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BACKGROUNDER

THE COLUMNS

– chronologically

– by general topic

DISCLAIMER

Reference: Rinck PA: Rinckside Webcast - Vienna this year: "The latest results …". Diagnostic Imaging Webcast. 6 March 2009; and "Walking down the corridors …" Diagnostic Imaging Webcast. 18 March 2009.

Key Words: Medical congresses; ECR; characteristics of participants; topics of the social program; reasons not to attend.

September 1996
July 1997
May 2000
March 2003
March 2004/2008
May 2006
February 2012

ome people think that I should not write serious articles. Frank opinions on science, medicine, or even reality can easily be contested, particularly because my truth is different from other people's.

The world today is scary enough, and radiology scares many of us even more. Therefore, we travel to attend the European Congress of Radiology Vienna just to find out that we know more than, or at least as much as, anybody else. Many of the participants are lucky – somebody else pays their fares and accommodation. Work and play mix, professionalism and tourism.

Lie back in your airplane seat and enjoy the flight. If you can, that is. Usually, you cannot because there is not enough space to stretch. But you can go for a spin for some days to relax in Austria's capital, if no blizzard is rolling up the city and you better lock yourself in your hotel room, order another blanket, and read a novel in bed.

Anyhow, there is something positive about Vienna: Its airport is definitely more attractive than Chicago's O'Hare, and Austrian immigration officials can distinguish between tourists and terrorists. Terrorists are better dressed.

At the Austria Center's lecture halls the lights go off, the speaker commences, and one falls asleep with the comforting awareness of being close to scientific progress.

I always have admired those people who, after drinking into the small hours, are up bright and shiny early in the morning for the first morning session, jumping up and down and asking well thought out questions as soon as the speaker finishes, while others are still fighting their hangover in the hotel bathroom.

When, accidentally, you lift one eyelid, you see – in a widescreen movie format – two rectangles fighting each other to get into a box; below them, the head of a hungry chicken, beak opening widely and then closing again, picking in succession all those birdseeds floating on the peaceful dark green background of the slide. You should be glad to be in this session; the image background could be pink and the text yellow, screaming into your eyes.

Sometimes you believe that you are attending a Strange Phenomena Conference. Some presentations seem to have been prepared after the authors attended a course in creative writing and PowerPointing. Their jargon can hardly be understood, and looking at the slides doesn't help either. The lid drops again.

After you have awakened and tried to understand the forms you are forced to fill out before you are allowed to leave the lecture hall, you meet an American in the corridor by the coffee shop who tells everybody, even the waiter from Bosnia-Herzegovina, that he could not live without his 3T MR equipment. I could. The waiter could, too. And the 3T machine could live without the American.

Chatter, babble; we dive into the social dynamics of the conference:

"When did you arrive?" "Where do you stay?" "Which airline did you fly?" "How many participants attend the meeting this year?" "Will it snow again?" "Let's cross over to the industrial exhibition and pocket some souvenirs at the booths." "Great to see you. How's Golda?"

Who the heck is Golda?

"Let's have a drink, breakfast, lunch, dinner, a baby – at least we could try."

The informal social contact often appears to be more important than the learned papers and those poster sessions without posters. But still, there are some pompous, complacent scientific exchanges, misinterpreting the latest results of the barium enigma.

Talking shop, eating, drinking; you see people you never expected to have a private life. Fortunately, with your mouth full of Sachertorte, you cannot discuss imaging of the urinary tract. The topics at the next table are money, the crisis, holidays, incompetent sales representatives, incompetent CEOs, the crisis, the decline of the market, sales, hostile takeovers, the crisis, and sex.

And then we hear the next talks: Liver imaging for the advanced alcoholic. Cappuccino as a nonexpensive oral contrast agent. The influence of the Vienna Volksoper on the angiography of the lower extremities.

In the commercial exhibition, the booth of Lyserg & Sharp and Doom (LSD) offers an easy way to color coding of erstwhile black-and-white images: concentric visuals of colored patterns form behind the eyes in the mind of the customer, facilitating any diagnosis, with the stress on "any".

Telepathy International is the new star in teleradiology – wireless, monitor-free, cheap, and without any electronics, plain eclectic. Theoretical reasoning does it all. It generates an entire PACS in your hypnotically charged brain. The price is reasonable.

Speech Impediment, Inc., the new Ruritanian dictation management company offers their novel "William Henry Gates III Memorial" software with integrated speech recognition, workslow management, and automatic random erasure. "Crying rage is our goal."

This year's congress will touch on almost every imaginable topic in the radiological arena, drawing speakers from across the globe with the usual balance between youth and academic inexperience.

The new hands-off courses include the following:

Topic 1: Fighting the economic crisis in medical imaging.
Does lobotomy help? Open forum and sterile resection.
Topic 2: Is there a crisis?
Learn the French way of denial. Italian dinner included.
Topic 3: How to mix your own nontoxic contrast agents.
Step by step, with PowerPoint presentation. Sponsored by Nestlé.
Topic 4: How to frame your MBA certificate and hang it
on the wall front to back. Examples on video.
Sponsored by Harvard Radiology Business Review.
Topic 5: Learning to live: Basic differences between hospital
administrator and radiologist. Explanatory graphics and role
playing. Bring your own Persian carpet.
Topic 6: PET on the Shmatterhorn. With bonus CME (approval
pending). Sponsored by Union Bank of Switzerland and
the Swiss taxpayer.
Topic 7: What happens to patients after the examination?
Hide and seek through all changing cubicles and resuscitation.
Real-life testimonials.
Topic 8: PACS for pygmies. How to reach the buttons.
Requires knowledge of bungee and/or trampoline jumping.
Topic 9: Are you really a radiologist or only a BMW driver?
An introduction to Freudian thinking. Help line and support
groups. Sponsored by Dacia, the Logan manufacturer.
Buy four tires and get a free car.
Topic 10: Digital mammography. Learning how to find things.
Topic 11: CT colonoscopy and bad breath.
T1 and T2 relaxation exercises, meditation, and breathing
techniques. Triple CME credits and double Austrian Airlines Miles
and Less.

Note: Due to the complexity and level of difficulty of their contents, each course will accept a maximum of four to eight participants each. Couples preferred.

Have fun at the meeting.

"Walking Down the Corridors..."

Vacant hotel rooms are aplenty in Vienna this year and prices negotiable. In the month before ECR, one hotel chain even called former guests and congress participants directly and offered good deals.

For some reason or another, I chatted with more people in the corridors or more people approached me than at earlier ECRs in Vienna. The economic crisis is one of the main topics for many of these congress participants, a crisis not only for the commercial companies, the manufacturers and vendors, but also for the radiologists, the health system at large, and, apparently, hotels in the Austrian capital.

The ramifications in medical imaging are wide-stretching, not only into new investments but also into imaging strategies in general. "Why buy a new CT if the old one is still good, reimbursement down, and the patients' outcome the same?"

I watched a conclave of dark-suited businessmen looking grimly through the windows of the Austria Center at the gray skies of the surrounding world. The last year had not been nice, and the empire had been stricken. Corruption scandals, products with dangerous side effects – "metus est plena." There is plenty of fear, commercial and personal, the sharpened sword of Damocles hanging directly above their heads by a single horsehair. The future seems not as bright as it was some years ago.

Others see it differently and, smilingly it seems, jump into the fray. Some new companies have turned up at the commercial exhibition, even some targeting the ailing contrast agent market, either with novel products or with generics. Good luck to them.

Radiologists live in their little worlds, even when they talk about globalization and "our European house."

The house is to be heated, and the money for it should come from the companies. Everybody wants to arrange his or her small or big congress, but as one of the officials of ECR puts it, the financial support in dire times must by concentrated on the big conferences, not on the small ones. For sponsors, there is better return on investment with the bigger meetings, he insisted.

However, an increasing number of small conferences in Europe cater to getting CME credits in subspecialties, a return of national and regional meetings. If you want to keep your license, there is no way around them. On the one hand, people want to hear difficult contents in their mother tongue and be able to ask questions. On the other hand, the CME requirements are getting tougher and more bureaucratic. It is easier to fulfill them locally, without too much fighting with the offices in charge of CME accreditation.

One male radiologist commented: "The problem of the future is rather subspecialization and the connected certifications. Not a big congress and commercial fair. What do you need for a good CME meeting? A handful of good speakers, pedagogically trained, and an auditorium. If the participants want fringe benefits, they pay cash out of their own pockets, including that pizza dinner with a bottle of red wine."

It's a dilemma, according to one participant, that the radiologists in charge of the program of the ECR are all "academicians," "having their heads in the clouds; they are so distant from reality in daily radiology."

For many radiologists out in the field, dealing with patients and referring physicians, the contact and understanding they get from company representatives is better and deeper than the comments they get from the university bigshots.

"The critical assessment is missing," one female radiologist from Italy comments. "The university radiologists are so far away from our life and daily problems. But I meet colleagues from all over Italy and we talk. The interesting part is the refresher courses, the exhibition, and Vienna."

Another opinion: "I wonder what the ECR rationale is. So much precious time is taken up with all these product-related lunch sessions that lure people away from the mainstream courses. The ECR appears to be practicing blatant commercialism rather than education."

Still there are many others: When I watch those happy participants in the corridors, in the lecture halls, at the commercial exhibition, unconsciously, I suppose, I demand that they conform to my ethical or moral concepts – the straight old Prussian concepts. I don't know if they are still applicable, and they couldn't care less. They want to have fun and some easily digestible information, and for the rest – who cares?

Mañana, domani, morgen, savtra, tomorrow. There is no suffering, except for the young speakers. They suffer and look stressed. I did, too, at their age. But I suspect that those who look relaxed and laugh deal as well or better with their patients than those serious-looking career-prone doctors.

Correct me if I am wrong.