EFSUMB Newsletter 2011 - 1st Issue

EFSUMB Newsletter

EFSUMB Newsletter European Federation of Societies for Ultrasound in Medicine and Biology

Editorial Michael Bachmann Nielsen

Each year the first issue of the EFSUMB Newsletter is sent to all EFSUMB members. This issue, which you are currently holding in your hands, contains all the of-

Future Courses

ficial papers from the society, including the reports from ExB and Committee chairmen. In addition we are pleased to present the winner of the Young Investigator Award 2010 and to highlight upcoming meetings.

The remaining issues of the Newsletter are published together with our journal every second month, and sent to all members who have joined the bulk subscription, currently 60 % of the members. You can always find the Newsletter on our website.

Michael Bachmann Nielsen Editor EFSUMB Newsletter

Title

Information/Contact

City, country

23–25 June 2011

CEUS School Microbubble Ultrasound Imaging Course

Eddie Leen edward.leen@csc.mrc.ac.uk

London, United Kingdom

26–29 August 2011

WFUMB EUROSON ULTRASCHALL 2011

www.wfumb2011.org

Vienna, Austria

23–24 Thorax-Sonography September 2011

November 2011

CEUS School

Prague, Prof Jan Tuma Czech Republic Jan.Tuma@hin.ch Gebhard Mathis gebhard.mathis@cable.vol.at Dr Hans Peter Weskott Central Ultrasound Department, Klinikum Region Hannover, Siloah Hospital weskotthp@t-online.de

Hannover, Germany

3–5 November 2011

CEUS and Doppler Ultrasound Course

Prof Jan Tuma Jan.Tuma@hin.ch

Košice, Slovakia

22–24 April 2012

EUROSON 2012

www.euroson2012.com

Madrid, Spain

10–13 May 2012

Interventional Ultrasound

Prof Dr Dieter Nűrnberg d.nuernberg@ruppiner-kliniken.de

Berlin, Germany

Contents ▶▶Editorial

91

▶▶Future Courses

91

▶▶President’s Report to the Board of Directors

92

▶▶Honorary Secretary’s Report to the Board of Directors

93

▶▶Honorary Treasurer Report to the Board of Directors

96

▶▶ECMUS Committee Report to the Board of Directors 97 ▶▶EFSUMB Education & Professional Standards Committee Report to the Board of Directors 99 ▶▶EFSUMB’s Publications Committee Report to the Board of Directors 100 ▶▶Report on Ultraschall in der Medizin/ European Journal of Ultrasound to the Board of Directors 100 ▶▶WFUMB 2011,

101

▶▶Winner of the Young Investigator Award – Luca Maria Sconfienza M.D

101

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EFSUMB Newsletter EFSUMB Officers and Committees

EUROSON 2010 Copenhagen, Denmark

President’s Report to the Board of Directors Executive Bureau 2009–2011

President: C Nolsøe (Denmark) President Elect: Fabio Piscaglia (Italy) Past-President: N Gritzmann (Austria) Honorary Secretary: C F Dietrich (Germany) Honorary Treasurer: I Sporea (Romania)

Christian Pállson Nolsøe

ECMUS – European Committee for Medical Ultrasound Safety Chairman: G ter Haar(UK) Members: M Delius (Germany) L Doležal (Czech Republic) C Kollmann (Austria) K Salvesen (Norway) L Valentin (Sweden)

Education and Professional Standards Committee

Chairman: O H Gilja (Norway) Secretary: H Strunk(Germany) Members: G Mathis (Austria) J Tuma (Switzerland) J Walton (UK) Co-opted: B Brkljačić (Croatia) Co-opted: F Drudi (Italy) Co-opted: CF Dietrich (Germany) Ex-officio: F Piscaglia (Italy)

Publications Committee

Chairman: M Bachmann Nielsen (Denmark) Members: L Greiner (Germany) J Y Meuwly (Switzerland) Torben Lorentzen (Denmark) Co-opted: Paul Sidhu (UK) Co-opted: Adrian Saftoiu (Romania) Ex officio: CF Dietrich (Germany)

EFSUMB Newsletter

Editor: M Bachmann Nielsen (Denmark)

Secretariat

Mrs Lynne Rudd, EFSUMB General Secretary 36 Portland Place, London W1B 1LS, U K Email: efsumb@efsumb.org Website: www.efsumb.org

Ultraschall in Med 2011; 32

I take this opportunity to thank our “new” General Secretary Lynne Rudd for all her hard work and efforts to make possible the many functions of our society and its different committees. Lynne you have a very steep learning curve and the energy of half the UK rugby team or the like, plus and unsurpassed multitasking capacity.

Since you took over this important but also demanding position only approximately one year back you have gained full control of the many, many different task and duties asked for from the General Secretary. Congratulations, this is really a great achievement. In addition you are an almost always smiling and very nice and easy person to work with.

Congresses ▼▼

In the EFSUMB universe time is a relative entity in the sense that there is rarely a year between two consecutive annual EUROSON Congresses. Thus there were only 8 months between EUROSON 2010 and our immediately previous congress, EUROSON 2009 in Edinburgh whereas there was a time lap of 18 months between EUROSON 2008 in Timisoara and the congress in Edinburgh. The reason for this being that a EUROSON Congress has to coincide with the national meeting of the hosting society. As a matter of fact there could have been as little as 5 months between the Edinburgh and Copenhagen congresses had the Danish Society of Diagnostic Ultrasound not decided to postpone their annual meeting from May to August. This cadence is a potential suboptimal arrangement that might be subject to change. Fortunately for those who like annual events to happen with approximately one year’s interval, our next congress will take place in exactly one year from now in Vienna August 26–29 2011. This

congress has the potential of being a once in a life time experience featuring the unique jointed meetings of WFUMB, ­EFSUMB, Dreiländertreffen, DEGUM, SGUM and ÖGUM and a lot of effort is put into making this a successful event by the organising committee under the leadership of Congress President Gerhard Mostbeck. I take this opportunity to thank our Past General Secretary Gianna Stanford for all her efforts and hard work to facilitate and make possible the many functions of our society and its different committees, since she took up her important position back in 1995. Gianna, you have been the very heart of EFSUMB for 14 years and we wish you a happy retirement.

You really deserve it.

Membership Status ▼▼

Founded back in 1972 with 13 national ultrasound societies to start with, EFSUMB now has 30 member societies and a total of 21,826 members. This means that we have crossed the magic line 20,000 by an increase from 19,524 to the present number of members. The main reason for this increase is found in the successful creation of the French Federation of Ultrasound (FFU) whereby several sub specialised French national ultrasound societies joined forces in the newly formed FFU, thereby increasing the French membership number from 291 to 2300 FFU in one step. Allow me to express a warm welcome to these 2010 new members. You are now a part of the world’s largest ultrasound society. If you go to the web site and click on the left side, number 2 down, menu point “Membership” you can read what advantages this includes for you as a society as well as individual members. I wish to congratulate FFU and the entire French ultrasound world with this great achievement and allow me furthermore to spell out in capitols that this is an example that ­EFSUMB would be happy to see followed in other of its member societies. EFSUMB is a federation of multidisciplinary national societies, and thus we strongly encourage our member societies to join forces with as many sub specialised national ultrasound societies as possible.

The more members, the stronger our voice when we speak in the European and international world of medical imaging.

EFSUMB Newsletter Our Journal ▼▼

Among other things, each year you will receive the first issue of EFSUMB official journal “Ultraschall in der Medizin/European Journal of Ultrasound” (UiM/EJU).

This is the world’s highest-ranking interdisciplinary ultrasound journal with an Impact Factor of 2.389. The new impact factor ranks the Journal #37 of 104 journals in the category „Radiology, Nuclear Medicine & Medical Imaging“ of the 2009 Thomson Reuters Journal Citation Reports. For comparison, Ultrasound in Medicine and Biology ranks #46, the Journal of Ultrasound in Medicine ranks #74.

Eleven of the 30 EFSUMB member societies have signed up to bulk subscription at a greatly reduced price, making UiM/EJU the official national journal of these societies and delivering the journal to the front door of each individual member 6 times annually.

I strongly suggest the non-bulk-subscribing societies, consider joining this advantageous arrangement.

Economy ▼▼

EFSUMB, as you can read in the Honorary Treasurers report, is happy to be in a strong financial position.

EFSUMB has no interest in accumulating money. According to our constitution we are put in this world to promote the exchange of scientific knowledge in the field of medical ultrasound. This is one of the major objectives of EFSUMB. Our aim is to build an educational portal on the web for the free use of it. It is therefore a great pleasure that our beneficial financial situation gives us the economic power to invest time and money in providing free information and education to ultrasound professionals throughout the world and not only to our numerous members, but actually to anybody who has internet access.

Committees ▼▼

I wish to direct a sincere thank to all members of the EFSUMB Executive Bureau (ExB) and our three committees: Education and Professional Standards Committee (EPSC), Publications Committee and European Committee of Medical Ultrasound Safety (ECMUS) for all the hours and hard work each of you have put in throughout this last term. Specific reports from each committee report can be found in the handed out BoD papers.

Particularly worthwhile mentioning, though, is the joint effort to establish an Educational Portal, headed by the EPSC, and a web based EFSUMB European

Course Book (ECB), lead by Honorary Secretary Christoph Dietrich, which are both being launched at our website these very days.

Other great achievements are the constantly increasing EUROSON School concept with, among other excellent courses, the newly established series of CEUS post graduate courses facilitated by BRACCO sponsorship, plus the ECMUS` own Micro Site with tons of information about safety of medical ultrasound and the literature thereof.

I intend to make it my major goal for the coming term to support the efforts of creating a superb educational portal with multimedia materials of all kinds. Guidelines, tutorial articles, picture gallery, case reports, “State-of-the-art” presentations, “how-to-do-it-videos” etc should be available on all major topics in medical ultrasound. Some of it you can already find at our website www.efsumb.org – a lot of it needs to be implemented.

Building a European ultrasound community is the EFSUMB motto, and we are right at it – but we strongly need input and help from both our member societies and all our individual members.

Let me know if you have visions for ­EFSUMB Christian Pállson Nolsøe President EFSUMB Email: cnolsoe@dadlnet.dk

Copenhagen, Denmark 21 August 2010

Honorary Secretary’s Report to the Board of Directors Introduction ▼▼

The task of the Honorary Secretary was even more exciting in the last period since a new General Secretary came on stage of EFSUMB, Lynne Rudd. I was amazed how easily Lynne Rudd took over the task as General Secretary of EFSUMB with excellent work, daily support and perfect good relationship; dear Lynne, thank you very much!

Identity of EFSUMB, European Course Book (ECB) ▼▼ Intention of the book

My personal workload during the last year was very much influenced by the prepara-

tion and publication of the European Course Book (ECB). We could publish the first chapters on the website on August 1st 2010 (Introductory Chapter [Educational Activities of EFSUMB], Liver, Estimation of Liver Stiffness Using Ultrasound Waves, Pancreas, Gastrointestinal Tract, Nephrology [Transplantation], Chest, Interventional Ultrasound and Sonopsychology).

There was an intensive discussion with the members and friends of the Executive Bureau (ExB), Publication Committee (PC) and Educational Committee (EPSC) since all the members have been involved in the success story. Authors from Austria, Czech Republic, Denmark, France, Germany, Italy, Norway, Poland, Romania, Sweden and the United Kingdom contributed to the first published seven chapters and re-

Christoph F. Dietrich

views and many other chapters are under preparation or even almost ready for publication. All members of the Board of Directors are invited to participate on the ongoing process of publication and reviewing chapters.

The ECB is Work in Progress

Just to repeat: The EFSUMB Course Book (ECB) is intended to supplement and complete the educational purposes of ­EFSUMB. The ECB might, therefore, strengthen the

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EFSUMB Newsletter evolution and power of EFSUMB and to improve the identity of its members. The course book is devoted to the interdisciplinary approach of the multinational societies of EFSUMB. The book might be especially helpful for countries which have not created so far their own course system. The ECB will incorporate the minimum training recommendations for the practice of medical ultrasound published

by EFSUMB. The book will be published on the website in close collaboration with the EFSUMB Publication and Education committees.

The Published Chapters in Detail:

▶▶Educational Activities of EFSUMB Odd Helge Gilja (National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, and Institute of Medicine, University of Bergen, Bergen, Norway), Michael Bachmann Nielsen (Dept of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark), Jan Tuma (Uster, Switzerland). ▶▶Ultrasound of the Liver Christoph F. Dietrich (Medizinische Klinik 2, Caritas-Krankenhaus Bad Mergentheim), Carla Serra (University of Bologna), Maciej Jedrzejczyk (Department of Diagnostic Imaging, 2nd Medical Faculty of Warsaw Medical University). ▶▶Estimation of Liver Stiffness Using Ultrasound Waves Ioan Sporea (Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Timişoara, Romania), Mireen Friedrich-Rust (Department of Internal Medicine 1, J.– W.–Goethe-University Hospital, Frankfurt, Germany), Odd Helge Gilja (National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, and Institute of Medicine, University of Bergen, Bergen, Norway). ▶▶Pancreas D’Onofrio Mirko (Department of Radiology, GB Rossi University Hospital, Verona, Italy), Vullierme Marie-Pierre (Department of Radiology, Beaujon Hospital, Paris, France), Válek Vlastimil (Department of Radiology, Brno University Hospital, Czech Republic), Principe Francesco (Department of Radiology, GB Rossi University Hospital, Verona, Italy), Canestrini Stefano (Department of Radiology, GB Rossi Uni-

Ultraschall in Med 2011; 32

versity Hospital, Verona, Italy), Gallotti Anna (Department of Radiology, GB Rossi University Hospital, Verona, Italy), Pozzi Mucelli Roberto (Department of Radiology, GB Rossi University Hospital, Verona, Italy). ▶▶Transabdominal Ultrasound of the Gastrointestinal Tract Alois Hollerweger (Abteilung für Radiologie, Nuklearmedizin, Krankenhaus Barmherzige Brüder, Salzburg, Austria), Klaus Dirks (Department of Gastroenterology, Klinikum Stuttgart – Hospital Bad Cannstatt, Germany), Kazimierz Szopinski (Department of Diagnostic Imaging, Second Faculty of Medicine, Medical University of Warsaw, Poland). ▶▶Nephrology, Transplantation and Shunts FM Drudi, F Malpassini, N Di Leo (Department of Radiology, University „La Sapienza“, Viale Regina Elena 324, 00161 Rome, Italy). ▶▶Chest Sonography Gebhard Mathis (Rankweil, Austria), Z Sparchez (3rd Medical Clinic, Department of Ultrasound, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania), G. Volpicelli (Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy).

▶▶Interventional Ultrasound Christian P. Nolsøe (Department of Gastroenterological Surgery, Herlev Hospital, Danmark), Torben Lorentzen (Department of Gastroenterological Surgery, Herlev Hospital, Danmark), Bjørn Ole Skjoldbye (Department of Radiology, Rigshospitalet, Copenhagen, Denmark), Michael Bachmann Nielsen (Department of Radiology, Rigshospitalet, Copenhagen, Denmark), Anders Nilsson (Department of Radiology, Uppsala University Hospital, Uppsala, Sweden), Luigi Solbiati (Department of Diagnostic Imaging and Interventional Oncologic Radiology, General Hospital of Busto Arsizio, Italy). ▶▶Sono-Psychology Lucas Greiner (Wuppertal, Germany).

EFSUMB Membership Status ▼▼

Some national societies develop better than others with respect to their number of individual members, their scientific and educational activities and their representation within EFSUMB. The oral report in Copenhagen will comment on few points regarding the Membership Status 2010 (qTab. 1).

Tab.1 Country

Numbers in Databases 2010

Email addresses

Austria

Members Payment 2009 762

762

573

Belgium

66

50

57

Bulgaria

135

135

0

Croatia

36

79

43

Czech Rep

45

45

34

Denmark

558

498

373

Finland

480

500

0

France

291

2300

216

Germany

7389

7389

0

Greece

53

0

0

Hungary

32

32

0

Israel

118

131

131

Italy

2095

2095

0

158

180

79 13

Latvia Lithuania

0

58

Macedonia

0

11

0

228

186

49

Moldova Netherlands

81

81

79

Norway

296

296

250

Poland

0

317

317

Portugal

70

70

0

Romania

575

560

385

Russia

185

185

0

30

30

0

Slovak Rep

EFSUMB Newsletter Slovenia Spain

0

128

0

180

180

54

Sweden Switzerland

33

31

31

2677

2677

1907

320

309

272

Turkey Uk Total

2314

2209

0

19524

21524

4546

Website Statistical Data for 5th May 2010 to 5th August 2010 (3 Month Period) Top 15 Page hits – Top Most Visited Pages/ Sections 1.

EFSUMB Home Page

71198

2.

Latest News Items

31456

3.

Member Societies List

22341

4.

Latest Newsletters

16191

5.

Bologna EUROSON Flash Presentation

11848

6.

Case of the Month

7145

7.

EUROSON Future Schools

3560

8.

EUROSON 2010 Symposia Information

2477

9.

AVUS Meeting (September 2010) Programme

1502

10.

CEUS Meeting (Lille) Event PDF

977

11.

Bylaws

624

12.

EUROSON School (Kosice) Event PDF

381

13.

ECMUS Home Page

302

14.

Diary Dates of Meetings

192

15.

EFSUMB 2010 Folder

168

Top 10 Countries (Where the Hits are Coming From)

Top 10 Keywords Used for Search

1

United Kingdom

1

ultrasound

2

Germany

2

efsumb

3

Italy

3

euroson

4

China

4

european

5

Netherlands

5

scan

6

Spain

6

medicine

7

Sweden

7

2010

8

Norway

8

society

9

United States

9

conference

10

France

10

congress

Kind Requests for the Membership Societies ▼▼

On behalf the Executive Bureau, we kindly ask (again and again) all members and especially the secretaries of each national society to provide us with email addresses of active members. Finally, a society but also a federation is as much alive as its members – so please do not hesitate to get in touch with us (www.efsumb.org). ▶▶Each membership society is kindly asked to supply the email addresses of their members to the EFSUMB bureau for improved communication regarding EFSUMB activities. ▶▶Each membership society is kindly asked to update the EFSUMB website with their Society’s Board changes and photographs.

Identity of EFSUMB, Case of the Month ▼▼

We recently (March 2008) initiated the “Monthly case reports” which is actually displayed on the EFSUMB website including videos (http://www.efsumb.org/).

This site has approximately 10,000 visitors’ hits on a regular basis. This is an opportunity to discuss interesting cases on a well known platform. Please participate actively and submit your cases of the month to efsumb@efsumb.org. The Instructions for Authors have been recently published in the EFSUMB-Newsletter. I was responsible for the Case of the Month from the very beginning up to the end of 2009. On January 1st Paul Sidhu took over the responsibility.

Identity of EFSUMB, Scientific Corner ▼▼

The scientific ultrasound community is challenged to perform more multicenter and interdisciplinary studies in the upcoming years to increase the influence of ultrasound techniques in daily practice. In that regard it is of interest that “our” (EFSUMB) scientific journal European Journal Ultrasound /Ultraschall in der Medizin“ has been dramatically improving over the last years. Additionally the successful CEUS-guidelines have been published early this year as well. For the scientist it might be also of interest to find a forum where to ask colleagues about rare and interesting case reports which might be published together by EFSUMB members of the different European countries. We have to prove all together that ultrasound is effective and also cost effective, including the emergency room and other access routes to the hospital, in the out patients care setting and under many other circumstances. So far, the Scientific Corner was not accepted. The topic should be discussed.

Honorary Secretary’s Agenda for Discussion ▼▼

▶▶Bids for the EUROSON congress for the years 2013, 2014, (2015), 2016

Varia ▼▼

The good relationship to the industry was also strengthened as important partners for improved patients care and innovative technology.

Finally, I would like to thank friends and colleagues in the ExB, Publication committees and EPSC, for the good team work.

Please refer to EFSUMB and the Honorary Secretary for support and discussion.

Cordially, Christoph F. Dietrich Honorary Secretary EFSUMB

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EFSUMB Newsletter 21 August 2010 Copenhagen, Denmark

Honorary Treasurer Report to the Board of Directors Ioan Sporea

In my position of Honorary Treasurer, I would like to inform you on the finalised financial balance of 2009 (which ended on the 31th of December 2009), that proved to be in a slight deficit. This was largely due to the far greater than anticipated expenditure for EFSUMB at EUROSON 2009 (Edinburgh is an expensive city) and the considerably reduced income from this Congress. As a direct consequence of this, the Board will be invited to approve the Bylaw 1 changes and accompanying Appendix, to formalise the obligations between the host society and EFSUMB. ­EFSUMB office expenditure was also higher for the last three months of 2009, when the outgoing Secretary overlapped with the new Secretary for three months. Following comments at last year’s Board of Directors’ Meeting, EFSUMB has produced the 2009 budget, showing expenditure which of course is all in the Accounts, but might give a more general overview of ­EFSUMB income and expenditure.

Considering the structure of the past recent budgets and the budget of 2011, we can see that the most important financial support originates in the membership fees, and I believe that it is very important to try to maintain, even to increase the number of EFSUMB members. For 2010, at this moment, the EUROSON membership fee of 8 Euros has been paid by 14 countries. However, the earlier date for payment (necessitated by the August Congress date and the requirement of voting based on paid up Society membership)

may be a cause of this situation. We trust that all National Societies will pay very soon. Future policies of EFSUMB must have as a main purpose to keep or maybe to increase the number of members, and we are happy that French Society of Ultrasound increased very much the number of her members, now EFSUMB over passing generously 20,000 members (our previous target).

EFSUMB is committed to looking at the cost effectiveness of its operations. This year there have been three Skype meetings in the Executive Bureau and one in the Education Committee, which have been useful and of course, without any cost to EFSUMB. The conclusion of all the members is that these meetings are useful, where there are specific issues to consider, but the personal interaction and with a full agenda, a face to face meeting is required. As in Edinburgh, Committees will meet in Copenhagen, saving time and money as most are present as invited speakers.

Regarding the budget of 2011, we have tried to build one in which the income will be at the same level with the costs, but this would be at the expense of the commitment to the record number of EUROSON Schools, the EUROSON Congress, the website and the European Course Book which EFSUMB regards as valuable tools for education. It is anticipated that the sales of the ECB will return the printing costs.

As a conclusion of the financial balance of the last years, I must inform you that ­EFSUMB still has a healthy financial status. It is important that we maintain sufficient funds to cover EFSUMB’s future commitments three years in advance – such as the Schools and Congresses, which we have contractual obligations to support, even if these events are unprofitable.

More precise information about the accounted budget and on the budget of 2011 can be found on the EFSUMB website, www.efsumb.org.

Ioan Sporea, EFSUMB Honorary Treasurer

The 2009 EFSUMB accounts can be found online: http://www.efsumb.org/governance/2010acc.pdf

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EFSUMB Newsletter Copenhagen, Denmark 21 August 2010

Gail ter Haar

ECMUS Committee Report to the Board of Directors 1. The Safety Committee met in Edinburgh in December 2009 ▼▼

All ECMUS activity since then has been by internet.

2. 2nd Edition of Safety of Medical Ultrasound ▼▼

BMUS and BIR (British Institute of Radiology) published the 1st edition of this book in 2000. This was sent free of charge to all BMUS members, and has become a well referenced text. It has now been agreed to update this volume as safety issues have moved on.

Costings from Sherry Dixon, BMUS: Up to 144 pages, plus cover Trim size B5 Print run 5,000 Printing - £ 5,000 (full colour); £ 3,900 (black & white text) Typesetting - £ 1,404 Copy editing - £ 700 Total: £ 7,104 for full colour; £ 6,004 for black & white text The following sponsorship has been obtained: EFSUMB £ 1400 (typesetting costs) BMUS £ 2000 National Physical Laboratories (UK) £ 4000–4500 The printing element assumed that we would distribute the book to all BMUS members and EUROSON 2011 delegates.

Proposed Content: Editor: Gail ter Haar ▶▶1. Introduction G. ter Haar (UK) ▶▶2. The propagation of ultrasound through tissue F. Duck (UK) ▶▶3. The acoustic output of diagnostic machines B. Ward (UK) ▶▶4. Ultrasound-induced heating and its biological consequences, Charlie Church (USA) +? Moonen (Fr) ▶▶5. Mechanical effects of diagnostic ultrasound – To be decided, ? Coussios (UK) or ?de Jong (NL) ▶▶6. Non-thermal effects — acoustic streaming and other radiation stress effects H. Starritt (UK)

▶▶7. Bio-effects – cells and tissues, G. ter Haar & Sienkiwiecz (UK) ▶▶8. The Safety of Ultrasound Contrast Agents, D. Miller (USA) + ? A. van Wamel (NL) ▶▶9. Epidemiological studies of diagnostic ultrasound, K. Salvesen (N) ▶▶10. Safety standards and regulations: the manufacturers’ responsibilities, F. Duck (UK) ▶▶11. Guidelines and recommendations for the safe use of diagnostic ultrasound: the users’ responsibilities, G. ter Haar (UK) I have suggested a deadline for full manuscript submission to BMUS of April 1st 2011, with the aim of publication in time for EUROSON 2011.

3. Ongoing ECMUS Activities ▼▼ I. Tutorial Articles

These are designed to be teaching articles aimed at the clinical user without a background in Physics. Suggestions for future topics will be gratefully received!

List of tutorial articles in preparation: ▶▶1. Sonothrombolysis: Complete ▶▶2. Keepsake scanning: In draft ▶▶3. Cellular effects: In draft ▶▶4. TI/MI Indices: In draft ▶▶5. Opthalmology: In draft ▶▶6. QA & Safety: In preparation ▶▶7. Neonatal Doppler: In preparation ▶▶8. Diagnostic exposures: In preparation – revision of 20: 03 version ▶▶9. HIFU & Prostate: To be written ▶▶10. Elastography

Past tutorial articles that are to be updated as necessary/republished in near future

▶▶Acoustic Cavitation & Capillary Bleeding (1999) ▶▶Color Flow Imaging – Safety Aspects (1996) ▶▶Epidemiology (2002) ▶▶Genetic Aspects (1994) ▶▶Non-linearity and Finite Amplitude Effects (1994) ▶▶Principles & Methods of Field Measurements (1994)

▶▶Pulsed Doppler Devises – Safety Aspects (1991/2) ▶▶Radiation Stress and its Bio-effects (2000) ▶▶Safety of Ultrasonic Contrast Agents (1999) ▶▶Terms used in Describing Ultrasound Exposures (1997) ▶▶Thermal and Mechanical Indices (1996/7) ▶▶Thermal Teratology (1999) ▶▶Transvaginal Ultrasonography – Safety Aspects (1993–95) ▶▶What Happens When you Alter the Settings on your Diagnostic Ultrasound Machine - Safety Considerations (1990-95)

II. Literature reviews

21 safety related articles are currently under review. These are published in the ­EFSUMB newsletter, and on the website.

III. Maintenance of Safety Statements

Existing safety statements are reviewed annually and revised as necessary.

(Clinical safety statement; Souvenir scanning statement). The latest safety statements are also to be found on the EFSUMB website www.efsumb.org.

IV. Congresses

A safety demonstration/lecture on safety indices and transducer heating has been arranged for Copenhagen 2010. The Post it pads with a safety message, advertising safety on the EFSUMB website will be available in Vienna 2011.

Gail ter Haar

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EFSUMB Newsletter Appendix A ▼▼ European Committee of Medical ­Ultrasound Safety (ECMUS)

A Safety Statement has been published by EFSUMB annually since 1994. The text is deliberately brief, and gives a concise overview of safety in the use of diagnostic ultrasound. The 2009 Statement is the sixth revision of the Statement.

Clinical Safety Statement for ­Diagnostic Ultrasound (2009)

Diagnostic ultrasound has been widely used in clinical medicine for many years with no proven deleterious effects. However, if used imprudently, diagnostic ultrasound is capable of producing harmful effects. The range of clinical applications is becoming wider, the number of patients undergoing ultrasound examinations is increasing and new techniques with higher acoustic output levels are being introduced. It is therefore essential to maintain vigilance to ensure the continued safe use of ultrasound.

Ultrasound examinations should only be performed by competent personnel who are trained and updated in safety matters.

It is also important that ultrasound devices are appropriately maintained.

Ultrasound produces heating, pressure changes and mechanical disturbances in tissue. Diagnostic levels of ultrasound can produce temperature rises that are hazardous to sensitive organs and the embryo/ fetus. Biological effects of non-thermal origin have been reported in animals but, to date, no such effects have been demonstrated in humans, except when a microbubble contrast agent is present.

The Thermal index (TI) is an on-screen guide to the user of the potential for tissue heating. The Mechanical index (MI) is an on-screen guide of the likelihood and magnitude of nonthermal effects. Users should regularly check both indices while scanning and should adjust the machine controls to keep them as low as reasonably achievable (ALARA principle) without compromising the diagnostic value of the examination. Where low values cannot be achieved, examination times should kept as short as possible. Guidelines issued by several ultrasound societies are available.

Some modes are more likely than others to produce significant acoustic outputs and, when using these modes, particular care should be taken to regularly check the TI and MI indices. Spectral pulse wave Doppler and Doppler imaging modes (colour flow imaging and power Doppler

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imaging) in particular can produce more tissue heating and hence higher TI values, as can B-mode techniques involving coded transmissions. Tissue harmonic imaging mode can sometimes involve higher MI values. 3D (three dimensional) imaging does not introduce any additional safety considerations, particularly if there are significant pauses during scanning to study or manipulate the reconstructed images.

However, 4D scanning (real-time 3D) involves continuous exposure and users should guard against the temptation to prolong examination times unduly in an effort to improve the recorded image sequence beyond that which is necessary for diagnostic purposes.

Ultrasound Exposure During ­Pregnancy

The embryo/fetus in early pregnancy is known to be particularly sensitive. In view of this and the fact that there is very little information currently available regarding possible subtle biological effects of diagnostic levels of ultrasound on the developing human embryo or fetus, care should be taken to limit the exposure time and the Thermal and Mechanical Indices to the minimum commensurate with an acceptable clinical assessment.

Temperature rises are likely to be greatest at bone surfaces and adjacent soft tissues.

With increasing mineralisation of fetal bones, the possibility of heating sensitive tissues such as brain and spinal cord increases. Extra vigilance is advised when scanning such critical fetal structures, at any stage in pregnancy. Based on scientific evidence of ultrasound-induced biological effects to date, there is no reason to withhold diagnostic scanning during pregnancy, provided it is medically indicated and is used prudently by fully trained operators. This includes routine scanning of pregnant women. However, Doppler ultrasound examinations should not be used routinely in the first trimester of pregnancy.

The power levels used for fetal heart rate monitoring (cardiotocography – CTG) are sufficiently low that the use of this modality is not contra-indicated on safety grounds, even when it is to be used for extended periods.

Safety Considerations for Other Sensitive Organs

Particular care should be taken to reduce the risk of thermal and non-thermal effects during investigations of the eye and

when carrying out neonatal cardiac and cranial investigations.

Ultrasound Contrast Agents (UCA)

These usually take the form of stable gas filled microbubbles, which can potentially produce cavitation or microstreaming, the risk of which increases with MI value.

Data from small animal models suggest that microvascular damage or rupture is possible. Caution should be considered for the use of UCA in tissues where damage to microvasculature could have serious clinical implications, such as in the brain, the eye, and the neonate. As in all diagnostic ultrasound procedures, the MI and TI values should be continually checked and kept as low as possible. It is possible to induce premature ventricular contractions in contrast enhanced echocardiography when using high MI and end–systolic triggering. Users should take appropriate precautions in these circumstances and avoid cardiac examinations in patients with recent acute coronary syndrome or clinically unstable ischaemic heart disease. The use of contrast agents should be avoided 24 hours prior to extra-corporeal shock wave therapy.

Appendix B ▼▼ Statement on the Use of Diagnostic Ultrasound for Producing Souvenir Images or Recordings in Pregnancy (2006)

Developments in real-time three dimensional ultrasonic imaging have led to parents asking for souvenir (keepsake) video recordings of the fetus, sometimes at several stages during the pregnancy. An area of concern is the growth of services designed to provide such images and recordings without any diagnostic element to the scan. Often, such services are unable to provide counselling or offer guidance if signs of a fetal abnormality are unexpectedly revealed. Apart from such services, there are many instances of diagnostic scans being prolonged in order to provide such recordings.

Very little information is currently available regarding possible subtle biological effects of diagnostic levels of ultrasound on the developing human embryo or fetus, and the possibility of developmental effects in the brain cannot be ruled out. There is evidence that diagnostic levels of ultrasound can influence development of the brain in small animals, although it is not possible to extrapolate this finding to

EFSUMB Newsletter the human situation. A balance must always be maintained between diagnostic benefit and risk to the patient. Therefore, it is difficult to justify souvenir or keepsake scanning that has no diagnostic benefit.

Recommendations: ▶▶1 Ultrasound scans should not be performed solely for producing souvenir

images or recordings of a fetus or embryo. ▶▶2 The production of souvenir images or recordings for the parents to keep is reasonable if they are produced during a diagnostic scan, provided that this does not require the ultrasound exposure to be greater in time or magnitude (as indicated by the displayed MI

and TI) than that necessary to produce the required diagnostic information. ▶▶3 Attention is drawn to the recommendation of the EFSUMB Clinical Safety Statement for Diagnostic Ultrasound that ultrasound examinations should be performed only by competent personnel who are trained and updated in ultrasound safety matters.

Copenhagen, Denmark 2010

Odd Helge Gilja

EFSUMB Education & Professional Standards Committee Report to the Board of Directors Membership from 2009 Odd Helge Gilja

Chairman

Norway

Fabio Piscaglia

Ex-officio member

Italy

Holger Strunk

Vice-chairman

Germany

Gebhard Mathis

Member

Austria

Jan Tuma

Member

Switzerland

Julia Walton

Member

UK

Francesco Drudi

Co-opted member

Italy

Boris Brkljacic

Co-opted member

Croatia

Christoph F Dietrich

Co-opted member

Germany

Lynne Rudd

General Secretary

UK

Euroson Schools ▼▼

The EPS Committee has worked to promote more Euroson Schools to be arranged throughout Europe. The first Euroson School of EFSUMB was arranged in 1992 and since then at least 55 courses have been held. Last year we experienced an ”all-time-high” record of 8 ES held in one year. We encourage all the National Societies and ultrasound groups all over Europe to consider establishing a post-graduate course under the umbrella of a Euroson School. A dedicated “start package” has been established to help the organisers of Euroson Schools (www.efsumb.org.) We are working to change the ES bylaws in order to reduce the formal requirements for potential organisers. Furthermore, the cooperation with BRACCO, also including financial support, has enabled several ES on CEUS to be held. Highly instructive electronic presentations from these ES on CEUS are available at our website.

The EFSUMB Website ▼▼

The EPS Committee stimulates production of educational material to be posted on the Web. EPSC has initiated the process of making the EFSUMB web-site an educational portal for ultrasound imaging. The launching of this new web-portal is taking place these days. The basic idea is to build up a database of high quality and relevant educational material (text, images, videos, presentations, course syllabus etc).

Minimum Training Recommendations ▼▼

The Committee values the great importance of ensuring high quality in education and sustaining high professional standards in ultrasound scanning. Therefore, EFSUMB has over the years established guidelines in ultrasound education for the different medical disciplines. EPSC will continue this work by completing already undertaken guidelines and stimulate new guidelines to be produced. The minimum training recommendations number 14 (on CEUS) has now been finalised and are soon to be published.

EFSUMB Course Book ▼▼

Prof. C.F. Dietrich has taken the initiative together with leading authors from many other European countries to create a common, truly European, interdisciplinary course book. The core of the first version of this course book is abdominal ultrasonography.

It is our hope that this systematic theoretical approach in combination with handson training led by experienced and even-

tually nationally licensed tutors should make a decisive contribution to counteract the complaints of incompetent ultrasound operators. Furthermore, we wish that the curriculum and the textbook may be of value for you in the development of systematic ultrasound training in your country.

EUROSON Congress ▼▼

These congresses are very important arenas for ultrasound education and communicating high professional standards. In Edinburgh 2009, the EPSC was responsible for a session on “Ultrasound on the web“ with the following program: Chairs: Odd Helge Gilja and Christian Nolsoe Overview of ultrasound educational web resources (D. Cosgrove) How to present and organise dynamic ultrasound images on the web? (L. Thorelius) CME on the web (F. Drudi) Integration of EFSUMB course book with the EFSUMB website. (C. Dietrich) For Copenhagen this year, the Committee is also responsible for a session on education.

Committee membership

Finally, I would like to thank my friends in the EPSC, for their work in the Committee and for the effort they make for the best of ultrasound education on a European level.

Odd Helge Gilja Chairman EPSC

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EFSUMB Newsletter Copenhagen, Denmark August 2010

EFSUMB’s Publications Committee Report to the Board of Directors The committee members 2009–2011 are ▶▶Dr. Torben Lorentzen (Denmark) ▶▶Prof. Lucas Greiner (Germany) ▶▶Ass. Prof. Jean-Yves Meuwly (Switzerland) ▶▶Dr. Paul Sidhu (UK), co-opted member ▶▶Prof. Adrian Saftoiu (Romania), co-opted member ▶▶Prof. Christoph Dietrich (Germany), ex-officio member ▶▶Prof. Michael Bachmann Nielsen (Denmark), committee chair

The committee held a short meeting during the last Euroson congress in Edinburgh in December. A meeting was held in April in Copenhagen (although the Icelandic volcano eruption did its best to prevent this) and the committee will meet again in August during Euroson 2010.

The EFSUMB Newsletter continues to bring interviews with delegates or presidents of the national societies, papers on current topics and new technology and information from all committees of ­EFSUMB. In addition we welcome to advertise for all Euroson congresses and Euroson schools.

The first issue each year is an extended issue (being sent to all members of EFSUMB) containing reports from the executive bureau and committees. The newsletter also brings report from EUROSON congresses and reports of young investigators awards. The upgrade in pages available for the newsletter has been very welcomed.

The EFSUMB web page www.efsumb.org continues to receive a large number of hits, 71,000 for the last 3 months period.

The top countries assessing the website are UK, Germany, Italy and China in that order. Dr. Torben Lorentzen (Denmark) is now in charge of updating the front page.

The Case of the Month has been maintained by Christoph Dietrich for a long time, and this has now been passed on to Paul Sidhu (UK). The case of the month also receives a large number of hits and under consideration is translation of the text into other European languages.

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Michael Bachmann Nielsen

The EFSUMB Course Book is described in detail in the report from the Honorary Secretary.

The Educational Portal is to be launched soon at www.efsumb.org.

A Scientific Corner is also under development and will hopefully appear soon on the website. It will be a place where you can post your ideas and get response from

colleagues all over the world and present strange or typical cases.

Michael Bachmann Nielsen Chairman EFSUMB’s Publication Committee Editor EFSUMB Newsletter

Copenhagen, Denmark August 2010

Report on Ultraschall in der Medizin/ European Journal of Ultrasound to the Board of Directors Ultraschall in der Medizin has been the official journal of EFSUMB since 2004. Eleven national societies now have bulk subscription for the journal, which is close to 60 % of the EFSUMB members. The members in these 11 countries receive all six annual numbers of the journal, the remaining receive issue one each year.

Price for bulk subscription in 2010 is 22.95 € plus 9.51 € postage. For individual subscription by EFSUMB members the price is 115 €, the regular subscription rate is 338.40 € Ultraschall has five editors: Karlheinz Seitz, Eberhard Merz, Kurt Jäger, Gerhard Mostbeck and myself. Each editor is responsible for handling specific topics.

The impact factor for 2009 is 2,394 (2,389 in 2008). The journal is still the highestranking interdisciplinary ultrasound journal. The majority of published articles are in English. UiM/EJU currently ranks #37 out of 104 journals listed in the category RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING. With the impact factor 2008 it ranked #43.

EFSUMB’s 2008 CEUS guidelines tops the list of online read abstracts as well as downloaded PDFs. The top list of submitted manuscripts per country for the last 12 months has Germany as number one, followed by Denmark, Italy, Switzerland, Romania and Austria.

During 2009 and the beginning of 2010 has been a steady increase in the number of manuscripts submitted compared to previous years. The increase is currently 10 % each year.

During EUROSON 2010 in Copenhagen there will be a scientific session with the editors of Ultraschall in der Medizin.

Michael Bachmann Nielsen Editor of Ultraschall in der Medizin/European Journal of Ultrasound

EFSUMB Newsletter Vienna, Austria, 26-29 August 2011

Gerhard Mostbeck

WFUMB 2011 Dear Colleagues and Friends, It is our great pleasure to invite you to the WFUMB 2011 Congress in Vienna, Austria.

WFUMB 2011 is the unique joint meeting of the 13th World Congress of the World Federation for Ultrasound in Medicine and Biology (WFUMB), the 23rd Congress of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) and the 35th Joint Meeting of the Austrian (ÖGUM), German (DEGUM) and Swiss (SGUM) Societies for Ultrasound in Medicine. Thus, whether you are a dedicated specialist in ultrasound or a novice with an interest in learning more on all subjects of ultrasound, you should visit Vienna and attend this important event – “connecting the world of ultrasound”.

The cornerstone of the success of previous WFUMB, EUROSON and “Dreiländertreffen” – meetings has been the high quality of the Educational and Scientific Programme. Along this line, it is the aim of the WFUMB 2011 Programme Planning Committee and the Local Organising Committee together with the Organising Secretariat in Vienna to continue these successful

stories focused in one major meeting here in beautiful Vienna, in the heart of Europe.

The Educational and Scientific Programme will address all aspects of ultrasound imaging. A focused educational programme with Categorical Courses, Refresher Courses and Live-Scanning Workshops will be offered to please all, beginners to experts in US imaging. Speakers and tutors will be worldwide recognised experts in their field. The educational programme is presented in English and German (40 %).

However, the scientific content of the meeting will be exclusively presented in English.

At the current stage the programme planning of the educational program has almost been finished. The Preliminary Programme will be published in January 2011. The deadline for abstract submission will be March 15, 2011. The Programme Committee of WFUMB 2011 invites submissions for scientific oral presentations and poster exhibits. Posters will be displayed electronically. We look forward to receiving your submissions for presentation!

EUROSON 2010, Copenhagen, Denmark

Winner of the Young Investigator Award – Luca Maria Sconfienza M.D. His PhD programme is entitled ‘Internal medicine, autoummunity and digestive diseases’.

He has published 11 scientific papers in peer-reviewed journals (total impact factor = 42,871), is co-author of 3 books and 5 book chapters. He also presented over 150 abstracts at Italian and foreign meetings. His research activity is mainly focused on skeletal radiology and ultrasound, ultrasound-guided procedures and pain treatment, and abdominal and genitor-urinary radiology. He won nine Italian and international scientific prizes for studies in musculoskeletal and genital ultrasound. In two years, he gave about 25 lectures on musculoskeletal and interventional ultrasound. He was involved as a radiologist in three international multi-cen-

tric clinical studies about inflammatory bowel diseases and rheumatoid arthritis.

He is invited reviewer for European Radiology, European Journal of Radiology, Skeletal Radiology, European Journal of Obstetrics & Gynecology and Reproductive Biology.

We do invite you to also take some time off to explore the beautiful city of Vienna, located in the heart of Europe, to enjoy its atmosphere, explore the historic centre, and discover its art and architecture. The climate at the end of August promises to be a perfect one to go experiencing the city. Last but not least! Please make use of the official congress website www. wfumb2011.org. There you will find always the most updated information.

We are looking forward to welcoming you to Vienna.

Gerhard Mostbeck Chairman of the Organising Committee

Abstract ▼▼ Purpose

To compare the short- and long-term outcome of US-guided percutaneous treatment of patient affected with plantar fasciitis based on dry needling and local injection of steroid, compared with simi-

Long-term Survey of Three Different Ultrasound (Us)-Guided Percutaneous Treatments of Plantar Fasciitis: Results of a Randomized Controlled Trial ▼▼

Sconfienza LM, Lacelli F, Bandirali M, Perrone N, Serafini G, Silvestri E Università degli Studi – Genova, Italy

Winner of the Young Investigator Award.

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EFSUMB Newsletter lar patients treated with simple steroid injection or dry needling.

Methods and Materials

Among 75 patients referred for US-guided treatment of plantar fasciitis, 25 (12 males; age 43.8 ± 7.6) were treated with dry needling and local injection of steroid together; 25 (12 males; age 46.2 ± 12.3) were treated with dry needling only; 25 (11 males; age 52.7 ± 10.0) were treated only with local injection of steroid. Pain was assessed using the visual analogue scale (VAS) at baseline and at 7, 14, 30, 90, 180, 360 days after the procedure. KruskallWallis test was used.

Results

Patients treated with the complete procedure had a faster and more permanent decrease of symptoms (VAS at 7 days=1.2±0.4 and VAS at 360 days=0.0 ± 0.1). Patients treated only with injection of steroid had a quick decrease of pain that was not permanent on a long-term basis (VAS at 7 days=1.2 ± 0.6 and VAS at 360 days=5.2 ± 0.4). Patients treated only with needling had a permanent but very slow decrease of symptoms (VAS at 7 days=5.7 ± 0.5, at 30 days VAS=2.6 ± 0.4, at 90 days VAS=0.3 ± 0.8,

Advertisement 1/2 landsape

Ultraschall in Med 2011; 32

and at 360 days VAS=0.1 ± 0.2). Difference was statistically significant (p<.001).

Conclusion

Patients treated with the combined procedure had a better outcome than other groups. Pain relief is faster and more permanent compared with slower or not stable results obtained in the other patients.

EFSUMB Newsletter

Please complete and forward to Creative Conferences 20, Prestwich Park Rd South, Prestwich, Manchester. M25 9PE or register on-line at www.ukcreativeconferences.co.uk Ultraschall in Med 2011; 32

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