EFSUMB Newsletter 2021 - Issue 4 by EFSUMB

EFSUMB Newsletter

European Federation of Societies for Ultrasound in Medicine and Biology

Presidential address Dear members of EFSUMB, dear members of our European ultrasound family, One month ago the General Assembly of our federation took place and elected the members of the Executive Bureau (ExB) and of the committees of EFSUMB. I really would like to thank all the delegates of our national societies for this really exciting election and for the trust you have placed in the newly elected members of EFSUMBs governing bodies.

Female leadership, democratic balance and future challenges For the first time in the history of EFSUMB we will have a female president. Two strong and imaginative women have run for this position. I am very happy about this because this gives voice, weight and a face in the leadership of the EFSUMB to the many women who are advancing medical ultrasound in clinical practice and also scientifically in the countries of Europe. My warmest congratulations to Associate Professor Caroline Ewertsen, the new president elect of EFSUMB! I am also happy that for two out of three positions in the Executive Bureau, there were two candidates for the delegates to choose between. This also required courage from the candidates and they stood for election not only as representatives of their national ultrasound societies, but also as personalities with their own particular visions for the future of the European ultrasound family. Important themes were openness to the different needs of our national and individual members, transparency, diversity, age and gender equality in the committees, but also uniformity in the professional standards across Europe. We will have to address these issues in the com-

ing years and also respond to challenges. How to better balance the interests of the small member societies with those of the large ones such as DEGUM, SIUMB and BMUS, while following democratic principles? How to involve affiliated national societies and individual members in the decision-making processes of our Federation? How to attract new members especially in countries where there are no or only very small national ultrasound societies? How to satisfy the scientifically committed ultrasound experts and at the same time assist the many ultrasound practitioners in practices and hospitals who perform high-quality clinical ultrasound diagnostics with sometimes rather simple equipment and often under high time pressure? How do we want to continue to establish high-quality scientific guidelines in the future with scarce resources and independent of economic interests? How can we succeed in remaining a truly European Federation, but at the same time take into account the justified needs for further ultrasound training in countries also outside our continent where this is difficult? We will look for answers, among other things, by working out proposals for modifications with a new working group. For this we need constructive dialogue with our members. I therefore ask you all to share your ideas and suggestions and, of course, your criticism with us.

EFSUMB Guidelines and Position Papers – a success story to be continued Over the last two decades, high-quality guidelines and continuing education have become important, globally recognised trademarks of the EFSUMB, valued not only in Europe but worldwide. A series of 7 guidelines and position papers on gastrointestinal ultrasound have just been published

under the leadership of our former president Professor Odd Helge Gilja. After the latest edition of the guidelines on contrastenhanced ultrasound (CEUS) of the liver was designed under the umbrella of the WFUMB under the leadership of two former EFSUMB presidents (Professors Christoph F. Dietrich and Christian Nolsoe), the EFSUMB under the leadership of Professor Vito Cantisani has successfully taken up the exciting topic of adapting the radiological Bosniak classification for renal cysts to the superior temporal and spatial resolution of CEUS. The publication of EFSUMB guidelines on musculoskeletal ultrasound diagnostics and point-of-care ultrasound (POCUS) is imminent. We will also soon publish a position paper, led by Professors Matthias Wüstner and Maija Radzina in collaboration between the EPSC and the EC, describing the uniform principles and quality criteria of professional ultrasound in Europe. We will follow up on this topic and describe and compare the different models by which medical ultrasound is practiced in Europe and beyond – everywhere with high quality and expertise, but by different professional groups: Clinicians of different specialisations, radiologists, sonographers and specialists in ultrasound diagnostics. Our past president Professor Paul S. Sidhu described ultrasound in 2015 as a multiparametric imaging modality that can go beyond morphological criteria to describe tissue properties such as elasticity, fat content, viscosity, vascularisation and perfusion. Consequently, our next major guideline project is dedicated to multiparametric ultrasound in pancreas, liver, thyroid, breast, testis and scrotum. There are many good ideas beyond that, we will see if we can muster the enthusiasm and strength to put it all into action in the next few years. Not least due to the guidelines of the EFSUMB published predominantly in our

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journal "Ultrasound in Medicine/ European Ultrasound Journal” (EJU) and the formative activity of the EFSUMB representatives in the editorial board Professors Vito Cantisani and Paul S. Sidhu, the impact factor (IF) of the EJU has continuously improved in the past few years. On 1 July, 2021 we received the great news that the EJU has been documented as having a remarkably high perception in the world of science, with an IF of 6.56 (from 4.966 for 2019). Congratulations to the Thieme publishers, to our coeditors and to all who have contributed by publishing in EJU!

Medical students – the future of ultrasound in Europe Ultrasound has already found its way into the curricula at many universities in Europe. It is not only taught as a diagnostic modality, but also used to understand human anatomy and physiology on living humans and in real time. Medical students and young doctors are now learning ultrasound as part of the clinical examination and are enthusiastic advocates of the method. At our EUROSON congresses in recent years, they designed fantastic programmes of their own with a special touch. We also learn from them the use of social media for the dissemination and training of ultrasound, which thus becomes a truly democratic imaging modality. The Students Committee has beaten all click records on the EFSUMB website with its unique “Image Challenge”, making our federation known and attractive to young medical professionals. This is very much appreciated. Together with the WFUMB, we have launched webinars for medical students in 2021 and want to take up further ideas from the students, especially to establish innovative, contemporary teaching formats for medical students and young doctors. In future, the honorary secretary of the EFSUMB, Professor Helmut Prosch, will therefore provide special support to the Student Committee as an ex-officio member. The Student Committee is also open to the co-option of further student comrades-in-arms from the countries of Europe in order to give this important work a broader platform.

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50th years anniversary: a look back and ahead The 11 February, 2022, marks the 50th anniversary of the founding of EFSUMB. We can look back on those five decades with pride. A rather small group of enthusiasts who met in Basel in February 1972 has grown into a society with a strong membership, which despite political upheavals, in different political systems and under very different economic conditions, and in the face of the rise of other imaging modalities, has defied numerous centrifugal forces and grown together into a strong-minded, lively, discussion-ready and influential European Ultrasound Family. EFSUMB in 2021 is a strong player in the European scientific and educational landscape. But the anniversary is also an occasion to pause, to reflect and to learn from the good and bad experiences of these 50 years of family history. Not all founding societies are still full members of the EFSUMB. The SGUM, whose predecessor society had been invited to the founding meeting, is no longer a full member of the EFSUMB. Belgium and Finland are no longer represented by national ultrasound societies in the EFSUMB. We have had wins and successes but have also suffered losses and setbacks. Some conflicts have accompanied us for more than 50 years. We want to build on the success story of these 50 years by learning from both: from the achievements and progress, but also from the mistakes of this multi-faceted family history. Our next EUROSON Congress from 25–28 May 2022 in Timisoara, jointly organised with WFUMB and the Romanian Ultrasound Society, will provide good opportunities to review 50 years of EFSUMB from different perspectives. I call on all member societies and members of the EFSUMB to add their national ultrasound histories to the “History of Ultrasound” section of our website. Also help us by sending interesting historical ultrasound images from your collections to create an Anniversary Ultrasound Quiz for the Congress in Timisoara. Other material for an anniversary brochure, such as photos of historical ultrasound equipment, anecdotes from 50 years of EFSUMB and memories of the highlights of the major European ultrasound congresses are also very welcome! I personally hope that an ebbing of the COVID pandemic will

enable us to have a successful live 33 rd EUROSON in Timisoara 2022 and to meet again in person. I wish the team around Professor Alina Popescu a good preparation of the joint WFUMB and EFSUMB congress and assure the Romanian ultrasound society and the local organising team our support to the best of our abilities.

Thanks and requests The past 1 ½ years have been strongly influenced by the COVID pandemic. Among others, we have learned one thing in particular: of course, travel educates, but there are also efficient and ecological alternatives for exchanging opinions and constructively working together. Zoom, WebEx, Microsoft Teams and other tools have partly made air travel superfluous. But it was a tough time for many international and national professional societies, including EFSUMB. I would like to express my sincere thanks to Professor Adrian Saftoiu who, as President of our Society, has led our Federation with wisdom, skill and confidence during this difficult time. He has certainly had one of the most difficult presidencies in the history of the EFSUMB and has handled it with flying colours. Thank you Adrian! Professor Paul S. Sidhu has retired from the EFSUMB ExB after 8 successful years of excellent work, marked by important guidelines under his leadership, diplomatic skills in the discussions about the balance within our Federation and far-sighted decisions for the future of EFSUMB. Thank you too, Paul, and congratulations to your election to the WFUMB ExB! And one remains, thankfully, without whom EFSUMB would be difficult to imagine, Lynne Rudd, the organising force and pacesetter for ExB and Committees. Thank you for being with us, Lynne! I would also like to thank another important woman at the side of EFSUMB, Suzanne Cain. You will all have noticed: the EFSUMB website has become better, faster, more beautiful and more secure – and it is accessed hundreds of thousands of times worldwide. But I would also like to thank all of you from so many European countries and beyond who have guaranteed the vitality of the EFSUMB as members and through active participation in committees and guideline groups, as speakers at congresses and in webinars, and as sponsors. I would like to ask you all

to support and critically accompany the representatives of the member societies as well as the individual members, the EFSUMB and the newly elected ExB on our way to closer and more respectful cooperation, democratic federation culture, diver-

sity, open discussion approaches and transparency. Together with you, we want to further advance ultrasound in Europe in the multi-parametric orchestra of imaging modalities.

Christian Jenssen, President

On behalf of the EFSUMB ExB.

EFSUMB Executive Bureau 2021–2023

PRESIDENT Christian Jenssen

PRESIDENT ELECT Caroline Ewertsen

PAST PRESIDENT Adrian Săftoiu

HONORARY SECRETARY Helmut Prosch

HONORARY TREASURER Vito Cantisani

CO-OPTED Alina Popescu

CO-OPTED Adrian Lim

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Education and Professional Standards Committee 2021–2023

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CHAIR Matthias Wüstner

MEMBER Alina Popescu

MEMBER Liat Appelbaum

MEMBER Vladimir V. Miktov

MEMBER Arturas Samuilis

MEMBER Gonçalo Ramos

EX-OFFICIO MEMBER Caroline Ewertsen

CO-OPTED Fernando Alfageme Roldan

CO-OPTED Jay Shyamal Chotai

Publications Committee 2021–2023

CHAIR Julian Künzel

EDITOR Case of the Month Zeno Sparchez

EDITOR Nesletter Malene Roland

MEMBER Maria del Mar Pérez

MEMBER Rosa Coelho

MEMBER Viktors Linovs

EX-OFFICIO MEMBER / EFSUMB EJU EDITOR Vito Cantisani

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Safety Committee 2021–2023

CHAIR Christian Kollmann

SECRETARY Klaus-V. Jenderka

LITERATURE SECRETARY Carmel Moran

MEMBER Susana Marques

MEMBER Panos Antsaklis

MEMBER Fernando Jimenez

MEMBER Emilia von Bohlen und Halbach

MEMBER Daniele Fresilli

Student Committee 2021–2023

MEMBER Flávio Pereira

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EFSUMB Young Investigator Winners 2021 Joint first prize for best technical presentation Improved drug delivery to the brain with Rapid Short-Pulses of focused ultrasound and microbubbles Sophie V Morse1, Tiffany G Chan, Nicholas J Long2, James J Choi1 1 Department of Bioengineering, Imperial College London, London, SW7 2BP, UK 2 Department of Chemistry, Imperial College London, Molecular Sciences Research Hub, London, W12 0BZ, UK

ABSTRACT Introduction Focused ultrasound and microbubbles can locally and noninvasively open the blood-brain barrier, allowing drugs into the brain. Clinical results in adults have been encouraging, however, there are concerns for more sensitive patients – elderly with dementia and children with brain cancer. With current ultrasound methods, drugs are delivered inefficiently to diseased regions with side effects including unpredictable drug distributions, the en-

trance of red blood cells and neurotoxic proteins, and hour-long tissue recovery.

Methods We have developed a Rapid Short-Pulse (RaSP) ultrasound sequence designed to improve drug delivery. We have evaluated the ability of RaSP to improve the performance and safety of drug delivery, by investigating the drug dose, distribution, tissue damage, immune response and tissue recovery in comparison with conventional long-pulses.

Results Despite depositing 150 times less energy into the brain, RaSP sequences delivered drugs more uniformly with a similar dose to long-pulses. RaSP resulted in the barrier closing within just 10 minutes rather than hours, with less neurotoxic proteins entering the brain. The immune response with RaSP was also reduced and no red blood cell extravasation or damage was observed.

Conclusion These results indicate that RaSP sequences will significantly improve the performance

Sophie V Morse

and safety of drug delivery to treat sensitive neurological diseases, such as neurodegenerative diseases and paediatric brain tumours. Sophie Morse was awarded a Masters in Engineering from Imperial College London in 2015 and then pursued a PhD in the Noninvasive Surgery and Biopsy Laboratory at Imperial working on drug delivery to the

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brain using focused ultrasound and microbubbles. She is currently an EPSRC doctoral prize research fellow in the Department of Bioengineering at Imperial College London. She has won numerous awards for her research including the Gold Medal in Engineering at the STEM for Britain event in the UK Parliament and the Image-guided therapy competition at the European Symposium on Ultrasound Contrast Imaging in Rotterdam. Her research interests include the non-invasive delivery of drugs and imaging agents to the brain and cellular stimulation using focused ultrasound.

Joint first prize for the best clinical presentation – Rares Craciun, Romania Ultrasound Guided Microwave Ablation and Transarterial Chemoembolization for Unresectable SolitaryNodule Hepatocellular Carcinoma – a Head-to-Head Survival Comparison Craciun Rares1,2, Mocan Tudor 1,2, Horhat Adelina1,2, Teglas Cristian1, Nenu Iuliana1,2, Comsa Mihai1, Sparchez Zeno1,2 1 “Prof. Dr. O. Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 2 ”Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca

ABSTRACT Introduction To compare the overall survival (OS) of patients treated with ultrasound guided microwave ablation (MWA) and transarterial chemoembolization (TACE) for a solitary hepatocellular carcinoma (HCC) nodule.

most of my professional formation within the “Prof. Dr. O. Fodor” Regional Institute of Gastroenterology and Hepatology in Cluj-Napoca, one of the largest tertiarycare facilities in Romania. In the past six years, my clinical focus was on hepatology, split between liver tumors and portal hypertension. Currently, I am a Ph.D. candidate, the research activity closely matching my clinical interest. To this point, I have coauthored over ten publications, mostly on interventional therapies in hepatocellular carcinoma and liver metastases, while being actively involved in the local and European scientific community.

Craciun Rares

function and patient preference. OS was compared using the log-rank test.

Results A total of 107 patients were enrolled, of which n = 77 (71.9 %) were treated with MWA and n = 30 (28.1 %) were treated with TACE. Patients in the TACE group had larger nodules (34 ± 9 vs. 23 ± 8 mm, p < 0.001). There were no other significant differences between groups with regards to patient characteristics. Complete response rate was higher in the MWA group (92.4 % vs. 70 %, p < 0.001). OS was significantly higher in the MWA group: 52 ± 3 months vs. 24 ± 1 months for the TACE group (log-rank 10.25, p < 0.001). Subgroup analysis was performed for patients with tumor size exceeding 3 cm. The difference in OS between groups persisted: patients who received MWA (n = 11) had an OS of 47 ± 5 months vs. 22 ± 2 months for TACE (logrank 4.41, p = 0.03).

A consecutive series of patients with a solitary, unresectable, HCC nodule under 5 cm in its largest diameter was prospectively enrolled from November 2015 to December 2019. The patients received either MWA or TACE. Treatment selection was decided by the institutional Tumor Board according to the most recent guidelines, considering tumor characteristics, underlying liver

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On Saturday, May 29, the 2021 EFSUMB Young Investigators Award session was launched. Initially, the session was supposed to be held at EUROSON 2021 in Timisoara, Romania, but the congress was cancelled due to the status of the pandemic. Despite this, the nominated young investigators, including myself, got the chance to present and win the award, which included the title and a money prize. We were all invited to participate in an online award session: a format we are all quite familiar with at this point.

Ultrasound guided MWA provided a better outcome for patients with solitary unresectable HCC nodules, when compared to TACE. Whenever possible, prioritization of MWA appears to be desirable.

At first, EFSUMB planned the presentations to be prerecorded. However, they decided a few weeks before the session to make it live instead using Zoom. There is no doubt that this made the session more vivid and exciting. However, it also brought along the challenges of online meetings, including young children at home, unmuted computers or phones, and technical issues when sharing the presentations. Luckily, I think the last year and a half has taught us all a great deal of patience and understanding for each other’s situations, working and presenting our results from home.

Born and raised in Transylvania, I am a GI and Hepatology fellow in training in my fourth year of practice. After receiving an MD degree at the “Iuliu Haţieganu” University of Medicine and Pharmacy, I have spent

The seven young investigators presented a broad range of topics. In the more technically oriented category, three pre-clinical studies all dealt with microbubbles. The talks in this category illustrated how the

Conclusion Methods

Review of the session for the EFSUMB Young Investigators Award 2021 by participant Sofie Bech Anderson

Sofie Bech Anderson

use of the tiny gaseous bubbles has expanded from being purely diagnostic to being both diagnostic and therapeutic. I gave a talk about how microbubbles make it possible to map the microvasculature at levels well below the diffraction limit of conventional ultrasound. This technique, called ultrasound super-resolution imaging, can potentially help us improve diagnostics and monitor diseases such as cancer and diabetes, where microvascular disruption plays a central role. Kirby Lattwein from the Netherlands showed how microbubbles can dissolve the devastating biofilm made by pathogenic bacteria: a technique called

Sonobactericide. Her results indicated that this treatment strategy has the potential to help thousands of persons affected by biofilm infections in the future. The winner of the technical part of the session, Sophie Morse from the UK, led us through her research on improved drug delivery to the brain with rapid short-pulses of focused ultrasound and microbubbles. She illustrated how instead of using long pulses of ultrasound, the rapid short-pulses improved the technique by, e. g., delivering drugs more uniformly to the tissue, closing the blood-brain barrier faster, and letting fewer neurotoxic proteins into the brain. This technique can improve drug delivery to the brain in the treatment of various neurological disorders. In the clinically oriented talks, research in liver cancer diagnostics and treatment prevailed. The winner of this session, Rares Craciun from Romania, showed how ultrasound-guided microwave ablation provided a better overall survival for persons with solitary unresectable hepatocellular carcinoma nodules compared with transarterial chemoembolization, indicating that microwave ablation should be used for this group of patients whenever possible. Teodora Komitova from Bulgaria presented research showing that ablation can benefit persons with hepatocellular carcinoma at stage BCLC-B (Barcelona clinic liver cancer (BCLC)

staging) and cirrhosis stage Child-Pugh B. Marco Arru from Italy also investigated the liver, but with a diagnostic aim. He had studied the contrast-enhanced ultrasound Liver Imaging Reporting And Data System (LI-RADS) as a diagnostic tool to better differentiate hepatocellular carcinoma and intrahepatic cholangiocarcinoma. Last but not least, and with a very different topic than the other clinical presentations, Tasias Konstantinos from Greece presented his research on the prevalence of agenesis of ductus venosus (ADV) in an unselected population, the types of drainage in ADV and the associated structural or chromosomal abnormalities as well as the postnatal outcome in these cases. After all the presentations were done, the judges went into a break-out room to decide on the winners. It was a peculiar experience, waiting alone behind the screen, but the moderators made a great effort to make us all entertained and fill the silence. After the winners had been announced, kind congratulations to all the participants ticked silently into the chat. We left the session to sit in each of our respective countries. I sat in my empty office at the empty university on a sunny summer day. It was a quiet way to end the experience. I really hope that next year’s participants get to meet and present in person.

EFSUMB Best Published Paper Prize 2021 Awarded to Sophie Morse for the publication entitled Rapid Short-pulse Ultrasound Delivers Drugs Uniformly across the Murine Blood-Brain Barrier with Negligible Disruption Journal: Radiology May 2019 291(2): 459–466

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EFSUMB Schools

EFSUMB Webinars (Past recordings can be found on the EFSUMB website webinar archive)

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EUROSON 2022, Timisoara Romania

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