
10:50 Refreshments
11:05 Infectious diseases in the head and neck ProfessorPradiptaHande,SeniorConsultantinRadiodiagnosis, BreachCandyHospitalTrust,Mumbai
11:35 Infection and the MSK system DrAndrewDunn,ConsultantMusculoskeletalRadiologistandHonorary ClinicalLecturer,RoyalLiverpoolUniversityHospital
12:05 Pneumonia DrJohnReynolds,ConsultantRadiologist/DeputyClinicalDirector, BirminghamHeartlandsHospital
12:35 Lunch
13:35 The world of the spores and hyphae DrDerekSloan,SeniorLecturerandConsultantPhysician, LiverpoolHeartandChestHospital
14:05 Fungal diseases and the thorax ProfessorArthurSSouzaJr,Professor,MedicalSchoolofRioPreto,Brazil
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14:35 Aspergillus: how, when and why it harms the human body ProfessorWilliamHope, ProfessorofTherapeuticsandInfectiousDiseases,UniversityofLiverpool
15:05 Imaging of aspergillus in the lungs DrSujalDesai,ConsultantRadiologistandHonorarySeniorLecturer, King’sCollegeLondon
15:35 Refreshments
15:50 Understanding environmental mycobacteria ProfessorPeterDavies,ConsultantChestPhysician, LiverpoolHeartandChestHospital
16:35 Viral infections and the thorax ProfessorDanteEscuissato,AssociateProfessorofRadiology, FederalUniversityofParaná,Brazil
17:05 Viral infections and the abdomen DrElizabethJoekes,ConsultantRadiologist, RoyalLiverpoolUniversityHospital
17:30 Learn, imagine and fly through the radiological times ProfessorAdrianThomas, Chairman,InternationalSocietyfortheHistoryofRadiology HonoraryLibrarian,TheBritishInstituteofRadiology
18:15 Close of day
19:30 Congress dinner (for those who have pre-registered)
_______________________________________________________________________
Certificate of attendance
Yourcertificateofattendancewillbeemailedtoyouwithinthenexttwoweeksonceyouhavecompletedtheonlineeventsurveyat:
https://www.surveymonkey.com/s/BIRAnnualCongress2014
BIR Annual Congress 2015: 4–5 November, London
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Speaker profiles (where supplied)
Professor Peter DaviesConsultant Chest Physician, Liverpool Heart and Chest Hospital
PeterDaviesqualifiedinmedicinefromOxfordUniversityin1973.
HedidhisjuniorhospitaljobsinLondonandCardiff,specialisinginGeneralandRespiratoryMedicine.HecompletedanMDthesisontuberculosisintheUKwhileworkingfortheMedicalResearchCouncil’sTuberculosisandChestDiseasesUnit.Fromthis,alifelonginterestintuberculosisdeveloped.
HewasappointedaConsultantRespiratoryPhysiciantoFazakerlyHospital(nowAintreeUniversityHospital)andtheCardiothoracicCentreTrustsin1988.In1990hesetuptheTuberculosisResearchandResourcesUnit(TBRRU),andisnowDirector.HehasconductedresearchintomanyepidemiologicalaspectsofTBinLiverpoolandotherpartsoftheworld,particularlyHongKongandIndia.In2004hewasappointedHonoraryProfessortoLiverpoolUniversity.In1998hehelpedformanewnationaltuberculosischarity:TBAlert,ofwhichheisthesecretary.
ProfessorDavieshaswrittenover120paperspublishedinrefereedJournals,30bookchapters,over100lettersandcommissionedarticlesandover170abstractsofpresentationsatscientificsocieties.ProfessorDavieshasalsoeditedtheonlydefinitivereferenceworkontuberculosispublishedoutsidetheUSA:“ClinicalTuberculosis”,publishedbyArnold,nowinitsfourth(2008)edition.Hehasco-authoredthesectionontuberculosisintheOxfordTextbookofMedicine(4thedition)andco-authored“CasesinClinicalTuberculosis,”alsopublishedbyArnold.
Dr Sujal DesaiConsultant Radiologist and Honorary Senior Lecturer, King’s College London
DrSujalDesaiwastrainedingeneralradiologyatKing’sCollegeHospitalandinthoracicimagingattheRoyalBromptonHospital.UnderthesupervisionofProfessorDavidHansell,hewasawardedanMDfromtheUniversityofLondonforhisworkonstructure-functionrelationshipsinfibrosinglungdiseases.Hisprincipalresearchinterestsareintheevaluationoffibrosinginterstitiallungdiseaseand,latterly,theareaofchroniclungdiseaseinadolescentswithvertically-acquiredHIVinfectionforwhichheistheprincipalcollaboratinginvestigatorwitharesearchgroupinZimbabwe.WithcolleaguesfromtheRoyalBromptonHospitalandHammersmithHospitals,heisalsotheprincipalinvestigatorinastudyevaluatingtheprevalenceofpleuralplaquesonCTandtheirrelationshipwithoccupationalhistory.Heistheprincipalauthor/co-authorof48peer-reviewpapers,13invitedreviews/editorials,and27bookchapters.Hehasalsoedited4books(including,mostrecently,theOxfordSpecialistSeriesinThoracicImaging).HeservedontheeditorialboardofClinicalRadiologyfor13yearsandispresentlyontheboardoftheJournalofThoracicImagingandtheEuropeanJournalofRadiology.InJune2012,DrDesaiwasPresidentoftheEuropeanSocietyofThoracicImaging(ESTI)andhostedthe20thannualmeetingofthesocietyinLondon.
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Dr Andrew DunnConsultant Musculoskeletal Radiologist and Honorary Clinical Lecturer,Royal Liverpool University Hospital
DrAndrewDunnisaConsultantMSKRadiologistandHonoraryClinicalLecturerattheRoyalLiverpoolUniversityHospital.DrDunntrainedintheMerseyregionbeforecompletingafellowshipinMSKimagingfromtheUniversityofToronto.DrDunnhaspublishedwidelyinthemusculoskeletalimagingliterature,includingbookchaptersonsportsinjuryandupperlimbimaging,andisonthefacultyofmanynationalmusculoskeletalimagingcoursesincludingtheBritishMedicalUltrasound,BritishSocietyofSkeletalRadiologyandOswestrySpinalImagingcourses.DrDunnmaintainsanactiveroleineducation,teachingontheMerseySchoolofRadiologyandtheNorthernFellowshipofSportsandExerciseMedicinetrainingprogrammes.
Professor Dante EscuissatoAssociate Professor of Radiology, Federal University of Paraná, Brazil
DrDanteLEscuissatoisProfessorofRadiologyandInternalMedicine,FederalUniversityofParanáandconsultantradiologistinDAPIClinicinCuritiba,Brazil.
DrEscuissatoislinkedtotheteachingactivitiesofThoracicRadiology(residencyandpost-graduate)attheFederalUniversityofParaná.Hispublications(scientificarticlesandbookchapters)mainlyfocusoninfectiouslungdisease,hematopoieticstemcelltransplantationandinterstitiallungdiseases.
Professor Pradipta Hande, Senior Consultant in Radiodiagnosis, Breach Candy Hospital Trust, Mumbai
Professor(Dr)PradiptaCHandeisaSeniorConsultantinRadiodiagnosisattheBreachCandyHospitalTrustatMumbai,amultispecialitytertiarycareteachinghospital.AnMDfromtheArmedForcesMedicalCollege,UniversityofPune,shedidherpostdoctoraltraininginheadandneckimagingatMumbaiandattheUniversityteachinghospital,Cologne,Germany.Withsixteenyearsofacademicexperience,sheisauniversityrecognisedpost-graduateteacherandexaminerwiththeNationalBoardofExaminationsinRadiodiagnosis.Herareasofspecialinterestincludeheadandneckimagingandneuroimaging.ShehasbeenpartofthenationalfacultyoftheIndianRadiologyandImagingAssociation(IRIA)formorethantenyearsandhasbeenaVisitingFellowattheNHSUniversityHospitals.Shehaspublicationsinvariousjournalsandpresentedpapersandguestlecturesinseveralnationalandinternationalconferencesandseminars.
Dr Tom Heller, Consultant in Internal Medicine and Infectious Diseases, Klinikum Perlach, Munich
DrTomHeller,born1969,graduatedfromtheMedicalSchooloftheTechnicalUniversityMunich,Germanyin1995.Hespecialisedingeneralinternalmedicine,aswellasininfectiousdiseasesandworkedinGermany,SaudiArabiaandSouth
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Africa.Hehasbeeninterestedindiagnosticandinterventionalultrasoundsincethebeginningofhiscareer.Hisresearchinterestsareultrasoundapplicationsintheresource-limitedsettingandsonographicdiagnosisandtreatmentofinfectiousdiseases.HeworkedonaprojectonremoteteachingofultrasoundinGabonandhasconductedultrasoundtrainingsinGermany,UK,Italy,Zimbabwe,Ethiopia,SouthAfrica,Ghana,SaudiArabia,Kuwait,PeruandCambodia.
Professor William HopeProfessor of Therapeutics and Infectious Diseases, University of Liverpool
WilliamHopeiscurrentlyanNIHRClinicianScientistandProfessorofTherapeuticsandInfectiousDiseasesatTheUniversityofLiverpoolintheUnitedKingdom.ProfessorHopeisaFellowoftheRoyalAustralasianCollegeofPhysiciansandaFellowoftheRoyalCollegeofPathologistsofAustralasia.
WilliamHopequalifiedinMedicinein1991beforeundertakingspecialisttrainingininfectiousdiseasesandclinicalmicrobiology.HecompletedhisPhDinantimicrobialpharmacologyin2006,whileundertakingfellowshipsatTheUniversityofManchesterandtheNationalInstitutesofHealth,Bethesda,USA.HewasawardedaChairinTherapeuticsandInfectiousDiseasesin2011atTheUniversityofManchester.HehasrecentlybeenappointedtoaChairintheDepartmentofMolecularandClinicalPharmacologyattheUniversityofLiverpool.
ProfessorHope’sareasofspecialinterestandresearchareantimicrobialpharmacokineticsandpharmacodynamics,mathematicalmodellingofantimicrobialagents,populationpharmacokinetics,andindividualisationofantimicrobialtherapy.ProfessorHopeisScientificAdvisortotheESCMIDFungalInfectionStudyGroup(EFSIG),amemberoftheICAACProgramCommitteeforAntimicrobialPharmacokinetics,PharmacodynamicsandGeneralPharmacology,andMedicalGuidelineDirectorfortheEuropeanSocietyofClinicalMicrobiologyandInfectiousDiseases(ESCMID).
Dr Elizabeth JoekesConsultant Radiologist, Royal Liverpool University Hospital
AftercompletionofspecialisttrainingintheNetherlandsin1998,DrJoekesworkedininterventionalradiologyandoncologyintheNetherlands.InJanuary2004shetookupapositionasHeadofRadiologyattheKomfoAnokyeTeachingHospitalinKumasi,Ghana.From2007shehasbeenemployedattheRoyalLiverpoolUniversityHospital,withacontinuinginterestintropicalandinfectiousdiseasesandglobalhealthradiology.SheisassociatelecturerattheLiverpoolSchoolofTropicalMedicineandexternalspecialistforthedepartmentofdiagnosticimagingofMedecinssansFrontieresinAmsterdam.
Dr Alexandre MancanoConsultant Chest Radiologist, Public Health System of Brasilia - DF
DrAlexandreMançanoisaconsultantchestradiologistintheStateHealthSecretaryofBrazil’sFederalDistrictandinAnchietaHospitalinFederalDistrict.Heisthe
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coordinatoroftheImageDeparmentoftheBrazilianSocietyofPneumologyandPhthisiologyandthePresidentoftheRadiologyandDiagnosticImagingSocietyofBrasília–FederalDistrict.HeisalsoafullmemberoftheBrazilianCollegeofRadiologyandDiagnosticImaging.
Alexandrehaspublishedwidelyinthechestimagingliterature,includingbookchapters,andisonthefacultyofmanyBrazilianchestimagingcoursesincludingBrazilianNationalCongress.Alexandremaintainsanactiveroleineducation,teachingontheBrazilianCollegeofRadiologyandDiagnosticImagingandintheBrazilianSocietyofPneumologyandPhthisiologytrainingprogrammes.
Dr John ReynoldsConsultant Radiologist/Deputy Clinical Director, Birmingham Heartlands Hospital
JohnReynoldshasbeenaconsultantradiologistatBirminghamHeartlandsHospitalwithaninterestinthoracicimagingsince1993.HehasservedasPresidentoftheBritishSocietyofThoracicImagingfrom2006to2009.Recentpublicationsincludearticlesonairwaydisease,diffuselungdiseaseandpulmonaryvasculitisalongwithseveralmodulesinthethoracicsectionoftheRoyalCollegeofRadiologistsIntegratedTrainingInitiative.HehasbeenontheeditorialboardofClinicalRadiology,BritishJournalofRadiologyandImagingandservedastherespiratoryexpertleadfori-Refer,theRoyalCollegeofRadiologistsclinicalguidelinepublication.HislungcancerinteresthasledtohimbeingonthemedicaladvisorygroupoftheUKLungCancerCoalition.
Dr Derek SloanSenior Lecturer and Consultant Physician, Liverpool Heart and Chest Hospital
DrDerekSloanisaSeniorLecturerandConsultantPhysicianinInfectiousDiseasesatLiverpoolHeartandChestHospitalandtheLiverpoolSchoolofTropicalMedicine.HisclinicaltrainingwasinGlasgowandLiverpool.HehasalsoworkedextensivelyinAfricancountrieswithhighratesofHIV-infection,includingKenya,SouthAfricaandMalawi.Hisprimaryresearchinterestistuberculosis,buthehasalsoauthoredseveralpublicationsonfungaldiseases,specificallycryptococcalmeningitis.HisresearchhasbeenfundedbytheWellcomeTrustandhehasaPhDininfectionandglobalhealth.
Professor Arthur S Souza JrProfessor, Medical School of Rio Preto
ProfessorArthurSoaresSouzaJrgraduatedandtrainedingeneralradiologyinSãoJosédoRioPreto,didaFellowshipinUniversityofAlabamaatBirmingham,USA,underthesupervisionofProfessorDavidM.WittenandLarryP.Elliott.Hisprincipalresearchinterestsareintheevaluationinfectionsanddiffuselungdiseases.Heistheauthor/co-authorof110peer-reviewpapers,and15bookchapters.HeispresentlyontheboardoftheBrazilianJournalofRadiologyandBrazilianJournalofPneumology.HeismemberofScientificCommitteeofSocietyPaulistadeRadiologia.
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Professor Bertie SquireProfessor of Clinical Tropical Medicine, Director, LSTM Centre for Applied Health Research and Delivery
Areasofinterest:Tuberculosis:improvingaccessbythepoortodiagnosisandclinicalcare,equityinhealthandappliedhealthresearch.
ProfessorSquirestudiedmedicineandimmunologyatUniversityCollegeLondonandCambridgeUniversitybeforeprofessionaltrainingininternalmedicine,infectiousdiseasesandrespiratorymedicineattheRoyalLondonHospitalandtheRoyalFreeHospital.From1992to1995hewasHeadoftheDepartmentofMedicine,KamuzuCentralHospital,Lilongwe,Malawi.SincehisappointmentatLSTMin1995,ProfessorSquirehasmaintainedhisresearchcollaborationwiththeNationalTBControlProgrammeinMalawiandhasfacilitatedthetransformationofthecollaborationintotheMalawi-registeredTrustforResearchonEquityAndCommunityHealth(REACH).Withcolleaguesinmanycountrieshehasbuiltupaprogrammeofmulti-disciplinaryappliedhealthresearchaimedatprovidingknowledgeforactioninmakinghealthservicesfortuberculosismoreaccessibletopoorpeopleindevelopingcountries(includingthoseaffectedbytheHIVpandemic).HeholdsanappointmentintheUKNationalHealthServiceasHonoraryConsultantinInfectiousDiseasesandTropicalMedicineattheRoyalLiverpoolUniversityHospitalandistheimmediatepastPresidentoftheInternationalUnionAgainstTuberculosis&LungDisease.
Professor Adrian ThomasChairman, The International Society for the History of RadiologyHonorary Librarian, The British Institute of Radiology
ProfessorThomaswasamedicalstudentatUniversityCollegeLondon.HewastaughtmedicalhistorybyEdwinClarke,BillBynumandJonathanMiller.Inthemid-1980shewasafoundingmemberofwhatisnowtheBritishSocietyfortheHistoryofRadiology.In1995heorganisedtheradiologyhistoryexhibitionfortheRöntgenCentenaryCongressandeditedhisfirstbookonradiologyhistory.Hehaspublishedextensivelyonradiologyhistoryandhasactivelypromotedradiologyhistorythroughouthiscareer.HeiscurrentlytheChairmanoftheInternationalSocietyfortheHistoryofRadiology.ProfessorThomasbelievesitisimportantthattheradiologyisrepresentedinthewidermedicalhistorycommunityandtothatendlecturesonradiologyhistoryintheDiplomaoftheHistoryofMedicineoftheSocietyApothecaries(DHMSA).Heistheimmediatepast-presidentoftheBritishSocietyfortheHistoryofMedicine,andtheUKnationalrepresentativetotheInternationalSocietyfortheHistoryofMedicine._____________________________________________________________________
Abstracts (where supplied)
A journey through the history of tuberculosisProfessor Bertie Squire
Thistalktracksourunderstandingoftuberculosis;thediseasecausedbymycobacteriumtuberculosis.Themajormilestonesofthisunderstandingarecloselylinkedtothemajormilestonesinthedevelopmentofmodernmedicine
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andthecontrolofinfectiousdiseases.Koch’sdiscoveryofthetuberclebacillusandhisworkdemonstratingthatthiswasthecauseofthediseasewhichwasoftenreferredtoas“consumption”cementedtheconceptofmicro-organismsascausativeagentsofdisease.Theuseofchestx-raystodiagnoseanddocumenttheextentofdiseasearecloselylinkedtothedevelopmentofthedisciplineofradiology.Randomised,controlledtrialsforassessingtreatmentoptionswerefirstdevelopedfortuberculosisandresultedincombinationchemotherapytoreducetherisksofthedevelopmentofdrugresistance.MorerecentlytheconceptoftreatmentasakeystepinpreventingtransmissionledtotheDOTSstrategywhichunderpinstheglobalstrategytocontroltuberculosis.Finally,wehavecomefullcircleinrecognisingthatthisclassicaldiseaseofpovertyanddeprivationwillnotbecontrolledwithoutensuringthateffectivetreatmentservicesaremadeavailableandaccessibleforpoorpopulationsalongwithinterventionstotackletheunderlyingdriversofdeprivation.
Thoracic tuberculosisDr Alexandre Mancano
DuringtheAidspandemia,inthebeginningofthe1980’s,wecouldseeanincreaseinthenumberofTuberculosis(TB)cases.
Wethought,inthattime,thatTBwasacontrolleddisease,butastheAIDSpandemiahasshownus,itwasnot.Inthattime,wefoundoutthatTBwastheimmediatecauseofthatpandemia,buttheunderlyingcausewasAIDS.
TheWorldHealthOrganization(WHO),in1993,namedTBaglobalemergencyandmadeanobscureprediction:Thatbetween1997and2020,wewouldhave1billionofnewcasesintheworldandwewouldseeabout70milliondeathscausedbyTB.
TBisaworldwidedisease.InEngland,wehaveabout10to19casesandinBrazil20to49casespera100thousandinhabitants.In2010,Englandhadabout500,000withTB,andinBrazilabout2millionpatientswithTB.
IfwecompareRiodeJaneirotoLondon,asseparatecities,wecanseeinRiosomethingbetween54to70TBcasesperahundredthousandinhabitants,andinLondonsomethingveryclosetothat.
So,thisisthereasonwhywearegoingtotalkaboutTBinthisimportantmeeting,inthe21stcentury.
TheobjectivesofourlecturewillbetoreviewandrecognisethemainradiologicaspectsinpulmonaryTB.Wecoulddividetheseobjectivesinfourtopics:1.PrimaryTB2.SecondaryTB3.TBinimunocompromisedhost4.Complicationspertinenttothedisease
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Abdominal tuberculosisDr Elizabeth JoekesDr Tom Heller
Thissessionwillprovideabriefclinical,case-basedintroductiontoabdominaltuberculosis,incorporatingCTimaging.Thiswillbefollowedbyamorein-depthdiscussionoftheuseofultrasound(US)inthediagnosisofextra-pulmonaryTB(EPTB)inHIV,asforthevastmajorityofaffectedpopulationsCTandradiologicalexpertisearenotavailable.Focusedassessmentwithsonography(FASH)byclinicianscaringforTB/HIVpatientsisincreasinglyusedtoassistinthediagnosisofEPTB.Feasibilityandtrainingwillbediscussedbriefly.
Learningobjectives:1.RecognisetypicalultrasoundfindingsofEPTB.2.UnderstandexpectedUSchangesduringandaftertreatment.3.AppreciatetheaddedvalueofFASH,comparedtochestX-rays.4.RecognisekeyfeaturesofabdominalTBonCT.
Infectious diseases in the head and neckProfessor Pradipta Hande
Infectionsoftheheadandneckarenotuncommonandareoftenassociatedwithhighmorbiditywithdismaloutcomes.Itcanresultinrapiddeteriorationduetoextensionofdiseaseandseriouscomplications,evenintheeraofantibiotics,especiallyinimmune-compromisedpatients.Whilethediagnosisisprimarilybyclinicalexamination,theextentofinfectionisdifficulttoestimateclinically.Theroleofradiologyiswellestablished,eventhoughplainradiographshavealimitedutilityandcross-sectionalimagingisvitalfortheassessmentofdisease.
Educationalaims:Computedtomography(CT)andmagneticresonanceimaging(MRI)helpindetailedevaluationofextentofdiseaseandearlydetectionofvascularandairwaycompromiseandthusassistinplanningsurgicalmanagement.MDCTwithisotropicimagingallowsmultiplanarreconstructions(MPR)andexquisite3Dreformats.Intravenousnon-iodinatedcontrastinjectionisusefultostudytheenhancementpatternsandhelptodifferentiatephlegmonousmassfromabscesswhichneedsimmediatesurgicaldrainage.Softtissue,boneand/orlungwindowsfordisplayisrecommendedfortheextentofinfection,boneinvolvementandtodetectgaswithinthetissuesasinabscess.CTisquick,widelyavailableandisthemodalityofchoiceforimaginginheadandneckinfections.MRIhasbetterinherentsofttissuecontrastandcandetectoedemaearly.T1-weightedimagesafterIVinjectionofGadolinium-basedcontrastcanbeproblem-solvinginspecificsituationsespeciallyinwidespreaddiseaselikefungalinfections.However,ithasalimitedroleduetolongacquisitiontimesanddifficultyinbreathholdinginveryillpatients.
Learningoutcomes:Theimagingprotocolsshouldbetailoredtotheclinicalconditionandanattemptshouldbemadetodetectintra-cranial,spinalorthoracicextensionofthedisease.Thesourceofthesepticfocusmaybeotolaryngologicordental,whichcanbeassessedonheadandneckimaging.
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Infection and the MSK systemDr Andrew Dunn
Successfulimagingdiagnosisofmusculoskeletalinfectionoftenrequiresamultimodalityapproachcomprisingradiography,ultrasound,MRI,CTandscintigraphy.Becauseeachoftheseimagingmodalitieshasitsownstrengthsandweaknesses,combinationsofmodalitiesareoftenutilised.Imagingshouldbecombinedatalltimeswithadetailedclinicalhistory,anddiscussionofimagingfindingswithcliniciansinthesettingofanInfectionMDTmeetingishelpfulinreachingarapiddiagnosisandplanningtreatment.Theeducationalaimsofthispresentationareasfollows:
1.Tocoverthemodesofspreadofmusculoskeletalinfectionwithparticularreferencetopatho-anatomyanddiscusssomeofthepathologicalterminologyofMSKinfection.2.TodiscusstheroleandapplicationofvariousimagingmodalitiesinthediagnosisofmusculoskeletalinfectionwithparticularfocusonradiographyandMRI.3.Considerhowandwhentoperforminterventionintheformofimageguidedfluidaspirationorbiopsy.4.Presentaproblem-solvingapproachwhenconsideringhowbesttoimageintheorthopaedicpost-operativesetting.5.TobrieflydiscusstheroleofnewerimagingmodalitiessuchasPET-CTinthediagnosisofMSKinfection.6.Presenttheimagingofsomeatypicalandsomerareorganismspecificmusculoskeletalinfections.
PneumoniaDr John Reynolds
Keyteachingpoints:1.Thechestradiographremainsakeyinvestigationwithsuspectedpneumoniaandformostitwillbetheonlyimagingtheyrequire.2.CTismoresensitivethanthechestradiographforthedetectionofpneumoniaandincertainclinicalsettingsmaygiveastrongenoughindicationofthetypeofinfectingorganismtoallowadecisiononanti-microbialtreatment.3.ComplicationsofpneumoniasuchaslungabscessorcomplicatedpleuraleffusionsmayrequirefurtherassessmentwithultrasoundorCT.4.MRItechnologyisadvancinganditprovidesanoptionforfollowupbutitdoesnotyetmatchCTasadiagnostictest.5.Mostpatientswithalungabscesswillrespondtomedicaltreatment.Forthosewhodonot,imageguidedcatheterplacementprovidesatreatmentoptionforthosenotfitforasurgicalapproach,particularlyiftheabscessabutsapleuralsurface.
References
1.ReynoldsJH,McDonaldG,AltonH,GordonSB.Pneumoniaintheimmunocompetentpatient.BritishJournalofRadiology2010;83:998-1009.
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2.FranquetT.Imagingofpulmonaryviralpneumonia.Radiology2011;260:18-39.3.ReynoldsJHandBanerjeeAK.Imagingpneumoniainimmunocompetentandimmunocompromisedindividuals.CurrOpinPulmMed2012;18:194-201.
The world of the spores and hyphaeDr Derek Sloan
Fungiareubiquitousintheenvironment.Initiallythoughttobepartoftheplantkingdom,theyareactuallymorecloselyrelatedtoanimals.Withapproximately1.5millionspeciesonearth,fungiareamongstthemostevolutionarydiverseorganismsontheplanet.Theyprovidevaluableecosystemservicesthroughdecompositionoforganicmatterandsymbioticassociationswithotherlivingsystems.Theyarealsousedasfood.
However,theutilityoffungitolifeonearth,iscounterbalancedbypathogenicity.Diseasesofplantsandanimalsmayhavedevastatingconsequencesforhumankind;astrikinghistoricalexampleisinfectionofpotatoesbyphytophthorainfestanswhichledtothe19thcenturyIrishfamineandcausedthedeathofover1millionpeople.
Approximately300fungalspeciesarepathogenictohumans,particularlyamongstindividualswithunderlyingimmunedysfunction.Sincethe1980s,effectsoftheglobalHIVepidemicandincreaseduseofimmunosuppressivemedications(e.g.totreatinflammatorydiseaseandmalignancyortopreventtissuerejectionafterorgantransplantation)havefocussedattentiononthediagnosisandmanagementoffungalinfectionsincludingcrypotococcosis,aspergillosis,candidiasis,histoplasmosis,andpneumocystiscarinii(jerovecii)pneumonitis.
Thislecturewillintroducefungaldiseasebydiscussinggeneralcharacteristicsoffungiandillustratingthethreattohumanhealthviaexamplesofclinicaldisease.
Fungal diseases and the thoraxProfessor Arthur S Souza Jr
Fungalinfectionsofthelungarelesscommonthanbacterialandviralinfectionsbutposesignificantproblemsindiagnosisandtreatment.Theymainlyaffectpeoplelivingincertaingeographicareasandthosewithimmunedeficiency.Theirvirulencevariesfromcausingnosymptomstocausingdeath.
Ratesofinvasivefungalinfectionshavesurgedduringrecentdecades,largelybecauseoftheincreasingsizeofthepopulationatrisk.
TheaimofthispresentationisdemonstratingthemainTCfindingsofthemostcommonlungmycosesinSouthAmerica.
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Imaging of aspergillus in the lungsDr Sujal Desai
Thepropensityforaspergillusspp.tocauselungdiseasehasbeenrecognisedforwelloveracentury.Yetthesatisfactoryclassificationofthesedisordershasprovedchallenging.Theproblemscausedinvasivediseaseinseverelyneutropenicpatients,saprophyticinfectionofpreexistingfibroticcavitiesandallergicreactionstoaspergillusarewelldocumentedintheliteratureandwillnotbethefocusofthepresentation.Incontrast,amorechronicformofaspergillus-relatedlungdiseasewhichhasthepotentialtocausesignificantmorbidityandmortality,hasbeenunder-reported.Thiswillbethemainfocusofthepresentation.Thesymptomsofthisformofaspergillusinfectionaregenerallynon-specificandbecauseofthisandtheradiologicalfindings(consolidationandcavitationintheupperzones)apresumptiveclinicaldiagnosisofmycobacterialinfectionisoftenmade.Indeed,non-tuberculousmycobacterialinfectionsfrequentlyco-existwithchronicpulmonaryaspergillosisandtheradiologistmaybethefirsttosuspectthisdiagnosis.Thecurrentpresentationwillconsiderstheclassificationconundrumsindiseasescausedbyaspergillusspp.anddiscussesthetypicalclinicalandradiologicalprofileofpatientswithchronicpulmonaryaspergillosis.
Understanding environmental mycobacteriaProfessor Peter Davies
Thesemycobacteriaarearealpest.Iwouldrathertreatapatientwithmulti-drugresistanttuberculosisanyday.YouknowwhereyouarewithMDRTBbutwiththeENorNTMsastheAmericanscallthemwearemostlyinthedark.Forastartiftheyareisolatedfromapatientwecan’tbesurethattheyareactuallycausingadisease,theymaybecommensalespeciallyifsmearnegative.WhenwedodecidetotreattherearepreciousfewRCTstoguideusastowhattotreatwithourhowlongtotreat.Becausetheyrelativelyrarelycausedeaththeyaregrosslyunderresearched.Alsoonecanvirtuallyneverdischargeapatientbecauseasthebacteriaareacquiredfromtheenvironment,patientscanbeinfectedtimeandtimeagain.Andtomakemattersworsetheclevermicrobehuntersseemtocomeupwithanewspeciesdaily.Herearejustsomeofthenamesforstarters.M.scrofulaceumM.szulgai,M.aviumcomplex(MAC).M.ulcerans,M.xenopi,M.malmoense,M.terrae,M.haemophilumM.genavense.M.chelonae,M.abscessus,M.fortuitumandM.peregrinum.M.smegmatisandM.flavescens.How’saguygoingtogetahandleonthatlot?
Viral infections and the thoraxProfessor Dante Escuissato
Virusesarecommoncausesoflowerrespiratorytractinfectionandmayresultintracheobronchitis,bronchiolitis,andpneumonia.Theseinfectionsaretransmittedfrompersontopersonbyhand-to-hand-contact,contactwithinfectedsurfaces,oraerosoltransmission.Viralpneumoniainadultscanbedividedintotwogroups:atypicalpneumoniainpreviouslynormalpatientsandviralpneumoniainimmunocompromisedhosts.Clinicalandimagingmanifestationsinviral
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infectionsarenotcharacteristics,makingitdifficulttodifferentiateinfectionswithotheragents.Althoughitisnotpossibletodiagnoseviralinfectionsbasedsolelyonimagingmethods,thecombinationofthesewithclinicaldatacanincreasetheaccuracyinthediagnosis.
Viral infections and the abdomenDr Elizabeth Joekes
Awiderangeofviralinfectionsmanifestsitselfwithintra-abdominalpathology.Formanyofthesetheroleofdiagnosticimagingislimitedorentirelyabsent.Forothers,likehepatitisanditscomplicationsofcirrhosisandHCC,theroleofimagingandimagingguidedtreatmentiswellknownandfeaturesprominentlyintheliterature.Thecurrentlecturewillfocusonthefeaturesoflesscommonlyencounteredviralinfectionsandtheirsequelaeanddifferentialsonimaging:CMV,EBVandHPVforexample.Followingabriefgeneraloverviewofviralinfectionsforradiologists,clinicalcases,usingmainlyCTandultrasoundwillbediscussed.Learningoutcomes:Torecognisewhenaviralinfectionshouldbeconsideredinthedifferentialofintra-abdominalimagingpathology.
Learn, imagine and fly through the radiological timesProfessor Adrian Thomas
Thereweresignificantadvancesinmedicineduringthe19thcenturywithincreasedknowledgeinmedicine,surgery,bacteriologyandchemicalpathology.Howeverourabilitytolookinsidethebodyhadshownlittleimprovementandwaslimitedtotheprobingfingerorsimpleendoscopy.Thiswasalltochangein1895whenWilhelmConradRöntgendiscoveredx-rays.Thedescriptionoftheabilitytoseethroughthebodywasgreetedbymanywithincredulityandearlyaccountshadtoreassurethepublicthatthiswasaseriousdiscoverybyarespectedscientist.
Earlyradiologywastechnicallydifficulttoperform,howeverduringthenextfewdecadestheequipmentgraduallyimproved.Initiallyimageinterpretationwasalsodifficultandittookmanyyearstodeciphertheseoftenconfusingshadows.Radiologywasalsonotwithoutrisk,withinjuriesrelatedtoionisingradiation,electricalinjuriesandchemicalinjuriesfromprocessingthefilmsandplates.
Radiologysteadilyprogressedwiththedevelopmentofthemodernx-raytube,contrastmedium,cathetersandimageintensification.Traditionalradiologyrevolutionisedmedicalcare.Howeverinvestigationswereofteninvasiveandpathologywasoftenshownindirectly.
Radiologyhasprofoundlychangedsincewhatcanbeseenasthegoldendecadeofthe1970s,startingwiththeannouncementofCTscanningin1972.DevelopmentsinCTscanning,ultrasound,nuclearmedicine,MRIscanning,andfinallyinterventionalradiologyhasplacedradiologyintheforefrontofmodernmedicine.Modernradiologynowallowsfornon-invasivediagnosis,andthishasfacilitatedminimallyinvasivetherapy.Thisstoryisexcitingandinteresting.
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Reading:Thomas,AMK.,Banerjee,AK.TheHistoryofRadiology.Oxford:OxfordUniversityPress(2013)
Educationalaimsandlearningoutcomes:1.Tounderstandthebackgroundtoradiology.2.Toseeconnectionsbetweenvariousfacetsoftheradiologicalscience.3.Tounderstandhowonedevelopmentfacilitatedanother.
_____________________________________________________________________
Certificate of attendance
Yourcertificateofattendancewillbeemailedtoyouwithinthenexttwoweeksonceyouhavecompletedtheonlineeventsurveyat:
https://www.surveymonkey.com/s/BIRAnnualCongress2014
BIR Annual Congress 2015: 4–5 November, London
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Programme DAY 1: Wednesday 22 October
ROOM 2: Cardiovascular imaging
08:30 Registration and refreshments
09:00 Welcome and introductionChair: DrSukumaranBinukrishnan,ConsultantCardiothoracicRadiologist, LiverpoolHeartandChestHospital
09:05 History of cardiac CT from inception to present DrTarunMittal,ConsultantCardiothoracicRadiologist, RoyalBrompton&HarefieldNHSTrust
09:50 Dual energy in cardiac CT DrBalazsRuzsics,ConsultantCardiologist RoyalLiverpoolUniversityHospital
10:20 Role of CT in imaging myocardial perfusion DrMichelleWilliams,RadiologyTrainee,RoyalInfirmaryofEdinburgh
10:50 Refreshments
11:05 Cardiac CT for the emergency department DrRussellBull,ConsultantRadiologist,RoyalBournemouthHospital
11:35 Imaging of the vulnerable plaque with cardiac CT DrBalazsRuzsics,ConsultantCardiologist RoyalLiverpoolUniversityHospital
12:05 Imaging in TAVI DrSukumaranBinukrishnan,ConsultantCardiothoracicRadiologist, LiverpoolHeartandChestHospital
12:35 Lunch
13:35 Management of pulmonary embolic disease ProfessorDuncanEttles,ConsultantCardiovascularandInterventional Radiologist,HullRoyalInfirmary
14:05 Acute aortic syndromes ProfessorPeterGaines,ConsultantVascularInterventionalRadiologist, SheffieldVascularInstitute
14:35 Management of acute thoracic dissections DrMohamadHamady,ConsultantInterventionalRadiologistand SeniorLecturer,ImperialCollegeLondon
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15:05 Management of thoracic/arch aortic aneurysm MrManojKuduvalli,ConsultantCardiacSurgeon, LiverpoolHeartandChestHospital
15:35 Refreshments
15:50 Management of aorto-iliac occlusive disease DrGrahamRobinson,ConsultantVascularRadiologistandClinicalLeadfor VascularRadiology,HullRoyalInfirmary
16:15 Stroke prevention: carotid artery stenting DrTrevorCleveland,ConsultantVascularRadiologist, SheffieldVascularInstitute
16:40 Management of abdominal aortic aneurysms DrNicholasChalmers,ConsultantVascularRadiologist, ManchesterRoyalInfirmary
17:05 Interventional management of hypertension DrTrevorCleveland,ConsultantVascularRadiologist, SheffieldVascularInstitute
THE FOLLOWING LECTURE WILL TAKE PLACE IN ROOM 1
17:30 Learn, imagine and fly through the radiological times ProfessorAdrianThomas, Chairman,InternationalSocietyfortheHistoryofRadiology
18:15 Close of day
19:30 Congress dinner (for those who have pre-registered)
_______________________________________________________________________
Certificate of attendance
Yourcertificateofattendancewillbeemailedtoyouwithinthenexttwoweeksonceyouhavecompletedtheonlineeventsurveyat:
https://www.surveymonkey.com/s/BIRAnnualCongress2014
BIR Annual Congress 2015: 4–5 November, London
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Speaker profiles (where supplied)
Dr Sukumaran BinukrishnanConsultant Cardiothoracic Radiologist, Liverpool Heart and Chest Hospital
DrBinukrishnanisaconsultantcardiothoracicradiologistatLiverpoolHeartandChestHospitalNHSTrustandRoyalLiverpoolandBroadgreenUniversityHospitalsNHSTrust.HeobtainedhisundergraduatedegreefromIndiaandMRCPfromEdinburgh.RadiologyspecialisttrainingwasfromMerseySchoolofRadiology.CardiacCTtrainingwasobtainedasfellowattheUniversityofErlangen,Nuremberg,GermanyandCardiacMRIasvisitingfellowatStanfordUniversity,California,USA.Hehasover6yearsofexperienceincardiacCTandcardiacMRIincludingadultcongenitalheartdiseases.Heisalsoaccreditedinchestandgeneralradiology.Publicationsareinthefieldofcardiacandchestimaging.
Dr Russell BullConsultant Radiologist, Royal Bournemouth Hospital
DrBullwasappointedasaconsultantradiologistattheRoyalBournemouthHospitalin2000.DrBullinitiallyworkedasageneralCrossSectionalRadiologistandstartedacardiacCTserviceatBournemouthin2003followedbyacardiacMRIservicethefollowingyear.Forthelast4yearshehasworkedalmostexclusivelyasaCardiothoracicRadiologistwithhistimesplitbetweencardiacCTandMRI.HisinterestsincludereducingradiationandcontrastdosesforCTexaminationsandincreasingefficiencywithinradiologydepartmentsbyoptimisingtechnologyandworkflows.DrBulliscurrentlysecretaryandeducationleadfortheBritishSocietyofCardiovascularImaging(BSCI).
Dr Nicholas Chalmers Consultant Vascular Radiologist, Manchester Royal Infirmary
DrNickChalmershasbeenaConsultantVascularRadiologistatManchesterRoyalInfirmaryformorethan20yearsandhasbeeninvolvedwithendoluminalrepairofaorticaneurysmformostofthistime.HewasaparticipantintheEVARandIMPROVETrials.
Dr Trevor Cleveland, Consultant Vascular Radiologist, Sheffield Vascular Institute
DrTrevorClevelandqualifiedinmedicinefromNottinghamUniversityin1985.Followingayear’spostinCambridgedoingA&E,neurotraumaandorthopaedics,hejoinedtheSheffieldSurgicalTrainingScheme.HebecameFellowoftheRoyalCollegeofSurgeonsofEnglandin1990,andcommencedradiologytraininginSheffield,withtheintentionofpursuingacareerininterventionalradiology.HebecameaFellowoftheRoyalCollegeofRadiologistsin1994.HewasappointedSeniorLecturer(HonoraryConsultant)inVascularRadiologyatSheffieldUniversityin1995andConsultantVascularRadiologistin2000.
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DrClevelandhasbeenamemberoftheBritishSocietyofInterventionalRadiologysince1995,andhasservedontheCouncil.HeisalsoaFellowandontheAdvisoryBoardofCIRSE,andisaDirectoroftheEuropeanSchoolofInterventionalRadiology.DrClevelandisalsoamemberoftheEuropeanSocietyofRadiologyandpresentlyservesontheBoardoftheFacultyoftheRoyalCollegeofRadiologists.
Professor Duncan EttlesConsultant Cardiovascular and Interventional Radiologist,Hull Royal Infirmary
DuncanEttlesisaConsultantCardiovascularandInterventionalRadiologistforHullandEastYorkshireHospitalsNHSTrustandHonoraryClinicalProfessorinradiologyattheUniversityofHull.HecurrentlyservesaspresidentoftheBritishSocietyofInterventionalRadiology,throughwhichhehasbeeninvolvedinthedevelopmentofUKinterventionalradiologyforover20years.HehasalsobeenactiveintrainingIRsthroughouthiscareer,includingrolesasformerheadoftraining,regionaladviserandexaminerfortheRoyalCollegeofRadiologists.ProfessorEttlesischairmanoftheNHSspecialisedcommissioninggroupforinterventionalradiologyandmemberoftheNICEGDGandQualityStandardsCommitteeforperipheralarterialdisease.
Professor Peter GainesConsultant Vascular Interventional Radiologist,Sheffield Vascular Institute
DegreefromManchesterMedicalSchool,MRCPafterendlessclinicalpostsfinallysettlingintoRadiologyatGuy’sHospital.MovedtoSheffieldtoextendvascularexperiencewiththeincredibleProfessorDavidCumberland.AfterayearinHongKong,twoyearsasSeniorLectureratSheffieldUniversity,he’sbeenConsultantRadiologistinSheffieldsince1995.HedevelopedtheautonymousSheffieldVascularInstitute1998.
HehasspentsometimespentwithDoHdevelopingPaymentbyResultsforInterventionalRadiology,NICE,MHRAandaspresidentoftheBritishSocietyofInterventionalRadiology.
Hehaswritten124originalscientificpapersandseveralchaptersandbooks.
Hisspecificinterestisthoracicaorticdisease,carotidinterventionandvascularmalformations.
HeiscurrentlyMDfortwodevicecompaniesandRadiologyConsultantforiGenewhoarerollingoutdigitalautopsyacrosstheUK.
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Dr Mohamad HamadyConsultant Interventional Radiologist and Senior Lecturer, Imperial College London
DrHamadygraduatedfrommedicalschoolin1998.Following3yearsofsurgicaltraining,hejoinedclinicalandinterventionalradiologytrainingattheAmericanUniversityofBeirut.HecompletedinterventionalradiologytrainingatKing’sCollegeLondonin2001.Hedid2yearsofclinicalresearchinIRatGuy’sandStThomas’Hospital.HethenjoinedImperialCollegeLondonin2003asConsultantandSeniorLecturerinVascularInterventionalRadiology.
Hisresearchinterestsincluderoboticendovascularinterventionandnavigation,virtualrealitysimulationtrainingofendovascularskills,aorticstentgraftingandovarianreservepostfibroidembolisation.Herecentlystartedaresearchworkonimprovingpatient’ssafetyinIR.
Hehasover120papersinpeer-reviewjournalsand12bookchapters.Hehasgivenmorethan65talksandkeynotelecturesinnationalandinternationalscientificmeetings.
Heiscurrentlydeveloping,incollaborationwithindustry,anewgenerationoffenestrated/branchedstentgraftforthoraco-abdominalaneurysms.DrHamadyhasdonetheworld-firstroboticendovascularaorticrepairin2008andtheworld-firstroboticfibroidembolisationin2012.
Mr Manoj Kuduvalli Consultant Cardiac Surgeon, Liverpool Heart and Chest Hospital
MrManojKuduvalligraduatedinIndiain1992andtrainedinMumbaiasacardiovascularandthoracicsurgeonbeforemovingtotheUKin1999.HefurthercompletedhistrainingprogrammeincardiothoracicsurgeryintheUKandwasappointedasaConsultantCardiacSurgeonattheLiverpoolHeartandChestHospitalin2007.Inadditiontogeneralcardiacsurgery,hismainareasofspecialinterestareinthoracicaorticsurgeryandtranscatheteraorticvalveimplantation(TAVI).
Dr Tarun Mittal, Consultant Cardiothoracic Radiologist, Royal Brompton & Harefield NHS Trust
DrMittalwastrainedinallaspectsofcardiacimaginginLeeds.Asaconsultantsince2002,hehasdevelopedandrunhighlysuccessfulclinicalservicesincardiacCTandMRatHarefieldhospitals.Hisresearchinterestsincludeimagingofcoronaryarterydisease,prevention,valvedisease,heartfailureandcardiactransplantation.HehasbeenactivelyinvolvedinteachingandtrainingwithRCRandrunningaverysuccessfulcourseincardiacCT.
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Dr Graham RobinsonConsultant Vascular Radiologist and Clinical Lead for Vascular Radiology, Hull Royal Infirmary
DrGrahamJRobinsonisaConsultantVascularRadiologistandtheClinicalLeadforVascularRadiologyattheHullandEastYorkshireNHSTrust.HequalifiedfromOxford,andtrainedinOxford,London,BirminghamandTorontopriortotakinguppostinHullin2000.HehasservedontheBSIRScientificProgrammeCommitteeandcurrentlysitsontheBSIRSafetyandQualityCommittee.HeisRCRtutorforHullRoyalInfirmary,andhasbeenactivelyinvolvedinthelocaltrainingschemesinceappointment.Hisinterestsincludeembolisation,aorticendografting,hereditaryhaemorrhagictelangiectasiaandmedicaldeviceregulation.
Professor Adrian ThomasChairman, The International Society for the History of RadiologyHonorary Librarian, The British Institute of Radiology
ProfessorThomaswasamedicalstudentatUniversityCollegeLondon.HewastaughtmedicalhistorybyEdwinClarke,BillBynumandJonathanMiller.Inthemid-1980shewasafoundingmemberofwhatisnowtheBritishSocietyfortheHistoryofRadiology.In1995heorganisedtheradiologyhistoryexhibitionfortheRöntgenCentenaryCongressandeditedhisfirstbookonradiologyhistory.Hehaspublishedextensivelyonradiologyhistoryandhasactivelypromotedradiologyhistorythroughouthiscareer.HeiscurrentlytheChairmanoftheInternationalSocietyfortheHistoryofRadiology.ProfessorThomasbelievesitisimportantthattheradiologyisrepresentedinthewidermedicalhistorycommunityandtothatendlecturesonradiologyhistoryintheDiplomaoftheHistoryofMedicineoftheSocietyApothecaries(DHMSA).Heistheimmediatepast-presidentoftheBritishSocietyfortheHistoryofMedicine,andtheUKnationalrepresentativetotheInternationalSocietyfortheHistoryofMedicine.
Dr Michelle WilliamsRadiology Trainee, Royal Infirmary of Edinburgh
DrMichelleWilliamsgraduatedfromtheUniversityofEdinburghin2005.ShecontinuedhermedicaltraininginEdinburghandrecentlycompletedaBritishHeartFoundationClinicalResearchFellowattheUniversityofEdinburgh.SheisnowaradiologytraineeattheRoyalInfirmaryofEdinburghandparticipatesinresearchstudiesattheClinicalResearchImagingCentreinEdinburgh.Hermaininterestsarecomputedtomographycoronaryangiographyandcomputedtomographymyocardialperfusionimaging.
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Abstracts (where supplied)
History of cardiac CT from inception to presentDr Tarun Mittal
CardiacCThascomealongwaysincetheorigininventionofCTscannerbySirGodfreyHounsfield.Ithasalwaysbeenpossibleforradiologiststodiagnosecardiacmassesandpericardialthickeningevenwiththesingleslicenon-helicalscanners.ElectronbeamCTscannersbroughtinaninnovativerapidwaytoscantheheartbuttheiruseremainedconfinedtocalciumscoring.Multi-slicehelicalscanningtechnologysincetheturnofthecenturyhasrevolutionisedcardiacimagingwiththeabilitytoimagethecoronaryarteriestodiagnosticlevelandthusbecomeacceptableinclinicalpractice.
Role of CT in imaging myocardial perfusionDr Michelle Williams
AdvancesincardiacCTimagingmeanthatitisnowpossibletoassessanatomy,function,perfusionandviabilityinonerapiddiagnostictest.CTcoronaryangiographynowhasadiagnosticaccuracyfortheidentificationofsignificantcoronarystenosissimilartoinvasivecoronaryangiography.Inaddition,CTmyocardialperfusionimagingcanaidintheassessmentofintermediatestenosis,heavilycalcifiedvesselsorcoronaryarterystents.MultimodalityimaginghasshownthediagnosticaccuracyofCTmyocardialperfusionimagingincomparisonwithMRI,fractionalflowreserveandoxygen15labeledwaterPETimaging.Importantly,CTmyocardialperfusionimagingisnowpossibleatalowradiationdose,comparativetoconventionalinvasivecoronaryangiographyornuclearmedicinetechniques.CurrentresearchaimstooptimizethistechniqueaspartofacomprehensivecardiacCTprotocol.Thistalkwillprovideanoverviewofthecurrentmethodstoassessmyocardialperfusion(suchasSPECTandMRI)andwhyassessingmyocardialperfusionisusefulindiagnosingandtreatingpatientswithcoronaryarterydisease.Thebasictechniquefortheacquisitionandinterpretationofimageswillbepresented.ThecurrentstateoftheevidenceforusingCTtoassessmyocardialperfusionwillbeexploredandfutureareasforresearchwillbehighlighted.
Cardiac CT for the emergency departmentDr Russell Bull
Chestpainisoneofthecommonestreasonsforpresentationtoanemergencydepartment.Investigationofacutechestpainvarieswidelyacrossthecountry.Oftenpatientswithacutechestpainarehospitalisedforfurtherinvestigation.Followingrelativelytime-consumingandexpensiveinvestigations,manyofthesepatientsarefoundtohavenosignificantdisease.Usingatleast64-detectortechnologyitispossibletoexcludecoronaryarterydiseasewithhighreliabilityandatlowradiationdoseusing‘prospective’ECGgating.Theso-called‘tripleruleout’examinationhasrecentlybeensuggestedbysomeauthorsasaneffectivewayofexcludingcoronaryarterydisease,pulmonaryembolusandaorticdissectiononthesameCTstudy.Thesestudiesaretechnicallyverychallengingtoperformusingconventional64detectortechnologyduetolongacquisition
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timesbuthaverecentlybecomemorestraightforwardwiththeadventofwideareadetectorordualtubetechnology.InorderforCTintheinvestigationofacutechestpaintobesafeandeffective,appropriateassessmentandriskstratificationbyanexperiencedclinicianisabsolutelyessential.Thetechnicalandlogisticalchallengesofthisapproachtogetherwiththepotentialbenefitsintermsofcostsavingsandspeedofdiagnosiswillbediscussed.
Imaging in TAVIDr Sukumaran Binukrishnan
Computedtomography(CT)playsanimportantroleintheworkupofpatientswhoarecandidatesforimplantationofacatheter-basedaorticvalve,aprocedurereferredtoastranscatheteraorticvalveimplantation(TAVI)ortranscatheteraorticvalvereplacement(TAVR).CTprovidesinformationontheaccurateannularsizing,aorticdimensions,predictfluoroscopicprojectionswhichareveryimportantforasuccessfulprocedure.CTisalsoimportantinreducing/predictingpostprocedurecomplicationsevaluatingvalve/myocardialcalcificationandcoronaryposition.Imagingofperipheralaccessvesselsprovidesinformationonsuitabilitytoaccommodatethelargesheathsnecessarytointroducetheprosthesis.Thelecturewillcoverdataacquisition,interpretation,andreporting.
Management of pulmonary embolic diseaseProfessor Duncan Ettles
IntheUK,pulmonaryembolism(PE)isrecordedonthedeathcertificatesofapproximately12,000peopleperannumandthenumberofdeathsduetoPEeachyearisbelievedtobearound60,000.Thepresentationofthiscommonconditionisveryvariable,withaspectrumrangingfromasymptomaticcasestomassiveembolismwithmortalityexceeding50%.Currentlyavailableguidelinesrecommendtheuseofanticoagulationandperipheralthrombolysisinthemanagementofmostsymptomaticpulmonaryemboli.Inalimitednumberofcases,treatmentbymechanicalthrombectomyorcatheterdirectedthrombolysismaybeindicatedwhenthereisevidenceofhaemodynamicinstabilityorothersignsofclinicaldeterioration.Mechanicaldisruptionoflargeembolifollowedbyaperiodofcatheterdirectedthrombolysiscanleadtorapidreductioninpulmonaryarterialpressureandreversalofrightheartoverload.However,clinicaloutcomesremainrelativelypoorandunpredictable.Forthisreason,ongoingresearchintoselectioncriteriaandoptimalinterventionalmanagementisneeded.Theuseofinferiorvenacava(IVC)filtersiswidelyacceptedinthepreventionofpulmonaryemboli.PlacementofIVCfiltersmaybeindicatedasanadjuncttoconventionalanticoagulationfollowingpulmonaryembolismandinpatientswhereuseofanticoagulantsiscontraindicated.Nowadays,retrievablefiltersareincommonuseandhavelargelyreplacedtheolderpermanentdesigns.TheyareincreasinglyusedinhighriskandtraumapatientsforpreventionofPE,withlowreportedmorbidityandcomplicationrates.Theroleofinterventionalradiologyinthemanagementofpulmonaryembolicdiseaseremainscontroversial.Clearrecommendationsregardingtreatmentindicationsandstrategyarehamperedbyalackoflevel1evidence,butthereiscontinuedinterestandenthusiasmforthedevelopmentofthesepotentiallylifesavingtechniques.
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Acute aortic syndromesProfessor Peter Gaines
Asyndromedefinesagroupofsymptomscommontoaparticularcondition.Theacuteaortaisthereforetheconverseofasyndromesinceitdescribesthreerelatedconditions–acutedissection(AD),intramuralhaematoma(IMH)andpenetratingulcer(PU)–thatsharecommonsymptomatologyandpotentialdevastatingoutcome.Allthreemostcommonlypresentwiththesevereaortictypetearingpain;anteriorlyinthechestwhenthediseaseaffectstheascendingaortaandintheback,whentheprocessinvolvesthedescendingthoracicaorta.Becausethatpainisfarfromdistinctive,theacuteaortaisfrequentlydiagnosedinpatientsinitiallyconsideredtohaveanacutecoronarysyndromeorpulmonaryembolus.Thedistributionofthepathologyaffectsoutcomeandthewaythattheconditionistreated.Ifthediseaseaffectstheascendingaorta,irrespectiveofhowfararoundtheaortatheconditionextends,thenthisisclassifiedasStanfordtypeA.Iftheascendingaortaisnotaffected,thenthisisreferredtoasStanfordtypeB.TypeAdiseasehasworseoutcomeandisusuallymanagedasanemergencybyopensurgery.TypeBdiseaseisrelativelymorebenignandismanagedbypharmaceuticallyrelievingstressupontheaorticwallandusingendovasculartechniquesinspecificsituations.Aorticdissectionreferstothepresenceofflowingbloodpassingintotheaorticwallthroughanentrytearandbackintothelumenthroughanexittear.Intramuralhaematomaistheoccurrenceofahaematomainthewallofthelumen,withoutflowingblood.Thismayprogressontofrankdissection.Apenetratingulceroccurswhenanatheroscleroticulcerpenetratesthroughtheinternalelasticlaminaintothemedia.ThismayprogresstoIMH,dissection,orpseudo-aneurysm.Thelecturewilldescriberiskfactors,naturalhistory,diagnosis,treatment,follow-upandoutcomeforthethreerelatedconditions.
Management of acute thoracic dissectionsDr Mohamad Hamady
Educationalaims:1.Todemonstrateevidence-basedpracticeinmanagementofAAD.2.TounderstandthecurrentchallengesinmanagingAAD.3.ToencourageradiologiststocontributetofutureresearchinthefieldofAAD.
Learningoutcomes:1.Tolearntheindicationsforsurgicalandinterventionaltreatment.2.TounderstandtheinterventionalstrategyinmanagingAAD.3.Tounderstandthecurrentlimitationsofvariousmanagementapproaches.4.TounderstandthefollowupplanforpatientswithAAD.
Acuteaorticdissection(AAD)isrelativelyrarebutpotentiallydevastatingpathology.AccordingtoStanfordclassification,AADisclassifiedintotwotypes,AandB.WhilesurgicalrepairisthegoldstandardtreatmentfortypeAdissection,endovascularstentgraft(ESTG)and/ormedicaltreatmentis
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thepreferredoptionfortypeBAAD.MedicaltreatmentforasymptomatictypeBAADisassociatedwithhighsurvivalrate.EndovascularstentgraftforsymptomaticAADisassociatedwithsignificantlybetteroutcomethanmedicaltreatmentaloneoropensurgery.RevascularisationstrategymightbeneededtosupplementESTGinpatientswithvisceralorlimbmalperfusion.AsymptomatictypeBAADremainsacontroversialmedicalproblem.However,thereisgrowingevidencethatESTGisassociatedwithpositiveaorticremodellingandgood5–yearsurvival.Despitedevelopmentsinimagingtechnology,wearestillshortofpracticalandaccurateimagingpredictorsofdiseaseprogression.Similarly,moreclinicalevidenceisstillneededtodefinethesub-groupofpatientswithasymptomaticAADwhowoulddefinitelybenefitfromearlyintervention.
Management of thoracic/arch aortic aneurysmMr Manoj Kuduvalli
Themanagementofaneurysmsofthethoracicaortaareheavilydependentonimagingmodalitiesbothfortheirsurgicalmanagementaswellaslongtermsurveillance.Awarenessoftherequirementsfromimagingforsurgicalprocedureplanningisanimportantaspectinreportingimages.
Thispresentationwilldealwiththespectrumofthoracicaorticaneurysms,theirmanagement,bothconservativeandsurgical,andtheuseofimagingmodalitiesincludingtheirapplicationtoprocedureplanning.
Management of aorto-iliac occlusive diseaseDr Graham Robinson
Patientswithaorto-iliacocclusivediseasemaybeasymptomaticormayhaveintermittentclaudicationorcriticallimbischemia.Treatmentoptionsincludemanagementofriskfactors,endovascularinterventionandsurgicalrevascularisation.Thelearningobjectivesforthispresentationincludeappropriatediagnosticworkup,patientselectionforinterventionandanunderstandingoftheTransAtlanticInter-SocietyConsensus(TASC)classification.TheTASCguidelines,firstpublishedin2000andrevisedin2007,classifyaorticandiliaclesionsbylesionmorphology.TASCAlesionsincludeunilateralorbilateralCIAstenosesorunilateralorbilateralsingleshortstenosis(3cm)ofEIA.TASCBlesionsincludeshortsegmentstenosis(3cm)oftheinfrarenalaorta,unilateralCIAocclusion,singleormultiplestenosistotalling3-10cminvolvingtheEIAandnotextendingintotheCFA,unilateralEIAocclusionnotinvolvingtheoriginsoftheIIAorCFA.TASCClesionsincludebilateralCIAocclusions,bilateralEIAstenoses3-10cmlongnotextendingintotheCFA,unilateralEIAstenosisextendingintotheCFA,unilateralEIAocclusionthatinvolvestheoriginsoftheIIAand/orCFA,heavilycalcifiedunilateralEIAocclusionwithorwithoutIIAand/orCFAorigininvolvement.TASCDlesionsinvolveinfrarenalaorto-iliacocclusion;diffusediseaseinvolvingtheaortaandbothiliacarteriesrequiringtreatment;diffusemultiplestenosisinvolvingtheunilateralCIA,EIA,andCFA;unilateralocclusionsofboththeCIAandEIA;bilateralocclusionsofEIA;iliacstenosesinthoserequiringtreatmentforAAAwhoarepoorcandidatesforendovasculartreatmentorwhohaveotherlesionsrequiringopensurgicalrepairofaorta
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oriliacarteries.TASCIIrecommendsendovasculartreatmentforTASCAandBlesionsandsurgicaltherapyforTASCCandDlesions.SeveralstudieshavereportedsuccesswithendovasculartreatmentofTASCCandDlesions,andpatientpresentationandcomorbidities,aswellaslocalexpertise,shouldbetakenintoaccountwhenplanningtreatment.
Stroke prevention: carotid artery stentingDr Trevor Cleveland
StrokeisanimportantcauseofmorbidityandmortalityintheUK.Preventingstrokehasthepotentialtohavemassivebenefitsforindividuals,aswellashealthcaremoregenerally.Asignificantproportionofstrokesarecausedbydiseaseofthecarotidarteries,mostcommonlyatheromaatthecarotidarterybifurcation.TIAandotherischaemiceventsmaygiveawarningthatanindividualmaysufferacompletedstroke,andinappropriatecircumstances,invasivetreatmentmaybebeneficial,inadditiontobestmedicalcare.Traditionallysurgicalendarterectomyhasbeenthemainstayofcarotidbifurcationintervention,butmorerecentlyangioplastyandstentinghavebecomeavailablefordiseaseatthebifurcation,andelsewhereinthecarotidarteryterritory.Carotidarterystentinghasmademanyadvances,inbothtechniqueandtechnology,andhasbeensubjectedtoanumberofrandomisedtrials.Despitethiscontroversycontinuestorageovertheindicationsforcarotidstenting,andwhenthisisappropriatetoofferapatient.Asaresult,manypatientsdonothaveaccesstothisoption,atatimewheretheDepartmentofHealthandNICErecommendtimelytreatment(interventionwithin2weeksoftheonsetofsymptoms).Thepresentationwillexaminehowcarotidstentingisperformed,inwhatcircumstancesitshouldbeconsidered,whatcanbedonetoimproveitssafetyprofile,andwhichpatientsmaybenefitfromit.
Management of abdominal aortic aneurysmsDr Nicholas Chalmers
Educationalaims:1.UnderstandtheAAAscreeningprogramme2.UnderstandtheevidenceforOpenversusEndovascularRepair(EVAR)ofelectiveandrupturedAAA3.RecognisesomenewandcomplexvariationsofEVARandconsidertheirplaceastreatmentoptions.
TheNHSAAAscreeningprogrammeinvitesmenaged65forultrasound.ThosewithanAAAof5.5cmorgreaterarereferredforprompttreatment.TheevidenceindicatesthatscreenedmenarelesslikelytodiefromanAAArelatedcause.However,screeningwillresultinsomeearlydeathsduetooperativemortality.Morethan700menwillneedtobescreenedtosaveoneaneurysmrelateddeathover4years.SinceAAAaccountsforonly2%ofdeaths,thereductioninoverallmortalitywillbeundetectable.
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TheEVARtrials(andothers)demonstratedreducedoperativemortalityofelectiveEVARcomparedwithopensurgery,butearlybenefitswerereversedafterabout5years.Also,EVARconferrednosurvivalbenefitcomparedwithconservativemanagementforpatientsunfitforopenrepair.RecentlytheIMPROVEtrialhasshownequalsurvivalfollowingEVARandopenrepairofrupturedaneurysms.Despitetherelativelybalancedtrialoutcomes,therehasbeenacultureshifttowardsofferingEVARwheneverpossibletobothfitandunfitpatients.
TheanatomicallimitationsofsuitabilityforEVARhavediminishedwiththedevelopmentoftechniquessuchasfenestratedEVAR,whichhasintroducedahigherlevelofcomplexity.Newconceptssuchasendovascularaneurysmsealing(EVAS)withtheNELLIXdeviceandmultilayerflow-modulatingstents(MFMS)havebeenintroducedbuttheirdurabilityisunknown.CTfollow-upisimportant,andrelevantfindingswillbeillustrated.
Interventional management of hypertensionDr Trevor Cleveland
Highbloodpressureisamajorriskfactorintheaetiologyofcardiovascularevents,includingheartattackandstroke.Reductioninbloodpressure,toadegreewhichmayonthesurfaceappearrelativelyminor,resultsinasignificantreductionincardiovascularevents.Themainstayoftreatmentforhypertensionisdrugtherapy,andNICE(andmanyotherorganisations)hasissuedguidanceonhowdrugtherapyshouldbedelivered.Thereare,however,asignificantnumberofpeoplewhohavesustainedbloodpressures,whicharehigherthanwouldbeconsidereddesirable,despitemedicaltherapy.Suchpatientsareconsideredtohavedrugresistanthypertension.Onesignificantpotentialconfounderisthatnon-compliancewithdrugrecommendationsisnotuncommon.Nevertheless,suchpatientscontinuetorunhighrisksofevents.Interventionalradiologytechniqueshavetwopotentialoptionsforthetreatmentofhypertension,renalarterystenting,forstenoticdisease,andrenaldenervation.Bothoftheseprocedureshavepotentialrisksandbenefits,andbothhavebeenthesubjectofrandomisedtrialswhichhaverecentlyreported.Asaresult,thenumberofrenalarterystentprocedureshassignificantlydeclinedoverrecentyears,thereasonsforthisandthepresentindicationswillbeconsidered.Renaldenervationisanewoption,theroleforwhichremainscontroversial,andanareawhereresearchcontinues.
Learn, imagine and fly through the radiological timesProfessor Adrian Thomas
Thereweresignificantadvancesinmedicineduringthe19thcenturywithincreasedknowledgeinmedicine,surgery,bacteriologyandchemicalpathology.Howeverourabilitytolookinsidethebodyhadshownlittleimprovementandwaslimitedtotheprobingfingerorsimpleendoscopy.Thiswasalltochangein1895whenWilhelmConradRöntgendiscoveredx-rays.Thedescriptionof
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theabilitytoseethroughthebodywasgreetedbymanywithincredulityandearlyaccountshadtoreassurethepublicthatthiswasaseriousdiscoverybyarespectedscientist.
Earlyradiologywastechnicallydifficulttoperform,howeverduringthenextfewdecadestheequipmentgraduallyimproved.Initiallyimageinterpretationwasalsodifficultandittookmanyyearstodeciphertheseoftenconfusingshadows.Radiologywasalsonotwithoutrisk,withinjuriesrelatedtoionisingradiation,electricalinjuriesandchemicalinjuriesfromprocessingthefilmsandplates.
Radiologysteadilyprogressedwiththedevelopmentofthemodernx-raytube,contrastmedium,cathetersandimageintensification.Traditionalradiologyrevolutionisedmedicalcare.Howeverinvestigationswereofteninvasiveandpathologywasoftenshownindirectly.
Radiologyhasprofoundlychangedsincewhatcanbeseenasthegoldendecadeofthe1970s,startingwiththeannouncementofCTscanningin1972.DevelopmentsinCTscanning,ultrasound,nuclearmedicine,MRIscanning,andfinallyinterventionalradiologyhasplacedradiologyintheforefrontofmodernmedicine.Modernradiologynowallowsfornon-invasivediagnosis,andthishasfacilitatedminimallyinvasivetherapy.Thisstoryisexcitingandinteresting.Reading:Thomas,AMK.,Banerjee,AK.TheHistoryofRadiology.Oxford:OxfordUniversityPress(2013)
Educationalaimsandlearningoutcomes:1.Tounderstandthebackgroundtoradiology.2.Toseeconnectionsbetweenvariousfacetsoftheradiologicalscience.3.Tounderstandhowonedevelopmentfacilitatedanother.
_______________________________________________________________________
Certificate of attendance
Yourcertificateofattendancewillbeemailedtoyouwithinthenexttwoweeksonceyouhavecompletedtheonlineeventsurveyat:
https://www.surveymonkey.com/s/BIRAnnualCongress2014
BIR Annual Congress 2015: 4–5 November, London
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Programme DAY 2: Thursday 23 October
ROOM 1: Lungs and abdomen
08:30 Registration and refreshments
09:00 Welcome and introductionChair: DrKlausIrion,ClinicalLead,DepartmentofRadiology, LiverpoolHeartandChestHospital BIRAnnualCongressDirector2014
09:05 The lung, that spongy organ: architectural solutions to keep it open,ventilated and perfused – fit for gas exchange ProfessorEwaldWeibel,EmeritusProfessor,InstituteofAnatomy, UniversityofBern
09:50 Differentiation of chronic thromboembolic pulmonary hypertension and pulmonary arterial hypertension DrNicholasScreaton,ConsultantCardiothoracicRadiologist, PapworthHospital
10:20 Lung nodules on screening - what happened to the “suspicious ones” DrJohnHolemans,ConsultantRadiologist, LiverpoolHeartandChestHospital
10:50 Refreshments
11:05 From a subjective impression to the future of imaging quantification ProfessorEricHoffman,ProfessorofRadiology,Medicineand BiomedicalEngineering,UniversityofIowa
11:50 Pulmonary nodules: the role of MRI ProfessorBrunoHochhegger,ProfessorofRadiology, RiodeJaneiroFederalUniversity
12:10 Lumps in the lung ProfessorJohnGosney,ConsultantThoracicPathologist, RoyalLiverpoolUniversityHospital
12:30 Lunch
13:30 The BIR Sir Godfrey Hounsfield memorial lecture: The isotope bone scan past, present and future ProfessorIgnacFogelman,ProfessorofNuclearMedicine, King’sCollegeLondon
14:15 Prizes and awards ceremony
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14:25 Investigating abdominal diseases through the times ProfessorAdrianDixon,EmeritusProfessorofRadiology, UniversityofCambridge
15:10 Pseudo liver lesions ProfessorAliNawazKhan,ConsultantRadiologist, NorthManchesterGeneralHospital
15:30 Diffusion weighted imaging of the bowel DrAndrewPlumb,HonoraryConsultantRadiologistand SeniorLecturerinMedicalImaging,UniversityCollegeLondon
15:50 Cystic liver lesions ProfessorAliNawazKhan,ConsultantRadiologist, NorthManchesterGeneralHospital
16:10 Refreshments
16:25 Imaging and renal failure DrJaneBelfield,ConsultantUro-Radiologist RoyalLiverpoolUniversityHospital
16:45 MR-based fat and iron quantification in the liver DrRadhoueneNeji,MRScientist,Siemens
17:05 Digital radiography MrUlrichNeitzel,SeniorManager,ClinicalScienceDiagnosticX-Ray, PhilipsHealthcare,Hamburg
17:25 Grand round in thoracic imaging DrPabloSantana,ConsultantRadiologist,Medimagen
17:40 Close of Congress
__________________________________________________________________
Certificate of attendance
Yourcertificateofattendancewillbeemailedtoyouwithinthenexttwoweeksonceyouhavecompletedtheonlineeventsurveyat:
https://www.surveymonkey.com/s/BIRAnnualCongress2014
BIR Annual Congress 2015: 4–5 November, London
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Speaker profiles (where supplied)
Dr Jane BelfieldConsultant Uro-Radiologist, Royal Liverpool University Hospital
DrJaneBelfieldistheleadconsultanturo-radiologistattheRoyalLiverpoolUniversityHospitalandhavebeeninpostsince2010.Followinggeneralradiologytraining,sheundertookafellowshipinuro-radiologywithanadditionalfocusonteaching.
Specialinterestsincluderenaltransplantimaging,testicularimagingandrenalimaging.SheisinterestedinmedicaleducationandhascompletedaMastersinMedicalEducationwiththeUniversityofDundee,graduatingin2013,forwhichsheundertookaresearchprojectlookingatmethodsofteachingrenaltransplantultrasound.SheistheUndergraduateRadiologyLeadfortheMerseySchoolofRadiology.
SheiscurrentlythesecretaryoftheBritishSocietyofUrogenitalRadiology(BSUR)andamemberoftheScrotalWorkingGroupoftheEuropeanSocietyofUrogenitalRadiology(ESUR).Recentguidelineshavebeenacceptedregardingfollowupimaginginpatientswithtesticularmicrolithiasis.
Professor Adrian DixonEmeritus Professor of Radiology, University of Cambridge
ProfessorAdrianKDixonisMasterofPeterhouse,theoldestCollegeatCambridgeUniversity,andEmeritusProfessorofRadiology,havingbeenheadoftheDepartmentofRadiologyfor15years.HeisalsoanhonoraryconsultantradiologistatAddenbrooke’sHospital,Cambridge.
FromanIrishbackground,hewasborninCambridgewhereheearnedabachelor’sdegreeatKing’sCollege.HequalifiedinmedicineafterclinicalstudiesatStBartholomew’sHospitalLondon.Hethenspecialisedingeneralmedicine,gaininghisMRCPin1974beforedecidingtopursueacareerinradiology(anappropriatecareerinviewofhisimpendingdeafness).Hequalifiedasaradiologistin1978andworkedinpaediatricradiologyatGreatOrmondStreetHospital,andincomputedtomographyatStBartholomew’sHospital.In1979,hebecamealecturerattheUniversityofCambridge’sDepartmentofRadiology.Heearnedhisdoctorofmedicinedegreeforhisthesisoncomputedtomographyofthelumbarspine.In1986,hewaselectedaFellowofPeterhouse,wherehebecamedirectorofmedicalstudies.
Throughouthiscareer,ProfessorDixonhasbeenactivelyengagedinthefieldofscientificpublishing,asbothauthorandeditor.Hehaspublishedextensivelyintheareasofcomputedtomography,magneticresonanceimagingandvariousaspectsofeffectivenesswithinradiology.Thisisinadditiontohavingwrittenandco-editedvariousbooksonCT,anatomyanddiagnosticradiology.HeservedaseditorofthejournalClinicalRadiologyfrom1998to2002,editor-in-chiefofEuropeanRadiology2007-2013andWardenoftheFacultyofClinicalRadiologyoftheRCRfrom2002to2006.HewasawardedFellowshipoftheAcademyofMedicalSciencesin1998.
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ProfessorDixonhasreceivedanumberofawardsthroughouthiscareerandheisanhonorarymemberofthenationalradiologicalsocietiesofFrance,Hungary,Spain,Sweden,SwitzerlandandtheUSA,aswellasbeinganHonoraryFellowoftheAmericanCollegeofRadiology,theRoyalAustralianandNewZealandCollegeofRadiologistsandtheFacultyofRadiologistsattheRoyalCollegeofSurgeonsinIreland.InrecentyearstheUniversitiesofCorkandMunichhaveawardedhimanHonoraryDoctorateofMedicine.In2014hewasawardedtheGoldMedaloftheEuropeanSocietyofRadiology.
HealsoservesasaTrusteeoftheDavidRossEducationalTrustandasamemberoftheHongKongUniversityGrantsCommittee.
Professor Ignac FogelmanProfessor of Nuclear Medicine, King’s College London
ProfessorFogelmaniscurrentlyProfessorofNuclearMedicine(NM),atKing’sCollegeLondonandHonoraryConsultantPhysician,Guy’sandStThomas’NHSTrustandDirectoroftheOsteoporosisScreeningandResearchUnit,Guy’sHospital.
HeisChairmanoftheBoardofExaminersfortheMScinNM,whichprovidestheonlyrecognisedtrainingprogrammeforNMintheUK.
Hehaswrittenover400articlesinpeerreviewedjournals,haswrittenoredited15books,andsupervised17PhD/MDstudents.
HeisaformerboardmemberandTrusteeoftheNationalOsteoporosisSocietyandwaspreviouslyChairmanofitsBoneDensitometry(BD)Forum.
Professor John GosneyConsultant Thoracic Pathologist, Royal Liverpool University Hospital
ProfessorJohnGosneyisConsultantThoracicPathologistattheRoyalLiverpoolUniversityHospital,Liverpool,UK,andProfessorofThoracicPathologyattheUniversityofLiverpool.
HeisaspecialistthoracicpathologistresponsibleforprovidingtheserviceindiagnosticthoracicpathologytotheRoyalLiverpoolUniversityHospitalandtotheLiverpoolHeartandChestHospital.Hehasinternationallyacknowledgedexpertiseinthepathologyoftumoursofthelung,especiallytheirdifferentialdiagnosisandtheirmorphological,immunochemicalandgeneticcharacterisation.Hehasresearchedwidelyinthefieldandhasnumerouspublicationsincludingoriginalpapers,reviewsandbookchapters.
Heisco-authoroftheUKRoyalCollegeofPathologists’guidelinesforthehandlingandreportingofthoracictumours,advisortoCancerResearchUKandcontributortotheWorldHealthOrganisation’sclassificationoftumoursofthelungsandpleura.
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Professor Eric HoffmanProfessor of Radiology, Medicine and Biomedical Engineering, University of Iowa
ProfessorEricAHoffmanisthedirectoroftheAdvancedPulmonaryPhysiomicImagingLaboratory(APPIL)intheDepartmentofRadiologyandthedirectoroftheIowaComprehensiveLungImagingCenter(I-Clic)attheUniversityofIowa.HereceivedhisPh.D.inPhysiologyfromtheUniversityofMinnesota/MayoGraduateSchoolofMedicinein1981andremainedonstaffattheMayoClinicwherehewasamemberoftheteamwhichdevelopedtheearliestvolumetricCTscanner,theDynamicSpatialReconstructor(DSR).In1987hejoinedthefacultyofradiologyattheUniversityofPennsylvaniawherehewasthedirectorofCardiothoracicImagingResearchCenterandmovedtotheUniversityofIowain1992.ProfessorHoffmanisafellowoftheAmericanInstituteforMedicalandBiomedicalEngineering,anhonorarylifetimememberoftheSocietyofThoracicRadiology,andamemberoftheFleischnerSociety,andfounderoftheSPIEMedicalImagingtrackonPhysiologyandFunctionfromMultidimensionalImages.HehasservedontheRespiratoryIntegrativeBiologyandTranslationalResearch(RIBT)studysectionoftheNIHandhasservedasamemberofthescientificreviewboardoftheAmericanAsthmaFoundation.Hehaspublishedmorethan450peerreviewedjournalarticles,numerousbookchaptersandreviewarticlesandholdsnumerouspatentsrelatedtolungimageanalysis,CTcontrastagentsandsynchronizationofrespirationtothecardiaccycleasameansofventricularassist.Herecentlyreceivedthe2014JosephRRodarteAwardforScientificDistinctionfromtheRespiratoryStructureandFunctionAssemblyoftheAmericanThoracicSocietyandthe2013JohnWestawardforOutstandingContributionstotheFieldofFunctionalPulmonaryImagingfromtheIWPFI.
Throughouthiscareerhehasusedadvancedimagingmethodologiestostudybasicrespiratoryphysiologycenteredlargelyonmechanismsofventilationandperfusionheterogeneityandregionallungmechanics.ProfessorHoffman’srecentworkhasleadhimtoanewhypothesisregardingtheetiologyofemphysemabaseduponnovelfunctionalimagingprotocolshehasdevelopedusingdualenergymultidetectorrowCT.Hislaboratoryhasserved,orisservingas,aradiologyoversightandanalysiscenterfornumerousNIHsponsoredmulti-centerstudieswhichincludetheNationalEmphysemaTreatmentTrial(NETT),theSeverAsthmaResearchProject(SARP),COPDGeneandtheSubpopulationsandintermediateoutcomemeasuresinCOPDstudy(SPIROMICS).Dr.HoffmanisafounderofVIDADiagnostics,acompanyprovidingquantitativesolutionstotheevaluationofCTimagesofthelung
Dr John HolemansConsultant Radiologist, Liverpool Heart and Chest Hospital
DrHolemansdevelopedaninterestinchestdiseasewhilstamedicalstudentatCharingCrossandWestminsterMedicalSchool,London.Hegraduatedin1989andsubsequentlytrainedasaradiologistatGuy’sandStThomas’Hospitals,LondonandalsospentashortattachmentattheTheRoyalBromptonHospital.In1997hewasappointedaConsultantRadiologistattheLiverpoolHeartand
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ChestHospitalandbecameHeadofDepartmentin2002.HeisaFellowoftheRoyalCollegeofRadiologists,RoyalCollegeofPhysiciansandBritishInstituteofRadiology.HismajorclinicalinterestsareHRCT,lungcancer,oesophagealcancerandaorticCTangiography,coronaryCTandCardiacMRI.Hereadall1000baselinelungcancerscreeningCTscansperformedinLiverpoolaswellasthefollowupscansaspartoftheUKLungCancerScreeningTrial.
Professor Ali Nawaz KhanConsultant Radiologist, North Manchester General Hospital
ProfessorAliNawazKhanwasConsultantRadiologistNorthManchesterHealthCareTrustfrom1979to2006.Hehashasauthoredsixbooks,600publications,chapters,abstractsandpostgraduatelectures.HewasvisitingProfessortoPakistanunderUnitedNationsDevelopmentProgram1992,1996and1999&2001coordinatingpostgraduateeducation,teachingandtrainingandworkingwithAfghanrefugees.HewasHonoraryProfessorofRadiology,AndizhanStateMedicalInstitute,UzbekistansinceOctober1998VisitingProfessortotheSovietUnion,Russia,Uzbekistan,KazakhstanandKirghizia1991,1992,1993,1994and1995,forgingacademiclinks.VisitingProfessor,InternationalNetworkforCancerTreatment&ResearchatInstitutPasteur,BrusselsBelgium2001-2005.MemberEducationCommittee,InternationalNetworkforCancerTreatment&ResearchatInstitutPasteur,BrusselsBelgium2001-2007.MemberEthicalReviewCommittee,InternationalNetworkforCancerTreatment&ResearchatInstitutPasteur,BrusselsBelgium2001-2007.HewasvisitingProfessorKuwaitUniversityApril2004.Lecturer,UniversityofManchesterfrom1982-2005.HaveapersonalexperienceintreatinghepatocellularcarcinomaintheUKwithanindividualseriesofover400chemoembolization’s.Hehasextensiveexperienceingeneralradiology,generalultrasound,CT,MRI,nuclearmedicine,visceralangiographyandvisceralvascularintervention.ProfessorandChairmanMedicalImaging,KingFahadHospital,NGHA,Riyadh,SaudiArabia31stJanuary2006-28thJanuary2009.
Mr Ulrich NeitzelSenior Manager, Clinical Science Diagnostic X-Ray, Philips Healthcare, Hamburg
DrUlrichNeitzelhasmorethan30yearsexperienceinthefieldofmedicalX-rayimaging,inparticulardigitalradiography.Hehasheldvariouspositionsinresearch,development,andclinicalapplicationofX-rayimagingsystemsandispresentlyseniormanagerofclinicalscienceforthediagnosticX-raybusinessunitofPhilipsHealthcareinHamburg,Germany.DrNeitzelhasauthoredorco-authoredmorethan60scientificpapersandbookchaptersandisafrequentlectureratinternationalconferences.HeholdsMSandPhDdegreesinphysicsfromGöttingenUniversity,Germany.
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Dr Andrew PlumbHonorary Consultant Radiologist and Senior Lecturer in Medical Imaging, University College London
DrAndrewPlumbisaSeniorLecturerinMedicalImagingatUniversityCollegeLondonandHonoraryConsultantRadiologist.AfterundergraduatemedicaltraininginOxford,hereturnedtohishometownofManchesterforSeniorHouseOfficerandgeneralradiologytraining.AftergainingtheFRCR,hemovedtoLondonforsub-specialtytrainingingastrointestinalimagingandtostudyforaPhDwithProfessorsSteveHalliganandStuartTaylor.Hismainresearchinterestsaregastrointestinalandoncologicalimaging,particularlyCTcolonography,colorectalcancerscreeningandtheuseofMRIinCrohn’sdisease.
Dr Nicholas ScreatonConsultant Cardiothoracic Radiologist, Papworth Hospital
DrScreatonisaConsultantCardiothoracicRadiologistatPapworthHospital,Cambridge.Hisspecialinterestsincludepulmonaryhypertension,interstitialandairwaysdiseases,andlungcancerscreening.
HewasRadiologyClinicalDirectorinPapworthHospital2004-12andPresidentoftheBritishSocietyofThoracicImaging2009-13.
HesitsontheBritishThoracicSocietyBronchiectasisGuidelinesdevelopmentgroup,NationalInstituteofClinicalExcellenceIdiopathicPulmonaryFibrosisQualityStandardsCommittee,NationalInstituteofClinicalExcellenceGuidelinesUpdatesStandingCommittee,andNationalClinicalCommissioninggroupforSpecialisedImaging(stakeholderrepresentative).
Professor Ewald WeibelEmeritus Professor, Institute of Anatomy, University of Bern
ProfessorEwaldRWeibel,bornin1929,studiedmedicineattheUniversityofZurich,graduatingasMDin1955.HespentfivepostdoctoralyearsintheUnitedStatesworkinginpathologyatYaleUniversity,incardio-respiratoryphysiologyatColumbiaUniversity,andincellbiologyatTheRockefellerInstitute.In1963hereturnedtoSwitzerlandasAssistantProfessorattheUniversityofZurichandbecame,in1966,ProfessorandChairmanoftheInstituteofAnatomyattheUniversityofBerneuntilhisretirementin1994,servingasRectoroftheUniversityofBernein1984-85.
Inhisresearchhedevelopedtheconceptandmethodsofmorphometry,basedprimarilyonstereology,thisinviewofquantitativestudiesofstructure-functionrelationsinthelung,focusingongasexchangeandmechanicalfunction.Heextensivelyusedtheapproachofcomparativephysiologytostudytheentirerespiratorysystemfromlungtomitochondria,thepathwayforoxygen.In1962hediscoveredaspecificorganelleofendothelialcells,todaycalledtheWeibel-Paladebody,ofcentralimportanceinbloodclottingcontrol.Heisauthorof
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MorphometryoftheHumanLung(1963),thePathwayforOxygen(1984),andSymmorphosis(2000).Hehaswrittenover400publicationswhichdealwithstructure-functionrelationsofthelungandofliverandmusclecells,withafocusonthequantitativemethodsandasystemsviewonintegratedfunctionsintherespiratorysystem.
AmongotherhonourshewasawardedtheMedaloftheAmericanCollegeofChestPhysiciansandtheH.R.SchinzMedaloftheSwissSocietyofRadiology.HereceivedHonoraryDoctoratesfromtheUniversitiesofEdinburghandGeneva.HeisForeignAssociateoftheUSNationalAcademyofSciences,memberoftheAcademiaEuropaea,andFellowoftheEuropeanRespiratorySociety.HewasPresidentoftheSwissAcademyofMedicalSciences,oftheInternationalUnionofPhysiologicalSciences,andoftheFleischnerSociety.______________________________________________________________
Abstracts (where supplied)
The lung, that spongy organ: architectural solutions to keep it open, ventilated and perfused – fit for gas exchangeProfessor Ewald Weibel
The“spongy”natureofthelungresultsfromahighdensityoftheair-bloodcontactsurfaceareasupportedbyaminimisedtissuebarrier.Theaimofthispresentationistofostertheunderstandingofhowsuchaminimisedstructurecanensurethelung’sgasexchangefunctionwhichdemandsthateachgasexchangeunitbeefficientlyventilatedandperfusedbyblood,andthatthesurfacebekeptopentoairatallstagesofrespiration.Threearchitecturalprinciplesthatensurethiswillbediscussed:(1)Complexityastheprincipleofbuildingthissurfaceandservingitbyforminghierarchicalfractaltreesofairwaysandbloodvesselssothatallgasexchangeunitsarereachedbyairandbloodalongshortandsimilarpathways.(2)Correlativitythatformsthestructuralbasisfornear-optimalmatchingofairandbloodflows,butphysicallimitationscausetheindividualgasexchangeunits,aboutthesizeofanalveolus,tobeventilatedinserieswhilebeingperfusedbybloodinparallelwiththepotentialofaventilation-perfusionmismatch.(3)Connectivityestablishedbyafibercontinuumthroughouttheflabbylungfromthecentralairwaystothepleurapassingrightthroughthealveolarwallswherethefibresareinterlacedwiththecapillaries;thelungisatensegritystructure,sowhensurfactantreducesalveolarsurfacetensionthiskeepsalveoliopentotheairwaysallthroughtherespiratorycycle.Tomakethespongylungfitforgasexchangeallthreeprinciplesmustberealised.
Differentiation of chronic thromboembolic pulmonary hypertensionand pulmonary arterial hypertensionDr Nicholas Screaton
Pulmonaryhypertensionisadiagnosiswithhighmorbidityandsignificantprognosticimplicationsindependentofitscause.Whilstthediagnosticreferencestandardinestablishingadiagnosisisinvasiverightheartcatheterisingnon-invasiveimaging,investigationsplayafundamentalroleinsuggestingthe
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diagnosisandinmanycasesidentifyingthecause.Pulmonaryhypertensionisclassifiedusingaclinicalclassificationwhichattemptstogrouptogetherdiseaseswithsimilarpatho-physiologicalmechanismandtreatmentoption.Themostrecentrevisionofthisclassificationfollowedthe5thWorldSymposiuminNicein2013.Theclassificationconsistsoffivegroups:Group1consistsofdiseasesaffectingthesmallvesselsofthelungwiththemaingroupbeing‘pulmonaryarterialhypertension’-diseaseswithpredominantlyarteriolarinvolvement.Whiletheunderlyingaetiologywithinthisgroupisdiversethemanagementoptionsaresimilarandfocusontargetedpharmacologicaltherapy.Groups2and3consistofpulmonaryhypertensionduetochronicleftheartdiseaseandchroniclungdisease(orchronichypoxia)respectively.Thesearebothverycommoncausesofpulmonaryhypertension.Group4representschronicthromboembolicpulmonaryhypertensionresultingfromorganisedthrombioccludingorstenosingvascularbeds.CTEPHiscommonandoftendiagnosedlate.Thefinalgroup(group5)consistsofdiseasewithunclearormultifactorialmechanisms.Thispresentationwillfocusonpulmonaryarterialhypertensionandchronicthromboembolicpulmonaryhypertension.WhilsttreatmentoftheformerispharmacologicalwithtargetedagentstomolecularpathwayswiththevascularendotheliumtreatmentofCTEPHmaybeeithersurgicalorpharmacological.CTEPHmaybeconsidered‘proximal’or‘distal’althoughthemostimportantquestionsdirectingtreatmentarewhetherthedistributionofdiseaseissurgicallyamenable,andwhetherthepatientislikelytobenefitfromsurgerywhichconsistsofbilateralendarterectomyperformedunderdeephypothermiccirculatoryarrest.Somecentresarenowusingballoonangioplastyinasubsetofpatients.ImagingplaysafundamentalroleinestablishingaspecificdiagnosisinPH(differentiatingIPAHfromCTEPHaswellasothercausesofPH)aswellasincharacterisingCTEPHanditsdistribution.Imagingalsoenablesdetailedcardiacassessmentenablingassessmentofhaemodynamicsatbaselineandfollow-up
Theobjectivesofthispresentationareto:1.Summarisethecurrentclinicalclassificationofpulmonaryhypertension.2.DescribeimagingfeaturesofPAHandCTEPHhighlightingtheirdifferences.3.DiscusstheroleofimaginginCTEPHandIPAHanditsimpactontherapeuticoptions.
Lung nodules on screening - what happened to the “suspicious ones”Dr John Holemans
UKLSisaRandomisedControlledTrial(RCT)ofLDCTsinglescanscreeningforlungcancerversususualcare.Apopulation-basedriskquestionnairewasusedtoidentifyhighriskindividuals.CTscreendetectednoduleswerecategorisedaccordingtotheUKLSnodulemanagementprotocol,byvolumeifsurroundedbylungorbydiameterifpleuralorjuxtapleural.ForsolidnodulesCategory1BenigncalcifiedorfattyOR≤3.0mmor≤15mm3;Category2Ifintraparenchymal15-49mm3orifpleural3.1mm-4.9mm;Category3Ifintraparenchymal50-500mm3;Ifpleural5.0mm-9.9mm;Category4Ifintraparenchymal>500mm3;Ifpleural≥10mm.ForsubsolidnodulesCategory1GGOandsolidpart(ifany)≤3.0mm;Category2GGO3.1-4.9andsolidpart
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(ifany)≤3.0mmor<15mm3;Category3GGO≥5.0mmandsolidpart(ifany)3.0mm-9.9mmor15mm3-500mm3;Category4Ifmixed(part-solid)andthesolidcomponentis>500mm3or≥10mm.4055subjectswererandomised,2,028intotheCTarm,ofwhom1994underwentaCT.Fortytwoparticipants(2.1%)hadconfirmedlungcancer,34(1.7%)atbaselineandeight(0.4%)atorbeforethe12monthsscan.Screendetectedcancerswereidentifiedas;Stage125/42(60%),Stage1and233/42(79%),34/42(81%)hadsurgicalresection.Therewereatotalof536subjects,472category3,and64category4nodules,requiringdiagnosticworkup,otherthanarepeatCTat12months;40/536werefoundtohavelungcancer,leaving496falsepositives.Thefalsepositiveratewas24.8%(496/1994),andthepositivepredictivevalue7.4%(40/536).479(24%)hadCategory2noduleswhoreceiveda12monthrepeatscan.Ofthese,eight(0.8%)werereferredtotheMDT.Two(0.2%)individualswerediagnosedwithlungcancer.
Learningpoints:Nearlyallscreendetectedcancerswere>50mm3involumeor>5mmindia.Thereisahighfalsepositiverate
From a subjective impression to the future of imaging quantificationProfessor Eric Hoffman
Coincidentwiththeintroductionofcomputedtomographicimagingofthethoraxintoclinicalpracticeinthemid1970’swasanefforttonon-invasively,volumetricallyimagethedynamicfunctioningoftheheartandlung.Withthedevelopmentofit’sprototypeinthemid1970’sandthearrivaloftheDynamicSpatialReconstructor(withit’s14x-rayguns,juxtaposedhemicylindricalflourescentscreenand14televisioncamerasrotatingat15RPM)attheMayoClinicin1979,toolsweredevelopedallowingfortheobjectiveassessmentoflungstructureandfunctionandmethodsforthreedimensionalvisualizationviatwo-dimensionalcomputermonitors.Focuswasinitiallyplacedonunderstandingthebasic,normalfunctioningoftheheartandlungswithinthenegativepressureenvironmentoftheneverinvadedintactthorax.Thetransferofthistechnologyintoclinicalresearchandclinicalpracticewasdelayed,largelybecauseofthelagincomputationaltechnologies,bynearlyaquarterofacenturyuntilmanufacturersintroducedmultiple-rowdetectorCT(MDCT)inthelate1990s.Withtheadventof16sliceandgreaterscanners,volumetricimagesofthelungwereachievablewithscantimesrequiringbreathholdsoflessthan20seconds.VariousconfigurationsofMDCTscannershaveevolvedwhichnowallowimagingofthethoraxinwellunderasecond.Multi-sepctralimagingprovidesnewmethodsforquantitativelyextractingmeasuresofiodine,xenonandkryptonforquantitationofregionalparenchymalperfusionandventilation.Improvementsinx-rayguntechology,detectorsensitivityandcomputationalcapabilitiesprovidetoolsthatnowallowvolumetricimagingatdoselevelsapproaching0.1mSvwithinherantspatialresolutionofscannersreachingdowntothatneededtoexploreasinglepulmonaryascinus,thusallowingustobegintoassessventilation/perfusionrelationshipsattheveryinterfaceofgasexchange.ThesenewtoolsforlungquantitationoffertheabilitytophenotypelungdiseasewherebybroadcategoriesoflungpathologysuchasCOPD,Asthma,orIPFcan
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nowbebrokendownintonumeroussub-categoriesbaseduponunderlyinganatomicandfunctionalvariants.Throughthelinkageofstructuretofunction,itisnowpossibletouseimagingasatoolto,notonlyassesstheroadmapofanatomicdestructionandremodeling,butalsotoassessthealteredphysiologicprecoursors.Withanunderstandingofthesub-phenotypesoflungdiseases,onecanbegintolinkphenotypeswithgenotypes.Whatissoughtarebreakthroughsinnewpharmaceuticalanddevice-basedinterventionswithimagingprovidingtoolsforidentificationofappropriatepopulationsinwhichtotestnewinterventionsandforassessingoutcomes.Throughthislecture,theevolutionofthequantitativeassessmentofthelungviax-raycomputedtomographywillbeexploredwithspecificexamplesfromthequesttounderstandquantitativesub-phenotypesofCOPDandAsthma.Examplesofregionallungfunctionassessedfrommulti-sepctralMDCTwillbeusedtoexplorehowsuchCT-derivedfunctionalinformationmightbeusedinthedelineationofunderlyingdiseaseetiology.
Pulmonary nodules: the role of MRIProfessor Bruno Hochhegger
Currentwidespreaduseofcross-sectionalimaginghasledtoexponentialriseindetectionofsolitarypulmonarynodules(SPNs).Whilstlargenumbersofthesearebenign‘incidentalomas’,lungcancerspresentingasSPNsareoftenearlydisease,whichhavegoodprognosis.Therefore,thereisrisingdemandandexpectationformoreaccurate,non-invasive,diagnosticteststocharacterizeSPNs,aimingtoavoidmissedordelayeddiagnosisoflungcancer.TherearewidedifferentialdiagnosesofbenignandmalignantlesionsthatmanifestasSPNs.Onconventionalimaging,themorphologicalfeaturessupportingbenignityincludestablesmallnodulesize,smoothdemarcatedmargins,andcalcifications.Althoughclinicalapplicationsofpulmonarymagneticresonanceimaging(MRI)facetechnicallimitations,currentlyavailableMRImethodshavecontributedtomorphologicandfunctionalevaluationsofpulmonarynodules.MRIusingdynamiccontrastenhancementordiffusion-weightedimaging(DWI)techniques,areamongthegrowingarmamentariumfordiagnosticimagingofSPNs.ThepurposeofthislectureistoreviewthecurrentstatusofMRIforevaluationofpulmonarynodules.
Lumps in the lungProfessor John Gosney
Thedifferentialdiagnosisofpulmonarynodules,manyofwhicharediscoveredincidentallyinasymptomaticindividuals,isenormous,andthequestionofhowtomanagethemisamatterofcontinuingdebate.DespitetheinexorableincreaseinthequalityandresolvingpowerofCTimagingofthethorax,thenatureofmanysuchlesionscannotbedeterminedwithoutexcisingthem,ameasurewhichoftenrevealsasurprisingandunexpecteddiagnosis.
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The BIR Sir Godfrey Hounsfield memorial lecture: The isotope bone scan past, present and futureProfessor Ignac Fogelman
Isotopebonescanninghasalonganddistinguishedhistory.Thestorycommencesinthe1960swithstrontiumandwithimagingatthattimeperformedusingarectilinearscannerandwithresolutionsopoorthatanatomicaloutlineshadoftentobeaddedtoassistinskeletallocalisation!Howevertherewererapidadvancesrelatingtobothradiopharmaceuticalsandinstrumentationandthedreamteamofabisphosphonateandagammacamerascameintoexistenceinthelate1970s.Initially,andindeedformanyyearsthereafter,theuseofthebonescanwasalmostexclusivelyinpatientswithknownmalignancybutsubsequentlyitsusehasexpandedintomanybenignapplicationsandnowadaysbenignconditionsaccountforsome50%ofcases.
Afurthersignificantadvanceoccurredwiththeuseoftomographicimaging(SPECT)inthelate1980swhereadramaticexamplewastheidentificationoffacetjointdisease.Thisseemedalmostmagicalatthetimewithoftenprominentfocaluptakeinindividual’swhohadunexplainedbackpainandanapparentlynormalplanarstudy.
Howeverthegreatleapforwardhasbeenwiththeuseofhybridimaging(SPECTCT)combiningfunctionalwithanatomicalstudiestakingadvantageofhighcontrastwithalteredmetabolicactivityandlocalisingthistopreciseanatomicaldata.Thishasreducedtheprevalenceofequivocallesionsonthebonescanfromsome60%to5-10%.
ThefutureisexcitingwiththeincreasingavailabilityofPET,eg.thepotentialforusingF-18asa‘routine’bonescanandwithquantitationoftraceruptakeinindividuallesionsnowpossible,andwithseveralnewtumourspecifictracers.WearealsoatthestartoftheeraofPET/MRI.
Investigating abdominal diseases through the timesProfessor Adrian Dixon
Educationalaim:toremindtheaudienceaboutthedevelopmentandlimitationsofvariousabdominalimaginginvestigations.
Inthebeginningwastheclinicalhistory;thenfollowedinspection,palpationandauscultation.ItisdebatablewhetherpalpationandauscultationwouldeverhavewithstoodtherigoursofNICE.Theelicitationofshiftingdullnessandthenuancesofborborygmiwereneveranexactscience.FortunatelytherapiddevelopmentofimagingtechniquesinthecenturyfollowingRoentgen’sdiscoverychangedeverything.
Bariumstudieswerethemainstayofabdominalimaginguntilthe1980sbut,beforeimageintensification,alotofimaginationwasrequired.Nevertheless,researchersintheUK,SwedenandJapanmaderemarkablescientificobservationsbythesemeans.Theintroductionofultrasoundgreatlyassistedthe
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investigationofthepelvisandupperabdomenandremainstheinvestigationofchoiceinthethinneradultandchildren;increasingadultobesitycurtailsitseffectivenessinmuchofthewesternworld.Computedtomography,andespeciallytheintroductionofspiralCTputpaidtoinvestigationsuchaslymphangiographyandretroperitonealairinsufflation.Magneticresonanceimaginghasbecometheoptimalmethodofinvestigatingtheliver,biliarytreeandmanystructureswithinthepelvis.PET/CTiscurrentlytheultimatemethodofassessingtheabdomenformanyoncologicalproblems.
Expertimagingisnotonlyneededtohelpthepatient,itisalsoneededtohelptheradiologistorsurgeonplanappropriatetreatmenttoreducemorbidityandcost.
Learningoutcomes:Appreciationoftheincreasingroleofabdominalimagingwithinmodernhealthcare.
Pseudo liver lesionsProfessor Ali Nawaz Khan
Liverpseudo-lesionsaregreatmimics,andunlesstheradiologistsandthecliniciansareawareoftheselesions,theirdiscoverymayleadtounnecessaryimaging/interventionandhealthservicecosts.Onesuchsignificantpseudo-lesionisproducedbytransienthepaticattenuationdifference(THAD).Increasedpressureinlobeorsegment,resultsinportalshuntingtonormalsegmentswiththecompensatoryincreaseinhepaticarterialflowtotheaffectedsegment.THADdoesnotimplyarterio-portalshuntingortumourinvasion.THADcauseaphysiologicalshutdown:notrophichormonesviaportalveinthusanyInsulinorGlucagondrive.Thus,theaffectedliversegmentisdepletedofglycogenandfat.Thesegmentisvulnerabletoischaemicnecrosis,whichisevengreaterwithbiliaryobstruction:infectedbiloma.Eventually,thesegment/lobeatrophyFocalfattyinfiltrationandfattyfocalsparingmaymimicavarietyoflesion.Avarietyofotherpseudo-lesionswillbediscussed.
Diffusion weighted imaging of the bowelDr Andrew Plumb
Diffusionweightedimaging(DWI)hasincreasinglybecomeanintegralpartofMRIprotocols,particularlyinthefieldofneuroradiologyandoncology.Itsroleininflammatoryconditionsislessdefined.RecentlydatasuggestsDWImayhavearoleinthedetectionandgradingofCrohn’sdiseaseduringMRenterography.IthasbeenwelldescribedthatrestricteddiffusionispresentinentericCrohn’s,althoughtheunderlyinghistologicalreasonsarecomplex.Increasedinflammatoryinfiltratelikelyrestrictdiffusionbuttheroleoftissueoedema,increasedvascularityandfibrosisininfluencingsignalfromDWIisunclear.ThismaycompromisetheutilityofDWIandapparentdiffusioncoefficientingradingdiseaseactivity.Itsuseindetectingabnormalbowelperseisclearer.
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ThispresentationwillpresentprotocolsforDWIduringMRenterographyanddescribetheunderlyinghistologicalfeatureswhichmayinfluenceimagingappearances.Datasupportingitsroleasamarkerofdiseaseactivitywillbepresentedwithexamples.Finally,howandwhyDWImaybeintegratedintostandardclinicalprotocolswillbediscussed.
Cystic liver lesionsProfessor Ali Nawaz Khan
Detectionoflivercystshasbecomecommonplacewithincreaseduseofcrosssectionalimaging.Whilstmostaresimplecystsothercysticlesionsaregreatmimics.Oncedetected,thereisanemphasisforfurthercharacterization.Thedifferentialdiagnosisofhepaticcystsisverywide.Differentiationofthesecysticlesionsisnecessaryformanagement.Thepresentationillustratestheentirespectrumofcystichepaticlesionsandprovidesanapproachfordifferentiatingthem.Theimportantfactorsassessedarethesize,septa,thicknessofthewall,internalnodulesorpapillaryprojections,calcification,densityandsignalintensitypatternsandcontrastenhancement.Ultrasound,Doppler,CTandMRIimagingfeaturesofthecysticlesionsareillustrated.Theaimofthispresentationistoarmtheradiologistwiththeknowledgerequiredtoofferadefinitivediagnosisaswithadvancedimagingitispossibletocharacterizemosthepaticcysticlesions.Clinicalinputisrequired.Withspiralinghealthcarecosts,thecostsmustbecurtailedsafely,minimizingpatientanxiety,andavoidunnecessaryinvasiveprocedures.
Imaging and renal failureDr Jane Belfield,
Chronickidneydisease(CKD)isatermusedtodescribepatientswithdecreasedrenalfunctionandisclassifiedin5stages,withstage5beingkidneyfailure(GFR<15ml/min).Themostcommoncausesincludediabetesmellitus,hypertension,vasculardiseaseandglomerulardisease.KidneydiseaseistheninthleadingcauseofdeathintheUnitedStatesandimaginginthisgroupofpatientscanbecomplexduetoboththeaetiologyofthediseaseandthecomplications.Thistalkaimstocoversomemoreunusualaspectsofimaginginthisgroupofpatientsthatarerelatedtoendstagerenalfailureoritscomplications.
Encapsulatingperitonealsclerosisisdefinedas“asyndromecontinuously,intermittently,orrepeatedlypresentingwithsymptomsofintestinalobstructionduetoadhesionsofadiffuselythickenedperitoneum,andapurelyclinicaldiagnosis.”Itisaconditionseeninpatientswhohavepreviouslyundergoneperitonealdialysis(PD),buttheexactaetiologyremainsuncertain.Itisthoughttoberelatedtotheglucosecontentinthedialysatewithintheperitonealcavity.ManycasespresentwhenPDhasbeendiscontinued.ClassicfeaturesasseenonCTwillbedescribed,includingperitonealthickeningandenhancement,cocooningofthebowelwithintheabdomen,fluidcollectionsandthickeningofbowelwall.Casesofperitonealsclerosiswillbepresentedtoillustratethefindings.
Contrastenhancedultrasound(CEUS)isanimagingmodalitythatcanbeusedinpatientswithrenalfailureduetothelackofnephrotoxicity.
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Contrastagentsarecomposedofgasmicrobubblesenclosedinaprotein,lipidorpolymershell.Thecompositionoftheagentallowsittolastinbloodvesselsfor5-7minutes.Thebubblescontractandexpandwhenincontactwithanultrasoundwaveandcanbeseeninthekidneysforapproximately2minutes.CEUSisparticularlyusefulindistinguishingasolidrenalmassfromapseudotumour,orcharacterisingacomplexcystinthisgroupofpatientsinwhomCTorMRIcontrastarerelativecontraindications.ExamplesofCEUSwillbeshowntodemonstrateitsuseinthisgroupofpatients.
Transplantationisthegold-standardtreatmentforpatientswithendstagerenalfailure.Increasingly,transplantsarebeingperformedfromlivingdonors,eitherrelatives,altruisticdonorsorpaireddonationswithmorethanonethirdofallrenaltransplantsbeingfromlivingdonors.Priortotransplantation,imagingisrequiredtoassessvascularityandanatomyofthedonoraswellastoidentifyanysalientincidentalfindings.LivingdonorCTimagingwillbedescribedwithexamplesofabnormalvascularandanatomicalanatomytodemonstratetheimportanceofimagingpriortoselectionfordonornephrectomy.
References:1.LeveyAS,CoreshJ,BalkE,KauszAT,etal.NationalKidneyFoundationpracticeguidelinesforchronickidneysdisease:evaluation,classification,andstratification.AnnInternMed.Jul152003;139(2):137-147.2.CentersforDiseaseControlandPrevention.DeathsandMortality.Availableathttp://www.cdc.gov/nchs/fastats/deaths.htm3.KawanishiH,MoriishiM.Encapsulatingperitonealsclerosis:preventionandtreatment.PeritDialInt200727:S289-S292.4.MorinS,LimA,CobboldJ,Taylor-RobinsonS.Useofsecondgenerationcontrast-enhancedultrasoundintheassessmentoffocalliverlesions.WorldJournalofGastroenteroloy.200713(45):5963-5970.5.CokkinosD,AntypaE,SkilakakiM,etal.Contrastenhancedultrasoundofthekidneys:whatisitcapableof?BioMedResearchInternational2013
Digital radiographyMr Ulrich Neitzel, Philips Healthcare
Thedevelopmentofthetechnologyandapplicationofdigitalradiographyoverthepastthirtyyearswillbereviewed.Today,digitalradiographyisthestandardtechniqueforx-rayprojectionexaminationsofthechestandtheskeleton.Comparedtopreviousscreen-filmimagingitoffersanumberofadvantages,likelargerdynamicrange,betterdoseefficiency,anddirectavailabilityoftheimagesinelectronicformat.Differenttechnologicalvariantsofdigitalradiographyexist,withtheirspecificprosandcons.
Theeducationalaimsandlearningoutcomesofthepresentationarethefollowing:1.Learntoknowthedifferencesbetweenthevariousdetectortypesfordigitalradiography2.understandtheadvantagesandlimitationsofdigitalradiography3.understandtheprinciplesandtheimportanceofproperimageprocessing4.learnaboutpresentandfuturedirectionsforfurtherdevelopmentofdigitalradiography
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Programme DAY 2: Thursday 23 October
ROOM 2: Neuro and MSK
08:30 Registration and refreshments
09:00 Welcome and introductionChair: DrAdamWaldman,ConsultantNeuroradiologist, ImperialCollegeLondon
09:05 Imaging the central nervous system; history and advances/past to future? DrAdamWaldman,ConsultantNeuroradiologist, ImperialCollegeLondon
09:50 Stroke and cerebrovascular disease DrShawnHalpin,ConsultantNeuroradiologist, UniversityHospitalofWales
10:20 Spinal trauma DrCurtisOffiah,ConsultantNeuroradiologist, TheRoyalLondonHospital
10:50 Refreshments
11:05 Normal ageing and disease – neurodegeneration and dementia ProfessorAlisonMurray, RolandSuttonProfessorofRadiology,UniversityofAberdeen
11:40 Brain tumours ProfessorPiaSundgren,ProfessorofRadiology,LundUniversity,Sweden
12:15 Quiz
12:30 Lunch
THE FOLLOWING LECTURE WILL TAKE PLACE IN ROOM 1
13:30 The BIR Sir Godfrey Hounsfield memorial lecture: The isotope bone scan past, present and future ProfessorIgnacFogelman,ProfessorofNuclearMedicine, King’sCollegeLondon
14:15 Prizes and awards ceremony
THE PROGRAMME WILL NOW CONTINUE IN ROOM 2
Session 1: Joint painChair: DrDavidWilson,ConsultantInterventionalMSKRadiologist, OxfordUniversityHospitalsNHSTrust President,BIR
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14:25 Pain – disconnection between imaging findings and patient’s symptoms DrFranzKainberger,DepartmentofDiagnosticRadiology, MedicalUniversityofVienna
14:50 Osteoarthritis as a cause of pain DrFionaWatt,SeniorClinicalResearchFellow, KennedyInstituteofRheumatology,UniversityofOxford
15:15 Synovial disease as a cause of pain (including infection) DrRichardWakefield,ConsultantinRheumatology, StJames’sUniversityHospital,Leeds
15:40 Stretch, strengthen, push, pull and jab - conservative treatment of musculoskeletal syndromes MrMarkMaybury,ExtendedScopePhysiotherapyPractitioner, GoodHopeHospital,Birmingham
16:05 Refreshments
Session 2: Insufficiency fractures
16:20 Epidemiology in the UK DrSimonDolin,ConsultantinPainMedicine, BMIGoringHallHospital,WestSussex
16:45 Causes of insufficiency fractures DrMKassimJavaid,AssociateProfessorofMetabolicBoneDisease, UniversityofOxford
17:10 Diagnostic methods DrNaomiWinn,ConsultantRadiologist, ManchesterRoyalInfirmary
17:35 Treatment options MrSeanMolloy,ConsultantOrthopaedicSpinalSurgeon, RoyalNationalOrthopaedicHospital,Stanmore
18:00 Close of Congress__________________________________________________________________
Certificate of attendance
Yourcertificateofattendancewillbeemailedtoyouwithinthenexttwoweeksonceyouhavecompletedtheonlineeventsurveyat:
https://www.surveymonkey.com/s/BIRAnnualCongress2014
BIR Annual Congress 2015: 4–5 November, London
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Speaker profiles (where supplied)
Dr Simon DolinConsultant in Pain Medicine, BMI Goring Hall Hospital
DrSimonDolinwaspreviouslyNHSConsultantinWesternSussexHospitals,nowanindependentpractitionerinSussex,SurreyandLondon.Hewasanearlyadopterofvertebroplastyinthedayswhenwehadtoaddopacifieronthebenchbyhandandtherewerenoinjectiondevices.Havingbeenaroundthecircleonthishehasgonebacktohandinjectionusingcortosssystem.
Professor Ignac FogelmanProfessor of Nuclear Medicine, King’s College London
ProfessorFogelmaniscurrentlyProfessorofNuclearMedicine(NM),atKing’sCollegeLondonandHonoraryConsultantPhysician,Guy’sandStThomas’NHSTrustandDirectoroftheOsteoporosisScreeningandResearchUnit,Guy’sHospital.HeisChairmanoftheBoardofExaminersfortheMScinNM,whichprovidestheonlyrecognisedtrainingprogrammeforNMintheUK.Hehaswrittenover400articlesinpeerreviewedjournals,haswrittenoredited15books,andsupervised17PhD/MDstudents.HeisaformerboardmemberandTrusteeoftheNationalOsteoporosisSocietyandwaspreviouslyChairmanofitsBoneDensitometry(BD)Forum.
Dr Shawn HalpinConsultant Neuroradiologist, University Hospital of Wales
DrHalpinqualifiedatKing’sin1982,andcompletedneuroradiologytrainingatQueen’sSquareaftertheradiologytrainingschemeatStGeorges.HewasappointedConsultantNeuroradiologistatUniversityHospitalofWales,Cardiffin1993.He’shadaninterestinadvancedCTimagingforcerebrovasculardiseaseinstrokeformanyyears,andhasworkedwithGEindevelopingtheirCTperfusionsoftware.
Dr M Kassim JavaidAssociate Professor of Metabolic Bone Disease, University of Oxford
DrMKassimJavaidisAssociateProfessorofMetabolicBoneDisease,NuffieldDepartmentofOrthopaedics,RheumatologyandMusculoskeletalSciences,UniversityofOxfordandHonoraryConsultantRheumatologist,NuffieldOrthopaedicCentre,OxfordUniversityHospitalsTrust.
DrMKJavaidcompletedhismedicaltrainingatCharingCrossandWestminsterMedicalSchoolthenspecialisedinadultrheumatologyattheWessexDeanery.HecompletedaPhDintheepidemiologyofosteoporosisasanARCClinicalFellowattheUniversityofSouthamptonandspentayearasanARCtravellingfellowinUCSFtostudytheroleofvitaminDandboneinlowerlimbOA.
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HewasappointedasLecturerinMetabolicBoneDisease/HonoraryconsultantRheumatologistatOxford.Hisresearchinterestsincludetheroleofepidemiologyofmusculoskeletaldiseases,mechanismofbonepainandco-leadforatheNIHRRDTRCrarebonediseasesinitiativeandworkswithintheClinicalScientificCommitteeoftheNationalOsteoporosisSociety,includingdevelopingthevitaminDguidelines,andtheInternationalOsteoporosisSociety,includingdevelopmentandimplementation
Mr Mark MayburyExtended Scope Physiotherapy Practitioner, Good Hope Hospital
Markisanextendedscopemusculoskeletalphysiotherapist,atGoodHopeHospital,HeartofEnglandFoundationTrustinBirmingham.Hespecialisesindiagnosticandinterventionalultrasound,andworksinthetraumaandorthopaedics,physiotherapyandradiologydepartments.HeisafacultymemberonmanyoftheleadingultrasoundcoursesintheUK,andavisitingspeakeratseveraluniversities.Additionally,heisapublishedauthor,andcurrentlyholdsanhonorarylecturerpositionattheUniversityofEssex.
Mr Sean MolloyConsultant Orthopaedic Spinal Surgeon, Royal National Orthopaedic Hospital
MrMolloyisaConsultantOrthopaedicSpinalSurgeonatTheRoyalNationalOrthopaedicHospital,Stanmore.HeisuniqueinbeingtheonlypersonintheUnitedKingdomholdingdualqualificationasaSpinalSurgeonandaChiropractor.HequalifiedasaChiropractorin1990.Hepractisedasachiropractorwhilsttrainingtobeadoctor.MrMolloygraduatedfromStGeorge’sHospitalMedicalSchoolin1995.HisspecialistregistraryearsinorthopaedicswerespentonthesouthwestThamestrainingrotation.MrMolloyundertookanMScinOrthopaedicEngineeringduringhisorthopaedicregistrartrainingandgraduatedin2002fromCardiffUniversity.
MrMolloydidaFellowshipyearattheprestigiousJohnsHopkinsUniversityHospitalintheUnitedStates.HethencompletedafurtherFellowshipinspinalsurgeryatTheRoyalNationalOrthopaedicHospital,Stanmore,beforebeingappointedasaconsultantinthesameinstitution.Hehasbeenactiveinscientificresearchandhisworkiscoveredinoversixtypublishedscientificpapers/presentationsbothnationallyandinternationally.
Professor Alison MurrayRoland Sutton Professor of Radiology, University of Aberdeen
ProfessorAlisonMurrayistheRolandSuttonProfessorofRadiologyattheUniversityofAberdeen.SheisDirectoroftheAberdeenBiomedicalImagingCentre.Sheleadsclinicalbrainimagingresearchinstructural,functionalandmolecularimagingcorrelatesofcognitiveageinganddementiaandworkincludesMRIintheAberdeen
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1936BirthCohort,andMRI,regionalcerebralbloodflow(rCBF)SPECTandFDGPETinclinicaltrialsofnovelTauAggregationInhibitortherapiesinAlzheimer’sdisease.ParticularinterestsaretherelativecontributionsofvascularriskfactorsandsubclinicalAlzheimer’sdiseasetocognitiveageing,contributorstocognitivereserveandresiliencetodementiaanddevelopingnovelmethodsofimaginginpatientswithdementia.ShehasextensiveNHSexperienceofbrainimagingindementiaandisresponsibleforthemajorityofNHSreferralsforstructuralandmolecularbrainimagingincludingCT,rCBFSPECTCTandFP-CITCTstudies.SheisafoundingmemberandexecutivememberoftheScottishImagingNetwork:APlatformforScientificExcellence(SINAPSE)www.sinapse.ac.ukasuccessfulbrainimagingpoolinginitiativefundedbytheScottishFundingCouncil,CSOandparticipatinguniversitiestodevelopstateoftheartbrainimagingresourcesandresearchtrainingacrossScotland,anexecutivememberoftheScottishDementiaResearchConsortiumandPresidentElectoftheScottishRadiologicalSociety.
Dr Curtis OffiahConsultant Neuroradiologist, The Royal London Hospital
DrCurtisOffiahisaConsultantNeuroradiologistworkingattheRoyalLondonHospitalwithinBartsHealthNHSTrustincorporatingtheRoyalLondonHospitalandStBartholomew’sHospital.TheRoyalLondonHospitalisalevel1traumacentreandoneofthefourdelegatedmajortraumaunitsforLondonandseesawealthofvariedtraumacasesincludingthosepertainingtothehead,neckandspine.Hehasanumberofsubspecialtyandresearchinterestsincludingneurotrauma.Hehaslecturednationallyandinternationallyinneurotraumaandhaspublishedpapersinpeer-reviewedradiologicaljournalsonneuroradiologicalaspectsoftrauma.Healsoadvisescoronerservicesandpoliceforcesonrelevantaccidentalandcriminalneurotraumacases.
Professor Pia SundgrenProfessor of Radiology, Lund University, Sweden
ProfessorPiaMalySundgrenistheHeadoftheDepartmentofDiagnosticRadiology,ClinicalSciencesLundUniversity,Sweden.Shehasabroadbackgroundinneuroradiologyasseniorneuroradiologyconsultant.Sheisaskilledclinicianwithexperienceinassessmentanddiagnosisofintracranialpathologies,andwithspecifictrainingandexpertiseinkeyresearchareassuchasfMRI,MRspectroscopyanddiffusionanddiffusiontensorimaginginbraindisordersandpainconditions.Hermainfocusofresearchisonidentifyingearlyimagingbiomarkersforearlypredictionoftherapeuticoutcomeandinmonitoringtreatmentresponseinpatientstreatedforprimarybraintumours,andofirradiationeffectsonbrainparenchyma.PiaSundgrenhaspublishedover125originalarticlesandreviews,severalbookchaptersandthreebooks.Sheisawell-knownlectureratinternationalmeetingswithalmost200lecturesworld-wide.SheistheChairoftheEuropeanSchoolofNeuroradiologyandactsasboardmemberinseveralinternationalsocietiesrelatedtoradiologyandneuroradiology.
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Dr Adam WaldmanConsultant Neuroradiologist, Imperial College London
DrWaldmangainedaPhDandundertookpost-doctoralresearchinbiophysicsbeforetraininginmedicineatCambridge.HetrainedinradiologyatUniversityCollegeHospitalsandsubsequentlyinneuroradiologyattheNationalHospitalforNeurologyandNeurosurgery,QueenSquare,London.DrWaldmanhasbeenConsultantNeuroradiologistatImperialCollegeHealthcareNHSTrust(formerlyHHNT)since2001.Since2006hehasbeendepartmentalacademicleadasResearchDirectorforRadiology,andhasalsofoundedanacademictrainingprogrammeinClinicalRadiology.Hewasawardedthe2009RoyalCollegeofRadiologistsRoentgenProfessorshipandmedal,andholdshonorarysenioracademicappointmentsatImperialCollegeLondon.Hismainresearchinterestsareinquantitativeandphysiologicalneuroimaging,particularlyasappliedtoneuro-oncologyandneurodegenerativediseases.
Dr Fiona WattSenior Clinical Research Fellow, Kennedy Institute of Rheumatology, University of Oxford
DrWattisaseniorclinicalresearchfellowattheKennedyInstituteofRheumatology,attheUniversityofOxfordandHonoraryConsultantRheumatologistattheNuffieldOrthopaedicCentre,Oxford.Herresearchinterestisosteoarthritis-theinitiatingmechanismsofthedisease,focussingontheidentificationofnewdiagnosticandprognostictests,andnoveltherapeutictargets.SheleadsthetranslationalprogrammewithintheArthritisResearchUKCentreforOsteoarthritisPathogenesis.Thisincludesworkonclinicaltrialsbutalsotranslationalstudiesinhumancohorts,suchasthosewithkneeinjuryorestablishedhandosteoarthritis.
ShehasaPhDincartilagebiochemistryfromImperialCollegeLondon,andcompletedspecialisttraininginnorthwestLondon,havinggainedresearchtrainingandMBBSinNewcastle.Fionaremainspassionateaboutcliniciansenteringscience,andthetranslationoflaboratoryscienceintotheclinic.
Dr David WilsonConsultant Interventional MSK Radiologist, Oxford University Hospitals NHS Trust and President, BIR
DrWilson’sprimaryinterestisintheapplicationofmodernimagingtechniquestodisordersofthelocomotorsystemandspineintervention.Hehasundertakenoriginalworkintheapplicationofdiagnosticultrasoundtojoint,muscle,andsofttissuediseasewithparticularattentiontojointeffusionandcongenitaldysplasiaofthehip.Hehasover20yearsofexperienceinvertebroplastyandistheauthorofpublicationsonmulticentrecontrolledtrialsonthetreatmentofinsufficiencyfractures.HehasestablishedinnovativetrainingcoursesintheUKinmusculoskeletalultrasoundinOxfordandBath.Heteachesinternationallyandisaleaderinthedevelopmentofultrasoundinmusculoskeletaldiseaseandinjectiontechniquesinthespine.Hehasconsiderableexperienceinallaspects
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ofmusculoskeletalimagingandistheEditoroftheprincipletextbookonMSKimaging.AsaformerPresidentoftheBritishSocietyofSkeletalRadiologistandapreviousMedicalDirectoroftheNuffieldOrthopaedicCentrehehaswideclinicalandresearchexperience.
Dr Naomi WinnConsultant Radiologist, Manchester Royal Infirmary
DrWinnisaConsultantMusculoskeletalRadiologist,workingatManchesterRoyalInfirmary.AftercompletingherRadiologySpecialtyTrainingintheNorthernDeanery,sheenjoyedayearofFellowshiptraininginMusculoskeletalRadiology,basedinEdmonton,Canada.Hersubspecialtyinterestsincludemusculoskeletalultrasoundandimagingofsofttissueandbonesarcomas.______________________________________________________________
Abstracts
Imaging the central nervous system; history and advances/past tofuture?Dr Adam Waldman
Technologicaladvanceshavebeenkeytothedevelopmentofbrainandspineimaging,fromtheearliestattemptstovisualisethesehiddenstructuresusingcisternographyandangiography,throughtheadventofcrosssectionalimagingwithCTandMRI,tocontemporaryfunctional,physiologicalandmolecularmethods.Wewillmovefromabriefillustrated20thcenturyhistoryofneuroimaging,todiscussthetranslationofemergingfunctionalandquantitativetechniquesintocurrentclinicalneuroradiologypracticeandcognitiveneuroscience,andfinallyconsiderpotentialfutureapplicationsofnovelexperimentalimagingtools.
Stroke and cerebrovascular diseaseDr Shawn Halpin
Imaginginstrokehasmanylayers.Atthebaseistheneedtoexcludecontra-indicationstothrombolysis,whileotherlayersleadthroughaccuratediagnosis,andthenontoanassessmentoftheappropriatenessofthrombolysis,andthenperhapsoftissueviability.Thislecturediscussesvariousimagingparadigmsinthehyperacutestrokepathway,from“justdoit”toimagingtailoredforindividualpatients.ThecurrentroleforCTperfusionstudiesisdiscussedindetail.
Spinal traumaDr Curtis Offiah
Accurateinterpretationofcomputedtomography(CT)andmagneticresonanceimaging(MRI)ofspinaltraumacanbeverychallengingbutiscentraltotheappropriatemanagementandprognosticationofsignificantlycompromisedandfrequentlyobtundedpatientsaswellasparamountinlimitingmorbidityin
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survivingpatientsofsignificanttrauma.ThelecturewilloutlinethesalientbasicrelevantanatomicalandbiomechanicalprinciplesassociatedwithacutespinaltraumaanddemonstratethekeyCTandMRimagingfeaturesandconsiderationsofthecommontraumaticinjuriesencounteredinrelationtothecraniocervicaljunction,thesubaxialcervicalspineandthethoracolumbosacralspine.Important“review”areasandappropriate“redflags”intheimaginginterpretationofacutespinaltraumawillalsobediscussedwhichmaybeusefulbothinlimitingpotentiallydeleteriousomissionsfromtheradiologicalinputinthepatientmanagementpathwayaswellasassistingclinicalprognostication.Finally,imagingassessmentinthemorerarely-encounteredcivilianpenetratingspinaltraumascenariowillalsobepresented.
EducationalAimsandLearningOutcomes:1.Understandingthenormalanatomyofthecraniocervicaljunctionandspine.2.UnderstandingtherequirementsofemergencyCTassessmentofthespinalaxis.3.Understandingtheconceptof“thestable”versus“theunstable”spinalinjury.4.Understandingthefractureandligamentousinjurypatternsassociatedwithsomeofthemoretypicalspinalinjuriesincludinghighenergymechanisminjuries.5.UnderstandingtheurgencyofMRIassessmentintheseverelyinjuredintubatedandventilatedpatientwithspinalinjury.6.UnderstandingprognosticMRIfeaturesincordinjuryassociatedwithspinaltrauma.
Normal ageing and disease – neurodegeneration and dementiaProfessor Alison Murray
Thispresentationwillreviewbrainimagingincognitiveimpairmentanddementia,referringtoresearchresults,currentevidenceforimagingandnationalandinternationalguidelines.Theeducationalaimsaretoupdateparticipantswithnewinformationandtogiveapragmaticoverviewofwhetherbrainimagingisappropriateinpatientswithdementia,ifso,whenbrainimagingshouldbeusedandwhatispracticalinacostconstrainedNHS.Threemainlearningpointswillbemadeinitially:1.Mostdementiarelatedneuropathologyismixed2.Mostevidenceignoresbaseline3.Currentlywecannotdiagnosedementiaonascan–evenanAPETscan!
FollowingarapidreviewoftheresultsofbrainimagingresearchintheAberdeenBirthCohorts,adescriptionofcognitivereserveandhowthisiscrucialtounderstandcognitiveageinganddementiaresearch.Also,whatwecanandcannottellfromroutinebrainimagesandrecentdrugdevelopmentinAlzheimer’sdisease,thepresentationwillconcludewithexamplesofwherebrainimagingisusefulindementiaandneurodegenerativediseases,areasforfutureresearchandwiththreemorelearningpoints:
1.Imagingincreasesdiagnosticaccuracy2.Infuturetheroleofimagingislikelytobevalidationofcheapertests3.Ifwecould“bottle”cognitivereserveitwouldhaveasmuchimpactasaneffectivenewdrug.
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Brain tumoursProfessor Pia Sundgren
Clinicalsymptomscombinedwiththeresultsoftheneurologicalexaminationraisethefirstsuspicionofthepossibilitythatthepersonmighthaveabraintumour.CTand/orMRimagingaremethodstoconfirmthepresenceofabraintumourandespeciallyMRIwithtailoredimagingprotocolwillleadtoprecisediagnosis.MRIisoftenusedtoplanfurtherstepsanddecideontherapyoptions.Despiteimprovementsinsurgery,radiationandchemotherapytheoverallsurvivalofbraintumoursvaries.Onemajorissueinbraintumourmanagementisthatconcurrenttreatmentwithradiotherapyandchemotherapyisassociatedwithsocalledpseudoprogression,reflectingtreatment-inducedchangesinthetumourresultinginanincreaseinsizeand/orabrighterappearancethanonpretreatmentMRI.Thesechangesmaymisleadinglysuggesttumourprogressionbutaretransientandeventuallythetumourwillstabilizeinsizeorevenshrink.NovelcombinationtherapieslikeBevacizumabtreatment,whichhamperswithtumourangiogensies,mayleadtodiminishededemaandcontrastenhancementsocalledpseudoresponse,withimagingfindingsthatcancausediagnosticdifficulties.Alsogammaknifetherapyisassociatedwithahighincidenceofradiationnecrosis,withsimilarmorphologicalcharacteristicsasrecurrenttumour.Earlyidentificationofpatientswhosufferfromtumourrecurrencecanbeofgreatadvantage:itprovidestheopportunitytoadjustindividualsmorerapidly,andsparingpatientsunnecessarymorbidity,anddelayininitiationofother,maybemoreeffective,treatment.Inthislecture,MRandCTimagingmethodsfordetectionanddifferentiationbetweendifferentbraintumorswillbediscussed.Inaddition,issueslikethedifferentiationbetweenpseudoprogressionandtruetumourprogression,theimagingfindingsinpseudoresponseandmonitoringschemestoassessearlytreatmentresponsewillbediscussed
The BIR Sir Godfrey Hounsfield memorial lecture: The isotope bone scan past, present and futureProfessor Ignac Fogelman
Isotopebonescanninghasalonganddistinguishedhistory.Thestorycommencesinthe1960swithstrontiumandwithimagingatthattimeperformedusingarectilinearscannerandwithresolutionsopoorthatanatomicaloutlineshadoftentobeaddedtoassistinskeletallocalisation!Howevertherewererapidadvancesrelatingtobothradiopharmaceuticalsandinstrumentationandthedreamteamofabisphosphonateandagammacamerascameintoexistenceinthelate1970s.Initially,andindeedformanyyearsthereafter,theuseofthebonescanwasalmostexclusivelyinpatientswithknownmalignancybutsubsequentlyitsusehasexpandedintomanybenignapplicationsandnowadaysbenignconditionsaccountforsome50%ofcases.
Afurthersignificantadvanceoccurredwiththeuseoftomographicimaging(SPECT)inthelate1980swhereadramaticexamplewastheidentificationoffacetjointdisease.Thisseemedalmostmagicalatthetimewithoftenprominentfocaluptakeinindividual’swhohadunexplainedbackpainandanapparentlynormalplanarstudy.
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Howeverthegreatleapforwardhasbeenwiththeuseofhybridimaging(SPECTCT)combiningfunctionalwithanatomicalstudiestakingadvantageofhighcontrastwithalteredmetabolicactivityandlocalisingthistopreciseanatomicaldata.Thishasreducedtheprevalenceofequivocallesionsonthebonescanfromsome60%to5-10%.
ThefutureisexcitingwiththeincreasingavailabilityofPET,eg.thepotentialforusingF-18asa‘routine’bonescanandwithquantitationoftraceruptakeinindividuallesionsnowpossible,andwithseveralnewtumourspecifictracers.WearealsoatthestartoftheeraofPET/MRI.
Osteoarthritis as a cause of painDr Fiona Watt, University of Oxford
Educationalaimsandoutcomes:Delegateswillbeableto:1.Describetheepidemiologyofpaininosteoarthritis.2.Understandsourcesofpainintheosteoarthriticjoint.3.Explorewhatpainpathwaystellusaboutosteoarthritis.4.Reviewtherelevanceofimagingpainfuljointsinosteoarthritis.
Notallpeoplewithosteoarthritishavepain.Butmostdo.OsteoarthritisremainsoneoftheleadingcausesofprimarycareconsultationsandworkdisabilityintheUK,andthemostcommonsymptomofosteoarthritisisjointpain.Painisalsothemajordriverforjointreplacement–aprocedurewhichisincreasingexponentiallyinlinewithourageingandobesepopulation.Articularcartilageisaneural,butOAisadiseaseofthewholejoint.ThroughMRI-basedandotherimagingstudies,wenowunderstandfarmoreaboutthejointtissues,structuresandotherprocesseswhichgiverisetopain.Inosteoarthritis,shouldweaimtotreatpain,orstructure,orboth?Inthesearchforadisease-modifyingdrug(DMOAD)forthedisease,therehasbeenmuchfocusonstructuremodification,butnosuccessfuldrugdevelopmenttodate.TherenewedfocusofPharmainosteoarthritisispainmodification.Drugswhichblockpainpathwaysareteachingussomeinterestinglessonsaboutthediseaseanditspathogenesisinbothanimalmodelsandhumans.Imagingremainsouronlyprovenbiomarkerforthedisease,anditsapplicationsintermsoffutureclinicaltrialswillbediscussed.
Stretch, strengthen, push, pull and jab - conservative treatment ofmusculoskeletal syndromesMr Mark Maybury
Thisisanexperientialtalkactingasanoverviewofphysiotherapyinthemanagementandtreatmentofpainfulmusculoskeletalconditions.Itisnotanextensiveorexhaustivelistoftreatmentoptionsforallconditionsbutfocusesontheuseofelectrotherapy,manualtherapy,acupunctureandinjectiontherapyinthetreatmentofmusculoskeletalconditions.Althoughthegeneralprinciplesgoverningtheuseofthesetreatmentswillbedescribed,thetreatmentofadhesivecapsulitiswillbefocusedonspecificallyasshoulderconditionsrepresentthemostcommonmusculoskeletalconditionreferredintosecondarycare.Otherconditionssuchasosteo-arthritisoftheknee,andothersofttissueinjurieswillbedescribed.
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Epidemiology in the UKDr Simon Dolin
Insufficiencyfracturesrefertovertebralcompressionfractureandsacralfractures.Thelatterarerelativelypoorlydescribedintheliteratureandincidenceandclinicalimpactprobablyunderestimated.VCFsarecommon.Alargepopulationstudy(TromsoVI)indicatesoverallprevalenceof11.89%inwomenand13.8%inmean.Thisincreasesconsiderablywithage,anditisestimatedthat50%willhaveVCFoverageof80.StudiesofpatientswithclinicalVCF(requiringinvestigationandtreatment)indicateanannualincidenceof10.7(women)and5.7(men)per1000.Reasonsfordiscrepancyinsexdifferencesislikelytobecomplex.VCFsclusteraroundT11-L2levelswithamixofwedgeandbiconcavedeformities.LyritisdescribedpainfulVCFaseitheracutetype1thatwasseverebutsettledover4-8weeksorchronictype2thatdevelopedinsidiouslywithprogressivewedgingovermanymonths.ClinicalconsequencesofVCFincludereducedpulmonaryfunction,decreasedactivitiesofdailylivingwithlossofindependence,abdominalsymptoms,increasedhospitaladmissionsandmortalityratioincreasedby1.6xwithasingleVCF.
Causes of insufficiency fracturesDr M Kassim Javaid
Insufficiencyfracturesarefracturesthatoccurwithnormalloadingandabnormalbone.Thecommonestcauseofinsufficiencyfracturesisosteoporosis.
Thelearningobjectivesofthissessionwillbe:1.Understandthecommoncausesofosteoporosis.2.Understandthecommonsecondarycausesforosteoporosis.3.Thepresentationofcommonanduncommontypesofosteomalacia.4.Thepresentationanddifferentialdiagnosisofprimaryhyperparathyroidism.5.Thefeaturesandmanagementofatypicalsubtrochantericfemoral.fractures.
Diagnostic methodsDr Naomi Winn
Thislectureonradiologywillincludeassessmentofbonemineraldensityandhowbesttoimageinsufficiencyfractures.TechniquesinassessingbonemineraldensitywillincludeDEXA,radiography,CT,quantitativeCTandhighresolutionMRI.Imagingofinsufficiencyfractureswillincluderadiography,CT,MRI,nuclearmedicineandultrasound,witharationaleonhowtochoosebetweenthedifferentimagingmodalities.
__________________________________________________________________
Certificate of attendance
Yourcertificateofattendancewillbeemailedtoyouwithinthenexttwoweeksonceyouhavecompletedtheonlineeventsurveyat:
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BIR Annual Congress 2015: 4–5 November, London
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Platinum sponsors
Philipsisadiversifiedhealthandwell-beingcompanyandaworldleaderinhealthcare,lifestyleandlighting.Ourvisionistomaketheworldhealthierandmoresustainablethroughmeaningfulinnovation.
Wedevelopinnovativehealthcaresolutionsacrossthecontinuumofcare,inpartnershipwithcliniciansandourcustomerstoimprovepatientoutcomes,providebettervalue,andexpandaccesstocare.
Aspartofthismissionwearecommittedtofuellingarevolutioninimagingsolutions,designedtodelivergreatercollaborationandintegration,increasedpatientfocus,andimprovedeconomicvalue.Weprovideadvancedimagingtechnologiesyoucancountontomakeconfidentandinformedclinicaldecisions,whileprovidingmoreefficient,morepersonalisedcareforpatients.
TheSiemensHealthcaresectorisoneoftheworld’slargestsupplierstothehealthcareindustryandatrendsetterinmedicalimaging,laboratorydiagnostics,medicalinformationtechnologyandhearingaids.Siemensoffersitscustomersproductsandsolutionsfortheentirerangeofpatientcarefromasinglesource–frompreventionandearlydetectiontodiagnosis,andontotreatmentandaftercare.Byoptimisingclinicalworkflowsforthemostcommondiseases,Siemensalsomakeshealthcarefaster,betterandmorecost-effective.Forfurtherinformationpleasevisit:http://www.siemens.co.uk/healthcare
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AllianceMedicalisEurope’sleadingindependentimagingservicesprovider.IntheUK,AllianceMedicalhas25years’experienceofdeliveringarangeofdiagnosticimagingservicesforpatients.WeoperatealargenetworkofscanningcentresandmobilesscannersacrosstheUKwhichofferpredominantlyMRIscanning,butmanysites/mobilesalsoofferarangeofotherdiagnosticmodalitiesincludingCT,PET/CT,DEXA,X-rayandUltrasound.
InJuly2013,AllianceMedicalcompletedthepurchaseofErigal,aleadingUKmanufacturerofradiotracers,tocreatetheUK’sonlyintegratedradiotracersupplyandimagingorganisation.
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TheNHSfacesmanychallengestodayaroundtheincreasingneedforgovernanceinordertodemonstratebestpatientcarewithinincreasingfinancialconstraints.BayerRadiologyandInterventional(R&I)iswellplacedtobethepartnerinhelpingTruststoaddressthesechallenges.Withmarketleadingcontrastmediaandpowerinjectorsystems,Bayerisabletoofferinnovativepatientcare,andwiththeadditionofitsinformaticsplatform,itcansupportradiologydepartmentsindrivingprotocolstandardisationandeasilyaccessibleauditdatathatenabledepartmentstomeetfurtherchallengesfacedaroundcontrastradiationdosemanagement.
TofindoutmoreaboutourR&Isolutionspleasecall01635-563999orvisitwww.bayer.co.uk
Dedicatedtomedicalimagingforover80years,Guerbetoffersacomprehensiverangeofcontrastmediaandassociatedmedicaldevicesforimagingdiagnosisandinterventionalradiologyinmajordiseaseareae.g.cardiovascular,cancer,inflammatoryandneuro-degenerativediseases.
Pleasevisitwww.guerbet.co.uktolearnmoreaboutouractivities.Forfurtherinfo,[email protected]:01217338542.
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MEDICAaretheUK’sleadingproviderofteleradiologyservices.InadditiontoourNighthawkOutofHoursCT/MRservice,weprovidesubspecialistreportingforCT,MR,Mammography,CTColonography,plainfilmandNM.Ourreportingisdeliv-eredintheUKbyradiologistswithaminimumoftwoyears’experienceasNHSconsultantsandwithinastrictqualityframework.
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RxEyeprovidesaglobalcollaborationplatformenablingeasyaccesstoexpertsandsecuredatasharingwithinmedicalimaging.
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4WaysHealthcareistheUKleaderinqualityRemoteRadiologyReporting.Weof-feranopportunitytoreportCT,MR,PlainFilmandspecialistdisciplinesfromyourownhome.4WaysistheidealchoicefortheRadiologistwhowantsaflexible,lucrativeparttimeorfulltimereportingrole.
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