Throughout 2021, the healthcare news in Europe largely resembled the news in the United States, which is to say COVID-19 defined everything. Still, from a business perspective, we saw a range of significant, non-pandemic, developments.

OEMs forged new partnerships, embarked on expansions, and constructed new facilities, mergers and acquisitions reshaped the power dynamic of the industry and new research pointed toward a future where care can be delivered faster and more economically.

There’s a lot to unpack, but here, in chronological order, we present the 10 biggest European radiology stories from our Daily News online. These were chosen by a combination of reader engagement and industry impact. To stay up to date on these current events as they happen, be sure to sign up for our free weekly European Newsletter.

Mobile stroke units improve survival rate for German hospital
Deploying mobile stroke units may give patients a greater likelihood of surviving and avoiding long-term disability.

That’s according to a new study out of university hospital Charité – Universitätsmedizin Berlin in Germany which, in February and for the first time, was able to link mobile stroke units to improved clinical outcomes.

Heinrich Audebert, of the Center for Stroke Research Berlin (CSB) and Charité's department of neurology and experimental neurology led the team that introduced the mobile units, known as STEMOs (Stroke-Einsatz-Mobile), to the streets of Berlin, with the first one launched in February 2011. Years of research showed STEMO-based stroke treatment to be safe and that it reduced time to treatment, which is crucial, as every minute counts after a stroke.

"Apart from normal ambulance stuff, STEMOs are equipped with a CT scanner and point-of-care laboratory. They are staffed with a neurologist trained in emergency medicine, a radiology technician and a paramedic. This enables the STEMO crew to complete a stroke workup directly after arrival at the scene and start thrombolysis before transport to hospital," Audebert told HCB News.

Known as the B_PROUD study, the evaluation looked at stroke emergencies in Berlin from between February 2017 and May 2019. A total of 749 cases out of 1,543 cases were treated in a STEMO (49%), while a conventional ambulance cared for patients in 794 cases (51%). The odds of patients incurring significant disabilities three months after stroke dropped by 29% if treated in a STEMO, according to the study.

The Berlin Fire Department operates three STEMO vehicles today. Through a collaboration between between Charité, Vivantes – Netzwerk für Gesundheit GmbH and Unfallkrankenhaus Berlin, these units cover most of the Berlin area.

The study was published in JAMA.

Shortage of nearly 2,000 radiologists hinders care in UK
In April, we reported that a 33% shortage of radiologists in the U.K. has left patients waiting in long lines to be scanned.

And it’s only projected to get worse by 2025 with a 44% shortfall, according to a Royal College of Radiology census, which estimates a need of 1,939 more radiologists in the NHS to meet pre-COVID-19 demand for scans.

Exacerbating the shortage is the departure of doctors who stayed on at the height of the pandemic, with 58% of hospital leaders saying they lack enough diagnostic and interventional radiologists to keep patients safe. In addition, 47% of NHS trusts and health boards report not having the staff or transfer arrangements to run safe 24/7 interventional radiology services.

While consultant numbers are increasing, they are not doing so fast enough, with waiting lists at record highs and backlogs for exams, such as MR and ultrasound, leaving thousands of patients waiting more than six weeks for a scan, according to the NHS. Stricter infection control and social distancing measures brought on by the pandemic have also made scanning slower.

RCR says radiologist staffing is at a “tipping point,” with the shortage threatening NHS recovery and patients facing “long, anxious and inevitable” waits for diagnoses and surgery.

Making matters worse is a poll of 1,089 radiology consultants in April that found 41% feeling moderately or severely demoralized in their jobs and 48% planning on working less after the past year. A fifth are considering leaving the NHS, while 12% are considering leaving in the next 12 months — a potential loss of 735 consultants and trainees nationwide.

To meet demand, the number of new radiologists being trained in the U.K. would have to triple from 300 to 900 training places annually, according to RCR.


Philips, CNIC partner to dramatically reduce cardiac MR acquisition time
Philips and the Spanish National Center for Cardiovascular Research (CNIC) teamed up in June to develop a new protocol that could make cardiac MR exams as short as a few minutes.

The technique, Enhanced SENSE by Static Outer-volume Subtraction (ESSOS), is expected to increase the viability of cardiac MR by improving patient comfort with shorter scan time, while still obtaining the same parameters as the usual technique. The approach reduces the time spent inside the machine by more than 90%, and decreases the need to have very experienced operators, something which could be relevant for nonacademic hospitals.

"We see this technology specifically valuable to characterize structural damage to the heart, its function after myocardial infarction, and whether the heart can be fully repaired," Dr. Borja Ibáñez, director of the Clinical Research Department of CNIC, Cardiologist at the University Hospital Fundación Jiménez Díaz, and clinical leader of this work, told HCB News.

In just over 20 seconds, the shape and function of the heart can be acquired with the approach, as can the degree of fibrosis after cardiac muscle death in another 20-second acquisition. This enables the cardiac study to be completed in less than a minute.

A patient simply holds their breath during an MR scan so that everything within their chest remains static, except for the beating heart. ESSOS allows clinicians to capture an image of the static outer volume part, only for this data to then be temporarily removed. The MR signal of the beating heart can now be more easily subtracted from subsequent scan data, and allows for up to four times faster acquisition of a 3D image of the heart, with a net acceleration factor of up to 32.

British researchers label over 100,000 MR exams in under 30 minutes
In July, researchers in London announced they had devised a technique to label more than 100,000 MR exams in less than 30 minutes.

The group at the School of Biomedical Engineering & Imaging Sciences at King’s College London automated brain MR image labeling to teach machine learning image recognition models to identify and accurately assign important labels from radiology reports to corresponding MR exams.

"By overcoming this bottleneck, we have massively facilitated future deep learning image recognition tasks and this will almost certainly accelerate the arrival into the clinic of automated brain MR readers,” they wrote. “The potential for patient benefit through, ultimately, timely diagnosis, is enormous."

Senior author Dr. Tom Booth and his colleagues evaluated model performance on unseen radiology reports as well as on unseen images. The latter of these tasks has been a challenge, he says, due to the enormous team of radiologists required.

The study adds further insight on recent breakthroughs in natural language processing, including the launch of larger transformer-based models such as BERT and BioBERT. Both have been trained on huge collections of unlabeled text such as all of English Wikipedia and all PubMed Central abstracts and free articles.

In addition, the authors say the elimination of manually labeling large numbers of MR exams will allow radiologists to focus on other challenges, such as the need to perform deep learning recognition tasks that also have multiple technical challenges. Once this is achieved, they can work to ensure the developed models still perform accurately across different hospitals with different scanners.

The researchers have made their code and models available to other researchers to ensure that as many people as possible can benefit from the work here."

The findings were published in European Radiology.


Northern Ireland identifies major discrepancies in 13,000 CT exams
A hospital in Northern Ireland announced in August that it had identified major discrepancies in a review of 13,030 radiology images analyzed by a temporary consultant neuroradiologist.

Following concerns raised by the General Medical Council about the radiologist’s work, the Northern Health Trust commissioned the review, which required it to notify 9,091 patients. It is the largest recall of patients in Northern Ireland and has so far affected 12 cases, according to BBC News.

"We believe there may be a number of patients who have died as a result of this, but we are not sure at this moment in time if they died as a result of a failure to diagnose something or not,” Dr. Seamus O'Reilly, medical director at the Northern Trust, told BBC Radio Foyle Wednesday.

The images were taken at Antrim Area, Causeway, Whiteabbey and Mid Ulster Hospitals as well as the Ballymena Health and Care Centre. The doctor worked at these facilities between July 2019 and February 2020, according to the Belfast Telegraph. O’Reilly says it is his understanding that she is no longer working with the National Health System (NHS).

About a fifth (2,434) of the images had been assessed by the time of our story. The discrepancies concern categories the doctor assigned to the scans, according to O’Reilly. "Most of these concern CT scans where inaccurate initial reading of the scans could, or is likely to, have had an impact on the patient's clinical treatment and outcome.

The most concerning images are the ones categorized as level one and two. Level one refers to a major discrepancy that has immediate and significant clinical impact, while level two concerns a major discrepancy with probable clinical impact. Of the images reviewed, 12 had been identified as level one and two.


Hyperfine to expand reach to UK and Pakistan
Hyperfine announced plans in October to bring its portable MR imaging system, Swoop, to European and Southern Asian shores with company expansions planned in the U.K. and Pakistan.

Equipped with a .064 Tesla magnet, Swoop has a lower field strength than standard MR systems, which shortens screening protocols and eliminates comprehensive metal detection to speed up scanning and diagnosis.

The U.K. and Pakistan are part of Hyperfine's plan to expand to four additional countries within the next six months. Helping it in Pakistan is Medequips, a company that provides hospitals and clinics with diagnostic imaging equipment and has agreed to market, distribute and sell the Swoop system there.

Swoop is designed to be wheeled to patient bedsides in hospitals, clinics and other settings outside of conventional MR suites to assess brain tissue in real time and help physicians make quick and informed clinical decisions.

“Expansion to the U.K. and Pakistan is a milestone moment and tremendous opportunity as we step forward to meet the global demand for better imaging access and ultimately drive a more comprehensive and efficient care continuum,” said Dave Scott, Hyperfine president and chief executive officer, in a statement.

Heading British operations will be Dr. Yossi Cohen as Hyperfine’s U.K. senior medical director. He will oversee clinical operations, commercial operations and regulatory activities related to Swoop installations. Cohen brings 20 years of multidisciplinary experience in medicine, research, engineering and software development.

Omer Manya will serve as business development partnership manager for the Pakistani region, where he will help boost the adoption of the swoop system. He has spent decades working in research and development in healthcare and other sectors, with his most recent position as IT director of infrastructure and operations at Aga Khan University in Karachi.


One-third of NHS trusts in England using scanners over 10 years old
About a third of NHS trusts in England are scanning patients with “technically obsolete” imaging equipment dating back more than 10 years, according to a report from last October.

Of all trusts in NHS England, 27.1% said they are still using at least one CT scanner that is 10 years old or more, and 34.5% said they have at least one MR system that is the same, reports The Guardian. The use of these systems goes against the advice of an NHS England report published last year that recommended that all imaging systems 10 years or older be replaced. This is because software upgrades may not be able to be installed on this equipment, or because older CT scanners may require higher radiation doses to produce the same image. Additionally, their use may pose risks to patients.

The issue was made public by the British investigation TV program Dispatches, which learned about it through freedom of information requests. Among the trusts identified are King’s College hospital NHS Foundation Trust in London, Royal Berkshire NHS Foundation Trust, Royal Cornwall hospitals NHS trust, and Chelsea and Westminster hospital NHS Foundation Trust. Notable standouts were London North West university healthcare NHS trust, where half of the MR systems are 16 years old, and Great Ormond Street Hospital Trust, which has been using an MR scanner for 21 years. In addition, Dispatches found X-ray equipment within the NHS dating back to the 1970s, 1980s and 1990s.

“We have backed the NHS with £525 million (more than $722 million) to replace diagnostics equipment over the last two years and have recently set up 40 new one-stop-shop diagnosis centers in the community to deliver 2.8 million more scans for patients across the country,” a spokesperson for the department of health and social care, told The Guardian.

Siemens constructs €350 million imaging component facility in Germany
In October, Siemens Healthineers announced it had built a 57,000 square-meter High Energy Photons Center (HEP) in Forchheim, Germany for €350 million (~$400 million). The facility, which is scheduled to go into operation in 2023, will become the site of production, research, development and logistics for X-ray tubes and generators used in its medical imaging scanners.

It is the largest single investment in new construction made by Siemens Healthineers, and the components from the center will be the primary parts in its CT, angiography and X-ray equipment. The factory will have highly automated equipment to reduce production costs, increase product quality and have space for further expansion.

“With the High Energy Photonics Center, we are now creating one of the most modern and sustainable facilities for the development and production of medical technology components in Europe and beyond," said Bernd Montag, CEO of Siemens Healthineers, in a statement. "As a global company, this milestone in our history also underlines our commitment to Germany and Bavaria as a technology center,"

The HEP center will be the first Siemens Healthineers factory with a complete end-to-end digitalization approach for the entire life cycle of each product. The development department will create a digital twin for each solution and transmit the data into production. This will save on cost, quality and transparency and optimize the entire manufacturing process.

The building is the size of eight soccer fields and offers space for around 700 workplaces. It is designed with a specially developed energy concept that enables it to be almost CO2-neutral.

The previous month, Siemens invested $32 million stateside to boost manufacturing at its Glasgow Laboratory Diagnostics Manufacturing Facility in Delaware for its diagnostics supply chain.

Affidea acquires Medicentro in Spain and Hillsborough in Northern Ireland
Affidea, the largest European provider for medical imaging and outpatient care, acquired Medicentro in Spain and Hillsborough Private Clinic in Northern Ireland in November.

With both organizations, Affidea’s reach now extends to 312 centers across 15 European countries, and provides more than 10 million patients it sees annually access to over 11,200 professionals.

The deals follow five others completed by Affidea in 2021 alone. In Spain, patients under Affidea will have direct access to multispecialty private healthcare service at Medicentro. In Northern Ireland, Hillsborough offers patients a range of outpatient surgical procedures, as well as access to numerous specialties.

"The acquisition of Medicentro in Spain signals the entry of Affidea in the ambulatory service market which will be the area of focus in our strategic inorganic development in the following years, while in Northern Ireland we have already established a strong and resilient network of outpatient and diagnostic imaging services through the addition of Hillsborough and Orthoderm clinic, which was acquired earlier this year," Affidea CEO Giuseppe Recchi told HCB News.

Medicentro and Hillsborough both add an extensive range of specialty consultations, blood collection points and same-day surgery procedures that align with Affidea's core business of diagnostic imaging. With the company's integrated service model and these two new additions, patients will have faster and easier access to care, says Recchi.

The two deals follow other recent expansions the company has made in Italy, U.K. and Croatia, and are two of 17 acquisitions it has completed in the last 24 months. In that time, it has expanded its network with 43 new medical centers, most of them to support its outpatient offerings and complement its core business of diagnostic imaging. Since 2019, Affidea has acquired and integrated 85 medical centers into its network of outpatient and laboratory service providers, including facilities in Italy, Greece, Portugal, Lithuania, Romania, Croatia and the U.K.

EU gives Microsoft the nod for $16 billion Nuance acquisition
Following an investigation, the European Commission unconditionally approved Microsoft’s proposed acquisition of Nuance in December.

In its reports on the decision, the commission said the transaction would not raise competition concerns in the European Economic Area for transcription software, cloud services, enterprise communication services, customer relationship management, productivity software or PC operating systems.

Microsoft said in April it was looking to acquire Nuance for $16 billion – $19.7 billion, when including net debt in an all-cash payment, and integrate Nuance’s speech and conversation AI software into its Microsoft Cloud for Healthcare technology. It would enable the solution to automate note transcription for doctors and help accelerate the adoption of cloud-based AI tools among providers. The acquisition is considered to be the largest made by the company in years.

Both companies filed for approval from the European Commission’s competition bureau last month, and the regulator had until December 21 to approve the deal or launch a deeper investigation.

The decision not to block the deal comes just a little more than a week after the agency asked customers and competitors to write up concerns on if and how the acquisition would negatively impact their own businesses.

Nuance says it currently serves 77% of U.S. hospitals. In any of its deals, it can use customer data to advance its voice recognition systems. Since big cloud vendors do not have unrestrained access to customers’ data for research and development, acquiring Nuance offers Microsoft a unique opportunity but is a concern to some.

One concern was that acquiring Nuance would provide Microsoft with unrestrained access to customer data in the 77% of U.S. hospitals that Nuance serves. Another suggestion was that Microsoft could force its Office suite on Nuance customers if it were to package them together.

The U.S. Justice Department and Australian Competition Commission conducted their own reviews in June and October, respectively, but the EU review was the most extensive.