Precise Diagnostics, Innovative Therapies, Networked Expertise: An Interview with Prof. Heußel

Prof. Dr. med. Claus Peter Heußel has been Chief of the Department of Diagnostic and Interventional Radiology with Nuclear Medicine at the renowned Thoraxklinik Heidelberg since 2006. As a recognized expert in his field, he combines state-of-the-art diagnostic imaging with interventional procedures, thereby making a significant contribution to providing patients with first-class medical care. Under his leadership, innovative methods and technologies are applied that not only enable precise diagnoses but also targeted therapeutic interventions.

The Heidelberg Thorax Clinic, one of Europe’s largest specialized clinics for lung diseases, offers an ideal setting for Prof. Dr. Heußel’s work thanks to its more than 100-year tradition and close affiliation with Heidelberg University Hospital. Here, cutting-edge science meets clinical practice, which is of central importance particularly in the diagnosis and treatment of lung cancer, interstitial lung diseases, and other thoracic conditions.

Prof. Dr. Heußel’s diagnostic focus encompasses a broad spectrum of imaging techniques, including computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine methods such as scintigraphy, as well as X-ray and ultrasound. He has particular expertise in high-resolution CT for the evaluation of lung parenchymal diseases, as well as in dynamic CT of the airways for the diagnosis of collapse. CT-guided biopsies and tumor ablations are also part of his range of services. Lung MRI allows for the radiation-free investigation of specific issues such as pulmonary blood flow, pulmonary embolism, or heart disease, which is particularly advantageous for radiation-sensitive patient groups such as pregnant women or children. Dynamic MRI can also provide answers to specific surgical questions, such as the relationship between thymus tumors and the major blood vessels and the heart, as well as diaphragmatic movement.

A particular focus of his work is interventional radiology, which enables minimally invasive procedures such as tumor ablation and biopsies for tissue sampling. These procedures help refine diagnoses and initiate targeted treatments, such as modern immunotherapies. Using state-of-the-art technology and through interdisciplinary collaboration—for example, with thoracic surgery, oncology, and pulmonology—Prof. Dr. Heußel makes a significant contribution to personalized patient care.

In addition to his clinical work, Prof. Dr. Heußel is actively involved in scientific projects, for example at the German Center for Lung Research, and contributes to the development of medical guidelines for organizations such as the German Radiological Society. This underscores his commitment to integrating the latest research findings into daily practice and thereby setting the highest standards in patient care. The Heidelberg Thoracic Clinic benefits from his many years of experience and his expertise in diagnostic imaging and interventional procedures. Patients find in Prof. Dr. Heußel a dedicated and highly qualified physician who is deeply committed to providing the best possible medical care.

The Radiology Department at the Heidelberg Thorax Clinic has also successfully integrated a comprehensive training and continuing education program. The accreditation received for radiology training and the fact that the department is fully staffed with physicians and medical radiology technicians (MTRA) demonstrate the strong interest among young professionals in pursuing training in the Radiology Department at the Heidelberg Thorax Clinic. The editorial team of the Leading Medicine Guide spoke with him and learned more about diagnostic and interventional radiology, using the example of lung cancer.

Smoking is a disaster!

“Before we dive into the topic of radiology, let me start with the most important message of all: Please don’t smoke! If you don’t smoke, everything is fine. If you’ve smoked and quit, you have to wait about 15 years, and then your lungs will be more or less back to normal. Of course, this applies not only to lung cancer but also to almost all the other serious diseases we see at the Thorax Clinic. No one should smoke—no matter what, no matter how, whether traditional or electronic—not a single cigarette! Then you don’t need to do anything else. You don’t need screening or early detection, because there are very few cases of bronchial carcinoma or severe lung diseases if you don’t smoke. The fact that smoking is still largely accepted in our society is a problem! “At our clinic, we offer smoking cessation support through our colleague Dr. Claudia Bauer-Kemény, the head of the Department of Prevention and Smoking Cessation,” Prof. Dr. Heußel emphasizes at the start of our conversation.

Lung cancer is one of the most common and serious forms of cancer, and it often goes unnoticed for a long time. Since early symptoms are usually absent, the diagnosis is frequently not made until an advanced stage, when, for example, neighboring organs have already been invaded. At that point, however, the chances of a cure are significantly lower. Early detection is therefore crucial to improving the chances of successful treatment. Radiological imaging techniques in particular, such as low-dose CT, play a central role in diagnosis, as they can reveal even the smallest changes in lung tissue at an early stage. Through regular screening examinations for at-risk patients, the progression of the disease can often be prevented in a timely manner or effectively treated. Diagnostic and interventional radiology is a medical specialty that deals with the application of imaging techniques for the diagnosis and treatment of diseases. While diagnostic radiology focuses on producing detailed images of the body to detect diseases or injuries, interventional radiology uses this imaging to perform minimally invasive therapeutic procedures.

Radiology offers a wide range of diagnostic options for the early detection and treatment of diseases such as lung cancer and other thoracic pathologies. 

“In about two-thirds of patients, lung cancer is detected because the patients have symptoms—such as coughing up blood or shortness of breath. By this point, the patient is usually at such an advanced stage that the lung cancer can no longer be cured. This is because, at this stage, the tumor has usually already invaded central structures from which it can no longer be surgically removed. This means that two-thirds of patients with symptoms can no longer be cured. For the remaining third, the cancer is discovered incidentally, for example, during an abdominal or cardiac CT scan,” explains Prof. Dr. Heußel, adding:

“Computed tomography is used for the early detection of lung cancer. It involves a certain amount of radiation exposure, which is why it is performed only for a valid reason and only in high-risk individuals. Here in Heidelberg, we are fortunate to also have the option of examining radiation-sensitive individuals—for example, those under 40—using MRI, which is radiation-free. The difficulty with early detection lies in the fact that CT is a highly sensitive procedure, meaning it also produces a large number of false-positive results. This means that we often find what is known as a round lesion, which is not bronchial carcinoma—that is, not malignant—but benign. This applies to approximately 97% of patients. For these patients, it is often difficult to understand that there is a round lesion that will not be operated on immediately. The lesion is then monitored over time using a specific algorithm. Identifying the lesions that are actually malignant requires good technical skill and a great deal of experience. Some patients become so anxious that they have the round lesion surgically removed by another doctor who, for example, does not work at a lung cancer center. “There are currently 96 lung cancer centers in Germany certified by the German Lung Cancer Society, and it is absolutely essential to go there because the quality of care at these centers is simply dramatically better (www.oncomap.de).”

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In 2022, approximately 1.8 million people died of lung cancer; in Germany alone, there were approximately 45,000 deaths. Lung cancer accounts for about 15% of healthcare costs in Europe. The earlier lung cancer is detected, the better the prognosis for survival. Early detection using low-dose CT (LDCT) of the lungs can reduce lung cancer-related mortality. Lung cancer is among the tumors with a poor prognosis; the 5-year survival rate is approximately 25% for women and about 19% for men. Histologically, three main types are primarily distinguished: Approximately 44% of cases are adenocarcinomas, about 21% are squamous cell carcinomas, and around 15% are small-cell bronchial carcinomas, which have the poorest prognosis due to their tendency to metastasize early.

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Interdisciplinary collaboration between radiologists and other specialties is an essential component of modern medicine and plays a crucial role in developing individualized treatment strategies and optimizing patient care. 

Radiology provides the fundamental diagnostic information that is essential for planning and guiding therapies. The use of high-precision imaging not only allows for the determination of a disease’s location, extent, and type, but also provides insights into tumor biology and response to therapies. Close collaboration with surgery, radiation oncology, and medical oncology makes it possible to develop customized treatment plans based on radiological findings. For example, functional imaging techniques such as PET-CT can be used to precisely determine tumor staging and detect metastatic spread at an early stage. This information is crucial for selecting the appropriate therapy, whether it be surgery, radiation therapy, immunotherapy, or chemotherapy. Through daily joint discussion of findings in tumor boards—which typically take place in the radiology department—all specialties can directly contribute their expertise and analyze complex cases from different perspectives, which contributes to more informed decision-making.

“Interdisciplinary collaboration at our Thorax Clinic in Heidelberg is very well established, as we are a specialized clinic and have all disciplines under one roof. We exchange information several times a day in various meetings. This creates a feedback loop that ensures consistently high quality. So if a patient’s course of illness is not going as well as it should, this is brought to everyone’s attention so that we can optimize the course of treatment again. This works so well precisely because we’re all under one roof. There are also studies showing that patients who (have to) “doctor-hop” tend to die earlier because individual test results can never contain everything. There’s no “push-button” solution—not even a CT scan has one. Imaging has as many settings as an airplane—correct interpretation requires close collaboration among physicians,” explains Prof. Dr. Heußel, who then goes on to point out a major problem:

“Unfortunately, there’s a problem with reimbursement for some of the necessary outpatient and inpatient services. Certain payers either don’t reimburse these costs at all or don’t cover them fully. However, we cannot afford to pay hundreds of euros out of pocket and are therefore reliant on patients obtaining these services elsewhere and bringing the results with them. For patients, this means additional appointments, trips, and organizational effort. Furthermore, the results are not always what we actually need for treatment. This is not easy for patients to understand.”

Logistical Challenges in Patient Care: When Outpatient Treatments Reach Their Limits

“Our Thorax Clinic in Heidelberg is by far the largest specialized lung clinic in Europe and Germany. Patients come to us from far and wide. It’s often the case that a patient simply can’t make it from home to the clinic by 8 a.m. to start therapy because the trip takes too long. But if, for example, a patient can’t get here until noon, there isn’t enough of the day left for us to get much done. We can’t perform surgery or a procedure in such cases simply because the patient must have an empty stomach. In that case, patients have to stay at a nearby hotel the night before, since we’re not allowed to admit them the day before. Of course, patients must cover any hotel costs themselves. On top of that, we have many older patients who rely on the help of family members or friends. This also places a financial and time burden on them. All of this presents a major logistical challenge. “It’s important to realize that medical care, as it is provided in Germany today, costs a great deal of money, and patients are also dependent on their social support network,” laments Prof. Dr. Heußel.

Interventional radiology is playing an increasingly central role in the treatment of complex diseases such as lung cancer and vascular diseases, as it provides minimally invasive procedures that often offer a precise and gentle alternative to conventional surgical interventions. 

“Interventional radiology is commonly understood to refer primarily to vascular interventions, but this has changed significantly in recent years. As recently as 15–20 years ago, most interventional radiology procedures were primarily therapeutic, such as in the context of angioplasty or tumor embolization—a method we no longer perform here at the Thoraxklinik. We perform approximately 1,500 procedures per year at the Thorax Clinic. These are primarily CT-guided biopsies for tissue sampling, but also include tumor ablations to destroy tumor tissue in the lungs. For example, if a patient from the early detection program presents with a round lesion that has grown slightly during follow-up, this naturally needs to be investigated. In the past, these round lesions were surgically removed; however, about one-third of them are benign, and surgery—which involves significant loss of lung tissue—is actually unnecessary. Or, upon later examination of the tissue from the surgery, it turned out to be bronchial carcinoma—in which case a second surgery was often required, as the entire lung lobe then had to be removed. A CT-guided biopsy of the round lesion allows pathologists to determine under the microscope whether surgery is actually necessary and, if so, what type of procedure is required. “And with tumor ablation, we offer—especially to patients with pre-existing conditions who are otherwise limited and have only a few small lesions—a minimally invasive method to destroy the tumor tissue, for example, using microwaves, which requires only very light sedation without general anesthesia,” explains Prof. Dr. Heußel.

Radiologists play a central role in the development of medical guidelines, as their expertise in diagnostic imaging and interventional procedures makes a decisive contribution to the establishment of evidence-based diagnostic and treatment strategies. 

A picture is worth a thousand words. Radiology provides a visual representation of the disease and is thus often one of the first steps in any medical treatment. Medical guidelines are systematically developed recommendations for physicians based on current scientific findings. They serve to ensure the best possible treatment for patients by specifying evidence-based diagnostic and therapeutic approaches. These guidelines are developed by professional societies and updated regularly. They are not mandatory regulations, but rather guidelines that provide physicians with a basis for decision-making. In doing so, they take into account not only the effectiveness of medical interventions, but also their risk-benefit ratio and cost-effectiveness.

“The Thoraxklinik in Heidelberg is always at the forefront of developing these guidelines. Personally, I was appointed by the German Radiological Society to serve as a representative on the guidelines for lung cancer, mesothelioma, pneumonia, emphysema, and other conditions. As Germany’s largest specialized lung clinic, the Thoraxklinik Heidelberg always holds a leading position in the field of pulmonary medicine,” comments Prof. Dr. Heußel.

Technological innovations and new therapeutic approaches are having a profound and far-reaching impact on diagnostic and interventional radiology, helping to further strengthen its role in interdisciplinary treatment centers. 

“Looking back at recent years, immunotherapy stands out. It is a true blessing and has enabled a dramatic improvement in survival rates over the past 15 years. However, it also costs a great deal of money. Today, we are also seeing long-term survival in patients with advanced lung cancer. The success has been so overwhelming that one is tempted to believe that lung cancer could potentially be cured with medication. First, immunotherapy requires a precise analysis of fine tissue—that is, from a biopsy. Throughout the course of tumor treatment, fresh tumor tissue is needed repeatedly to optimize and tailor the next steps of treatment. This is because only through ongoing, up-to-date examinations can new approaches for ongoing immunotherapy be identified. And this is precisely where interventional radiology comes into play again. But even in pure diagnostic imaging, there is currently a development in CT technology: so-called photon-counting CT (PCCT), an innovative advancement in computed tomography (CT) that enables higher image quality or lower radiation exposure. With this technology, spatial resolution can be increased by a factor of nearly 10, the radiation dose can be reduced to one-tenth, and at the same time, it is possible to measure the quality of the radiation. This makes it possible to use different contrast agents simultaneously—for example, those based on iodine, barium, iron, or gold—each of which highlights different organs. The PCCT is then capable of capturing the various signals simultaneously and, in the future, differentiating between the different contrast agents and generating images that, for example, simultaneously depict organs, tumors, and blood vessels separately. This technical development is far from complete, and some of the contrast agents do not even exist yet. However, CT technology is already available at a few select locations in Germany. “This development will have a significant impact on CT technology in the coming years,” states Prof. Dr. Heußel.

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Photon-Counting CT: The Future of Imaging

Photon-Counting CT (PCCT) is a groundbreaking advancement over conventional computed tomography. It enables higher image quality with lower radiation exposure, as it counts individual X-ray photons and analyzes their energy. As a result, it offers higher resolution, more precise differentiation of tissues, and more efficient use of contrast agents. PCCT significantly improves diagnostics, particularly in oncology, cardiology, and pulmonology. The technology is already being used in some hospitals and has the potential to revolutionize CT diagnostics in the coming years.

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“My greatest wish is that people would stop smoking! That would by far have the greatest impact. The Federal Center for Health Education offers excellent tips and resources on this topic. The lung cancer early detection program has been in place since 2024, though it costs each patient about 300 euros. However, I’ve noticed that most smokers don’t even want to quit. They want a ‘clean bill of health’ so they can keep smoking. Many smokers have successfully quit and want to undergo screening to ensure they don’t have a round lesion. Most people in the high-risk group, however, want neither to quit smoking nor to participate in the screening. Optimistically speaking, 5% of the high-risk group is expected to participate in early detection—personally, I estimate it will be closer to 2–3%. This means that 95% of those at risk do not undergo early detection. It will take well into next year before screening could become a benefit covered by health insurance, although it is questionable whether it is worth the effort. After all, this ultimately leads to the false-positive results already mentioned, resulting in unnecessary surgery and the removal of a portion of the lung that might have been preserved. Assessing a round focus requires a very high level of expertise! This expertise is available at the current 96 German lung cancer centers. “However, being confronted with a round lesion diagnosed in oneself can also personally motivate smokers to quit smoking after all, because this has a different effect than the ‘shock images’ on cigarette packs,” notes Prof. Dr. Heußel, and with that we conclude our conversation.

Thank you very much, Professor Dr. Heußel, for this open and critical discussion!