2014 ISSUE 4 Newsletter

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EFSUMB Newsletter

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

Tel Aviv, Israel

Highlights from EUROSON 2014 This year’s EUROSON was held in Tel Aviv from 26 to 28 of May at the David Intercontinental Hotel close to the oceanfront in Tel Aviv. The organisers had made a varied program with leading experts within several fields, and many sessions were occupied to the last chair. Some of the highlights are covered below.

72 electronic posters were displayed in the exhibition area, and the winner of the prize for the best poster was Gordana Ivanac (HR) with the poster: “Elastographic E-values of benign and malignant breast lesions and surrounding tissue”. Several other interesting posters were presented, making the competition close.

The Hans Henrik Holm lecture was introduced at EUROSON 2003 in Copenhagen in honour of Professor Holm, who was one of the pioneers in interventional ultrasound. Dr. Torben Larsen (DK), who covered interesting topics on obstetrical ultrasound – possibilities and responsibility, held this year’s lecture. In the same session Dr. Christian Jenssen (DE) held the DEGUM-lecture entitled “Cystic pancreatic lesions: the role of EUS”.

The Young Investigator’s session was also a very interesting session, where new research around Europe was covered. This year 8 shooting stars joined the competition for the 1000 € prize and the title „Young Investigator 2014“. Ass. Prof. Vito Cantisani (IT) and Prof. Odd Helge Gilja (NO) were chairmen of the sessions, and the presentations were judged in terms of relevance, comprehensibility, study design and performance.

A combined session between the European Society of Radiology and EFSUMB was a repetition of a similar session at the European Congress of Radiology this year. The joint session between the 2 societies was introduced in 2013. A highlight from this year’s session was the presentation of results from dynamic contrast enhanced ultrasound in tumours compared with CT, MRI and PET/CT, by Dr. Nathalie Lassau (FR).

Maarten Kuenen (NL) won the competition and the 1000 € prize for his presentation entitled “Contrast ultrasound dispersion imaging for prostate cancer localisation: comparison between imaging and histopathology”. David Kenwright (UK) was second and Natalia Buda (PL) third.

Prof. Dieter Nürnberg (DE) and Dr. Peteris Prieditis (LV) covering bowel ultrasound and thyroid ultrasound respectively, held the WFUMB and EUROSON lectures this year. Another interesting and well-visited session was the EFSUMB joint session between the Publication Education and Safety Committees about elastography. The session included live-demonstration of thyroid ultrasound including elastography and also theoretical aspects from safety to applications in the liver and breast.

The prizes for the Young Investigator competition and the poster competition were presented at the congress dinner held on Tuesday 27 of May. The congress dinner took place at the Tel Aviv port, and started with aperitifs being served on a beach terrace overlooking the sun set on the Mediterranean Sea. As the evening progressed, speeches were given by EFSUMB-President Prof. Christoph F. Dietrich (DE) and Congress President Prof. Diana Gaitini (IL) and afterwards entertainment was abundant with both traditional Israeli dancing and singing.

Prof. Andreas Schuler scanning Dr. Maija Radzina.

From the left, Prof. Dietrich, Maarten Kuenen (YI winner), David Kenwright, Natalia Buda and Prof. Gilja.

A presentation to Diana Gaitini for her successful Congress organisation.

We thank the organizers for a very interesting congress in the fascinating country of Israel. Jonathan F. Carlsen, Iben Riishede, Caroline Ewertsen

Apart from the scientific program it was possible to participate in guided tours to Jerusalem and other parts of Israel.

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EFSUMB Newsletter

EFSUMB Atlas In the Atlas section (www.efsumb-atlas. org) of the EFSUMB website you can find pictures and videoclips illustrating the typical patterns of most of the ultrasound findings described in guidelines, whose display is indexed according to the structure of the guidelines, to allow an easy and rapid access directly to the topic of your interest. Musculoskeletal ultrasound (MSK-US) education and training includes attending theoretical and practical courses, as well as independent studying-textbooks, DVD‘s or websites. Having access to USequipment and performing supervised normal and pathological MSK-US examinations for a training period is mandatory for consolidating MSK-US learning. Webbased learning is a validated teaching method.

Since 2014 a new Musculoskeletal ultrasound section has been created. Musculoskeletal ultrasound is an excellent and validated tool in the diagnostics and assessment of musculoskeletal diseases such as inflammatory and non-inflammatory joint diseases. Musculoskeletal ultrasound plays an important role in visualising several soft-tissue structures and MSK-US is able to detect a variety of pathologic changes using predominantly linear scan probes with frequencies in a range between 5 MHz and 22 MHz, depending on the investigated tissue. MSK structures are assessed dynamically in real-time and static with the advantage of a multiplanar view. Further MSK-US is a useful tool for guided interventions of the MSK-system. An introductory publication about MSK-ultrasound is published in the

EFSUMB Course Book Student Edition (ECBSE) (http://www.kosmos-design. co.uk/efsumb-ecb/ecbse-ch14-msk.pdf). The images in the MSK ultrasound atlas have been selected to help the practitioner discover the pitfalls in MSK-ultrasound while observing the guidelines in MSK anatomy and to show cases of interest. The EFSUMB Atlas is work in progress and we cordially invite contributions of images and video‘s using the submission template which can be accessed here (http://issuu.com/efsumb/docs/atlas2014_submissiontemplate ?e=3336122/6603975). Giorgio Tamborrini

Elastography- everywhere, but not just in any way The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) is currently comprised of 19223 members and yet only a fraction of them use new, more advanced echography techniques such as contrast enhanced ultrasound, elastography or the hybrid technique. For this reason, the program of the 26th EUROSON Congress consisted of parallel presentation sessions focused on standard ultrasound, as well advanced ultrasound techniques. One of these sessions, the EFSUMB Joint Session, entitled “All you need to know about elastography in 90 Minutes”, provided an elastography marathon for practitioners, for those who plan on applying it in their clinical practice or just for those who wish to be informed regarding the latest techniques. Due to the increasing

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need of Guidelines in medical practice, Vito Cantisani – Chairman of the Education Committee of EFSUMB – presented ,,The EFSUMB Guidelines and Recommendations on the Clinical Use of Ultrasound Elastography”, which was also published last year in 2 parts in the European Journal of Ultrasound. The first. part of the guideline - Basic Principles and Technology -

Ass Prof Vito Cantisani with ‘patient’ Dr Maija Radzina

describes in detail the technical principles of elastography [1]. The second. part of the guideline - Clinical Applications – focuses on the practical applications of elastography, which are divided into 2 main categories: strain elastography (SE) and shear wave elastography (SWE) [2]. In strain elastography (SE), tissue deformation is generated by applying external pressure using the probe or by endogenous stress such as cardiovascular movements. SWE is based on shear waves, which are produced by ultrasound systems, and includes transient elastography (TE), acoustic radiation force impulse (ARFI), point SWE (pSWE) and 2D-SWE. The presentation of the EFSUMB Guidelines was followed by a live demonstration. Andreas Schuler from Germany performed strain elastography on a patient/colleague with multiple thyroid nodules This pathology was chosen due to the high frequency of thyroid nodules discovered in clinical practice and due to the difficulties in establishing their benign or malignant nature through standard ultrasound. Elas-


EFSUMB Newsletter tography presented a higher sensitivity and specificity when compared to all the features of conventional ultrasound. The presentation began with the examination technique and was followed by elastography skills and pitfalls. Consequently, during an interactive discussion, the issue of benign or malignant characteristics of thyroid nodules was addressed. The examiner used both qualitative as well as quantitative elastographical analyses (strain values and ratios) to determine thyroid nodule stiffness. Frequent interventions by Vito Cantisani added practical as well as scientific data from the numerous studies published by his team to the discussion. The next topic was in the field of the breast pathology. A well-known fact is that most cancers present high stiffness compared to both normal breast tissue and benign lesions. Therefore, strain elastography has a very high accuracy in characterisation of the breast nodules. Moreover, strain elastography was the first type of elastography introduced into clinical practice providing its best diagnostic performance in mammary gland pathology. Following this presentation, another author of the EFSUMB elastography guidelines, Professor Adrian Saftoiu, presented

the clinical applications of elastography in his field of expertise, Gastroenterology, focusing on liver and pancreatic pathology. Elastography is mainly used in hepatic pathology for the assessment of fibrosis in chronic liver disease, which is very important for prognosis and patient management. All the elastographic techniques up to date have been evaluated for their performance in determining hepatic fibrosis. Unfortunately, it is very likely that the results provided by these methods are not equivalent because cut-off values are system-specific and cannot readily be compared across machines. Until now, transient elastography has been the most studied elastography technique, while other methods are awaiting further results. In the field of endoscopic ultrasound (EUS) only strain elastography is currently available, Professor Saftoiu’s team having published numerous studies regarding the applications of EUS elastography in the characterization of focal pancreatic lesions or lymph nodes. The elastography marathon concluded with Christian Kollmann’s presentation on safety guidelines. It has showed that strain elastography and shear wave elastography have identical ultrasound safety considerations compared to conventional ultrasound imaging modes, whereas ARFI

is similar to Doppler mode regarding patient safety. The potential medical uses for elastography do not end here. Elastrography techniques are constantly being developed and their applications are more and more diverse. Consequently, elastography is currently being evaluated for use in various pathologies involving the brain (intraoperative), the uterine cervix (for the prediction of premature delivery), as well as in testicular tumors, anal incontinence, rectal and anal carcinomas, arterial stiffness, atherosclerosis and many others. Studies on new applications and new technologies will surely be available by next year’s congress. So, see you at EUROSON 2015, Athens, Greece. Adrian Saftoiu and Larisa Sandulescu References  1 Bamber J, Cosgrove D, Dietrich CF. et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology. Ultraschall Med. 2013; 34:169-184.  2 Cosgrove D, Piscaglia F, Bamber J, et al. EFSUMB Guidelines Recommendations on the Clinical Use of Ultrasound Elastography. Part 2: Clinical Applications. Ultraschall in Med 2013; 34: 238–253

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