EFSUMB Newsletter 2015 – Issue 4

EUROSON 2015, Athens, Greece 6 – 8 November 2015 is only 9 weeks away! .... www.euroson2015.org/site

2015euroson

 Join us in Athens for a comprehensive ultrasound programme

Categorical courses covering Breast, MSK, Cardiovascular, Upper Abdomen, Trauma, Urology, Head & Neck, Interventional Ultrasound, Ob/Gyn and Anaesthesia.

Refresher courses additionally covering Elastography, Intestinal Ultrasound and Physics.
Over 330 speakers, both international and national, cover 3 days of intensive lectures not only on the above topics but Contrast enhanced Ultrasound and a DEGUM Session focusing on Obstetrics, Gynecology and Breast. Romania and Latvia too have special sessions. Visit the programme online http://euroson2015.org/site/wp-content/uploads/2015/07/PROGRAM.pdf

Practical courses in the topics offer hands on experience under expert tuition.

Symposia, supported by GE, Bracco and Toshiba will take place.

A special GE Session limited to 30 participants “3D Automated Breast Ultrasound (ABUS) as an adjunct to digital mammography for screening women with dense breast tissue: from a clinical need to a practical integration”- including Live scanning session Presentation and interactive Workshop led by Prof. Dr. László Tabár, M.D., F.A.C.R. (Hon.)

The Opening Ceremony will include the lecture “Hippocratic Medicine through the Centuries” by the author and former Professor of History of Medicine at the University of Ioannina, Greece, Stefanos Geroulanos. We can expect to hear of his passion for history, Greek poetry and numismatics and perhaps even of the medicinal plants mentioned in the Corpus Hippocraticum.

During the congress EFSUMB and ENSCH will present new ultrasound guidelines.

Sunday features a Students’ Round Table Discussion and practical courses.

The Walter Krienitz Society offers 500 euro for the best oncological abstract submitted and will be awarded at the Congress.

EFSUMB will present a 500 euro prize for the best published paper in the last three years for younger authors.

The EFSUMB Young Investigator Award of 1000 euro for the best presentation will be contested by scientists from 10 countries. This session is always one of the most exciting to see the emerging fresh talent,

State of the Art Lecture Prof Jung Hwan Baek of Soeul, Korea will be demonstrating his innovative techniques of ultrasound guided thyroid ablation.


 

EFSUMB guidelines on interventional ultrasound (INVUS)

Steering Committee: Christoph F Dietrich, Torben Lorentzen, Paul S. Sidhu, Christian Jenssen, Odd Helge Gilja, Fabio Piscaglia

EFSUMB guidelines
Over the last decade, EFSUMB has produced a series of Guidelines and Recommendations. Contrast-enhanced ultrasound (CEUS) guidelines were first introduced by EFSUMB in 2004, updated in 2008 and in 2012 produced with WFUMB. EFSUMB CEUS non-liver guidelines were also recently published. These guidelines and recommendations provide general advice on the use of all currently clinically available ultrasound contrast agents (UCA). In addition, the first elastography guidelines worldwide were published by EFSUMB in 2013. The Guidelines and Good Clinical Practice Recommendations are freely available to download from the EFSUMB website (www.efsumb.org). A website atlas illustrates the various recommendations and guidelines.

Methodology
European experts created the interventional ultrasound guidelines from the defined subchapters and key topics of the 6 guidelines sections. The Oxford Centre for Evidence-Based Medicine Levels of Evidence (March 2009 edition) were used to judge the level of evidence (LoE) and grade of recommendations (GoR). Drafts of recommendations and comments were provided by one author, revised by the other members of the small author groups and reviewed by the section leaders. After approval by the subgroup the revised drafts were submitted to the whole expert group before the expert meeting, held in Frankfurt, Germany on January 30 – 31, 2015. All recommendations were discussed, improved, and finally subject to a vote by the expert panel. Only recommendations with strong consensus or broad agreement were included in the final version of the guidelines. Finally, external experts not involved in the development of the INVUS guidelines reviewed the final drafts with special focus on LoE and GoR.

guidelines_committee

Frankfurt Meeting of INVUS Experts, January 2015 – tired after two full days but satisfied with the outcome.

Interventional ultrasound (INVUS)

The guidelines consist of six main parts
1. Part I: General aspects.
2. Part II: Abdominal diagnostic procedures.
3. Part III: Abdominal treatment procedures using the transcutaneous approach.
4. Part IV: EUS-guided interventions: General aspects and EUS-guided sampling.
5. Part V: EUS-guided therapeutic interventions.
6. Part VI: Ultrasound-Guided Vascular Interventions.

Part I General aspects of interventional ultrasound
This part deals with generalities that are important and relevant for all kind of INVUS procedures, diagnostic as well as therapeutic: B-mode imaging and the use of CEUS in INVUS procedures, Guiding techniques including fusion imaging, Patient information, informed consent and patient preparation, Local anesthesia and sedation, Hygiene management, Puncture routes and accessing techniques. How to reduce and/or eliminate complications and finally how INVUS is organized locally.

Part II Abdominal diagnostic procedures
This part deals with the workup both in clinical terms and in imaging, prior to the use of an interventional procedure to either diagnose or treat an abnormality. The section divides into both an organ specific discussion as well as targeting particular ‘niche’ areas that will concern readers of the guidelines. All imaging modalities play a role in the work-up of these patients, and not always will an ultrasound-guided procedure be the most appropriate imaging tool. This is detailed with evidence-based assessment of the diagnostic route and the final image approach to resolve the clinical situation.

Part III Abdominal treatment procedures using the transcutaneous approach
Therapeutic abscess drainage and the drainage of pancreatic pseudocysts, interventional tumor ablation techniques, interventional treatments for cysts in general and specifically also parasitic diseases (PAIR for echinococcosis) enrich our daily practice as do established therapeutic procedures such as PTCD, PEG, PUG, biliary and urinary bladder drainage and nephrostomy. In the matter of interventional guidance and approach, it is often necessary to decide between the competing modalities of CT guidance and other imaging techniques, which in some case can and should be used to complement or supplement one another. The role of ultrasound contrast agents in the preparation, support and guidance of interventional procedures is also addressed. Symptom-oriented palliative care interventions are an important issue that concludes the chapter.

Part IV EUS-guided interventions: General aspects and EUS-guided sampling
EUS-guided sampling was introduced in the early 1990s and 20 years later was proclaimed to have afforded a “disruptive innovation effect” for pancreatic pathology . It combines most advanced high-resolution ultrasound imaging of lesions within the wall and in the vicinity of the gastrointestinal tract and provides safe and effective tissue acquisition. The guidelines deal with indications and clinical impact of EUS-guided sampling and try to balance advantages and drawbacks in comparison with image-guided percutaneous biopsy. Needle choice and biopsy technique as well as specimen processing are crucial for success, and therefore evidence-based recommendations are given for almost all steps of EUS-guided sampling as well as for safe performance.

Part V EUS-guided therapeutic interventions
Soon after introduction of EUS-guided fine-needle aspiration, the therapeutic potential of EUS-guidance was discovered, and first successful attempts of EUS-guided celiac plexus neurolysis, pseudocyst drainage, and cholangiopancreatography have been reported. The spectrum of EUS-guided therapeutic procedures has broadened since those first steps, and scientific literature on EUS-guided treatment is prospering. This is reflected by evidence-based recommendations on EUS-guidance of tumour ablation therapy, injection treatment of the celiac plexus, vascular interventions, drainage of pancreatic and non-pancreatic fluid collections and –not least- drainage procedures of the biliary tree and pancreatic duct. EUS-guided therapeutic techniques are compared with their percutaneous alternatives to help the clinician in choosing the most appropriate solutions for challenging therapeutic problems.

Part VI Ultrasound-Guided Vascular Interventions
Real-time US-guidance for central venous access was performed for the first time in 1986 and, supported by overwhelming evidence, is now regarded to be a key safety measure in modern medicine. Systematic analysis of scientific literature shows, that US-guidance may also facilitate efficacy and reduce adverse events in peripheral venous access and endovascular interventions. Moreover, recommendations endorse the use of ultrasound to detect complications of vascular access and US-guided treatment of arterial pseudoaneurysms.

On-line and In-print Versions of the Guidelines

The INVUS guidelines will be published in EJU followed by various online versions only. Some chapters and multimedia material are also intended only for the EFSUMB website. Online versions will help provide more details that do not fit in the limited available printed space, which will be focused on main issues supporting the recommendations.

Conclusion

The guidelines are an expression of interdisciplinary and multiprofessional viewpoints, some of which represent different approaches. The principle of “do no harm” is expressed in repeated pleas to apply the techniques judiciously in everyday practice and not become fascinated with technology for its own sake. The decision to proceed with an interventional procedure is always an individual one and should be measured by its benefit for the patient

Acknowledgments

EFSUMB is a registered UK charity and funded by subscriptions from its member National Societies to carry out educational and scientific activities These Guidelines were made possible by the generous support of the following companies listed in alphabetical order: Analogic, Bracco, Covidien, Esaote, Fujifilm, GE Healthcare, Hitachi, Olympus, Peter Pflugbeil, Philips, Siemens, Supersonic and Toshiba. EFSUMB only accepts donations from industry if unrestricted and for educational purposes and favours working with a consortium of companies. EFSUMB is satisfied that accepting such support did not adversely affect its independent status and/or reputation. There was no attempt on the part of the companies to influence EFSUMB policy or actions explicitly or implicitly and EFSUMB retains full editorial control and copyright over all publications and printed materials funded by these companies.

The expert opinions expressed within the Guidelines are independent and free of bias, based on the best evidence for clinical practice and any potential conflict of interest of each individual author is disclosed in the online version for a maximal transparency, as should be expected for guidelines drafted according to modern standards.


 

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