Wessex branch meeting: pushing the boundaries of radiology

Pushing the boundaries of radiology Meeting organised by the Wessex Branch of The British Institute of Radiology Friday 13 December 2013 Wessex Heartbeat Centre Southampton General Hospital 12:30

Registration and lunch

Chair:

Dr Stephen Harden, Consultant Radiologist, University Hospital Southampton NHS Foundation Trust

13:30

Future directions of the BIR and the implications for education Professor Andrew Jones, President, BIR

14:00

Cardiac CT – how is it possible?

Mr Matthew Benbow, Superintendent Radiographer, Royal Bournemouth Hospital

14:20

Imaging in spontaneous intracranial hypotension Dr Andrea Romsauerova, Consultant Neuroradiologist, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust

14:35

MR imaging of anterior knee pain Dr Kiruthika Chandrasekaran, ST4 in Radiology, University Hospital Southampton NHS Foundation Trust

14:50

The role of the radiologist in pancreatic islet cell transplantation Dr Jane Phillips-Hughes, Consultant Radiologist and Head, School of Radiology, Oxford University Hospitals NHS Trust

15:15

Refreshments

15:45

Are all filling defects on CTPA pulmonary emboli?

Dr Cheryl Main, ST3 Radiology, University Hospital Southampton NHS Foundation Trust

Incorporated by Royal Charter Patron - Her Majesty The Queen

President Prof Andrew Jones BSc MSc FIPEM CSci FBIR Chief Executive Ms Jacqueline Fowler BA, MInstF(Cert)

The British Institute of Radiology 48-50 St John Street London EC2M 4DG

T : +44(0)20 3668 2226 E : admin@bir.org.uk www.bir.org.uk

Registered Charity No. 215869 VAT Registration No. GB 233 7553 63

16:00

Functional MRI in clinical practice Dr Angela Darekar, Lead MRI Physicist, University Hospital Southampton NHS Foundation Trust

16:20

Update and advances in nuclear medicine Dr Francis Sundram, Consultant and Clinical Lead Nuclear Medicine, University Hospital Southampton NHS Foundation Trust

16.40

A new quality parameter in CT Dr Stephen Harden, Consultant Radiologist, University Hospital Southampton NHS Foundation Trust

17:00

Close of meeting

CPD: 3 credits Please complete the meeting evaluation survey online at: https://www.surveymonkey.com/s/pushing_the_boundaries We will email your CPD certificate upon collation of your feedback.

*The next meeting organised by the Wessex Branch will take place on 13 June 2014 in Winchester

We are most grateful to

For supporting this conference

Speaker profiles and abstracts (where supplied) Biography Mr Matthew Benbow, Superintendent Radiographer, Royal Bournemouth Hospital I have always worked along the south coast – Brighton, Southampton, Truro and Bournemouth for 14 years so far. I have been working with CT for the past 17 years, including cardiac CT for 10 years. We now perform over 100 such examinations per month.

Abstract Cardiac CT – how is it possible?

Cardiac CT has been available for around 10 years, but has not been an easy examination to crack. Indeed, the heart is the only body part that patients are unable to keep still and this does not lend itself well to high resolution, motion-free imaging. The technology that has made coronary artery CT possible is ever evolving and this presentation aims to explore this journey from the beginnings right up to where we have reached today. It will discuss the problems that needed to be overcome and the solutions that have allowed us to succeed in this challenging area.

Biography Dr Andrea Romsauerova, Consultant Neuroradiologist, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust Consultant Neuroradiologist since 01/04/13 to current at the Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust.

Neuroradiology Fellowship 03/08/11- 30/03/13 at Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust.

Radiology Training 01/08/07- 01/08/11- East of Scotland Deanery, Ninewells Hospital, Dundee.

Abstract Imaging in spontaneous intracranial hypotension Spontaneous intracranial hypotension (SIH) is an important, but not well recognised entity.

Patients with SIH are often misdiagnosed leading to significant delay in the initiation of the treatment and severe consequences if mistreated.

The educational aim is to demonstrate multimodality imaging findings of spontaneous intracranial hypotension and to illustrate pitfall cases with misdiagnosis leading to inappropriate or delayed management.

The representative MRI findings of intracranial hypotension include brain sagging, engorgement of venous structures, extra-axial fluid collections and pachymeningeal enhancement. However, some cases have no typical MRI imaging abnormalities. Brain sagging is demonstrated by flattening of the ventral pons against the clivus, inferiorly displaced third ventricle, low-lying cerebellar tonsils, loss of the basal cisterns, decreased mamillopontine distance, and draping of the chiasm over the pituitary gland. Venous engorgement is demonstrated by prominent, rounded dural sinuses, pachymeningeal thickening and enhancement, and by pituitary enlargement.

Spontaneous intracranial hypotension is thought to be caused by a CSF leak from the spinal dural sac. MRI of the spine and CT myelography are useful in the diagnosis of SIH by

pinpointing the site of the CSF leak. Dynamic CT myelography might be valuable in situations of multiple leak sites or high-flow CSF leaks.

The learning objective is to raise awareness of SIH by recognising the common and less common imaging features. This aims to reduce the high rate of misdiagnosis and emphasise the important role of radiologists in diagnosing and treatment of this condition.

Abstract Dr Kiruthika Chandrasekaran, ST4 in Radiology, University Hospital Southampton NHS Foundation Trust MR imaging of anterior knee pain Anterior knee pathology is a frequent cause of joint pain and limitation of function and mobility among patients presenting to an orthopaedic department. Despite its high prevalence, the aetiology and differential diagnosis remains a challenge for the treating physician, mainly due to the fact that there are no specific clinical signs and the term “anterior knee pain� encompasses a wide spectrum of disorders. A good understanding of the normal anatomy and of the various abnormalities which affect this area of the knee will enable us to make an accurate diagnosis.

The initial imaging evaluation usually includes plain radiography which represents a fast and cost-effective way to identify a wide range of knee disorders, such as fractures, osteoarthritic degenerative changes and joint effusions. Multidetector computed tomography (MDCT) offers several advantages over plain radiography, especially for the evaluation of acute knee trauma. But if the medical history, physical examination and initial imaging studies are inconclusive or intraarticular and ligamentous injuries are suspected, then MRI is useful for assessing the soft tissues in and around the knee. The typical MR imaging pattern contributes in establishing the correct diagnosis and thus tailoring the appropriate therapy.

The purpose of this presentation is to provide a comprehensive view of the characteristic MR features of the various common and uncommon disorders causing anterior knee pain.

Biography Dr Jane Phillips-Hughes, Consultant Radiologist and Head of School of Radiology, Oxford University Hospitals NHS Trust Dr Jane Phillips-Hughes has been a Consultant Radiologist at the Oxford University Hospitals NHS Trust since 1995.

She specialises in interventional GI and pancreatico-biliary radiology and endoscopy.

She was Training Programme Director in Oxford from 2005-2013 and is now Head of School.

She was Honorary Editor of the BJR for 2010-13.

She is currently Vice President (Publications) of the BIR. Abstract The role of the radiologist in pancreatic islet cell transplantation Pancreatic islet cell transplantation (PICT) is a novel treatment for patients with type-1 diabetes who have poor hypoglycaemic control despite aggressive medical management.

It is a multidisciplinary procedure that requires radiological image guidance. It is a safe and relatively simple procedure, but understanding the technique and optimisation of the patient pre-procedure is extremely important to reduce procedural complications.

I will review the history of PICT, describe the technique, and present an illustrated review of our experience with percutaneous trans hepatic PICT: 19 patients underwent 31 islet cell transplantation procedures from February 2007November 2013. Patients with C-peptide-negative type-1 diabetes with severe hypoglycaemic control despite compliance with optimal medical treatment were selected as per our institution protocol. The islet cells were obtained from brain-stem dead, heartbeating donors. Access into the portal vein was gained via the percutaneous transhepatic approach. Islet cells were infused with intermittent monitoring of the portal vein pressures.

Technical success (portal vein cannulation and infusion of islet cells) was achieved in all cases. In a majority of cases ultrasound was used as the primary guidance modality. There were 3/31 procedures with serious complications. 75% patients remained insulin free at 6 months and 50% at one year.

Challenges and limitations of the technique will be discussed, and compared to alternative treatments such as whole organ transplantation.

Biography Dr Angela Darekar, Lead MRI Physicist, University Hospital Southampton NHS Foundation Trust Dr Angela Darekar leads the MRI Physics Group, within the Department of Medical Physics, at University Hospital Southampton (UHS) and has worked in Southampton since 1998. Her role includes supporting both the clinical MRI service (e.g. service development, safety and QA), and enabling and supporting research projects utilising MRI, from both within UHS and the University of Southampton, thus covering a wide range of applications.

She has a keen interest in facilitating and encouraging the translation of research MRI techniques into the clinical setting, working closely with clinical colleagues and using her expertise in MRI physics to successfully enable this. She has acquired specialist knowledge in many areas of MRI, including musculoskeletal MRI, the assessment of body and liver fat using MRI, and MRI-based iron quantification. A large component of her work in Southampton has been concerned with applying and developing advanced neurological MRI techniques, both for research and clinical purposes. This has involved establishing appropriate imaging protocols as well as developing image and data processing techniques.

Her PhD, awarded in 2010, was an investigation into the BOLD MRI response of the brain to alterations in blood pressure.

She is a corporate member of the Institute of Physics and Engineering in Medicine (IPEM).

She has served as a member of the IPEM Magnetic Resonance Special Interest Group, and has advised on National Occupational Standards for MRI Physicists. Dr Darekar is a State Registered Clinical Scientist.

Abstract Functional MRI in clinical practice Functional MRI can be used to assess cognitive, motor and sensory processes in the brain and is becoming more widely used in the clinical setting. As such, it needs to be employed in a simple and robust manner. Its main use in such a setting is as a pre-surgical assessment tool, and this talk will describe how this technique has been implemented locally to aid in the lateralisation of language function in temporal lobe epilepsy patients who are candidates for surgery.

Lateralisation of language (and memory) can be achieved by carrying out an intra-carotid amobarbital (WADA) test; however this is invasive, time-consuming and expensive.

Potentially replacing this test with a functional MRI scan, for selected patients, is a cheaper and simpler method to use, which is now being introduced into routine clinical practice.

However, this is still a developing clinical application and there are limitations to the

technique which need to be understood and carefully considered.

This talk will introduce the background to the physiological basis of the BOLD (blood oxygenation level dependent) functional MRI signal and describe what factors affect this signal. Details regarding the practicalities associated with performing functional MRI in a clinical setting will be provided. Finally, the clinical context of this technique and the multidisciplinary approach to its successful implementation will also be discussed, including some local case-studies.

Biography Dr Francis Sundram, Consultant and Clinical Lead Nuclear Medicine, University Hospital Southampton NHS Foundation Trust Consultant and Clinical Lead Nuclear Medicine, University Hospital Southampton NHS Foundation Trust (UHSFT).

Special interests include PET/CT and radionuclide therapy.

Lead clinician for PET/CT at UHSFT .

Wessex representative on the National PETCT Clinical Reference Group (CRG).

British Nuclear Medicine Society (BNMS) Regional Representative for Wessex/South East England.

BNMS Education Committee Member.

Abstract Update and advances in nuclear medicine To provide a brief update on a few key areas in both diagnostic and therapeutic nuclear medicine, with a focus on developments at UHSFT.

Our platinum sponsors

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Philips is a diversified health and well-being company and a world leader in healthcare, lifestyle and lighting. Our vision is to make the world healthier and more sustainable through meaningful innovation.

We develop innovative healthcare solutions across the continuum of care, in partnership with clinicians and our customers to improve patient outcomes, provide better value, and expand access to care.

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FORTHCOMING EVENTS

North Branch meeting: Contrast study day and essential physics for FRCR 23-24 January 2014 Liverpool Radiology errors 31 January 2014 London Scottish Branch meeting: Recent advances in diagnostic imaging 14 February 2014 Glasgow 3rd Annual SPECT/CT symposium: Current status and future directions of SPECT/CT imaging 24 February 2014 London Multi-parametric imaging of prostate cancer can it facilitate a paradigm shift in management?

28 February 2014 London Biological optimisation of radiotherapy 13 March 2014 London Paediatric body MRI course 1 April 2014 London Management and radiology - a guide to current and future management issues in radiology 2 May 2014 London Radiotherapy: meeting the current workforce challenges for patient care 19 May 2014 London

VISIT: WWW.BIR.ORG.UK FOR MORE INFORMATION AND TO REGISTER!

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