Lorenzo Derchi

Q&A with ESR president, Lorenzo Derchi

February 26, 2019
by Sean Ruck, Contributing Editor
The annual gathering of the European Congress of Radiology will take place this year from February 27 to March 3 in Vienna. This year marks the 25th anniversary of the Congress being held in Vienna with the event spanning just over three decades in total. We spoke with European Society of Radiology president, professor Lorenzo Derchi to learn more about this year’s event, get the updates on the society and his take on the challenges and advancements in radiology.

HCB News: With ESR representing such a wide range of countries, are lots of different methods/processes introduced to the society or does ESR act more as a singular guide for radiologists to look to?
Lorenzo Derchi: Europe comprises a number of different nations and each of them has its own healthcare system; therefore, the ways of practice are somewhat different from each other. Additionally, because postgraduate training systems are different in many of the European nations, i.e., driven only by universities, by teaching hospitals (or by both of these institutions), the length of residency programs is therefore not homogeneous (although programs are quite similar and postgraduate certification obtained in one nation is valid throughout the entire EU).

I do believe that the most important goal of ESR is probably the “harmonisation” of radiology in Europe and we have a number of initiatives working to achieve this goal. We published the “European Training Curricula” (for undergraduate teaching, for residency programs and for sub-specialization level), which are endorsed not only by national radiological societies, but also the UEMS (European Union of Medical Specialists).

We have developed the “European Diploma of Radiology” (EDiR), which does not substitute the certification in radiology provided by the national authorities, but is a certification that demonstrates that the holder has reached the competencies, attitudes and skills outlined in the curricula. We are working, again together with the UEMS, on the “European Training Assessment Program” (ETAP) and the “Accreditation Council for Imaging” (ACI), harmonising the assessment of residency programs and the accreditation of European meeting and educational activities.

We run an office in Brussels that closely follows the activities of the EU, works on increasing the profile of radiology within the European institutions, and contributes to shaping European health policies and standards. The European Institute for Biomedical Imaging Research (EIBIR) established by the ESR helps radiologists and related professionals obtain research funds from the European Commission to advance biomedical imaging research in Europe. EuroSafe Imaging is an ESR initiative aimed to support and strengthen medical radiation protection across Europe following a holistic, inclusive approach.

HCB News: Are there dramatic differences in the technology being used and the training in different member countries?
LD: The training curricula prepared by the ESR have been endorsed by our National Societies members. This endorsement has been put into action, since most of the national training programs in Europe have been developed following the contents proposed in the ESR curricula, thereby demonstrating that our harmonising effort is working. Regarding the technologies being used, there are relatively wide differences in terms of numbers of high-end machines within the different nations. However, as far as I know, the variations are not dramatic. At a European level, patient organisations are working to decrease differences in terms of availability and ease of access, but the quality of services offered by radiologists is quite high in all European nations.

HCB News: In last year’s ESR interview, a key challenge for members was the cost reduction drivers in healthcare and austerity measures being pushed. Has the problem increased, decreased or remained steady in the last 12 months?
LD: There are still problems in the healthcare systems in Europe, although these differ from nation to nation. The main way of measuring the services provided by radiology is based on the volume of examinations performed, meaning “productivity” is what most administrators want from us. The last time I met one of our regional health administrators, here in Genoa, he told me that he expected from us radiologists more examinations with less expenses. He stated this without mentioning any quality criteria about our work, just as if radiological departments were “examination factories” and the approach to each patient could be standardised with a correct and timely diagnosis granted in each instance.

We, however, have to recognize that, following the debate on value-based healthcare started in the USA a few years ago, discussions about a new way of providing reimbursements to caregivers according to the outcomes of the care provided have also started in Europe. The ESR has recently published a white paper about value-based radiology, discussing the “value” of radiological examinations in patient care and suggesting metrics to measure it. Furthermore, the society is currently working on a paper addressing this topic, together with some of the most important radiological societies worldwide, to be published in a major general medicine journal. Additionally, it must be underlined that in many European healthcare systems, and even at EU level, a lot of attention is paid to the appropriateness of radiological requests. Through a collaboration with the ACR (American College of Radiology), the ESR has developed a Clinical Decision Support system that integrates imaging guidelines into the ordering system of hospitals, guiding referring physicians to request the most appropriate study for each clinical indication. The “ESR iGuide” system is already used and fully integrated in a number of institutions throughout Europe, and the results obtained by its use will be discussed at ECR 2019.

HCB News: Have any new problems emerged in the last 12 months?
LD: I do not see any specifically “new” problems. However, the issue of artificial intelligence (AI) is still very prominent, as it has been continuously growing during the past year. At ECR 2019, its current importance will be shown not only by the number of sessions in which invited experts will discuss the present and future applications of AI in radiology but, more importantly, by the 263 scientific abstracts which have been received on this topic. This is a clear indication that there are many research and clinical centers within the radiological community working on AI, and that there is a willingness from the radiologists to be an active part in the application of AI, with the topic entering into everyday clinical practice.

HCB News: There is concern among some American radiologists that artificial intelligence could compete for their jobs in the future. How do European counterparts view AI?
LD: I am sure that some of my European colleagues are concerned as well, but let me assure them that this is not what the future development of AI will bring for radiologists.

Myself, and indeed all of us at the ESR, encourage all our members and radiologists worldwide to view AI not as a threat, but as an addition to the radiological toolkit, which can, and already does, help us with our work and ultimately benefits patients. Especially when it comes to big data, there is no way around artificial intelligence; there are tasks which simply can’t be done without AI.

So will AI change radiology? Definitely, but if you take a look back at the history of radiology then you will see that there have always been technological innovations and revolutions in our field. Radiology has changed a lot since its humble beginnings, but a constant is that it has always benefited from a close relationship between technology and the human knowledge and expertise, and I am convinced that this will not change in the future.

I would like to ask your readers if they are familiar with the “three laws of robots” created by Isaac Asimov, the great science fiction writer. The future cannot be predicted, but can be prepared, and we have to prepare ourselves for this new challenge.

HCB News: What are you most looking forward to at the upcoming congress?
LD: This is a tough question to answer in brief. First of all, ECR 2019 is the 25th congress in Vienna, which is a major anniversary for us and shows how far the ESR/ECR and European radiology, in general, have come. I can’t reveal too much as of now, but let me tell you that to honor the anniversary, we have come up with a couple of fascinating new things for ECR 2019, including a breathtaking opening ceremony, the “Grand Opening” which will explore the theme of the “Five Senses”, and other new concepts that will leave participants speechless.

I am very much looking forward to a new addition to the program called “Women in Focus”, which was envisioned by myself and the ESR, and is being led by professor Hedvig Hricak. “Women in Focus” will explore and celebrate the crucial role that women play in healthcare on a daily basis, whilst offering advice and insights to all attendees. The two-day programme will provide a platform for a diverse range of speakers to share their inspiring experiences, offer constructive advice and debate the often difficult issues surrounding gender and healthcare. The entire programme will be held in memoriam to the late professor Alexander Margulis.

Education, science and training at the highest level are an ECR trademark and despite my being amongst the few people who have attended every single congress since its debut in Vienna in 1991, I still get excited every year about the lectures, courses and workshops to come. This year, it is not only the stunning honorary lectures, the great number of premier clinical trials, the sessions with our “ESR meets” partners Africa, Italy and Pakistan, or the impressive contributions from our younger colleagues that excite me, but also the notion that every single session at ECR can widen your horizons as a medical professional.

One development I would like to draw your attention to is the fact that The Cube, ECR’s dedicated learning space for interventional radiology, has more than doubled in size for ECR 2019. Due to its outstanding success last year, The Cube will move into a new building, the DC Tower, which is the tallest building in Austria and is located just a few steps away from the conference center. The tower, together with the adjoining Techgate and the DC Box, mark the latest three additions to the ECR City, which is growing every year as the congress expands to other surrounding buildings.

Another thing not to miss at ECR 2019 will be the great additions to the technical exhibition, which will, amongst other topics, focus on artificial intelligence, and will be presented in a very exciting and unique way.

There are many more developments I could mention, but let me conclude with the thing I am most looking forward to, which is meeting all of you at ECR 2019.

HCB News: Can you give a prediction as to how radiology will evolve in the next decade?
LD: There are two main challenges. The first is to ensure the availability of radiological services everywhere. There are still many areas in the world where only basic radiological services are available and too many people still have no access to up-to-date technology. The ESR has a number of initiatives and educational activities which help to tackle these issues. The second, as mentioned before, is related to the rapid advancement of technology. Artificial intelligence (AI) is entering our field and it is difficult to foresee how and in which ways exactly it will impact our profession. The program of ECR 2019 will explore this issue with a number of sessions dedicated to AI from a variety of points of view. These include looking at the applications of AI in our current work, what the possible future developments of AI will be, how these will affect our daily work, and how they will change the doctor/patient relationship.