EFSUMB Newsletter Meets Greece

Table of Contents

• Population: 11 million

• Capital City: Athens

• EFSUMB members: 53

The interview with representative from the Hellenic Society for Ultrasound in Medicine and Biology Dr. Pavlos S. Zoumpoulis, MD, by Chairman of EFSUMB Publications Committee Professor Michael Bachmann Nielsen took place in September 2010.

Dr. Zoumpoulis started working with ultrasound in the early 80‘s: "A young enthusiastic radiologist, after four years internship in Athens‘ hospitals feels that something is changing in Radiology and starts writing letters in order to find his way through the "new era of Radiology" he feels coming. He wrote many letters to USA, British, Scandinavian and French Universities and Hospitals. Many responses came. A proposition for a radiology resident post attracts his interest: it proposes training in Ultrasound in Hotel Dieu hospital, in Paris.” Today his main interests are ultrasonography of the liver (including elastographic studies with different types of equipment), US of the prostate, breast and thyroid, guided biopsies and musculoskeletal US.

The Parthenon, Athens completed in 432 BC.

How Ultrasound is Organized in Greece

Both public and private health sectors are developed in Greece and ultrasound has an active role in this development. "The public sector is under-equipped: most of the US machines are installed in radiology and cardiology departments in public hospitals and fewer machines are installed in gastroenterology and urology departments. Those machines are in the large majority old, dating from the 90‘s or even the 80‘s. The status of the sonographer does not exist in Greece, but there are some sonographers, mainly in the OBGYN and vascular fields with education from the UK or USA. The educational level of doctors practicing ultrasound (US) in the public hospital is good, because US takes part of the teaching and practical skills in every specialty having to do with ultrasound.”

"The private sector is, on the contrary, over-equipped: many new and "big" US machines are in the hands of gynaecologists, cardiologists and radiologists. Gynaecologists have recent 3D machines in the flourishing obstetrical clinics or in private practices. Radiology and imaging departments are the main source of income for the different size – and quality – private Diagnostic Centres all around Greece. During the last 10 years many endocrinologists, gastroenterologists, GP‘s, urologists and recently orthopaedics and rheumatologists are involved. Most of the "newcomers" are autodidacts and ensure by their own means the renewal of their US skills with short refresher courses in congresses or visits to specialized centres, mainly in Europe.”

The economic crisis is hurting heavily the public and the private health sectors: fewer investments, loss of jobs, lowering of prices. The ultrasound community is not excluded. "Most of the private diagnostic centres base their resources on the public-controlled health insurance organizations. Public institutions are heavy, bureaucratic and unable to establish health strategy which imposes large diminution of reimbursement prices of ultrasound acts. Public institutions even stop paying many popular US examinations as cardiac US, carotid, thyroid and breast colour Doppler exams. As a result from such restrictions many diagnostic centres are lowering-down activity or even closing. The public sector ultrasound departments, which are over-used and under-equipped, are unable to accept the augmenting demand of US acts: schedules are over-booked and basic rules of quality of services and exams are not respected.”

The Newsletter: HSUMB-Echo

The re-organized Greek Society of Ultrasound (HSUMB) continues the educational activity of the Ultrasound Network (Echonet) – a private-owned network of professionals in ultrasound. Echonet published in its bi-monthly bulletin in a form of Newsletter, of all scientific, educational and commercial activities in the field of Ultrasonography, called "Echonews". The re-edition of Echonews is going to be a digital (non printed) edition via the website of the Society http://www.hsumb.gr.

US Training in Greece

Every doctor aiming to exercise ultrasound has to follow a 6-month training course in a public hospital‘s US department of his specialty and pass through an oral examination organized by the Ministry of Health. The HSUMB has not until now organized official training courses. Echonet has organized series of US theory and training courses: US of Abdomen, US of Pelvis, US of the Prostate and TRUS, US of the Thyroid and US guided FNA, Musculoskeletal US, US of the Breast and US guided procedures.

The educational activity of the Society is only organized during the national Congresses and Ultrasound Meetings. The last congress was in 2008 and the last US Meeting happened in January 2010, entitled "Ultrasonography Today" focused on Elastography.

Pavlos Zoumpoulis (left) with Pl Kehagias coordinating a session at the Congress US Today.

HSUMB Website

The website of the Society – http://www.hsumb.gr – is publishing the "Case of the day" and offers free access for its members to a database of interesting cases, organized by organ and pathology.

"I observed the progress of the European Textbook of Ultrasound project in the EFSUMB website and shared with the members of the HSUMB your invitation to participate”, Dr Zoumpoulis adds.

Courses and National Congresses

The HSUMB is planning to organize a EUROSON School in Athens on 2011 on Musculoskeletal US and USCA in order to start following EFSUMB guidelines and address education and training to different levels of competences.

The last national Congress was in 2008. "We are planning the next Congress for 2011. Last Congress was a meeting of 1400 colleagues from Greece and had a few delegates from Albania, Serbia, FYROM and Cyprus”, Dr Zoumpoulis says. That Congress succeeded in gathering colleagues from all specialties dealing with US. The main body of participants was radiologists, gynaecologists and gastroenterologists. The Congress was also financially equilibrated and succeeded in rebalancing the finances of the Society. "We did not succeed however to consolidate relations with inactive and "lost” members of the Society during and after the Congress.”

Conflict Between Medical Specialities

"We had a long and difficult pathway in order to establish solid scientific and professional connections with all medical specialties dealing with US. For many years US was rather a point of professional conflict of interest between radiologists, on one side, and other specialties, on the other side, instead of a point of educational and professional point of cooperation and communication. The Greek Society of Ultrasound was one of the victims of this confrontation. Radiologists were excluded from the Society. The reunion is not. Recently a more long-term strategy connects the members of the multidisciplinary Board of the Society.”

There is no official status of sonographers in Greece. The large number of cardiologists and gynaecologists working with US are organized in a well structured section of the Greek Cardiological Society and in a specialized and active Society for US in Obstetrics and Gynaecology.

The Future

Dr Zoumpoulis: "We try to be realistic and design the future of the Society in connection with the evolution of Ultrasound and in coordination with EFSUMB. In front of the question of starting editing and publishing a Greek Journal of Ultrasound, we decided to concentrate our resources and efforts towards an active participation to the European Journal of Ultrasound. We are also interested in the Case studies launched by the website of the EFSUMB. The EUROSON School in 2011 will be an occasion of restarting educational activity and establishing connections with old and new members of the Society.”