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EM 1 - Radiology and Swiss chocolate: a sweet combination
Genitourinary Musculoskeletal Head and Neck Professional Issues
Friday, March 2, 10:30 - 12:00
Room: B
Moderators: B. Hamm (Berlin/DE), D. Weishaupt (Zurich/CH)

Introduction: What Swiss radiology and Swiss chocolate have in common
D. Weishaupt; Zurich/CH
Learning Objectives

1. To become familiar with the status of radiology in Switzerland.
2. To learn how Swiss Society of Radiology supports radiology in Switzerland.
3. To discuss the link between Swiss radiology and top-quality innovative Swiss chocolate culture.


The Swiss Society of Radiology, with more than 100 years of history and about 1,000 members, is a professional medical society dedicated to promoting radiology in Switzerland. The aims of the society - among others - are: to assure high-quality postgraduate training in radiology by maintaining the radiology residency training curriculum as well as conducting the Swiss board examinations in radiology, to support education in radiology by organising the Swiss Congress of Radiology, offer activities dealing with quality assurance, patient safety and radiation protection, improve patient care and the health of the population through medical imaging, support the professional and economic interests of our members, and serve as a responsible counterpart to the Swiss Health authorities and other official bodies. The aim of providing high quality radiology and the pursuit of excellence are important characteristics of radiology in Switzerland. These characteristics link Swiss radiology with Swiss chocolate, which is considered to be one of the highest quality products manufactured in our country. Within this session, three educational presentations by three renowned Swiss radiologists will underline the broad spectrum of cutting edge radiology performed in the country. In addition, you will learn about the secret of production and refinement of high-quality chocolate made in Switzerland. A representative of a leading family owned Swiss chocolate manufacturer will present the fascinating chocolate production process and illustrate how high quality chocolate is handmade and how innovative chocolate products are designed for the future.

Truffle No. 1: MR-diffusion of the urogenital tract: where it really helps
H. C. Thoeny; Berne/CH
Learning Objectives

1. To learn how DWI can be integrated in the acquisitions protocols and whether it precludes the need for other sequences.
2. To learn if DWI can provide useful information for tissue characterisation.
3. To understand the clinical circumstances in which DWI is most helpful.


After its initial application in the brain diffusion-weighted MRI (DWI) is now part of most MR exams in the abdomen. In the urogenital tract DWI is particularly helpful because it can be applied without contrast medium administration which is a major advantage in patients with renal impairment. For daily clinical routine image analysis of DWI is performed qualitatively based on visual assessment of the high b-value images and the corresponding ADC map. However, image interpretation of DWI has always to be performed in combination with morphological images to avoid misinterpretation, e.g., a tumour, an abscess and a haematoma have the same findings on DWI but can be differentiation in combination with anatomical sequences. The ADC value, the quantitative parameter of DWI can further provide more detailed information of the underlying tissue. DWI in the urogenital tract can be applied for detection, characterisation and monitoring of various pathologies. DWI helps to detect pyelonephritis in adults and children without contrast medium administration and typically normal findings on morphology. It is also routinely applied to detect significant prostate cancer and provides even information on tumour aggressiveness when the ADC value is taken into account. The differentiation between cystic renal cell carcinoma and an abscess is also possible based on DWI and even the differentiation of renal cell carcinoma subtypes is possible in many cases based on the underlying ADC-value. Several applications and examples showing the usefulness of this technique in the urogenital tract will be discussed and explained.

Interlude 1: The backbone of a truffle: From cocoa bean to chocolate mass
A. Trümpler; Enneda/CH
Truffle No. 2: hip preservation surgery: a fast evolving field also for imaging
C. W. A. Pfirrmann; Zurich/CH
Learning Objectives

1. To learn about the history and recent advances in hip preservation surgery.
2. To understand the biomechanics of the abnormal hip and how to integrate biomechanical aspects in the imaging protocol and image interpretation.
3. To know imaging pitfalls and asymptomatic findings.


Joint-preserving surgery of the hip is one of the most important fields of innovation in orthopedics and sports medicine. Before the era of hip replacement hip osteotomies were popular to treat osteoarthritis of the hip. Hip osteotomies lost a lot of their importance with the introduction of the total hip arthroplasty which is considered one of the most successful surgical procedures. With the scientific work of Reinhold Ganz and his team at the University of Bern in Switzerland joint-preserving surgery of the hip has regained importance and has become one of the fastest evolving fields in the last two decades. The goal of joint- preserving hip surgery is to prevent osteoarthritis in the hip before degeneration becomes evident. Studies on the detailed anatomy of the blood supply of the femoral head were the scientific bases to develop a new approach for open surgical dislocation of the hip without the risk of avascular necrosis. This gave new insights in hip biomechanics and the development of the new concept of femoroacetabular impingement (FAI). FAI has been identified as the leading cause of the premature osteoarthritis of the hip. Imaging of the hip has become increasingly important to assess morphology of the hip joint as well as the structural damages mainly to the cartilage and the labrum.

Interlude 2: Truffle Art: How to create hand-made chocolate masterpieces
A. Trümpler; Enneda/CH
Truffle No. 3: multiparametric imaging in head and neck oncology
M. Becker; Geneva/CH
Learning Objectives

1. To understand the complementary role of morphologic, functional and metabolic imaging techniques in head and neck oncology.
2. To review the role of diffusion and perfusion imaging for the diagnosis and follow-up of head and neck cancers.
3. To discuss diagnostic pitfalls and how they can be avoided with multiparameteric imaging.


Contrast enhanced CT and MRI with diffusion-weighted imaging (DWI) are routinely used for the assessment of submucosal tumour spread in head and neck carcinoma, to stage nodal disease, to monitor treatment response and to detect recurrent disease. PET/CT is widely used to stage nodal disease, to detect distant metastases and synchronous tumours, to identify unknown primary tumours in patients with metastatic neck nodes, to assess treatment response and prognosis after chemo radiotherapy and for radiotherapy planning. Recent data regarding the complementarity of multiparametric information derived from hybrid MR/PET systems in clinical settings holds promise because it can combine morphologic, functional and molecular information and helps to avoid diagnostic pitfalls. This lecture focuses on clinical applications of multiparametric imaging in head and neck cancer. Current evidence about the complementarity of CT, MRI, DWI, perfusion and PET is discussed with particular emphasis on the added value of multiparametric information and quantification. The variable appearance of functional phenomena mimicking disease as well as diagnostic pitfalls and how they can be avoided are discussed. Current research trends regarding texture analysis are addressed. Emphasis will be put on ongoing developments in head and neck oncology.

Panel discussion: The way of maintaining and improving quality of Swiss radiology
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