2018 issue02 efsumb online pdf

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EFSUMB Newsletter

European Federation of Societies for Ultrasound in Medicine and Biology

EFSUMB welcomes Georgia as its newest society tries. Radiology used to be a unity of different subspecialties. Today, ultrasound is part of general radiology and it is mostly performed by radiologists with some exceptions: neurosonoscopy, cardiovascular examinations – conducted by physicians and radiologists.

Dr. Elene Gotsiridze – EFSUMB delegate

Professional background Dr. Elene Gotsiridze graduated from Tbilisi State Medical University in 2008. Completed residency in radiology in 2010 in Tbilisi, Georgia. The same year graduated from the Geojeff – Jefferson Ultrasound Radiology Education Institute (JUREI) (Philadelphia, Pennsylvania, USA) affiliated center in Tbilisi, Georgia. Underwent training in Radiology (CT,MRI, ultrasound) at the Corintains Diagnostics radiology centre in New York in 2010. Started pediatric ultrasound investigations from 2015 following fellowship program at Department of Pediatric radiology of the Cologne University Clinic in Germany. Since 2011 Elene has been working as a radiologist/ultrasound specialist at various institution in Tbilisi, Georgia. Currently works at the European Limbach diagnostic group – “Mrcheveli” and “Jo Ann” medical centre in Tbilisi, Georgia. In 2016 the Georgian Association of Ultrasound was founded. The Association has twenty members: ultrasound specialists, radiologists, hepatologists, gastroenterologists, and pediatricians. Its goal is: ▪ bringing together young specialists for development of this direction

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Population: 3.719 million (2016) Area: 69,700 km² Capital: Tbilisi EFSUMB members: 20

▪ enhancing communication with local and international colleagues ▪ sharing knowledge and information ▪ implementing new diagnostic methods ▪ educational and scientific activities ensuring continuous professional development ▪ translating International guidelines into Georgia and implementing in everyday practice ▪ involving regions and provinces in all activities Training in ultrasound In order to receive a license as a radiologist/ ultrasound specialist in Georgia, one has to undergo three year residency in general radiology – continuous professional medical education; the course contains education on x-ray and ultrasound.

The Georgian association of radiology was founded in 1997 by Professor Pridon Todua. Nearly 120 radiologists are united in this association. There is also the Association of cardiovascular and interventional radiology founded by Dr. Malkhaz Mizandari in 2009. Ultrasound examinations are available throughout country at nearly all medical clinics and diagnostic centres. The population of Georgia has easy access to it through both medical insurance programs and/or personal visits. Access to medical care in Georgia The Georgian Government provides financial coverage through the Ministry of Labour, Health and Social Affairs of Georgia, which includes state and social service agency; however, patients have to share expenses for some services through co-payment. The State finances healthcare but delivery of medical care is reliant on private medical facilities. The insurance sector is one of the mostly developed sectors of Georgia. A number of private insurance companies offer the population medical insurance schemes.

Short-term training courses are organized by the Geojeff – Jefferson Ultrasound Radiology Education Institute (JUREI) (Philadelphia, Pennsylvania, USA) affiliated center in Tbilisi, Georgia, every three months for both local and international students.

Citizens of Georgia who are insured by private companies are able to access medical care at any private medical institutions; the part of population which does not have private insurance relies on state partial coverage.

Radiology and Ultrasound examinations in Georgia Medicine and all its subspecialties in Georgia are rapidly developing, as in all ex-Soviet coun-

Apart from this, there are certain projects of the Ministry of Health of Georgia under which certain criteria are set for providing total financial cover for medical care.

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EFSUMB Newsletter

History of Ultrasound Just to summarize in a few words that in 1972, the delegates of 13 European ultrasound societies met in Basel, Switzerland for the formal foundation of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB). Today the Federation comprises 29 National Societies with 21 000 members, which means EFSUMB is the largest Society within the World Federation for Ultrasound in Medicine and Biology (WFUMB). The European Federation’s purpose has been to promote the exchange of scientific knowledge in the field of ultrasound. EFSUMB aims are served by arrangement of congresses, meetings and courses at an international level, as well as the exchange of information both in and outside Europe by the member organizations (Dietrich CF, Rudd L, 2013; Dietrich CF et al., 2017). EFSUMB in general has aimed to enrich the ultrasound community with updated material on many aspects of ultrasound. History of ultrasound details may be forgotten soon since so many pioneers have been passing away and with them the detailed know-

ledge of the first scanners, congresses and meetings by competition and friendship. EFSUMB is aware that this is the right time to reflect and illustrate the achievements of European Ultrasound. EFSUMB has strengthened the interdisciplinary collaboration in the field of diagnostic ultrasound and promoted safety of ultrasound in medical use and most recently started a project on EFSUMBs History of Ultrasound ▪ To summarize the history of ultrasound from the very beginning up to the introduction of the most recent technologies of contrast enhanced ultrasound and elastography. ▪ To present the very beginning and advances of ultrasound technology. ▪ To present the pioneers and their important followers. ▪ To present most important references. ▪ To present important events (congresses). ▪ To present illustrative images of the pioneers and technologies. ▪ To present the convergence and divergence of various ultrasound disciplines.

One of the main objectives is to give the EFSUMB member societies a platform to present their impressive achievements. Over the next month EFSUMB will collect the information of member societies on the EFSUMB website. We might finally achieve a book, e-book or at least an app of all this important information. Please consider contributing with facts, photos and memories of our beautiful method under the principle “when art meets the history of ultrasound science”. Christoph F Dietrich EFSUMB Past President 2013 – 2015 References 1. Dietrich CF, Rudd L. The EFSUMB website, a guide for better understanding. Med Ultrason 2013; 15: 215 – 223. 2. Dietrich CF, Rudd L, Saftiou A, Gilja OH. The EFSUMB website, a great source for ultrasound information and education. Med Ultrason 2017; 19: 102 – 110.

EUROSON 2018 Poznan, Poland EUROSON 2018 in POZNAN (The 30th EUROSON Congress of the EFSUMB) We have the great pleasure to invite you to the 30th EUROSON Congress of EFSUMB, which will take place in Poznan 6 – 9 September 2018. The Congress will be held in the Congress Centre of the Poznan International Fair simultaneously with the XIV Congress of Polish Scientific Society of Ultrasonography.

Ultrasound Education Center for Students – EUROSON 2018 “Let's Make Ultra-Future Together” Thursday: 15:00 – 16:30 Opening Ceremony

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Friday: 9:00 – 10:00 “Test Your Knowledge” – Ultrasound Anatomy of the Abdomen 10:00 – 11:45 “Test Your Skill” – Hands-onTraining with Real-Time Examination Guide: Abdomen 11:45 – 12:00 Q & A with The Expert 12:00 – 13:00 “Test Your Experience” – Ultrasound-based Differential Diagnosis Challenge: Abdomen Part I 13:00 – 15:00 Lunch (Hands-on-Training) 15:00 – 16:00 “Test Your Experience” – Ultrasound-based Differential Diagnosis Challenge: Abdomen Part II 16:00 – 17:00 Guest Presentation

Saturday: 9:00 – 9:45 Tips & Tricks for Abdominal Ultrasound (with Hands-on-Training) 9:45 – 10:00 Q & A with The Expert 10:00 – 11:00 “Test Your Knowledge” – Ultrasound Anatomy: Thyroid, Neck, Mediastinum, Lungs 11:00 – 12:00 Guest Presentation 12:00 – 13:00 “Test Your Skill” – Hands-onTraining with Real-Time Examination Guide: Thyroid, Neck, Mediastinum, Lungs Part I 13:00 – 15:00 Lunch (Hands-on-Training) Sunday: 9:00 – 10:00 “Test Your Skill” – Hands-onTraining with Real-Time Examination Guide: Thyroid, Neck, Mediastinum, Lungs Part II Ultraschall in Med 2018; 39: 225–229


10:00 – 12:00 “Test Your Experience” – Ultrasound-based Differential Diagnosis Challenge: Thyroid, Neck, Mediastinum, Lungs 12:00 – 13:00 Tips & Tricks: Thyroid, Neck, Mediastinum, Lungs 12:45 – 13:00 Q & A with The Expert 13:00 Closing Ceremony

UltraSQAN – Ultrasound Student Quiz for Advanced and Novice at EUROSON 2018 We invite everyone interested in testing their ultrasound knowledge to take part in the UltraSQAN – Ultrasound Student Quiz for Advanced and Novice. The competition will be conducted in two categories:

a team of 3-person groups of students from all over Europe, and an individual one in which every participant of the EUROSON Congress can take part. The tournament will be conducted in two parts, theoretical and practical. At first, teams and individual participants will answer a number of questions regarding ultrasound anatomy, ultrasound physics, basic diagnostic challenges and more… This phase will be carried out using the Kahoot! App, therefore it is necessary to have an electronic device with Internet access (i. e. smartphone) on which the free Kahoot! App has been installed! An individual winner will be selected and receive a surprise gift from the organizers of the EUROSON Congress. The theoretical part will also allow us to select two best student teams that will cross transducers in the practical part.

In the second part of the Quiz, both teams will have the opportunity to present their skills by performing a number of tasks assigned to them by the Competition Jury. Victory will be determined by precision, knowledge of various examination techniques, ingenuity and time of task completion. The second stage will select three Best Young Sonography Adepts in Europe. Three-person teams of students wishing to take part in the Quiz are invited to send their application to: euroson2018@mtp.pl (please write “UltraSQAN” in the title of the application). Individual participants will be able to take part in the Competition without prior registration. The competition will be conducted in English.

What does the EFSUMB 7 euro membership fee provide? ▪ Guidelines on topical issues – with free access – Update on CEUS non-liver, ePublished – Elastography non-liver guidelines, in preparation – Gastrointestinal US guidelines, part published – Point of Care guidelines, in preparation – Musculoskeletal guidelines, planned – Rheumatology guidelines, planned – CEUS liver guidelines update, under review ▪ Atlas of images to accompany the guidelines – Atlas of normal images under preparation ▪ The App publication EFSUMB Course Book 2nd Edition (free to download from website) – Editor Christoph F Dietrich

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▪ Reduced rates at EUROSON Congresses ▪ Website with information on Euroson Schools – Archived recordings of CEUS Euroson Schools ▪ Information on EFSUMB Endorsed Courses ▪ Webinars with free access on Contrast Enhanced US – Access to the webinar archive on CEUS and Elastography ▪ EFSUMB Case of the Month – Archive of unusual and interesting cases ▪ Working with other international Societies to bring ultrasound to the community ▪ WFUMB membership – EFSUMB payment of 1.50 USD for each of our 21,621 members

Why EFSUMB needs you ▪ To promote ultrasound in large and lower middle income countries ▪ To implement good quality practice ▪ To provide ultrasound education ▪ To promote research ▪ To reach the public and politicians to implement investment in ultrasound within health systems ▪ For National Society nominations of leaders for EFSUMB and WFUMB committees ▪ To endorse projects to improve ultrasound in Europe ▪ To propose future direction and accountability for EFSUMB policies ▪ To bring good clinical practice to the patient – our customer!

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EFSUMB Newsletter

Future Euroson Schools

Joint ESR/EFSUMB Session at ECR 2018 This year at ECR 2018, the joint ESR/EFSUMB session was Elastography of Superficial Structures: Where are we now? The session was moderated by Prof. Paul Sidhu EFSUMB President and Prof. Michel Claudon, Chairman of US working Group and an EFSUMB Past President. ▪ Thyroid US elastography: indications and limitations Vito Cantisani (Italy)

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▪ Elastography of the breast: when should we assess tumour stiffness? Jonathan Carlsen (Denmark) ▪ Is there any value in tendon and nerve assessment? Andrea Klauser (Austria) ▪ Scrotal elastography: hype or real? Michele Bertolotto (Italy) The session was very well attended and the room was crowded. The stimulating discussions were animated by several questions

on the widespread use of elastography of superficial structures, to understand the strengths and weaknesses of current applications, to be able to appreciate the potential in many fields and to be able to incorporate elastography into clinical practice. Dr. Cantisani, Chairman of EFSUMB Publication and of Policlinico Umberto I, Univ. Sapienza, US and Diagnostic innovations Unit, provided the personal experience and Ultraschall in Med 2018; 39: 225–229


an update of the current literature, focusing especially on the already published recommendations by EFSUMB and WFUMB and anticipating the upcoming EFSUMB ones about US elastography thyroid nodule characterization. To date, only few papers have been published to compare the accuracy of strain and shear wave elastographic techniques. Both the techniques seem to be useful in the multiparametric ultrasound evaluation increasing the accuracy in this setting. Some premises have been shown by means of 2 – 3 and mechanical 3D USelastography which is postulated to be useful especially for the planning and follow up on mini-invasive treatments. For breast tumour diagnostics, Dr Carlsen stressed that elastography should be used in combination with B-mode examination. Both strain and shear wave elastography can be used, and it was discussed if strain elastography may be preferable for evaluation of stiff tumours, while shear wave elastography is more reliable in soft tumours. The ways of combining elastography with the BI-RADS classification has been the topic of many articles, and for comparative

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evaluations of breast elastography studies, the awareness of the different combinations used is pivotal. Dr Carlsen concluded that both strain and shear wave elastography should mainly be used as an adjunct for assessing probably benign (BIRADS 3) and low-suspicion tumours (BIRADS 4a), where elastography can be used to either upgrade or downgrade tumours. Despite the increasing number articles in the last years in musculoskeletal diseases, only a limited increase in evidence level is observed. For Achilles tendinopathy, ultrasound elastography increased in evidence level from D to B with an expert indication grade of 3. In addition, the use of ultrasound elastography was scored with evidence level B of and an indication grade of 1 for soft-tissue tumour examination. This is understandable as ultrasound elastography is designed to distinguish tissues with different stiffness and believed that ultrasound elastography for soft-tissue masses and nerve entrapment is a promising technique. We have to acknowledge that most published studies related to ultrasound elastography are pre-clinical or feasibility

studies, currently insufficient to increase the evidence level. However, the progressive implementation of musculoskeletal ultrasound with ultrasound elastography should produce studies with the potential to impact clinical practice. Prof. Klauser (Medical University Innsbruck) concluded, that at the moment elastography impacts on tendon disease with Level 1b, recommendation 1, whereas nerves show a lower level of 2b. Further longitudinal studies in order to verify impact of elastography in musculoskeletal disorders in clinical routine examination is still demanded. Finally, Prof. Bertolotto from University of Trieste updated the current knowledge on Testis US elastography. He concluded that testicular lesions need a multiparametric assessment, mainly based on colour Doppler US and CEUS, reserving to US elastography an additional role. The session will be repeated at EUROSON 2018 in Poznan, Poland from 6 to 9 September.

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