Philip Ward

As I embark on a new episode in my journalistic career, I can reflect on the past 17 years as the editor of 

The 1990s were a particularly special decade for me. Our three children were born, and I began working for 

. I realize it must seem slightly odd to mention these personal and professional landmark events in the same breath, but it's relevant to do so because they both not only involved huge challenges but also brought great rewards.

It has been an absolute pleasure for me to see 

 evolve and mature over the years. I have enjoyed every moment. The thrill, excitement, and satisfaction of opening a fresh box of printed issues remains as strong as ever and continues to fill me with a sense of pride.

As in any partnership, teamwork has proved integral to the magazine's success. When I wrote my first editorial in March 1994, I encouraged readers to become more closely involved. I explained that we were seeking to transform 

 was called then, from the offshoot of a successful, established U.S. publication into a stand-alone European magazine with its own identity and distinctive regional content.

At the time, I had no idea what response I'd get. I knew medical doctors were incredibly busy, and I wondered if they would really want to take on yet more work, especially when it was unpaid.

I needn't have worried, because the response and willingness to contribute have always been forthcoming. Across the globe, medical training appears to instill an overriding and unquestioning desire to share information and ideas freely with others, and such openness has allowed us to grow and develop. Many authors have shown their readiness to prepare articles for us, and a band of regular columnists have added great insight and entertainment. Having such a healthy pipeline of strong material has provided great reassurance and given us firm foundations on which to build. Regular feedback has come from readers in the form of letters to the editor and survey responses. And last but definitely not least, the Editorial Advisory Board has given me constant encouragement and fresh ideas.

In addition, I have been incredibly fortunate to work with so many talented and creative publishing colleagues in editorial, sales, marketing, and circulation. Without their hard work and input, the magazine would not have prospered.

I would like to acknowledge and thank everybody for their support over the years. You have made the job stimulating and rewarding.

Articles

As I embark on a new episode in my journalistic career, I can reflect on the past 17 years as the editor of Diagnostic Imaging Europe and Diagnostic Imaging Asia Pacific.

After two decades, it's time to bid farewell and thanks

The RSNA has pulled off a giant publicity coup by signing up former U.S. president Bill Clinton to give a special address at its congress in Chicago later this month. However, the bold move may well backfire if he fails to include any real substance in his talk.

By early October, professional attendees had snapped up most of the 4250 tickets for the Clinton lecture, to be held in the Arie Crown Theater on the afternoon of Tuesday, Nov. 30. Non–ticket-holders can watch the lecture on a big screen in one of 10 overflow rooms at McCormick Place. Clearly the organizers anticipate huge interest and expect the meeting to grind to a virtual halt for an hour or so.

The prospect of a politician being given star billing at a top scientific congress is bound to raise eyebrows among the purists, but it has created a buzz, judging by the demand for tickets and the publicity generated by the announcement. A senior French radiologist has suggested-in private and probably with tongue in cheek-that the bosses of JFR (les Journées Françaises de Radiologie) should book their own celebrity speaker.

It will be fascinating to hear what Clinton has to say, although as a member of the news media, it's not clear I'll be able to do so. According to the RSNA, working members of the press will be banned from the theater and the overflow rooms and must wait for a report in the organization's own 
 publication.

It's unclear whether an abstract or outline will appear before the event, and even the title of his talk has not been revealed yet. The RSNA gives no further details on its website, merely stating that “as a powerful voice for progress around the world, President Clinton will address the RSNA audience.”

During his presidency, Clinton had a mixed record on healthcare. In 1993, he keenly promoted a universal healthcare plan, and his wife, Hillary, led a task force on the issue. Many insurers, doctors, business leaders, and Republicans strongly opposed the plan, which was officially shelved a year later. If he speaks openly about the lessons learned in the 1990s, and/or about how radiologists may fare in the current wave of reforms, then his message will be relevant. He said in a March 2009 interview with CNN that healthcare changes will be easier to implement now because there is greater consensus, and this suggests he may focus on the current reforms at RSNA 2010.

Clinton collected nearly $40 million in speaking fees between 2001 and 2006, and is typically paid around $150,000 per engagement, according to a 

 article from Feb. 23, 2007. His fee for the Chicago congress is being paid by an outside donor, and the terms are confidential, but Clinton (or his foundation) is likely to be rewarded handsomely for the lecture. Let's hope he's worth the hype.

The RSNA has pulled off a giant publicity coup by signing up former U.S. president Bill Clinton to give a special address at its congress in Chicago later this month.

Celebrity speaker creates a stir, but represents major risk

Everybody loves to read about the future. We may not be too keen to admit it openly, but we all feel varying degrees of fear and apprehension about what lies around the corner. Getting some advance notice about what’s in store for us, in both our professional and personal lives, can help us to plan better and accept change a little more readily.

 editorial advisory board at ECR 2010, we conducted a survey among the members, and one question focused on which topics should be covered in greater depth. The number one response, overwhelmingly, was “the future of imaging.” Nearly 90% of respondents ticked this item, whereas a much smaller proportion wanted more articles on management issues (53%), national news (47%), oncology imaging (47%), cardiac imaging (42%), radiation protection (42%), industry news (37%), developments in the U.S. (10.5%), and human interest stories (10.5%).

The outcome was pretty much the same in our last poll, two years earlier.

This research prompted us to ask a very highly respected, level-headed Englishman with a global perspective to do some crystal-ball gazing. For our interview with Prof. Adrian Dixon from Cambridge, U.K., please turn to the Big Picture column on the last page of this issue.

Dixon is surprisingly positive and upbeat about radiology’s future, and would not hesitate to recommend the profession to young doctors and medical students. He accepts that there are tough challenges and choices ahead, but, provided radiologists continue to develop their skills and display the right attitude, their prospects remain bright. He’s also got some quite specific practical advice for readers.

Continuing this theme of looking to the future, the RSNA congress-known simply as “The Big One” among our publishing staff-starts to loom large at this time of year, as does the JFR, les Journées Françaises de Radiologie, which takes place in Paris in late October. In the run-up to these important international meetings, we will be showcasing exhibitors' new products and services in our ever-popular Technology Update section (see page 14). Part 2 of our roundup is due to appear in the October edition.

I hope you enjoy this coverage and get some useful ideas and pointers for the coming weeks, months, and years. As always, please contact me, at 

, with any feedback, comments, or suggestions. I am always keen to hear from you. '

Everybody loves to read about the future. We may not be too keen to admit it openly, but we all feel varying degrees of fear and apprehension about what lies around the corner.

Act now and your future is sound, Dixon advises

You can really feel the excitement, tension, and eager anticipation in the packed poster hall at the RSNA congress when the much sought after rosettes are pinned up on the prize-winning exhibits during Wednesday afternoon. Many of the posters are now electronic, but this hasn’t detracted from the spectacle. You almost get the feeling that if you don’t watch out, you may get trampled in the stampede as research teams rush to their posters or to the nearest computer terminal.

At the last RSNA meeting, the atmosphere was particularly frenzied because a purple summa cum laude rosette made its first appearance in Chicago since 1998. A modest and unassuming group of German informatics experts were stunned by their success, and when I arrived to interview them, their unbridled joy and immense pride were evident to all.

The team kindly agreed to prepare an overview article about their research, and to find out what impressed the RSNA judges, DI Europe’s readers should turn to the cover story in this issue.

Prof. Oliver Bott and his colleagues have developed new software for simulation- based C-arm fluoroscopy training to help improve image quality and radiation protection. C-arm fluoroscopy is very operator-dependent, but the package enables nonhazardous, lifelike training while providing extra information, such as visualization of scattered radiation, during a simulated procedure. The tool is of great value to technologists and nurses who perform fluoroscopy during trauma procedures and orthopedic surgery and who have traditionally undergone their training on actual patients, Bott said.

The annual Computer Assisted Radiology and Surgery congress takes place in Geneva, Switzerland, in late June, and copies of this issue will be distributed at the meeting. We hope that delegates enjoy reading it and find it valuable.

Finally, please make sure that you visit our Europe microsite on the web. You can access it by going to DiagnosticImaging. com and clicking on the Europe button on the left side of the home page. The new Asia Pacific site will also be of interest.

As you will have noticed, we are facing severe space constraints at present, and we are able to publish only a limited number of articles and news stories in print. This situation has prompted us to post an increasing volume of material online. For instance, Dr. Carla Ribeiro’s article about imaging of the adrenal glands was posted on our Europe site on April 21 and is well worth reading. You can expect to find further original articles on our site over the coming months, and if you have any feedback or comments, please don’t forget to contact me at 

You can really feel the excitement, tension, and eager anticipation in the packed poster hall at the RSNA congress when the much sought after rosettes are pinned up on the prize-winning exhibits during Wednesday afternoon.

Raw emotion rules in poster hall during RSNA congress

Molecular imaging is hugely expensive, risky, difficult to understand, heavily regulated, without immediate clinical benefit, and not reimbursed. These factors are halting progress in the field. The solutions for radiology are to collaborate, cooperate, co-own, and cotrain.

That’s the opinion of Prof. Gabriel Krestin, a professor of radiology at the Erasmus Medical Center in Rotterdam, the Netherlands. He addressed this emerging area at an ECR professional challenges session about the radiologist of the future during the March congress.

“Big sharks are waiting out there,” Krestin said, referring to turf battles on the horizon. These battles will be against the powerful, who want to become even more powerful (cardiology, internal medicine, and neurology/neurosciences); the knowledgeable, who know more and do it better (molecular biology and biochemistry); and against the weak, who want to survive (nuclear medicine, neurosurgery).

Radiology must care about molecular imaging (MI) because it represents the future and opens the way for personalized medicine, he said. Furthermore, clinicians will ask for it increasingly often, it boosts imaging research and is a good source of funding, it is sexy, and if radiologists don’t do it, others will.

Krestin noted that surveys have shown the following:

• The main focus of MI is oncology, followed by cardiovascular diseases and technology development (U.S.) or neurosciences (EU).

• There is a positive correlation between the number of radiologists in a department and available MI modalities and funding, and the amount of grants correlates negatively with the number despite struggle for continued existence of exams in the U.S, but this is not the case in the EU.

• Larger research-oriented and wellfunded departments of radiology in the EU tend to participate in enterprisewide MI programs.

• Multidisciplinary teams are characteristic for MI programs, both in the U.S. and the EU.

His short-term recommendations are to create a network of centers of excellence, which could be certified as reference training centers in MI; set up and sponsor workshops and scholarships on MI; guarantee growth of MI topics at major radiology meetings; sponsor young radiologists to attend MI workshops and major MI meetings; and develop collaborations with the other European societies involved in MI (European Association of Nuclear Medicine, European Society for Molecular Imaging) for a common and multidisciplinary approach.

His midterm suggestions are that institutions apply jointly for research grants in MI to develop new applications or new imaging technologies; to set up clinical research grants for development of translational projects or pilot clinical trials in MI; to sponsor training in new hybrid technologies; to build up a webbased collection of teaching materials accessible to ESR members; to raise public and private funds for development of MI in radiology ; and to implement a specific training curriculum for acquiring knowledge in cell and molecular biology, genetics, and MI.

A version of this article appeared in the 2010 ECR Today newspaper.

Molecular imaging is hugely expensive, risky, difficult to understand, heavily regulated, without immediate clinical benefit, and not reimbursed.

Molecular imaging holds promise despite struggle for continued existence

The world of medical imaging will miss Linda Clarkson, who passed away unexpectedly in March. Not only was she a warm, friendly, and genuine person who was fun to be around, but she was also a talented and progressive-thinking radiographer and educator.

Linda was a prolific and valued contributor to 

, along with her partner, Paul Arnold. When I first met them in the mid-1990s, they were working as radiographers at St. James' University Hospital in Leeds, U.K. They had developed a detailed knowledge of clinical protocols used in spiral CT, and had been recommended to me as potential authors. We published their first article as the cover story in our April 1997 edition, and it received really positive feedback. Linda and Paul were thrilled with the recognition in a magazine widely read by European radiologists.

One of Linda's many virtues was her willingness to share her expertise with others. When Frances Rylands- Monk-now a contributing editor based in northern France-joined 

 in 1997, I asked Linda and Paul if Frances could spend a day with them in order to learn about clinical practice. They agreed straight away and couldn't do enough for her, and Frances benefited greatly from the experience.

In her post as a clinical radiographer (advanced practitioner), Linda became part of the multidisciplinary team for gynecological cancer, and was sponsored by Cancer UK to undertake research within the field of ovarian cancer. She then became a lecturer at the University of Bradford and was postgraduate course leader in CT and cranial CT reporting. Given her enthusiasm, commitment, and passion for the subject, hundreds of radiography students must have been inspired by her teaching.

Linda wrote many articles and research papers; last year she produced a textbook for radiographers new to CT and published a case report on intrathoracic renal ectopia in the 

. She also presented regularly at national and international congresses, including the UKRC, ECR, and RSNA. I would often see her and Paul at the departure lounge in Manchester Airport, and enjoyed many friendly chats with them. She was always bursting with life and fresh ideas. During the UKRC in June, Paul will be presenting on her behalf about radiography education.

Linda was a colorful personality, and it was fitting that guests at her funeral were asked not to wear black. She loved fun, which was highlighted when she made the long trek to North Wales with Paul to attend a salsa charity concert that I'd helped to organize last summer.

“Gone too soon” was the simple message in the announcement in the 

. Nobody would disagree with those words.

The world of medical imaging will miss Linda Clarkson, who passed away unexpectedly in March.

Imaging community mourns loss of colorful CT specialist

When it comes to the sizzling hot topic of carcinogenesis and diagnostic radiation, it is crucial to differentiate hypothesis from scientific fact, maintain a sober mind, and separate science from politics and economics.

That's the view of Dr. Michael Brant- Zawadzki, medical director for neurosciences at Hoag Memorial Hospital in Newport Beach, California, and an adjunct clinical professor of radiology at Stanford University, in Stanford, California. During the W.C. Roentgen honorary lecture at the ECR, he urged congress attendees to assure the appropriateness of studies, standardize safe dose levels, use the lowest acceptable dose, and introduce a quality assurance process, including recording cumulative doses in a patient's file.

“Someone who comes in with a stroke could die today. But if they are worried about a cancer 30 years from now, they may refuse a lifesaving scan,” Brant- Zawadzki said.

Dr. James Thrall, chief radiologist at Massachusetts General Hospital in Boston, Massachusetts, had made the same statement in Tuesday's edition of 

The risk to patients of radiation dose is evaluated in terms of effective dose as defined by the International Commission on Radiological Protection, Brant- Zawadzki said. Effective dose combines the absorbed dose and a weighting factor related to the radiosensitivity of each organ exposed. Effective dose allows for comparison of various sources and can be calculated for standard body configurations, though not easily for individual patients. The unit of effective dose measurement is the Sievert (Sv).

He gave some ballpark figures for the effective dose of selected examinations: head CT,1 to 2 mSv; chest CT, 5 to 7 mSv; abdominal and pelvic CT, 8 to 11 mSv; diagnostic coronary angiogram, 3 to 30 mSv; SPECT thallium, 25 mSv; SPECT sestamibi 12 mSv; and coronary CT angiogram, 6 to 13 mSv.

“In CT, the science of diagnostic radiation and carcinogenesis has recently become very embroiled in my country, and I'm sure in Europe as well, in the politics and economics of overutilization of this rather expensive technology,” he said.

Radiation injury is either deterministic, which occurs only above a threshold dose, or stochastic, which assumes no threshold. In the former, a degree of injury is related to the dose, and in the latter, the probability of injury increases with dose. Radiation-induced hair loss can result from perfusion CT and a prolonged neuro-interventional procedure with angiography, for example. The top of Brant-Zawadzki's own hands have no hair, presumably due to exposure, he said.

He said it is worth remembering, however, that a major decline in cancer mortality has occurred in the U.S. over the past 50 years, even though cancer incidence has remained relatively stable. This suggests that improvements in cancer detection, treatment, and/or prevention have reduced the risk of cancer-related death.

In some regions, radiation is considered to have a positive impact on health, Brant-Zawadzki said. Bad Gastein, in Switzerland, is one of Europe's leading spa resorts, with 17 thermal springs. The apparent secret of its success is radon, an inert gas producing mildly radioactive emissions. It has a healing, regenerative effect on tissue, and stimulates the metabolic processes. The list of therapeutic indications include rheumatic, arthritic, and scoliotic disease, spinal and disc problems, fertility and potency problems, age-related complaints, and certain metabolic diseases.

Brant-Zawadzki also spoke about the case of Tsutomu Yamaguchi, who was the last double atomic bomb survivor. He was badly burned in Hiroshima, and three days later was in Nagasaki when the second bomb exploded. He lived to be 93, and died of stomach cancer in January of this year.

Furthermore, in the U.S., background radiation in three mountain states is three times that of three gulf states, but the cancer mortality rate is 25% higher in the gulf states, he said.

A version of this article appeared in the 2010

Politicization of radiation debate increases risk of misinformation

That’s the view of Dr. Michael Brant-Zawadzki, medical director for neurosciences at Hoag Memorial Hospital in Newport Beach, CA, and an adjunct clinical professor of radiology at Stanford University. During the W.C. Roentgen honorary lecture at the European Congress of Radiology in March, he urged congress attendees to assure the appropriateness of studies, standardize safe dose levels, use the lowest acceptable dose, and introduce a quality assurance process, including recording cumulative doses in a patient’s file.

“Someone who comes in with a stroke could die today. But if they are worried about a cancer 30 years from now, they may refuse a lifesaving scan,” Brant-Zawadzki said.

Dr. James Thrall, chief radiologist at Massachusetts General Hospital in Boston, had made the same statement 

The risk to patients of radiation dose is evaluated in terms of effective dose as defined by the International Commission on Radiological Protection, Brant-Zawadzki said.

Effective dose combines the absorbed dose and a weighting factor related to the radiosensitivity of each organ exposed. Effective dose allows for comparison of various sources and can be calculated for standard body configurations, though not easily for individual patients. The unit of effective dose measurement is the Sievert (Sv).

“In CT, the science of diagnostic radiation and carcinogenesis has recently become very embroiled in my country, and I’m sure in Europe as well, in the politics and economics of overutilization of this rather expensive technology,” he said.

Radiation injury is either deterministic, which occurs only above a threshold dose, or stochastic, which assumes no threshold. In the former, a degree of injury is related to the dose, and in the latter, the probability of injury increases with dose. Radiation-induced hair loss can result from perfusion CT and a prolonged neurointerventional procedure with angiography, for example. The top of Brant-Zawadzki’s own hands have no hair, presumably due to exposure, he said.

In some regions, radiation is considered to have a positive impact on health, Brant-Zawadzki said. Bad Gastein, in Switzerland, is one of Europe’s leading spa resorts, with 17 thermal springs. The apparent secret of its success is radon, an inert gas producing mildly radioactive emissions. It has a healing, regenerative effect on tissue, and stimulates the metabolic processes. The list of therapeutic indications include rheumatic, arthritic, and scoliotic disease, spinal and disc problems, fertility and potency problems, age-related complaints, and certain metabolic diseases.

Brant-Zawadzki also spoke about the case of Tsutomu Yamaguchi, who was the last person to survive both atomic bomb explosions at the end of World War II. He was badly burned in Hiroshima, and three days later was in Nagasaki when the second bomb exploded. He lived to be 93, and died of stomach cancer in January of this year.

Science, not politics should define imaging dose debate

Several years ago, I asked an Indian ultrasound specialist if he had knowingly taken part in a genderselective abortion. He said he hadn't, but he knew of sonographers who did occasionally reveal the sex of a fetus to a patient. He said they always did this very discreetly, for instance by writing “F” or “M” on a scrap of paper. They told him that the pressure from a patient was often immense, and they were concerned that if they did not pass on the information, the patient would merely go straight to an unscrupulous back-street practitioner who could not be relied upon to give a correct answer, and who would charge an exorbitant fee.

This must be a dreadful ethical dilemma for sonographers and radiologists, and there is no easy solution. Furthermore, these groups are now facing unfair treatment from the authorities, as outlined in the lead news story on page 1 of this edition.

“The provisions of the PC-PNDT Act for ‘Save the Girl Child' are good on paper, but illogical on many occasions, causing harassment to the radiologist without having any desired results,” noted Prof. Kishor Taori, president of the Indian Radiological and Imaging Association, during his address to the association's annual meeting in Ahmedabad in late January. He said that IRIA would help educate society and make people realize that boys and girls are of the same value, but he was deeply concerned that a simple breach of the law, such as a missing signature on a form, may result in the seizure of ultrasound machines.

Taori deserves the support of the worldwide radiological community for his courageous stance and for speaking out publicly on such a sensitive issue. Clamping down on rogue practitioners is in everybody's best interests, but the heavyhanded approach of some bureaucrats must be resisted vigorously.

You can read more about the IRIA's annual congress at our new Asia Pacific microsite (

). We are planning similar coverage of the important regional and national meetings throughout this year, and we hope you will get involved by telling us about future events and contributing a short report. Please send me an e-mail at 

Also, for the eighth consecutive year, we have produced an online news service from the European Congress of Radiology, held in Vienna in early March. Please take a few moments to look at our diverse selection of articles. ECR moved to the Austrian capital in 1991, and has been held annually since 1999. It is now a highly respected and wellattended international scientific event with a large technical exhibition. You can catch up with ECR 2010 by logging on to DiagnosticImaging.com and looking for “News from ECR.” I hope you enjoy it.

Several years ago, I asked an Indian ultrasound specialist if he had knowingly taken part in a genderselective abortion.

Indian radiologists deserve support in battle with bureaucracy

The overall number of attendees at this year’s European Congress of Radiology was 19,017, representing an increase of nearly 5% compared with the 2009 event, according to congress organizers. 

  There were 11,817 professional and 7200 industry/other delegates at ECR 2010. The country breakdown for professional delegates is given below. Of the 1036 radiographers who attended, 165 came from Denmark and 117 came from Norway. 

  By comparison, a total of 18,200 participants were at ECR 2009.

The overall number of attendees at this year’s European Congress of Radiology was 19,017, representing an increase of nearly 5% compared with the 2009 event, according to congress organizers.