The European Society of Radiology (ESR) has renewed its initiatives to harmonize medical training for radiologists across Europe. Following advocacy on the part of the radiology community, in close coordination with the European Union of Medical Specialists (UEMS), after the modernization of the Professional Qualifications Directive in 2013, the current political climate offers new opportunities for adapting the legal framework regulating the free movement of doctors and recognition of professional qualifications.
 
Considering the ongoing evaluation of the Professional Qualifications Directive, the ESR brings again to the attention of the European Commission its twofold request to change Annex V, Section 5.1.3. in order to safeguard the highest standards of medical training and patient care throughout Europe.

Once again, the ESR has joined forces with the UEMS, the authority on medical education in Europe, demonstrating its continuous commitment to collaborating with partner organizations on the harmonization of medical education.
 
In an official letter submitted to the European Commission, the ESR strongly urges the European Commission to adopt a delegated act to increase the minimum years of training for radiologists from four to five years, in full compliance with the European Training Curriculum for Radiology that was developed to further harmonize radiology education throughout Europe.

Growing training needs and the introduction of digital solutions in medical imaging require equally high standards of training that can only be met by implementing a full-fledged five-year radiology training.
 
In addition, the ESR calls on the Member States and the European Commission to change the name of the discipline from “Diagnostic Radiology” to “Radiology”, reflecting the profession’s current practice comprising both diagnostic and interventional procedures.

As Member States hold the competence to unilaterally enter the name of a profession into Annex V, individual Member States are strongly encouraged to unilaterally enter “Radiology” as the name of the discipline as a first step towards harmonization. Nevertheless, the ESR believes that an EU-wide solution is needed and therefore urges the Member States and the European Commission to enter into dialogue in the interest of the free movement of radiologists in Europe.
 
The ESR supports a multi-layered approach, simultaneously launching initiatives at national and EU levels, to strengthen the voice of radiology in the debate. Therefore, the ESR counts on the national radiological societies to be the messenger of the unified radiology position towards national Ministries of Health and health authorities.

Only a coordinated approach involving the ESR and its institutional members can lead to the highest standards and a true harmonization of radiology training and enhance the mobility of the radiology profession in Europe.

https://tinyurl.com/y2q4m5ht

The greater the volume of blood removed from the brain via minimally invasive surgery after a cerebral haemorrhage the greater the odds of better functional recovery, according to late breaking science presented at the American Stroke Association’s International Stroke Conference 2019.
Minimally Invasive Surgery Plus Alteplase for Intra-cerebral Haemorrhage Evacuation (MISTIE) is the stereotactic catheter aspiration and clearance of large bleeds within the brain, with the clot-buster alteplase.
The MISTIE III trial is the first surgical trial assessment of whether greater removal of blood impacts the likelihood of favourable functional outcome after one year and factors associated with greater efficiency of blood removal.
Among 506 intra-cerebral haemorrhage (ICH) cases enrolled in the trial, 242 ICH patients (average age 62, 63 percent male) underwent the MISTIE III surgical procedure by 110 surgeons at 73 sites, with follow-up at one year. The trial excluded patients whose bleeding had not stabilized, and cases with cerebellar and brainstem haemorrhage.
Researchers found that among cases undergoing the MISTIE III surgical procedure, removing blood volume by 70 percent or more, or leaving 15 milliliters or less of residual blood at the end of treatment were twice as likely to achieve milder disability one year later. Lesser removal was needed to avoid mortality, but the patients who had less than 70 percent of the blood removed, or more than 15 mL residual blood, had no difference in disability than patients treated with medical therapy, or those with lesser removal.
Researchers noted that more efficient ICH evacuation was more likely accomplished in cases with certain shapes of hematoma, where the surgical protocol was rigorously followed and by surgeons and sites with greatest experience in MISTIE technique.
“When assessing the results of surgery for brain haemorrhage, it is critical to consider how much blood was successfully evacuated. Unless a large majority of clot is removed and only a very small residual of blood is left, the full benefits of surgery will not be realized,” said Issam A. Awad, M.D, M.Sc., study lead author and director of Neurovascular Surgery at the University of Chicago Medicine and Biological Sciences. “This had never been considered as a factor in the success or failure of such surgeries and cannot be taken for granted.”
American Heart Association https://tinyurl.com/y2n7kt35

After cardiac arrest and resuscitation, part of the patients will be in a coma and treated at an intensive care unit. Their prospects are uncertain. What is needed to get an outcome prediction that is reliable? Researchers of the University of Twente and the ‘Medisch Spectrum Twente’ hospital, both in Enschede, The Netherlands, developed a learning network that is capable of interpreting EEG-patterns. It can make a reliable outcome prediction, and thus forms a valuable extra source of information.
In The Netherlands, about one third of the people that had a cardiac arrest followed by resuscitation, will have to be treated at the ICU. These patients, about 7000 each year, are in a coma. More than half of them will not regain consciousness. The family will want to know what the prospects are and, if their relative regains consciousness, what will be the quality of life. The question ‘does further treatment make sense?’ can only be answered after careful analysis of the situation. One of the options, now, is the SEPP-t
The electrical signals of the brain, the EEG pattern measured via electrodes on the head, give a lot of information as well. Analysis of EEG using artificial intelligence gives a very accurate outcome prediction, as the researchers show in their latest paper. Twelve hours after resuscitation, the learning network is capable of predicting a good outcome with 58 percent accuracy and a bad outcome with 48 percent. This is a better performance than the trained eye of a neurologist. Both computer and human, however, still have a category ‘I don’t know’, in situations the EEG data are not specific enough.
The first author, Marleen Tjepkema, already made a plea for using EEG in the outcome prediction, in her PhD thesis in 2014 as a UT Technical Medicine graduate. She and her colleagues now take this an important step further by introducing automated interpretation of the EEG scan. The learning network has been trained using 600 EEG patterns, it did not get any hints on what to look at. After that, it was fed with 300 EEG patterns to see how it performed in giving a prediction. Neurologists have to look at hundreds of EEG’s as well, as part of their training. An experienced neurologist will point out specific characteristics. Still, the EEG-patterns are so information-rich that the computer outperforms the human eye.
Once trained, the network will be capable of judging the EEG very fast, well within a second. The researchers expect that this adds valuable information to human judgment. One of the other advantages is flexibility, a prediction can be made any time of the day. Using the new technology at ICU’s will show if the ‘intensivist’ also sees as a valuable tool.
University Twentehttps://tinyurl.com/y6amneh9