2016 Issue 5 Newsletter

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EFSUMB Newsletter

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

First ever guidelines and recommendations on gastrointestinal ultrasound (GIUS) Although there is ample evidence for the clinical use of gastrointestinal ultrasound (GIUS) no guidelines for its practice have previously been published. Recently, the “EFSUMB Recommendations and Guidelines for Gastrointestinal Ultrasound, Part 1: Examination Techniques and Normal Findings� was accepted for publication in Ultraschall in der Medizin/ European Journal of Ultrasound on 09.08.16. A short version focusing on the recommendations and a long version containing more detailed information was published online 31.08.16. These recommendations were a result of the work from a task force group in GIUS which was established in October 2014. The task force group consists of international experts of GIUS from 9 European countries recruited through the EFSUMB network with the objective of promoting the use of GIUS in a clinical setting by publishing guidelines and recommendations and starting training networks. They are a

part of a guideline-series that also will cover inflammatory bowel disease, transrectal / perineal ultrasound, other inflammatory disorders, functional disorders and miscellaneous pathologies. This first paper describes the use of different ultrasound modalities in the gastrointestinal tract, presents examination techniques and normal findings in the GI tract and peri-intestinal tissues. Altogether 19 recommendations are presented with level of evidence and grade of

evidence. As there is scarce scientific evidence for some the issues included, some of the statements has a level of evidence comparable to expert opinion. Therefore each recommendation was discussed and voted on in a consensus meeting and the degree of consensus reported. We hope you will find these guidelines and recommendations helpful in your clinical work and an inspiration for future research. On behalf of the GIUS Task Force Group, Dr. Kim Nylund, and Prof. Odd Helge Gilja Bergen, Norway

EUROSON 2016 Leipzig, Germany

the abstract book and final programme are now available online: ultrasound2016.org

Visit the EFSUMB Ultrasound Learning Area at UEG Visit the EFSUMB Ultrasound Learning Area (close to the Endoscopic area) at UEG week for hands-on training, basic and advanced courses in ultrasound for the gastroenterologist and lectures covering liver, GI and the pancreas from expert gastroenterologists.

EFSUMB Euroson Schools with more information on www.efsumb.org

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EFSUMB Newsletter

CEUS LI-RADS 2016 diagnostic scheme of the American College of Radiology released in September 2016 The Liver Imaging Reporting and Data System® (LI-RADS®) is an American College of Radiology (ACR) initiative whose immediate goal is to standardize reporting and data collection of non-invasive imaging for hepatocellular carcinoma (HCC). It provides the features for a confident diagnosis of HCC in the liver in at-risk patients and, for nodules not meeting HCC criteria, an ordinal classification based on the relative probability of HCC or non-hepatocellular malignancy. The Steering Committee is chaired by Prof Claude Sirlin (University of California, San Diego). The first LIRADS® scheme was released by the ACR website in 2011 (with subsequent updates in 2013 and 2014) and focuse on CT and MRI. Contrast-Enhanced Ultrasound (CEUS) is recognized for its ability to characterise liver nodules in cirrhosis. In 2014, a decision was made to start work on an official

LI-RADS® scheme for CEUS. A Working Group was convened under the Chairmanship of Drs Yuko Kono (UCSD) and Andrej Lyshchik (Thomas Jefferson University, Philadelphia). They assembled a team of advisors which included American, Canadian and European experts. The Working Group, mainly meeting via regular telephone conferences, modified the existing LI-RADS® document to allow for the differences between contrast enhanced CT/MR and Ultrasound, especially the fact that ultrasound operates in real time and so is uniquely able to capture rapid and early haemodynamic events. The Working Group’s progress was reported at international meetings in 2015 and 2016 and the completed document was submitted to the LI-RADS® Steering Committee body in April 2016; it was accepted by the Steering Committee in June 2016 and posted on the ACR website in Septem-

ber 2016 where it is freely accessible: http://www.acr.org/quality-safety/resources/LIRADS The publication of the ACR CEUS LIRADS® algorithm is likely to be of interest for many EFSUMB members performing abdominal ultrasound in patients with chronic liver disease. Importantly, CEUS LI-RADS® recognizes that HCC and nonspecific malignancies such as cholangiocarcinoma can be differentiated based on careful inspection of washout pattern: wash out that is “late” (≥ 60 s) in onset and mild in degree is characteristic of HCC, while washout that is either “early” (< 60 sec) or marked in degree is nonspecific and raises concern for a non-HCC malignancy. Recognition by LI-RADS® that CEUS can differentiate HCC from non-HCC malignancy non-invasively is anticipated to build confidence in the use of CEUS for characterization of liver nodules in cirrhosis and restore its place in the few international hepatology guidelines that had removed it. Please visit the website, download the CEUS LI-RADS® slides, pilot the system in your department, and feedback to the ACR committee. Yours sincerely Odd Helge Gilja, EFSUMB President,

Fig.1 LIRADS algorithm for characterization of focal liver lesions (FLL) in the at-risk patient. (Courtesy of American College of Radiology)

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EFSUMB Newsletter

There’s life in the old “Dogs” still

ECMUS committee 2016: Gail ter Haar (chair, UK), Christian Kollmann (vice-chair, Austria), Nico deJong (the Netherlands), Klaus Jenderka (Germany), Pepe Salvesen (Norway), Carla Serra (Italy).

It was in 1978 that Kit Hill approached Jens Bang with the idea of setting up a safety committee within EFSUMB. As a result, a group of experts representing diverse interests and nationalities met during the EFSUMB congress in Dubrovnik in 1979. Nicknamed the “Watchdogs”1, the attendees were Jens Bang (OB / GYN, Denmark, chair), Klaus Brendel (physicist, Germany), Ivo Hrazdira (biologist, Czechoslovakia), Gail ter Haar (physicist, UK), Enza Mazzeo (ophthalmologist, Italy), Han-Dieter Rott (geneticist, Germany), David Serr (OB / GYN, Israel) and Roy Williams (biologist, UK). Bill O’Brien, a physicist from the USA, and a member of the AIUM’s safety committee was also invited to help initiate projects and actions (q Fig. 1). This year, this committee held its 50th meeting, in Bologna. Over the years, the safety committee, now known as ECMUS (the European Committee for Medical Ultrasound Safety), has recruited members from Austria, Czechoslovakia, Denmark, Germany, Italy, the Netherlands, Norway, Sweden & the UK, indicating that the need to ensure the safe use of diagnostic ultrasound is recognised across Europe (q Fig. 2). It is in everyone’s interest that ultrasound is used safely and appropriately in order that it can continue to provide its power1 “Watchdog” : a person or group of persons that acts as a protector or guardian against inefficiency, illegal practices, etc (Collins English Dictionary)

ful benefits for diagnosis and intervention. The remit of ECMUS is therefore to provide guidance and advice to EFSUMB’s membership on topics related to the safe use of ultrasound. This is achieved in a variety of ways, by: 1. Writing statements on safety related topics; 2. Writing guidelines that provide advice on the procedures to be followed to ensure that ultrasound scanning is performed as safely as possible; 3. Providing educational material on safety related issues by developing a slide show on the topic, with accompanying MCQs, and publishing tutorial articles that discuss, in non-technical terms, topics relevant to ultrasound safety on subjects as diverse as, for example, ‘Thermal & Mechanical indices’ and ‘Elastography’; 4. Reviewing the published literature, and providing expert informed reviews of those articles of most relevance to diagnostic ultrasound. These can all be found on the EFSUMB website (http://www.efsumb.org/safety). Probably the most visible contributions of ECMUS are the safety statements it drafts on behalf of EFSUMB. These are reviewed annually by ECMUS, updated when new techniques come into clinical use and relevant information becomes available, and are approved by EFSUMB’s Board of Delegates. ECMUS has been very pro-active in ensuring that the many national and Fig. 1  First ECMUS (Watchdog) meeting, Dubrovnik 1979. From left around the table Klaus Brendel, Gail ter Haar, Kit Hill, Hans-Dieter Rott, Bill O’Brien, Enza Mazzeo, Ivo Hrazdira, Roy Williams (partially hidden), Jens Bang,

Fig. 2  ECMUS committee 2016. From left around the table Gail ter Haar, Klaus Jenderka, Pepe Salvesen, Nico de Jong, Carla Serra, Christian Kollmann

international safety committees have similar, and preferably identical, statements on these important topics. The most notable success in this regard is the ‘Statement on the safe use of Doppler ultrasound during scans at 11–14 weeks (or earlier) in pregnancy’ which has been agreed and approved by WFUMB, AFSUMB, AIUM, BMUS and JSUMB. The statement on souvenir scanning is identical to that approved by WFUMB and ISUOG. EFSUMB’s current statements are: ▶▶ECMUS Statement – EFSUMB Statement on the Safe Use of Doppler Ultrasound During Scans at 11–14 Weeks (or Earlier) in Pregnancy; ▶▶ECMUS Statement – EFSUMB Clinical Safety Statement for Diagnostic Ultrasound; ▶▶EFSUMB Recommendations on Non Medical Use of Imaging Ultrasound; ▶▶ECMUS Statement – EFSUMB Policy Statement on Souvenir Imaging of the Fetus; ▶▶ECMUS Statement – Live Ultrasound Scanning at Exhibitions. In addition, there are ‚Guidelines for the Safe Use of Doppler ultrasound in clinical applications‘. ECMUS exists to help EFSUMB’s members. They would welcome ideas of how the committee can help, and of what further is needed to help ensure that all users understand safety related implications of their ultrasound practice and training.

EFSUMB Lynne Rudd 28 Portland Place, London W1B 1LY, United Kingdom Tel: +44 (0) 20 7099 7140 Email: efsumb@efsumb.org

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