ESHNR Diploma

European Board in Head and Neck Radiology Diploma

1. Aim(s) and target group

The diploma first introduced by the European Society of Head and Neck Radiology (ESHNR) in 2009 is the common European qualification for head and neck radiology specialists and standardises training and expertise in head and neck imaging subspecialisation across Europe. The European Board in Head and Neck Radiology (EBiHNR) Diploma is endorsed by the European Society of Radiology (ESR), as well as by some national radiological societies.
The EBiHNR Diploma is a document certifying in-depth knowledge of the pertinent anatomy, pathology, clinical-radiologic and imaging-related issues in the field of head and neck and maxillo-facial radiology as defined in Appendix 1, going beyond the requirements included in the Revised European Training Charter for Clinical Radiology (European Diploma in Radiology, EDiR).
This diploma represents a recognised qualification in head and neck imaging subspecialisation and assists head and neck imagers in the promotion of their skills and experience when dealing with other clinical colleagues and with the general public.

The candidates are fully-trained, licensed and practicing radiologists
•    who have completed at least 5 years of general radiology training and
•    have a nationally recognised European radiology qualification diploma, the equivalent of an European radiology diploma or the EDiR.

2. Fee structure

Handling Fee Regular Examination:

•    400,00€ ESHNR Members
•    800,00€ ESHNR Corresponding Members

In case a candidate does not pass the EBiHNR Diploma, the candidate may apply one year later again, in order to re-take the examination. No reduced fee for re-examination will be granted.

3. Eligibility criteria

Eligible for the European Board in Head and Neck Radiology (EBiHNR) Diploma are radiologists who have:

  • completed at least 5 years of general radiology training and have a nationally recognized European radiology qualification diploma or the equivalent of a European radiology diploma or have the European Diploma in Radiology (EDiR)
  • who are members of the ESHNR and ESR for at least 2 subsequent years
  • no restriction on nationality and country of training
  • have a major interest in head and neck radiology and have attended at least 200 hours of structured postgraduate teaching as outlined in the requirements below and recognised by the ESHNR (Appendix 2)
    spent or will spend at least 80% of their clinical activity in the field of head and neck radiology for a minimum period of 2 years, as certified by the chairman of the department where they work. If a candidate wishes to take the examination before the completion of the required 2 years of training, he/she may do so during the second year of Level III training; however, the diploma in case he/she successfully passes the examination, will be awarded only upon completion of the minimum required period of 2 years.

4. Requirements

•    Acquired a total amount of 200 points by:

1. Attending two annual meetings of the ESHNR (recognition of 25 points per meeting resulting in a total of 50 points, compulsory for the diploma)
2. Attending different meetings (that cover the different sub-fields of the head and neck as described in the Appendix 2). The candidate has to attend certain meetings organized or co-organized by active members of the ESHNR and recognized by the Educational Board of the ESHNR. These meetings are in English or in other European languages. They include a variety of meetings, such as the ERASMUS Course on Head and Neck, the European School of MRI on Head and Neck, Leuven Course on Ear Imaging, Refresher Courses of the ECR and other courses (see Appendix 2). 
2. Presenting a paper/poster at the ESHNR meeting or by publishing a paper in a peer-reviewed journal as first author (a maximum of 80 points may be granted)
3. Attending the ESOR-ESHNR 3 months Exchange Fellowship Programme (100 points) 

•    Fulfilled the eligibility criteria, in particular document at least a 2 year training in head and neck radiology
•    Application form and requested documents should be provided to the ESHNR Office
•    Payment of the application fee

The examination takes place twice a year, at the annual scientific meeting of ESHNR and during the European Congress of Radiology (ECR). The examination consists of a written and oral part. Both parts have to be passed. The detailed instructions for the examination are included in Appendix 3.
The candidates will be examined by internationally recognised ESHNR experts and fellows of the ESHNR.

5. Examination structure

Written exam
•    Four types of questions:
………– multiple choice questions,
………– normal / normal variant versus abnormal
………– annotate the structures questions
………– short clinical cases
•    The written exam lasts 75 minutes
•    The topics that will be examined include normal anatomy, imaging techniques and pathologic conditions involving the :
………– petrous bone, the skull base and cranial nerves,
………– orbit and visual pathways
………– sinuses, the face and the deep spaces of the suprahyoid neck
………– oral cavity, the pharynx and the larynx,
………– the neck, including lymph nodes and its vasculature and the deep spaces of the infrahyoid neck
………– the salivary glands
………– the mandible and temporomandibular joints
………– the thyroid gland and the parathyroid glands, the thoracic inlet and the brachial plexus

Oral exam
•    45 minutes oral examination by two ESHNR experts
•    4 cases covering different fields will be presented to each candidate

The oral and written exam are both held in English
Candidate performance is scored using a standardized questionnaire and evaluation sheet
The candidate is expected to be able to describe the relevant findings and discuss them with the examiners, provide a differential diagnosis and discuss possible treatment options or further diagnostic tests. The most important part of the oral examination is that the candidate shows that he/ she is able to analyse the case appropriately and provide a suitable differential diagnosis.

6. Terminology

Successful candidates will be awarded the European Board of Head and Neck Radiology (EBiHNR) Diploma.

7. Application for the diploma

To apply for the diploma, the application form has to be filled out and returned to the ESHNR Office for approval by the Educational Committee. The ESHNR Office will confirm the receipt of the application and all required additional information once received.

The next European Board in Head and Neck Radiology Diploma examination will take place during the ECR 2018 Congress in Vienna/AT
We kindly ask you to send the completed application form together with the other required documents via email to office@eshnr.eu.
Deadline for applications: January 15, 2018

 

Appendix 1

The anatomic areas covered by head and neck radiology include:

  1. the petrous bone, the skull base and cranial nerves,
  2. the orbit and visual pathways
  3. the sinuses, the face and the deep spaces of the suprahyoid neck
  4. the oral cavity, the pharynx and the larynx,
  5. the neck, including lymph nodes and its vasculature and the deep spaces of the infrahyoid neck
  6. the salivary glands
  7. the mandible and temporomandibular joints
  8. the thyroid gland and the parathyroid glands, the thoracic inlet and the brachial plexus

 

Appendix 2

Courses and meetings recognised by the Educational Board of the ESHNR in view of the EBiHNR Diploma*

* unless otherwise specified, the course language is English, see also webpage of the society

All courses recognised for the diploma are organised or co-organised by active and internationally recognised members of the ESHNR.
All courses are accredited by the UEMS and/or by the national radiological societies.
For meetings and courses that deal only in part with head and neck radiology, only the lectures on head and neck topics are recognised for the curriculum.

One course hour = 1 point.
A total of 200 points are required for the diploma.

All or only part of the necessary 200 points may be acquired by attending the below specified courses. Certificates of attendance are required for documentation.

Annual courses and meetings:

– Annual meeting and refresher course of the ESHNR: 20 – 25 points
– ERASMUS Course on Head and Neck (course coordinator JW Casselman): 32 points
– Advanced Head and Neck MR Imaging organised by the ESMRMB (course coordinator R Maroldi): 18 points
– Refresher Courses of the ECR in Vienna: 6.5 points
– DIU ORL in Paris organised by the CIREOL (course coordinator, P. Halimi, French): 100 points
– Symposia of the CIREOL (twice per year, French): about 6 points per meeting
– BSHNI Annual Meeting: about 5-10 points (depending on programme)

Other courses and meetings:

– GALEN Advanced Course ESOR: Head and Neck Cross-Sectional Imaging
– Leuven Course on Ear Imaging
– Leuven Course on Head and Neck Cancer Imaging
– HNO Radiology: Part I Face (organised by the AG Kopf-Hals Diagnostik, course coordinator S. Kösling, German)
– HNO Radiology: Part II Temporal bone (organised by the AG Kopf-Hals Diagnostik, course coordinator S. Kösling, German)
– HNO Radiology: Part III Neck (organised by the AG Kopf-Hals Diagnostik, course coordinator S. Kösling, German)
– International Diagnostic Course Davos: Diseases of the Brain, Head and Neck and Spine
– Course on Larynx/pharynx in Paris
– MRI in otorhinolaryngology in Strasbourg
– Imaging of the ear in Strasbourg
– Swiss Forum Head and Neck Diagnostics
– Sandwichcursus Neuro- en Hoofd-Hals Radiologie
– London Petrous Temporal bone Imaging Course 

Appendix 3

Practical information for candidates taking the diploma examination

This examination for the EBiHNR Diploma will take place twice, namely at the ECR in Vienna and at the annual meeting of the ESHNR at the respective congress venue.

The examination includes two parts:

  • a written examination of 75 minutes and
  • an oral examination of 45 minutes

All candidates will be notified about the results of the examination at the latest 7 days after the examination. The candidates who have passed the examination and who are ESR members will receive the European Board in Head and Neck Radiology Diploma document by regular mail. All candidates who have passed the examination will also receive the Fellowship award of the ESHNR at the Gala evening of the society during the awards ceremony of the annual meeting.

All candidates are asked to make sure that the following fees have been paid prior to the exam:

  • the examination fee
  • the annual ESHNR membership fee (both payments to the bank account of the ESHNR)
  • the annual ESR fee.

The topics that will be examined include normal anatomy, imaging techniques and pathologic conditions involving the:

  1. the petrous bone, the skull base and cranial nerves,
  2. the orbit and visual pathways
  3. the sinuses, the face and the deep spaces of the suprahyoid neck
  4. the oral cavity, the pharynx and the larynx,
  5. the neck, including lymph nodes and its vasculature and the deep spaces of the infrahyoid neck
  6. the salivary glands
  7. the mandible and temporomandibular joints
  8. the thyroid gland and the parathyroid glands, the thoracic inlet and the brachial plexus

 

Written examination

Examples of questions are given below:

1. “Multiple choice” questions:

Note that one, two or three answers may be correct

Q1. Which of the following statements is correct?

Laryngeal cancers involving the epiglottis

  1. are most often caused by HPV 16 infection
  2. most often invade the arytenoid and cricoid cartilages
  3. are seen more often in females than in males
  4. very often invade the pre-epiglottic space
  5. may not be seen on DWI sequences

Correct answer: d and e

Q2. A 39-year old patient with a history of sinusitis treated with antibiotics since 5 days by the family physician presents with fever, leukocytosis, facial swelling and erythema in the emergency department. No neurologic deficit. Which is the examination method of choice?

  1. no radiologic exam needed
  2. conventional X rays of the paranasal sinuses
  3. contrast enhanced CT
  4. unenhanced low-dose CT
  5. cone beam CT

Correct answer: c

 2. “Normal/ normal variant versus abnormal” questions:

Q3. T2W image of a 66year old male.

Indicate whether it is normal or abnormal and if abnormal provide the diagnosis.

Grafik 1 Website

Answer: abnormal, pathologic enlarged level II lymph nodes bilaterally, probably metastatic

 

Q4. MRI of a 66-year old male obtained 5 months after surgery for a floor of the mouth squamous cell cancer T2N0M0. Clinical examination: normal mucosa.

Indicate whether the MRI examination is normal or abnormal and if abnormal provide the diagnosis.

Grafik 2 Website


Answer: abnormal, recurrent squamous cell cancer left masticator space (perineural spread along V3)


3. “Annotate the structures” questions

Q5. Name the anatomic structures 1- 5 on the following PET CT image:

Grafik 3 Website

Answer:

  1. sternocleidomastoid muscle
  2. internal pterygoid muscle
  3. palatine tonsil
  4. ascending ramus of the mandible
  5. level IIa lymph node

 
4.
“Short cases” questions:

Note that one short case may have several questions as shown below

Q6. 50-year old patient of Caucasian origin presenting with bilateral mixed hearing loss, on the right more pronounced than on the left. No neurologic deficit. Medical history: hypertension under treatment. The patient has spent several years in Congo as a child. Since over 20 years has been living in Switzerland. A CT of the temporal bone was performed.

Grafik 4 Website

  1. Indicate the abnormality on this CT image by means of a circle

Answer:
Grafik 5 Website

1. What is your differential diagnosis (at least 2)

Answer: otospongiosis, tuberculosis, syphilis

2. What is the most likely diagnosis ?

Answer: fenestral and cochlear otospongiosis

3. Which CT findings are seen in tuberculous otitis media ?

    1. Destruction of the otic capsule
    2. Involvement of the oval window
    3. Cochlear fistula
    4. Ossicular erosion
    5. Soft tissue in the tympanic cavity
    6. All of the above

Correct answer: f

 

Oral Examination

The oral examination includes 4 cases from different anatomic regions of the head and neck area. The cases will be presented in a DICOM format or a Power point format by the examiners and the candidate is asked to comment/discuss the cases as she/he would do it during clinical routine work.

The candidate is expected to be able to describe the relevant findings and discuss them with the examiners, provide a differential diagnosis and discuss possible treatment options or further diagnostic tests. The most important part of the oral examination is that the candidate shows that he/ she is able to analyse the case appropriately and provide a suitable differential diagnosis.

The examination language is English. Therefore, knowledge of the English language (understanding of written and spoken language, as well as knowledge of English medical terminology) is required.