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EFSUMB Newsletter meets Norway

Facts on Norway ▼ ▶ Population 4.8 million ▶ Largest cities: Oslo 600,000, ▶ Bergen 250,000 ▶ Area: 285,000 km2 ▶ EFSUMB members: 242

The interview between the former presi-dent of the Norwegian Society for Diag-nostic Ultrasound in Medicine and cur-rent Chaimen of EFSUMB‘s Education & Professional Standards Committee Profes-sor Odd Helge Gilja and Editor of the Newsletter Professor Michael Bachmann Nielsen took place in July 2009. The Nor-wegian society joined EFSUMB in 1975.

Could you tell us a little about your cur-rent position and how you became invol-ved in ultrasound?

▼My current position is senior consultant at National Centre for Ultrasound in Gast-roenterology at Haukeland University Hospital, which is a centre of excellence appointed by the Norwegian Health Au-thorities in 2001. I am also professor at the University of Bergen and leader of the re-search cluster MedViz (http://medviz.uib.no/). From 2001 to 2007 I was president of the Norwegian Ultrasound Society (NFUD) and I am now chairing the Education and Professional Standards Committee in EFS-UMB. I became involved in ultrasound in 1992 during my work at the Department of Me-dicine through an inspiring meeting with prof. Ødegaard and other colleagues. I saw the great potential for ultrasound in a cli-nical­setting­to­do­efficient­work-up­of­pa-tients with a variety of diseases. Soon I was­engaged­in­research­and­in­1997­I­fi-nished a PhD on 3D ultrasound and novel methods in stomach scanning.

Tell us a short version about how ultra-sound is organized in your country and the present status.

▼The main organization for ultrasound in Norway­is­NFUD,­where­different­medical­specialties, midwifes and engineers are members. However, many radiologists and cardiologists are organized in respec-tive disciplinary societies. A clear trend is that more and more general practitioners are using ultrasound and they have also formed their own small society.

Does your society have a newsletter and what format does it have?

▼Yes, NFUD established its own newsletter “Flaggermusen”­in­2001­and­it­was­soon­incorporated in Ultraschall/Eur J Ultra-sound.

How is education in ultrasound organised within your society, do you have official training courses, if so how many, and of-ten are they organised and do you have of-ficial exams to pass before you are certi-fied to do ultrasound?

▼NFUD arranges yearly courses in conjunc-tion with the Annual assembly. These courses are usually accredited by the dif-ferent speciality boards for a certain amount of hours in coursing. However, Norway­has­no­official­CME­accreditation­and­therefore­no­official­exams­need­to­be­passed. Nevertheless, in some specialities like cardiology, ob/gyn and gastroentero-

logy compulsory courses are included in the curriculum.

Do you have a website and do you have educational material on the website?

▼Yes, our website (www.nfud.no) was esta-blished during my presidency in NFUD. The website contains abstracts and some ppt-files­and­links­to­other­educational­si-tes. A case-quiz has also recently been es-tablished to increase the interactivity.

Do your courses follow different levels of competences ex. similar to the EFSUMB guidelines?

▼Yes, we try to comply with the EFSUMB recommendations. However, most of our courses are on level 1. Only a very few courses are intended for level 2.

How often do you hold national conferen-ces? Please also tell us a bit about your last conference.

▼NFUD hold National conferences once a year, usually in March-April. To our mee-ting in Oslo this year, we also invited Da-nish and Swedish colleagues to j-. The pro-gram was an interdisciplinary mixture of contributions from gyn/obs, radiology, rheumatology, gastroenterology and en-gineering. Dr. Torbjørn Moe Eggebø ended his long and good service in the NFUD-Board and his 2 years duty as president and Dr. Hilde Hammer (rheumatologist) was elected as new president.

What are your expectations and hopes for the future concerning relation between your country and EFSUMB?

▼I hope that NFUD and EFSUMB can conti-nue to build a strong relationship to the best of both parts. One important area of cooperation is education. Both NFUD and EFSUMB should continue to include edu-cational material (images, videos, cases, .ppt/PDF­ files­ of­ presentations­ etc.)­ on­their­websites.­ “Ultrasound­on­ the­web”­will be a special session on the up-coming EUROSON congress in Edinburgh.

EFSUMB NewsletterEuropean Federation of Societies for Ultrasound in Medicine and Biology

Odd Helge Gilja

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Contrast Enhanced Ultrasonography, es-pecially using second generation contrast agents (SonoVue), became more and more popular in daily practice, because it is qui-te easy to perform, it is less expensive as compared to CT or MRI (both using cont-rast), and also because it is a rapid method that can be used in the ultrasound room, following the standard ultrasound evalu-ation that found the lesion.

In these conditions, the demand of CEUS is increasing in Romania, a country where the ultrasound evaluation is used in daily practice by clinicians (gastroenterolo-gists, nephrologists, internal medicine doctors, emergency specialists and others) and radiologists. For this reason, the Romanian Society of Ultrasound (SRUMB) decided to organize this year an Euroson School on this topic. After the first­CEUS­Course­in­Hannover,­in­the­au-tumn of 2008, Bucharest became the city of the second Postgraduate Course regar-ding the clinical use of contrast agents in Ultrasonography.

It was a one day course, covering multiple aspects of this type of examination, star-ting with the principles of CEUS, continu-ing with the EFSUMB guidelines for the use­of­contrast­agents,­and­finishing­with­the­utility­of­CEUS­in­specific­fields­(liver­and portal thrombosis, kidney, spleen, pancreas, adrenal glands, trauma and va-scular medicine). The largest part of the course was dedicated to the evaluation of liver lesions, starting with the benign pa-thology­and­finishing­with­the­malignant­tumours. The usefulness of ultrasound contrast in portal thrombosis was also discussed. At the end of the meeting there was a session of clinical cases, with inter-active discussions, concerning the inter-pretation­ of­ the­ different­ imagines.­ A­short questionnaire was distributed to the participants­at­the­end­of­the­final­session,­to assess the level of information acquired during the whole day.

A number of 122 attendees participated to this course, mostly physicians with a good practice­in­the­field­of­ultrasound,­but­also­

beginners­in­this­field­(fellows­that­wan-ted­ to­ find­ information­ regarding­ the­place of CEUS in the daily practice). The interest of the participants for the topic of the conference was proved by the interac-tive discussions with the faculty during the sessions and during the break periods.

The faculty was a very skilled one, 6 for-eign guests and 8 local speakers participa-ted. The presence of Christian Nolsøe (Pre-sident-Elect of EFSUMB), Michael Bach-mann Nielsen (Chairman EFSUMB Publi-cations Committee), Dieter Nürnberg (President­ of­ DEGUM),­ Hans­ Peter­Wes-kott, Lucas Greiner and Byung Ihn Choi (Co-opted­Councilor­of­WFUMB)­assured­a­very­good­scientific­level­of­the­meeting.­From Romania, the faculty included many very experienced ultrasound specialists

(Radu­Badea,­Adrian­ Săftoiu,­ Zeno­ Spâr-chez, Alina Popescu and others).

We­consider­that­the­meeting­was­a­suc-cess, regarding both the number of parti-cipants­and­the­level­of­the­scientific­pre-sentations, and that it should be a very good practical guide for those who use or want to use CEUS in their daily practice. At this moment, in Romania, like in other many countries, there is a real emulation regarding the use or the introduction of CEUS in as many hospitals as possible.

Following the success of this meeting on the topic of CEUS, in September 2009 we shall have a workshop regarding contrast enhanced ultrasound for abdominal use in Timişoara­ that­ will­ include­ theoretical­presentations and also a practical part, during­a­one­week­period.­We­hope­that­the number of participants to this mee-ting­will­confirm­the­interest­for­this­me-thod in Romania, and following the practi-cal results of this meeting, many doctors will start to use CEUS on a daily basis.

Prof. Ioan Sporea, MD, PhD President of the Romanian Society of Ult-rasonography in Medicine and Biology

Report Euroson School

Contrast Enhanced Ultrasound Bucharest 15 May 2009

This curriculum is intended for physicians who perform intensive care ultrasound scans. Because this usually is a focused as-sessment, herein only special aspects con-cerning intensive care ultrasound are dis-cussed. For regular examinations of organ systems requirements can be found in the respective syllabi/recommendations.

This curriculum includes standards for theoretical and practical skills. Standard skills are graded into 3 levels based on ex-perience­and­difficulty­of­the­scan­or­pro-cedure. A level 1 competence should be obtained by anyone performing intensive care ultrasound.

Level 1 Training and Practice ▶ It is recommended that trainees should perform a minimum of 300 ex-aminations over a 6 month period un-der supervision. This training should be supervised by a Level 2 Practitioner.

In certain circumstances it may be ap-propriate to delegate some of this su-pervision to an experienced Level 1 Practitioner with at least two years of regular practical experience. However trainees will acquire the necessary skills­at­different­rates­and­the­end­point of training should be judged by an assessment of all competencies. Examinations should encompass the full range of conditions listed in the knowledge base.

▶ During the course of training the com-petency assessment sheet should be completed as this will determine in which area or areas the trainee can practice independently.

▶ A log book, listing the types of exami-nations undertaken, should be kept.

▶ The trainee should learn how to com-municate both normal and abnormal findings­to­the­patient,­the­family­of­the patient and to colleagues.

Appendix 13: Intensive Care Ultrasound

Minimum Training Requirements for the Practice of Medical Ultrasound in Europe

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▶ The trainee should attend a course program preferably at the beginning of the training period. This should inclu-de a basic course and an advance course. He or she should read approp-riate textbooks and literature.

Level 1 Knowledge Base

Physics and technology, ultrasound tech-niques and administration, psychological aspects, ethical aspects and quality con-trol.

▶ Approaches to: ▶ Basic thoracic ultrasound ▶ Basic abdominal ultrasound for in-tensive care physicians

▶ Basic vascular ultrasound for inten-sive care physicians

▶ In detail: ▶ Chest:­pleural­effusion,­pneumotho-rax,­pericardial­effusion

▶ Abdomen:­free­fuid­(ascites),­gall­bladder stones and bile ducts occlu-sion, splenic enlargement, hydrone-phrosis, stomach and bowel disten-sion.

▶ Vascular: aortic aneurysma, throm-bosis of central veins for CV cathete-rizations, occlusion of arteries for in-vasive blood pressure measure-ments.

▶ Invasive procedures: puncture tech-niques under ultrasound guidance

Level 1 Competencies to be acqui-red

▶ Lung:­Detect­pleural­effusions­with­ul-trasound,­be­able­to­compare­findings­by ultrasound with other imaging mo-dalities of the thorax. Be able to depict the pleural space (motion of the pleu-ra) and to perform basic scans of lung ultrasound with regard to its patholo-gic changes.

▶ Abdomen: Recognize: hepatic and por-tal venous anatomy, abnormalities of the gallbladder, size of the spleen, in-testinal obstruction, normal or full sto-mach,­free­fuid­or­fuid­collections,­hydronephrosis, aortic abnormalities.

▶ Heart: Recognize: volume overload or depletion, diameter of the vena cava, right and left ventricular size, pericar-dial­effusion

▶ Vascular: ultrasound guided vascular access: central venous and arterial pressure lines (IJV, subclavian and fe-moral vein, radial and femoral artery).

All: understand the principles for further investigation of more comprehensive as-sessment or the need to call for more ex-perienced physicians.

Level 2 Training and Practice

A period of at least 1 year after having ac-quired level 1 competency should be ac-complished which should include:

▶ A minimum of 500 ultrasound exami-nation per year.

▶ 300 clinical interventional procedures in a centre under the supervision of at least a level 2 practitioner.

▶ completed clinical residency ▶ during the course of training the com-petency assessment sheet should be completed.

Level 2 Knowledge Base

Intensive Care Ultrasound Training Com-petency

▶ Diagnosis of basic problems in thoracic abdominal ultrasonography, vascular anatomy and pathology e.g. cardiac in-sufficiency­(heart­failure),­valve­dys-functions and their impact on organ manifestations,­respiratory­insufficien-cies and emergencies that require prompt treatment

▶ Interventional procedures, e.g. vascu-lar access, thoracic access, abdominal access, regional anaesthesia blocks

▶ Technologies and interventional pro-cedures in the use of ultrasound

▶ Role of ultrasound compared to other imaging modalities e.g. magnetic reso-nance imaging, CT scan etc.

Level 2 Competencies to be acqui-red

The level 2 intensive care physician should be able to diagnose and treat intensive care emergencies fast and successfully. This includes invasive puncture tech-niques in all relevant organ systems in the setting of an ICU.

▶ Heart: be able to detect: Fast focused and more comprehensive than level 1 competency exam of the heart (apical, parasternal, subcostal view - all trans-thoracic): Recognize signs of pulmona-ry embolism (RA/RA dilation and dys-function, tricuspid regurgitation, mid-to severe pulmonary hypertension, possibly opening of PFO with right to left­shunt);­­differential­diagnosis­of­hyperdynamic left ventricular function (LV­underfilling,­increased­contractili-

ty, decreased afterload), perform a comprehensive regional wall motion assessment­(this­includes­3­different­levels- basal, mid and apical- of the parasternal view), assess the amount of­pericardial­fuid­in­regard­with­car-diac contractility and the understan-ding of surgical intervention, assess the respiratory variation of the inferior vena cava (this includes 2D and M-mo-de). Be able to treat and adapt heart failure with catecholamines or other inotropic substances based on regular heart examination by ultrasound.

▶ Lung:­be­able­to­drain­pleural­effusions­with prior measurement of the pleural effusion­extend­or­direct­drainage­with­ultrasound guidance, detect a (ten-sion- ) pneumo- or hematothorax and to place chest tubes, to recognize ult-rasound signs of ARDS, lung edema, detect abnormalities of the diaphragm, to­detect­and­differentiate­subpleural­lung consolidations

▶ Abdomen: Compared to level 1 compe-tency perform a more comprehensive ultrasound examination of the abdo-men including all solid organs within the abdomen. To be able to perform ultrasound guided drainage of perito-neal­fuid­collections,­in­the­pelvic­ca-vity be able to place suprapubic cathe-ters with ultrasound guidance, measu-re and detect masses, hematoma or fuid­collections­in­the­pelvic­cavity.­

▶ Vascular: Be able to perform ultra-sound guided vascular access of all possible site (including catheterization of the innominate vein, radial and ul-nar artery at the level of the mid-fore-arm, brachial artery). Recognize: re-verse­fow­and­steal­phenomena­of­the­carotid vessels, occlusions of veins and arteries,­aortic­aneurysms,­fistula­and­understand the principle of surgical intervention

▶ Other: Percutaneous tracheotomy, pe-ripheral nerve blocks to obtain a sym-pathicolysis of the extremities

Level 3 Training and Practice

At Level 3 Practitioners are likely to spend the majority of their time in intensive care medicine also undertaking ultrasound processing and/or teaching, research and development and will be an ‘expert’ in this area.

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-Maintenance of Skills: All Levels

Having been assessed as competent to practise there will be a need for continued medical education (CME) and continued professional development and mainte-nance of practical skills.

Practitioners should: ▶ Include ultrasound in their ongoing continued medical education (CME) and continued professional develop-ment (CPD)

▶ Audit their practice ▶ Participate in multidisciplinary mee-tings

▶ Keep up to date with relevant litera-ture

An intensive care specialist will need to continue to perform ultrasound scans throughout the remainder of the training programme. Such further ultrasound

practice may be intermittent, but no more than 3 months should elapse without the trainee using his/her scanning skills.

A medical practitioner scanning ▶ at Level 1 should perform at least 300 ultrasound examinations per year and have regular meetings with ultrasound colleagues,

▶ to maintain level 2 status the practiti-oner should perform at least 500 exa-minations per year,

▶ at Level 3 the practitioners are suppo-sed to spend much of their time in ult-rasound research and education practices in addition to clinical scan-ning.

EFSUMB is grateful to Dr. med. Thomas Grau and Dr Tim Mäcken: Klinik für An-ästhesiologie, Intensive, Palliativ- und Schmerzmedizin, BG Kliniken Berg-mannsheil, Ruhr-Universität Bochum and

Prof. Dr. Holger Strunk, Radiologische Uni-versitätsklinik Bonn for preparing these guidelines.

Whilst­ every­ attempt­has­been­made­ to­provide accurate and useful information, neither EFSUMB nor members of EFSUMB nor other persons or institutions contri-buting to the formation of these guideli-nes make any warranty, express or im-plied, with regard to accuracy, omissions and usefulness of the information herein. Furthermore, the same parties do not as-sume liability with respect to the use, or subsequent damages resulting from the use of the information contained in these guidelines.

Trainee Trainer

• Diagnostic procedures

• Psychological aspects• Ethical aspects• Quality control

Competencies/Skills to be acquired Level 1

Date Trainer Signature Date

• Stomach • Vascular systematics of arteries and veins

• Liver and gallbladder • Flow measurements

• Vessels • Interventional procedures for vessels• Kidneys, spleen

• Urinary Bladder

• Intraperitoneal area

• Diaphragma

• Demonstration of the cardial function

Systematic examination of the vascular system

A log book of documented cases should be kept.

• Pericard: normal pericard and pericardial effusion

• Demonstration of the function of the valves

APPENDIX 13: INTENSIVE CARE ULTRASOUND ASSESSMENT SHEET

LEVEL 1 Knowledge Base & Recommended Contents of Theoretical CourseA basic and advanced course is required preferably at the beginning of the training period. This should include:

A formal theoretical and practical examination should take place at the end of training. To be competent to perform/diagnose etc the following competence is demanded:

• Pleura : normal pleura effusion/ pneumothorax

• Lung: normal lung and atelectasis, pneumonia, edema

Systematic examination of the abdominal area

• Physics and technology, ultrasound techniques and administration, lung ultrasound, cardiac ultrasound, abdominal ultrasound and vascular ultrasound for intensive care

• Invasive procedures: Puncture techniques under ultrasound

Trainer Signature

Systematic examination of the thoracic area

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Trainee Trainer

Date Trainer Signature Date

Level 2 Knowledge Base & Recommended contents of Theoretical Course• Diagnosis in thoracic, abdominal ultrasonography, vascular anatomy and pathology

• Safety of ultrasound • Interventional procedures, vascular access,

•  Quality control

•  Psychology and ethics

Competencies/Skills to be acquired Level 2

• Abdominal US : ascites, free fluid

• diagnosis of vascular aneurysms

• Thoracic US : pneumo- or hematothorax, • Pleural puncture and pericardial puncture

ARDS, edema of the lung, subpleural lung consolidations

• Pain Management : Single shot or continuous cathetertechniques (peripheral or neuroaxial nerve blocks)

APPENDIX 13: INTENSIVE CARE ULTRASOUND ASSESSMENT SHEET

Trainer Signature

II) Interventional procedures

• Abdominal procedures (puncture of ascites, urinary bladder)

• Vascular access in children and adults (both venous & arterial)

• Literature search, internet databases, etc. thoracic access, abdominal access, regional anaesthesia blocks

• Technologies and interventional procedures in the use of ultrasound

• Vascular access for different instrumentations (ECMO, balloon-pump)

•  Role of ultrasound compared to other imaging modalities, e.g. magnetic resonance imaging CT Scan etc.

I) Produce sufficient and fast diagnosis in all relevant organ systems

The Level 2 Intensive Care Physician should be able to hold a documentation of 200 completed cases.

• Pre-examination of the trachea for DPT percutaneus tracheotomie

Be able to: Diagnose intensive care emergencies and have knowledge of their management: critical cardial emergencies, critical pulmonal emergencies and critical abdominal emergencies.

A log book of well documented cases (e.g pneumothorax, pleural effusion, cardiac examination, abdominal examination etc.) should be kept.

• Puncture of the stomach for percutaneus gastrostoma placement• Vascular US : thrombosis, embolus, vena cava diameter, doppler-flow• Nerval US : neuroaxial and peripheral nerve imaging

Facebook

Several organizations and medical con-gresses are now joining Facebook. This is a great way to keep up to date with con-gresses that you know you will regularly attend­like­EUROSON­and­WFUMB­meet-ings.

Therefore I invite you to create your ac-count on www.facebook,com and search for­ the­„Friends­of­EUROSON“­as­well­as­„WFUMB­2009“.­By­this­you­will­join­us­on­the web and help us in getting in contact with you with the latest information. Facebook is a great way of sharing infor-mation regardless of where you live.

Michael Bachmann Nielsen

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DAY 1- Sunday 6th December

TIME Pentland Auditorium Sidlaw Suite Fintry Suite Workshops - Galloway Suite Integrated Training Day - Lomond Suite

9.00-10.30 Physics 1- Developments in Ultra-sound Technology-Doppler Tissue Imaging - Professor Professor Norman McDicken, Edin-burgh -Strain RateImaging - Dr Jan D‘Hooge, Belgium

Renal Imaging-Contrast enhanced Ultrasound in Kidney Tumours - Dr Hans Pe-ter Weskott, Germany-US and Colour Doppler in renal transplantation-Professor Francesco Drudi, Italy

Paediatric Ultrasound-What a Paediatric Nephrologist needs from the Ultrasound Depart-ment - Dr Henry Morgan, Liverpool-What a Paediatric Urologist needs from the Ultrasound Department - Mr Simon Kenny, Liverpool-Ultrasound in Gastro oesophageal reflux - Dr Stephan Schneider,Spain

National Point-of-Care Ultra-sound (NPoCUS) – Chest Ultra-sound in the acute/emergency settingDr Bob Jarman, GatesheadDr Jim Connolly, Newcastle

Gastroenterology

Transabdominal Ultrasound in Gastroenterology:Basic Level

This is a one day work-shop aimed at clinicians and sonographers who wish to develop their hands-on skills in ultra-sound imaging of the GI tract

10.30- 11.00 Coffee

11.00-12.30 Physics 2- Developments in Ultra-sound -Technology3D Ultrasound -Professor Richard Prager, Cam-bridge-3D ultrasound and flow dynamics - Dr Piero Tortoli, Italy

Obstetrics 1 Organising ultrasound in preg-nancy- Dr Sturla Eik Nes, NorwayFetal Ultrasound – relevance for adult life- Dr Guttorm Haugen, NorwayFetal Anomaly Screening Pro-gramme Dr Trish Chudleigh, CambridgePrenatal ultrasound and fetal MRI to predict outcome in congenital CMV- Dr Luc de Catte, Belgium

Thyroid ImagingTherese Planiol Lecture Elastography of thyroid - Dr H Mon-peyssen, France Cystic neck masses - Dr Rhodri Evans, SwanseaThyroid cancer on ultrasound - Dr Arne Heilo, Norway

12.30- 13.30 Lunch - Bracco Symposium 12.45 BMUS Annual General Meeting

13.30-15.00 Vascular Ultrasound-AAASP progress to date and future developments - Mr Jonothon Earns-haw, AAA Programme Director-Evidence Based Follow–Up Post EVAR Dr Colin Nice, Gateshead-Ultrasound of Aortic Stent Grafts. Mr Tim Hartshorne, Leicester

Obstetrics 2-Fetal Assessment--3D sweeps in 1st Trimester ultra-sound Australasian Society for Ultra-sound in Medicine (ASUM)- President‘s lecture – Professor Ron Benzie Fetal liver circulation- Dr Torvid Kiserud, Norway-The TRUFFLE trial (Trial of umbili-cal and fetal flow in Europe) trial) - Dr Christoph Lees, Cambridge-Long term follow up of GRIT (Growth Restriction Intervention Trial) - Neil Marlow, London

NPoCUS/BMUS Joint sessionLed by Dr Bob Jarman, Gateshead, Dr Jim Connolly, Newcastle

Doppler Ultrasound in the up-per Abdomen-Is your abdominal ultrasound practice up to date? This half day workshop will providedemonstrations and hands-on experience for delegates to de-velop their skills using Dopplerin the abdomen. This will be led by national expert Jane Bates.

15.00-15.30 Tea

15.30 – 17.00 European Federation of Societies for Ultrasound in Medicine & Bio-logy (EFSUMB) Contrast-New Application in Contrast Enhan-ced Ultrasound -Professor Peter Burns, Canada-CEUS of carotid plaque neo-vascu-larisation -Dr Edoardo Vicenzini, Rome-CEUS in lymph node characterisati-on - Dr Michael Hocke, Germany-CEUS quantification - Dr Nathalie Lassau, France

Ultrasound imaging of superfi-cial structures-CEUS of the testis- Professor Thierry Puttemans, Belgium

Quiz -The quiz will consist of a competi-tion between the audience and the panel.

17.00-18.00 Donald MacVicar & Brown LectureProfessor Yves Ville - Obstetrics (Paris)

Scientific Programme

Abstract Submission deadline – Friday 21st August. Proffered papers will be allocated to the scientific sessions

www.euroson2009.org

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DAY 2- Monday 7th December

TIME Pentland Auditorium Sidlaw Suite Fintry Suite Workshops - Galloway Suite Integrated Training Day - Lomond Suite

9.00-10.30 Hepatic Biliary Ultrasound-Hans Henrik Holm Lecture – Ultra-sound Guided Ablation of Liver Tumors - Dr Bjørn Skjoldbye, Denmark-The role of ultrasound in liver lesions in cirrhotic and non-cirrhotic liver – Dr Mark Calloway, Bristol-The evaluation of liver fibrosis by ultra-sound – Professor Ioan Sporea, Roma-nia

Experimental Vascular/Physics-IntravascularUltrasoundAssessment ofAtherosclerosis -Professor Ton vander Steen,The Netherlands-Functionalimaging of theheart, arteries andmuscles.Dr Chris L de Korte,The Netherlands

Breast-BI-RADS in breast ultrasound- Dr Jan Tuma, Switzerland-Ultrasound Evaluation of palpable Breast Abnormalities - Dr Karl-Peter Jun-gius, Switzerland-Core biopsies versus vacuum assisted biopsies in sonografic breast lesions - Dr Rosanna Zanetti Dällenbach, Switzer-land-Mastitis puerperalis: diagnostics and therapy - Dr Cora Vökt, Switzerland

3D/4D Imaging-This half day workshop is desig-ned to review the 3D and 4D tech-nologies, image acquisition, inter-pretation and clinical applications through a session comprisingdemonstrations by experts and hands-on experience for delega-tes.Mr Bill Smith, London

Developing skills in ultra-sound scanning for DVT

A comprehensive training day and refresher course which will include practical trainingsessions on upper limb, fem-pop and calf DVTs. There will be supporting lectures on up-per and lower limb anatomy, scanning guidelines, alterna-tive pathology, service design and delivery issues and re-porting skills.

10.30- 11.00 Coffee

11.00-13.00 Plenary Lectures-EUROSON and WFUMB

EUROSON Lecture Ultrasound and Endosonography in diagnostics of adrenal diseases - Professor Dieter Nürnberg, President German Society for Ultrasound in Medicine (DEGUM) World Federation for Ultrasound in Medicine and Biology (WFUMB) Lecture – Professor David Evans, Leicester

13.00-14.00 Lunch - Siemens Symposium

14.00 –15.30 Professional Issues- Ultrasound service provision outside the NHS-The inception of an independent ultra-sound service in a large NHS Trust - Dr David Nicolson, Manchester -When things go wrong with indepen-dent service providers – lessons lear-ned - Dr Peter RowlandsNational Ultrasound Clinical Guardian, Department of Health-National clinical standards to inform NHS and non NHS service deliveryMrs Julie Walton, On behalf of the De-partment of Health-Medico-legal implications of practitio-ners in private practice - Mrs Julie Bur-nage, Independent Ultrasound Practi-tioner

Interventional Procedures

CEUS Guided intervention - Why and How?- Dr Christian Nolsøe, Denmark

EFSUMB Publications ‘Know-how in publishing a Scientific article’-The importance of publishing – Dr Karl-heinz Seitz, Germany-How to write a Scientific Paper – Dr Jeff Bamber, Surrey-How to read and article, Professor Lu-cas Greiner, Germany-How to review an article – Dr Emma Chung, Leicester

BreastA half day interactive workshop with demonstration, instruction and supervised practice insmall groups to include elastogra-phy and ultrasound guided inter-ventional techniques in the bre-ast.Mrs Anne-Marie Dixon, Leeds

15.30-16.00 Tea

16.00 –17.30Contrast Ultrasound(including Safety of Contrast)-Targeted contrast microbubbles- Pro-fessor Peter Burns, Canada-Second Order Ultrasound Filed Ima-ging (SURF) – a new ultrasound techno-logy - DrBjorn Angelsen, Norway

Bowel Ultrasound-Acute small bowel - Dr Nigel Grunshaw, Darlington-The acute RIF - Dr Tony Higgin-son, Portsmouth-The role of EUS-FNA in Oncologi-cal Staging – speaker tbc

Debate: Hot TopicsDoppler in the first trimester-For – The safety of Doppler ultrasound examinations during the first trimester ofPregnancy- Professor Yves Ville, France-Against Dr Christoph Brezinka, Austria -4D Scanning: The Elephant in the Room -Physicist, Obstetrician, Patient, Sonog-rapher views on souvenir scanning

Scientific Programme

Abstract Submission deadline – Friday 21st August. Proffered papers will be allocated to the scientific sessions

www.euroson2009.org

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DAY 3 - Tuesday 8th December

TIME Pentland Auditorium Sidlaw Suite Fintry Suite Workshops - Galloway Suite Integrated Training Day - Lo-mond Suite

9.00-10.30 Introduction to Musculoskeletal Ul-trasound 1-Led by Dr Ian Beggs, Edinburgh-Lecture series to introduce the novice to technology and applications for ul-trasound inMSK imaging.-Introduction/ shoulder anatomy-Shoulder demo-Shoulder pathology-Elbow anatomy/ technique/pathology-Wrist anatomy /technique/pathology

EFSUMB Young Investigator Pres-entations

Gynaecology 1- Ultrasound in Emergency Gynaecology-Diagnosing congenital uterine ab-normalities using 3D transvaginal ultrasound - Mr Bill Smith, London-Ultrasound and gynaecological cancer – current uses, management and future plans – Dr Robert Mac-Donald, Liverpool -Investigating acute inflammatory diseases of the female pelvis- tbc-Ovarian torsion- An acute gynaeco-logical emergency: Diagnosis and management- Professor Tom Bourne, London

Ultrasound of the Carotids ar-teries-Can you competently perform ultrasound assessment of the ca-rotid arteries. If the answer to this is no, then this one day training session is definitely for you!This is a growing area of practice given the national stroke strate-gy.It will cover relevant gross and ul-trasound anatomy, system opti-mization and safety,techniques for scanning the ca-rotids, image interpretation and examples of pathology.There will be time to practice your clinical skills on human mod-els.

Veterinary Ultrasound-Practical scanning session Focus on hearts in all creatures great and small. -Proffered papers.

10.30- 11.00 Coffee

11.00-12.30 Musculoskeletal Ultrasound 2Led by Dr Ian Beggs, Edinburgh- Knee anatomy/technique/Pathology- Ankle anatomy/technique/patthology

EFSUMB Education and Professio-nal Standards Session-U/S on the web-Overview of ultrasound educational web resources - Professor David Cos-grove, London-How to prepare presentations and organize movies, videos, set up web-sites make - Dr Lars Thorelius, Swe-den-Integration of the EFSUMB course book with the EFSUMB web site - Pro-fessor Christoph Dietrich, Germany -Ultrasound CME on the web - Profes-sor Francesco Drudi, Italy-The technical implementations, pos-sibilities and limitations - Mrs Suzan-ne Cain, Kosmos Design, UK

Gaecology Ultrasound 2-Early Pregnancy-Embryological development in ear-ly pregnancy- Dr Neil Sebire-What gestation is acceptable for a booking scan? Under 10 weeks is ac-ceptable- Dr Devinder Roberts, Li-verpool-What gestation is acceptable for a booking scan? A booking scan must be done over 12 weeks- Dr Kypros Nicholaides, London-The role of 3D sweeps in 1st Trimes-ter imaging- Mr Bill Smith, London

12.30-14.00 Lunch- Sonosite Symposium

14.00 – 15.30 UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)-Expert faculty involved with the trial will present an update and practitioner accreditation for ovarian cancer assess-ment.-Welcome Professor Ian Jacobs, Direc-tor of UKCTOCS-Introduction to UKCTOCS- Mrs Gwen Fletcher, National Lead Sonographer-Sonographers’ perspective of their role in the Trial- Mrs Kathy Ford, Liver-pool -Standardisation of scanning for the Tri-al Professor Stuart Campbell, London-Natural history of ultrasound detected inclusion cysts in postmenopausal wo-men inUKCTOCS Dr Aarti Sharma, Notting-ham Day Complex adnexal masses on imaging-Dr Gill Turner, Derby -Is there a role for CT/MRI in ovarian screening?- Dr Carol Brunell, UCLH-Volunteer Satisfaction Survey for Ult-rasound Screening in UKCTOCS- Dr Alex Gentry-Findings on prevalence screening in UKCTOCS Dr Usha Menon, London

Abdominal Ultrasound (DEGUM)-Differential diagnosis of pancreatic lesions- Professor Christoph Dietrich, Germa-ny-Ultrasound management of pan-creatic transplantation- Dr Giulio Di Candio, Italy-Peritoneum and mesentery- Dr TonyHigginson, Portsmouth

Professional Issues- Issues in ad-vanced & consultant practice for sonographers-The Consultant Ultrasound Practiti-oner – were they ever born?! - Mr Peter Cantin, Plymouth-Sonographers in advanced practice roles: impact on service delivery, training and governance issues: tbc-Sonographer led HyCoSy service: Mrs Kathy Ford, Liverpool-Sonographer led Amniocentesis service: Jane Williams, Lancashire-Sonographer led Interventional procedures - Mrs Jane Bates, Leeds-Bandings inultrasound: how to get 8a and 8b gradings!On behalf of the West Midlands So-nographer Action Group

MSK This MSK workshop will be led by Dr Iain Beggs, an expert Consul-tant Radiologist in MSK ultra-sound. You will have the opportu-nity to see demonstrations and have hands-on experience under expert guidance of a wide variety of MSK applications.