Incorporated by Royal Charter Patron - Her Majesty The Queen

President Prof Andrew Jones BSc MSc FIPEM CSci FBIR

Chief Executive Ms Jacqueline Fowler BA, MInstF(Cert)

The British Institute of Radiology 48-50 St John Street London EC2M 4DG

T : +44(0)20 3668 2226 E : admin@bir.org.uk

www.bir.org.uk

Registered Charity No. 215869 VAT Registration No. GB 233 7553 63

Recent advances in diagnostic imaging

Meeting organised by the Scottish Branch of

The British Institute of Radiology

Friday 14 February 2014

Royal College of Physicians and Surgeons of Glasgow

08:30 Registration, tea and coffee

Chair Dr Khalid Ali, Meeting Organiser, BIR Scottish Branch

09:00 Interventional radiology – a completely different animal!

Professor Jon Moss, Consultant Interventional Radiologist,

Gartnavel General Hospital

09:40 Update in cardiac CT

Dr Ross MacDuff, Consultant Radiologist,

Glasgow Royal Infirmary

10:20 Update in thoracic imaging

Dr John Reid, Consultant Radiologist, Borders General

Hospital

11:00 Future directions of the BIR and the implications for

education education

Professor Andrew Jones, President, BIR

11:10 Refreshments

11:30 Glasgow oxygen level dependent (GOLD) technology:

Novel metabolic MRI techniques to identify the

penumbra Dr Celestine Santosh, Consultant

Neuroradiologist,

Institute of Neurological Sciences

12:10 Brain imaging in cognitive impairment and dementia -

what, when and how?

Professor Alison Murray, Professor of Radiology,

University of Aberdeen

12:50 Lunch

13:50 Update in GI imaging

Dr Peter MacLean, Consultant Radiologist,

Western General Hospital

14:30 Selected applications of SPECT-CT

Dr Dilip Patel, Consultant Radiologist, Royal Infirmary of

Edinburgh

15:10 Refreshments

15:40 Imaging of groin pain: Inguinal disruption

Dr Scott McKie, Consultant MSK Radiologist,

Royal Infirmary of Edinburgh

16:20 Stiffness and slices: the new tools in breast imaging

Professor Andrew Evans, Professor of Breast Imaging,

University of Dundee

Honorary Consultant Radiologist, NHS Tayside

17:00 Close of meeting

CPD: 6 credits

Please complete the meeting evaluation survey online at:

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

We will email your CPD certificate upon collation of your feedback.

We are most grateful to

For supporting this conference

Speaker profiles and abstracts (where supplied)

Abstract

Professor Jon Moss, Consultant Interventional Radiologist,

Gartnavel General Hospital

Interventional radiology – a completely different animal!

Medicine continues to superspecialise and radiology is no exception. A major split is

occurring between diagnostic and interventional radiology with IR now having

subspecialty status in the U.K. and several other countries. The waters are murky

however with little clear guidance for trainees and many deciding to stick with

diagnostic radiology. From a strategic high point some years ago IR now faces a less

certain path with inadequate training numbers, unfilled consultant posts and other

specialities looking to take advantage of this situation. This is all happening at a time

when the number of IR techniques and the evidence base for their use has never

been higher.

Biography

Dr Ross MacDuff, Consultant Radiologist, Glasgow Royal Infirmary

Having trained in the West of Scotland I took up a Consultant post at Glasgow Royal

Infirmary and Stobhill Hospital in 2010. I have a subspecialist interest in

cardiothoracic imaging including cardiac CT and MRI.

Abstract

Update in cardiac CT

Over the past decade technological advances in CT have allowed rapid development

in CT imaging of the heart. CT coronary angiography has become a recognised and

validated technique in the assessment of coronary artery disease. The role of CTCA is

expanding and more patient subgroups are being investigated with this technique. Its

use in emergency departments is expanding and has been suggested to allow rapid

discharge and significant cost savings. In this talk we will review the current

indications for CT coronary angiography and look at potential developments in

cardiac CT.

Educational aims:

To review current indications for cardiac CT

Assess the utility of triple rule out scanning

Introduce the role of CT myocardial perfusion

Biography

Dr John Reid, Consultant Radiologist, Borders General Hospital

Consultant Radiologist at Borders General Hospital from 1996 to present.

Formerly Consultant Cardiothoracic Radiologist at Edinburgh Royal Infirmary from

1986-1996.

I was a Nycomed Scholar studying cardiac imaging and cardiac intervention in

Stockholm and Oslo in 1986.

Clinical Tutor at Edinburgh University 1986-present.

I have an interest in all aspects of cardiothoracic imaging and in all modalities from

thoracic CT to cardiac MRI. My main sphere of expertise is in the diagnosis of

thromboembolic disease and lung cancer. I have co-authored the British Thoracic

Society guidelines on the diagnosis and management of pulmonary embolism and

chaired the United Nations Atomic Energy Experts Group on the utility of

scintigraphy for the diagnosis of PE. I was a contributor to the SIGN guideline on the

diagnosis and management of lung cancer.

Abstract

Update in thoracic imaging

Today’s presentation will provide an update on selected topics in thoracic imaging.

These will include a review of the current thinking on the diagnosis and follow up of

pulmonary embolism. Recent improvements in CT technology have created a wealth

of new data concerning this common condition. Particular reference will be paid to

the place of CT perfusion imaging.

Idiopathic interstitial pneumonias confuse everyone. The America Thoracic Society

and the European Respiratory have just issued guidance on the classification of this

group of conditions and I shall review what this new guidance means for thoracic

radiologists and give a brief overview of the radiological features of IIPs.

Next up: pulmonary nodules. This vexed issue is becoming even more important with

the rising tide of thoracic CT and I shall review the current thinking on nodule follow

up.

With pulmonary nodules in mind, I shall conclude my presentation with a review of

the worrying rise of litigation against radiologists. This will have an emphasis on

thoracic imaging and the phenomenon known as hindsight bias.

Update of classification of IIPs

Am J Crit Care Med 2013,188:733-48

Missed Lung Cancer on Chest Radiography and Computed Tomography

Fardanesh M, White C. Seminars in Ultrasound, CT and MRI 2012, 33:280-7

Hindsight bias. Roese, N. J., & Vohs, K. D. 2012. Perspectives on Psychological

Science, 7:411-26

Biography

Dr Celestine Santosh, Consultant Neuroradiologist,

Institute of Neurological Sciences

I graduated in Medicine in 1982 and have been working in Neuroradiology since

1987. I am currently a Consultant Neuroradiologist at the Institute of Neurological

Sciences in Glasgow. I also have an Honorary appointment as a Clinical Associate

Professor, College of Medical, Veterinary and Life Sciences, University of Glasgow.

I have been working with the animal 7.1 MRI scanner since 2004. I have been the

lead in developing novel metabolic MRI techniques using perflourocarbons to

visualize the penumbra in stroke, now know as Glasgow Oxygen Level Dependent

(GOLD) techniques. Some of this work has been recognised by the scientific

community having received the Astra-Zeneca prize at the ISMRM British Chapter in

2008, the Integrated Mammalian Biology Poster Prize in 2009 and the Scottish Life

Sciences Awards 2013 for the best innovation originating within NHS Scotland. We

also had the privilege of being invited to present this work at the 2012 Gordon

Conference on Brain.

Discosure: I am a founding member and the Chief Medical Officer for Aurum

Biosciences Limited, which is a spinout company to take GOLD into clinical practice.

Abstract

Glasgow oxygen level dependent (GOLD) technology: Novel metabolic

MRI techniques to identify the penumbra

One in six people have a stroke in their lifetime. Actilyse, (aka rt-PA & only licensed

therapy for acute stroke), is a thrombolytic with a 4.5hrs from onset treatment

window. However, <7% of patients receive Actilyse. Inability to characterise individual

pathophysiology with imaging excludes many patients from treatment: 75% on time

criteria.

Existing brain scanning methods are impractical for urgent clinical use or give no

information about the affected brain ability to use oxygen, the critical indicator of

whether it will survive. Glasgow Oxygen Level Dependent (GOLD) techniques

comprises an intravenous perflurocarbon (PFC) oxygen carrier, increased inspired

oxygen and three novel MRI techniques to identify the penumbra. The PFC also

protects the penumbra.

Technique 1: Is based on Blood Oxygen Level Dependent (BOLD) T2* signal. The

penumbra can be defined by a T2* oxygen challenge (OC) imaging, by an increased

oxygen extraction fractions (OEF) and oxygen utilisation (Santosh et al, 2008).

Technique 2: Lactate change imaging, detects changes in lactate co-incident with

increased oxygen delivery during an oxygen challenge (OC) to identify the penumbra

(Holmes et al, 2012). This technique is able to identify hypoxic tissues with anaerobic

metabolism but still have potential for aerobic metabolism and survival, ie the

penumbra.

Technique 3: With this technique the penumbra is identified during the injection of

PFC, hyperoxia and a T2* sequence. This is identified as a sharp dip and occurs only

in the penumbra and it is due to repolarisation, which follows a peri-infarct

depolarisation wave.

Biography

Professor Alison Murray, Professor of Radiology, University of Aberdeen

Alison Murray is the Roland Sutton Professor of Radiology at the University of

Aberdeen. She is Director of the Aberdeen Biomedical Imaging Centre

www.abdn.ac.uk/ims/research/abic, Lilian Sutton Building, University of Aberdeen,

Foresterhill Health Campus. This houses the Philips 3T research magnetic resonance

imaging (MRI) scanner. Research MRI facilities are located within the acute NHS

hospital and are immediately adjacent to the John Mallard Positron Emission

Tomography (PET) Centre and the NHS Department of Nuclear Medicine, facilitating

combined studies of brain structure and function. She leads clinical brain imaging

research in structural and functional imaging correlates of cognitive ageing and

dementia and work includes MRI in the Aberdeen 1936 Birth Cohort, and MRI,

regional cerebral blood flow SPECT and FDG PET in clinical trials of novel Tau

Aggregation Inhibitor therapies in Alzheimer's disease. Particular interests are the

relative contributions of vascular risk factors and subclinical Alzheimer's disease to

cognitive ageing and contributors to cognitive reserve and resilience to dementia.

She is also involved in brain imaging research in other diseases, including CNS

correlates of fatigue in chronic inflammatory diseases and satiety in type 2 diabetes,

using quantitative assessment of disease burden, brain volumes and function.

She has extensive NHS experience of brain imaging in dementia, being responsible

for most NHS referrals for structural and molecular brain imaging including CT,

regional cerebral blood flow SPECT CT and FP-CIT studies.

She is a founding member and executive member of the Scottish Imaging Network:

A Platform for Scientific Excellence (SINAPSE) www.sinapse.ac.uk a successful brain

imaging pooling initiative funded by the Scottish Funding Council and participating

universities to develop state of the art brain imaging research training and resources

across Scotland.

Abstract

Brain imaging in cognitive impairment and dementia - what, when and how?

This presentation will review evidence for brain imaging in cognitive impairment and

dementia, referring to research results, current evidence and national and

international guidelines. The aim is to update participants with new information and

to give a pragmatic overview of whether brain imaging is appropriate in patients with

dementia, if so, when brain imaging should be used and what is practical in a cost

constrained NHS.

Three main learning points will be made initially:

Most dementia related neuropathology is mixed

Most evidence ignores baseline

Currently we cannot diagnose dementia on a scan – even a PET scan!

Following a rapid review of the results of brain imaging research in the Aberdeen

Birth Cohorts, a description of cognitive reserve and how this is crucial to understand

in cognitive ageing and dementia research, what we can and cannot tell from routine

brain images and recent drug development in Alzheimer’s disease, the presentation

will conclude with examples of where brain imaging is useful in dementia and

neurodegenerative diseases and with three more learning points:

Imaging increases diagnostic accuracy

In future role of imaging is likely to be validation of cheaper tests

If we could “bottle” cognitive reserve it would have as much impact as an

effective new drug

Biography

Dr Peter MacLean, Consultant Radiologist, Western General Hospital

Having trained as a Radiologist in Glasgow, I was appointed a Consultant in

Edinburgh in 2007. As a major cancer centre, approximately 50% of my workload is

related to oncology, particularly in the abdomen and pelvis. I have a major interest in

imaging of the small bowel and colon, especially with MR and CT.

Abstract

Update in GI imaging

Scotland has a very high incidence of early onset disease.

Faecal Calprotectin (FC) now used routinely in specialist centres to stratify risk,

monitor response.

MR perfectly placed to image this group – often young and requiring repeated

imaging studies with extra-intestinal manifestations and complications.

Technique overview with brief discussion on IV contrast, DWI, motility studies.

Important signs: mural thickening with stricture, mural oedema and contrast

enhancement.

Recent work on correlating ileal disease with FC shows positive results.

SIGGAR Trial

• Largest randomised controlled trial of CT colon (CTC) vs optical

colonoscopy (OC) and Ba enema in symptomatic patients in the diagnosis

of colonic carcinoma.

• Unique study design with 2 arms.

• CTC much more sensitive than BaE.

• CTC comparable to OC.

• Increased rates of further colonic investigation and apparent drawback of

CTC.

Biography

Dr Dilip Patel, Consultant Radiologist, Royal Infirmary of Edinburgh

Dilip Patel has been a Consultant Radiologist at the Royal Infirmary of Edinburgh for

the past 15 years and is responsible for the Radionuclide Imaging service at that

hospital.

He is Lead Radiologist for the NHS Lothian PET/CT service.

His clinical interests include Upper GI, hepatobiliary, transplant and endocrine

imaging.

Abstract

Selected applications of SPECT-CT

Whilst nuclear medicine imaging techniques provide functional information,

historically this has been at the expense of low anatomical resolution making the

imaging difficult to interpret and utilise for clinicians and non nuclear medicine

radiologists.

The development of high resolution gamma cameras latterly combined with MDCT

scanners has allowed integrated image fusion thus combining the unique functional

information obtained by nuclear medicine with the high resolution anatomical

information derived from CT.

The aim of this presentation is to outline the technique and some of the practical

applications in current clinical use.

Biography

Dr Scott McKie, Consultant MSK Radiologist, Royal Infirmary of Edinburgh

I a Consultant MSK Radiologist in the Royal Infirmary of Edinburgh (3 years), and

prior to this a consultant in NHS Fife (6 years). Radiology trained in Edinburgh and

MSK fellowship in Leeds. Initially embarked on orthopaedic surgical career before

seeing the light. I have a special interest in sports injuries, imaging of the groin and

MSK intervention. Member of British Skeletal Society and Royal College of Physicians

and Surgeons of Glasgow.

Abstract

Imaging of groin pain: Inguinal disruption

Imaging of the groin in the sportsperson is difficult due to the complex anatomy,

with many important structures converging on a very small area which often has pre-

existing abnormalities. This is compounded by the fact that the nomenclature has

been confusing and contradictory. In January 2014 a consensus was published by the

British Hernia Society retiring the diagnosis of "sportsman's hernia" and instead

advising the term "inguinal disruption- ID", referring to the specific diagnosis of

external ring dilatation, conjoint tendon damage, and tears of the inguinal ligament.

This presentation will explain the imaging features of ID on MRI and Ultrasound, and

pictorially review the other potential causes of groin pain in the sportsperson

including osteitis pubis, rectus/adductor tendinosis, stress injuries, ischiofemoral

impingement, true hernias, neural impingement, and referred pain.

In addition there will be a brief outline of the different surgical options and

radiological interventional procedures, although the use of these techniques remains

contentious and controversial.

Biography

Professor Andrew Evans, Professor of Breast Imaging, University of Dundee

Honorary Consultant Radiologist, NHS Tayside

Andy Evans is a graduate of Birmingham Medical School and after gaining his MRCP

trained in Diagnostic Radiology in Nottingham gaining the FRCR. He became a

Consultant Radiologist with a special interest in breast imaging in 1992. He was

appointed Director of the Nottingham International Breast Education Centre in 2006.

In 2009 Andy moved to Dundee to become Professor of Breast Imaging. He is the

author of over 120 peer reviewed papers, 4 books and 14 book chapters. He is the

current chairman of the British Society of Breast Radiology. Andy plays the french

horn and is a successful composer of classical music.

Our platinum sponsors

GE Healthcare provides transformational medical technologies and services to meet

the demand for increased access, enhanced quality and more affordable healthcare

around the world. GE (NYSE: GE) works on things that matter - great people and

technologies taking on tough challenges. From medical imaging, software & IT,

patient monitoring and diagnostics to drug discovery, biopharmaceutical

manufacturing technologies and performance improvement solutions, GE Healthcare

helps medical professionals deliver great healthcare to their patients.

Philips is a diversified health and well-being company and a world leader in

healthcare, lifestyle and lighting. Our vision is to make the world healthier and more

sustainable through meaningful innovation.

We develop innovative healthcare solutions across the continuum of care, in

partnership with clinicians and our customers to improve patient outcomes, provide

better value, and expand access to care.

As part of this mission we are committed to fuelling a revolution in imaging

solutions, designed to deliver greater collaboration and integration, increased patient

focus, and improved economic value. We provide advanced imaging technologies

you can count on to make confident and informed clinical decisions, while providing

more efficient, more personalised care for patients.

The Siemens Healthcare sector is one of the world’s largest suppliers to the

healthcare industry and a trendsetter in medical imaging, laboratory diagnostics,

medical information technology and hearing aids. Siemens offers its customers

products and solutions for the entire range of patient care from a single source –

from prevention and early detection to diagnosis, and on to treatment and aftercare.

By optimising clinical workflows for the most

common diseases, Siemens also makes healthcare faster, better and more cost-

effective. For further information please visit: /www.siemens.co.uk/healthcare

FORTHCOMING EVENTS

3rd Annual SPECT/CT symposium:

Current status and future directions of SPECT/CT imaging

24 February 2014

London

Multi-parametric imaging of prostate cancer -

can it facilitate a paradigm shift in management?

28 February 2014

London

Biological optimisation of radiotherapy

13 March 2014

London

Paediatric body MRI course

1 April 2014

London

Management and radiology - a guide to current and future management issues in

radiology

2 May 2014

London

Radiotherapy - meeting the current and future workforce challenges for patient

care in a changing context

19 May 2014

London

Molecular radiotherapy dosimetry

4 June 2014

Oxford

Wessex Branch Summer meeting

13 June 2014

Winchester

Optimisation in CT

18 June 2014

Edinburgh

IRMER update

29 September 2014

London

VISIT: WWW.BIR.ORG.UK FOR MORE INFORMATION AND TO REGISTER!

NOTES

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

NOTES

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

NOTES

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

NOTES

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________