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no.2 03 2012 www.visus.com one pacs for all all for one reports view including all about pacs ii in the netherlands and italy strong partnership for pacs solutions in finland and hungary think global act regional ­ spain focuses on centralized pacs architecture challenges ­ the lack of radiologists in europe

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visus view imprint publisher visus technology transfer gmbh universitätsstraße 136 d ­ 44799 bochum fon +49 234 936 93 0 fax +49 234 936 93 -199 info@visus.com www.visus.com editorial services and design european hospital verlags gmbh ralf buchholz healthcare communications circulation 10.000 all rights remain with visus reproduction in whole or in part inclusion in online services and other internet platforms as well as copying of material onto data carriers such as cd-rom dvdrom etc without prior permission of visus is prohibited by-lined contributions and enterprise presentations express the author s personal opinion visus does not accept liability for the accuracy and completeness of contributions and quoted sources including spelling errors.

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editorial peter rosiepen visus vice president dear readers dear friends of visus when in rome do as the romans do this little piece of advice will not only help you do rome ­ or any other place for that matter ­ on holidays but also on business in healthcare it business for example national differences in the pacs market are mind-boggling the same holds true for differences in distribution channels and practices thus taking your business across the border can be quite a challenge we at visus are prepared to master the challenge with flexible products and strong partners that know their way around while in germany we have our own sales organization internationally we count on business partners whose product portfolio and market strategies are in sync with our own objectives currently we focus our efforts on europe a small market with huge potential to pacs providers this market appears to be split into two distinct entities ­ a mature market and an emerging market the former comprises inter alia belgium the netherlands and luxembourg benelux with a pacs coverage of close to 100 percent in these countries hospitals are entering the next phase of digitising where step by step different clinical departments and areas are being integrated into the pacs these facilities require a so-called pacs ii solution ­ and visus can deliver our product we are proud to say is miles ahead of the competition and thus it is no surprise that our partnerships in the benelux countries are outstandingly fruitful we hope to be able to take our experience and know-how across the channel to the uk where the nhs is currently sourcing replacement pacs that will go beyond radiology at the other end of the pacs coverage spectrum is for example france where the reimbursement system has long favored analogue recording and archiving solutions for radiology data consequently today the french pacs market is characterized by high demand very promising indeed and the french healthcare system now promotes the establishment of regional archives another visus core competency we are busy forging regional partnerships to spread our know-how in france spain has similar plans for regional archives in eastern europe jivex is already a major player in poland and the czech republic the visus mammography solution is very popular and in hungary jivex enterprise has many happy customers you see our jivex developers ensure that we can do as the romans do wherever we are this strategy gives us as a mid-sized company an edge over the competition the user reports that we have collected in this second international issue of visus view show that our strategy is successful enjoy peter rosiepen

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visus view no.2 03 2012 4

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contents contents 6 view news teleradiology networks zooming in on pacs ii and mir in genova 2012 view reports 8 11 12 13 18 24 dutch hospital s paper-free healthcare environment maasstad hospital in rotterdam visus and alphatron link up to offer hospital imaging solutions alphatron rotterdam the netherlands nordic by nature ­ jivex the work horse of finnish radiology koskiröntgen in finland one partner many advantages onemed oy helsinki finland pacs installation crosses hospital s imaging boundaries kenézy kórház nonprofit kft hospital hungary dicom opens the door to the or videomed digital or solutions in two hospitals in bologna italy view 14 radiology facing recruitment challenges across europe professor malgorzata szczerbo-trojanowska head of the department of interventional radiology and neuroradiology at the university medical school lublin poland major challenges for hungary s healthcare system dr gabor csiba president of the alliance of strategical hospitals of hungary emd and visus join forces for sophisticated software solutions emd group central and eastern europe save costs go regional spain focuses on centralized pacs archives fujitsu technology solutions spain teleradiology networks what s cooking dr marc kämmerer radiologist and product manager at visus 16 17 20 26 view solutions 21 22 28 30 31 the three pillars of a regional pacs solution jivex storage service for pacs ssp and jivex dicom platform image management as you like it visus and ihe xds integration platform for management of all images in the hospital jivex dicom platform seamless image management around intervention jivex or integrating ecg waveforms into campus-wide image management jivex ecg 5

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view news real-time real life teleradiology network fully in service after a one-year long pilot phase led by medecon ruhr on 1 january 2012 the teleradiology network ruhr went fully into service the initiators of the network ­ medecon ruhr contec fraunhofer isst ztg and visus ­ aimed at establishing an infrastructure that allows vendor-neutral barrier-free and safe exchange of dicom data within the ruhr region in germany the project is headed by professor dr lothar heuser director of the institute for diagnostic and interventional radiology neuroradiology and nuclear medicine at knappschaftskrankenhaus bochum during the pilot phase 35 hospitals and doctors offices successfully participated now after the full launch more will join us in the pilot phase more than 100 gigabyte of image date were sent and received per month the network is being used for a variety of tasks ­ to obtain second opinions or to transfer image data down the treatment chain to specialized physicians and institutions or to rehabilitation facilities says marcus kremers project coordinator at visus summarizing the results of the test phase and three user meetings the technical foundation of the network is provided by visus jivex dicom mail including a directory service this solution complies with the recommendations of the german röntgen society and enables the participants to exchange dicom images in diagnostic quality safely and quickly and without major technical and financial burden building upon widely used e-mail technology and existing infrastructures networks can be easily established and expanded dr marc kämmerer visus product management radiologist marcus kremers visus business development professional services events 2012/13 notepad 2012/13 · ecr 2012 march 1­5 vienna aut · 93 deutscher röntgenkongress may 16­19 hamburg ger · management in radiology annual scientific meeting 2012 october 11­12 genoa it · medica 2012 november 14­17 düsseldorf ger · rsna 2012 98th scientific assembly and annual meeting november 25­30 mccormick place chicago illinois · arab health 2013 january 28­31 dubai international convention exhibition centre 6

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view news guido bötticher sales director germany zooming in on pacs ii new solutions for new markets drive visus growth number of customers up revenue up strategy successfully implemented outlook for 2012 very positive that is the visus fiscal year 2011 in a nutshell regarding the technical trends particularly pacs ii is playing an increasing role as last year s medica has shown the clear trend towards image management outside radiology in addition to pacs migrations several large dentistry departments at university hospitals were equipped with our solutions thanks to our product philosophy ­ jivex for radiology full image management mammography screening and teleradiology ­ we are excellently positioned to benefit from this trend says guido bötticher sales director germany internationally as well pacs ii is playing an increasingly important role case in point maasstad hospital in rotterdam the 600-bed facility is fully digitised and paperless jivex is being used in all departments as enterprise pacs it is linked to more than 160 imaging devices and to the radiology pacs of a third party vendor more than 200,000 examinations per year are being managed and archived with the help of jivex and even legacy paper files are scanned and transferred to our product says peter rosiepen vice president international sales and business development another trend that will continue in 2012 is the integration of non-dicom data for example electrocardiogramsecgs our jivex ecg modality gateway obviously meets an urgent need of hospitals and manufacturers it ensures smooth integration and storage of vital data and offers specialized measurement and analysis tools jörg holstein managing director at visus concludes mir 2012 in genoa management in radiology mir is among the most important annual events for those responsible for running a successful radiology department because of the interesting subjects innovations and topics that are discussed during the sessions in addition it is also a very attractive event due to the high concentration of expert knowledge ­ and the scenic and sunny spots that are chosen by the organizers from nice in 2011 the congress will move to genoa in 2012 and as in recent years visus is the sponsor of the event as part of the scientific program radiologist dr mark kämmerer product manager at visus will encourage the attendees for a vital discussion with his speech pacs ii ­ enterprise-wide imaging mir formerly emgwr was established in 1999 as a working group to develop ideas for greater involvement and the training of radiologists in the management of radiological departments the group introduced an annual congress on management with a mixture of invited and proffered papers and a winter workshop on aspects of management led by academics in management since 2009 a junior course has been held annually mir provides a forum for education and exchange of ideas and state-of-the-art concepts on management within europe aimed at enhancing the contribution of radiology to medicine the current head of the management subcommittee of the professional organisation committee professor peter mildenberger from mainz germany said that he expected that some hot issues in 2011 ­ such as reporting ­ will continue to be aired this year other subjects will be new on the agenda or resurface such as radiation exposure and examination management error registries leadership training and coaching of radiologists 7

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view report maasstad hospital rotterdam dutch hospital s paper-free healthcare environment the maasstad hospital in rotterdam is an ambitious forward-looking centre of healthcare adopting innovative approaches to medicine and treatment of patients yet it has gone beyond many other hospitals in the way it has embraced new technology a partnership between visus and dutch system-integrated-solution firm alphatron has enabled it to benefit from advances in it to achieve an environmentally-friendly goal that many other healthcare institutions still aspire to as hospitals have embraced new systems and new technologies in recent years one of the great goals is to achieve a totally paper-free environment those advances have seen reports being available to be read in a digital format on-screen imaging is now available onscreen whenever and wherever the clinician requires it and there is rapid exchange of imagery data and information between authorized users many hospitals are getting very close to the sought-after paper-free goal and many more are continually striving to achieve a totally paperless environment but one unit that has been successful in reaching that landmark is the maasstad hospital in south rotterdam in the netherlands so that means no more paper he said we are completely digital there may be some paper ­ there are always people that like to print something from their e-mail ­ but we can do everything without paper while that is a clear technological milestone that has been passed it is also an advance that has positive implications for the wider global environment in terms of sustainability he said that everything is now in jivex with something like 1.3 million images currently stored in the system in the widely-accepted dicom standard achieving full potential from investment in technology working with alphatron jivex and visus to ensure that the full potential was realised from its investment in the technologies maasstad hospital has developed the `tree structure which consists of three basic elements documents investigations and archive below that are further easily identifiable and accessible structures containing all documents and images and enabling doctors to easily trace and retrieve a specific image whenever they require it right across maasstad hospital which is a large general hospital with a diverse patient population it sees about 400,000 patients a year in its numerous clinics offering a wide range of medical care covering virtually every specialty with a number of basic and special functions for complex specialist clinical care the maasstad hospital has a specialist burns unit a dialysis center heart center and hiv/aids treatment center in addition it has a level iii intensive care unit and also offers perinatal care and ivf treatments the hospital runs three separate technical systems the hospital information system containing all the written information an existing pacs for its radiology imaging and reporting and jivex pacs ii for all other departments `no more paper this has been achieved with the crucial and innovative support of the jivex pacs ii solution supplied by dutch systemintegrated-solution providing company alphatron which has established close links with visus since 2005 the pacs ii solution has been installed for the whole hospital meaning a pacs facility is available for all the pictures from units ­ such as surgery intensive care cardiology and the laboratories ­ apart from radiology which has an existing pacs maasstad hospital has more than 600 beds and 26 different departments and all are connected through jivex pacs ii all data that comes in from doctors such as reports and imagery are digitalised and go into the jivex pacs ii system explained maurice rijnen who is the team leader internal desktop support service desk and team leader of technical application and database management in the department information and communication technology at the hospital 8

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view report maasstad hospital rotterdam maurice rijnen team leader internal desktop support service desk and team leader technical application and database management in the department information and communication technology open access to pacs as with any hospital or healthcare unit there are standard operation procedures to decide who has access to the data these protocols have been developed at maasstad hospital between ict and the medical board via the his a clinician can click on jivex pacs ii and have all images and documents that are digitalised ­ and not from radiology ­ at his disposal one of the impressive benefits of jivex is that it connects to all modalities and communicates easily with existing systems and those from other manufacturers mr rijnen said these and a number of other specific confidential areas remain accessible only to those staff with particular authorisation but apart from that the hospital operates a relatively open access system to pacs with a log-in for every authorized use and transparent user traceability features to control this these and a number of other specific confidential areas remain accessible only to those staff with particular authorisation but apart from that the hospital operates a relatively open access system to pacs with a log-in for every use and transparent user traceability features with the development of the `tree structure and education and training for staff maasstad hospital is now beginning to see the full benefits of the jivex system and see it achieve its full potential as the hospital embraces the paper-free care environment the hospital brought in the jivex pacs towards the end of 2009 and went totally digital in may 2011 after an implemen it experts at the heart of paperless hospital 9

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view report maasstad hospital rotterdam tation period with the system operating fully the addition of images to jivex is soaring on a daily basis mr rijnen said we now sit on an average of 4,000 to 5,000 images per day which we are putting into the system we also have an ecg management system with all the cardiologists using the jivex with authorisation the next step for the hospital is to update its radiology pacs and allow greater access and archiving of older images as well as quicker retrieval at present there are five companies that are in the race to supply that pacs mr rijnen said that is one of the big issues we are facing at present you need to have confirmation from the patient that the hospital can share their images with outside units or `with only this doctor or with only this hospital the problem is how do i make a system that has that intelligence that knows `this picture you can share with everybody but this picture you cannot share however it is an issue that is being actively discussed in the wider healthcare context within the netherlands at present and steps are being taken to try to address and overcome the obstacles for the benefits of patients and clinicians once addressed maasstad will be able to use the full potential of jivex to easily exchange images challenges over exchanging images one area that maasstad hospital is particularly keen to improve its performance on is the facility for exchanging images with other hospitals and units elsewhere in the country at present the options are relatively limited either via the internet with limited authorised access or encryption or the less attractive option of burning the images onto a cd and sending them on to the relevant clinician or unit with the inevitable risks that the data may potentially get lost along the way another issue within the netherlands ­ and one beyond the jurisdiction of the hospital and any advances in technology ­ are regulatory restrictions currently in place in the country on sharing information and images with other hospitals leading the way with innovation maasstad hospital is an ambitious and forward-looking hospital equipped with the latest technologies and is striving to become one of the leading hospitals in the netherlands by offering a high level of professional skills from its staff and clinicians introducing the latest technological advances and maintaining an important concentration on customer focus it is set in a unique location with the hospital site also incorporating the so-called care boulevard which includes numerous related health-care facilities across a gross floor area covering 132,000 square metres some 84,000 square metres of this area is taken up for the hospital site which is surrounded by other health activities that are either directly or indirectly linked with the activities of the hospital these include a psychiatric center rehabilitation centers and a gp care hotel but already the maasstad hospital is proving that it is leading the way in innovation and technology with its achievement in managing to reach the level where it is operating in a paperfree environment that has been supported by visus working with alphatron to successfully implement the jivex pacs ii system in a hospital that has a drive and determination to offer the highest levels of care in a technologically-advanced and environmentally-friendly way 10

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alphatron view report visus and alphatron link up to offer hospital imaging solutions medical innovations puter with an eight-hour battery that adapts to the need of the nurse with caps needle container and a medication box to dispense the pills to the patient visus enables niche opportunity alphatron medical systems is also providing software solutions such as pacs through visus to about 15-20 of hospitals in holland the dutch market is well advanced in it terms with radiology already covered in terms of pacs but alphatron has found a niche through the link-up with visus which began in 2005 after seeing its pacs solution hospitals need their equipment to work efficiently and effectively but sometimes require expert advice and support to help them achieve the best results dutch system-integrated-solution providing company alphatron has emerged as specialists in this area but has recognised the expertise visus offers through the jivex concept and the role it can play in benefitting hospitals and healthcare organisations mr verloop added to have a solution which unifies radiology images surgery images pathology images endoscopic images and ecg data and to come up with one view is happening right now it all goes into a pacs and for that pacs we have used visus since 2005 we call it pacs ii jivex offers flexible solution alphatron manager product group pacs patrick zondag said hospitals already have an existing radiology pacs ­ often from another manufacturer ­ with the jivex system serving all other departments such as cardiology orthopaedics surgery and pathology but the two systems still communicate effectively with each other alphatron offers jivex software to store and file the images in the dicom format linked to the epr for retrieval by authorised users at any place and at any time mr zondag said a surgeon who wants to see the solution from pacs ii can do so as can the radiologist who wants to see images from outside the radiology system images from both systems are available on one screen in one application in a secure environment with visus capable of putting both elements together getting the most out of existing technology based in rotterdam alphatron has divisions in shipping marine communications security and broadcast technology as well as medical systems director harald verloop explained the core business of alphatron is that we use mostly existing technology and try to adapt that to the user in a more convenient user-friendly way with a flat management structure which keeps the customer close to the development and manufacturing process alphatron can quickly and efficiently adapt a solution to the customer s needs solutions for healthcare settings it provides hardware solutions such as medical work stations desks and computers with healthcare-oriented characteristics to 80 of dutch hospitals installing them in operating theatres intensive care units and nursery departments where there are electrical safety ergonomics and hygienic considerations in november alphatron introduced the totally new concept of the mobile care station for the nurse ­ a wireless com harald verloop l director patrick zondag manager product group pacs 11

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view report koskiröntgen nordic by nature ­ jivex the work horse of finnish radiology timo vainio systems specialist at koskiröntgen juha seppälä managing director at koskiröntgen in a medical environment things have to run without a hitch this holds true for public healthcare facilities and even more so for private institutions that are deliberately chosen by the patients well aware of the complex needs and requirements of their customers the radiologists at koskiröntgen the largest private radiology practice in finland located in tampere chose only topof-the-line equipment with regard to pacs they opted for visus jivex which is distributed by onemed oy the finnish market leader for medical equipment koskiröntgen is closely connected to koskiklinikka oy a private clinic and obviously there is a lively exchange of patient data between the two institutions which makes a stable and comfortable pacs connection essential koskiklinikka is not the only institution that uses our radiological service but it is definitely our closest partner we also provide examinations for public hospitals and other private clinics two of which have access to our pacs archive says dr matti lehto medical chief officer at koskiröntgen altogether the team performs almost 35,000 examinations per year 6,000 mri scans 3,500 mammograms 4,000 ultrasound diagnostic exams and 21,000 x-ray exams both dr and cr back in 2003 the team started to look for a suitable pacs solution with the goal of going digital a koskiröntgen team visited several hospitals to compare systems and observe them in real life situations since at that time onemed had already been a reliable visus partner for years jivex was a contender from the very beginning and the one that by the end of the day turned out to be the best the system was implemented in 2004 it is integrated in the patient information system and the ris which was bought later the system was stable from day one and continued an uptime of more than 99 percent reports timo vainio systems specialist at koskiröntgen timo by the way is the only person taking care of the in-house jivex maintenance he is impressed by the system s reliability ease-of-use and workflow friendliness equally important for timo onemed and visus provide exceptional service last autumn koskiröntgen implemented a system update that pushed the team into the pacs ii era today also non-radiological data can be managed and archived this is important for our colleagues from koskiklinikka who have a lot of ecg data videos from endoscopy or jpg files from dermatology to be stored thanks to the integration into the pacs handling of these data has become much more convenient because we do not have to deal with separate systems moreover patient administration is easier and safer now matti letho points out koskiröntgen onemed oy and visus are a trio in perfect harmony because they share the philosophy of providing the best possible service in every environment dr matti lehto medical chief officer at koskiröntgen 12

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one med view report onemed oy one partner many advantages it is the visus philosophy to cooperate with strong local partners in the international business in finland visus chose onemed group to distribute the jivex product portfolio the leading supplier of medical supplies equipment and services in the finnish market has been working with the bochum-based pacs specialist since 2002 a perfect match says tapio teppo business unit director medical equipment at onemed as it offers his company the possibility to provide their customers with comprehensive state-of-the-art solutions onemed oy has two business units medical supplies and medical equipment and services our medical imaging sales team one of our three sales teams in the medical equipment and services division takes care of the visus products says teppo explaining the position of the jivex range within onemed during the last ten years pacs has become an integral part of the product and service portfolio offered by onemed which includes products from the leading brand manufacturers as well as high-quality own-branded products while the primary care division covers protection and wound care sampling and self-care the acute care division covers anesthesia sterilization and surgery in finland and the baltic countries the acute care division also provides equipment for anesthesia imaging and diagnostics from many renowned manufacturers onemed group was formed between 2006 and 2009 by combining six companies that were operating in the medical supplies market in the baltic sea region additional acquisitions have grown the group to its current leading presence in the northern european markets in 2010 onemed was the leading medical supplies company in northern europe with sales of approximately eur 380 million and approximately 660 employees the company operates in thirteen countries around the baltic sea and in eastern europe finland sweden norway denmark poland estonia latvia and lithuania czech republic and slovakia its customers include hospitals health centers senior citizen facilities home care and private healthcare operations while the suppliers are international and local manufacturers of medical supplies and equipment onemed group serves healthcare professionals and their patients with reliable top quality products and services that make the healthcare process safe efficient and comfortable so does visus ­ a major reason why this partnership is more than efficient 13

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view lack of radiologist in europe radiology facing recruitment challenges across europe across europe radiology is at a critical point in terms of recruiting new people to the profession in some countries it is already accepted that there is a shortage of radiologists while in others the problem exists in particular subspecialties elsewhere forward-thinking recruitment better workforce planning and pro-active attempts to make the profession more attractive have been taken to try to avoid shortages while a number of factors have been pinpointed as the cause of shortages ­ a gap between trained radiologists joining the profession and those retiring greater demands on the radiologist s time and increased demand for radiology services ­ this has been countered by advances in technology and through teleradiology there are also geographical variations a european society of radiology esr survey in 2007 showed an average of 104 radiologists per one million population in europe but this number varied from 15 to 215 professor malgorzata szczerbo-trojanowska chair of the department of radiology and head of the department of interventional radiology and neuroradiology at the university medical school in lublin poland said the workload imposed upon radiologists is growing faster than new specialists enter the field therefore it is becoming difficult to meet workload demands she said there are various reasons for the shortages one of the main reasons is the development of new imaging technologies and their central position in the diagnostic workup another is with imaging procedures increasingly split up into additional areas such as molecular cellular genetic or functional applications she added nearly 70 of those imaging procedures performed by today s radiologists did not exist 10 ­ 20 years ago introduction of new imaging technologies incited a great demand for radiological services statistics show that the numbers of imaging procedures performed are increasing about 10 every year more shortages are anticipated triggering concerns that radiology departments may be unable to provide some services because of the lack of personnel as most diagnostic and therapeutic procedures involve radiology there are concerns that could lead to longer hospital waiting times it is recognised that it can never totally replace the role of the radiologist but in times when many hospitals and health systems are under financial constraints ­ and struggling to recruit radiologists ­ new technology it and telemedicine have a clear and important role to play improved it tools are improving the quality of radiological service enhancing its efficiency and accelerating workflow and offering solutions through pacs computer-aided diagnosis or speech recognition software these save time for the radiologist and also help speed up access to images and allow them to share them with col 14

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view view leagues remotely if a second opinion is needed particularly in a specific area of expertise that is not available in-house the shortage of radiologists has seen more hospitals use remote radiology services to overcome specific difficulties teleradiology centers can provide services to many hospitals using the internet to exchange diagnostic images in this way they improve patient care by interpreting radiology cases quickly and efficiently around the clock but there must always be safeguards and the esr is anxious that teleradiology remains defined as a medical act and the clear responsibility of the radiologist professor szczerbo-trojanowska stressed the primary goal of teleradiology is not to create new business opportunities but to improve the quality of services to alleviate staff shortage and most importantly to improve patient care by referral for a specialist judgment professor malgorzata szczerbo-trojanowska chair of the department of radiology and head of the department of interventional radiology and neuroradiology at the university medical school in lublin in addition to it and teleradiology several other approaches have been advocated to cope with the shortage ­ from more advanced training for radiographers to allow them to perform routine procedures usually performed by radiologists along with improving rewards for radiologists in terms of salary training and incentives encouraging residents to choose radiology national radiological societies are actively attempting to attract more young people to the discipline norway for example has introduced a mandatory national training programme and offers free attendance at national radiology meetings as well as taking positive steps to maintain high job satisfaction among new recruits with relevant support and mentoring some parts of europe are seeing senior radiologists retire without enough coming through the training system to replace them in the uk senior radiologists believe that sufficient radiologists are being trained but some consultant vacancies are not being advertised by hospitals for cost-saving reasons problems have also arisen in recruiting to some subspecialties ­ the uk for example has a particular shortage of pediatric and interventional radiologists but it is technology which has significantly advanced the role of radiologists in recent years it has added new dimensions and modalities to the discipline and helped offset increasing workloads ­ at a time the radiologist is a scarce commodity ­ while improving the service patients receive 15

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