Professor Yi-Hong Chou is Chair and Professor of Radiology at Yuanpei University of Medical Technology and National Yang Ming University School of Medicine in Taipei City, Taiwan/Chinese Taipei. He will be presented with ESR Honorary Membership at ECR 2020.

Chou is the former director of occupational safety and health administration and chief of medical ultrasound and breast imaging at Taipei Veterans General Hospital. He has greatly helped to advance ultrasound imaging and raise educational standards across Asia and Oceania. He has also given impetus to developing relationships between European and Asian radiologists.

Professor Yi-Hong Chou from Taipei City, Taiwan/Chinese Taipei.

Chou is currently the Vice President of the World Federation for Ultrasound in Medicine and Biology (WFUMB). He is the former President and Chairman of the Education Committee of the Asian Federation of Societies for Ultrasound in Medicine and Biology (AFSUMB) and the Society of Ultrasound in Medicine of the Republic of Taiwan (SUMROC).

Chou is immediate past president of the Asian Oceanian Society of Radiology (AOSR), the Asian Society of Abdominal Radiology (ASAR) and the Asian Breast Diseases Association (ABDA).

Through his leadership roles across Asia, he has gained unique insight into how radiology has grown in the region. “Radiology in Asia is growing at a pace similar to the region’s economy and at present Asia represents one of the fastest growing economies in the world, partly because of China and India’s increase in regional GDP. The radiology societies of Korea and Japan are the most academically advanced societies in Asia and actively publicise their annual meetings via international media,” he said.

Value of ultrasound in Asia

Chou’s research interests have centred on ultrasound – especially in the breast – and abdominal imaging, as well as emergency radiology. He is currently focusing on clinical and experimental studies of various aspects of tumour vascularity with regard to Doppler techniques and microbubble contrast agents, and interventional techniques in tumour ablation.

“In my institution, elastography is routinely used in the evaluation of solid breast nodules and selectively used in thyroid nodules. Elastic imaging – ARFI or shear wave elastography – is selectively used for liver disorders. CEUS is almost routinely used in the treatment planning and monitoring of RFA procedures for hepatocellular carcinoma. CEUS is also commonly used in the differential diagnosis of focal liver lesions,” he said.

Radiology practise in Asia is facing challenges, with fewer industry partners conducting and contributing to new development in medical imaging and fewer educational opportunities than in the EU or the US, especially for young radiologists. There is also an increasing workload and subsequent shortage of radiologists in Asia.

In this context, working with ultrasound presents several benefits, because it is more widely available than CT or MRI, and it is cost-efficient in certain organ systems.Ultrasound is also easier to install in all settings, including remote areas with poorer access to healthcare.

“Some sonologists consider ultrasound the poor man’s CT. In less developed countries or areas, these physicians use ultrasound to solve most problems that are more commonly diagnosed with CT,” he said.

In Asia, ultrasound is generally performed by sonologists, i.e. physicians who are trained in ultrasound within a certain specialty or subspecialty, such as hepatologists, urologists, general surgeons, radiologists, paediatricians, etc. Ultrasound is performed by sonographers or radiological technicians only in some institutions.

Educational challenges

Chou has worked actively in scientific and educational programmes nationally and internationally, and has organised a number of international congresses, workshops and symposia.

A lot has been accomplished to improve education in the region, but much remains to be done. “There is a general growing demand in Asia to standardise radiology and ultrasound training, to establish structured clinical courses and assess competency according to well-defined and reproducible criteria,” he said.

The AOSR and the AFSUMB have set up the Asian Oceanian School of Radiology (AOSOR) and the AFSUMB Workshops, respectively, to enhance local initiatives and standardise quality, as well as the predictability of outcomes across all educational programmes.

“Standardised assessment of medical imaging diagnosis and ultrasound skills is particularly important in certain less developed regions or countries, where education is not adequately provided,” he said.

The AOSOR and AFSUMB Workshops have helped to raise the standards of radiology and ultrasound practice, with training opportunities for young radiologists and researchers.

The AFSUMB does not have its own diploma in diagnostic ultrasound, but it has been contributing on an on-going basis to educational efforts of affiliated national societies by providing qualified speakers, researchers and faculty for annual meetings and various symposia and workshops. The federation also provides scholarships for trainees.

“Some universities in AFSUMB member countries with advanced graduate medical education, such as Japan, Korea, and Taiwan, have established a hybrid curriculum with lectures, laboratories, and problem-based learning for medical school ultrasound-related education. For example, the integrated medical school ultrasound curriculum at the National Yang Ming University in Taipei provides ultrasound courses during the last two years of medical school. Some universities in Asia also provide students with short reference ultrasound scanning videos for independent review throughout their Objective Structured Clinical Examination (OSCE) courses. Ultrasound machines and some ultrasonographic simulators or phantoms are commonly available at these OSCE stations,” he explained.

All medical students in China are taught mandatory basic ultrasound at the beginning of their 5th year of medical school. Students will then complete a 3–6 month ultrasound curriculum during their first three years of clinical training at university hospitals, with the aim of acquiring the fundamental knowledge and skills to perform different ultrasound examinations, understanding the anatomy and pathology of different diseases on ultrasound imaging, and becoming familiar with the local ultrasound reporting system.

Improving the relationship with Europe

Extensive collaborative relationships have been built between Asian and European radiology communities in the past 15 years.

“More internationally renowned faculty have been invited to Asia by the AOCR, familiarising young radiologists in Asia with leading training institutions worldwide and motivating them to attend relevant educational activities at the ECR or other European conventions,” Chou said.

The ECR provides a very important international academic and clinical radiology exchange platform. Every year the ECR attracts many radiologist attendees from Asia and members from Asia accounted for around 30% of ESR membership in 2019.

“The ECR is now considered to be the most attractive international radiology meeting for young radiologists in Asia,” he said.

In recognition of his efforts to advance cooperation between the two continents, and radiology in Asia, Professor Yi-Hong Chou will be presented with ESR Honorary Membership at ECR 2020.