Prof. Dr. med. Claus Peter Heußel has been Head Physician of the Department of Diagnostic and Interventional Radiology with Nuclear Medicine at the renowned Thorax Clinic in Heidelberg since 2006. As a proven expert in his field, he combines state-of-the-art imaging diagnostics with interventional procedures and thus makes a significant contribution to the first-class medical care of patients. Under his leadership, innovative methods and technologies are used that not only enable precise diagnoses, but also targeted therapeutic interventions.
The Thoraxklinik Heidelberg, one of Europe's largest specialist clinics for lung diseases, offers an ideal setting for Prof. Dr. Heußel's work with its more than 100 years of tradition and its close connection to Heidelberg University Hospital. This is where state-of-the-art science meets clinical practice, which is particularly important in the diagnosis and treatment of lung cancer, interstitial lung diseases and other thoracic diseases.
Prof. Dr. Heußel's diagnostic focus includes a wide range of imaging procedures, including computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine methods such as scintigraphy, X-rays and ultrasound. He has particular expertise in high-resolution CT for the examination of lung diseases and in dynamic CT of the airways for collapse diagnostics. CT-guided biopsies and tumor ablation are also part of his range of services. With MRI of the lungs, special issues such as pulmonary perfusion, pulmonary embolism or heart disease can be examined without radiation, which is particularly advantageous for radiation-sensitive patient groups such as pregnant women or children. Dynamic MRI can also be used to answer special surgical questions such as the relationship of thymus tumors to the large 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 to obtain tissue. These procedures help to clarify diagnoses and initiate targeted treatments such as modern immunotherapies. With state-of-the-art technology and interdisciplinary collaboration, for example with thoracic surgery, oncology and pneumology, Prof. Dr. Heußel makes a significant contribution to individualized patient care.
In addition to his clinical work, Prof. Dr. Heußel is actively involved in scientific projects, e.g. at the German Center for Lung Research, and contributes to the creation of medical guidelines, e.g. for the German Radiological Society. This underlines his commitment to integrating the latest research findings into daily practice and thus setting the highest standards in patient care. The Thoraxklinik Heidelberg benefits from his many years of experience and expertise in imaging diagnostics and intervention. Patients will find in Prof. Dr. Heußel a dedicated and highly qualified physician who is committed to providing the best possible medical care.
A successful concept is also being integrated into the training and further education program at the Radiology Department of the Thorax Clinic Heidelberg. The authorization for further training in radiology and full staffing of the existing staffing ratio for doctors and radiographers show the great interest of young employees in training in the radiology department of the Thorax Clinic Heidelberg. The editorial team of the Leading Medicine Guide spoke to him and learned more about diagnostic and interventional radiology using the example of lung cancer.
Smoking is a disaster!
“Before we go into the subject of radiology, I would like to make the most important appeal of all: please don't smoke! If you don't smoke, then everything is fine. If you have smoked and stopped, you have to wait about 15 years and then everything in your lungs will be halfway fine again. Of course, this applies not only to lung cancer, but also to almost all other serious diseases that we see in the Thorax Clinic. Nobody is allowed to smoke - no matter what, no matter how, whether traditional or electronic - no cigarettes! Then you don't need to do anything else. There is no need for screening or early detection, because there are only very few bronchial carcinomas or serious lung diseases if you stop smoking. The fact that smoking is still widely accepted in our society is problematic! At our clinic, we offer a smoking cessation program with our colleague Dr. Claudia Bauer-Kemény, head of the Department of Prevention and Tobacco Cessation,” Prof. Dr. Heußel clearly reminds us at the beginning of our conversation.
Lung carcinoma is one of the most common and most serious forms of cancer that often goes unnoticed for a long time. As there are usually no early symptoms, the diagnosis is often only made at an advanced stage, for example when neighboring organs have already been infiltrated. However, the chances of recovery are then considerably worse. Early detection is therefore crucial in order to improve the chances of treatment. Radiological imaging techniques in particular, such as low-dose CT, play a central role in diagnostics, as they can make the smallest changes in lung tissue visible at an early stage. Regular screening of patients at risk can often prevent the progression of the disease in good time or treat it effectively. Diagnostic and interventional radiology is a medical specialty that deals with the use of imaging techniques for the diagnosis and treatment of diseases. While diagnostic radiology focuses on creating 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.
“Around two thirds of patients are diagnosed with lung cancer because they have symptoms such as coughing up blood or shortness of breath. At this point, the patient is usually at such an advanced stage that the lung cancer can no longer be treated. This is because the tumor has usually already grown into central structures at this point, from which the tumor can no longer be cut away. This means that two thirds of patients with symptoms can no longer be cured. The remaining third are incidental findings, for example when an abdominal or cardio-CT scan is performed,” explains Prof. Dr. Heußel and adds:
“Computer tomography is used for the early detection of lung cancer. This involves a certain amount of radiation, which is why it is only carried out if there is a good reason and only on people at risk. Fortunately, here in Heidelberg we also have the option of examining people who are sensitive to radiation, e.g. under the age of 40, with MR without radiation. The difficulty with early detection is that CT is a very sensitive procedure, so it also produces a lot of false positive results. This means that a so-called round focus is often found which is not a bronchial carcinoma, i.e. not a malignant tumor, but benign. This applies to around 97% of patients. It is often difficult for them to understand that there is a round focus that is not immediately operated on. This is then monitored using a specific algorithm. Identifying the actual malignant foci requires a good technique and a lot of experience. Some patients are so frightened that they have the focus removed by another doctor who is not at a lung cancer center, for example. In Germany, there are currently 96 lung cancer centers certified by the German Lung Cancer Society, and you should definitely go there because the quality in these centers is simply dramatically better (www.oncomap.de)“.
In 2022, around 1.8 million people died from lung cancer, with around 45,000 deaths in Germany alone. Lung cancer accounts for around 15% of healthcare costs in Europe. The earlier the disease is detected, the better the prognosis for surviving lung cancer. Early detection with low-dose CT (LDCT) of the lungs can reduce lung cancer-associated mortality. Lung cancer is a prognostically unfavorable tumor, with a 5-year survival rate of around 25% for women and around 19% for men. Histologically, a distinction is made between 3 main types: around 44% of cases are adenocarcinomas, around 21% are squamous cell carcinomas and around 15% are small cell lung carcinomas, which have the worst prognosis due to their early tendency to metastasize.
Interdisciplinary networking between radiologists and other specialist areas is an essential component of modern medicine and plays a decisive role in the development of individual treatment strategies and the optimization of patient care.
Radiology provides the basic diagnostic information that is essential for the planning and management of therapies. The use of high-precision imaging not only enables the localization, extent and type of a disease to be determined, but also provides information on tumour biology and the response to therapy. Close collaboration with surgery, radiotherapy and oncology makes it possible to create customized treatment plans based on radiological findings. For example, functional imaging such as PET-CT can be used to precisely determine tumor stages and detect metastatic spread at an early stage. This information is crucial for the choice of therapy, be it surgery, radiotherapy, immunotherapy or chemotherapy. Through the daily joint discussion of findings in tumor boards, which usually take place in the radiology department, all specialist disciplines can contribute their expertise directly and analyze complex cases from different perspectives, which contributes to more informed decision-making.
“The interdisciplinary collaboration at our Thorax Clinic in Heidelberg is very well established, as we are a specialist clinic and have all disciplines under one roof. We exchange information several times a day in various meetings. This gives us a control loop that ensures consistently good quality. If the course of a patient's illness is less than optimal, then this is mirrored so that we can optimize the course again. This only works so well because we are under one roof. There are also studies that show that patients who (have to) go doctor hopping die earlier because the individual findings can never contain everything. There is no 'push button' - not even a CT has one. Imaging has as many setting options as an airplane - the correct interpretation requires close cooperation between doctors,” explains Prof. Dr. Heußel, who also points out a major problem:
“Unfortunately, there is a problem with the reimbursement of costs for some of the necessary outpatient and inpatient services. These are not reimbursed or not reimbursed at cost by certain payers. However, we cannot afford to pay hundreds of euros on top of this and are reliant on patients obtaining these services elsewhere and bringing the results with them. This means additional appointments, travel and organization for the patients. In addition, the result is not always what we actually need for the 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 specialist lung clinic in Europe and Germany. Patients come to us from far and wide. It is often the case that a patient simply can't make it from home to the clinic at 8 a.m. to start treatment because the journey takes too long. However, if a patient can only come to us at 12 noon, for example, there is too little left of the day for us to do much. We can then no longer perform an operation or intervention because of the need to fast. Patients then have to go to a neighboring hotel the day before, as we are not allowed to admit them the day before. Any hotel costs must of course be borne by the patients themselves. In addition, we have many elderly patients who are dependent on the help of relatives or friends. They also have financial and time-related burdens. All of this represents a major logistical challenge. You have to be aware that medical care, as it is provided in Germany today, costs a lot of money and you also have to rely on your social 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 generally understood to mean vascular interventions, which has changed considerably in recent years. Just 15-20 years ago, most interventional radiological examinations were more therapeutic, for example in the context of vasodilatation or tumour embolization - a method that we no longer perform here at the Thorax Clinic. We carry out around 1,500 interventions per year in the Thorax Clinic. These are mainly CT-guided biopsies to obtain tissue, but also tumor ablations to kill tumor tissue in the lungs. If, for example, a patient comes from screening with a round focus that has grown slightly during follow-up, this must of course be clarified. In the past, these round foci were surgically removed, but around a third of them are benign and surgery with a relevant loss of lung tissue is not actually necessary. Or, when the tissue from the operation was later processed, it turned out to be a bronchial carcinoma - in which case a second operation was often necessary, as the entire lobe of the lung then had to be removed. A CT-guided biopsy of the round focus allows the pathology department to clarify under the microscope whether and what kind of surgery is actually necessary. And with tumour ablation, we offer a gentle method of destroying the tumor tissue, e.g. with microwaves, which only requires very light sedation without anaesthesia, especially for patients with pre-existing disease and therefore limited mobility,” 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 definition of evidence-based diagnostic and treatment strategies.
A picture is worth a thousand words. Radiology provides a picture of the disease and is therefore often one of the first steps in any medical treatment. Medical guidelines are systematically developed recommendations for doctors based on current scientific knowledge. They serve to ensure the best possible treatment for patients by specifying evidence-based diagnostic and therapeutic approaches. These guidelines are drawn up and regularly updated by specialist societies. They are not binding regulations, but rather orientation aids that provide doctors with a basis for decision-making. They take into account not only the effectiveness of medical measures, but also their risk-benefit ratio and cost-effectiveness.
“The Thorax Clinic in Heidelberg is always at the forefront of the development of guidelines. I was personally commissioned by the German Radiological Society to represent it in the guidelines on lung cancer, mesothelioma, pneumonia, emphysema, etc. As Germany's largest specialist lung clinic, the Thoraxklinik Heidelberg is always in a leading position when it comes to the lungs,” comments Prof. Dr. Heußel.
Technological innovations and new treatment concepts are having a profound and comprehensive impact on diagnostic and interventional radiology and are helping to further strengthen its role in interdisciplinary treatment centers.
“If you look at the last few years, immunotherapy stands out. It is a real blessing and has enabled a dramatic improvement in survival rates over the last 15 years. But it also costs a lot of money. Today, we can also report long-term survival from advanced lung cancer. The success is so overwhelming that one is inclined to believe that lung cancer can potentially be cured with medication. First of all, immunotherapy requires a precise analysis of the fine tissue, i.e. from the biopsy. In the course of tumour treatment, fresh tumour tissue is always needed in order to optimize and coordinate the next steps of treatment. This is because new approaches for ongoing immunotherapy can only be developed through continuous up-to-date examinations. And this is exactly where interventional radiology comes into play again. But there is also a current development in CT technology for pure imaging diagnostics: photon counting CT (PCCT), an innovative further development of computed tomography (CT) that enables higher image quality or lower radiation exposure. Here, either the spatial resolution can be increased by a factor of almost 10, the radiation dose can be reduced to 1/10, and at the same time it is possible to measure the radiation quality. This allows different contrast agents to be used simultaneously, e.g. based on iodine, barium, iron or gold, each of which marks different organs. The PCCT will then be able to record the various signals simultaneously and, in the future, differentiate between the various contrast agents and calculate images that show organs, tumors and vessels separately, for example. This technical development is far from complete, and some of the contrast media do not even exist yet. But CT technology is already available in a few places in Germany. This development will have a significant influence on CT technology in the coming years,” states Prof. Dr. Heußel.
Photon Counting CT: The future of imaging
Photon counting CT (PCCT) is a groundbreaking advancement of conventional computer 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 material differentiation and more efficient use of contrast media. PCCT significantly improves diagnostics, particularly in oncology, cardiology and pulmonology. The technology is already being used in the first clinics and has the potential to revolutionize CT diagnostics in the coming years.
“My greatest wish is that humanity would stop smoking! That would have by far the greatest effect. The Federal Center for Health Education has very good tips and support. The lung cancer screening program has been in place since 2024, but it costs each patient around 300 euros. However, I have noticed that most smokers don't want to quit. They want to get a 'certificate of persil' that they can continue smoking. Many smokers have successfully stopped smoking and want to be screened to make sure that they don't have a round focus. However, most people in the main risk group do not want to stop smoking or take part in screening. Optimistically calculated, 5% of the risk group are expected to take part in screening - I personally estimate that it will be more like 2-3%. So 95% of people at risk will not attend screening. It will be well into next year before screening becomes a statutory health insurance benefit, although it is questionable whether this is worthwhile. In the end, this also leads to the false-positive results already mentioned, so that surgery is again unnecessary and a piece of lung is removed that could possibly have been preserved. You need a very high level of expertise to be able to assess a round focus! This is currently available at the 96 German lung cancer centers. However, being confronted with your own detected round focus can also personally motivate smokers to stop smoking, because this has a different effect than the 'shock images' on cigarette packets,” says Prof. Dr. Heußel, and with this we conclude our conversation.
Thank you very much, Professor Dr. Heußel, for this open and critical discussion!
