ISSUE 65 NOVEMBER 2015

I am back from a series of conferences in Barcelona and Paris where the future of radiology was discussed. This time there was something new.

One of the conferences, which was by invitation only, was the Global Summit on Radiological Quality and Safety. Radiology leaders from all over the world gathered to discuss current issues such as quality, patient primacy and value added of radiology.

For the first time, one of the 52 participants was the President of a US based patient organization, called Powerful Patient, a program focusing on issues of interest to people with complex medical issues or disabilities, and those seeking a diagnosis. The goal of this organization is to empower patients with information that will make their conversation with their doctors richer and more focused. Joyce Graff, the patient advocate, wanted to understand the potential impact of radiation. In her report of the meeting, she summarizes accurately what she heard, and suggests to patients to create their own log of their exposures by recording a number of information, including names of the technician and radiologist (Who), organ studied (What), place where the study was performed (Where), reason for study (Why), date and time (When)and the amount of radiation delivered during the scan, or an estimate.

On the same line, the International Alliance of Patient’s Organizations, stated through Kawaldip Sehmi, its CEO, that health is a human right and patients are the ones who bear the impact of many decisions made without them. Better services can be designed and outcomes delivered by communicating more openly and effectively, listening to and involving patients at all levels, and feeding back to patients on changes, improvements and ongoing challenges.

INS IDE THIS EDITION

The European Patients Forum promotes patient empowerment, a multi-dimensional process that helps people gain control over their own lives and increases their capacity to act on issues that they themselves define as important.

What does it mean for us in radiology? Not only sustained and quality communication with our patients, but also better access to information: transparency, informed decisions, availability, and mainly provide patients with access to images and reports through patient portals.

This reflects a major evolution in our relation with our patients. The future of our healthcare system is patient centric and most importantly accountable to patients.

Next week, we celebrate our Radiation Technologists and I want to take this opportunity to thank very sincerely our MRTs for the excellent work they are performing at all our sites and the compassionate care they provide to our patients.

We also celebrate the International Day of Radiology on November 8. It marks this year the 120th anniversary of Wilhelm Roentgen’s discovery of X-rays, and is dedicated to paediatric imaging. You can download “the Gentle Way” the book published specially for this occasion at: http://www.myesr.org/start/IDoR2015/IDoR2015_Paediatric%20Imaging%20Book_FINAL.pdf

All the best,

David Koff Chief of Diagnostic Imaging, HHS Chair, Department of Radiology, FHS

Educational News 2

Rounds Calendar 3

National Radiologic Technology Week

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CME Events 5

Run for the Cure 6

Breast Cancer Awareness

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ARRS Bias Definition 8-10

Interventional Radiology

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November Code Purple & Silver

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Research Corner 12

THE LAST PAGE 13

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M E D I C A L I M A G I N G B U L L E T I N

Dr. Michael Laniado, residents & Dr. Sat Somers—October 6 –7, 2015 Visit our Visiting Professor Program web page to view all of Visiting Professor group photos with our Radiology Residents at: http://www.fhs.mcmaster.ca/radiology/vpp/

VISITING PROFESSOR SERIES - 2015/16 SCHEDULE

EDUCATIONAL NEWS

Future Visiting Professors & Group Photo

Tuesday January 12th and Wednesday January 13th , 2016

Dr. Anne M Covey – Interventional Radiology

Tuesday February 2nd and Wednesday February 3rd Dr. Zoran Rumboldt – Neuro/Head and Neck

Tuesday March 1st and Wednesday March 2nd

Dr. Vincent Mellnick – Abdomen/Pelvis

Tuesday April 5th and Wednesday April 6th

Dr. Costantine Raptis – Thoracic

Tuesday May 3rd and Wednesday May 4th Annual W Peter Cockshott Lecture

Dr. Zehava Rosenberg - MSK

Tuesday, Nov 3rd, 2015

6:00 p.m. “Complications after bariatric surgery”

Wednesday, Nov 4th, 2015 7: 30 a.m. “MRI of acutely ill pregnant patients”

12:00 p.m. “Abdominal errors in the ER: a

Canadian perspective”

St. Joseph’s Healthcare Hamilton CAMPBELL Auditorium—Level 2—Room T2202, Juravinski Tower

EMERGENCY RADIOLOGY GRAND ROUNDS -

Dr. Ania Kielar Associate Professor, University of Ottawa

Active Staff , Department of Radiology , The Ottawa Hospital Director of Abdominal and Pelvic Imaging,

The Ottawa Hospital Ottawa, Ontario

November 3rd & 4th , 2015

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M E D I C A L I M A G I N G B U L L E T I N

MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY

JURAVINSKI HOSPITAL & CANCER CENTRE

0800 Resident Rounds (all rounds in DI Conf. Rm.)

1200 Rad/Path Breast Rds (Rm 106 E Wing)

0800 MSK Rounds

1200 Resident Rounds

0800 Resident Rounds 0800 Multidisciplinary Breast Rounds

0730 Hepatobiliary Rounds

1200 Resident Rds 1310 Sarcoma Rounds - (3rd floor conference room)

1200 Interesting Case Rounds

HAMILTON GENERAL

1200 Radiology Teaching Rounds

0700 Spine Rds 0800 Regional Cardiology Rds (David Braley Centre, General Campus, Auditorium) 1200 Radiology Teaching Rounds 1200 Combined Stroke Rounds, DI Classroom, Rm 2-158 1600 Trauma Rds (Theatre Auditorium) M&M Rounds 1st Tues. of mo.

0730 Vascular Rounds (5N Teaching Room)

0800 Arrhythmia Rds. (Theatre Auditorium, HGH)

1230 M&M Rds. (DI Classroom), set once a month

0800 Stroke Rds.(David Braley Centre, General Campus, Auditorium) 0800 CNS Tumor Rds. HGH (DI Classroom) once a month 1200 Radiology Rds. Interesting Cases 1200 Dr. Bradley’s Rds, every 3rd Thurs. each month. (notify residents call Dr. Bradley & Med. Resident on 8 South)

0800 Neuroscience Rds. David Braley Centre, General Campus, Auditorium)

1200 Radiology Teaching Rounds

MUMC

0800 Resident Rds 0800 Tumor Brd (3F) 1200 OB Rds (Dr. Mohide) Rm 2S32 1200 Neuroradiology Rds Rm 3N50

0800 Resident Rds 1230 Neurooncology Rds 3F 1445 Neonatal (US) Rds Rm 2S32

0800 Resident Rounds (TBA) 0800 Adult GI Rounds, Rm.2S32 0800 RPC (3rd Wed ea. mo.) Rm 2S32

0800 Resident Rounds 0800 Surg/Rad/ Path (SRP) Rds – 4th Thurs. of ea. mo. Rm 2S32 1130 Rheumatology - ev.other wk Rm TBA 15:00 Clinical Teaching Unit (CTU) Every 4th Thursday, Room 2S32

0800 Resident Rounds

1200 GI Ped Rounds Room 2S32

ST. JOSEPH’S HEALTHCARE HAMILTON

(All rounds in DI Conference Room T0102, unless otherwise specified)

1200 – 1300 Resident Hot Seat Rounds (Rad Residents, Students, PA Clerks) 12:00 SJHH Ultrasound Rounds

0700 – 0800 ENT Rds. last Tues.of each mo. Dr.J.Coret-Simon 0730 – 0800 Small Renal Tumour Board Rounds - 1st Tues. of each mo. 0800 – 0900 Vascular Difficult Access Rounds – 1st Tues. of ea mo.. 1200 – 1300 Interesting Case Rounds presented by Fellows for Residents, Students, PA Clerks & Radiologists – 1st, 3rd & 4th Tues. of the mo. 1200 – 1300 – QA Rounds, Radiologists only – 2nd

Tues. each mo. 1300 – 1400 Resident Hot Seat Rounds – Rad Residents/Students /PA Clerks, Radiologists’ Reporting Rm. Indicated by an (*) asterisk on the weekly rad schedule

1200 – 1300 No rounds 1st Wed. of Oct/Nov/Jan/Feb/Mar/ Apr/May - MSK Radiology Rheumatology Rounds, MSK Fellows, Residents,Rads, Rheumatologists Vasculitis Rounds – 3rd Wed. of each mo. 16:30 -17:30 Gen Surg/ Radiology Colorectal Rds – 1st Wed of each mo. Surg.rads, residents, Fellows, Students, PA Clerks 1200 – 1700 Radiology Residents’ Half Day Presentation/Rds/Journal Club-Rotating sites- Juravinski/MUMC/St. Joe’s/Hamilton General

0700 Hepatobiliary Rounds, Surgeons, Rads, Residents, Fellows, Elective Students - Juravinski 0800 – 0900 Monthly Neuroradiology Rds,

nd 2 Thu ea mo. 1200 – 1300 Breast – Pathology Rounds, Rads, Residents, Pathologists, Techs, Breast Fellows 1300 – 1400 Sarcoma DST Rounds, via videoconference DI Conf Rm (T0102) 1300 – 1400 Resident Hot Seat Rounds, Rad Residents / Students/ PA Clerks, Rads’ Reporting Rm. Indicated by (*) on weekly rad schedule

0730 – 0830 (2nd Fri. of ea. month) Radio / Respirology Rds, Fellows, Residents, Rads, Respirologists, Students, Thoracic Surg., Fellows Residents, PA Clerks 1200 – 1300 US Rds. Fellows, Residents, Techs,Nurses, Rads, Elect. Students, Firestone Clinic Conf. Rm. T1152 (Tower) 1200 – 1300 Lung DST Rds,1st,2nd,4th Fri ea mo. Videocon. JCC/DIConf. T0102 1300 – 1400 Resident Hot Seat Rds, Rad Residents Elect Students,Rads’ Reporting Rm. Indicated by (*) on wkly rad schedule

ROUNDS CALENDAR

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National Radiologic Technology Week® is celebrated annually to recognize the vital work of R.T.s across the nation. The celebration takes place each year during the week that includes Nov. 8 to commemorate the discovery of the x-ray by Wilhelm Conrad Roentgen on Nov. 8, 1895.

The week-long celebration calls attention to the important role medical imaging and radiation therapy professionals play in patient care and health care safety.

NRTW 2015 will be celebrated Nov. 8-14. The theme for 2015 is Discovering the Inside Story. More information can be found at:

http://www.asrt.org/events-and-conferences/national-radiologic-technology-week

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M E D I C A L I M A G I N G B U L L E T I N

“Pitfalls in Imaging of Bowel and Mesenteric Injury” on Tuesday, March 15, 2016 from 9:15 AM to 9:50 AM. Michael N. Patlas, MD, FRCPC, Ania Kielar, MD, FRCPC

For additional information go to:

http://www.abdominalradiology.org/?

Welcome to RSNA 2015 Meeting Central—This is your destination to register, browse courses and events, build your agenda, explore the exhibitor list, discover courses, and view the Virtual Meeting program. Go to: https://rsna2015.rsna.org/exhibitor list, discover courses, and view the Virtual Meeting program.

Date: Friday, April 15, 2016 Time: 09:15 - 09:45

Title of Track: Comparative Effectiveness - How to Stay Relevant Session Title: Renal Colic: Could Less be More

Michael N. Patlas, MD, FRCPC

Date: Saturday, April 16, 2016 Time: 09:45 -10:15

Title of Track: Great Debates in Radiology Session Title: Do we need oral contrast for the imaging of patients with acute abdominal pain?

Michael N. Patlas, MD, FRCPC

For more information: http://car.ca/en/education/annual-scientific-meeting/2016-asm.aspx

2016 Annual Meeting April 17—22, 2016

Los Angeles, CA “CT of Appendicitis—Dr. Michael N. Patlas, MD, FRCPC

http://www.arrs.org/Education/Meetings/

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October was Breast Cancer Awareness Month It promotes a healthy lifestyle and increased awareness to take appropriate steps to detect the disease in its early stages and engage others to do the same. Cancer Care Ontario (CCO) indicates that breast cancer is the most common cancer in Canadian women and designated Wed Oct 21/15 as the “Day of the Mammogram”. Both the St. Joe’s Charlton and King Campuses have Ontario Breast Screening Programs in place (OBSP) and were decked out to celebrate the event with special treats, cupcakes, cookies, Kernels Popcorn & information brochures. A special raffle was held for patients and walk-in patients were encouraged at the King Campus. The staff and volunteers in Women’s Health were enthusiastic and sported “pink” to promote the week and provide special treats for the patients.

Charlton Staff (r to l) Lee, Sue, Maria

King Staff (l to r) Patty, Flo, Megan, Lina and Colleen

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ARRS Bias Definition

The ARRS takes both a proactive and a reactive approach to ensuring and maintaining the integrity of its CME program. The disclosure and conflict of interest processes are proactive, meaning they occur before a speaker presents to identify and manage any conflict that could result in a biased presentation/session. The ARRS also has a bias resolution policy that describes ARRS’ course of action in the rare instance when bias is noted in a presentation. This document was developed to better inform planners and faculty members about bias, conflict of interest and content expectations. By clearly defining these items and sharing the information with all involved parties, planners and faculty can incorporate these items in the planning process and in their presentations. It won’t change the planners’ or faculty members’ disclosures, but it may help ensure that when they plan the activities and/or create their presentations, the activities/presentations will be free of bias. The goal is to engage this group at the beginning so bias will be avoided.

Identifying Potential Bias: Disclosure What Should Faculty/Speakers Disclose? Faculty members and planners should disclose any financial relationships they or a member of their immediate family have had within the past 12 months with a for-profit or not-for-profit organization that may have an interest in the content of the educational activity. Here are some examples:

ARRS is planning an instructional course on radiation dose reduction. Dr. Smith and Dr. Jones are speaking at the session. They should disclose their relationship with any for-profit or not-for-profit organization that offers products or services related to radiation dose reduction. Those relationships include: speakers’ bureau, advisory board (or similar board), consultant, research grants, stockholder, etc.

Dr. Johnson sits on the board of a nonprofit organization that offers a series of courses that result in certification in cardiac imaging. Dr. Johnson has been asked to speak at an ARRS course on cardiac imaging, with his focus being on setting up a new cardiac program. Dr. Johnson should disclose his relationship with the nonprofit organization.

Dr. Brown is the section chair for the upcoming instructional courses on breast imaging. Dr. Brown was recently appointed to the advisory board for XYZ breast biopsy company. Dr. Brown should disclose this relationship, and any other relationship as noted above.

How Should Faculty/Speakers Disclose? Disclosure is important because it allows the learners to put each presentation into context. Faculty members must disclose:

to the society by submitting completed disclosure forms prior to the presentations; to the learners by including a disclosure slide as the second slide in every presentation, and; to the learners by reading his/her disclosure slide at the beginning of the presentation.

Resolving Potential Conflict of Interest There is an assumption that persons with a financial relationship to a commercial organization or other organization have the potential to have a conflict of interest and thus could be biased in favor of those organizations. Therefore, presentations in which there is a disclosure of a financial or fiduciary relationship are reviewed for conflict of interest. If a potential conflict of interest is found, steps are taken to resolve the conflict. How Is Conflict of Interest Resolved? If a conflict of interest is found before planning of an activity, the potential conflict is assessed and the person may be recused from decision-making related to planning the activity or from participating in the activity.

If a faculty member has a potential conflict, his or her handout/presentation is reviewed by a physician (involved in planning but

with no conflict) and staff. If there is a problem with the handout/presentation, the faculty member may specifically be

instructed to make appropriate changes in the presentation. If he/she refuses, he/she will be removed from presenting at the

activity.

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Avoiding Real or Perceived Bias The three key ways to avoid real or perceived bias are to ensure the content is:

Evidence-based, Focused on promoting improvements in healthcare rather than a proprietary interest, and Balanced.

The three are not mutually exclusive. All content that offers CME credit should be evidence-based if possible. Evidence-based information should always include the best available research. Evidence-based information may also include experiential evidence (based on professional insight, understanding, skill and expertise) as well as contextual evidence, but these should be secondary to well supported, well vetted research.

CME content should be based on the last two items on the continuum below whenever possible. CME content should never be

unsupported or undetermined or based solely on anecdotal results.

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The Accreditation Council for Continuing Medical Education (ACCME) indicates that all accredited providers are responsible for

validating the clinical content of CME activities that they provide. The ACCME specifies the following regarding evidence-based

CME activities:

1. “All the recommendations involving clinical medicine in a CME activity must be based on evidence that is accepted within

the profession of medicine as adequate justification for their indications and contraindications in the care of patients.

2. All scientific research referred to, reported, or used in CME in support or justification of a patient care recommendation

must conform to the generally accepted standards of experimental design, data collection and analysis.

3. Providers are not eligible for ACCME accreditation or reaccreditation if they present activities that promote

recommendations, treatment, or manners of practicing medicine that are not within the definition of CME, or known to

have risks or dangers that outweigh the benefits or known to be ineffective in the treatment of patients.”

Content should promote improvements or quality in healthcare, rather than a proprietary interest. ARRS adheres to the ACCME accreditation criteria and standards designed to ensure nonpromotional content as follows:

ARRS CME programs and activities should advance the public interest without bias that would influence health professionals to overuse or misuse the products or services of a commercial interest.

The content or format of a CME activity or its related materials must promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

ARRS recognizes that content bias can occur if a speaker has either a fiduciary interest or responsibility to non-commercial interests or a leadership role, related to the topic to be discussed. Potential speakers with this type of interest or responsibility will be carefully reviewed as noted above. The content should be balanced. The ACCME requires that presentations be balanced.

Presentations must give a balanced view of therapeutic options. Use of generic names will contribute to this impartiality. If the CME educational material or content includes trade names, where available trade names from several companies should be used, not just trade names from a single company.

There are times when one speaker may focus on how his/her facility is using a specific technology by a specific vendor. Other speakers in the course would need to be identified who can talk about the other options available so the course is balanced. There are rare times, specifically when novel technologies are being discussed, when only one vendor offers the technology or only one facility provides the service. In this event, the faculty member must specifically indicate this is the case and strive to present all available data (both good and bad) on the new technology. If there is a different technology that accomplishes the same purpose as the new technology, that should be included in the presentation.

Responding When Bias Is Noted There are rare instances in which learners or peer reviewers note bias in a CME activity. The ARRS has an approved policy in place

that specifically describes actions that will be taken. The policy is reviewed each year and modified if and as needed.

Submitted by Dr. Michael Patlas

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Robin Urekar could have died

within hours had he not sought treatment for a large, bleeding ulcer. Robin is alive today thanks to the Interventional Radiology Program. Juravinski Hospital and Cancer Centre Foundation will enable help for more patients by raising $1.5-million needed for the Interventional Radiology Program, a high-tech and versatile program that supports the diagnosis and treatment of diseases using the least invasive techniques. Interventional Radiology uses a variety of diagnostic imaging equipment such as CT, ultrasound and MRIs in conjunction with surgical instruments so the physician can view the organ or organ system while conducting a procedure.

November is for Code Purple (Hostage situation) & Silver (Active Shooter) Review

The HHS 2015 Code Response Plans for these codes and related resources are attached and

online on the EDM intranet site

Code Purple section @ http://hhssharepoint/teams/edm/codepurple/default.aspx

and

Code Silver section @ http://hhssharepoint/teams/edm/codesilver/default.aspx

Essentials for Excellence –

Interventional Radiology

Interventional Radiology can be used to conduct a wide variety of procedures, such as: biopsying a mass, inserting a dialysis catheter, or injecting chemotherapy at a higher dose directly to the tumour. “Interventional Radiology has significant advantages over other treatment methods,” says Dr. George Markose, Interventional Radiologist, Juravinski Hospital and Cancer Centre. “Patients can have the majority of their procedures done as day cases, then be at home in a

matter of three to four hours.”

Taken from HHS—”The Insider”

http://www.hamiltonhealthsciences.ca/workfiles/PR/HHS%20Insider%20-%20October%2016,%202015.pdf

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RESEARCH CORNER

Male and female hearts don't grow old the same way October 21, 2015 source: Johns Hopkins Medicine A recent study from Johns Hopkins Medicine may shed light on gender differences in heart failure. A federally funded analysis of MRI scans of the aging hearts of nearly 3,000 adults shows significant differences in the way male and female hearts change over time. Results of the research, led by investigators at Johns Hopkins, do not explain exactly what causes the sex–based differences but they may shed light on different forms of heart failure seen in men and women that may require the development of gender–specific treatments, the scientists say. The research, published online on October 20th in the journal Radiology, is believed to be the first long-term follow-up using MRI showing how hearts change as they age. Over a period of 10 years, the weight of the left ventricle increased by an average of 8 grams in men and decreased by 1.6 grams in women. The heart’s filling capacity, marked by the amount of blood the left ventricle can holds between heartbeats, declined in both sexes but more quickly so in women, by about 13 milliliters, compared with just under 10 milliliters in men. The differences in size, volume and pumping ability occurred independently of other risk factors known to affect heart muscle size and performance, including body weight, blood pressure, cholesterol levels, exercise levels and smoking. Submitted by Jane Castelli.

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THE BACK PAGE

M E D I C A L I M A G I N G B U L L E T I N

UPCOMING DATES OF INTEREST

Nov 3-4, 2015—Visiting Professor—Dr. Ania Kielar -

Emergency Radiology

Nov 29—Dec 4, 2015—RSNA Annual Meeting

Jan 12 & 13, 2016—Visiting Professor—Dr. Anne M.

Covey—Interventional Radiology

March 13-18—SAR 2016 Annual Meeting

April 14-17, 2016—CAR Annual Scientific Meeting

April 17—22, 2016—ARRS Annual Meeting

The poem "In Flanders Fields" by the Canadian army physician John McCrae remains to this day one of the most memorable war poems ever written. It is a lasting legacy of the terrible battle in the Ypres salient in the spring of 1915.

In Flanders Fields In Flanders fields the poppies blow Between the crosses, row on row, That mark our place; and in the sky The larks, still bravely singing, fly Scarce heard amid the guns below. We are the Dead. Short days ago We lived, felt dawn, saw sunset glow, Loved, and were loved, and now we lie In Flanders fields. Take up our quarrel with the foe: To you from failing hands we throw The torch; be yours to hold it high. If ye break faith with us who die We shall not sleep, though poppies grow In Flanders fields.

Congratulations To

Sam Ibrahim (MUMC charge tech) and his wife on the birth of a beautiful baby girl on Saturday, October 17th.

Mom, Dad and Vienna-Rose are all doing fine.

Submissions to: Marguerite Jackson

McMaster Site, HSC - Room 4N-49 jacksonmar@hhsc.ca