BIR Annual Congress 2014

BIR ANNUAL CONGRESS 2014Venue: Royal College of General Practitioners

CPD: 8 Credits (per day)

22–23OCTOBER

2014

BAYER HEALTHCARE HAS PROVIDEDSPONSORSHIP FOR THE COST OF THE

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• Room1Primers for the non-specialistsSessionorganisedbyDrDavid

Wilson,ConsultantInterventional

MSKradiologist,OxfordUniversity

HospitalsNHSTrust

• Room2Radiation protectionSessionorganisedbyMrAndy

Rogers,HeadofRadiationPhysics,

NottinghamUniversityHospitals

NHSTrust

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• Room1Clinical hybrid imaging in oncologySessionorganisedbyDrGopinathGnanasegaran,ConsultantPhysicianinNuclearMedicine,StThomas’Hospital

• Room2Musculoskeletal imagingSessionorganisedbyDrRichardWakefield,ConsultantinRheumatology,StJames’sUniversityHospital

Essentials for the radiology traineeSessionorganisedbyDrHardiMadani,RadiologyRegistrar,RoyalFreeLondonHospitalandDrAusamiAbbas,CardiothoracicRadiologyPostCCTFellow,UniversityHospitalAlberta

Day 2Day 1

BIR ANNUAL CONGRESS 20154–5 NOVEMBER

LONDON

WelcomeandthankyouforcomingtotheBritishInstituteofRadiologyAnnualCongress2014.Thistwo-dayeventpromisesafascinatinginsightintovarioustopics,includinginfectious diseases, cardiovascular imaging, pulmonary diseases,MSK, neuroimagingandGIradiology.

Wehopethatbytheendofthecongress,youwillhavenotonlylearnttechnicalinformationthatwillhelpwithyourdailyactivities,butalsomanyotherinterestinghistoricalaspects,whichmaytriggernewresearchideasoneachofthosesubjects.

Wehave the fantastic additionof ePosters this year,whichwill bedisplayedon thescreensinthefoyer,wherestudents,traineesandconsultantswillbeshowcasingtheircurrentresearch.Pleasetakethetimetoviewtheseandasktheauthor(s)questions;thetimetableofscheduledtalksisinyourconferencepack.

ThefirstBIRCongressdatesbackto1897.Ifyouareinterestedinfindingoutwhatwasdiscussedattheveryfirstcongressandthosethereafter,theBIRhistorystand(inthefoyer)willrevealall.

Weareextremelygratefultoalloursponsorsforsupportingthiseventandwehopeyouwillvisittheirexhibitionstandstofindoutmoreabouttheservicestheyoffer.

Finally,I,theorganisingcommitteeandtheBIRwishyouaveryenjoyableandeducationalexperienceattheBIRAnnualCongress2014.

DrKlausIrionClinicalLead,DepartmentofRadiology,LiverpoolHeartandChestHospitalBIRAnnualCongressDirector2014

We are most grateful to

for supporting this conference





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Day 2

Programme DAY 1: Wednesday 22 October

ROOM 1: Imaging in infection

08:30 Registration and refreshments

09:00 Welcome and introductionChair: DrKlausIrion,ClinicalLead,DepartmentofRadiology, LiverpoolHeartandChestHospital BIRAnnualCongressDirector2014

09:05 A journey through the history of tuberculosis ProfessorBertieSquire,ProfessorofClinicalTropicalMedicine, Director,LSTMCentreforAppliedHealthResearchandDelivery

09:50 Thoracic tuberculosis DrAlexandreMancano,ConsultantChestRadiologist, PublicHealthSystemofBrasilia-DF,Brazil

10:20 Abdominal tuberculosis DrElizabethJoekes,ConsultantRadiologist, RoyalLiverpoolUniversityHospitaland DrTomHeller,ConsultantinInternalMedicineandInfectiousDiseases, KlinikumPerlach,Munich

10:50 Refreshments

11:05 Infectious diseases in the head and neck ProfessorPradiptaHande,SeniorConsultantinRadiodiagnosis, BreachCandyHospitalTrust,Mumbai

11:35 Infection and the MSK system DrAndrewDunn,ConsultantMusculoskeletalRadiologistandHonorary ClinicalLecturer,RoyalLiverpoolUniversityHospital

12:05 Pneumonia DrJohnReynolds,ConsultantRadiologist/DeputyClinicalDirector, BirminghamHeartlandsHospital

12:35 Lunch

13:35 The world of the spores and hyphae DrDerekSloan,SeniorLecturerandConsultantPhysician, LiverpoolHeartandChestHospital

14:05 Fungal diseases and the thorax ProfessorArthurSSouzaJr,Professor,MedicalSchoolofRioPreto,Brazil

14:35 Aspergillus: how, when and why it harms the human body ProfessorWilliamHope, ProfessorofTherapeuticsandInfectiousDiseases,UniversityofLiverpool

15:05 Imaging of aspergillus in the lungs DrSujalDesai,ConsultantRadiologistandHonorarySeniorLecturer, King’sCollegeLondon

15:35 Refreshments

15:50 Understanding environmental mycobacteria ProfessorPeterDavies,ConsultantChestPhysician, LiverpoolHeartandChestHospital

16:35 Viral infections and the thorax ProfessorDanteEscuissato,AssociateProfessorofRadiology, FederalUniversityofParaná,Brazil

17:05 Viral infections and the abdomen DrElizabethJoekes,ConsultantRadiologist, RoyalLiverpoolUniversityHospital

17:30 Learn, imagine and fly through the radiological times ProfessorAdrianThomas, Chairman,InternationalSocietyfortheHistoryofRadiology HonoraryLibrarian,TheBritishInstituteofRadiology

18:15 Close of day

19:30 Congress dinner (for those who have pre-registered)

_______________________________________________________________________

Certificate of attendance

Yourcertificateofattendancewillbeemailedtoyouwithinthenexttwoweeksonceyouhavecompletedtheonlineeventsurveyat:

https://www.surveymonkey.com/s/BIRAnnualCongress2014

BIR Annual Congress 2015: 4–5 November, London

Speaker profiles (where supplied)

Professor Peter DaviesConsultant Chest Physician, Liverpool Heart and Chest Hospital

PeterDaviesqualifiedinmedicinefromOxfordUniversityin1973.

HedidhisjuniorhospitaljobsinLondonandCardiff,specialisinginGeneralandRespiratoryMedicine.HecompletedanMDthesisontuberculosisintheUKwhileworkingfortheMedicalResearchCouncil’sTuberculosisandChestDiseasesUnit.Fromthis,alifelonginterestintuberculosisdeveloped.

HewasappointedaConsultantRespiratoryPhysiciantoFazakerlyHospital(nowAintreeUniversityHospital)andtheCardiothoracicCentreTrustsin1988.In1990hesetuptheTuberculosisResearchandResourcesUnit(TBRRU),andisnowDirector.HehasconductedresearchintomanyepidemiologicalaspectsofTBinLiverpoolandotherpartsoftheworld,particularlyHongKongandIndia.In2004hewasappointedHonoraryProfessortoLiverpoolUniversity.In1998hehelpedformanewnationaltuberculosischarity:TBAlert,ofwhichheisthesecretary.

ProfessorDavieshaswrittenover120paperspublishedinrefereedJournals,30bookchapters,over100lettersandcommissionedarticlesandover170abstractsofpresentationsatscientificsocieties.ProfessorDavieshasalsoeditedtheonlydefinitivereferenceworkontuberculosispublishedoutsidetheUSA:“ClinicalTuberculosis”,publishedbyArnold,nowinitsfourth(2008)edition.Hehasco-authoredthesectionontuberculosisintheOxfordTextbookofMedicine(4thedition)andco-authored“CasesinClinicalTuberculosis,”alsopublishedbyArnold.

Dr Sujal DesaiConsultant Radiologist and Honorary Senior Lecturer, King’s College London

DrSujalDesaiwastrainedingeneralradiologyatKing’sCollegeHospitalandinthoracicimagingattheRoyalBromptonHospital.UnderthesupervisionofProfessorDavidHansell,hewasawardedanMDfromtheUniversityofLondonforhisworkonstructure-functionrelationshipsinfibrosinglungdiseases.Hisprincipalresearchinterestsareintheevaluationoffibrosinginterstitiallungdiseaseand,latterly,theareaofchroniclungdiseaseinadolescentswithvertically-acquiredHIVinfectionforwhichheistheprincipalcollaboratinginvestigatorwitharesearchgroupinZimbabwe.WithcolleaguesfromtheRoyalBromptonHospitalandHammersmithHospitals,heisalsotheprincipalinvestigatorinastudyevaluatingtheprevalenceofpleuralplaquesonCTandtheirrelationshipwithoccupationalhistory.Heistheprincipalauthor/co-authorof48peer-reviewpapers,13invitedreviews/editorials,and27bookchapters.Hehasalsoedited4books(including,mostrecently,theOxfordSpecialistSeriesinThoracicImaging).HeservedontheeditorialboardofClinicalRadiologyfor13yearsandispresentlyontheboardoftheJournalofThoracicImagingandtheEuropeanJournalofRadiology.InJune2012,DrDesaiwasPresidentoftheEuropeanSocietyofThoracicImaging(ESTI)andhostedthe20thannualmeetingofthesocietyinLondon.

Dr Andrew DunnConsultant Musculoskeletal Radiologist and Honorary Clinical Lecturer,Royal Liverpool University Hospital

DrAndrewDunnisaConsultantMSKRadiologistandHonoraryClinicalLecturerattheRoyalLiverpoolUniversityHospital.DrDunntrainedintheMerseyregionbeforecompletingafellowshipinMSKimagingfromtheUniversityofToronto.DrDunnhaspublishedwidelyinthemusculoskeletalimagingliterature,includingbookchaptersonsportsinjuryandupperlimbimaging,andisonthefacultyofmanynationalmusculoskeletalimagingcoursesincludingtheBritishMedicalUltrasound,BritishSocietyofSkeletalRadiologyandOswestrySpinalImagingcourses.DrDunnmaintainsanactiveroleineducation,teachingontheMerseySchoolofRadiologyandtheNorthernFellowshipofSportsandExerciseMedicinetrainingprogrammes.

Professor Dante EscuissatoAssociate Professor of Radiology, Federal University of Paraná, Brazil

DrDanteLEscuissatoisProfessorofRadiologyandInternalMedicine,FederalUniversityofParanáandconsultantradiologistinDAPIClinicinCuritiba,Brazil.

DrEscuissatoislinkedtotheteachingactivitiesofThoracicRadiology(residencyandpost-graduate)attheFederalUniversityofParaná.Hispublications(scientificarticlesandbookchapters)mainlyfocusoninfectiouslungdisease,hematopoieticstemcelltransplantationandinterstitiallungdiseases.

Professor Pradipta Hande, Senior Consultant in Radiodiagnosis, Breach Candy Hospital Trust, Mumbai

Professor(Dr)PradiptaCHandeisaSeniorConsultantinRadiodiagnosisattheBreachCandyHospitalTrustatMumbai,amultispecialitytertiarycareteachinghospital.AnMDfromtheArmedForcesMedicalCollege,UniversityofPune,shedidherpostdoctoraltraininginheadandneckimagingatMumbaiandattheUniversityteachinghospital,Cologne,Germany.Withsixteenyearsofacademicexperience,sheisauniversityrecognisedpost-graduateteacherandexaminerwiththeNationalBoardofExaminationsinRadiodiagnosis.Herareasofspecialinterestincludeheadandneckimagingandneuroimaging.ShehasbeenpartofthenationalfacultyoftheIndianRadiologyandImagingAssociation(IRIA)formorethantenyearsandhasbeenaVisitingFellowattheNHSUniversityHospitals.Shehaspublicationsinvariousjournalsandpresentedpapersandguestlecturesinseveralnationalandinternationalconferencesandseminars.

Dr Tom Heller, Consultant in Internal Medicine and Infectious Diseases, Klinikum Perlach, Munich

DrTomHeller,born1969,graduatedfromtheMedicalSchooloftheTechnicalUniversityMunich,Germanyin1995.Hespecialisedingeneralinternalmedicine,aswellasininfectiousdiseasesandworkedinGermany,SaudiArabiaandSouth

Africa.Hehasbeeninterestedindiagnosticandinterventionalultrasoundsincethebeginningofhiscareer.Hisresearchinterestsareultrasoundapplicationsintheresource-limitedsettingandsonographicdiagnosisandtreatmentofinfectiousdiseases.HeworkedonaprojectonremoteteachingofultrasoundinGabonandhasconductedultrasoundtrainingsinGermany,UK,Italy,Zimbabwe,Ethiopia,SouthAfrica,Ghana,SaudiArabia,Kuwait,PeruandCambodia.

Professor William HopeProfessor of Therapeutics and Infectious Diseases, University of Liverpool

WilliamHopeiscurrentlyanNIHRClinicianScientistandProfessorofTherapeuticsandInfectiousDiseasesatTheUniversityofLiverpoolintheUnitedKingdom.ProfessorHopeisaFellowoftheRoyalAustralasianCollegeofPhysiciansandaFellowoftheRoyalCollegeofPathologistsofAustralasia.

WilliamHopequalifiedinMedicinein1991beforeundertakingspecialisttrainingininfectiousdiseasesandclinicalmicrobiology.HecompletedhisPhDinantimicrobialpharmacologyin2006,whileundertakingfellowshipsatTheUniversityofManchesterandtheNationalInstitutesofHealth,Bethesda,USA.HewasawardedaChairinTherapeuticsandInfectiousDiseasesin2011atTheUniversityofManchester.HehasrecentlybeenappointedtoaChairintheDepartmentofMolecularandClinicalPharmacologyattheUniversityofLiverpool.

ProfessorHope’sareasofspecialinterestandresearchareantimicrobialpharmacokineticsandpharmacodynamics,mathematicalmodellingofantimicrobialagents,populationpharmacokinetics,andindividualisationofantimicrobialtherapy.ProfessorHopeisScientificAdvisortotheESCMIDFungalInfectionStudyGroup(EFSIG),amemberoftheICAACProgramCommitteeforAntimicrobialPharmacokinetics,PharmacodynamicsandGeneralPharmacology,andMedicalGuidelineDirectorfortheEuropeanSocietyofClinicalMicrobiologyandInfectiousDiseases(ESCMID).

Dr Elizabeth JoekesConsultant Radiologist, Royal Liverpool University Hospital

AftercompletionofspecialisttrainingintheNetherlandsin1998,DrJoekesworkedininterventionalradiologyandoncologyintheNetherlands.InJanuary2004shetookupapositionasHeadofRadiologyattheKomfoAnokyeTeachingHospitalinKumasi,Ghana.From2007shehasbeenemployedattheRoyalLiverpoolUniversityHospital,withacontinuinginterestintropicalandinfectiousdiseasesandglobalhealthradiology.SheisassociatelecturerattheLiverpoolSchoolofTropicalMedicineandexternalspecialistforthedepartmentofdiagnosticimagingofMedecinssansFrontieresinAmsterdam.

Dr Alexandre MancanoConsultant Chest Radiologist, Public Health System of Brasilia - DF

DrAlexandreMançanoisaconsultantchestradiologistintheStateHealthSecretaryofBrazil’sFederalDistrictandinAnchietaHospitalinFederalDistrict.Heisthe

coordinatoroftheImageDeparmentoftheBrazilianSocietyofPneumologyandPhthisiologyandthePresidentoftheRadiologyandDiagnosticImagingSocietyofBrasília–FederalDistrict.HeisalsoafullmemberoftheBrazilianCollegeofRadiologyandDiagnosticImaging.

Alexandrehaspublishedwidelyinthechestimagingliterature,includingbookchapters,andisonthefacultyofmanyBrazilianchestimagingcoursesincludingBrazilianNationalCongress.Alexandremaintainsanactiveroleineducation,teachingontheBrazilianCollegeofRadiologyandDiagnosticImagingandintheBrazilianSocietyofPneumologyandPhthisiologytrainingprogrammes.

Dr John ReynoldsConsultant Radiologist/Deputy Clinical Director, Birmingham Heartlands Hospital

JohnReynoldshasbeenaconsultantradiologistatBirminghamHeartlandsHospitalwithaninterestinthoracicimagingsince1993.HehasservedasPresidentoftheBritishSocietyofThoracicImagingfrom2006to2009.Recentpublicationsincludearticlesonairwaydisease,diffuselungdiseaseandpulmonaryvasculitisalongwithseveralmodulesinthethoracicsectionoftheRoyalCollegeofRadiologistsIntegratedTrainingInitiative.HehasbeenontheeditorialboardofClinicalRadiology,BritishJournalofRadiologyandImagingandservedastherespiratoryexpertleadfori-Refer,theRoyalCollegeofRadiologistsclinicalguidelinepublication.HislungcancerinteresthasledtohimbeingonthemedicaladvisorygroupoftheUKLungCancerCoalition.

Dr Derek SloanSenior Lecturer and Consultant Physician, Liverpool Heart and Chest Hospital

DrDerekSloanisaSeniorLecturerandConsultantPhysicianinInfectiousDiseasesatLiverpoolHeartandChestHospitalandtheLiverpoolSchoolofTropicalMedicine.HisclinicaltrainingwasinGlasgowandLiverpool.HehasalsoworkedextensivelyinAfricancountrieswithhighratesofHIV-infection,includingKenya,SouthAfricaandMalawi.Hisprimaryresearchinterestistuberculosis,buthehasalsoauthoredseveralpublicationsonfungaldiseases,specificallycryptococcalmeningitis.HisresearchhasbeenfundedbytheWellcomeTrustandhehasaPhDininfectionandglobalhealth.

Professor Arthur S Souza JrProfessor, Medical School of Rio Preto

ProfessorArthurSoaresSouzaJrgraduatedandtrainedingeneralradiologyinSãoJosédoRioPreto,didaFellowshipinUniversityofAlabamaatBirmingham,USA,underthesupervisionofProfessorDavidM.WittenandLarryP.Elliott.Hisprincipalresearchinterestsareintheevaluationinfectionsanddiffuselungdiseases.Heistheauthor/co-authorof110peer-reviewpapers,and15bookchapters.HeispresentlyontheboardoftheBrazilianJournalofRadiologyandBrazilianJournalofPneumology.HeismemberofScientificCommitteeofSocietyPaulistadeRadiologia.

Professor Bertie SquireProfessor of Clinical Tropical Medicine, Director, LSTM Centre for Applied Health Research and Delivery

Areasofinterest:Tuberculosis:improvingaccessbythepoortodiagnosisandclinicalcare,equityinhealthandappliedhealthresearch.

ProfessorSquirestudiedmedicineandimmunologyatUniversityCollegeLondonandCambridgeUniversitybeforeprofessionaltrainingininternalmedicine,infectiousdiseasesandrespiratorymedicineattheRoyalLondonHospitalandtheRoyalFreeHospital.From1992to1995hewasHeadoftheDepartmentofMedicine,KamuzuCentralHospital,Lilongwe,Malawi.SincehisappointmentatLSTMin1995,ProfessorSquirehasmaintainedhisresearchcollaborationwiththeNationalTBControlProgrammeinMalawiandhasfacilitatedthetransformationofthecollaborationintotheMalawi-registeredTrustforResearchonEquityAndCommunityHealth(REACH).Withcolleaguesinmanycountrieshehasbuiltupaprogrammeofmulti-disciplinaryappliedhealthresearchaimedatprovidingknowledgeforactioninmakinghealthservicesfortuberculosismoreaccessibletopoorpeopleindevelopingcountries(includingthoseaffectedbytheHIVpandemic).HeholdsanappointmentintheUKNationalHealthServiceasHonoraryConsultantinInfectiousDiseasesandTropicalMedicineattheRoyalLiverpoolUniversityHospitalandistheimmediatepastPresidentoftheInternationalUnionAgainstTuberculosis&LungDisease.

Professor Adrian ThomasChairman, The International Society for the History of RadiologyHonorary Librarian, The British Institute of Radiology

ProfessorThomaswasamedicalstudentatUniversityCollegeLondon.HewastaughtmedicalhistorybyEdwinClarke,BillBynumandJonathanMiller.Inthemid-1980shewasafoundingmemberofwhatisnowtheBritishSocietyfortheHistoryofRadiology.In1995heorganisedtheradiologyhistoryexhibitionfortheRöntgenCentenaryCongressandeditedhisfirstbookonradiologyhistory.Hehaspublishedextensivelyonradiologyhistoryandhasactivelypromotedradiologyhistorythroughouthiscareer.HeiscurrentlytheChairmanoftheInternationalSocietyfortheHistoryofRadiology.ProfessorThomasbelievesitisimportantthattheradiologyisrepresentedinthewidermedicalhistorycommunityandtothatendlecturesonradiologyhistoryintheDiplomaoftheHistoryofMedicineoftheSocietyApothecaries(DHMSA).Heistheimmediatepast-presidentoftheBritishSocietyfortheHistoryofMedicine,andtheUKnationalrepresentativetotheInternationalSocietyfortheHistoryofMedicine._____________________________________________________________________

Abstracts (where supplied)

A journey through the history of tuberculosisProfessor Bertie Squire

Thistalktracksourunderstandingoftuberculosis;thediseasecausedbymycobacteriumtuberculosis.Themajormilestonesofthisunderstandingarecloselylinkedtothemajormilestonesinthedevelopmentofmodernmedicine

andthecontrolofinfectiousdiseases.Koch’sdiscoveryofthetuberclebacillusandhisworkdemonstratingthatthiswasthecauseofthediseasewhichwasoftenreferredtoas“consumption”cementedtheconceptofmicro-organismsascausativeagentsofdisease.Theuseofchestx-raystodiagnoseanddocumenttheextentofdiseasearecloselylinkedtothedevelopmentofthedisciplineofradiology.Randomised,controlledtrialsforassessingtreatmentoptionswerefirstdevelopedfortuberculosisandresultedincombinationchemotherapytoreducetherisksofthedevelopmentofdrugresistance.MorerecentlytheconceptoftreatmentasakeystepinpreventingtransmissionledtotheDOTSstrategywhichunderpinstheglobalstrategytocontroltuberculosis.Finally,wehavecomefullcircleinrecognisingthatthisclassicaldiseaseofpovertyanddeprivationwillnotbecontrolledwithoutensuringthateffectivetreatmentservicesaremadeavailableandaccessibleforpoorpopulationsalongwithinterventionstotackletheunderlyingdriversofdeprivation.

Thoracic tuberculosisDr Alexandre Mancano

DuringtheAidspandemia,inthebeginningofthe1980’s,wecouldseeanincreaseinthenumberofTuberculosis(TB)cases.

Wethought,inthattime,thatTBwasacontrolleddisease,butastheAIDSpandemiahasshownus,itwasnot.Inthattime,wefoundoutthatTBwastheimmediatecauseofthatpandemia,buttheunderlyingcausewasAIDS.

TheWorldHealthOrganization(WHO),in1993,namedTBaglobalemergencyandmadeanobscureprediction:Thatbetween1997and2020,wewouldhave1billionofnewcasesintheworldandwewouldseeabout70milliondeathscausedbyTB.

TBisaworldwidedisease.InEngland,wehaveabout10to19casesandinBrazil20to49casespera100thousandinhabitants.In2010,Englandhadabout500,000withTB,andinBrazilabout2millionpatientswithTB.

IfwecompareRiodeJaneirotoLondon,asseparatecities,wecanseeinRiosomethingbetween54to70TBcasesperahundredthousandinhabitants,andinLondonsomethingveryclosetothat.

So,thisisthereasonwhywearegoingtotalkaboutTBinthisimportantmeeting,inthe21stcentury.

TheobjectivesofourlecturewillbetoreviewandrecognisethemainradiologicaspectsinpulmonaryTB.Wecoulddividetheseobjectivesinfourtopics:1.PrimaryTB2.SecondaryTB3.TBinimunocompromisedhost4.Complicationspertinenttothedisease

Abdominal tuberculosisDr Elizabeth JoekesDr Tom Heller

Thissessionwillprovideabriefclinical,case-basedintroductiontoabdominaltuberculosis,incorporatingCTimaging.Thiswillbefollowedbyamorein-depthdiscussionoftheuseofultrasound(US)inthediagnosisofextra-pulmonaryTB(EPTB)inHIV,asforthevastmajorityofaffectedpopulationsCTandradiologicalexpertisearenotavailable.Focusedassessmentwithsonography(FASH)byclinicianscaringforTB/HIVpatientsisincreasinglyusedtoassistinthediagnosisofEPTB.Feasibilityandtrainingwillbediscussedbriefly.

Learningobjectives:1.RecognisetypicalultrasoundfindingsofEPTB.2.UnderstandexpectedUSchangesduringandaftertreatment.3.AppreciatetheaddedvalueofFASH,comparedtochestX-rays.4.RecognisekeyfeaturesofabdominalTBonCT.

Infectious diseases in the head and neckProfessor Pradipta Hande

Infectionsoftheheadandneckarenotuncommonandareoftenassociatedwithhighmorbiditywithdismaloutcomes.Itcanresultinrapiddeteriorationduetoextensionofdiseaseandseriouscomplications,evenintheeraofantibiotics,especiallyinimmune-compromisedpatients.Whilethediagnosisisprimarilybyclinicalexamination,theextentofinfectionisdifficulttoestimateclinically.Theroleofradiologyiswellestablished,eventhoughplainradiographshavealimitedutilityandcross-sectionalimagingisvitalfortheassessmentofdisease.

Educationalaims:Computedtomography(CT)andmagneticresonanceimaging(MRI)helpindetailedevaluationofextentofdiseaseandearlydetectionofvascularandairwaycompromiseandthusassistinplanningsurgicalmanagement.MDCTwithisotropicimagingallowsmultiplanarreconstructions(MPR)andexquisite3Dreformats.Intravenousnon-iodinatedcontrastinjectionisusefultostudytheenhancementpatternsandhelptodifferentiatephlegmonousmassfromabscesswhichneedsimmediatesurgicaldrainage.Softtissue,boneand/orlungwindowsfordisplayisrecommendedfortheextentofinfection,boneinvolvementandtodetectgaswithinthetissuesasinabscess.CTisquick,widelyavailableandisthemodalityofchoiceforimaginginheadandneckinfections.MRIhasbetterinherentsofttissuecontrastandcandetectoedemaearly.T1-weightedimagesafterIVinjectionofGadolinium-basedcontrastcanbeproblem-solvinginspecificsituationsespeciallyinwidespreaddiseaselikefungalinfections.However,ithasalimitedroleduetolongacquisitiontimesanddifficultyinbreathholdinginveryillpatients.

Learningoutcomes:Theimagingprotocolsshouldbetailoredtotheclinicalconditionandanattemptshouldbemadetodetectintra-cranial,spinalorthoracicextensionofthedisease.Thesourceofthesepticfocusmaybeotolaryngologicordental,whichcanbeassessedonheadandneckimaging.

Infection and the MSK systemDr Andrew Dunn

Successfulimagingdiagnosisofmusculoskeletalinfectionoftenrequiresamultimodalityapproachcomprisingradiography,ultrasound,MRI,CTandscintigraphy.Becauseeachoftheseimagingmodalitieshasitsownstrengthsandweaknesses,combinationsofmodalitiesareoftenutilised.Imagingshouldbecombinedatalltimeswithadetailedclinicalhistory,anddiscussionofimagingfindingswithcliniciansinthesettingofanInfectionMDTmeetingishelpfulinreachingarapiddiagnosisandplanningtreatment.Theeducationalaimsofthispresentationareasfollows:

1.Tocoverthemodesofspreadofmusculoskeletalinfectionwithparticularreferencetopatho-anatomyanddiscusssomeofthepathologicalterminologyofMSKinfection.2.TodiscusstheroleandapplicationofvariousimagingmodalitiesinthediagnosisofmusculoskeletalinfectionwithparticularfocusonradiographyandMRI.3.Considerhowandwhentoperforminterventionintheformofimageguidedfluidaspirationorbiopsy.4.Presentaproblem-solvingapproachwhenconsideringhowbesttoimageintheorthopaedicpost-operativesetting.5.TobrieflydiscusstheroleofnewerimagingmodalitiessuchasPET-CTinthediagnosisofMSKinfection.6.Presenttheimagingofsomeatypicalandsomerareorganismspecificmusculoskeletalinfections.

PneumoniaDr John Reynolds

Keyteachingpoints:1.Thechestradiographremainsakeyinvestigationwithsuspectedpneumoniaandformostitwillbetheonlyimagingtheyrequire.2.CTismoresensitivethanthechestradiographforthedetectionofpneumoniaandincertainclinicalsettingsmaygiveastrongenoughindicationofthetypeofinfectingorganismtoallowadecisiononanti-microbialtreatment.3.ComplicationsofpneumoniasuchaslungabscessorcomplicatedpleuraleffusionsmayrequirefurtherassessmentwithultrasoundorCT.4.MRItechnologyisadvancinganditprovidesanoptionforfollowupbutitdoesnotyetmatchCTasadiagnostictest.5.Mostpatientswithalungabscesswillrespondtomedicaltreatment.Forthosewhodonot,imageguidedcatheterplacementprovidesatreatmentoptionforthosenotfitforasurgicalapproach,particularlyiftheabscessabutsapleuralsurface.

References

1.ReynoldsJH,McDonaldG,AltonH,GordonSB.Pneumoniaintheimmunocompetentpatient.BritishJournalofRadiology2010;83:998-1009.

2.FranquetT.Imagingofpulmonaryviralpneumonia.Radiology2011;260:18-39.3.ReynoldsJHandBanerjeeAK.Imagingpneumoniainimmunocompetentandimmunocompromisedindividuals.CurrOpinPulmMed2012;18:194-201.

The world of the spores and hyphaeDr Derek Sloan

Fungiareubiquitousintheenvironment.Initiallythoughttobepartoftheplantkingdom,theyareactuallymorecloselyrelatedtoanimals.Withapproximately1.5millionspeciesonearth,fungiareamongstthemostevolutionarydiverseorganismsontheplanet.Theyprovidevaluableecosystemservicesthroughdecompositionoforganicmatterandsymbioticassociationswithotherlivingsystems.Theyarealsousedasfood.

However,theutilityoffungitolifeonearth,iscounterbalancedbypathogenicity.Diseasesofplantsandanimalsmayhavedevastatingconsequencesforhumankind;astrikinghistoricalexampleisinfectionofpotatoesbyphytophthorainfestanswhichledtothe19thcenturyIrishfamineandcausedthedeathofover1millionpeople.

Approximately300fungalspeciesarepathogenictohumans,particularlyamongstindividualswithunderlyingimmunedysfunction.Sincethe1980s,effectsoftheglobalHIVepidemicandincreaseduseofimmunosuppressivemedications(e.g.totreatinflammatorydiseaseandmalignancyortopreventtissuerejectionafterorgantransplantation)havefocussedattentiononthediagnosisandmanagementoffungalinfectionsincludingcrypotococcosis,aspergillosis,candidiasis,histoplasmosis,andpneumocystiscarinii(jerovecii)pneumonitis.

Thislecturewillintroducefungaldiseasebydiscussinggeneralcharacteristicsoffungiandillustratingthethreattohumanhealthviaexamplesofclinicaldisease.

Fungal diseases and the thoraxProfessor Arthur S Souza Jr

Fungalinfectionsofthelungarelesscommonthanbacterialandviralinfectionsbutposesignificantproblemsindiagnosisandtreatment.Theymainlyaffectpeoplelivingincertaingeographicareasandthosewithimmunedeficiency.Theirvirulencevariesfromcausingnosymptomstocausingdeath.

Ratesofinvasivefungalinfectionshavesurgedduringrecentdecades,largelybecauseoftheincreasingsizeofthepopulationatrisk.

TheaimofthispresentationisdemonstratingthemainTCfindingsofthemostcommonlungmycosesinSouthAmerica.

Imaging of aspergillus in the lungsDr Sujal Desai

Thepropensityforaspergillusspp.tocauselungdiseasehasbeenrecognisedforwelloveracentury.Yetthesatisfactoryclassificationofthesedisordershasprovedchallenging.Theproblemscausedinvasivediseaseinseverelyneutropenicpatients,saprophyticinfectionofpreexistingfibroticcavitiesandallergicreactionstoaspergillusarewelldocumentedintheliteratureandwillnotbethefocusofthepresentation.Incontrast,amorechronicformofaspergillus-relatedlungdiseasewhichhasthepotentialtocausesignificantmorbidityandmortality,hasbeenunder-reported.Thiswillbethemainfocusofthepresentation.Thesymptomsofthisformofaspergillusinfectionaregenerallynon-specificandbecauseofthisandtheradiologicalfindings(consolidationandcavitationintheupperzones)apresumptiveclinicaldiagnosisofmycobacterialinfectionisoftenmade.Indeed,non-tuberculousmycobacterialinfectionsfrequentlyco-existwithchronicpulmonaryaspergillosisandtheradiologistmaybethefirsttosuspectthisdiagnosis.Thecurrentpresentationwillconsiderstheclassificationconundrumsindiseasescausedbyaspergillusspp.anddiscussesthetypicalclinicalandradiologicalprofileofpatientswithchronicpulmonaryaspergillosis.

Understanding environmental mycobacteriaProfessor Peter Davies

Thesemycobacteriaarearealpest.Iwouldrathertreatapatientwithmulti-drugresistanttuberculosisanyday.YouknowwhereyouarewithMDRTBbutwiththeENorNTMsastheAmericanscallthemwearemostlyinthedark.Forastartiftheyareisolatedfromapatientwecan’tbesurethattheyareactuallycausingadisease,theymaybecommensalespeciallyifsmearnegative.WhenwedodecidetotreattherearepreciousfewRCTstoguideusastowhattotreatwithourhowlongtotreat.Becausetheyrelativelyrarelycausedeaththeyaregrosslyunderresearched.Alsoonecanvirtuallyneverdischargeapatientbecauseasthebacteriaareacquiredfromtheenvironment,patientscanbeinfectedtimeandtimeagain.Andtomakemattersworsetheclevermicrobehuntersseemtocomeupwithanewspeciesdaily.Herearejustsomeofthenamesforstarters.M.scrofulaceumM.szulgai,M.aviumcomplex(MAC).M.ulcerans,M.xenopi,M.malmoense,M.terrae,M.haemophilumM.genavense.M.chelonae,M.abscessus,M.fortuitumandM.peregrinum.M.smegmatisandM.flavescens.How’saguygoingtogetahandleonthatlot?

Viral infections and the thoraxProfessor Dante Escuissato

Virusesarecommoncausesoflowerrespiratorytractinfectionandmayresultintracheobronchitis,bronchiolitis,andpneumonia.Theseinfectionsaretransmittedfrompersontopersonbyhand-to-hand-contact,contactwithinfectedsurfaces,oraerosoltransmission.Viralpneumoniainadultscanbedividedintotwogroups:atypicalpneumoniainpreviouslynormalpatientsandviralpneumoniainimmunocompromisedhosts.Clinicalandimagingmanifestationsinviral

infectionsarenotcharacteristics,makingitdifficulttodifferentiateinfectionswithotheragents.Althoughitisnotpossibletodiagnoseviralinfectionsbasedsolelyonimagingmethods,thecombinationofthesewithclinicaldatacanincreasetheaccuracyinthediagnosis.

Viral infections and the abdomenDr Elizabeth Joekes

Awiderangeofviralinfectionsmanifestsitselfwithintra-abdominalpathology.Formanyofthesetheroleofdiagnosticimagingislimitedorentirelyabsent.Forothers,likehepatitisanditscomplicationsofcirrhosisandHCC,theroleofimagingandimagingguidedtreatmentiswellknownandfeaturesprominentlyintheliterature.Thecurrentlecturewillfocusonthefeaturesoflesscommonlyencounteredviralinfectionsandtheirsequelaeanddifferentialsonimaging:CMV,EBVandHPVforexample.Followingabriefgeneraloverviewofviralinfectionsforradiologists,clinicalcases,usingmainlyCTandultrasoundwillbediscussed.Learningoutcomes:Torecognisewhenaviralinfectionshouldbeconsideredinthedifferentialofintra-abdominalimagingpathology.

Learn, imagine and fly through the radiological timesProfessor Adrian Thomas

Thereweresignificantadvancesinmedicineduringthe19thcenturywithincreasedknowledgeinmedicine,surgery,bacteriologyandchemicalpathology.Howeverourabilitytolookinsidethebodyhadshownlittleimprovementandwaslimitedtotheprobingfingerorsimpleendoscopy.Thiswasalltochangein1895whenWilhelmConradRöntgendiscoveredx-rays.Thedescriptionoftheabilitytoseethroughthebodywasgreetedbymanywithincredulityandearlyaccountshadtoreassurethepublicthatthiswasaseriousdiscoverybyarespectedscientist.

Earlyradiologywastechnicallydifficulttoperform,howeverduringthenextfewdecadestheequipmentgraduallyimproved.Initiallyimageinterpretationwasalsodifficultandittookmanyyearstodeciphertheseoftenconfusingshadows.Radiologywasalsonotwithoutrisk,withinjuriesrelatedtoionisingradiation,electricalinjuriesandchemicalinjuriesfromprocessingthefilmsandplates.

Radiologysteadilyprogressedwiththedevelopmentofthemodernx-raytube,contrastmedium,cathetersandimageintensification.Traditionalradiologyrevolutionisedmedicalcare.Howeverinvestigationswereofteninvasiveandpathologywasoftenshownindirectly.

Radiologyhasprofoundlychangedsincewhatcanbeseenasthegoldendecadeofthe1970s,startingwiththeannouncementofCTscanningin1972.DevelopmentsinCTscanning,ultrasound,nuclearmedicine,MRIscanning,andfinallyinterventionalradiologyhasplacedradiologyintheforefrontofmodernmedicine.Modernradiologynowallowsfornon-invasivediagnosis,andthishasfacilitatedminimallyinvasivetherapy.Thisstoryisexcitingandinteresting.

Reading:Thomas,AMK.,Banerjee,AK.TheHistoryofRadiology.Oxford:OxfordUniversityPress(2013)

Educationalaimsandlearningoutcomes:1.Tounderstandthebackgroundtoradiology.2.Toseeconnectionsbetweenvariousfacetsoftheradiologicalscience.3.Tounderstandhowonedevelopmentfacilitatedanother.

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Programme DAY 1: Wednesday 22 October

ROOM 2: Cardiovascular imaging


09:00 Welcome and introductionChair: DrSukumaranBinukrishnan,ConsultantCardiothoracicRadiologist, LiverpoolHeartandChestHospital

09:05 History of cardiac CT from inception to present DrTarunMittal,ConsultantCardiothoracicRadiologist, RoyalBrompton&HarefieldNHSTrust

09:50 Dual energy in cardiac CT DrBalazsRuzsics,ConsultantCardiologist RoyalLiverpoolUniversityHospital

10:20 Role of CT in imaging myocardial perfusion DrMichelleWilliams,RadiologyTrainee,RoyalInfirmaryofEdinburgh

10:50 Refreshments

11:05 Cardiac CT for the emergency department DrRussellBull,ConsultantRadiologist,RoyalBournemouthHospital

11:35 Imaging of the vulnerable plaque with cardiac CT DrBalazsRuzsics,ConsultantCardiologist RoyalLiverpoolUniversityHospital

12:05 Imaging in TAVI DrSukumaranBinukrishnan,ConsultantCardiothoracicRadiologist, LiverpoolHeartandChestHospital

12:35 Lunch

13:35 Management of pulmonary embolic disease ProfessorDuncanEttles,ConsultantCardiovascularandInterventional Radiologist,HullRoyalInfirmary

14:05 Acute aortic syndromes ProfessorPeterGaines,ConsultantVascularInterventionalRadiologist, SheffieldVascularInstitute

14:35 Management of acute thoracic dissections DrMohamadHamady,ConsultantInterventionalRadiologistand SeniorLecturer,ImperialCollegeLondon

15:05 Management of thoracic/arch aortic aneurysm MrManojKuduvalli,ConsultantCardiacSurgeon, LiverpoolHeartandChestHospital

15:35 Refreshments

15:50 Management of aorto-iliac occlusive disease DrGrahamRobinson,ConsultantVascularRadiologistandClinicalLeadfor VascularRadiology,HullRoyalInfirmary

16:15 Stroke prevention: carotid artery stenting DrTrevorCleveland,ConsultantVascularRadiologist, SheffieldVascularInstitute

16:40 Management of abdominal aortic aneurysms DrNicholasChalmers,ConsultantVascularRadiologist, ManchesterRoyalInfirmary

17:05 Interventional management of hypertension DrTrevorCleveland,ConsultantVascularRadiologist, SheffieldVascularInstitute

THE FOLLOWING LECTURE WILL TAKE PLACE IN ROOM 1

17:30 Learn, imagine and fly through the radiological times ProfessorAdrianThomas, Chairman,InternationalSocietyfortheHistoryofRadiology

18:15 Close of day

19:30 Congress dinner (for those who have pre-registered)

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Dr Sukumaran BinukrishnanConsultant Cardiothoracic Radiologist, Liverpool Heart and Chest Hospital

DrBinukrishnanisaconsultantcardiothoracicradiologistatLiverpoolHeartandChestHospitalNHSTrustandRoyalLiverpoolandBroadgreenUniversityHospitalsNHSTrust.HeobtainedhisundergraduatedegreefromIndiaandMRCPfromEdinburgh.RadiologyspecialisttrainingwasfromMerseySchoolofRadiology.CardiacCTtrainingwasobtainedasfellowattheUniversityofErlangen,Nuremberg,GermanyandCardiacMRIasvisitingfellowatStanfordUniversity,California,USA.Hehasover6yearsofexperienceincardiacCTandcardiacMRIincludingadultcongenitalheartdiseases.Heisalsoaccreditedinchestandgeneralradiology.Publicationsareinthefieldofcardiacandchestimaging.

Dr Russell BullConsultant Radiologist, Royal Bournemouth Hospital

DrBullwasappointedasaconsultantradiologistattheRoyalBournemouthHospitalin2000.DrBullinitiallyworkedasageneralCrossSectionalRadiologistandstartedacardiacCTserviceatBournemouthin2003followedbyacardiacMRIservicethefollowingyear.Forthelast4yearshehasworkedalmostexclusivelyasaCardiothoracicRadiologistwithhistimesplitbetweencardiacCTandMRI.HisinterestsincludereducingradiationandcontrastdosesforCTexaminationsandincreasingefficiencywithinradiologydepartmentsbyoptimisingtechnologyandworkflows.DrBulliscurrentlysecretaryandeducationleadfortheBritishSocietyofCardiovascularImaging(BSCI).

Dr Nicholas Chalmers Consultant Vascular Radiologist, Manchester Royal Infirmary

DrNickChalmershasbeenaConsultantVascularRadiologistatManchesterRoyalInfirmaryformorethan20yearsandhasbeeninvolvedwithendoluminalrepairofaorticaneurysmformostofthistime.HewasaparticipantintheEVARandIMPROVETrials.

Dr Trevor Cleveland, Consultant Vascular Radiologist, Sheffield Vascular Institute

DrTrevorClevelandqualifiedinmedicinefromNottinghamUniversityin1985.Followingayear’spostinCambridgedoingA&E,neurotraumaandorthopaedics,hejoinedtheSheffieldSurgicalTrainingScheme.HebecameFellowoftheRoyalCollegeofSurgeonsofEnglandin1990,andcommencedradiologytraininginSheffield,withtheintentionofpursuingacareerininterventionalradiology.HebecameaFellowoftheRoyalCollegeofRadiologistsin1994.HewasappointedSeniorLecturer(HonoraryConsultant)inVascularRadiologyatSheffieldUniversityin1995andConsultantVascularRadiologistin2000.

DrClevelandhasbeenamemberoftheBritishSocietyofInterventionalRadiologysince1995,andhasservedontheCouncil.HeisalsoaFellowandontheAdvisoryBoardofCIRSE,andisaDirectoroftheEuropeanSchoolofInterventionalRadiology.DrClevelandisalsoamemberoftheEuropeanSocietyofRadiologyandpresentlyservesontheBoardoftheFacultyoftheRoyalCollegeofRadiologists.

Professor Duncan EttlesConsultant Cardiovascular and Interventional Radiologist,Hull Royal Infirmary

DuncanEttlesisaConsultantCardiovascularandInterventionalRadiologistforHullandEastYorkshireHospitalsNHSTrustandHonoraryClinicalProfessorinradiologyattheUniversityofHull.HecurrentlyservesaspresidentoftheBritishSocietyofInterventionalRadiology,throughwhichhehasbeeninvolvedinthedevelopmentofUKinterventionalradiologyforover20years.HehasalsobeenactiveintrainingIRsthroughouthiscareer,includingrolesasformerheadoftraining,regionaladviserandexaminerfortheRoyalCollegeofRadiologists.ProfessorEttlesischairmanoftheNHSspecialisedcommissioninggroupforinterventionalradiologyandmemberoftheNICEGDGandQualityStandardsCommitteeforperipheralarterialdisease.

Professor Peter GainesConsultant Vascular Interventional Radiologist,Sheffield Vascular Institute

DegreefromManchesterMedicalSchool,MRCPafterendlessclinicalpostsfinallysettlingintoRadiologyatGuy’sHospital.MovedtoSheffieldtoextendvascularexperiencewiththeincredibleProfessorDavidCumberland.AfterayearinHongKong,twoyearsasSeniorLectureratSheffieldUniversity,he’sbeenConsultantRadiologistinSheffieldsince1995.HedevelopedtheautonymousSheffieldVascularInstitute1998.

HehasspentsometimespentwithDoHdevelopingPaymentbyResultsforInterventionalRadiology,NICE,MHRAandaspresidentoftheBritishSocietyofInterventionalRadiology.

Hehaswritten124originalscientificpapersandseveralchaptersandbooks.

Hisspecificinterestisthoracicaorticdisease,carotidinterventionandvascularmalformations.

HeiscurrentlyMDfortwodevicecompaniesandRadiologyConsultantforiGenewhoarerollingoutdigitalautopsyacrosstheUK.

Dr Mohamad HamadyConsultant Interventional Radiologist and Senior Lecturer, Imperial College London

DrHamadygraduatedfrommedicalschoolin1998.Following3yearsofsurgicaltraining,hejoinedclinicalandinterventionalradiologytrainingattheAmericanUniversityofBeirut.HecompletedinterventionalradiologytrainingatKing’sCollegeLondonin2001.Hedid2yearsofclinicalresearchinIRatGuy’sandStThomas’Hospital.HethenjoinedImperialCollegeLondonin2003asConsultantandSeniorLecturerinVascularInterventionalRadiology.

Hisresearchinterestsincluderoboticendovascularinterventionandnavigation,virtualrealitysimulationtrainingofendovascularskills,aorticstentgraftingandovarianreservepostfibroidembolisation.Herecentlystartedaresearchworkonimprovingpatient’ssafetyinIR.

Hehasover120papersinpeer-reviewjournalsand12bookchapters.Hehasgivenmorethan65talksandkeynotelecturesinnationalandinternationalscientificmeetings.

Heiscurrentlydeveloping,incollaborationwithindustry,anewgenerationoffenestrated/branchedstentgraftforthoraco-abdominalaneurysms.DrHamadyhasdonetheworld-firstroboticendovascularaorticrepairin2008andtheworld-firstroboticfibroidembolisationin2012.

Mr Manoj Kuduvalli Consultant Cardiac Surgeon, Liverpool Heart and Chest Hospital

MrManojKuduvalligraduatedinIndiain1992andtrainedinMumbaiasacardiovascularandthoracicsurgeonbeforemovingtotheUKin1999.HefurthercompletedhistrainingprogrammeincardiothoracicsurgeryintheUKandwasappointedasaConsultantCardiacSurgeonattheLiverpoolHeartandChestHospitalin2007.Inadditiontogeneralcardiacsurgery,hismainareasofspecialinterestareinthoracicaorticsurgeryandtranscatheteraorticvalveimplantation(TAVI).

Dr Tarun Mittal, Consultant Cardiothoracic Radiologist, Royal Brompton & Harefield NHS Trust

DrMittalwastrainedinallaspectsofcardiacimaginginLeeds.Asaconsultantsince2002,hehasdevelopedandrunhighlysuccessfulclinicalservicesincardiacCTandMRatHarefieldhospitals.Hisresearchinterestsincludeimagingofcoronaryarterydisease,prevention,valvedisease,heartfailureandcardiactransplantation.HehasbeenactivelyinvolvedinteachingandtrainingwithRCRandrunningaverysuccessfulcourseincardiacCT.

Dr Graham RobinsonConsultant Vascular Radiologist and Clinical Lead for Vascular Radiology, Hull Royal Infirmary

DrGrahamJRobinsonisaConsultantVascularRadiologistandtheClinicalLeadforVascularRadiologyattheHullandEastYorkshireNHSTrust.HequalifiedfromOxford,andtrainedinOxford,London,BirminghamandTorontopriortotakinguppostinHullin2000.HehasservedontheBSIRScientificProgrammeCommitteeandcurrentlysitsontheBSIRSafetyandQualityCommittee.HeisRCRtutorforHullRoyalInfirmary,andhasbeenactivelyinvolvedinthelocaltrainingschemesinceappointment.Hisinterestsincludeembolisation,aorticendografting,hereditaryhaemorrhagictelangiectasiaandmedicaldeviceregulation.

Professor Adrian ThomasChairman, The International Society for the History of RadiologyHonorary Librarian, The British Institute of Radiology

ProfessorThomaswasamedicalstudentatUniversityCollegeLondon.HewastaughtmedicalhistorybyEdwinClarke,BillBynumandJonathanMiller.Inthemid-1980shewasafoundingmemberofwhatisnowtheBritishSocietyfortheHistoryofRadiology.In1995heorganisedtheradiologyhistoryexhibitionfortheRöntgenCentenaryCongressandeditedhisfirstbookonradiologyhistory.Hehaspublishedextensivelyonradiologyhistoryandhasactivelypromotedradiologyhistorythroughouthiscareer.HeiscurrentlytheChairmanoftheInternationalSocietyfortheHistoryofRadiology.ProfessorThomasbelievesitisimportantthattheradiologyisrepresentedinthewidermedicalhistorycommunityandtothatendlecturesonradiologyhistoryintheDiplomaoftheHistoryofMedicineoftheSocietyApothecaries(DHMSA).Heistheimmediatepast-presidentoftheBritishSocietyfortheHistoryofMedicine,andtheUKnationalrepresentativetotheInternationalSocietyfortheHistoryofMedicine.

Dr Michelle WilliamsRadiology Trainee, Royal Infirmary of Edinburgh

DrMichelleWilliamsgraduatedfromtheUniversityofEdinburghin2005.ShecontinuedhermedicaltraininginEdinburghandrecentlycompletedaBritishHeartFoundationClinicalResearchFellowattheUniversityofEdinburgh.SheisnowaradiologytraineeattheRoyalInfirmaryofEdinburghandparticipatesinresearchstudiesattheClinicalResearchImagingCentreinEdinburgh.Hermaininterestsarecomputedtomographycoronaryangiographyandcomputedtomographymyocardialperfusionimaging.


History of cardiac CT from inception to presentDr Tarun Mittal

CardiacCThascomealongwaysincetheorigininventionofCTscannerbySirGodfreyHounsfield.Ithasalwaysbeenpossibleforradiologiststodiagnosecardiacmassesandpericardialthickeningevenwiththesingleslicenon-helicalscanners.ElectronbeamCTscannersbroughtinaninnovativerapidwaytoscantheheartbuttheiruseremainedconfinedtocalciumscoring.Multi-slicehelicalscanningtechnologysincetheturnofthecenturyhasrevolutionisedcardiacimagingwiththeabilitytoimagethecoronaryarteriestodiagnosticlevelandthusbecomeacceptableinclinicalpractice.

Role of CT in imaging myocardial perfusionDr Michelle Williams

AdvancesincardiacCTimagingmeanthatitisnowpossibletoassessanatomy,function,perfusionandviabilityinonerapiddiagnostictest.CTcoronaryangiographynowhasadiagnosticaccuracyfortheidentificationofsignificantcoronarystenosissimilartoinvasivecoronaryangiography.Inaddition,CTmyocardialperfusionimagingcanaidintheassessmentofintermediatestenosis,heavilycalcifiedvesselsorcoronaryarterystents.MultimodalityimaginghasshownthediagnosticaccuracyofCTmyocardialperfusionimagingincomparisonwithMRI,fractionalflowreserveandoxygen15labeledwaterPETimaging.Importantly,CTmyocardialperfusionimagingisnowpossibleatalowradiationdose,comparativetoconventionalinvasivecoronaryangiographyornuclearmedicinetechniques.CurrentresearchaimstooptimizethistechniqueaspartofacomprehensivecardiacCTprotocol.Thistalkwillprovideanoverviewofthecurrentmethodstoassessmyocardialperfusion(suchasSPECTandMRI)andwhyassessingmyocardialperfusionisusefulindiagnosingandtreatingpatientswithcoronaryarterydisease.Thebasictechniquefortheacquisitionandinterpretationofimageswillbepresented.ThecurrentstateoftheevidenceforusingCTtoassessmyocardialperfusionwillbeexploredandfutureareasforresearchwillbehighlighted.

Cardiac CT for the emergency departmentDr Russell Bull

Chestpainisoneofthecommonestreasonsforpresentationtoanemergencydepartment.Investigationofacutechestpainvarieswidelyacrossthecountry.Oftenpatientswithacutechestpainarehospitalisedforfurtherinvestigation.Followingrelativelytime-consumingandexpensiveinvestigations,manyofthesepatientsarefoundtohavenosignificantdisease.Usingatleast64-detectortechnologyitispossibletoexcludecoronaryarterydiseasewithhighreliabilityandatlowradiationdoseusing‘prospective’ECGgating.Theso-called‘tripleruleout’examinationhasrecentlybeensuggestedbysomeauthorsasaneffectivewayofexcludingcoronaryarterydisease,pulmonaryembolusandaorticdissectiononthesameCTstudy.Thesestudiesaretechnicallyverychallengingtoperformusingconventional64detectortechnologyduetolongacquisition

timesbuthaverecentlybecomemorestraightforwardwiththeadventofwideareadetectorordualtubetechnology.InorderforCTintheinvestigationofacutechestpaintobesafeandeffective,appropriateassessmentandriskstratificationbyanexperiencedclinicianisabsolutelyessential.Thetechnicalandlogisticalchallengesofthisapproachtogetherwiththepotentialbenefitsintermsofcostsavingsandspeedofdiagnosiswillbediscussed.

Imaging in TAVIDr Sukumaran Binukrishnan

Computedtomography(CT)playsanimportantroleintheworkupofpatientswhoarecandidatesforimplantationofacatheter-basedaorticvalve,aprocedurereferredtoastranscatheteraorticvalveimplantation(TAVI)ortranscatheteraorticvalvereplacement(TAVR).CTprovidesinformationontheaccurateannularsizing,aorticdimensions,predictfluoroscopicprojectionswhichareveryimportantforasuccessfulprocedure.CTisalsoimportantinreducing/predictingpostprocedurecomplicationsevaluatingvalve/myocardialcalcificationandcoronaryposition.Imagingofperipheralaccessvesselsprovidesinformationonsuitabilitytoaccommodatethelargesheathsnecessarytointroducetheprosthesis.Thelecturewillcoverdataacquisition,interpretation,andreporting.

Management of pulmonary embolic diseaseProfessor Duncan Ettles

IntheUK,pulmonaryembolism(PE)isrecordedonthedeathcertificatesofapproximately12,000peopleperannumandthenumberofdeathsduetoPEeachyearisbelievedtobearound60,000.Thepresentationofthiscommonconditionisveryvariable,withaspectrumrangingfromasymptomaticcasestomassiveembolismwithmortalityexceeding50%.Currentlyavailableguidelinesrecommendtheuseofanticoagulationandperipheralthrombolysisinthemanagementofmostsymptomaticpulmonaryemboli.Inalimitednumberofcases,treatmentbymechanicalthrombectomyorcatheterdirectedthrombolysismaybeindicatedwhenthereisevidenceofhaemodynamicinstabilityorothersignsofclinicaldeterioration.Mechanicaldisruptionoflargeembolifollowedbyaperiodofcatheterdirectedthrombolysiscanleadtorapidreductioninpulmonaryarterialpressureandreversalofrightheartoverload.However,clinicaloutcomesremainrelativelypoorandunpredictable.Forthisreason,ongoingresearchintoselectioncriteriaandoptimalinterventionalmanagementisneeded.Theuseofinferiorvenacava(IVC)filtersiswidelyacceptedinthepreventionofpulmonaryemboli.PlacementofIVCfiltersmaybeindicatedasanadjuncttoconventionalanticoagulationfollowingpulmonaryembolismandinpatientswhereuseofanticoagulantsiscontraindicated.Nowadays,retrievablefiltersareincommonuseandhavelargelyreplacedtheolderpermanentdesigns.TheyareincreasinglyusedinhighriskandtraumapatientsforpreventionofPE,withlowreportedmorbidityandcomplicationrates.Theroleofinterventionalradiologyinthemanagementofpulmonaryembolicdiseaseremainscontroversial.Clearrecommendationsregardingtreatmentindicationsandstrategyarehamperedbyalackoflevel1evidence,butthereiscontinuedinterestandenthusiasmforthedevelopmentofthesepotentiallylifesavingtechniques.

Acute aortic syndromesProfessor Peter Gaines

Asyndromedefinesagroupofsymptomscommontoaparticularcondition.Theacuteaortaisthereforetheconverseofasyndromesinceitdescribesthreerelatedconditions–acutedissection(AD),intramuralhaematoma(IMH)andpenetratingulcer(PU)–thatsharecommonsymptomatologyandpotentialdevastatingoutcome.Allthreemostcommonlypresentwiththesevereaortictypetearingpain;anteriorlyinthechestwhenthediseaseaffectstheascendingaortaandintheback,whentheprocessinvolvesthedescendingthoracicaorta.Becausethatpainisfarfromdistinctive,theacuteaortaisfrequentlydiagnosedinpatientsinitiallyconsideredtohaveanacutecoronarysyndromeorpulmonaryembolus.Thedistributionofthepathologyaffectsoutcomeandthewaythattheconditionistreated.Ifthediseaseaffectstheascendingaorta,irrespectiveofhowfararoundtheaortatheconditionextends,thenthisisclassifiedasStanfordtypeA.Iftheascendingaortaisnotaffected,thenthisisreferredtoasStanfordtypeB.TypeAdiseasehasworseoutcomeandisusuallymanagedasanemergencybyopensurgery.TypeBdiseaseisrelativelymorebenignandismanagedbypharmaceuticallyrelievingstressupontheaorticwallandusingendovasculartechniquesinspecificsituations.Aorticdissectionreferstothepresenceofflowingbloodpassingintotheaorticwallthroughanentrytearandbackintothelumenthroughanexittear.Intramuralhaematomaistheoccurrenceofahaematomainthewallofthelumen,withoutflowingblood.Thismayprogressontofrankdissection.Apenetratingulceroccurswhenanatheroscleroticulcerpenetratesthroughtheinternalelasticlaminaintothemedia.ThismayprogresstoIMH,dissection,orpseudo-aneurysm.Thelecturewilldescriberiskfactors,naturalhistory,diagnosis,treatment,follow-upandoutcomeforthethreerelatedconditions.

Management of acute thoracic dissectionsDr Mohamad Hamady

Educationalaims:1.Todemonstrateevidence-basedpracticeinmanagementofAAD.2.TounderstandthecurrentchallengesinmanagingAAD.3.ToencourageradiologiststocontributetofutureresearchinthefieldofAAD.

Learningoutcomes:1.Tolearntheindicationsforsurgicalandinterventionaltreatment.2.TounderstandtheinterventionalstrategyinmanagingAAD.3.Tounderstandthecurrentlimitationsofvariousmanagementapproaches.4.TounderstandthefollowupplanforpatientswithAAD.

Acuteaorticdissection(AAD)isrelativelyrarebutpotentiallydevastatingpathology.AccordingtoStanfordclassification,AADisclassifiedintotwotypes,AandB.WhilesurgicalrepairisthegoldstandardtreatmentfortypeAdissection,endovascularstentgraft(ESTG)and/ormedicaltreatmentis

thepreferredoptionfortypeBAAD.MedicaltreatmentforasymptomatictypeBAADisassociatedwithhighsurvivalrate.EndovascularstentgraftforsymptomaticAADisassociatedwithsignificantlybetteroutcomethanmedicaltreatmentaloneoropensurgery.RevascularisationstrategymightbeneededtosupplementESTGinpatientswithvisceralorlimbmalperfusion.AsymptomatictypeBAADremainsacontroversialmedicalproblem.However,thereisgrowingevidencethatESTGisassociatedwithpositiveaorticremodellingandgood5–yearsurvival.Despitedevelopmentsinimagingtechnology,wearestillshortofpracticalandaccurateimagingpredictorsofdiseaseprogression.Similarly,moreclinicalevidenceisstillneededtodefinethesub-groupofpatientswithasymptomaticAADwhowoulddefinitelybenefitfromearlyintervention.

Management of thoracic/arch aortic aneurysmMr Manoj Kuduvalli

Themanagementofaneurysmsofthethoracicaortaareheavilydependentonimagingmodalitiesbothfortheirsurgicalmanagementaswellaslongtermsurveillance.Awarenessoftherequirementsfromimagingforsurgicalprocedureplanningisanimportantaspectinreportingimages.

Thispresentationwilldealwiththespectrumofthoracicaorticaneurysms,theirmanagement,bothconservativeandsurgical,andtheuseofimagingmodalitiesincludingtheirapplicationtoprocedureplanning.

Management of aorto-iliac occlusive diseaseDr Graham Robinson

Patientswithaorto-iliacocclusivediseasemaybeasymptomaticormayhaveintermittentclaudicationorcriticallimbischemia.Treatmentoptionsincludemanagementofriskfactors,endovascularinterventionandsurgicalrevascularisation.Thelearningobjectivesforthispresentationincludeappropriatediagnosticworkup,patientselectionforinterventionandanunderstandingoftheTransAtlanticInter-SocietyConsensus(TASC)classification.TheTASCguidelines,firstpublishedin2000andrevisedin2007,classifyaorticandiliaclesionsbylesionmorphology.TASCAlesionsincludeunilateralorbilateralCIAstenosesorunilateralorbilateralsingleshortstenosis(3cm)ofEIA.TASCBlesionsincludeshortsegmentstenosis(3cm)oftheinfrarenalaorta,unilateralCIAocclusion,singleormultiplestenosistotalling3-10cminvolvingtheEIAandnotextendingintotheCFA,unilateralEIAocclusionnotinvolvingtheoriginsoftheIIAorCFA.TASCClesionsincludebilateralCIAocclusions,bilateralEIAstenoses3-10cmlongnotextendingintotheCFA,unilateralEIAstenosisextendingintotheCFA,unilateralEIAocclusionthatinvolvestheoriginsoftheIIAand/orCFA,heavilycalcifiedunilateralEIAocclusionwithorwithoutIIAand/orCFAorigininvolvement.TASCDlesionsinvolveinfrarenalaorto-iliacocclusion;diffusediseaseinvolvingtheaortaandbothiliacarteriesrequiringtreatment;diffusemultiplestenosisinvolvingtheunilateralCIA,EIA,andCFA;unilateralocclusionsofboththeCIAandEIA;bilateralocclusionsofEIA;iliacstenosesinthoserequiringtreatmentforAAAwhoarepoorcandidatesforendovasculartreatmentorwhohaveotherlesionsrequiringopensurgicalrepairofaorta

oriliacarteries.TASCIIrecommendsendovasculartreatmentforTASCAandBlesionsandsurgicaltherapyforTASCCandDlesions.SeveralstudieshavereportedsuccesswithendovasculartreatmentofTASCCandDlesions,andpatientpresentationandcomorbidities,aswellaslocalexpertise,shouldbetakenintoaccountwhenplanningtreatment.

Stroke prevention: carotid artery stentingDr Trevor Cleveland

StrokeisanimportantcauseofmorbidityandmortalityintheUK.Preventingstrokehasthepotentialtohavemassivebenefitsforindividuals,aswellashealthcaremoregenerally.Asignificantproportionofstrokesarecausedbydiseaseofthecarotidarteries,mostcommonlyatheromaatthecarotidarterybifurcation.TIAandotherischaemiceventsmaygiveawarningthatanindividualmaysufferacompletedstroke,andinappropriatecircumstances,invasivetreatmentmaybebeneficial,inadditiontobestmedicalcare.Traditionallysurgicalendarterectomyhasbeenthemainstayofcarotidbifurcationintervention,butmorerecentlyangioplastyandstentinghavebecomeavailablefordiseaseatthebifurcation,andelsewhereinthecarotidarteryterritory.Carotidarterystentinghasmademanyadvances,inbothtechniqueandtechnology,andhasbeensubjectedtoanumberofrandomisedtrials.Despitethiscontroversycontinuestorageovertheindicationsforcarotidstenting,andwhenthisisappropriatetoofferapatient.Asaresult,manypatientsdonothaveaccesstothisoption,atatimewheretheDepartmentofHealthandNICErecommendtimelytreatment(interventionwithin2weeksoftheonsetofsymptoms).Thepresentationwillexaminehowcarotidstentingisperformed,inwhatcircumstancesitshouldbeconsidered,whatcanbedonetoimproveitssafetyprofile,andwhichpatientsmaybenefitfromit.

Management of abdominal aortic aneurysmsDr Nicholas Chalmers

Educationalaims:1.UnderstandtheAAAscreeningprogramme2.UnderstandtheevidenceforOpenversusEndovascularRepair(EVAR)ofelectiveandrupturedAAA3.RecognisesomenewandcomplexvariationsofEVARandconsidertheirplaceastreatmentoptions.

TheNHSAAAscreeningprogrammeinvitesmenaged65forultrasound.ThosewithanAAAof5.5cmorgreaterarereferredforprompttreatment.TheevidenceindicatesthatscreenedmenarelesslikelytodiefromanAAArelatedcause.However,screeningwillresultinsomeearlydeathsduetooperativemortality.Morethan700menwillneedtobescreenedtosaveoneaneurysmrelateddeathover4years.SinceAAAaccountsforonly2%ofdeaths,thereductioninoverallmortalitywillbeundetectable.

TheEVARtrials(andothers)demonstratedreducedoperativemortalityofelectiveEVARcomparedwithopensurgery,butearlybenefitswerereversedafterabout5years.Also,EVARconferrednosurvivalbenefitcomparedwithconservativemanagementforpatientsunfitforopenrepair.RecentlytheIMPROVEtrialhasshownequalsurvivalfollowingEVARandopenrepairofrupturedaneurysms.Despitetherelativelybalancedtrialoutcomes,therehasbeenacultureshifttowardsofferingEVARwheneverpossibletobothfitandunfitpatients.

TheanatomicallimitationsofsuitabilityforEVARhavediminishedwiththedevelopmentoftechniquessuchasfenestratedEVAR,whichhasintroducedahigherlevelofcomplexity.Newconceptssuchasendovascularaneurysmsealing(EVAS)withtheNELLIXdeviceandmultilayerflow-modulatingstents(MFMS)havebeenintroducedbuttheirdurabilityisunknown.CTfollow-upisimportant,andrelevantfindingswillbeillustrated.

Interventional management of hypertensionDr Trevor Cleveland

Highbloodpressureisamajorriskfactorintheaetiologyofcardiovascularevents,includingheartattackandstroke.Reductioninbloodpressure,toadegreewhichmayonthesurfaceappearrelativelyminor,resultsinasignificantreductionincardiovascularevents.Themainstayoftreatmentforhypertensionisdrugtherapy,andNICE(andmanyotherorganisations)hasissuedguidanceonhowdrugtherapyshouldbedelivered.Thereare,however,asignificantnumberofpeoplewhohavesustainedbloodpressures,whicharehigherthanwouldbeconsidereddesirable,despitemedicaltherapy.Suchpatientsareconsideredtohavedrugresistanthypertension.Onesignificantpotentialconfounderisthatnon-compliancewithdrugrecommendationsisnotuncommon.Nevertheless,suchpatientscontinuetorunhighrisksofevents.Interventionalradiologytechniqueshavetwopotentialoptionsforthetreatmentofhypertension,renalarterystenting,forstenoticdisease,andrenaldenervation.Bothoftheseprocedureshavepotentialrisksandbenefits,andbothhavebeenthesubjectofrandomisedtrialswhichhaverecentlyreported.Asaresult,thenumberofrenalarterystentprocedureshassignificantlydeclinedoverrecentyears,thereasonsforthisandthepresentindicationswillbeconsidered.Renaldenervationisanewoption,theroleforwhichremainscontroversial,andanareawhereresearchcontinues.

Learn, imagine and fly through the radiological timesProfessor Adrian Thomas

Thereweresignificantadvancesinmedicineduringthe19thcenturywithincreasedknowledgeinmedicine,surgery,bacteriologyandchemicalpathology.Howeverourabilitytolookinsidethebodyhadshownlittleimprovementandwaslimitedtotheprobingfingerorsimpleendoscopy.Thiswasalltochangein1895whenWilhelmConradRöntgendiscoveredx-rays.Thedescriptionof

theabilitytoseethroughthebodywasgreetedbymanywithincredulityandearlyaccountshadtoreassurethepublicthatthiswasaseriousdiscoverybyarespectedscientist.

Earlyradiologywastechnicallydifficulttoperform,howeverduringthenextfewdecadestheequipmentgraduallyimproved.Initiallyimageinterpretationwasalsodifficultandittookmanyyearstodeciphertheseoftenconfusingshadows.Radiologywasalsonotwithoutrisk,withinjuriesrelatedtoionisingradiation,electricalinjuriesandchemicalinjuriesfromprocessingthefilmsandplates.

Radiologysteadilyprogressedwiththedevelopmentofthemodernx-raytube,contrastmedium,cathetersandimageintensification.Traditionalradiologyrevolutionisedmedicalcare.Howeverinvestigationswereofteninvasiveandpathologywasoftenshownindirectly.

Radiologyhasprofoundlychangedsincewhatcanbeseenasthegoldendecadeofthe1970s,startingwiththeannouncementofCTscanningin1972.DevelopmentsinCTscanning,ultrasound,nuclearmedicine,MRIscanning,andfinallyinterventionalradiologyhasplacedradiologyintheforefrontofmodernmedicine.Modernradiologynowallowsfornon-invasivediagnosis,andthishasfacilitatedminimallyinvasivetherapy.Thisstoryisexcitingandinteresting.Reading:Thomas,AMK.,Banerjee,AK.TheHistoryofRadiology.Oxford:OxfordUniversityPress(2013)

Educationalaimsandlearningoutcomes:1.Tounderstandthebackgroundtoradiology.2.Toseeconnectionsbetweenvariousfacetsoftheradiologicalscience.3.Tounderstandhowonedevelopmentfacilitatedanother.

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Programme DAY 2: Thursday 23 October

ROOM 1: Lungs and abdomen


09:00 Welcome and introductionChair: DrKlausIrion,ClinicalLead,DepartmentofRadiology, LiverpoolHeartandChestHospital BIRAnnualCongressDirector2014

09:05 The lung, that spongy organ: architectural solutions to keep it open,ventilated and perfused – fit for gas exchange ProfessorEwaldWeibel,EmeritusProfessor,InstituteofAnatomy, UniversityofBern

09:50 Differentiation of chronic thromboembolic pulmonary hypertension and pulmonary arterial hypertension DrNicholasScreaton,ConsultantCardiothoracicRadiologist, PapworthHospital

10:20 Lung nodules on screening - what happened to the “suspicious ones” DrJohnHolemans,ConsultantRadiologist, LiverpoolHeartandChestHospital

10:50 Refreshments

11:05 From a subjective impression to the future of imaging quantification ProfessorEricHoffman,ProfessorofRadiology,Medicineand BiomedicalEngineering,UniversityofIowa

11:50 Pulmonary nodules: the role of MRI ProfessorBrunoHochhegger,ProfessorofRadiology, RiodeJaneiroFederalUniversity

12:10 Lumps in the lung ProfessorJohnGosney,ConsultantThoracicPathologist, RoyalLiverpoolUniversityHospital

12:30 Lunch

13:30 The BIR Sir Godfrey Hounsfield memorial lecture: The isotope bone scan past, present and future ProfessorIgnacFogelman,ProfessorofNuclearMedicine, King’sCollegeLondon

14:15 Prizes and awards ceremony

14:25 Investigating abdominal diseases through the times ProfessorAdrianDixon,EmeritusProfessorofRadiology, UniversityofCambridge

15:10 Pseudo liver lesions ProfessorAliNawazKhan,ConsultantRadiologist, NorthManchesterGeneralHospital

15:30 Diffusion weighted imaging of the bowel DrAndrewPlumb,HonoraryConsultantRadiologistand SeniorLecturerinMedicalImaging,UniversityCollegeLondon

15:50 Cystic liver lesions ProfessorAliNawazKhan,ConsultantRadiologist, NorthManchesterGeneralHospital

16:10 Refreshments

16:25 Imaging and renal failure DrJaneBelfield,ConsultantUro-Radiologist RoyalLiverpoolUniversityHospital

16:45 MR-based fat and iron quantification in the liver DrRadhoueneNeji,MRScientist,Siemens

17:05 Digital radiography MrUlrichNeitzel,SeniorManager,ClinicalScienceDiagnosticX-Ray, PhilipsHealthcare,Hamburg

17:25 Grand round in thoracic imaging DrPabloSantana,ConsultantRadiologist,Medimagen

17:40 Close of Congress

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Dr Jane BelfieldConsultant Uro-Radiologist, Royal Liverpool University Hospital

DrJaneBelfieldistheleadconsultanturo-radiologistattheRoyalLiverpoolUniversityHospitalandhavebeeninpostsince2010.Followinggeneralradiologytraining,sheundertookafellowshipinuro-radiologywithanadditionalfocusonteaching.

Specialinterestsincluderenaltransplantimaging,testicularimagingandrenalimaging.SheisinterestedinmedicaleducationandhascompletedaMastersinMedicalEducationwiththeUniversityofDundee,graduatingin2013,forwhichsheundertookaresearchprojectlookingatmethodsofteachingrenaltransplantultrasound.SheistheUndergraduateRadiologyLeadfortheMerseySchoolofRadiology.

SheiscurrentlythesecretaryoftheBritishSocietyofUrogenitalRadiology(BSUR)andamemberoftheScrotalWorkingGroupoftheEuropeanSocietyofUrogenitalRadiology(ESUR).Recentguidelineshavebeenacceptedregardingfollowupimaginginpatientswithtesticularmicrolithiasis.

Professor Adrian DixonEmeritus Professor of Radiology, University of Cambridge

ProfessorAdrianKDixonisMasterofPeterhouse,theoldestCollegeatCambridgeUniversity,andEmeritusProfessorofRadiology,havingbeenheadoftheDepartmentofRadiologyfor15years.HeisalsoanhonoraryconsultantradiologistatAddenbrooke’sHospital,Cambridge.

FromanIrishbackground,hewasborninCambridgewhereheearnedabachelor’sdegreeatKing’sCollege.HequalifiedinmedicineafterclinicalstudiesatStBartholomew’sHospitalLondon.Hethenspecialisedingeneralmedicine,gaininghisMRCPin1974beforedecidingtopursueacareerinradiology(anappropriatecareerinviewofhisimpendingdeafness).Hequalifiedasaradiologistin1978andworkedinpaediatricradiologyatGreatOrmondStreetHospital,andincomputedtomographyatStBartholomew’sHospital.In1979,hebecamealecturerattheUniversityofCambridge’sDepartmentofRadiology.Heearnedhisdoctorofmedicinedegreeforhisthesisoncomputedtomographyofthelumbarspine.In1986,hewaselectedaFellowofPeterhouse,wherehebecamedirectorofmedicalstudies.

Throughouthiscareer,ProfessorDixonhasbeenactivelyengagedinthefieldofscientificpublishing,asbothauthorandeditor.Hehaspublishedextensivelyintheareasofcomputedtomography,magneticresonanceimagingandvariousaspectsofeffectivenesswithinradiology.Thisisinadditiontohavingwrittenandco-editedvariousbooksonCT,anatomyanddiagnosticradiology.HeservedaseditorofthejournalClinicalRadiologyfrom1998to2002,editor-in-chiefofEuropeanRadiology2007-2013andWardenoftheFacultyofClinicalRadiologyoftheRCRfrom2002to2006.HewasawardedFellowshipoftheAcademyofMedicalSciencesin1998.

ProfessorDixonhasreceivedanumberofawardsthroughouthiscareerandheisanhonorarymemberofthenationalradiologicalsocietiesofFrance,Hungary,Spain,Sweden,SwitzerlandandtheUSA,aswellasbeinganHonoraryFellowoftheAmericanCollegeofRadiology,theRoyalAustralianandNewZealandCollegeofRadiologistsandtheFacultyofRadiologistsattheRoyalCollegeofSurgeonsinIreland.InrecentyearstheUniversitiesofCorkandMunichhaveawardedhimanHonoraryDoctorateofMedicine.In2014hewasawardedtheGoldMedaloftheEuropeanSocietyofRadiology.

HealsoservesasaTrusteeoftheDavidRossEducationalTrustandasamemberoftheHongKongUniversityGrantsCommittee.

Professor Ignac FogelmanProfessor of Nuclear Medicine, King’s College London

ProfessorFogelmaniscurrentlyProfessorofNuclearMedicine(NM),atKing’sCollegeLondonandHonoraryConsultantPhysician,Guy’sandStThomas’NHSTrustandDirectoroftheOsteoporosisScreeningandResearchUnit,Guy’sHospital.

HeisChairmanoftheBoardofExaminersfortheMScinNM,whichprovidestheonlyrecognisedtrainingprogrammeforNMintheUK.

Hehaswrittenover400articlesinpeerreviewedjournals,haswrittenoredited15books,andsupervised17PhD/MDstudents.

HeisaformerboardmemberandTrusteeoftheNationalOsteoporosisSocietyandwaspreviouslyChairmanofitsBoneDensitometry(BD)Forum.

Professor John GosneyConsultant Thoracic Pathologist, Royal Liverpool University Hospital

ProfessorJohnGosneyisConsultantThoracicPathologistattheRoyalLiverpoolUniversityHospital,Liverpool,UK,andProfessorofThoracicPathologyattheUniversityofLiverpool.

HeisaspecialistthoracicpathologistresponsibleforprovidingtheserviceindiagnosticthoracicpathologytotheRoyalLiverpoolUniversityHospitalandtotheLiverpoolHeartandChestHospital.Hehasinternationallyacknowledgedexpertiseinthepathologyoftumoursofthelung,especiallytheirdifferentialdiagnosisandtheirmorphological,immunochemicalandgeneticcharacterisation.Hehasresearchedwidelyinthefieldandhasnumerouspublicationsincludingoriginalpapers,reviewsandbookchapters.

Heisco-authoroftheUKRoyalCollegeofPathologists’guidelinesforthehandlingandreportingofthoracictumours,advisortoCancerResearchUKandcontributortotheWorldHealthOrganisation’sclassificationoftumoursofthelungsandpleura.

Professor Eric HoffmanProfessor of Radiology, Medicine and Biomedical Engineering, University of Iowa

ProfessorEricAHoffmanisthedirectoroftheAdvancedPulmonaryPhysiomicImagingLaboratory(APPIL)intheDepartmentofRadiologyandthedirectoroftheIowaComprehensiveLungImagingCenter(I-Clic)attheUniversityofIowa.HereceivedhisPh.D.inPhysiologyfromtheUniversityofMinnesota/MayoGraduateSchoolofMedicinein1981andremainedonstaffattheMayoClinicwherehewasamemberoftheteamwhichdevelopedtheearliestvolumetricCTscanner,theDynamicSpatialReconstructor(DSR).In1987hejoinedthefacultyofradiologyattheUniversityofPennsylvaniawherehewasthedirectorofCardiothoracicImagingResearchCenterandmovedtotheUniversityofIowain1992.ProfessorHoffmanisafellowoftheAmericanInstituteforMedicalandBiomedicalEngineering,anhonorarylifetimememberoftheSocietyofThoracicRadiology,andamemberoftheFleischnerSociety,andfounderoftheSPIEMedicalImagingtrackonPhysiologyandFunctionfromMultidimensionalImages.HehasservedontheRespiratoryIntegrativeBiologyandTranslationalResearch(RIBT)studysectionoftheNIHandhasservedasamemberofthescientificreviewboardoftheAmericanAsthmaFoundation.Hehaspublishedmorethan450peerreviewedjournalarticles,numerousbookchaptersandreviewarticlesandholdsnumerouspatentsrelatedtolungimageanalysis,CTcontrastagentsandsynchronizationofrespirationtothecardiaccycleasameansofventricularassist.Herecentlyreceivedthe2014JosephRRodarteAwardforScientificDistinctionfromtheRespiratoryStructureandFunctionAssemblyoftheAmericanThoracicSocietyandthe2013JohnWestawardforOutstandingContributionstotheFieldofFunctionalPulmonaryImagingfromtheIWPFI.

Throughouthiscareerhehasusedadvancedimagingmethodologiestostudybasicrespiratoryphysiologycenteredlargelyonmechanismsofventilationandperfusionheterogeneityandregionallungmechanics.ProfessorHoffman’srecentworkhasleadhimtoanewhypothesisregardingtheetiologyofemphysemabaseduponnovelfunctionalimagingprotocolshehasdevelopedusingdualenergymultidetectorrowCT.Hislaboratoryhasserved,orisservingas,aradiologyoversightandanalysiscenterfornumerousNIHsponsoredmulti-centerstudieswhichincludetheNationalEmphysemaTreatmentTrial(NETT),theSeverAsthmaResearchProject(SARP),COPDGeneandtheSubpopulationsandintermediateoutcomemeasuresinCOPDstudy(SPIROMICS).Dr.HoffmanisafounderofVIDADiagnostics,acompanyprovidingquantitativesolutionstotheevaluationofCTimagesofthelung

Dr John HolemansConsultant Radiologist, Liverpool Heart and Chest Hospital

DrHolemansdevelopedaninterestinchestdiseasewhilstamedicalstudentatCharingCrossandWestminsterMedicalSchool,London.Hegraduatedin1989andsubsequentlytrainedasaradiologistatGuy’sandStThomas’Hospitals,LondonandalsospentashortattachmentattheTheRoyalBromptonHospital.In1997hewasappointedaConsultantRadiologistattheLiverpoolHeartand

ChestHospitalandbecameHeadofDepartmentin2002.HeisaFellowoftheRoyalCollegeofRadiologists,RoyalCollegeofPhysiciansandBritishInstituteofRadiology.HismajorclinicalinterestsareHRCT,lungcancer,oesophagealcancerandaorticCTangiography,coronaryCTandCardiacMRI.Hereadall1000baselinelungcancerscreeningCTscansperformedinLiverpoolaswellasthefollowupscansaspartoftheUKLungCancerScreeningTrial.

Professor Ali Nawaz KhanConsultant Radiologist, North Manchester General Hospital

ProfessorAliNawazKhanwasConsultantRadiologistNorthManchesterHealthCareTrustfrom1979to2006.Hehashasauthoredsixbooks,600publications,chapters,abstractsandpostgraduatelectures.HewasvisitingProfessortoPakistanunderUnitedNationsDevelopmentProgram1992,1996and1999&2001coordinatingpostgraduateeducation,teachingandtrainingandworkingwithAfghanrefugees.HewasHonoraryProfessorofRadiology,AndizhanStateMedicalInstitute,UzbekistansinceOctober1998VisitingProfessortotheSovietUnion,Russia,Uzbekistan,KazakhstanandKirghizia1991,1992,1993,1994and1995,forgingacademiclinks.VisitingProfessor,InternationalNetworkforCancerTreatment&ResearchatInstitutPasteur,BrusselsBelgium2001-2005.MemberEducationCommittee,InternationalNetworkforCancerTreatment&ResearchatInstitutPasteur,BrusselsBelgium2001-2007.MemberEthicalReviewCommittee,InternationalNetworkforCancerTreatment&ResearchatInstitutPasteur,BrusselsBelgium2001-2007.HewasvisitingProfessorKuwaitUniversityApril2004.Lecturer,UniversityofManchesterfrom1982-2005.HaveapersonalexperienceintreatinghepatocellularcarcinomaintheUKwithanindividualseriesofover400chemoembolization’s.Hehasextensiveexperienceingeneralradiology,generalultrasound,CT,MRI,nuclearmedicine,visceralangiographyandvisceralvascularintervention.ProfessorandChairmanMedicalImaging,KingFahadHospital,NGHA,Riyadh,SaudiArabia31stJanuary2006-28thJanuary2009.

Mr Ulrich NeitzelSenior Manager, Clinical Science Diagnostic X-Ray, Philips Healthcare, Hamburg

DrUlrichNeitzelhasmorethan30yearsexperienceinthefieldofmedicalX-rayimaging,inparticulardigitalradiography.Hehasheldvariouspositionsinresearch,development,andclinicalapplicationofX-rayimagingsystemsandispresentlyseniormanagerofclinicalscienceforthediagnosticX-raybusinessunitofPhilipsHealthcareinHamburg,Germany.DrNeitzelhasauthoredorco-authoredmorethan60scientificpapersandbookchaptersandisafrequentlectureratinternationalconferences.HeholdsMSandPhDdegreesinphysicsfromGöttingenUniversity,Germany.

Dr Andrew PlumbHonorary Consultant Radiologist and Senior Lecturer in Medical Imaging, University College London

DrAndrewPlumbisaSeniorLecturerinMedicalImagingatUniversityCollegeLondonandHonoraryConsultantRadiologist.AfterundergraduatemedicaltraininginOxford,hereturnedtohishometownofManchesterforSeniorHouseOfficerandgeneralradiologytraining.AftergainingtheFRCR,hemovedtoLondonforsub-specialtytrainingingastrointestinalimagingandtostudyforaPhDwithProfessorsSteveHalliganandStuartTaylor.Hismainresearchinterestsaregastrointestinalandoncologicalimaging,particularlyCTcolonography,colorectalcancerscreeningandtheuseofMRIinCrohn’sdisease.

Dr Nicholas ScreatonConsultant Cardiothoracic Radiologist, Papworth Hospital

DrScreatonisaConsultantCardiothoracicRadiologistatPapworthHospital,Cambridge.Hisspecialinterestsincludepulmonaryhypertension,interstitialandairwaysdiseases,andlungcancerscreening.

HewasRadiologyClinicalDirectorinPapworthHospital2004-12andPresidentoftheBritishSocietyofThoracicImaging2009-13.

HesitsontheBritishThoracicSocietyBronchiectasisGuidelinesdevelopmentgroup,NationalInstituteofClinicalExcellenceIdiopathicPulmonaryFibrosisQualityStandardsCommittee,NationalInstituteofClinicalExcellenceGuidelinesUpdatesStandingCommittee,andNationalClinicalCommissioninggroupforSpecialisedImaging(stakeholderrepresentative).

Professor Ewald WeibelEmeritus Professor, Institute of Anatomy, University of Bern

ProfessorEwaldRWeibel,bornin1929,studiedmedicineattheUniversityofZurich,graduatingasMDin1955.HespentfivepostdoctoralyearsintheUnitedStatesworkinginpathologyatYaleUniversity,incardio-respiratoryphysiologyatColumbiaUniversity,andincellbiologyatTheRockefellerInstitute.In1963hereturnedtoSwitzerlandasAssistantProfessorattheUniversityofZurichandbecame,in1966,ProfessorandChairmanoftheInstituteofAnatomyattheUniversityofBerneuntilhisretirementin1994,servingasRectoroftheUniversityofBernein1984-85.

Inhisresearchhedevelopedtheconceptandmethodsofmorphometry,basedprimarilyonstereology,thisinviewofquantitativestudiesofstructure-functionrelationsinthelung,focusingongasexchangeandmechanicalfunction.Heextensivelyusedtheapproachofcomparativephysiologytostudytheentirerespiratorysystemfromlungtomitochondria,thepathwayforoxygen.In1962hediscoveredaspecificorganelleofendothelialcells,todaycalledtheWeibel-Paladebody,ofcentralimportanceinbloodclottingcontrol.Heisauthorof

MorphometryoftheHumanLung(1963),thePathwayforOxygen(1984),andSymmorphosis(2000).Hehaswrittenover400publicationswhichdealwithstructure-functionrelationsofthelungandofliverandmusclecells,withafocusonthequantitativemethodsandasystemsviewonintegratedfunctionsintherespiratorysystem.

AmongotherhonourshewasawardedtheMedaloftheAmericanCollegeofChestPhysiciansandtheH.R.SchinzMedaloftheSwissSocietyofRadiology.HereceivedHonoraryDoctoratesfromtheUniversitiesofEdinburghandGeneva.HeisForeignAssociateoftheUSNationalAcademyofSciences,memberoftheAcademiaEuropaea,andFellowoftheEuropeanRespiratorySociety.HewasPresidentoftheSwissAcademyofMedicalSciences,oftheInternationalUnionofPhysiologicalSciences,andoftheFleischnerSociety.______________________________________________________________


The lung, that spongy organ: architectural solutions to keep it open, ventilated and perfused – fit for gas exchangeProfessor Ewald Weibel

The“spongy”natureofthelungresultsfromahighdensityoftheair-bloodcontactsurfaceareasupportedbyaminimisedtissuebarrier.Theaimofthispresentationistofostertheunderstandingofhowsuchaminimisedstructurecanensurethelung’sgasexchangefunctionwhichdemandsthateachgasexchangeunitbeefficientlyventilatedandperfusedbyblood,andthatthesurfacebekeptopentoairatallstagesofrespiration.Threearchitecturalprinciplesthatensurethiswillbediscussed:(1)Complexityastheprincipleofbuildingthissurfaceandservingitbyforminghierarchicalfractaltreesofairwaysandbloodvesselssothatallgasexchangeunitsarereachedbyairandbloodalongshortandsimilarpathways.(2)Correlativitythatformsthestructuralbasisfornear-optimalmatchingofairandbloodflows,butphysicallimitationscausetheindividualgasexchangeunits,aboutthesizeofanalveolus,tobeventilatedinserieswhilebeingperfusedbybloodinparallelwiththepotentialofaventilation-perfusionmismatch.(3)Connectivityestablishedbyafibercontinuumthroughouttheflabbylungfromthecentralairwaystothepleurapassingrightthroughthealveolarwallswherethefibresareinterlacedwiththecapillaries;thelungisatensegritystructure,sowhensurfactantreducesalveolarsurfacetensionthiskeepsalveoliopentotheairwaysallthroughtherespiratorycycle.Tomakethespongylungfitforgasexchangeallthreeprinciplesmustberealised.

Differentiation of chronic thromboembolic pulmonary hypertensionand pulmonary arterial hypertensionDr Nicholas Screaton

Pulmonaryhypertensionisadiagnosiswithhighmorbidityandsignificantprognosticimplicationsindependentofitscause.Whilstthediagnosticreferencestandardinestablishingadiagnosisisinvasiverightheartcatheterisingnon-invasiveimaging,investigationsplayafundamentalroleinsuggestingthe

diagnosisandinmanycasesidentifyingthecause.Pulmonaryhypertensionisclassifiedusingaclinicalclassificationwhichattemptstogrouptogetherdiseaseswithsimilarpatho-physiologicalmechanismandtreatmentoption.Themostrecentrevisionofthisclassificationfollowedthe5thWorldSymposiuminNicein2013.Theclassificationconsistsoffivegroups:Group1consistsofdiseasesaffectingthesmallvesselsofthelungwiththemaingroupbeing‘pulmonaryarterialhypertension’-diseaseswithpredominantlyarteriolarinvolvement.Whiletheunderlyingaetiologywithinthisgroupisdiversethemanagementoptionsaresimilarandfocusontargetedpharmacologicaltherapy.Groups2and3consistofpulmonaryhypertensionduetochronicleftheartdiseaseandchroniclungdisease(orchronichypoxia)respectively.Thesearebothverycommoncausesofpulmonaryhypertension.Group4representschronicthromboembolicpulmonaryhypertensionresultingfromorganisedthrombioccludingorstenosingvascularbeds.CTEPHiscommonandoftendiagnosedlate.Thefinalgroup(group5)consistsofdiseasewithunclearormultifactorialmechanisms.Thispresentationwillfocusonpulmonaryarterialhypertensionandchronicthromboembolicpulmonaryhypertension.WhilsttreatmentoftheformerispharmacologicalwithtargetedagentstomolecularpathwayswiththevascularendotheliumtreatmentofCTEPHmaybeeithersurgicalorpharmacological.CTEPHmaybeconsidered‘proximal’or‘distal’althoughthemostimportantquestionsdirectingtreatmentarewhetherthedistributionofdiseaseissurgicallyamenable,andwhetherthepatientislikelytobenefitfromsurgerywhichconsistsofbilateralendarterectomyperformedunderdeephypothermiccirculatoryarrest.Somecentresarenowusingballoonangioplastyinasubsetofpatients.ImagingplaysafundamentalroleinestablishingaspecificdiagnosisinPH(differentiatingIPAHfromCTEPHaswellasothercausesofPH)aswellasincharacterisingCTEPHanditsdistribution.Imagingalsoenablesdetailedcardiacassessmentenablingassessmentofhaemodynamicsatbaselineandfollow-up

Theobjectivesofthispresentationareto:1.Summarisethecurrentclinicalclassificationofpulmonaryhypertension.2.DescribeimagingfeaturesofPAHandCTEPHhighlightingtheirdifferences.3.DiscusstheroleofimaginginCTEPHandIPAHanditsimpactontherapeuticoptions.

Lung nodules on screening - what happened to the “suspicious ones”Dr John Holemans

UKLSisaRandomisedControlledTrial(RCT)ofLDCTsinglescanscreeningforlungcancerversususualcare.Apopulation-basedriskquestionnairewasusedtoidentifyhighriskindividuals.CTscreendetectednoduleswerecategorisedaccordingtotheUKLSnodulemanagementprotocol,byvolumeifsurroundedbylungorbydiameterifpleuralorjuxtapleural.ForsolidnodulesCategory1BenigncalcifiedorfattyOR≤3.0mmor≤15mm3;Category2Ifintraparenchymal15-49mm3orifpleural3.1mm-4.9mm;Category3Ifintraparenchymal50-500mm3;Ifpleural5.0mm-9.9mm;Category4Ifintraparenchymal>500mm3;Ifpleural≥10mm.ForsubsolidnodulesCategory1GGOandsolidpart(ifany)≤3.0mm;Category2GGO3.1-4.9andsolidpart

(ifany)≤3.0mmor<15mm3;Category3GGO≥5.0mmandsolidpart(ifany)3.0mm-9.9mmor15mm3-500mm3;Category4Ifmixed(part-solid)andthesolidcomponentis>500mm3or≥10mm.4055subjectswererandomised,2,028intotheCTarm,ofwhom1994underwentaCT.Fortytwoparticipants(2.1%)hadconfirmedlungcancer,34(1.7%)atbaselineandeight(0.4%)atorbeforethe12monthsscan.Screendetectedcancerswereidentifiedas;Stage125/42(60%),Stage1and233/42(79%),34/42(81%)hadsurgicalresection.Therewereatotalof536subjects,472category3,and64category4nodules,requiringdiagnosticworkup,otherthanarepeatCTat12months;40/536werefoundtohavelungcancer,leaving496falsepositives.Thefalsepositiveratewas24.8%(496/1994),andthepositivepredictivevalue7.4%(40/536).479(24%)hadCategory2noduleswhoreceiveda12monthrepeatscan.Ofthese,eight(0.8%)werereferredtotheMDT.Two(0.2%)individualswerediagnosedwithlungcancer.

Learningpoints:Nearlyallscreendetectedcancerswere>50mm3involumeor>5mmindia.Thereisahighfalsepositiverate

From a subjective impression to the future of imaging quantificationProfessor Eric Hoffman

Coincidentwiththeintroductionofcomputedtomographicimagingofthethoraxintoclinicalpracticeinthemid1970’swasanefforttonon-invasively,volumetricallyimagethedynamicfunctioningoftheheartandlung.Withthedevelopmentofit’sprototypeinthemid1970’sandthearrivaloftheDynamicSpatialReconstructor(withit’s14x-rayguns,juxtaposedhemicylindricalflourescentscreenand14televisioncamerasrotatingat15RPM)attheMayoClinicin1979,toolsweredevelopedallowingfortheobjectiveassessmentoflungstructureandfunctionandmethodsforthreedimensionalvisualizationviatwo-dimensionalcomputermonitors.Focuswasinitiallyplacedonunderstandingthebasic,normalfunctioningoftheheartandlungswithinthenegativepressureenvironmentoftheneverinvadedintactthorax.Thetransferofthistechnologyintoclinicalresearchandclinicalpracticewasdelayed,largelybecauseofthelagincomputationaltechnologies,bynearlyaquarterofacenturyuntilmanufacturersintroducedmultiple-rowdetectorCT(MDCT)inthelate1990s.Withtheadventof16sliceandgreaterscanners,volumetricimagesofthelungwereachievablewithscantimesrequiringbreathholdsoflessthan20seconds.VariousconfigurationsofMDCTscannershaveevolvedwhichnowallowimagingofthethoraxinwellunderasecond.Multi-sepctralimagingprovidesnewmethodsforquantitativelyextractingmeasuresofiodine,xenonandkryptonforquantitationofregionalparenchymalperfusionandventilation.Improvementsinx-rayguntechology,detectorsensitivityandcomputationalcapabilitiesprovidetoolsthatnowallowvolumetricimagingatdoselevelsapproaching0.1mSvwithinherantspatialresolutionofscannersreachingdowntothatneededtoexploreasinglepulmonaryascinus,thusallowingustobegintoassessventilation/perfusionrelationshipsattheveryinterfaceofgasexchange.ThesenewtoolsforlungquantitationoffertheabilitytophenotypelungdiseasewherebybroadcategoriesoflungpathologysuchasCOPD,Asthma,orIPFcan

nowbebrokendownintonumeroussub-categoriesbaseduponunderlyinganatomicandfunctionalvariants.Throughthelinkageofstructuretofunction,itisnowpossibletouseimagingasatoolto,notonlyassesstheroadmapofanatomicdestructionandremodeling,butalsotoassessthealteredphysiologicprecoursors.Withanunderstandingofthesub-phenotypesoflungdiseases,onecanbegintolinkphenotypeswithgenotypes.Whatissoughtarebreakthroughsinnewpharmaceuticalanddevice-basedinterventionswithimagingprovidingtoolsforidentificationofappropriatepopulationsinwhichtotestnewinterventionsandforassessingoutcomes.Throughthislecture,theevolutionofthequantitativeassessmentofthelungviax-raycomputedtomographywillbeexploredwithspecificexamplesfromthequesttounderstandquantitativesub-phenotypesofCOPDandAsthma.Examplesofregionallungfunctionassessedfrommulti-sepctralMDCTwillbeusedtoexplorehowsuchCT-derivedfunctionalinformationmightbeusedinthedelineationofunderlyingdiseaseetiology.

Pulmonary nodules: the role of MRIProfessor Bruno Hochhegger

Currentwidespreaduseofcross-sectionalimaginghasledtoexponentialriseindetectionofsolitarypulmonarynodules(SPNs).Whilstlargenumbersofthesearebenign‘incidentalomas’,lungcancerspresentingasSPNsareoftenearlydisease,whichhavegoodprognosis.Therefore,thereisrisingdemandandexpectationformoreaccurate,non-invasive,diagnosticteststocharacterizeSPNs,aimingtoavoidmissedordelayeddiagnosisoflungcancer.TherearewidedifferentialdiagnosesofbenignandmalignantlesionsthatmanifestasSPNs.Onconventionalimaging,themorphologicalfeaturessupportingbenignityincludestablesmallnodulesize,smoothdemarcatedmargins,andcalcifications.Althoughclinicalapplicationsofpulmonarymagneticresonanceimaging(MRI)facetechnicallimitations,currentlyavailableMRImethodshavecontributedtomorphologicandfunctionalevaluationsofpulmonarynodules.MRIusingdynamiccontrastenhancementordiffusion-weightedimaging(DWI)techniques,areamongthegrowingarmamentariumfordiagnosticimagingofSPNs.ThepurposeofthislectureistoreviewthecurrentstatusofMRIforevaluationofpulmonarynodules.

Lumps in the lungProfessor John Gosney

Thedifferentialdiagnosisofpulmonarynodules,manyofwhicharediscoveredincidentallyinasymptomaticindividuals,isenormous,andthequestionofhowtomanagethemisamatterofcontinuingdebate.DespitetheinexorableincreaseinthequalityandresolvingpowerofCTimagingofthethorax,thenatureofmanysuchlesionscannotbedeterminedwithoutexcisingthem,ameasurewhichoftenrevealsasurprisingandunexpecteddiagnosis.

The BIR Sir Godfrey Hounsfield memorial lecture: The isotope bone scan past, present and futureProfessor Ignac Fogelman

Isotopebonescanninghasalonganddistinguishedhistory.Thestorycommencesinthe1960swithstrontiumandwithimagingatthattimeperformedusingarectilinearscannerandwithresolutionsopoorthatanatomicaloutlineshadoftentobeaddedtoassistinskeletallocalisation!Howevertherewererapidadvancesrelatingtobothradiopharmaceuticalsandinstrumentationandthedreamteamofabisphosphonateandagammacamerascameintoexistenceinthelate1970s.Initially,andindeedformanyyearsthereafter,theuseofthebonescanwasalmostexclusivelyinpatientswithknownmalignancybutsubsequentlyitsusehasexpandedintomanybenignapplicationsandnowadaysbenignconditionsaccountforsome50%ofcases.

Afurthersignificantadvanceoccurredwiththeuseoftomographicimaging(SPECT)inthelate1980swhereadramaticexamplewastheidentificationoffacetjointdisease.Thisseemedalmostmagicalatthetimewithoftenprominentfocaluptakeinindividual’swhohadunexplainedbackpainandanapparentlynormalplanarstudy.

Howeverthegreatleapforwardhasbeenwiththeuseofhybridimaging(SPECTCT)combiningfunctionalwithanatomicalstudiestakingadvantageofhighcontrastwithalteredmetabolicactivityandlocalisingthistopreciseanatomicaldata.Thishasreducedtheprevalenceofequivocallesionsonthebonescanfromsome60%to5-10%.

ThefutureisexcitingwiththeincreasingavailabilityofPET,eg.thepotentialforusingF-18asa‘routine’bonescanandwithquantitationoftraceruptakeinindividuallesionsnowpossible,andwithseveralnewtumourspecifictracers.WearealsoatthestartoftheeraofPET/MRI.

Investigating abdominal diseases through the timesProfessor Adrian Dixon

Educationalaim:toremindtheaudienceaboutthedevelopmentandlimitationsofvariousabdominalimaginginvestigations.

Inthebeginningwastheclinicalhistory;thenfollowedinspection,palpationandauscultation.ItisdebatablewhetherpalpationandauscultationwouldeverhavewithstoodtherigoursofNICE.Theelicitationofshiftingdullnessandthenuancesofborborygmiwereneveranexactscience.FortunatelytherapiddevelopmentofimagingtechniquesinthecenturyfollowingRoentgen’sdiscoverychangedeverything.

Bariumstudieswerethemainstayofabdominalimaginguntilthe1980sbut,beforeimageintensification,alotofimaginationwasrequired.Nevertheless,researchersintheUK,SwedenandJapanmaderemarkablescientificobservationsbythesemeans.Theintroductionofultrasoundgreatlyassistedthe

investigationofthepelvisandupperabdomenandremainstheinvestigationofchoiceinthethinneradultandchildren;increasingadultobesitycurtailsitseffectivenessinmuchofthewesternworld.Computedtomography,andespeciallytheintroductionofspiralCTputpaidtoinvestigationsuchaslymphangiographyandretroperitonealairinsufflation.Magneticresonanceimaginghasbecometheoptimalmethodofinvestigatingtheliver,biliarytreeandmanystructureswithinthepelvis.PET/CTiscurrentlytheultimatemethodofassessingtheabdomenformanyoncologicalproblems.

Expertimagingisnotonlyneededtohelpthepatient,itisalsoneededtohelptheradiologistorsurgeonplanappropriatetreatmenttoreducemorbidityandcost.

Learningoutcomes:Appreciationoftheincreasingroleofabdominalimagingwithinmodernhealthcare.

Pseudo liver lesionsProfessor Ali Nawaz Khan

Liverpseudo-lesionsaregreatmimics,andunlesstheradiologistsandthecliniciansareawareoftheselesions,theirdiscoverymayleadtounnecessaryimaging/interventionandhealthservicecosts.Onesuchsignificantpseudo-lesionisproducedbytransienthepaticattenuationdifference(THAD).Increasedpressureinlobeorsegment,resultsinportalshuntingtonormalsegmentswiththecompensatoryincreaseinhepaticarterialflowtotheaffectedsegment.THADdoesnotimplyarterio-portalshuntingortumourinvasion.THADcauseaphysiologicalshutdown:notrophichormonesviaportalveinthusanyInsulinorGlucagondrive.Thus,theaffectedliversegmentisdepletedofglycogenandfat.Thesegmentisvulnerabletoischaemicnecrosis,whichisevengreaterwithbiliaryobstruction:infectedbiloma.Eventually,thesegment/lobeatrophyFocalfattyinfiltrationandfattyfocalsparingmaymimicavarietyoflesion.Avarietyofotherpseudo-lesionswillbediscussed.

Diffusion weighted imaging of the bowelDr Andrew Plumb

Diffusionweightedimaging(DWI)hasincreasinglybecomeanintegralpartofMRIprotocols,particularlyinthefieldofneuroradiologyandoncology.Itsroleininflammatoryconditionsislessdefined.RecentlydatasuggestsDWImayhavearoleinthedetectionandgradingofCrohn’sdiseaseduringMRenterography.IthasbeenwelldescribedthatrestricteddiffusionispresentinentericCrohn’s,althoughtheunderlyinghistologicalreasonsarecomplex.Increasedinflammatoryinfiltratelikelyrestrictdiffusionbuttheroleoftissueoedema,increasedvascularityandfibrosisininfluencingsignalfromDWIisunclear.ThismaycompromisetheutilityofDWIandapparentdiffusioncoefficientingradingdiseaseactivity.Itsuseindetectingabnormalbowelperseisclearer.

ThispresentationwillpresentprotocolsforDWIduringMRenterographyanddescribetheunderlyinghistologicalfeatureswhichmayinfluenceimagingappearances.Datasupportingitsroleasamarkerofdiseaseactivitywillbepresentedwithexamples.Finally,howandwhyDWImaybeintegratedintostandardclinicalprotocolswillbediscussed.

Cystic liver lesionsProfessor Ali Nawaz Khan

Detectionoflivercystshasbecomecommonplacewithincreaseduseofcrosssectionalimaging.Whilstmostaresimplecystsothercysticlesionsaregreatmimics.Oncedetected,thereisanemphasisforfurthercharacterization.Thedifferentialdiagnosisofhepaticcystsisverywide.Differentiationofthesecysticlesionsisnecessaryformanagement.Thepresentationillustratestheentirespectrumofcystichepaticlesionsandprovidesanapproachfordifferentiatingthem.Theimportantfactorsassessedarethesize,septa,thicknessofthewall,internalnodulesorpapillaryprojections,calcification,densityandsignalintensitypatternsandcontrastenhancement.Ultrasound,Doppler,CTandMRIimagingfeaturesofthecysticlesionsareillustrated.Theaimofthispresentationistoarmtheradiologistwiththeknowledgerequiredtoofferadefinitivediagnosisaswithadvancedimagingitispossibletocharacterizemosthepaticcysticlesions.Clinicalinputisrequired.Withspiralinghealthcarecosts,thecostsmustbecurtailedsafely,minimizingpatientanxiety,andavoidunnecessaryinvasiveprocedures.

Imaging and renal failureDr Jane Belfield,

Chronickidneydisease(CKD)isatermusedtodescribepatientswithdecreasedrenalfunctionandisclassifiedin5stages,withstage5beingkidneyfailure(GFR<15ml/min).Themostcommoncausesincludediabetesmellitus,hypertension,vasculardiseaseandglomerulardisease.KidneydiseaseistheninthleadingcauseofdeathintheUnitedStatesandimaginginthisgroupofpatientscanbecomplexduetoboththeaetiologyofthediseaseandthecomplications.Thistalkaimstocoversomemoreunusualaspectsofimaginginthisgroupofpatientsthatarerelatedtoendstagerenalfailureoritscomplications.

Encapsulatingperitonealsclerosisisdefinedas“asyndromecontinuously,intermittently,orrepeatedlypresentingwithsymptomsofintestinalobstructionduetoadhesionsofadiffuselythickenedperitoneum,andapurelyclinicaldiagnosis.”Itisaconditionseeninpatientswhohavepreviouslyundergoneperitonealdialysis(PD),buttheexactaetiologyremainsuncertain.Itisthoughttoberelatedtotheglucosecontentinthedialysatewithintheperitonealcavity.ManycasespresentwhenPDhasbeendiscontinued.ClassicfeaturesasseenonCTwillbedescribed,includingperitonealthickeningandenhancement,cocooningofthebowelwithintheabdomen,fluidcollectionsandthickeningofbowelwall.Casesofperitonealsclerosiswillbepresentedtoillustratethefindings.

Contrastenhancedultrasound(CEUS)isanimagingmodalitythatcanbeusedinpatientswithrenalfailureduetothelackofnephrotoxicity.

Contrastagentsarecomposedofgasmicrobubblesenclosedinaprotein,lipidorpolymershell.Thecompositionoftheagentallowsittolastinbloodvesselsfor5-7minutes.Thebubblescontractandexpandwhenincontactwithanultrasoundwaveandcanbeseeninthekidneysforapproximately2minutes.CEUSisparticularlyusefulindistinguishingasolidrenalmassfromapseudotumour,orcharacterisingacomplexcystinthisgroupofpatientsinwhomCTorMRIcontrastarerelativecontraindications.ExamplesofCEUSwillbeshowntodemonstrateitsuseinthisgroupofpatients.

Transplantationisthegold-standardtreatmentforpatientswithendstagerenalfailure.Increasingly,transplantsarebeingperformedfromlivingdonors,eitherrelatives,altruisticdonorsorpaireddonationswithmorethanonethirdofallrenaltransplantsbeingfromlivingdonors.Priortotransplantation,imagingisrequiredtoassessvascularityandanatomyofthedonoraswellastoidentifyanysalientincidentalfindings.LivingdonorCTimagingwillbedescribedwithexamplesofabnormalvascularandanatomicalanatomytodemonstratetheimportanceofimagingpriortoselectionfordonornephrectomy.

References:1.LeveyAS,CoreshJ,BalkE,KauszAT,etal.NationalKidneyFoundationpracticeguidelinesforchronickidneysdisease:evaluation,classification,andstratification.AnnInternMed.Jul152003;139(2):137-147.2.CentersforDiseaseControlandPrevention.DeathsandMortality.Availableathttp://www.cdc.gov/nchs/fastats/deaths.htm3.KawanishiH,MoriishiM.Encapsulatingperitonealsclerosis:preventionandtreatment.PeritDialInt200727:S289-S292.4.MorinS,LimA,CobboldJ,Taylor-RobinsonS.Useofsecondgenerationcontrast-enhancedultrasoundintheassessmentoffocalliverlesions.WorldJournalofGastroenteroloy.200713(45):5963-5970.5.CokkinosD,AntypaE,SkilakakiM,etal.Contrastenhancedultrasoundofthekidneys:whatisitcapableof?BioMedResearchInternational2013

Digital radiographyMr Ulrich Neitzel, Philips Healthcare

Thedevelopmentofthetechnologyandapplicationofdigitalradiographyoverthepastthirtyyearswillbereviewed.Today,digitalradiographyisthestandardtechniqueforx-rayprojectionexaminationsofthechestandtheskeleton.Comparedtopreviousscreen-filmimagingitoffersanumberofadvantages,likelargerdynamicrange,betterdoseefficiency,anddirectavailabilityoftheimagesinelectronicformat.Differenttechnologicalvariantsofdigitalradiographyexist,withtheirspecificprosandcons.

Theeducationalaimsandlearningoutcomesofthepresentationarethefollowing:1.Learntoknowthedifferencesbetweenthevariousdetectortypesfordigitalradiography2.understandtheadvantagesandlimitationsofdigitalradiography3.understandtheprinciplesandtheimportanceofproperimageprocessing4.learnaboutpresentandfuturedirectionsforfurtherdevelopmentofdigitalradiography

Programme DAY 2: Thursday 23 October

ROOM 2: Neuro and MSK


09:00 Welcome and introductionChair: DrAdamWaldman,ConsultantNeuroradiologist, ImperialCollegeLondon

09:05 Imaging the central nervous system; history and advances/past to future? DrAdamWaldman,ConsultantNeuroradiologist, ImperialCollegeLondon

09:50 Stroke and cerebrovascular disease DrShawnHalpin,ConsultantNeuroradiologist, UniversityHospitalofWales

10:20 Spinal trauma DrCurtisOffiah,ConsultantNeuroradiologist, TheRoyalLondonHospital

10:50 Refreshments

11:05 Normal ageing and disease – neurodegeneration and dementia ProfessorAlisonMurray, RolandSuttonProfessorofRadiology,UniversityofAberdeen

11:40 Brain tumours ProfessorPiaSundgren,ProfessorofRadiology,LundUniversity,Sweden

12:15 Quiz

12:30 Lunch

THE FOLLOWING LECTURE WILL TAKE PLACE IN ROOM 1

13:30 The BIR Sir Godfrey Hounsfield memorial lecture: The isotope bone scan past, present and future ProfessorIgnacFogelman,ProfessorofNuclearMedicine, King’sCollegeLondon

14:15 Prizes and awards ceremony

THE PROGRAMME WILL NOW CONTINUE IN ROOM 2

Session 1: Joint painChair: DrDavidWilson,ConsultantInterventionalMSKRadiologist, OxfordUniversityHospitalsNHSTrust President,BIR

14:25 Pain – disconnection between imaging findings and patient’s symptoms DrFranzKainberger,DepartmentofDiagnosticRadiology, MedicalUniversityofVienna

14:50 Osteoarthritis as a cause of pain DrFionaWatt,SeniorClinicalResearchFellow, KennedyInstituteofRheumatology,UniversityofOxford

15:15 Synovial disease as a cause of pain (including infection) DrRichardWakefield,ConsultantinRheumatology, StJames’sUniversityHospital,Leeds

15:40 Stretch, strengthen, push, pull and jab - conservative treatment of musculoskeletal syndromes MrMarkMaybury,ExtendedScopePhysiotherapyPractitioner, GoodHopeHospital,Birmingham

16:05 Refreshments

Session 2: Insufficiency fractures

16:20 Epidemiology in the UK DrSimonDolin,ConsultantinPainMedicine, BMIGoringHallHospital,WestSussex

16:45 Causes of insufficiency fractures DrMKassimJavaid,AssociateProfessorofMetabolicBoneDisease, UniversityofOxford

17:10 Diagnostic methods DrNaomiWinn,ConsultantRadiologist, ManchesterRoyalInfirmary

17:35 Treatment options MrSeanMolloy,ConsultantOrthopaedicSpinalSurgeon, RoyalNationalOrthopaedicHospital,Stanmore

18:00 Close of Congress__________________________________________________________________






Dr Simon DolinConsultant in Pain Medicine, BMI Goring Hall Hospital

DrSimonDolinwaspreviouslyNHSConsultantinWesternSussexHospitals,nowanindependentpractitionerinSussex,SurreyandLondon.Hewasanearlyadopterofvertebroplastyinthedayswhenwehadtoaddopacifieronthebenchbyhandandtherewerenoinjectiondevices.Havingbeenaroundthecircleonthishehasgonebacktohandinjectionusingcortosssystem.

Professor Ignac FogelmanProfessor of Nuclear Medicine, King’s College London

ProfessorFogelmaniscurrentlyProfessorofNuclearMedicine(NM),atKing’sCollegeLondonandHonoraryConsultantPhysician,Guy’sandStThomas’NHSTrustandDirectoroftheOsteoporosisScreeningandResearchUnit,Guy’sHospital.HeisChairmanoftheBoardofExaminersfortheMScinNM,whichprovidestheonlyrecognisedtrainingprogrammeforNMintheUK.Hehaswrittenover400articlesinpeerreviewedjournals,haswrittenoredited15books,andsupervised17PhD/MDstudents.HeisaformerboardmemberandTrusteeoftheNationalOsteoporosisSocietyandwaspreviouslyChairmanofitsBoneDensitometry(BD)Forum.

Dr Shawn HalpinConsultant Neuroradiologist, University Hospital of Wales

DrHalpinqualifiedatKing’sin1982,andcompletedneuroradiologytrainingatQueen’sSquareaftertheradiologytrainingschemeatStGeorges.HewasappointedConsultantNeuroradiologistatUniversityHospitalofWales,Cardiffin1993.He’shadaninterestinadvancedCTimagingforcerebrovasculardiseaseinstrokeformanyyears,andhasworkedwithGEindevelopingtheirCTperfusionsoftware.

Dr M Kassim JavaidAssociate Professor of Metabolic Bone Disease, University of Oxford

DrMKassimJavaidisAssociateProfessorofMetabolicBoneDisease,NuffieldDepartmentofOrthopaedics,RheumatologyandMusculoskeletalSciences,UniversityofOxfordandHonoraryConsultantRheumatologist,NuffieldOrthopaedicCentre,OxfordUniversityHospitalsTrust.

DrMKJavaidcompletedhismedicaltrainingatCharingCrossandWestminsterMedicalSchoolthenspecialisedinadultrheumatologyattheWessexDeanery.HecompletedaPhDintheepidemiologyofosteoporosisasanARCClinicalFellowattheUniversityofSouthamptonandspentayearasanARCtravellingfellowinUCSFtostudytheroleofvitaminDandboneinlowerlimbOA.

HewasappointedasLecturerinMetabolicBoneDisease/HonoraryconsultantRheumatologistatOxford.Hisresearchinterestsincludetheroleofepidemiologyofmusculoskeletaldiseases,mechanismofbonepainandco-leadforatheNIHRRDTRCrarebonediseasesinitiativeandworkswithintheClinicalScientificCommitteeoftheNationalOsteoporosisSociety,includingdevelopingthevitaminDguidelines,andtheInternationalOsteoporosisSociety,includingdevelopmentandimplementation

Mr Mark MayburyExtended Scope Physiotherapy Practitioner, Good Hope Hospital

Markisanextendedscopemusculoskeletalphysiotherapist,atGoodHopeHospital,HeartofEnglandFoundationTrustinBirmingham.Hespecialisesindiagnosticandinterventionalultrasound,andworksinthetraumaandorthopaedics,physiotherapyandradiologydepartments.HeisafacultymemberonmanyoftheleadingultrasoundcoursesintheUK,andavisitingspeakeratseveraluniversities.Additionally,heisapublishedauthor,andcurrentlyholdsanhonorarylecturerpositionattheUniversityofEssex.

Mr Sean MolloyConsultant Orthopaedic Spinal Surgeon, Royal National Orthopaedic Hospital

MrMolloyisaConsultantOrthopaedicSpinalSurgeonatTheRoyalNationalOrthopaedicHospital,Stanmore.HeisuniqueinbeingtheonlypersonintheUnitedKingdomholdingdualqualificationasaSpinalSurgeonandaChiropractor.HequalifiedasaChiropractorin1990.Hepractisedasachiropractorwhilsttrainingtobeadoctor.MrMolloygraduatedfromStGeorge’sHospitalMedicalSchoolin1995.HisspecialistregistraryearsinorthopaedicswerespentonthesouthwestThamestrainingrotation.MrMolloyundertookanMScinOrthopaedicEngineeringduringhisorthopaedicregistrartrainingandgraduatedin2002fromCardiffUniversity.

MrMolloydidaFellowshipyearattheprestigiousJohnsHopkinsUniversityHospitalintheUnitedStates.HethencompletedafurtherFellowshipinspinalsurgeryatTheRoyalNationalOrthopaedicHospital,Stanmore,beforebeingappointedasaconsultantinthesameinstitution.Hehasbeenactiveinscientificresearchandhisworkiscoveredinoversixtypublishedscientificpapers/presentationsbothnationallyandinternationally.

Professor Alison MurrayRoland Sutton Professor of Radiology, University of Aberdeen

ProfessorAlisonMurrayistheRolandSuttonProfessorofRadiologyattheUniversityofAberdeen.SheisDirectoroftheAberdeenBiomedicalImagingCentre.Sheleadsclinicalbrainimagingresearchinstructural,functionalandmolecularimagingcorrelatesofcognitiveageinganddementiaandworkincludesMRIintheAberdeen

1936BirthCohort,andMRI,regionalcerebralbloodflow(rCBF)SPECTandFDGPETinclinicaltrialsofnovelTauAggregationInhibitortherapiesinAlzheimer’sdisease.ParticularinterestsaretherelativecontributionsofvascularriskfactorsandsubclinicalAlzheimer’sdiseasetocognitiveageing,contributorstocognitivereserveandresiliencetodementiaanddevelopingnovelmethodsofimaginginpatientswithdementia.ShehasextensiveNHSexperienceofbrainimagingindementiaandisresponsibleforthemajorityofNHSreferralsforstructuralandmolecularbrainimagingincludingCT,rCBFSPECTCTandFP-CITCTstudies.SheisafoundingmemberandexecutivememberoftheScottishImagingNetwork:APlatformforScientificExcellence(SINAPSE)www.sinapse.ac.ukasuccessfulbrainimagingpoolinginitiativefundedbytheScottishFundingCouncil,CSOandparticipatinguniversitiestodevelopstateoftheartbrainimagingresourcesandresearchtrainingacrossScotland,anexecutivememberoftheScottishDementiaResearchConsortiumandPresidentElectoftheScottishRadiologicalSociety.

Dr Curtis OffiahConsultant Neuroradiologist, The Royal London Hospital

DrCurtisOffiahisaConsultantNeuroradiologistworkingattheRoyalLondonHospitalwithinBartsHealthNHSTrustincorporatingtheRoyalLondonHospitalandStBartholomew’sHospital.TheRoyalLondonHospitalisalevel1traumacentreandoneofthefourdelegatedmajortraumaunitsforLondonandseesawealthofvariedtraumacasesincludingthosepertainingtothehead,neckandspine.Hehasanumberofsubspecialtyandresearchinterestsincludingneurotrauma.Hehaslecturednationallyandinternationallyinneurotraumaandhaspublishedpapersinpeer-reviewedradiologicaljournalsonneuroradiologicalaspectsoftrauma.Healsoadvisescoronerservicesandpoliceforcesonrelevantaccidentalandcriminalneurotraumacases.

Professor Pia SundgrenProfessor of Radiology, Lund University, Sweden

ProfessorPiaMalySundgrenistheHeadoftheDepartmentofDiagnosticRadiology,ClinicalSciencesLundUniversity,Sweden.Shehasabroadbackgroundinneuroradiologyasseniorneuroradiologyconsultant.Sheisaskilledclinicianwithexperienceinassessmentanddiagnosisofintracranialpathologies,andwithspecifictrainingandexpertiseinkeyresearchareassuchasfMRI,MRspectroscopyanddiffusionanddiffusiontensorimaginginbraindisordersandpainconditions.Hermainfocusofresearchisonidentifyingearlyimagingbiomarkersforearlypredictionoftherapeuticoutcomeandinmonitoringtreatmentresponseinpatientstreatedforprimarybraintumours,andofirradiationeffectsonbrainparenchyma.PiaSundgrenhaspublishedover125originalarticlesandreviews,severalbookchaptersandthreebooks.Sheisawell-knownlectureratinternationalmeetingswithalmost200lecturesworld-wide.SheistheChairoftheEuropeanSchoolofNeuroradiologyandactsasboardmemberinseveralinternationalsocietiesrelatedtoradiologyandneuroradiology.

Dr Adam WaldmanConsultant Neuroradiologist, Imperial College London

DrWaldmangainedaPhDandundertookpost-doctoralresearchinbiophysicsbeforetraininginmedicineatCambridge.HetrainedinradiologyatUniversityCollegeHospitalsandsubsequentlyinneuroradiologyattheNationalHospitalforNeurologyandNeurosurgery,QueenSquare,London.DrWaldmanhasbeenConsultantNeuroradiologistatImperialCollegeHealthcareNHSTrust(formerlyHHNT)since2001.Since2006hehasbeendepartmentalacademicleadasResearchDirectorforRadiology,andhasalsofoundedanacademictrainingprogrammeinClinicalRadiology.Hewasawardedthe2009RoyalCollegeofRadiologistsRoentgenProfessorshipandmedal,andholdshonorarysenioracademicappointmentsatImperialCollegeLondon.Hismainresearchinterestsareinquantitativeandphysiologicalneuroimaging,particularlyasappliedtoneuro-oncologyandneurodegenerativediseases.

Dr Fiona WattSenior Clinical Research Fellow, Kennedy Institute of Rheumatology, University of Oxford

DrWattisaseniorclinicalresearchfellowattheKennedyInstituteofRheumatology,attheUniversityofOxfordandHonoraryConsultantRheumatologistattheNuffieldOrthopaedicCentre,Oxford.Herresearchinterestisosteoarthritis-theinitiatingmechanismsofthedisease,focussingontheidentificationofnewdiagnosticandprognostictests,andnoveltherapeutictargets.SheleadsthetranslationalprogrammewithintheArthritisResearchUKCentreforOsteoarthritisPathogenesis.Thisincludesworkonclinicaltrialsbutalsotranslationalstudiesinhumancohorts,suchasthosewithkneeinjuryorestablishedhandosteoarthritis.

ShehasaPhDincartilagebiochemistryfromImperialCollegeLondon,andcompletedspecialisttraininginnorthwestLondon,havinggainedresearchtrainingandMBBSinNewcastle.Fionaremainspassionateaboutcliniciansenteringscience,andthetranslationoflaboratoryscienceintotheclinic.

Dr David WilsonConsultant Interventional MSK Radiologist, Oxford University Hospitals NHS Trust and President, BIR

DrWilson’sprimaryinterestisintheapplicationofmodernimagingtechniquestodisordersofthelocomotorsystemandspineintervention.Hehasundertakenoriginalworkintheapplicationofdiagnosticultrasoundtojoint,muscle,andsofttissuediseasewithparticularattentiontojointeffusionandcongenitaldysplasiaofthehip.Hehasover20yearsofexperienceinvertebroplastyandistheauthorofpublicationsonmulticentrecontrolledtrialsonthetreatmentofinsufficiencyfractures.HehasestablishedinnovativetrainingcoursesintheUKinmusculoskeletalultrasoundinOxfordandBath.Heteachesinternationallyandisaleaderinthedevelopmentofultrasoundinmusculoskeletaldiseaseandinjectiontechniquesinthespine.Hehasconsiderableexperienceinallaspects

ofmusculoskeletalimagingandistheEditoroftheprincipletextbookonMSKimaging.AsaformerPresidentoftheBritishSocietyofSkeletalRadiologistandapreviousMedicalDirectoroftheNuffieldOrthopaedicCentrehehaswideclinicalandresearchexperience.

Dr Naomi WinnConsultant Radiologist, Manchester Royal Infirmary

DrWinnisaConsultantMusculoskeletalRadiologist,workingatManchesterRoyalInfirmary.AftercompletingherRadiologySpecialtyTrainingintheNorthernDeanery,sheenjoyedayearofFellowshiptraininginMusculoskeletalRadiology,basedinEdmonton,Canada.Hersubspecialtyinterestsincludemusculoskeletalultrasoundandimagingofsofttissueandbonesarcomas.______________________________________________________________

Abstracts

Imaging the central nervous system; history and advances/past tofuture?Dr Adam Waldman

Technologicaladvanceshavebeenkeytothedevelopmentofbrainandspineimaging,fromtheearliestattemptstovisualisethesehiddenstructuresusingcisternographyandangiography,throughtheadventofcrosssectionalimagingwithCTandMRI,tocontemporaryfunctional,physiologicalandmolecularmethods.Wewillmovefromabriefillustrated20thcenturyhistoryofneuroimaging,todiscussthetranslationofemergingfunctionalandquantitativetechniquesintocurrentclinicalneuroradiologypracticeandcognitiveneuroscience,andfinallyconsiderpotentialfutureapplicationsofnovelexperimentalimagingtools.

Stroke and cerebrovascular diseaseDr Shawn Halpin

Imaginginstrokehasmanylayers.Atthebaseistheneedtoexcludecontra-indicationstothrombolysis,whileotherlayersleadthroughaccuratediagnosis,andthenontoanassessmentoftheappropriatenessofthrombolysis,andthenperhapsoftissueviability.Thislecturediscussesvariousimagingparadigmsinthehyperacutestrokepathway,from“justdoit”toimagingtailoredforindividualpatients.ThecurrentroleforCTperfusionstudiesisdiscussedindetail.

Spinal traumaDr Curtis Offiah

Accurateinterpretationofcomputedtomography(CT)andmagneticresonanceimaging(MRI)ofspinaltraumacanbeverychallengingbutiscentraltotheappropriatemanagementandprognosticationofsignificantlycompromisedandfrequentlyobtundedpatientsaswellasparamountinlimitingmorbidityin

survivingpatientsofsignificanttrauma.ThelecturewilloutlinethesalientbasicrelevantanatomicalandbiomechanicalprinciplesassociatedwithacutespinaltraumaanddemonstratethekeyCTandMRimagingfeaturesandconsiderationsofthecommontraumaticinjuriesencounteredinrelationtothecraniocervicaljunction,thesubaxialcervicalspineandthethoracolumbosacralspine.Important“review”areasandappropriate“redflags”intheimaginginterpretationofacutespinaltraumawillalsobediscussedwhichmaybeusefulbothinlimitingpotentiallydeleteriousomissionsfromtheradiologicalinputinthepatientmanagementpathwayaswellasassistingclinicalprognostication.Finally,imagingassessmentinthemorerarely-encounteredcivilianpenetratingspinaltraumascenariowillalsobepresented.

EducationalAimsandLearningOutcomes:1.Understandingthenormalanatomyofthecraniocervicaljunctionandspine.2.UnderstandingtherequirementsofemergencyCTassessmentofthespinalaxis.3.Understandingtheconceptof“thestable”versus“theunstable”spinalinjury.4.Understandingthefractureandligamentousinjurypatternsassociatedwithsomeofthemoretypicalspinalinjuriesincludinghighenergymechanisminjuries.5.UnderstandingtheurgencyofMRIassessmentintheseverelyinjuredintubatedandventilatedpatientwithspinalinjury.6.UnderstandingprognosticMRIfeaturesincordinjuryassociatedwithspinaltrauma.

Normal ageing and disease – neurodegeneration and dementiaProfessor Alison Murray

Thispresentationwillreviewbrainimagingincognitiveimpairmentanddementia,referringtoresearchresults,currentevidenceforimagingandnationalandinternationalguidelines.Theeducationalaimsaretoupdateparticipantswithnewinformationandtogiveapragmaticoverviewofwhetherbrainimagingisappropriateinpatientswithdementia,ifso,whenbrainimagingshouldbeusedandwhatispracticalinacostconstrainedNHS.Threemainlearningpointswillbemadeinitially:1.Mostdementiarelatedneuropathologyismixed2.Mostevidenceignoresbaseline3.Currentlywecannotdiagnosedementiaonascan–evenanAPETscan!

FollowingarapidreviewoftheresultsofbrainimagingresearchintheAberdeenBirthCohorts,adescriptionofcognitivereserveandhowthisiscrucialtounderstandcognitiveageinganddementiaresearch.Also,whatwecanandcannottellfromroutinebrainimagesandrecentdrugdevelopmentinAlzheimer’sdisease,thepresentationwillconcludewithexamplesofwherebrainimagingisusefulindementiaandneurodegenerativediseases,areasforfutureresearchandwiththreemorelearningpoints:

1.Imagingincreasesdiagnosticaccuracy2.Infuturetheroleofimagingislikelytobevalidationofcheapertests3.Ifwecould“bottle”cognitivereserveitwouldhaveasmuchimpactasaneffectivenewdrug.

Brain tumoursProfessor Pia Sundgren

Clinicalsymptomscombinedwiththeresultsoftheneurologicalexaminationraisethefirstsuspicionofthepossibilitythatthepersonmighthaveabraintumour.CTand/orMRimagingaremethodstoconfirmthepresenceofabraintumourandespeciallyMRIwithtailoredimagingprotocolwillleadtoprecisediagnosis.MRIisoftenusedtoplanfurtherstepsanddecideontherapyoptions.Despiteimprovementsinsurgery,radiationandchemotherapytheoverallsurvivalofbraintumoursvaries.Onemajorissueinbraintumourmanagementisthatconcurrenttreatmentwithradiotherapyandchemotherapyisassociatedwithsocalledpseudoprogression,reflectingtreatment-inducedchangesinthetumourresultinginanincreaseinsizeand/orabrighterappearancethanonpretreatmentMRI.Thesechangesmaymisleadinglysuggesttumourprogressionbutaretransientandeventuallythetumourwillstabilizeinsizeorevenshrink.NovelcombinationtherapieslikeBevacizumabtreatment,whichhamperswithtumourangiogensies,mayleadtodiminishededemaandcontrastenhancementsocalledpseudoresponse,withimagingfindingsthatcancausediagnosticdifficulties.Alsogammaknifetherapyisassociatedwithahighincidenceofradiationnecrosis,withsimilarmorphologicalcharacteristicsasrecurrenttumour.Earlyidentificationofpatientswhosufferfromtumourrecurrencecanbeofgreatadvantage:itprovidestheopportunitytoadjustindividualsmorerapidly,andsparingpatientsunnecessarymorbidity,anddelayininitiationofother,maybemoreeffective,treatment.Inthislecture,MRandCTimagingmethodsfordetectionanddifferentiationbetweendifferentbraintumorswillbediscussed.Inaddition,issueslikethedifferentiationbetweenpseudoprogressionandtruetumourprogression,theimagingfindingsinpseudoresponseandmonitoringschemestoassessearlytreatmentresponsewillbediscussed

The BIR Sir Godfrey Hounsfield memorial lecture: The isotope bone scan past, present and futureProfessor Ignac Fogelman

Isotopebonescanninghasalonganddistinguishedhistory.Thestorycommencesinthe1960swithstrontiumandwithimagingatthattimeperformedusingarectilinearscannerandwithresolutionsopoorthatanatomicaloutlineshadoftentobeaddedtoassistinskeletallocalisation!Howevertherewererapidadvancesrelatingtobothradiopharmaceuticalsandinstrumentationandthedreamteamofabisphosphonateandagammacamerascameintoexistenceinthelate1970s.Initially,andindeedformanyyearsthereafter,theuseofthebonescanwasalmostexclusivelyinpatientswithknownmalignancybutsubsequentlyitsusehasexpandedintomanybenignapplicationsandnowadaysbenignconditionsaccountforsome50%ofcases.

Afurthersignificantadvanceoccurredwiththeuseoftomographicimaging(SPECT)inthelate1980swhereadramaticexamplewastheidentificationoffacetjointdisease.Thisseemedalmostmagicalatthetimewithoftenprominentfocaluptakeinindividual’swhohadunexplainedbackpainandanapparentlynormalplanarstudy.

Howeverthegreatleapforwardhasbeenwiththeuseofhybridimaging(SPECTCT)combiningfunctionalwithanatomicalstudiestakingadvantageofhighcontrastwithalteredmetabolicactivityandlocalisingthistopreciseanatomicaldata.Thishasreducedtheprevalenceofequivocallesionsonthebonescanfromsome60%to5-10%.

ThefutureisexcitingwiththeincreasingavailabilityofPET,eg.thepotentialforusingF-18asa‘routine’bonescanandwithquantitationoftraceruptakeinindividuallesionsnowpossible,andwithseveralnewtumourspecifictracers.WearealsoatthestartoftheeraofPET/MRI.

Osteoarthritis as a cause of painDr Fiona Watt, University of Oxford

Educationalaimsandoutcomes:Delegateswillbeableto:1.Describetheepidemiologyofpaininosteoarthritis.2.Understandsourcesofpainintheosteoarthriticjoint.3.Explorewhatpainpathwaystellusaboutosteoarthritis.4.Reviewtherelevanceofimagingpainfuljointsinosteoarthritis.

Notallpeoplewithosteoarthritishavepain.Butmostdo.OsteoarthritisremainsoneoftheleadingcausesofprimarycareconsultationsandworkdisabilityintheUK,andthemostcommonsymptomofosteoarthritisisjointpain.Painisalsothemajordriverforjointreplacement–aprocedurewhichisincreasingexponentiallyinlinewithourageingandobesepopulation.Articularcartilageisaneural,butOAisadiseaseofthewholejoint.ThroughMRI-basedandotherimagingstudies,wenowunderstandfarmoreaboutthejointtissues,structuresandotherprocesseswhichgiverisetopain.Inosteoarthritis,shouldweaimtotreatpain,orstructure,orboth?Inthesearchforadisease-modifyingdrug(DMOAD)forthedisease,therehasbeenmuchfocusonstructuremodification,butnosuccessfuldrugdevelopmenttodate.TherenewedfocusofPharmainosteoarthritisispainmodification.Drugswhichblockpainpathwaysareteachingussomeinterestinglessonsaboutthediseaseanditspathogenesisinbothanimalmodelsandhumans.Imagingremainsouronlyprovenbiomarkerforthedisease,anditsapplicationsintermsoffutureclinicaltrialswillbediscussed.

Stretch, strengthen, push, pull and jab - conservative treatment ofmusculoskeletal syndromesMr Mark Maybury

Thisisanexperientialtalkactingasanoverviewofphysiotherapyinthemanagementandtreatmentofpainfulmusculoskeletalconditions.Itisnotanextensiveorexhaustivelistoftreatmentoptionsforallconditionsbutfocusesontheuseofelectrotherapy,manualtherapy,acupunctureandinjectiontherapyinthetreatmentofmusculoskeletalconditions.Althoughthegeneralprinciplesgoverningtheuseofthesetreatmentswillbedescribed,thetreatmentofadhesivecapsulitiswillbefocusedonspecificallyasshoulderconditionsrepresentthemostcommonmusculoskeletalconditionreferredintosecondarycare.Otherconditionssuchasosteo-arthritisoftheknee,andothersofttissueinjurieswillbedescribed.

Epidemiology in the UKDr Simon Dolin

Insufficiencyfracturesrefertovertebralcompressionfractureandsacralfractures.Thelatterarerelativelypoorlydescribedintheliteratureandincidenceandclinicalimpactprobablyunderestimated.VCFsarecommon.Alargepopulationstudy(TromsoVI)indicatesoverallprevalenceof11.89%inwomenand13.8%inmean.Thisincreasesconsiderablywithage,anditisestimatedthat50%willhaveVCFoverageof80.StudiesofpatientswithclinicalVCF(requiringinvestigationandtreatment)indicateanannualincidenceof10.7(women)and5.7(men)per1000.Reasonsfordiscrepancyinsexdifferencesislikelytobecomplex.VCFsclusteraroundT11-L2levelswithamixofwedgeandbiconcavedeformities.LyritisdescribedpainfulVCFaseitheracutetype1thatwasseverebutsettledover4-8weeksorchronictype2thatdevelopedinsidiouslywithprogressivewedgingovermanymonths.ClinicalconsequencesofVCFincludereducedpulmonaryfunction,decreasedactivitiesofdailylivingwithlossofindependence,abdominalsymptoms,increasedhospitaladmissionsandmortalityratioincreasedby1.6xwithasingleVCF.

Causes of insufficiency fracturesDr M Kassim Javaid

Insufficiencyfracturesarefracturesthatoccurwithnormalloadingandabnormalbone.Thecommonestcauseofinsufficiencyfracturesisosteoporosis.

Thelearningobjectivesofthissessionwillbe:1.Understandthecommoncausesofosteoporosis.2.Understandthecommonsecondarycausesforosteoporosis.3.Thepresentationofcommonanduncommontypesofosteomalacia.4.Thepresentationanddifferentialdiagnosisofprimaryhyperparathyroidism.5.Thefeaturesandmanagementofatypicalsubtrochantericfemoral.fractures.

Diagnostic methodsDr Naomi Winn

Thislectureonradiologywillincludeassessmentofbonemineraldensityandhowbesttoimageinsufficiencyfractures.TechniquesinassessingbonemineraldensitywillincludeDEXA,radiography,CT,quantitativeCTandhighresolutionMRI.Imagingofinsufficiencyfractureswillincluderadiography,CT,MRI,nuclearmedicineandultrasound,witharationaleonhowtochoosebetweenthedifferentimagingmodalities.

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Platinum sponsors

Philipsisadiversifiedhealthandwell-beingcompanyandaworldleaderinhealthcare,lifestyleandlighting.Ourvisionistomaketheworldhealthierandmoresustainablethroughmeaningfulinnovation.

Wedevelopinnovativehealthcaresolutionsacrossthecontinuumofcare,inpartnershipwithcliniciansandourcustomerstoimprovepatientoutcomes,providebettervalue,andexpandaccesstocare.

Aspartofthismissionwearecommittedtofuellingarevolutioninimagingsolutions,designedtodelivergreatercollaborationandintegration,increasedpatientfocus,andimprovedeconomicvalue.Weprovideadvancedimagingtechnologiesyoucancountontomakeconfidentandinformedclinicaldecisions,whileprovidingmoreefficient,morepersonalisedcareforpatients.

TheSiemensHealthcaresectorisoneoftheworld’slargestsupplierstothehealthcareindustryandatrendsetterinmedicalimaging,laboratorydiagnostics,medicalinformationtechnologyandhearingaids.Siemensoffersitscustomersproductsandsolutionsfortheentirerangeofpatientcarefromasinglesource–frompreventionandearlydetectiontodiagnosis,andontotreatmentandaftercare.Byoptimisingclinicalworkflowsforthemostcommondiseases,Siemensalsomakeshealthcarefaster,betterandmorecost-effective.Forfurtherinformationpleasevisit:http://www.siemens.co.uk/healthcare

Silver sponsors

AllianceMedicalisEurope’sleadingindependentimagingservicesprovider.IntheUK,AllianceMedicalhas25years’experienceofdeliveringarangeofdiagnosticimagingservicesforpatients.WeoperatealargenetworkofscanningcentresandmobilesscannersacrosstheUKwhichofferpredominantlyMRIscanning,butmanysites/mobilesalsoofferarangeofotherdiagnosticmodalitiesincludingCT,PET/CT,DEXA,X-rayandUltrasound.

InJuly2013,AllianceMedicalcompletedthepurchaseofErigal,aleadingUKmanufacturerofradiotracers,tocreatetheUK’sonlyintegratedradiotracersupplyandimagingorganisation.

Forfurtherinformationpleasevisitwww.alliancemedical.co.uk,[email protected].

TheNHSfacesmanychallengestodayaroundtheincreasingneedforgovernanceinordertodemonstratebestpatientcarewithinincreasingfinancialconstraints.BayerRadiologyandInterventional(R&I)iswellplacedtobethepartnerinhelpingTruststoaddressthesechallenges.Withmarketleadingcontrastmediaandpowerinjectorsystems,Bayerisabletoofferinnovativepatientcare,andwiththeadditionofitsinformaticsplatform,itcansupportradiologydepartmentsindrivingprotocolstandardisationandeasilyaccessibleauditdatathatenabledepartmentstomeetfurtherchallengesfacedaroundcontrastradiationdosemanagement.

TofindoutmoreaboutourR&Isolutionspleasecall01635-563999orvisitwww.bayer.co.uk

Dedicatedtomedicalimagingforover80years,Guerbetoffersacomprehensiverangeofcontrastmediaandassociatedmedicaldevicesforimagingdiagnosisandinterventionalradiologyinmajordiseaseareae.g.cardiovascular,cancer,inflammatoryandneuro-degenerativediseases.

Pleasevisitwww.guerbet.co.uktolearnmoreaboutouractivities.Forfurtherinfo,[email protected]:01217338542.



Silver sponsors

MEDICAaretheUK’sleadingproviderofteleradiologyservices.InadditiontoourNighthawkOutofHoursCT/MRservice,weprovidesubspecialistreportingforCT,MR,Mammography,CTColonography,plainfilmandNM.Ourreportingisdeliv-eredintheUKbyradiologistswithaminimumoftwoyears’experienceasNHSconsultantsandwithinastrictqualityframework.

Forfurtherinformationpleasevisit:www.medicagroup.co.uk

RxEyeprovidesaglobalcollaborationplatformenablingeasyaccesstoexpertsandsecuredatasharingwithinmedicalimaging.

Collaborateinascalable,accessibleplatformwithfullcontroloftheworkflow.Addnewhospitalsandspecialiststoyournetworkfastandsmooth.Gainaccesstoothernetworksandcreatenewcollaborations.

Forfurtherinformationpleasevisit:www.rxeye.com

4WaysHealthcareistheUKleaderinqualityRemoteRadiologyReporting.Weof-feranopportunitytoreportCT,MR,PlainFilmandspecialistdisciplinesfromyourownhome.4WaysistheidealchoicefortheRadiologistwhowantsaflexible,lucrativeparttimeorfulltimereportingrole.

Forfurtherinformationpleasevisit:www.4whc.com

Bronze sponsors



JointheBIRtodaytobenefitfromreduceddelegateratesforourevents.Formembershipinformationvisit:www.bir.org.uk/join-us

48–50StJohnStreet,London,EC1M4DG

www.bir.org.uk

Registeredcharitynumber:215869

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TheBritishInstituteofRadiology

BIR Annual Congress 2014

Documents

Transcript of BIR Annual Congress 2014