The emergence of new technologies in the medical field is putting pressure on the technologist's job. Among other questions, training, performance of these technologies and image quality are especially under scrutiny. This presentation will cover these aspects, always from a technologist's point of view and will give an outlook on the implications expected from the emergence of these new technologies in the radiographers' world. The influence of the technicians' role will be demonstrated through MR and CT images acquired following standard procedures. A longitudinal follow-up study will show not only that regular refresher courses are one part of the solution to be applied for a better image quality, but also that the technologists should be part of the front line of developments, through regular readings of specialised papers, participation to technical congresses and to professionals forums. This is very often not compatible with a daily work and it is one topic of concern to be addressed by the radiology management. The radiographer is instrumental in today's and tomorrow's medicine, but he/she needs to be constantly challenged, helped and brought to the highest possible level of education, always ultimately to the benefit of the patient. Continuous education of radiographers is needed to keep up with state-of-the-art techniques. To maintain a high quality standard of radiological examinations we introduced a continuous education programme for radiographers. The Academic Medical Center Amsterdam started to make an inventory of the actual expertise and preferences for education of radiographers in 2008. The main outcome of the initial inventory was that radiographers appeared less competent on new technology, such as emergency CT. Also, the prior level of education appeared to be a mediating factor in the competence of the radiographers. Subsequently, continuous education was implemented on a per modality basis and at two levels for some modalities. The attendance to education was registered by means of Edumanager. Also, radiographers were able to maintain a digital education portfolio by themselves. The effectiveness of the education was evaluated after two years (2010). The radiographers valued the education highly. Higher expertise of the radiographers was found after two years regarding emergency CT. The effectiveness of the education varied with the prior education level of the radiographers. Additionally, radiologists were asked to evaluate the quality of the radiological examinations. The radiologists valued about 5% of the radiological examinations as insufficient and approximately 75% as good-excellent. We did not find a significant trend over time. Continuous education remains urgently needed to keep up to date with current radiological technique. Our continuous education will be adapted based on the outcomes of the questionnaires. The difference in prior education is a matter of concern and needs special attention. Radiographers working within cross-sectional imaging need to understand their role in respect to the pathology they are imaging and the significance of the images they produce in respect to patient care-pathways. Adaptation and implementation of new and 'novel' techniques is fundamental in achieving the best possible information for the clinician and thus improved patient treatment. The modern cross-sectional radiographer needs to be knowledgeable, flexible and be able to operate in an MDT environment in order to deliver a 'first class' service. Only then can the profession advance to become an integral part in the patient care delivery. Besides drug therapy, the mainstays in the treatment of coronary heart disease (CHD) are interventional therapy and coronary bypass surgery. The need to image coronary bypass grafts is based on their limited lifetime: the occlusion rate at 10 years ranges between 5 and 15 % for arterial, and between 40 and 50% for venous grafts, respectively. Graft sclerosis develops in 38% of nonoccluded venous bypass vessels after 5 years and in 75% after 10 years. This sclerosis causes more than 50% luminal narrowing in approximately half of the affected vessels. Non-invasive imaging of coronary bypass grafts by MD-CT requires information about the operative procedure. With the increasing implementation of 64slice CT scanners and beyond, it is possible to scan the heart and the full anatomic extent of grafts with sub-millimeter slice-thickness within a single breath-hold. When analysing the grafts, three graft segments should be assessed: the origin or proximal anastomosis, the body of the graft and the cardiac anastomosis, either single or sequential. Recent studies have shown that graft patency and the presence of significant graft stenosis can be assessed with an accuracy of 100% using most recent MD-CT technology (256/320 slice CT or dual source CT). The assessment of native coronaries with respect to the progression of CAD may still be problematic in cases with severe calcifications of the native coronary arteries. In these cases, MR perfusion imaging in combination with Cine and late gadolinium enhancement (LGE) imaging may be helpful in detecting newly developed, stress-induced myocardial ischaemia. The metabolic syndrome refers to the clustering of cardiovascular risk factors that include diabetes, obesity, dyslipidaemia and hypertension. The association between metabolic syndrome and cardiovascular diseases raises important questions about the underlying pathological processes, especially for designing targeted therapeutic interventions. Insulin resistance and visceral obesity have been recognised as the most important pathogenic factors. Metabolic syndrome generally precedes and is often associated with type 2 diabetes. Cardiovascular risk reduction in individuals with metabolic syndrome should include 1) control of obesity, unhealthy diet and lack of physical activity; 2) control of the individual components of metabolic syndrome, especially atherogenic dyslipidaemia, hypertension, hyperglycaemia and prothrombotic state; and 3) control of insulin resistance, a defect closely linked to metabolic syndrome. Appropriate management of metabolic syndrome should be able to prevent the progression from impaired glucose tolerance to frank diabetes and thus to prevent the increasing prevalence of type 2 diabetes and vascular diseases. Each 1% increase in HbA1c is associated with a 28% increase in risk of incident PAD. Diabetes is also highly associated with progression of PAD and especially with development of critical limb ischaemia. Rigorous control of blood The testicular varicocele is a pathological dilatation and tortuosity of the veins of the pampiniform plexus of unknown aetiology. Clinical presentation can include scrotal swelling and pain; the varicocele is more often seen in the subfertile or infertile man. The primary diagnostic imaging tool is ultrasound. Right-sided varicoceles can be symptomatic; a profound abdominal diagnostics is necessary. Therapeutic options include minimally invasive surgical and open microsurgical treatment, as well as interventional radiological therapy. The IR treatment by percutaneous venography includes the selective catheterisation of the spermatic vein and subsequent embolisation or sclerotherapy. Technical and clinical success rates are encouraging and complications are rare. In this lecture, diagnostic modalities, clinical and imaging features plus the indications for therapy will be discussed. In addition, the different therapy options and its results will be elucidated; furthermore, the management of the endovascular occlusion in treatment of varicoceles will be demonstrated in a step by step fashion. Myocardial function and coronary anatomy from one scan? This "science"-fiction has become true now for computed tomography (CT). Over years, we have often worried whether a lesion found on CTA is "significant" (= causes myocardial ischaemia indicating the need for coronary revascularisation) or not. Now, CT-perfusion (CTP) provides that information. Different CTP-techniques will be discussed (e.g. the "one-shot" approach and "dynamic"). New CT technology providing low radiation dose will be highlighted in this course. CT is also established technique for imaging of global and regional cardiac function. Beyond, imaging of myocardial viablity using delayed enhancement will be discussed. The aim of this course is to understand basic principles of functional imaging by CT, to learn "how-to" perform these scans, to review current scientific evidence and to discuss potential clinical applications. Most commonly MRI myocardial perfusion images are analysed by visual inspection, noting regions of hypointensity (ischaemia) during the first pass of a contrast medium bolus of a gadolinium chelate. High temporal resolution is required to capture transient ischaemia in the myocardium under pharmacological stress and to distinguish artefacts (e.g. dark rim artefacts during a few frames at peak enhancement). Various modifications of T1-weigthed, ECG gated, multislice acquisitions have been proposed to assess first-pass myocardial signal intensity changes in cine mode. The time-versus-intensity curves allow quantitative analysis by deriving parameter values from the time series of intensity values (e.g. upslope, peak, absolute myocardial blood flow). Epi/endocardial contour tracing is required for segmental analysis, by pixels or to construct perfusion maps. Time intensity curves are deconvoluted for arterial input function using a Fermi function for estimating Peripheral arterial disease (PAD) is a common cardiovascular complication in patients with diabetes. In contrast to non-diabetic PAD, it is more prevalent and, because of the distal territory of vessel involvement and its association with peripheral neuropathy, it is more commonly asymptomatic. Diabetic PAD may present later with more severe disease and have a greater risk of amputation. The pervasive influence of diabetes on the atherothrombotic milieu of the peripheral vasculature is unique. The abnormal metabolic state accompanying diabetes results in changes in the arterial structure and function. The proatherogenic changes include increases in vascular inflammation and derangements in the vascular cellular components, alterations in blood cells and haemostatic factors. These changes are associated with an increased risk for accelerated atherogenesis as well as poor outcomes. In contrast to the focal and proximal atherosclerotic lesions of non-diabetic PAD, in diabetic patients the lesions are more likely to be more heavily calcified, diffuse and distal, sparing the proximal vessels and mainly affecting the more distal arteries in the calf and the foot. By identifying a patient with subclinical disease and instituting preventative measures, it may be possible to avoid acute, limb-threatening ischaemia. The primary imaging modality to be used should be duplex ultrasound, due to its non-invasive nature, lower risks and costs. CT-angiography and MR-angiography are now replacing DSA as standard imaging methods, providing a non-invasive assessment of the localisation and extension of a vascular lesion and allowing an accurate planning of endovascular and/or surgical treatment. The choice of the appropriate modality for imaging of the peripheral vascular system strongly depends on the type of disease. In the acute setting of lower leg ischaemia caused by embolism or thrombosis on top of a pre-existing high-grade stenosis, CT angiography frequently is the imaging modality of choice due to its 24-hour availability and robustness with reasonable accuracy in the upper leg exceeding 90%. With the introduction of dual energy CT, visualisation of lower leg arteries and highly calcified areas has improved. For elective patients, contrast-enhanced MR-angiography (CE-MRA) is the technique of choice, in patients with renal insufficiency preferably at 3 Tesla with a single dose of macrocyclic contrast agents. Recent continuous table-movement techniques have substantially reduced the complexity and scan time and extended the spectrum to the emergency stetting. Time-resolved CE-MRA improves the detection of small arteries in the lower leg and reduces artefacts from venous overlay. Accuracy of state-of-the art CE-MRA exceeds 95% compared to digital subtraction angiography (DSA). New fast-spin echo and steady-state free precession MRA techniques without contrast media demonstrate a high negative predictive value in areas without motion. DSA should be restricted to the display of the target lesion, inflow and run-off during the interventional procedure, as well as to the in-detail visualisation of the anastomosis site prior to surgical revascularisation, particularly in the lower calf. Learning Objectives: