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ESER European Society of Emergency Radiology

proudly meeting

NORDTER Nordic Forum Trauma and Emergency Radiology 4TH NORDIC COURSE, MAY 13 – 16, 2013, UPPSALA, SWEDEN Ulrich Linsenmaier, MD PhD

The Increasing Importance of New Subspecialities in European

Radiology

ESER -‐-‐ ESOI -‐-‐ ESMOFIR Update on three new socie=es @ ESR

Ulrich Linsenmaier, MD PhD

Director Ins=tute for Diagnos=c and Interven=onal Radiology, KMPP & Augus=num, Munich Associate Professor of Radiology, LMU Munich

President European Society of Emergency Radiology (ESER)

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3 new Subspecialty and Allied Sciences Societies est. 2011/12 ü a move toward process driven radiology

ü providing a European platform for emergency radiologists

ü dedicated to teaching, research & development and supra-national collaboration

3 new Subspecialty and Allied Sciences Societies / est. 2011-12 ESER . European Society of Emergency Radiology www.eser-‐society.org ESMOFIR . European Society of Molecular and Functional Imaging in Radiology www.esmofir.org ESOI . European Society of Oncologic Imaging www.esoi-‐society.org

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“INSTITUIONAL MEMBERS SOCIETIES”

ESR has the following ins=tu=onal members socie=es: 1. Na4onal Socie4es of Radiology of European countries •  represented by its president in the ESR “Na=onal Socie=es CommiTee” •  sending delegates to “Professional Organiza=on CommiTee”, “Educa=on CommiTee”

and the “Research CommiTee” 2. European Subspecialty Socie4es of Radiology and Allied Sciences Socie4es •  provide the dedicated subspecialized radiological knowledge in modern radiology

in research, educa=on and clinical prac=ce •  Sending delegates to ESR commi>ees:

“Subspecial=es and Allied Sciences CommiTee” “Professional Organiza=on CommiTee” “Educa=on CommiTee”, “Research CommiTee”, “ECR Scien=fic SubcommiTee”

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NATIONAL SOCIETIES (41)


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SUBSPECIALTY AND ALLIED SCIENCES SOCIETIES (11 + 3 = 14)

Why do we need new Subspecialty Societies ?

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Subspecializa=on in Radiology Ø  star=ng from anglo-‐american countries back in the 1980s

Ø  early specializa=on based on organ systems or body regions

(neuro, pediatrics, mammo) or modali=es (CT, MR, XA, IR)

Ø  some grew and increased in importance (e.g. CT and MR, ) in one modality others further developed (Abdominal, Thoracic, MSK imaging) using mul=ple modali=es

Ø  specializa=on in Radiology was and is today not sta=c but dynamic Ø  new developments are process driven and result of complex and

comprehensive imagining procedures, overcoming organ based specializa=on: “Oncologic Imaging” and “Emergency Imaging” are examples represen=ng fastest growing fields in radiology.

Subspecializa=on in Radiology in Europe Ø  ESR has a successful model represen=ng all major fields of radiology

Ø  na=onal subspecializa=on in Europe is differently developed, depending on

<historic backgrounds, <local demands, <resources (hospitals & teaching facili=es), <organiza=onal issues, <influence of established subspecilai=es

Ø  all na=onal subspecialty socie=es and working groups are invited to join and collaborate with the new subspecialty socie=es ESER, ESOI and ESMOFIR

Ø  Subspecialty socie=es have an important role @ ECR program planning scien=fic sec=ons @ EUROPEAN RADIOLOGY and INSIGHTS into IMAGING contribu=ons to @ TRAINING CURRICULUM and EUROPEAN DIPLOMA in Radiology

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Three New Socie=es under the umbrella of the ESR “Knowledge and demands for radiologist have changed constantly (…) and have become more and more specific” “For a single radiologist , it is no longer possible acquire this extensive knowledge and experiences (…) modern diagnos=c and interven=onal radiology has developed drama=cally.” “The logical consequence is .. an increase in subspecializa4on.” M. Reiser /Munich, DE, 2012 / Past President ESR 2010-‐11

M. Reiser / Munich, Past President ESR 2010-‐11

Founder and promoter of these ini=a=ves was

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New Subspecializa=on in Radiology -‐ Reasons Ø  for a long =me targeted imaging procedures were carried out from usually

one specific clinical ques=ons Ø  recent developments ( as WBCT or MRI or PET-‐CT ) allow fast and innova=ve new

concepts in imaging the en=re body

Ø  fast whole-‐body imaging requires new competences not limited to body regions new modali=es are highly innova=ve & process driven

Ø  in func=onal and molecular imaging new hybrid modali=es as PET-‐CT, SPECT-‐CT , MR-‐PET are on its way

Ø  “All these aspects have been discussed with ESR for years .. .. 3 new socie=es should supplement the classic radiological disciplines .. to be prepared for the challenges of the future “(M.Reiser)

s/p fall on subway track

Get whole body CT WBCT for !

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new Subspecialty and Allied Sciences Societies

ESER . European Society of Emergency Radiology ü  Initiative launched in the year 2008-2009

discussed with ESR @CR 2010 by U. Linsenmaier, M. Scaglione, G. Schueller

ü  A group of 14 founding members was called in

ü  legally founded in October 2011 under Austrian law “Vereinsrecht”

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ESER Founding Members

Dominic Barron, MD; Leeds, UK Paul Bode, MD, Leiden, NL OTo Chan; London, UK Markus Körner, MD; Munich DE Digna Kool; Nijmegen, NL Seppo Koskinen; Helsinki, FI Ber=l Leidner, MD, Stockholm, SW Ulrich Linsenmaier; Munich, DE ViTorio Miele, MD; Roma, IT Michael Rieger, MD, Innsbruck, AT Mariano Scaglione, MD; Napoli, IT Gerd Schueller, MD; Vienna, AT Michele Tonerini, MD; Pisa, IT Stefan Wirth, MD, Munich, DE Prof. Dr. Fred E. Avni, ESR Subspecial=es CommiTee Chairman, Bruxelles, BE Prof. Dr. Lorenzo Bonomo, President of ECR 2012, Rome, IT Univ. Prof. Dr. Chris=an HEROLD, Past President of ESR, Vienna, AT Prof. Dr. Dr. med. M. Reiser, FACR, FRCR, Past President of ESR, Munich, DE


ESER . European Society of Emergency Radiology . Purpose

Ø  to establish Emergency Radiology (ER) as an area of special interest and expertise …

Ø  to collaborate with the European Society of Radiology (ESR), its committees and established subspecialty societies

Ø  .. to provide both, a scientific and educational forum

Ø  .. to promote research and technical developments

Ø  .. to collaborate with 41 national radiological societies and their ER sections

Ø  .. to promote a joint European approach in Emergency Radiology

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ESER . European Society of Emergency Radiology Executive Board (2012-2013) President U. Linsenmaier, Munich/DE Vice President M. Scaglione, Napoli /IT London/ UK Treasurer G. Schueller, Zurich/CH Program Officer S. Wirth, Munich/DE Education Officer V. Miele, Roma/IT Member at Large L. Derchi, Genoa/IT Member at Large L. Donoso, Barcelona/ES

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ESER Facts

Ø Scientific subcommittee @ ECR; SS, RC program 2012 M. Scaglione, ‘13 U. Linsenmaier, ‘14 G. Schueller, ‘15 Stajgis

Ø Scientific subcommittee @ EUROPEAN RADIOLOGY P. Poletti, H. Alkhadi, K. Shanmughanathan

Ø ER scholarships @ ESOR 1st in 2011 LMU Munich, different

Ø ESER Office / Vienna: Kornelia Fünder, Wolfgang Duchek

Ø Call for members from April 2012: July ‘12 > 110, May ‘13 > 200

Ø  “Emergency Radiology of the Adomen” @ SPRINGER March 2012

Ø  ER contents in European Training Charter in Radiology

1st ESER ER textbook Ø  3 volumes planned: Ø  “Thorax & CV Systm” Ø  “Brain & Spine

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ESER 2011 © U Linsenmaier, LMU Munich, ESER, 01.03. 2011

ESER Executive Board (2012-2013) U. Linsenmaier, Munich/DE M. Scaglione, London/ UK G. Schueller, Zurich/CH

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1st ESER . Summer Course 2012 on Emergency Radiology July 5-6, 2012, in Munich, Germany Congress Organizers: S.Grab, S.Wirth, U.Linsenmaier. LMU University Campus (Hosting institution) Prof.Dr.Dr.M.Reiser, Chairman, Past President of ESR more than 155 participants from 27 countries

ü Pediatric emergencies

ü Emergent Neuroimaging ü Acute chest (non-trauma) ü Acute abdomen (non-trauma)

ü Sports injuries (trauma) ü Highlights/Trends ü Polytrauma

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ESER ü  Membership is open to all physicians and scientists with a special interest

in these innovative field

ü  Encourage your colleagues to join and become members

ü  Join ESER / ESOI /ESMOFIR at ECR 2013 (Scientific Session, RC, SA, Business meeting)

ü  Submit ER manuscripts to EUROPEAN RADIOLOGY

ü  Check for ER OI MI Scholarships @ ESOR

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Support and join The new Subspecialty and Allied Sciences Societies !!

TRENDS in Emergency Radiology Numbers of ED visits with CT from 1995 to 2007.

Larson DB et al. (2011). Radiology. 258: 164-173

Ø  exponen=al growth Ø  annual growth rate 16.0% Ø  doubling =me 4.7 years

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Trends in use of CT in the ED (from 1995 to 2007)

•  Exponen=al rise of the CT use in the ED ▲  6-‐fold increase of the number of ED visits w CT

▲  5-‐fold increase of the percentage of ED visit w CT ▲  con=nuous increase in the older popula=on

Nat Hospital Ambulatory Medical Care Survey > 350.000 or 30 044 visits / year evaluated 1995 to 2007 Larson DB et al. (2011). Radiology. 258: 164-173

Percentages of ED visits w CT based on patient age


Annual growth rates Ø  children 12.7% Ø  young adults 15.2% Ø  middle-‐aged 14.4% Ø  elderly 11.9%

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Trends in the ED

•  MDCT improves pa=ent triage and door-‐to-‐treatment =mes

•  MDCT is the most important diagnos=c tool for ED physicians

•  MDCT: 1 out of 5 ED pa=ents receive a CT

•  MDCT use increased 330% (since 1995) largest increase: pts older than 79 (9.1% in 1996 to 29.1% in 2007).

•  MDCT: Correla=on between with drop in hospital admissions and shi? away from expensive ICU admissions.

Nat Hospital Ambulatory Medical Care Survey > 350.000 or 30 044 visits / year evaluated 1995 to 2007 Larson DB et al. (2011). Radiology. 258: 164-173

How can this increase be explained ?

ED Visits Involving CT [%] according to Chief Complaint

•  common CT indica=ons show increase

• Headache + 234 % (15.2% to 35.5%) • Accidents + 523 % (6.4% to 33.5%) • Head injury+ 218 % (19.1% to 40.7%)

•  new CT indica=ons show exponen=al increase • 

• Flank pain + 1008 % (0.4% to 43.3%) • Abdominal pain+ 1650 % (2.0% to 33.0%) • Chest pain + 1141 % (1.2% to 13.7%)


[% ED visits involving CT] [% increase]

[% increase] [% ED visits involving CT]

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ESER European Society of Emergency Radiology ESER Membership Benefits Membership is open to all persons interested in emergency radiology offering benefits as: - Representation of your subspecialty on a European level - Reduced course/congress registration fees - ESOR scholarship programme - ESER newsletter - Certificate of membership

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Ryan and Easyjet fly to BGY (Milan/Bergamo) and MXP (Milan/Malpensa)

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www.eser-socity.org

3-eser 2013 nordter uppsala 05 2013 ul

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