Volume 16 No 1 / December 2019
Quarterly publication of The Royal Australian and New Zealand College of Radiologists
REFLECTING ON THE PAST AND LOOKING TO THE FUTURE. We bring you the highlights of ASM 2019
Also Featured in this edition
Does the rise of sub-specialism mean the end for generalism in radiology?
Artificial Intelligence
– Your questions answered
Polycystic Ovarian Syndrome (PCOS) –
What is the role of the radiologist?
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Working directly with I-MED offers you: • Priority listing of vacancies with access to over 240 clinics nationally • Customised and timely in-house recruitment service • $3000 - $4000 daily rate (dependant on skills and location) • All travel and accommodation provided (single or family occupancy) • Direct communication with our clinic leaders and general managers during the recruitment process • Access to a broad clinical case mix • Public/Private Hospital and comprehensive clinic environments • State-of-the-art imaging equipment and network-wide RIS/PACS • Access to Australia’s largest network of sub-specialist radiologists for second opinions To be added to our regular locum mail out list, or find out more about other unique opportunities within the I-MED Network please contact Leanne.OBrien@i-med.com.au | 02 8274 1075 Come and join us as we strive to be the provider of choice, constantly delivering high quality healthcare, to every patient, every time.
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Editor’s Pick 5 7
9 13 14
The President’s Message CEO’s Message
Polycystic Ovarian Syndrome (PCOS): What is the role of the radiologist? Changes to Your Medical Registration requirements The Foundations of Leadership in Radiation Oncology course comes to Sydney
17 19
Artificial Intelligence: Your questions answered Reflecting on the past and looking to the future: We bring you the highlights of ASM 2019
What are your thoughts?
23 26 27 28 30 31
44 54 55 59 60
National Sonographer Regulation Quantitative Spectral CT adds diagnostic value to head and neck imaging Targeting Cancer InsideRadiology 2020 RANZCR Workshops, Courses and Events
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Diagnostic error in radiology: Complaints and claims insights
Training and Assessment Reform Heading Towards Implementation
From the Faculty of Clinical Radiology
From the Faculty of Radiation Oncology Interventional Radiology Committee Update News from the Professions New Zealand Branch News NSW Health and Specialist Medical Colleges Roundtable
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If you have thoughts or comments about one of the stories you have read in this issue, we want to hear from you. The submission of letters to the editor, articles and news items are encouraged. Please email any submissions to editor@ranzcr.edu.au
Does the rise of subspecialism mean the end for generalism in radiology?
Grants, Awards and Prizes 2020 RANZCR Member Rewards
In Memoriam Professor Geoff Benness News in Brief
Have you moved recently? Log into the MyRANZCR, Portal and ensure your contact details are up to date at www.myranzcr.com
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All rights reserved. No part of this publication may be reproduced or copied in any form or by any means without the written permission of the publisher. Publication of advertisements and articles submitted by external parties does not constitute any endorsement by The Royal Australian and New Zealand College of Radiologists of the products or views expressed.
Inside News © 2019 The Royal Australian and New Zealand College of Radiologists® (RANZCR®)
SUPPORT THAT’S AS INDIVIDUAL AS THEY ARE *
*Helping to meet the needs of patients with prostate cancer and healthcare professionals through initiatives such as patient support materials and supporting educational activities.
Zoladex is indicated for:1 Palliative treatment of metastatic ( M+ ) or locally advanced prostate cancer where suitable for hormonal manipulation. Adjuvant and neoadjuvant therapy in combination with radiotherapy for the management of locally advanced prostate cancer in men suitable for hormonal manipulation.
Before prescribing please review full Product Information available on request from AstraZeneca on 1800 805 342 or at www.astrazeneca.com.au/ PI PBS Information: Zoladex 10.8mg. Restricted benefit for locally advanced
( equivalent to stage C ) or metastatic ( equivalent to stage D) carcinoma of the prostate. Zoladex® 10.8 mg Implant ( goserelin acetate ) Minimum Product Information. Indications: Metastatic ( M+ ) or locally advanced prostate cancer; adjuvant and neoadjuvant therapy in combination with radiotherapy for locally advanced prostate cancer. Contraindications: Hypersensitivity to LHRH, LHRH agonist analogues or any components of ZOLADEX. Precautions: Not indicated for use in females or in children; patients with metastatic cancer at risk of developing ureteric obstruction or spinal cord compression - use of ZOLADEX should be carefully considered and monitored closely in the first month; injection site injury, including pain, haematoma, haemorrhage and vascular injury, care with patients of low BMI and /or receiving full anticoagulation medications; bone pain; serum testosterone concentrations may rise if implant is omitted or delayed; loss of bone mineral density; hyperglycaemia and increased risk of developing diabetes – periodically monitor blood glucose and /or glycosylated haemoglobin ( HbA1c ). Androgen deprivation therapy may result in prolongation of QT/QTc interval- consider benefits versus risks in patients with congenital long QT syndrome, congestive heart failure, frequent electrolyte abnormalities or taking drugs known to prolong the QT interval. Correct electrolyte abnormalities. Monitor for symptoms and signs of development of cardiovascular disease and manage appropriately. Effects on fertility – see full PI. Adverse reactions: Very common ( ≥10% ): decreased libido, hot flush, abnormal blood pressure, hyperhidrosis, erectile dysfunction, gynaecomastia, breast tenderness, paraesthesia, decreased bone mineral density; Common ( ≥1% to <10% ): impaired glucose tolerance, spinal cord compression, incontinence/urinary frequency ( post-radiotherapy ), rash, bone pain, arthralgia, injection site reaction, cardiac failure, myocardial infarction, increased weight, mood swings; For less common adverse reactions, see full PI. Dosage: One implant ( 10.8 mg ) injected subcutaneously into anterior abdominal wall every 3 months. Caution should be taken while inserting ZOLADEX into the anterior abdominal wall due to the proximity of underlying inferior epigastric artery and its branches. Use extra care when administering ZOLADEX to patients with a low BMI and /or who are receiving full anticoagulation medication. Date of first inclusion in the ARTG: 22 May 1996. Date of most recent amendment: 16 May 2017. References: 1. Zoladex 10.8 mg Approved Product Information. Zoladex® is a registered trademark of the AstraZeneca group of companies. Registered user AstraZeneca Pty. Ltd. ABN 54 009 682 311. 66 Talavera Road, Macquarie Park, NSW 2113. www.astrazeneca.com.au. For Medical Information enquiries: 1800 805 342 or medinfo.australia@astrazeneca.com. To report an adverse event: 1800 805 342 or via https://aereporting.astrazeneca.com. AU -5913, WL302306, April 2019
Introduction
Perceptions of a profession A message from the President
Dr Lance Lawler
Are radiologists healthcare professionals or healthcare profiteers? An insulting question, members might say, but external perceptions rule our practice, and we ignore them at our peril. What do patients understand about your work? In a College stakeholder survey undertaken in 2016, we found that patients had a high opinion of their understanding and awareness of the role and value of the clinical radiologist (over 50% said 'adequate' or 'excellent'). In contrast, referrers rated patients' understanding and awareness of clinical radiologists somewhat lower (about one-third said 'adequate' or 'excellent'), while radiologists themselves rated the patients' understanding and awareness of their role and value much lower—fewer than 7% said 'adequate' or 'excellent.' In short, as you traverse the healthcare continuum there is little consensus on what we do. The reality is that most diagnostic scans do not involve contact between patient and radiologist, and even when they do, they are usually brief, one-off interactions, so the opportunity for improving perceptions is limited. GPs fall under the same limitation, but to a significantly less extent because they have many interactions with radiologists and a few of these are long-running. As a consequence, radiologists in that survey rated understanding and awareness of clinical radiology among referrers (over 60% said it was 'adequate' or 'excellent') much more highly than that of the patients.
These ratings are largely a consequence of the nature of the work of clinical radiologists. Radiologists cannot meet with all or even most of their patients and referrers—if they did the system of diagnostic imaging would collapse.
have that contact, their focus is on the patient, not the purse, and they spend a lot of time talking or working with colleagues and referrers about the best or most appropriate image to meet the needs of the referrer.
However, perceptions part company with reality when patients or referrers interpret the absence of a physical presence as a sign that the radiologist is hiding from care. We've all heard the GPs quip that radiologists and anaesthetists are doctors who don't like patients, or that radiologists are more interested in maximising profits than patient outcomes. According to those who share this view, we're a bunch of cave dwellers and slaves to the computer screen. This perception, which gets too much currency, is not only unfair, it's at odds with the perceptions of the majority of referrers, who told our survey that their view of us was positive, noting their 'excellent working relationships' with radiologists and their respect for us as fellow professionals. However, a minority of referrers (about one in seven) held a mixed view, much of it based on their experience with individual radiologists. These minority opinions should be interpreted properly: that is, referrers are discerning, and they can tell the difference between below par and excellent radiology.
Where we fall short is in how clinical radiologists promote themselves and what the College is doing as an educational body to weed out unempathetic attitudes in our profession. This applies to radiation oncologists as well. I strongly feel the issue may only be resolved with a tieback to new curricula in which added emphasis is given to reinforcing positive perceptions of our role as providers of high-quality patient care.
While I don't have the hard data to back this up, in my own experience, radiologists have more contact with patients and referrers than most appreciate, and in general they are good at it. Even when they do not
References 1. Hill + Knowlton Strategies, Profile of the Clinical Radiologist Report (Sydney: RANZCR), January 2016.
Volume 16 No 1 I December 2019
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Annual Scientific Meeting 2020 Intercontinental Hotel, Wellington Radiology Keynote Speakers
Key Dates
Professor Laurie A. Loevner
Registration Open: 9 April 2020
Chief, Division of Neuroradiology Professor of Radiology, Neurosurgery, Otorhinolaryngology: Head & Neck Surgery, and Ophthalmology University of Pennsylvania Health System Philadelphia, USA
Abstract Submission Open: 9 April 2020 Abstract Submission Close: 28 June 2020 Early Bird Registration Close: 5 July 2020
Associate Professor Bruno Giuffrè University of Sydney at Northern Clinical School Radiology Department, Royal North Shore Hospital Sydney, Australia
Radiation Oncology Keynote Speakers To be confirmed
www.ranzcr2020.co.nz
Introduction
Highlights of 2019 From the Chief Executive Officer
Ms Natalia Vukolova I would like to share some highlights from 2019 with the College members. In 2019 the College was rigorously assessed through a reaccreditation process by the Australian Medical Council (AMC) and Medical Council of New Zealand (MCNZ). The process was wide-ranging and included a formal submission against the 10 AMC domains, site visits, surveys and a formal four-day assessment at the College office in Sydney. Countless clinical leaders of the College and most staff have contributed to the reaccreditation process. The contribution of our Chief Censors, A/Prof Lehman and Dr Thomas, and of Head of Specialty Training Pamela Spoors was particularly wonderful and extensive. We have learnt much by undertaking the reaccreditation and look forward to receiving the formal report from the AMC in early 2020. Implementation of enhanced training programs (the Training and Assessment Reforms) has commenced. This marks a significant step forward in maintaining the quality and agility of our training programs to be able to respond to a world that is evolving at an unprecedented rate. The enhanced training programs are the result of extensive research, development and consultations and it is exciting to have a ‘go live’ date in December 2020 for New Zealand and January 2021 for Australia.
5,385,865 (388% increase from 2017/18) along with a record number of meetings (39) with Ministers and Shadow Ministers in both Australia and New Zealand. Our work in the Artificial Intelligence space continues to gain traction with Ethical Principles for Artificial Intelligence (AI) in Medicine being perhaps our most downloaded document. Our member engagement is at an all time high, with 79% of members engaging in College activities in some way, and a whopping 1572 members having volunteered their time to the College. Thank you, thank you, thank you! I would also like to express my gratitude to the Board of Directors and Faculty Councillors who have worked on many difficult issues throughout the year but kept a positive and constructive discussion going. Of course, much of our work has relied on College’s excellent professional staff, but I will give them their due at the College staff Christmas Party. In the meantime, I'm looking forward to a nice break and an awesome 2020. If you have any thoughts or comments, please email me on ceo@ranzcr.edu.au Warm wishes for the festive season, Natalia Vukolova
The public persona of the College achieved some significant goals. The highest ever media coverage for the College total audience reached:
Volume 16 No 1 I December 2019
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Advertising feature
“We’re so lucky as Radiologists today, to have the freedom to build our careers from any country we choose” explains Dr Emmy de Heer. “Radiology has always been recognized as a lifestyle specialty and, with the emergence of teleradiology, that ability to work remotely has opened up the entire world.”
FOLLOW THE SUN TO THE IDEAL CAREER DESTINATION
D
r de Heer is one of over 180 FRANZCR-qualified specialist Radiologists who have chosen to join the teleradiology revolution with Everlight Radiology. Having completed her training at Sydney’s Royal North Shore Hospital, she jumped at the opportunity to see the world while building her clinical career reporting a challenging mix of emergency cases. Emmy was surprised at how easy she found the transition to living and working in Europe, with the assistance of Everlight’s specialist RadCare team, who helped to co-ordinate and fund her relocation. “I didn’t even need to get my medical registration swapped over,” she explains. “Although I’m based in London, I’m working for ANZ and only seeing ANZ patients. So I just needed my AHPRA and MCNZ registrations.” Everlight are pioneers of the ‘follow the sun’ model, whereby specialist Radiologists are relocated to different time zones to provide emergency out-of-hours reporting for over 350 client hospitals and clinics across Australia and New Zealand. Everlight radiologists generally only work daylight 8
Inside News
If you are interested in learning more about a career in teleradiology, visit everlightradiology.com
hours, avoiding the risk of fatigue and burnout. It’s all part of a central ethos of a company founded by a group of doctors determined to create the most radiologistfriendly workplace in the world. As a result, Dr de Heer has the flexibility to select a shift pattern to suit her lifestyle and typically works the midday until 9pm shift on a week-on, week-off basis. “It’s ideal for me because I’m more of a night owl than an early-bird,” says Emmy. “Plus, the week on week-off roster means I’ve been doing lots of travelling. Last week I was in Italy, next week I’ll be in France, then Norway and Morocco.” This freedom is at the heart of Everlight’s popularity with doctors at every stage of their careers, says Dr Bryan Khoury, a Clinical Director for Everlight’s ANZ business, who has worked from their Cape Town office for
“The doctors don’t work for Everlight, Everlight works for its doctors. The support team takes care of all the peripheral noise so that I can focus on the radiology”
five years. “Everlight offers the flexibility that doctors could previously only ever dream about”, Bryan enthuses. “Young radiologists can supplement their income while doing fellowships anywhere in the world. I’ve been able to return to South Africa and raise my family while building a senior clinical career. And we have many highly-experienced radiologists who are enjoying the chance to travel and reduce their workload towards the end of their careers.” “I think in the past teleradiology has had a bit of a bad reputation in Australia,” says Dr de Heer. “There are lots of misconceptions – a key one being the idea that it is poorly paid. In fact I’m earning broadly the same as a locum radiologist in Australia, but working fewer and far friendlier hours”. Dr Khoury agrees, and is at pains to point out the clinical benefits of the ‘follow the sun’ model. “The doctors don’t work for Everlight, Everlight works for its doctors”, he explains. “The support team takes care of all the peripheral noise so that I can focus on the radiology, which is one of the reasons we are consistently significantly below the international benchmarks for our error rates.”
Features
Polycystic Ovarian Syndrome (PCOS): What is the role of the radiologist? by Dr Bridget Sutton years, the diagnosis and treatment of PCOS has been challenging and controversial. Within the broader diagnosis of polycystic ovarian syndrome, there are multiple recognised phenotypes, with and without obesity, and clinical features that vary over a patient’s lifetime.
The Pathophysiology of PCOS
Whether you are working in a specialised women’s imaging unit or a general radiology practice, it is a rare day that you would not see a referral form with the clinical question? PCOS. Since 2003, the investigation and work up of PCOS has included the use of pelvic ultrasound. It has become apparent over the years since then is that a very basic pelvic ultrasound examination and report is not adequate to assess for the criteria of polycystic ovarian appearance. Current evidencebased consensus criteria now demand that our imaging report be specific and include ovarian volumes and a total follicle count. We are required to identify dominant follicles and corpus lutea separate from antral follicles and make reasonable comment about endometrial thickness and morphology. In addition, we are expected to assess the uterus, endometrium and ovaries in the context of a patient’s menstrual history and her current cycle and determine for ourselves whether the ultrasound findings are consistent with a normal ovulatory cycle. More is being
asked of us as imaging specialists in this regard. Women are frequently referred to us for ultrasound as part of a clinical workup for PCOS, and polycystic ovaries are commonly an incidental finding on pelvic ultrasound. It is important therefore, that we are aware of the current diagnostic criteria for PCOS and the utility and limitations of ultrasound in diagnosis of the condition.
Introduction Polycystic ovarian syndrome is the most common endocrinopathy in Australian women. It affects approximately 8-13 percent of reproductive aged women with up to 70 percent of affected women remaining undiagnosed. The incidence is thought to be even higher in indigenous populations. Women with PCOS present with a myriad of diverse features including reproductive (irregular menstrual cycles, hirsutism and infertility), metabolic (insulin resistance, pre-diabetes, type 2 diabetes and cardiovascular risk factors) and psychological features (anxiety, depression, body image). Over the
In a word, hyperandrogenism. This increased secretion of androgens results from abnormalities at multiple levels of the hypothalamic-pituitary-gonadal axis. In the ovarian theca cells, LH regulates the synthesis of androgens from cholesterol. FSH regulates aromatase activity within granulosa cells, which in turn determines the amount of oestrogen produced from androgenic precursors. When the LH-FSH ratio is increased, a common finding in women with PCOS, the ovaries will preferentially produce androgen. Insulin has both direct and indirect roles in the pathogenesis of hyperandrogenaemia. In the ovary, insulin works with LH to increase androgen production in the theca cells. Insulin also inhibits the production of sex hormone binding globulin (SHBG) in the liver, resulting in an increased amount of free testosterone in the circulation. Hyperandrogenism is also thought to be the main cause of ovulatory dysfunction in women with PCOS. An androgen-induced arrest in antral follicle development results in a failure to select and mature a dominant follicle with a resultant accumulation of antral follicles 2-9mm in size. Predominantly anovulatory cycles are associated with prolonged periods of unopposed oestrogen. This in combination with other comorbidities including obesity, can result in endometrial hyperplasia and an continued over... Volume 16 No 1 I December 2019
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Features
increased risk of endometrial cancer.
Diagnostic Criteria for PCOS The first international conference on PCOS held at the National Institutes of Health (NIH) in 1990, proposed the following diagnostic criteria in an attempt to form a consensus as to the definition of the syndrome: (a) clinical or biochemical evidence of hyperandrogenism, (b) chronic anovulation and (c) exclusion of other disorders. In 2003, the Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group added the ultrasonographic finding of polycystic ovaries to the diagnostic criteria. The Rotterdam criteria required at least two of the following three conditions to be present for the diagnosis of PCOS: (a) oligo- or anovulation, (b) clinical or biochemical signs of hyperandrogenism and (c) polycystic ovarian morphology (ultrasound features of polycystic ovaries). The criteria were reviewed, updated and expanded in February 2018, and published as the current International evidence-based guideline for the
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Inside News
assessment and management of polycystic ovary syndrome 2018. The 2018 guidelines attempt to facilitate accurate diagnosis for women with PCOS, whilst avoiding over diagnosis, particularly in the adolescent population. Ultrasound criteria have been tightened to reflect the significant advancements in ultrasound technology since 2003. Defining specific diagnostic features around menarche and menopause can be quite difficult. By way of acknowledgment of this challenge, the current guidelines state that ultrasound is now not recommended for diagnosis in those within 8 years of menarche, that young “at risk” women may be identified with follow up assessment where diagnosis is unclear and that diagnostic features should be refined to limit overlap with those who do not have PCOS. One requirement shared by all of the sets of criteria for PCOS is the exclusion of other causes of hyperandrogenism such as thyroid or pituitary dysfunction, hypothalamic amenorrhoea or ovarian or adrenal neoplasms.
Ultrasound and Polycystic Ovarian Morphology The development of ultrasound criteria for polycystic ovarian morphology centred around a narrative review which asked: when is ultrasound indicated to diagnose PCOS, and what are the most effective ultrasound criteria to diagnose PCOS? The narrative, supplemented with additional evidence from a systematic review of previous research on PCOS, made a series of clinical recommendations. Using endovaginal ultrasound transducers with a frequency bandwidth that includes 8MHz, the threshold for PCOM should be on either ovary, a follicle number per ovary of ≥ 20 and/or an ovarian volume ≥10ml, ensuring no corpora lutea, cysts or dominant follicles are present. These are, in essence, the revised ultrasound criteria for PCO morphology. Despite their relative simplicity, the way in which images are acquired, ovarian volumes measured, total follicle number estimated, and the findings reported, can vary widely across imaging practices.
Features
In order for the criteria to mean anything, it is crucial that there is some uniformity in this process. The consensus committee therefore made the following additional recommendations, specifically aimed at those performing the ultrasound examinations: The transvaginal ultrasound approach is preferred in the diagnosis of PCOS, if sexually active and if acceptable to the individual being assessed. In transabdominal ultrasound reporting is best focussed on ovarian volume with a threshold of ≼10ml, given the relative difficulty of reliably assessing follicle number with this approach. Possibly the most directive of the guidelines is that in which a list of recommended reporting standards is included. It refers to current protocols recommended for reporting follicle number per ovary and ovarian volume. It also recommends that in addition to an antral follicle count and three dimensional ovarian measurements and volume, the minimum reporting standards should include the date of the last menstrual period, whether the
scan was performed endovaginally or transabdominally, endometrial thickness and appearance, other ovarian and uterine pathology as well as ovarian cysts, corpus luteum, dominant follicles ≼10mm. These current 2018 guidelines endorse the existing Rotterdam PCOS diagnostic criteria in adults but they also: a. Highlight that ultrasound is not necessary in diagnosis when hyperandrogenism and ovulatory dysfunction are present, however, ultrasound will identify the complete PCOS phenotype. b. State that within eight years of menarche, both hyperandrogenism and ovulatory dysfunction are required for diagnosis, with ultrasound not recommended.
The role of the radiologist? Pelvic ultrasound, particularly ovarian imaging, is integral to the evaluation of women with suspected PCOS. As such, clinical radiologists and sonographers need to have a working knowledge of the current clinical and ultrasound criteria for PCOS, particularly for patients who are referred for evaluation of ovulatory dysfunction or hyperandrogenism. Our reports need to be structured, detailed and specific, include total antral follicle counts and ovarian volumes, and relevant findings such as a dominant follicle, corpus luteum or abnormal endometrial morphology. In some cases, further training in careful and meticulous follicle counting per ovary may be necessary to improve reporting. And while armed with knowledge and expertise, ready to apply the ultrasound criteria for PCOS in adult patients as necessary in an expertly crafted report, we are at once able to gently explain to a referring physician, the limitations of the diagnostic criteria in their adolescent patient who presents holding a request form that reads? PCOS.
Reference 1 International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018, Teede et al on behalf of the International PCOS Network in collaboration with CREPCOS, ASRM, Monash University and ESHRE.
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Features
Professional Development
CHANGES TO YOUR MEDICAL REGISTRATION REQUIREMENTS
Remediation
ARE YOU PREPARED?
Wellbeing
Changes to Medical Registration At the College’s recent 2019 Annual Scientific Meeting (ASM) a bi-faculty expert panel was convened to interactively discuss the upcoming changes to medical registration requirements in both Australia and New Zealand and how the College is preparing for the changes and supporting members through the process. ASM delegates were fortunate to hear from panel members, chaired by Associate Professor Dinesh Varma (Chair Clinical Radiology Professional Practice Committee), Dr Ziad Thotathil (Chair Radiation Oncology Post Fellowship and Education Committee), Dr Carol Johnson (Chair New Zealand Radiation Oncology Executive) and Ms Amy Young (Manager Standards and Quality Team RANZCR). Delegate questions centred around a number of specific areas which were addressed directly by the panel. For those who could not attend, we have collated some of these responses for you.
The role of the Medical Board of Australia and the Medical Council of New Zealand Every doctor registered to practise medicine in Australia and New Zealand will be impacted when changes are imposed by the Medical Board of Australia (MBA) and Medical Council of New Zealand (MCNZ). These changes are anticipated to come into effect from 2022. The changes will transform the way doctors maintain their medical registration by shifting the focus to tailored professional development activities, that aim to enhance patient safety. The MBA is responsible for regulating medical practitioners practising in Australia. Medical practitioners who
are engaged in any form of practice are required to participate regularly in CPD that is relevant to their scope of practice in order to maintain, develop, update and enhance their knowledge, skills and performance to ensure that they deliver appropriate and safe care. Medical practitioners with specialist registration must continue to meet the requirements set out by their relevant college. Registered medical practitioners will be required to make a declaration that they have met the MBA’s registration standard for continuing professional development when they apply for renewal of registration.1 MCNZ plays a key role in ensuring public safety by putting in place mechanisms to ensure doctors are competent and safe to practise. As part of its responsibility, MCNZ sets recertification programme requirements for doctors. These programmes establish regular and ongoing processes by which doctors in New Zealand demonstrate that they are competent and up to date. Recertification programmes support doctors to maintain their competence, take responsibility for their performance and to stay current in their practice2.
Measuring Outcomes In the future, CPD activities will likely fall within three categories of Professional Development: educational activities, reviewing performance and measuring outcomes. From delegate feedback at the panel session, measuring outcomes is generating significant member uncertainty, particularly for practitioners who are not in predominately clinical positions. Members in solo practice/ remote practices also expressed concern about the logistics of incorporating these items into their work. The MBA has advised that Colleges will have
some flexibility in determining what a measuring outcome activity is for their specialty. The College is keen to engage with members in determining these, and would welcome any comments and suggestions to cpd@ranzcr.com. Within the future arrangements, all practitioners will be required to have a professional development plan in place, with predicted outcomes which can be measured (or completed). The College continues its extensive work in this area.
Have your say The MBA has released for public consultation the ‘Draft revised Registration Standard: Continuing professional development’. This can be viewed at www.medicalboard.gov. au/news/currentconsultations.aspx The relevant College committees are reviewing this and will provide feedback. Members are also encouraged to provide their own feedback to the MBA via performanceframework@ahpra.gov.au by close of business on 14 February 2020. continued on page 56...
To view the Changes to your medical registration requirements. Are you prepared? panel session, go to our website’s Annual Scientific Meeting page, the webcast catalogue is available for streaming. References 1. Medical Board of Australia Registration Standard: Continuing Professional Development (October 2016) 2. Medical Council of New Zealand Draft model for recertification requirements for vocationallyregistered doctors practising in New Zealand (April 2019)
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Features
The Foundations of Leadership in Radiation Oncology course comes to Sydney
Forty-four developing young leaders from all radiation oncology professions participated in the inaugural Southern Hemisphere Foundations of Leadership in Radiation Oncology (FLiRO) course in Sydney. The on-line and face to face (“blended”) program was held from July to August 2019. This was the first occasion it has been hosted by RANZCR, having been run in conjunction with the European Society of Radiotherapy and Oncology (ESTRO) with meetings in 2018 (Barcelona) and 2019 (Milan). It was also held at the Canadian Association of Radiation Oncology (CARO) annual meeting in Montreal in 2019. Across the four editions of the course, 136 radiation oncology (RO) professionals (radiation/clinical oncologists, radiation therapists, physicists and nurses) from 31 countries have taken part. In Sydney, 19 radiation oncologists, 18 radiation therapists, five medical physicists and one radiation oncology nurse participated. There were two radiation oncologists that came all the way from the US and another attendee from Belgium. The course was born out of the fact that of the many educational offerings available to RO professionals across the breadth of technical, clinical, scientific and research-oriented topics through a number of organisations, notably ESTRO, ASTRO and the College
there were no RO-specific courses dedicated to leadership development. A collaboration between ESTRO, CARO and RANZCR was established in 2017 to build a leadership course aimed at junior or aspiring leaders for the purpose of teaching foundation skills upon which ongoing leadership development can occur. Meredith Giuliani (CARO), Kim Benstead (ESTRO) and myself (Sandra Turner) are the joint course directors. The course was designed applying the literature evidence for effective education in this area. An interdisciplinary
teaching faculty was convened from across the relevant regions. Central to learning is an interdisciplinary team-based approach linked to ROspecific workplace scenarios and including plenty of interaction between participants and teachers. The on-line tutorial, homework (online modules, videos and a quality improvement exercise) and live sessions cover the fundamentals of leadership development including: • I ntroduction to leadership theory and styles • I ntroduction to quality improvement (QI) and QI tools •E xamining self- and relationalawareness ow to build effective teams •H •A primer in conflict management •P rinciples of managing change •C reating and communicating your Vision (for change) •D eveloping networks for leadership The live sessions were held over two days in Sydney and from the teachers’ perspective based on the ‘buzz’ in the
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Features
Overview of course components and topics Introductions
On-line modules
Introductions
Learning objectives
• Leadership qualities • Running effective meetings • Dealing with conflict • Negotiating skills
Leadership theory & styles
What is leadership? Quality improvement (QI) tools Conflict primer Description of homework Troubleshooting
Personal Insights profiling QI homework Select readings & other related videos
live sessions
I’d like to thank the co-directors (Meredith and Kim) and other teaching faculty who have shown such dedication to this project: Barbara-Ann Millar (Canada), Lucinda Morris (Sydney), Sean Geoghegan (physicist, Adelaide) and Matthew Seel (New Zealand). Gina Hesselberg (course convenor) was a joy to work with and Sarah Dowd
A/Prof Sandra Turner, Course Director
home work
There is already a request for the course to be run again, possibly in New Zealand. FLiRO will run at ESTRO39 in 2020 and there are plans afoot for the UK as well as Latin America in partnership with the Brazilian Society of Radiation Oncology.
provided impeccable College support in organising the course. I’m also most grateful to AstraZeneca, Varian, ICON Group and Mundipharma whose who sponsorship of this event allowed more participants from all professions to attend. Hopefully there will be many more future editions of the course in this part of the world. In the meantime, you are very welcome to join FLiRO in Vienna in April.
on-line tutorial
room were highly successful. Participants were very engaged in the many groupbased exercises and challenges, interwoven with short talks on theoretical aspects and concepts around effective leadership. The activities based on the individual ‘Insights’ profiles were a highlight as usual. Delving into selfawareness and understanding of others’ perspectives led to much discussion and amusement. The formal feedback has likewise been extremely positive.
Building teams Insights into self & others Managing change Quality improvement Communicating vision Developing networks
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Volume 16 No 1 I December 2019
15
®
Simple* and Convenient ADT †
1, 2
*Reconstitution and intramuscular administration vs. leuprolide SC † Available in 1, 3 and 6 month dosage forms
ADT: Androgen Deprivation Therapy These are not actual patients and are used for illustrative purposes only.
ADT for the treatment of hormone-dependent locally advanced or metastatic prostate cancer1
Before prescribing please refer to full Product Information which is available from Ipsen Medical Information. Ph: 1800 317 033 or from www.guildlink.com.au/gc/ws/ipsen/pi.cfm?product=ispdiphi. PBS Information: Restricted Benefit. Locally advanced (stage C) or metastatic (stage D) carcinoma of the prostate. Diphereline®: Triptorelin embonate 3.75 mg (1-month formulation) and 11.25 mg (3-month formulation) and 22.5 mg (6-month formulation). Indications: Hormonedependent locally advanced or metastatic prostate cancer. Contraindications: Known hypersensitivity to triptorelin or product excipients, GnRH or other GnRH agonist analogues; spinal cord compression secondary to prostate cancer metastases. Precautions: Androgen deprivation therapy may prolong the QT interval; potential bone mineral density loss; increased risk of mood changes and incident depression; adjustment of antihypertensive therapy may be required; initial transient increase in serum testosterone levels with potential transient worsening of symptoms of prostate cancer (tumour flare) and cancer related pain (metastatic pain) – consider administration of anti-androgen to counteract initial rise in serum testosterone levels and worsening of clinical symptoms; isolated cases of spinal cord compression or urethral obstruction; haematoma risk in patients treated with anticoagulants; suppression of the pituitary gonadal system; unmasking of previously unknown gonadotroph cell pituitary adenoma; hyperglycaemia and increased risk of diabetes mellitus; increased risk of cardiovascular events; not indicated for use in children or females. Drug Interactions: Use with caution when administered with medicines known to prolong the QT interval or induce torsade de pointes; or with other medicines affecting pituitary secretion of gonadotrophins; hyperprolactinaemic agents should not be prescribed concomitantly. Effect on driving / using machinery: Ability to drive and use machines may be impaired because of side effects of treatment or as a result of underlying disease. Adverse Events: Very common (≥10%): asthenia, back pain, paraesthesia lower limbs, libido decreased, erectile dysfunction, hyperhydrosis, hot flush. Common (≥1%, <10%): nausea, dry mouth, injection site erythema, inflammation, pain, reaction, oedema, hypersensitivity, weight increased, musculoskeletal pain, pain in extremity, headache, dizziness, loss of libido, depression, mood changes, pelvic pain, hypertensionsee full PI. Dose: Diphereline 3.75 mg once a month or 11.25 mg once every three months or 22.5 mg once every six months. Administration: Intramuscular injection; injection site should be varied periodically; inadvertent intravascular injection must be strictly avoided- see full PI for administration details. Storage: Store below 25°C. References: 1. Diphereline Approved Product Information. 2. Shore ND et al. Urologic Nursing 2013; 33:236-44 Diphereline® is a registered trade mark of Ipsen Pharma S.A.S. For further information about Diphereline®, contact Ipsen Pty Ltd: T (03) 8544 8100 F (03) 9562 5152 E info@ipsen.com.au www.ipsen.com.au. Ipsen Pty Ltd, ABN 47 095 036 909. Level 2, Building 4, Brandon Office Park, 540 Springvale Road, Glen Waverley, Victoria 3150, Australia. Date of preparation October 2019. TRI-AU-000410. 8672IPS
Features
Artificial Intelligence Your questions answered Earlier this year RANZCR became the first professional peak body to develop Ethical Principles for Artificial Intelligence in Medicine, ensuring Australia and New Zealand are positioned to become leading players in the application of artificial intelligence (AI) in healthcare. AI presents many opportunities for a more efficient and accessible healthcare system that delivers improved outcomes for patients. RANZCR continues to be a thought leader in the AI space with the ongoing development of a set of professional standards for the use of AI in radiology and radiation oncology, profession-led implementation and workforce transition to support the effective implementation of AI in clinical practice. This work was presented to members who attended the ASM and the resulting discussion led us to put together a short Q&A to help you understand the current environment as well as the implications of the introduction of AI.
Why did the College start with ethics? Clinical radiology and radiation oncology have always been at the forefront of technology adoption in the healthcare industry. These disciplines have evolved through embracing both transformative and disruptive technologies. It is expected that AI will create similar significant change over the next 10 years. Our specialists are well positioned to lead this transition having dealt with a constant wave of technology-driven disruption since the profession began. The College prioritised the development of ethical principles as they provide support to hospitals and healthcare practices by outlining principles that support the most appropriate use of AI that may then successfully help drive
even better patient care. They will also provide a framework for more detailed implementation documents that include regulations, standards and training modules.
How will AI products be regulated? According to the Therapeutic Goods Administration (TGA), the current regulatory framework does not adequately address software that provides information used to diagnose or treat a medical condition, or that directly provides therapy through patient interaction1.The TGA commenced consultation on regulation of software, including Software as a Medical Device (SaMD), in February 2019.
How is the College advocating to the Australian and New Zealand Governments on AI? Advocacy from RANZCR ahead of the Australian Federal Election in 2019 resulted in all major parties committing to support the development of a
comprehensive strategy to prepare for the adoption of AI in healthcare. Since then, a dedicated officer within the Department of Health has been appointed to lead this work. In New Zealand, RANZCR is engaging with the policy lead at the Ministry of Health on developments in AI. The President has also presented to the Medical Council of NZ on the College's work in this space.
What changes will be made to the training program to assist with the adoption of AI? Including AI in the College curriculum is the next step in embracing technology advancements to ensure radiologists can provide time-efficient, effective and even greater quality treatment for patients. The recently developed curriculum module is aimed at ensuring that trainees understand the current setting, what AI may be used for and the basis on which decisions are reached. continued over...
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Features
Upon completion of the training module, trainee radiation oncologists and clinical radiologists will have a demonstrable awareness and understanding of: • Concepts and principles pertaining to machine learning • Current and future trajectory of machine learning within clinical medicine, including the stages of machine learning model development, testing and implementation in clinical practice • Ethics of AI in medical imaging • Appropriate safety measures during development, testing, deployment and monitoring of machine learning • Potential benefits and limitations of machine learning and human perception • How those using AI may best use the combination of machine and human characteristics to provide high quality care to patients. As the technology develops, the College expects that the health system will routinely use AI for workflow prioritisation, data management and analysis, and potentially routine tasks currently performed by clinicians such as measurement of tumours and change to tumours and other structures.
Participating societies include the American College of Radiology (ACR), European Society of Radiology (ESR), Radiology Society of North America (RSNA), Canadian Association of Radiologists (CAR), Society for Imaging Informatics in Medicine (SIIM), European Society of Medical Imaging Informatics (EuSoMII), and American Association of Physicists in Medicine (AAPM)2. RSNA launched an AI-focused journal in early 2019 and includes an education hub with webinars. The ESR has also developed educational webinars and has a blog dedicated to AI. International uptake on this work continues to increase and RANZCR is committed to continue being a leader in this space.
How do I prepare myself for AI? The application of RANZCR’s ethical principles will maximise the opportunities AI presents, allowing for a more efficient and accessible healthcare system that safely delivers improved outcomes for patients.
How does RANZCR’s work compare internationally?
There has been much speculation about AI and its impact on the future radiology workforce. However, it is important to understand the limits of AI in health and healthcare. Currently, AI’s major function is to automate basic repetitive functions, leaving the high-order cognitive skills to the expert medical specialist.
RANZCR was the first professional peak body to develop Ethical Principles for AI in Medicine, and continues to position Australia and New Zealand as leading players in the application of AI in healthcare.
Clinicians should also be mindful that the application of AI should start from a medical problem that needs to be solved with consideration as to how that may improve patient care, rather than from technical possibilities.
Other international medical colleges are also developing ethical guidance documents, with the major radiology organisations from the US, Europe and Canada jointly drafting a statement on the Ethics of AI in Radiology.
If you have any questions or would like some more information, please contact Project Officer, Kirsten Fitzpatrick at fcr@ranzcr.edu.au
18
Inside News
What should I check before implementing AI into my Practice or Department? Health professionals in Australia should confirm with the TGA that no restrictions are in place prior to implementing AI in their practice. Other considerations include: • Discussing with the developer what training and testing data was used to ensure that it is relevant and applicable to your locality • Understanding performance and accuracy of the system as well as its weaknesses before purchase and deployment • Consider interoperability with existing settings, databases and other digital health tools • Ensure adequate measures are in place to guarantee that work will continue if AI experiences a fault or failure • Appropriately train all relevant staff prior to implementing AI or ML Medical practitioners in Australia are expected to practise in accordance with the Medical Board of Australia’s Good Medical Practice: A Code of Conduct for Doctors in Australia and the Australian Medical Council’s Good Medical Practice. Medical practitioners in New Zealand are expected to practise in accordance with the New Zealand Medical Council’s Good Medical Practice and the Code of Ethics set by the New Zealand Medical Association. RANZCR has also developed a more explicit Code of Ethics for clinical radiologists and radiation oncologists.
References 1. Consultation: Regulation of software, including Software as a Medical Device (SaMD), February 2019 https://www.tga.gov.au/sites/default/files/ consultation-regulation-software-including-softwaremedical-device-samd.pdf 2. https://www.acr.org/Advocacy-and-Economics/ Advocacy-News/Advocacy-News-Issues/In-theMarch-2-2019-Issue/Call-for-Comments-on-theEthics-of-AI-in-Radiology
Features
Reflecting on the past and looking to the future We bring you the highlights of ASM 2019 The 70th anniversary of the College’s Annual Scientific Meeting was held last month at the SKYCity Convention Centre in Auckland, New Zealand. This year we were taken Back to the Future to celebrate the anniversary, reflect on how the ASM has evolved into the impressive meeting it is today, and to recognise the advancements in clinical radiology and radiation oncology over the past seven decades. The meeting fostered various networking opportunities and gave delegates the chance to meet at some iconic locations around Auckland. For many it was an early start to the ASM with the Women in Leadership Breakfast once again kicking off the official program. Around 70 delegates were in attendance to hear Dr Valerie Jackson, President, RSNA and Dr Elizabeth Dhillon, Clinical Director – Western Australia, Everlight Radiology speak about challenges they have faced in their career and choosing your own adventure within the industry. Thank you to Everlight Radiology for their sponsorship of the second Women in Leadership Breakfast. The scientific program was opened with a traditional Maori Welcome and Ceremonial Dance which left everyone with goose bumps. This was followed by a joint plenary session on Doing Right with AI; Doing Right by Patients from A/Prof Jaron Chong from the McGill University, Montreal, Canada. This year Intelligence19 was held in conjunction with the ASM on the first day where national and international speakers discussed artificial intelligence and what you need to know about this transformative and futuristic technology. RANZCR was honoured to host experts in the field of clinical radiology and radiation oncology as part of the scientific program. International speakers travelled from the UK, USA, Europe and Canada, complementing
the highly regarded speakers from New Zealand and Australia. The large complement of international keynote speakers included: • Dr David Beyer – Dr Beyer has published more than 40 peer reviewed articles on cancer treatments and guideline development with an emphasis on prostate cancer. He has been actively involved in cancer care policy development throughout the past decade of health care reform. • Dr Drew Moghanaki – Radiation oncologist and clinical investigator within the US Department of Veteran’s Affairs, Dr Moghanaki focuses on lung cancer research and implementation. • Prof Arjun Sahgal – Prof Sahgal is an international clinical and research leader in the field of high precision stereotactic radiation to the brain and spine for both metastases and primary tumors. • Dr Michelle S Ginsburg – Based at Memorial Sloan Kettering Cancer Center, Dr Ginsburg’s research focuses on detection, characterisation and measurement of thoracic
•
•
•
•
malignancies and improving techniques to assess tumour response. Dr Andrew J Grainger – Dr Grainger works closely with a team of musculoskeletal radiologists providing MSK imaging services. He has a particular interest in sports imaging and imaging arthritis. Dr David Panicek – Dr Panicek shared his expertise in oncologic imaging, with a focus on musculoskeletal tumours. Dr David Sacks – Interventional Radiologist, Dr David Sacks, has authored and co-authored over 120 scientific publications and book chapters, and is committed to the education of physicians offering interventional stroke care. Dr Paula Woodward – Dr Paula Woodward’s clinical and research focus is pelvic and foetal imaging.
continued over...
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A highlight from the program on Friday was the session on accelerated silicosis. Facilitated by Dr Sharyn MacDonald and presented by Dr Catherine Jones, the session examined the emerging health crisis and shared clinical experiences from Australia. Dr Jones said of the key lessons out of the Australian silicosis experience was a need for greater educational resourcing across all of the healthcare industry. At the Annual Ceremony on the Friday evening more than 70 new Fellows were welcomed into the College in front of many proud family members, friends and colleagues. The atmosphere was joyous and inspiring as the 2019 New Zealander of the Year, and this year’s Nisbet Orator, Mike King shared his personal experiences working in mental health. His message to have passion, commitment and bring your loved ones along with you on your professional and personal journeys had a profound impact on the audience and will undoubtedly stay with our new Fellows as they continue to progress through their careers.
Saturday saw more than 80 participants wake up before dawn and head to Auckland’s Viaduct Basin for the Targeting Cancer Fun Run. Dr Gracie Keown once again took out the title for the fastest female runner, while Dr Adam Byrne was the male winner. The results from RANZCR’s Radiation Oncology 2018 Workforce Census were presented at the conference on Saturday. Statistics showed that the number of radiation oncologists practising in Australia and New Zealand has increased significantly. Since 2014 the number of radiation oncologists has risen from 439 to 514; a 17 per cent increase. Trainee numbers have remained stable and trainees reported increased job satisfaction with their career and workplaces. Later that evening we were taken Back to the ‘80s for the much anticipated RANZCR Annual Gala Dinner. The main plenary room was transformed into an ‘80s oasis, complete with leg-warmers, neon, big hair and a DeLorean from the ‘80s movie Back to the Future. During the formalities, various researchers
were recognised for their outstanding achievements including Varian Prize winner Dr Christopher Williams who won for his presentation; The diminishing role of neck dissection in node positive HPV-associated oropharyngeal cancer following (chemo)radiotherapy. The Branch of Origin prize was awarded to Dr Gregory Tarr for Factors Associated with Change in Management Due to Inclusion of Pre-operative Staging PSMA PET CT in Patients with High Risk Prostate Cancer. Once the formalities concluded, the party started with the band 80sx playing hits from a decade which is so familiar to a lot of us. It only took the first two songs to fill the dance floor! Delegates will have received their certificate of attendance by now, so don’t forget to claim your CPD points via CPD online. A maximum of 28.75 RANZCR CPD points can be claimed for full attendance at the ASM (additional points are claimable for attendance at workshops). The 70th annual ASM was an inspiring and energising occasion thanks to the collaborative atmosphere that was fostered by all who attended. The dedication and passion reflected the spirit of the radiology and radiation oncology communities, which the College is proud to lead. The College would like to take this opportunity to thank everyone who attended, particularly the speakers, exhibitors, and sponsors, including Platinum Partners Intelerad and Varian, for their support of the meeting. A special thanks to the 2019 Organising Committee for their hard work and dedication to the quality of the scientific program.
20
Inside News
Features
Special Thanks to the 2019 ASM Organising Committee
Please make sure you mark your diary for the 71st RANZCR 2020 ASM: Elysium: Diagnostics and Therapeutics (now and the future) with AI which will be held from 15 18 October 2020 at the Melbourne Convention and Exhibition Centre.
Dr Gabes Lau | Clinical Radiology Convenor Dr Ben Wilson | Clinical Radiology Representative Dr Jash Agraval | Clinical Radiology Representative Dr Louis Lao | Radiation Oncology Co-Convenor Dr Ramesh Arunachalam |Radiation Oncology Co-Convenor Dr Acrane Li | Clinical Radiology Trainee Committee Representative Dr Anna Gubbins | Radiation Oncology Trainee Committee Representative
Volume 16 No 1 I December 2019
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More specialty expertise. More doctors protected. We’ve got your back.
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As a respected doctor, you stand by your reputation and our reputation is built on protecting yours. The fact is, no medical indemnity insurer has more resources or expertise to safeguard your reputation than Avant. With Avant, you’ll have the support of award winning Avant Law, Australia’s largest specialist medico-legal firm. And more doctors on staff delivers
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Features
Diagnostic error in radiology: complaints and claims insights The initial chest x-ray and spirometry report were normal. The patient, Chris, was a 32-year-old male with a 10 pack a year history of smoking and an intermittent non-productive cough but no other significant past medical history. The GP’s referral to the radiologist had noted concern about the potential for stonemason’s silicosis, based on a recent employment history of installing kitchen benchtops. The GP’s clinical note had prompted the radiologist to include in the report that while the chest x-ray showed no abnormalities, it was insufficient to exclude silicosis and that a high-resolution CT chest was recommended. The GP did order follow-up scans, which showed bilateral diffuse ground-glass opacities. The GP referred Chris to a respiratory physician for further assessment and Chris was recently diagnosed with accelerated silicosis. - Melissa Yee, B.Psych (Hons), M.Org. Psych., Research and Evaluation Manager, Avant Effective communication between primary care and diagnostic specialists can be key to a successful diagnosis, as this case illustrates. Unfortunately, many of the cases Avant sees have played out rather differently. Radiologists will probably not be surprised to learn that missed or delayed diagnoses were among the most frequent issues we have assisted radiologist members with.
Complaints and claims involving diagnostic error in radiology A recent analysis of complaints and claims data, indicated that diagnostic errors were behind 66 percent of the claims for compensation and regulatory complaints involving Avant’s radiologist members. Three out of four of these involved allegations of a missed or
delayed diagnosis, for example due to incorrect interpretation of an image, or delay or failure to report on an incidental finding. Diseases of the respiratory system were common among the missed or delayed diagnoses in the sample we analysed. There are a number of practical steps radiologists can take to avoid errors in interpreting clinical images1. However, in over half of the cases in our data review, the radiologist’s care was assessed as having met the expected standard. This suggests that any failure to make a diagnosis was not due to an error interpreting the original image. Are there other steps radiologists can take to avoid being subject to claims or complaints? One other issue we see is communication breakdown between some of those involved in the diagnosis – diagnostic specialists, primary care practitioners, and patients.
Encourage effective communication The NSW Clinical Excellence Commission guidelines on avoiding diagnostic error2 encourage primary care practitioners to “speak directly with the staff providing you with diagnostic test results: radiologists, pathologists, and clinical pathologists. If you aren’t sure of the most appropriate diagnostic strategy, ask, or use online testordering advice.” For radiologists, it may be helpful to encourage referring practitioners to take this approach to communication. If you need more information on clinical history or differential diagnoses to aid your examination, ask for clarification from the referring doctor and / or patient if possible.
Specifically in the case of silicosis, awareness of this disease affecting young men working with artificial stone is increasing in Australia, in part thanks to recent media coverage and the announcement of a National Dust Diseases Task Force.3 The Royal Australian and New Zealand College of Radiologists’ recent release of guidelines on screening for silicosis also attracted attention in the medical media.4 However primary practitioners may not have seen cases of silicosis and may not always be aware of screening recommendations. Considering silicosis as a potential differential diagnosis and recommending further testing as appropriate in your report may be key to successful and early diagnosis. Following up directly with the referring doctor if there is any doubt may also be appropriate.
Be clear about the limits of testing We also see problems arising because of misunderstandings about the limitations of radiologic studies. In your reports and in any direct dealings with patients, it is important to explain when tests may not be enough to rule out a particular condition, and to recommend further evaluation or follow-up testing if clinically indicated. Of course, remember to document any discussions with referring clinicians. Bear in mind that patients will have direct access to your reports (including via their My Health Record) so it is important to be consistent in your messaging and take care to avoid jargon or acronyms. Missed and delayed diagnoses may not be entirely avoidable. They are much more likely however if the limitations of a particular test, or the need for ongoing monitoring, are not clearly articulated or understood by everyone involved. continued over... Volume 16 No 1 I December 2019
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Compensation claims and complaints insights Radiologists Diagnosis issues 66% of claims and complaints related to diagnosis issues. Of these: One in 12 Avant radiologist members had a claim for compensation, complaint to a regulator, coronial inquiry or another matter raised about the provision of their care in FY19. However, doctors sometimes have allegations made against them even though they provided appropriate care.
6%
3 in 4
were allegations of a missed or delayed diagnosis (e.g. due to incorrect interpretation of an image or delay/failure to report on an incidental finding).
1 in 4
were allegations of a misdiagnosis (e.g. due to incorrect interpretation of an image).
37%
Coronial cases
Claims for compensation
The most common types of diagnoses missed or delayed were: •
Neoplasms e.g. malignant neoplasms.
Other (includes Medicare)
•
Injury and other consequences of external causes e.g. fractures, complications of prosthetic devices/implants or grafts.
11%
•
Diseases of the respiratory system e.g. pneumoconiosis.
•
Diseases of the nervous system.
8%
Employment disputes
38% Regulatory complaints
*Data source: matters indemnified FY2015-FY2019
15% of claims and complaints were related to procedural issues e.g. injections, of which:
Our medico-legal data Members asked us for more information about medico-legal matters such as claims for compensation and complaints to regulators. In response we conducted a retrospective review of routinely collected and coded data. The following is based on over 200 matters involving Avant radiologist members from across Australia, indemnified and closed over the five-year period from July 2014 to June 2019. These insights may help you better understand and manage your medico-legal risks, and optimise the quality and safety of your care.
Common claims and complaints
66% 8% 4%
were issues that occurred during the procedure (e.g. poor procedural performance).
24%
were pre or post-procedural.
Practitioner behaviours 8% of claims and complaints were related to practitioner behaviours. These included issues regarding communication with the team, other providers or patients; boundary transgressions and other practitioner behaviours.
Diagnosis
When a medico-legal evaluation of expected standards of care was conducted, the doctor was considered to have met the standard in more than half of cases. Regardless, these cases can still take years to resolve.
Procedural
43% Did not meet the standard
Practitioner behaviours
Consent
7%
76%
Resolution of matters
The majority of medico-legal matters were claims for compensation and regulatory complaints. These related to:
15%
Procedural issues
Other
57% Met the standard
1800 128 268 avant.org.au
where you will find articles, factsheets, case studies, podcasts and many other resources. If you receive a claim or complaint contact our Medico-legal Advisory Service on 1800 128 268 for expert advice on how to respond, available 24/7 in emergencies.
Features
Key insights
Glossary
Our data highlights that claims and complaints against radiologists are fairly infrequent and it is not surprising the majority are related to diagnosis issues.
•
Claims refers to claims for money, compensation and civil litigation claims.
•
Complaints relates to formal complaints to regulators.
We also identified other issues that can give rise to claims and complaints, such as communication. In our experience, paying attention to communication with patients can help to reduce the likelihood of experiencing a claim or complaint.
•
Matters include; claims, complaints, coronial cases and other matters such as employment disputes and Medicare.
•
Employment disputes are matters where Avant defends members against complaints or supports members to resolve employment issues.
Useful resources For more information on diagnostic issues, communicating with patients and a wide range of other topics, visit the Avant Learning Centre – www.avant.org.au/avant-learning-centre/ where you will find articles, factsheets, case studies, podcasts and many other resources.
For any queries please contact us at research@avant.org.au
If you receive a claim or complaint contact our Medico-legal Advisory Service on 1800 128 268 for expert advice on how to respond, available 24/7 in emergencies.
IMPORTANT: Avant routinely codes information collected in the course of assisting member doctors in medico-legal matters into a standardised, deidentified dataset. This retrospective analysis was conducted using this dataset. The findings represent the experience of these doctors in the period of time specified, which may not reflect the experience of all doctors in Australia. This publication is not comprehensive and does not constitute legal or medical advice. You should seek legal or other professional advice before relying on any content, and practise proper clinical decision-making with regard to the individual circumstances. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgement or seek appropriate professional advice relevant to their own particular practice. Compliance with any recommendations will not in any way guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional or practice. Avant is not responsible to you or anyone else for any loss suffered in connection with the use of this information. Information is only current at the date initially published (July 2019). © Avant Mutual Group Limited 2019. MJN-151 10/19 (1043-6)
For more information or immediate advice, call our Medico-legal Advisory Service on 1800 128 268, 24/7 in emergencies.
1800 128 268 avant.org.au More information:
Note about data:
clinical decision-making with regard to the individual circumstances. Persons IMPORTANT: Avant routinely codes implementing any recommendations For more information on diagnostic information collected in the course of contained in this publication must exercise issues and communicating with assisting member doctors in medico-legal their own independent skill or judgement or intodoctors a standardised, deidentified patients, articles, factsheets, IMPORTANT: including Avant routinely codes information collected in the course of matters assisting member in medico-legal matters into a standardised, deidentified This retrospective analysis was conducted this seek dataset. appropriate professional advice using relevant dataset. The findingspodcasts represent the experience of these doctors in the period of time specified, may not reflectanalysis the experience of all doctors in Australia. This publication is not comprehensive and does not constitute dataset. This which retrospective was case studies, visit the Avant to their own particular practice. Compliance legal or medical advice. You should seek legal or other professional advice conducted before relying on any content, anddataset. practise proper clinical decision-making with regard to the individual circumstances. Persons implementing any using this The findings Learning Centre any recommendations will in any way recommendations contained in this publication must exercise their own independent skill orthe judgement or seek appropriate professional advice relevant towith their own particular practice. Compliance with anynot recommendations represent experience of these doctors guarantee discharge theelseduty care owed will not in any way guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional or practice. Avant is not responsible to you or of anyone for anyofloss suffered in in the period of time specified, which connection with the of thisresearch information. Information date initially published (July 2019). © Avant Mutual Group Limited 2019. to patients and others coming MJN-151 10/19 (1043-6) into contact For queries onusethe pleaseis only current at the may not reflect the experience of all with the health professional or practice. Avant contact us at research@avant.org.au doctors in Australia. This publication is not is not responsible to you or anyone else for comprehensive and does not constitute any loss suffered in connection with the use or medicaladvice, advice. You seek For more information orlegal immediate callshould our Medico-legal Advisory Service of this information. Information is only current legal or other professional advice before at the date initially published (July 2019). on 1800 128 268, 24/7 in emergencies. relying on any content, and practise proper © Avant Mutual Group Limited 2019.
Volume 16 No 1 I
1800 128 268 avant.org.au December 2019 25
Features
National Sonographer Regulation
In Australia, sonographers are the only medical imaging professionals without national regulation. As a result, there are no enforceable standards of practice that set the minimum expectations of ultrasound examinations performed by sonographers in Australia. Other important patient safety and quality controls, such as recency of practice requirements, also do not exist for sonographers. And critically, without national regulation, there is no uniform or consistent system for complaints handling for sonographer’s patients.
Aren’t sonographers already regulated? The Australian Sonographer Accreditation Registry (ASAR) was introduced in 2001, linking sonographers to Medicare diagnostic ultrasound services. However, ASAR is not a registration board. The ASAR accredits sonography courses and has a register of sonographers that have completed a recognised course of training and maintain minimum CPD requirements. The ASAR doesn’t have any power to impose practice conditions or sanctions on a sonographer. It does not receive complaints about sonographers. The ASAR cannot remove a sonographer from the register due to poor practice standards or professional misconduct or prevent a sonographer from practising.
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Inside News
Why is sonographer regulation so important? As you are aware, sonographers play a vital role in the provision of quality ultrasound services with sonographers often working autonomously to capture medical images under the supervision of a radiologist or sonologist. You rely on the sonographer to identify and capture quality images or identify pathologies and provide accurate and timely information. Failure by a sonographer – such as failure to view the entire structure or recognise that something is not normal – may mean diagnostic information is missed, and your report may not be accurate. Ultimately patient safety is at risk.
How will sonographers become regulated? The ASA, with an industry working group, is developing a submission to the Council Of Australian Governments (COAG) Health Council to have sonographers nationally regulated, by adding sonographers to the existing AHPRA Medical Radiation Practice Board of Australia (MRPBA). This cost-effective solution assures patient safety, bringing together all diagnostic imaging professions and reducing the inefficient administrative mechanisms currently in place. This recommendation has the support of the MRPBA, the wider diagnostic imaging industry and other key health stakeholders. This model is also reflective of the regulation that exists for sonographers in New Zealand.
Importantly this change would only apply for sonographers and will not regulate who can and cannot perform an ultrasound. Achieving sonographer regulation is a five-step process which first requires approval by the COAG Health Council, made up of state, territory and federal health ministers. We are aiming to have our submission submitted mid-2020. Building the case for sonographer regulation relies on gathering evidence of the risk to patients resulting from the lack of regulation and enforceable standards. Therefore, we are seeking deidentified case examples from radiologists of poor or detrimental sonographer practice. If you have an example, please take five minutes to record the anonymous case examples here www.sonographers.org/advocacy/ case-examples. Be assured the identity of patients and practitioners will remain strictly confidential. If you would like more information on sonographer regulation, including FAQs, please visit the ASA website www. sonographers.org. Thank you for your support of this important work. By Jodie Long, CEO of the Australasian Sonographers Association (ASA)
Education
Quantitative Spectral CT adds diagnostic value to head and neck imaging
I am delighted to report to the College that Dr Cassandra Jeavons, a RANZCR trainee from the Gold Coast University Hospital, was recently awarded the prestigious Gabriel H. Wilson Award at the Western Neuroradiology Society (WNRS) held in Coeur d'Alene, Idaho, United States from 26 - 29 Sep 2019. The Gabriel H. Wilson Award is presented to the best oral scientific paper presentation at the WNRS and was established in 1988 in honour of the first WNRS President, Gabriel H. Wilson, MD. Gold Coast University Hospital is one of a few selective sites in Australasia that has successfully integrated the on demand self-post processing of imaging data from the newer generation of IQon Spectral CT scanner Philips® into the daily reporting workflow. Dr Jeavons and I have been working towards a better understanding of quantitative diagnostic utility of iodine map and Z-effective map in the diagnosis and staging of upper aerodigestive tract cancers. Early results are promising and show a statistically significant difference of both iodine value and Z-effective value between the normal mucosa and cancer. Dr Jeavons
emphasised the difference between the two colour maps, “Iodine density maps demonstrate improved definition of the normal tissue and tumour interface. Whereas the Z-effective maps demonstrate better contrast of tissues with different atomic numbers, hence are more suited to detect tumour invasion in bone or cartilage.” Dr Jeavons has been invited to present her scientific paper again at the America Society of Neuroradiology meeting in Las Vegas 2020. Yours Sincerely, Dr Charlie Chia-Tsong Hsu
Dr Cassandra Jeavons
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Targeting Cancer continues to focus on GP education GP education evenings a great success Newcastle Calvary Mater, Canterbury Regional Cancer and Haematology Service at Christchurch Hospital and Wellington Hospital recently hosted GP Education Evenings. More than 50 GPs and other health professionals attended the important events, run as part of the Targeting Cancer campaign. The GP-focused education program across Australia and New Zealand provides GPs with a face-to-face opportunity to learn about radiation therapy as a safe and cost-effective treatment option for cancer patients. It is imperative that more GPs and healthcare professionals are aware of radiation therapy to ensure that patients are fully informed about the range of treatment options available to them.
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We know that patients are potentially missing out on life-saving or lifeimproving treatment, and one of the reasons is lack of awareness. GPs play a vital role in the management and referrals of cancer patients to ensure that they receive the best care possible and can receive the most appropriate treatment for them. The education evenings serve as a way for GPs to learn about the indications, technology and practicalities of modern radiation therapy in a social and informal setting. Survey results evaluating the GP education program show that hundreds of GPs across both countries have improved their knowledge of the aims, practicalities and the positive impact modern radiation therapy has had on patient reported outcomes.
If you would like to host a GP Education Evening, please contact faculty@ranzcr.edu.au You can also refer GPs and other healthcare professionals to the virtual GP education evening videos on the Targeting Cancer website. The videos focus on the role of radiation therapy in general practice and include a tour of a radiation oncology department. For more information and resources visit www.targetingcancer.com.au/useful-links
Advocacy
General Practice Conference & Exhibition (GPCE) In addition to the GP education evenings, which provide GPs an opportunity to be shown around a radiation oncology centre/department, radiation oncologists have been extolling the benefits of radiation therapy at GPCE events across Australia. Running for 25 years, GPCE is one of the largest GP CPD events held in Australia. With four events occurring each year (held in Sydney, Brisbane, Perth, and Melbourne), Targeting Cancer has had a presence for the last two years. Over 400 GPs have attended our sessions.
There was a festive atmosphere around the Viaduct Basin as members, sponsors, exhibitors, consumers and College staff came together for the event. From dancing through warm-ups with a personal trainer to cheering each other across the finish line, the unwavering commitment and joyous spirit amongst the Targeting Cancer supporters was clear. Congratulations goes to this year’s fastest female and male runners, Drs Gracie Keown and Adam Byrne, who received their prizes, sponsored by Auckland Radiology Group, at the ASM Gala Dinner.
It’s not too early to start training for next year’s Fun Run in Melbourne, which promises to be even bigger and better! Fun runs and other public events are a great opportunity to promote Targeting Cancer and a simple way to highlight the campaign and radiation therapy. Targeting Cancer can provide t-shirts, caps and other helpful merchandise; email info@targetingcancer.com.au for more information.
We would like to thank the coordinator of the GPCE sessions, Dr Gina Hesselberg, and all the radiation oncologists who have given up their time (often on a weekend) to present to GPs.
Targeting Cancer in leaps and bounds Nearly 100 people were up before the sun on a crisp Auckland morning to take part in the annual Targeting Cancer Fun Run. The pavement was rain-soaked and the air chilly but that did not dampen the spirits of our runners and walkers. The Fun Run, which raises awareness of radiation therapy as a safe, effective and underused cancer treatment, was again a highlight of the ASM program. This was the fifth year that the Fun Run has taken place, proudly sponsored by GenesisCare.
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InsideRadiology is an Australasian resource on clinical radiology tests, procedures, and interventions, providing up-to-date information to health consumers and health professionals and improving doctor-patient communication. www.insideradiology.com.au
InsideRadiology, along with the College is proud to participate in the International Day of Radiology, an initiative of the European Society of Radiology, the Radiological Society of North America and the American College of Radiology. The International Day of Radiology is an annual event which is held with the aim of building greater awareness of the value that radiology contributes to safe patient care and improving understanding of the vital role radiologists play in the healthcare continuum. The event is celebrated on 8 November, the anniversary of Wilhelm Conrad Roentgen’s discovery of the existence of X-rays in 1895.
International Day of Radiology 2019 The theme for International Day of Radiology (IDoR) 2019 was ‘Sports Imaging’. Musculoskeletal radiology is a fast-growing subspecialty of diagnostic radiology that plays an increasingly important role in the assessment and management of patients with a wide range of injuries. Sports Imaging forms an integral part of Musculoskeletal radiology. Clinical radiologists play an important role in the clinical management of top athletes as well as of people involved in sports at various levels.
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As much as 70 percent of the population will experience a sports-related injury in their lives. The development of imaging technology has resulted in the superior visualisation of tendons, ligaments, and cartilage, giving increased importance to medical imaging in the diagnosis and treatment of such injuries. Technology advances mean radiology plays a key role in the field of prevention as radiologists can detect problems and abnormalities at earlier stages. InsideRadiology hosts a range of information items for health consumers and professionals on musculoskeletal imaging and has released two stories from elite athletes in Australia and New Zealand demonstrating the vital role radiology has played in their professional sporting careers. For more information about International Day of Radiology please visit www.internationaldayofradiology.com
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Education
2020 RANZCR Workshops, Courses and Events A number of educational activities and events are on the calendar for 2020 across clinical radiology and radiation oncology.
Statistics and Research Methods (SMART) Workshop The SMART Workshop will be taking place on Monday 16 March 2020 to coincide with the 2020 Trans-Tasman Radiation Oncology Group (TROG) Annual Scientific Meeting in Sydney. This year the workshop will take place on the first day of the ASM, with the TROG conference scheduled to run from 17 to 19 March. The workshop is aimed at phase 1 exam radiation oncology trainees and for the first time this year clinical radiology trainees. It is designed around eight short didactic presentations by biostatisticians followed by interactive sessions during which groups of five to seven trainees are guided by radiation oncologist facilitators. Each small group session links back to the minilectures, prompting discussion of the key statistics and research methods through structured question sets relating to mostly radiation oncology trial publications. Trainees attending the SMART Workshop have access to a discounted registration rate to attend the TROG ASM. Registration fee: AU$95.00 per delegate for the SMART Workshop only. Additional registration fees apply for the TROG ASM. Register at www.asm.trog.com.au/ workshops/
ESTRO Basic Clinical Radiobiology Workshop The ESTRO Basic Clinical Radiobiology Course is being held from 30 April – 3 May at the PARKROYAL Darling
Harbour, Sydney. The course is designed to be an introduction to radiation biology as applied to radiotherapy, focusing on technology, biology and molecular oncology. It represents a valuable opportunity for radiation oncology professionals to learn from an international faculty of expert radiobiologists and clinicians in Australia.
Phase 1 Course
Registration fees:
Course Objectives:
ESTRO Member - RANZCR Trainee: $1,354.50
• Inspire trainees to learn for life rather than for the exams • Provide guidance on how to approach the next 12 months of their training in the most efficient way • Provide didactic lectures in the main topic areas to supplement trainee knowledge in the four basic sciences • Provide an opportunity for trainees to ask specific questions of experts in a dedicated questions and answer session as well as informally following individual sessions • Provide specific guidance on exam preparation and technique including mock exams and • Provide an opportunity for trainees to network professionally and socially. Register: Registration opens early 2020
ESTRO Member - Radiation Oncologist: $1,749.50 ESTRO Member - Radiation Therapist/ Physicist/Radiobiologist/other members in training: $1,547.50 Non ESTRO members - all categories: $1,954.50 Register: www.ranzcr.com/whats-on/ events
Phase 2 Exam Preparation Course The Phase 2 Exam Preparation Course will be taking place in Sydney during May. The course is designed for trainees as they approach exam readiness and aims to provide trainees with an opportunity to: • Better understand the exam development process and how exams are marked • Simulate sitting the viva exam, with feedback provided immediately afterwards • Practice a written question from each paper to workshop the answers with the Phase 2 examiners, and • Develop strategies to cope with exam stress to ensure they perform to the best of their abilities. Register: Registration opens early 2020.
The Phase 1 Foundation and Exam Preparation Courses will be combined in 2020. The course will be held in Sydney from 19-21 June. The course is designed for Phase 1 trainees who are in the first six months of training and for trainees who are aiming to sit the Phase 1 Exams in September 2020.
RANZCR/ACR Education Center Courses The RANZCR/ACR Education Center Courses next year are being held in Melbourne, Victoria from 7 – 16 August. These courses are the most intensive, rewarding training for radiologists outside of North America. Dates and Topics: • 7-9 August: High Resolution CT of the Chest • 10-12 August: Emergency Radiology • 10-12 August: Paediatrics • 14-16: Musculoskeletal MR Commonly Imaged Joints Register: Registration opens December 2019
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Workshops 1 January 2020 – 31 March 2020 Winter Imaging Update in Beaver Creek, Beaver Creek Colorado, 06 – 10 January Imaging in the Bahamas, The Bahamas, 03 – 06 February The 5th International 4 Corners of Cardiology Meeting (4CC), Melbourne VIC, 07 – 08 February MMND-ITRO 2020: Innovative Technologies in Radiation Oncology, Wollongong NSW, 10 – 13 February Macquarie University Graduate Diploma of Anatomy, North Ryde NSW, 24 February Winter Imaging Update in Jackson Hole, Teton Village Wyoming USA, 24 – 28 February 2020 TROG ASM, Sydney NSW, 01 – 19 March Radiation Oncology Trainee SMART Workshop, Sydney NSW, 16 March RANZCR WA Weekend Meeting 2020, Nedlands WA, 21 –22 March Abdominal Radiology Group of Australia and New Zealand (ARGANZ) Annual Meeting 2020, Brisbane QLD, 28 – 29 March Diagnostic Imaging Update on Maui, Maui, HI, USA, 23 – 26 March 2020 Diagnostic Imaging Update in Hawaii, Kauai, HI, USA, 30 March – 2 April 2020 These events are subject to change. Please visit the RANZCR Events page for further details.
Cardiac CT Training 2020 We go beyond simply meeting training requirements: l
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Education
Training and Assessment Reform Towards Implementation
The Training and Assessment Reform (TAR) project is a quality improvement initiative to ensure our training programs are up to date, align with current and contemporary practice, and are compliant with relevant regulatory requirements. We are pleased that the project has achieved the milestone of completion of the draft training program for both Clinical Radiology and Radiation Oncology, with learning outcomes/curriculum, work-basedassessments and structured learning activities, examinations and progression rules determined and finalised by the various working groups and steering committees.
We are indebted to all Fellows, Educational Affiliates, Trainees, other medical specialists, educationalists, consumers and College staff who have dedicated their time and provided invaluable advice and contribution to this project. We are also grateful to those who have provided feedback on the learning outcomes during the member consultation, and those who have participated in piloting the new assessment tools. All feedback and suggestions will be considered by steering committees, in order to further update the learning outcomes and improve the work-based-assessment tools.
Both training programs are designed as five-year programs with three Phases in Clinical Radiology, and two Phases in Radiation Oncology. The enhanced programs recognise that trainees learn at different rates and have the flexibility to support this, with milestones and mechanisms created throughout to monitor progress and provide support when necessary.
We are confident the enhanced training programs will ensure we produce highly-skilled practitioners in the fields of Clinical Radiology and Radiation Oncology, to provide optimal patient care.
What’s What? The Training and Assessment Reform is now moving to the implementation stage, with the aim to launch the enhanced training program in December 2020 for New Zealand trainees, and February 2021 for Australian and Singapore trainees. In addition to the program enhancements, the Trainee Information Management System (TIMS) will be replaced by a new fit for purpose Learning Management System (LMS), to support the delivery of enhanced training programs, to measure identified outcomes and allow tracking of trainee progression. The College has decided that all current trainees will transition to the enhanced programs when they are implemented. This will allow all trainees to benefit from the new programs and avoid the need to operate two IT systems concurrently, and reduce potential confusion. continued over...
Clinical Radiology Training Program
Radiation Oncology Training Program
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Education
Planning is now underway to minimise any disruption and make the transition smooth and seamless. The College will endeavour to avoid disadvantaging trainees, and to allow some flexibility during the transition. To expedite the transition, all trainees are asked to keep their relevant information and records under the current training programs up to date in TIMS, including details of training status, rotation, experiential training requirements, logbooks and work-based assessments. This will ensure that the data being transferred to the LMS is as accurate as possible. In the coming months, more information regarding the transition will be provided through College communication channels to ensure all members, particularly trainees, are well-informed and properly supported throughout the transition process. College members are encouraged to read the information and keep abreast of changes.
As part of the Communication plan the College is planning roadshows to networks/branches in 2020, with the first visits to take place in February-April to share general information, and the second visits in August-October on practical application and how to use the new Learning Management System (LMS). If you would like more information or have any questions regarding the Training and Assessment Reform project, please visit College website www.ranzcr.com/tar, or contact Ms Legend Lee, Manager, Training Programs at the College at legend.lee@ranzcr.edu.au.
Both Faculties have now established Implementation Working Groups to oversee the implementation of the enhanced training program, including trainees’ transition; marketing and communication; training and support for members; policy review and update; and input into the development of LMS. The Implementation Working Groups include representatives from branches/ networks to ensure all training networks are engaged in all implementation activities.
1 in 2 people with cancer would benefit from radiation therapy Greater awareness that radiation therapy is safe and provides good clinical outcomes will improve utilisation. Sign up at targetingcancer.com.au to show your support. @TargetingCancer
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RadiationOncologyTargetingCancer
Radiation-Oncology-Targeting-Cancer
ELYSIUM: DIAGNOSTICS AND THERAPEUTICS (NOW AND THE FUTURE) WITH AI
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Clinical Radiology
A year of achievement but the work continues A Message from the Dean Clin A/Prof Sanjay Jeganathan To paraphrase the poet John Mark Green, I blinked my eyes and in an instant my first year as Dean has passed. Clinical radiology is a dynamic sector and I have been amazed by the volume and variety of issues that we are constantly faced with. It is a great credit to hundreds of my Radiologist colleagues who contribute to College work and our extremely dedicated staff that we have achieved so much over the past 12 months. I am very fortunate to work with such an engaged group of people. There are too many achievements from this year to mention them all, but I would like to highlight a few key successes. Our advocacy work in both jurisdictions is showing very positive effect, with the Australian government’s commitment to index CT, x-ray, mammography and ultrasound from 2020. We seek greater transparency from the government in the allocation of MRI licenses but are none-the-less very pleased to see patient access to MRI increasing both through additional licensed machines and the new listing of Obstetric MRI and Liver MRI. In New Zealand we are making headway with our contribution to the National Cancer Plan and submission to the Health and Disability Review. These activities will continue next year, and I anticipate that the College will be influential in the strategies developed from these key reform initiatives. Our College’s response to the emerging silicosis epidemic was swift. We have published a position statement outlining
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the role of clinical radiology in the diagnosis of this horrible disease to ensure patients are given access to the best diagnostic tools available. Our position statement has been widely reported in the media and even quoted in NSW Parliament.
We believe that these changes risk patient safety by providing a platform for radiographers to expand their scope of practice significantly beyond their training into areas of practice that require medical and post-graduate specialist training.
There is a constant flow of critical issues that need immediate attention, but we can’t dedicate all our resources to being reactive, it is important to also carve out time to plan for the future. This is evident in the ground-breaking work being done by our Artificial Intelligence Committee. RANZCR is leading the medical communities in Australia and New Zealand, and dare I say internationally, with the publication of Ethical Principles for Artificial Intelligence in Medicine. Building on the ethical principles the AI Committee has developed AI Standards of Practice which provide guidance on how the ethical principles should be implemented.
We have also been in protracted negotiations with Cardiac Society of Australian and New Zealand in relation to appropriate credentialing for providers of Cardiac MRI. The challenge has been to harmonise the perspective of each profession toward quality and achievability of requirements to provide this service.
We have established several new working groups such as the Postmortem Imaging Working Group and Theranostics Working Group to identify the future direction of these fields and advise FCR Council on how the profession should prepare for these areas of practice. We are also facing some challenges that require our attention and advocacy such as the Medical Radiation Practice Board, the body that registers radiographers, making changes to their Professional capabilities for medical radiation practice.
The Australian government has considerably increased funding and resources for Medicare compliance activity. We are very supportive of stamping out inappropriate billing but at the same time need to ensure that the government understands clinical radiology practice in the context of a very complex and often difficult to understand Medicare schedule. I anticipate that the coming year will be equally as challenging as this year has been. I look forward to working with all members to address both the challenges and opportunities we face and build a positive future for clinical radiology. I wish you and your families a very happy and safe Christmas and a healthy and successful 2020.
Clinical Radiology
The viva voce (viva) examination Chief Censor in Clinical Radiology
Dr Meredith Thomas
In considering the place of the viva examination amongst other assessment tools, we have considered its purpose, its reliability and validity, and its capacity to assess learning and determine competence. We have also considered required resources, feasibility and sustainability with anticipated increases in candidate numbers in the future. The viva has been used extensively in medical education, with the belief that professional behaviour is best assessed in a face-to-face interaction, allowing an examiner to probe knowledge, but also reasoning, and use expert judgement to determine competence. The viva has been part of our Fellowship assessment for many years. Historically vivas were interactive, with experienced Fellows showing cases and questioning the candidate about the case. In more recent years there has been increasing recognition of the need to improve standardisation by minimising variability of the candidate experience and limiting the information provided to the candidate to a succinct history. This likely improves reliability but limits interaction. With reduced interaction the viva has become increasingly about assessing a candidate’s medical expert knowledge, with a reduced capacity to assess the non-medical expert roles such as communication, collaboration, judgement and professionalism, which were historically assessed in a more interactive, albeit less standardised viva.
A strength of our viva is its capacity to allow a global expert opinion of a candidate’s competence within a particular system. The vivas are the only Part 2 formative assessments which are conjunctive, ensuring competence is achieved in all systems. Written components of the Part 2 examinations are conversely compensatory, allowing a poor performance in one system to be compensated for by a strong performance in another. In reforming the viva examination, we aimed to identify competencies best assessed by the vivas and determine what competencies currently assessed in the viva could be better assessed in alternative ways. We have incorporated assessment of professionalism, communication and other intrinsic roles, as well as incorporating elements of anatomy, applied imaging technology and pathology. Additionally, the new viva format will optimise reliability, validity and educational impact, while ensuring that it remains feasible now and in the future. The format of the viva is recommended to be a single assessment more like a radiological Objective Structured Clinical Examination (OSCE), with 7 stations of 25 minutes each, each comprising one topic area with approximately ten cases.
questions and comprehensive marking templates for each case while allowing some targeting questioning. All cases will be scored according to previously determined rating scales, ensuring objectivity in scoring. The spread of categorisation will be retained, with a predetermined spread in degree of difficulty. Increasing the number of cases will allow wide sampling and ensuring that all candidates see the same number of cases will improve inter-case reliability. Through moving from hard copy to digitised cases, the viva examination will better reflect day to day practice. Retaining 14 examiners will ensure interrater reliability. OSCE literature suggests that reliability is improved, not only by objectivity and standardisation but by wide sampling across content and examiners. Effort continues to be made to ensure that College members are aware of the reasons for change, and of the decisions made to date. There has been a sense of urgency around the need for change to the viva, with recognition of areas in which the viva can be improved. There will be extensive ongoing consultation with members and external stakeholders, not only around proposed changes to the viva format, but with the more extensive changes to the curriculum and to other assessment methods.
Incorporating standardisation and structure to the viva examination will improve reliability; by creating standard
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Clinical Radiology
Clinical Radiology Trainee Matters
Another training year is coming to an end. First off massive congratulations to all of you who achieved (or are about to achieve) your fellowship this year! It’s such a long time to be studying- since the start of med school, but now you’ve finally reached the pinnacle and I can’t overstate how awesome that is! Well done! To all the regs who are still going, keep up the good work! You’ll get there, and half the fun is the journey itself (even if it doesn’t feel like it at the time). I’m sure you’ve all acquitted yourselves admirably, and don’t worry if the exams haven’t all gone your way, you’ll get them next time (or even the next time if you choose the “optional” third sitting like stars such as myself did- mainly because I’ve been assured the vivas are “fun!”…..) The RANZCR ASM was such an amazing conference and I was particularly happy to see how well everyone embraced the 80s theme for the gala dinner, it was the most fun I’ve had at a conference ever! (The All blacks dominating Ireland straight after the dinner was the icing on the cake!) I was also glad to see so many trainees and aspiring trainees turn out for talks by College members (particularly from Meredith Thomas the Chief Censor and Barry Soans the Deputy Chief Censor) regarding the new training programme and trainees’ transition to this. I can’t stress how important it is for trainees and their DOTs to be aware of what changes are coming well ahead of time. So, start asking questions, make enquires, check the RANZCR website and talk to your DOTs and/ or your trainee representative. If your DOTs aren’t fully aware of what’s happening, this is the perfect time to get them up to speed so the transition in 2021 (late 2020 for NZ) is seamless.
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As I reflect on my time as a trainee, I can honestly say I think we are all privileged to be in such an inclusive, supportive and forward-thinking specialty, with the promise of many game changing technologies and challenges on the horizon. It’s exciting to think how much our specialty can still grow and how new exciting modalities or adjuncts for imaging and intervening will no doubt arrive in our practising careers. I think it’s wonderful how open the College is to new ideas and tech, with the College embracing AI and becoming a world leader in our response and policies, to hone and embrace powerful new tools as they become available. I’ve loved my time working with the College and trainee committees, but as my time as a trainee is almost over, it’s time to step down and hand the chair over to the next generation. I’ll be handing over the reins to one of the 2020 CTRC members, possibly to the Trumpesque machinations of Matt Lukies, or one of his minions. (His campaign has gained serious traction of late.) I don’t think even if Sarah the Kiwi representative’s promises to give Australia the rugby world cup and the America’s cup, will be able to stop the political juggernaut that his campaign has become. And to be perfectly honest as a soon to be consultant, a wall between us and emergency is sounding more and more appealing... Warmest Regards, Dr Ben Addison (CRTC Chair)
Dr Ben Addison
Clinical Radiology
Chief of Professional Practice Update
Post-Mortem Imaging Working Group
A/Prof Dinesh Varma
The end of 2019 marks one full year in operation for the Professional Practice Committee (PPC). The PPC was established by the Faculty of Clinical Radiology in late 2018 to provide guidance and oversight for the development, implementation and review of post-Fellowship learning. Since the first meeting of the committee, by way of a planning day in January 2019, there has been a significant amount of work which has been undertaken.
Clinical Radiology Range of Practice Members of the PPC have been working hard to draft the Clinical Radiology Range of Practice. This document aims to assist in identifying the range of practice or types of procedures which a Fellow of the College can undertake. We are working toward having this ready for the FCR council at their first meeting in February 2020. This draft document will then be available for consultation and I encourage all members to take this opportunity to provide input to this important piece of work.
Earlier in the year, expressions of interest were called for members to join the newly formed Post-Mortem Imaging Working Group. Post-mortem imaging is a niche area of radiology which is growing in significance, not only in the forensic environment, but also at a hospital level and for paediatrics. This working group will be tasked with developing a standards framework to support radiologists practicing in this field now and into the future and will report into the PPC. Arrangements are currently being finalised to determine the membership of this working group and an inaugural meeting will be held shortly. We look forward to providing an update on progress of this working group in future editions of InsideNews.
Imaging in Occupational Dust Lung Disease Position Statement The PPC commissioned the Australian and New Zealand Society for Thoracic Radiology (ANZSTR) to develop a position statement on Imaging of Occupational Lung Disease in response to the rising incidence of workers exposed to silica within engineered stone. This was released in early October and was a proud moment for the Faculty and for the College. The position statement will underpin the College’s ongoing advocacy efforts regarding this important issue and since release, has gained much traction in medical focused media, including print, radio and television across both Australia and New Zealand. I would again like to extend my sincere gratitude for the time and effort given by Dr Sharyn MacDonald, Dr Catherine Jones, Dr Stefan Heinze and Dr David Milne on this crucial piece of work.
Consolidation of the Continuing Professional Development Committee into the Professional Practice Committee Since the inception of the PPC, a detailed workplan has been developed to define our role as a committee. This process identified several areas of intersection between the PPC and CPD committees, including potential duplication particularly in relation to CPD reforms, policy and program development. To address this, the CPD committee has been consolidated into the PPC effective as of August 2019. I am pleased to announce that all standing members of the CPD committee were invited and accepted a position on the PPC which will ensure we maintain the corporate knowledge of CPD committee members and bolster the relatively small PPC. The Members joining the PPC are: • • • • •
Dr Marc Agzarian (South Australia) Dr Kwang Chin (Victoria) Dr Joe Feltham (New Zealand) Dr Catherine Mandel (Victoria) Dr Aditya Varma (Queensland)
In closing, I would like to wish everyone a very, safe and happy holiday season and extend my best wishes for the New Year and thank members for their support in 2019. I look forward to bringing you further updates on the work of the PPC as we move into 2020. Yours sincerely, Dinesh Associate Professor Dinesh Varma Chief of Professional Practice Faculty of Clinical Radiology
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Clinical Radiology
Does the rise of sub-specialism mean the end for generalism in radiology? FCR Faculty Forum The Clinical Radiology Faculty Forum at the 2019 ASM explored the rise of subspecialism and what this might mean for the future of clinical radiology practice. More than 100 radiologists at varying stages of their career and with varied clinical experience filled the auditorium for the session, engaging in discussion and answering live online poll questions. The interactive and engaging session was introduced by the Dean of Faculty of Clinical Radiology, A/Prof Sanjay Jeganathan and moderated by Chair of the Professional Practice Committee, A/Prof Dinesh Varma. A panel of experienced clinical radiologists lead the debate. The panel comprised of Dr Matthew Andrews, Dr Brigid Connor, Dr Emmeline Lee and A/Prof Tom Sutherland who represented experience and practice across numerous areas. The panel provided wide-ranging views and perspectives on the topic and put a spotlight on some the challenges our specialty faces into the future. The session delved into how our membership can flourish as radiologists and provide patients with both high quality and accessible services, which are often seen to be at opposite ends of the generalist versus sub-specialist spectrum.
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What the expert panelists had to say There was consensus amongst the panelists that while sub-specialised radiologists provide invaluable interpretations of the images from their area of expertise, the assessments of the whole patient, including the whole of the imaging provided by generalist radiologists, remains critically important. While some radiologists practice in tertiary institutions with high levels of sub-specialism, the vast majority of radiologists in Australia and New Zealand practice in smaller hospitals or private practice, some in regional and rural areas. And this is where a generalist perspective remains crucial.
Two of our panelists shared their experience of spending around 80 per cent of their time in highly subspecialised practice working in tertiary referral centres. They noted that the more generalised nature of their on-call work presents a challenge, and they are increasingly reliant on the support of their sub-specialist colleagues for opinion on cases outside their areas of expertise. They thought that overall it was not practical or beneficial for patients or radiologists to be too subspecialised, except in a tertiary hospital setting. Dr Connor noted that as an interventionalist, broader diagnostic skills are invaluable in providing the best patient care. This is due to the varied
Clinical Radiology
interactions with clinicians from many different specialties and the requirement to deal with a broad range of body parts and imaging modalities.
How did attendees at the Forum respond? There was no single accepted definition of the term sub-specialist but members in attendance demonstrated a clear desire to be generalists with a subspecialty interest. The panel and audience discussed the importance of radiologists as generalists and that this increasingly unique skill set enables our members to synthesise multisystem information and guide complex patient care. When asked the question ‘What is radiology’s future?’, 63 per cent of the audience responded that sub-specialism was the way forward, however when asked what they would prefer to be, the results were less definitive – 55 per cent of respondents said they want to be generalists, and 45 per cent said they want to be sub-specialists.
It was also voiced that sub-specialty interests should not be credentialled or defined by the College or other governing bodies, and that instead, radiologists were professionals who could decide which studies they could and could not report. The value of second opinions from radiologists with sub-specialty interests was discussed with the general feeling that these interactions were beneficial for both parties and allowed upskilling of the radiologist workforce as well as providing a more interesting and rewarding work experience. After much discussion and lively debate, one thing was clear – while the profession will continually evolve and bring challenges for clinicians, our key objective will always be to provide outstanding care for our patients. If you have any questions, feedback or would like more information on the Faculty Forum please contact Executive Officer Melissa Doyle at melissa.doyle@ranzcr.edu.au
Food for thought Participants at the session generally agreed on the following. • There is a general trend towards sub-specialisation, but this should not be to the exclusion of the general radiologist. There is considerable value in sub-specialists having generalist knowledge and continuing practice. • The definitions of generalist and sub-specialists are not clear and none of the forum attendees considered themselves to be pure sub-specialists. • It was recognised that a radiologist’s practice range and skill set will largely be determined by local practice setting requirements. • The standard of service is paramount and the key to appropriate practice is the radiologist knowing when to seek a more expert opinion. • Relationships with referrers play a significant role in providing radiology services, whether so called generalist or subspecialist. • AI has a role to play in supporting generalists in sub-specialist practice and is not a risk to generalists.
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Clinical Radiology
Radiology recognised at Parliament House 14 years. 15 years. 18 years. Or even longer. Those of us involved in radiology are all too familiar with the years of study, training and commitment it takes to become a fully-fledged radiologist. Those numbers however, were met with surprise and even a degree of shock when conveyed in a new video to peak body stakeholders and MPs from across the political spectrum in Canberra last month. At an event hosted by ADIA at Parliament House Canberra to celebrate the 2019 International Day of Radiology, the video featured interviews with four leading radiologists from around Australia – Dr Steven Knox (Benson Radiology, Adelaide), Dr Lisa Sorger (I-Med Radiology, Darwin), Dr Sally Sojan (Darling Downs Radiology, Toowoomba) and Dr Sanjay Dhupelia (Queensland X-Ray, Brisbane). It was Dr Dhupelia who perhaps summed it up best in the video when he revealed that his 10-year old son was showing interest in becoming a radiologist, but that it would be about 2042 before he could expect to have made it!
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The video also conveyed the critical role radiologists play in the diagnosis, staging and treatment of illnesses, as well as the amount of time radiologists now spend working directly with patients, liaising with other specialists and driving multi-disciplinary meetings – all with the aim of improving patient outcomes. Health Minister Greg Hunt and Shadow Minister Chris Bowen both spoke to the gathering and reiterated their support and commitment to radiology as a fundamental element of effective health care. We were also delighted to have Senator Catryna Bilyk address the gathering. The Senator is the embodiment of how ‘radiology saves lives’; an MRI in 2008 found two benign tumours just four hours before the pressure on her brain would have left her in a vegetative state. I invite you to watch the video at www. adia.asn.au because its message is central to ADIA’s advocacy; demonstrating that radiology is not just a technical service but rather an essential cornerstone of medicine led by medical specialists, providing the crucial information and insight that is relied upon by all other health professionals.
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Radiation Oncology
2019 – the year that was A Message from the Dean
Dr Madhavi Chilkuri As 2019 comes to a close, it is time to sit back and reflect upon the year that was. I started 2019 somewhat apprehensively. Despite a wonderful handover period with A/Prof Dion Forstner, the reality of being Dean of the Faculty of Radiation Oncology started to sink in. I was aware that there was a lot planned for 2019 (as there is with any new year). I was also acutely aware that there would be much that was unplanned. The support provided to me by A/Prof Forstner, my colleagues on Council, my colleagues at The Townsville Hospital, College staff, and family have ensured that I remain grounded and capable of fulfilling the requirements of Dean. I extend my thanks to you all.
Unwrapping 2019 The year started with ramping up of Training and Assessment Reform (TAR) activities. With much of the groundwork now having been completed, the implementation group is now working full steam for a planned 2021 roll out. A special thanks to A/Prof Margot Lehman and the TAR teams for the enormous amount of work they have put in so far. The College has gone through the Australian Medical Council’s accreditation process. A large amount of work by College staff and a great many members went into this. Though we are still awaiting the formal report, we can be proud of what we do as a College. During the 2019 Australian Federal election campaign, cancer featured quite prominently. The government committed to increase radiation therapy access to regional patients through the
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provision of funding toward 13 new regional centres. The government is on the cusp of fulfilling its commitment and I am heartened to see the level of engagement they are seeking from stakeholders. We, as a Faculty, will work very closely with the Department of Health as they commence planning of these services. We have also commenced a review of the College’s Establishing and Sustaining Regional, Rural and Remote Radiation Therapy Centres position paper, which will serve as a guidance document for the Department. The Medicare Benefits Schedule (MBS) Review continued (and will continue well into 2020). For the new radiation oncology schedule, the Minister of Health requested that the Department of Health works with the College on modelling the new schedule. Work is commencing on this. If the government gets this wrong it is likely to impact all of us practising in Australia, hence the importance of us collaborating with the Department. We will need centres to participate in modelling, so I would ask that you start conversations in your centres now, about how you may be able to assist. Advocacy with the Urological Society of Australia and New Zealand (USANZ) and the Prostate Cancer Foundation of Australia (PCFA) has progressed well through 2019. A special thanks to Dr Stephen Marks, President of USANZ, and Prof Jeff Dunn, CEO of PCFA, for their active engagement and collaboration. The Faculty will work with both organisations to review and
develop resources for prostate cancer patients. We also look forward to the implementation of the explanatory note for radical prostatectomy MBS items. The Board has recognised that, as a College, we have much to do to address Indigenous health issues. The Māori, Aboriginal and Torres Strait Islander Executive Committee (MATEC) was formally approved to give advice and support to all College activities relating to Māori, Aboriginal, or Torres Strait Islander people, patients, and communities. We hope to forge formal relationships with relevant organisations and individuals to help progress our work. The Faculty and Radiation Oncology Alliance are working very closely with Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) to develop a national incident reporting and learning system. Such a system would potentially build on the existing reporting system and also include near misses. We had a very informative session last month at the RANZCR ASM about the feasibility of such a system along with discussions on jurisdictional and regulatory issues. The RANZCR 2019 ASM took us ‘Back to the Future’ and was a perfect lead in to the 2020 ASM (‘Elysium: diagnostics and therapeutics (now and the future)’). I would like to thank all our supporters and sponsors of the ASMs, as well as members who presented or attended— without you, these meetings would not be the successes they are. Special thanks to Varian for their sponsorship of the annual Faculty Dinner at the ASM.
Radiation Oncology
Looking to the future: 2020 2020 will be another busy year for the Faculty Council, standing committees, working groups, and special interest groups. Just some of the activities on the horizon for the next year include: continued work on the Training and Assessment Reform, Radiation Oncology Practice Standards review, advocacy for regional radiation therapy centres, theranostics, incident reporting, MBS Review…not to mention core business as usual.
With that in mind, and the Christmas period being upon us, I would like to take this opportunity to encourage all members, staff, stakeholders, friends, and families to enjoy any time away from work; to take the opportunity to unwind and rest; and to share this time with your families and friends. I wish you all a safe, happy, and peaceful Christmas break.
Upload your anonymous resume to the RANZCR job board and let your next job come to you! How does it work? Upload your resume to RANZCR job board and choose “public” (your contact information will remain private)
An interested employer will contact you via our messaging system with job information
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Increase the chances of landing your dream job Upload your resume at jobs.ranzcr.com/resumes today RANZCR_Half Page_v3.indd 1
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Radiation Oncology
Reflections and thanks Chief Censor in Radiation Oncology
A/Prof Margot Lehman
This will be my final report for Inside News as, after four years as Chief Censor, my term is now coming to an end.
Training and Assessment Reform Without a doubt, the largest piece of work occurring during my term was the Training and Assessment Reform. I am extremely pleased to report that the draft program has been completed with learning outcomes/curriculum, work-based assessments, structured learning activities, examinations and progression rules all reviewed and updated. The enhanced program was presented at the recent Annual Scientific Meeting (including the Director of Training workshop and Trainee Day) and pleasingly, the feedback has been very positive to date. I would like to express my sincere thanks to the members of the Steering Committee (A/Prof Sandra Turner, Dr Matthew Seel, Dr Yaw Chin, Dr Sean Brennan and Dr Lucinda Burke) and the many Fellows and College staff who gave so freely of their time in contributing to this work. In particular, I would like to acknowledge Dr Claire Hardie, Dr Tanya Holt, Dr Mark Pinkham, Dr Andrew Potter, Dr Ben Chua, Dr Trang Pham, Dr Patrick Dwyer, Dr Andrej Bece, Dr Keen Hun Tai, Mrs Pamela Spoors, Mrs Legend Lee and Ms Julia Snedic. Now that the program development phase has been completed, the Implementation phase, prior to the planned roll-out of the enhanced program for all trainees in 2021,
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will begin. I am very grateful to Dr Matthew Seel who has kindly agreed to take on the role of Interim Chair of the Implementation Team. The Implementation phase will see training roadshows and other educational and training activities being conducted throughout 2020.
Phase 1 Examination Changes I would also like to thank Dr Sean Brennan (Chief of Examinations), and the Phase 1 Examination leads (Dr Claire Hardie, and Dr Carminia Lapuz) who have, in conjunction with the Australian Council for Educational Research, recommended changes to the Phase 1 examination. From 2022, the Phase 1 examination will consist of three separate subject based papers consisting of short answer and multichoice questions or diagram labelling. There will be two examination sittings per year (with a maximum of three attempts). The trainees will not be required to sit all three papers at each sitting and can carry subject passes into the next examination sitting if required.
AMC Re-accreditation Australian Medical Council (AMC) Re-accreditation was another major focus for the Specialty Training Unit this year. The re-accreditation process was rigorous, and I am grateful to the Fellows in the various Departments the AMC visited for participating in this process. Although the final report is not expected until next year, an interim report appears favourable.
Accreditation A/Prof John Leung has stepped down from the role of Chief Accreditation Officer. I would like to thank John for his invaluable contribution, and the professionalism and commitment he demonstrated whilst in this role. I would like to welcome Dr Vanessa Estall who will now take on the role of CAO and to thank the members of the accreditation panel for their important work.
Denise Lonergan Educational Service Award Congratulations to Dr Kumar Gogna for being awarded the Denise Lonergan Education service award. This award recognises outstanding contributions to education activities and assessment, above and beyond their expected education role. Kumar’s long association with the pathology examinations and his pathology tutoring made him a very deserving recipient of this award.
continued over...
Radiation Oncology
Trainee Wellbeing The wellbeing of trainees is of paramount importance to the College. The Trainee Liaison Officer position was developed to provide an additional line of support for trainees. I would like to congratulate Mr Chris Bartley for the outstanding job he did whilst in this role.
In conclusion, my time as Chief Censor has been both challenging and rewarding. I have been extremely fortunate to work with wonderful and supportive colleagues. I would like to thank all Fellows and College staff involved in the important educational roles within the College. I extend my very best wishes to Dr Yaw Chin as he steps into this role in 2020.
Quality Corner The recent report by the Expert Advisory Group on revalidation for the Medical Board of Australia (MBA) has recommended changes in continuing professional development (CPD) requirements that the MBA plan to commence in approximately 2021.(1,2) One major change is the requirement of measuring outcomes.(1) The Faculty of Radiation Oncology, in preparation for these changes, have introduced characteristics of the new requirements for the 2019-2021 CPD program, and to meet CPD compliance, participants must complete a minimum of one measuring outcomes activity, such as conducting a clinical audit.(2) Although these activities have been included in the CPD program previously, they were not requirements until this triennium of 2019-2021. It is thus a good time to review your department’s
practices in storing patient records and maintaining databases containing patient information, not only to be able to effectively and efficiently perform these CPD activities, but to also reflect on how these processes can be improved and how measuring outcomes can better deliver quality healthcare as a practitioner and at a departmental level. A review of organisational support and resources available to produce high quality patient outcome data may also be required. Clinical audits are aimed at improving patient care and outcomes through systematic review of care against explicit measures such as quality indicators.(1) Radiation Oncology has a long history of developing and defining consensus quality indicators.(3) A comprehensive review of Radiation Oncology specific indicators has been published by Albert
and Das (2013), and I refer the reader to this publication for an overview of quality indicators that may be useful in the clinical audit process.(3) These changes to CPD requirements are one of many drivers aimed at improving patient healthcare outcomes. Readily accessible high quality patient outcome data can be limited. It is thus a good time to review your departmental practices in preparation for meeting CPD requirements. Dr Howard Liu
1. Medical Board of Australia (2017). Expert Advisory Group on revalidation – Final Report. Available from: http://www.medicalboard.gov.au/ documents/default.aspx?record=WD17%2F24295&dbid=AP&chksum=Txmn8C7v%2BC53Wjsz3sXn2w%3D%3D 2. Royal Australian and New Zealand College of Radiologists, Faculty of Radiation Oncology (2018). Continuing Professional Development (CPD) Handbook, 2019 – 2021 Triennium. Available from: https://www.ranzcr.com/documents/4775-2019-2021-radiation-oncology-cpd-handbook/file 3. Albert JM, Das P (2013). Quality Indicators in Radiation Oncology. International Journal of Radiation Oncology Biology Physics, 85(4),p904-911.
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Radiation Oncology Trainee Matters relationship must optimally be more than a ‘check-the-box’ procedure. Ideally, it should be more than simply allocating a minimum number of faceto-face meetings annually, occasional phone or email conversations or hoping that an organised relationship will yield value in terms of learning and career prospects. While there is a vast body of extensive literature on mentoring, the common attributes that make any mentoring relationship successful and sustained are frequently described.
Dr Mihir Shanker The Faculty of Radiation Oncology will soon be launching the Radiation Oncology Mentoring Working Group aimed at facilitating a mentoring program for trainees and junior consultants. Whilst getting feedback from colleagues in a range of specialties on the concept of mentoring in medicine, it was surprising to note the range of responses and feelings towards the enterprise of a mentoring relationship. Too often, it seemed that both trainees and mentors felt that while the idea of mentoring was grounded in positive sentiment, in practice the relationship commonly seemed to be unsustained and not yield value to both mentors and mentees. Most of us who make our way through training will land in a satisfying practice career in a specialty we enjoy and for the majority of us, this path will not have been accomplished alone. Almost invariably, we benefit from and seek guidance from senior colleagues who provide invaluable input that is often beyond that limited to clinical training and skills. As trainees, there can be tremendous value in engaging both in having a mentor as well as being a mentor to junior colleagues. This
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1. Put the relationship before the mentorship: When engaging with a mentor or mentee, a prerequisite that should be strived for is a genuine collegial relationship with a specific goal. As a mentee, look for someone you professionally admire who is ahead of you in the field, or in a position that you might envision for yourself, and establish a partnership by asking a specific question. 2. Start with the end in sight: Both as mentor and mentee it is vital to have a clear idea what you feel is characteristic of a long-term successful partnership. Embarking on a journey as a mentor or mentee without a clear idea of what can be offered or what you would like to gain is like sailing a ship without the ultimate destination in mind and this can be to the detriment of the long-term success of the partnership. 3. Don’t be afraid to pivot: A common reason that reinforces a cynical notion of mentorship can be that often we feel obliged to remain and continue to engage with mentors or mentees with whom the partnership is not a good fit. If the partnership isn’t working, take ownership of the situation and address the situation proactively. Thank the person for the guidance so far and move forward professionally on a positive note.
I encourage all trainees to provide any feedback on what you would like the mentoring program to look like and how best the College can facilitate it. Please contact myself or your ROTC representative at any time. Finally, a huge thanks to all the trainees who attended the RANZCR Annual Scientific Meeting in Auckland this year and especially to Dr Anna Gubbins who worked tirelessly with the Convening Committee to produce an exceptional Trainee Day. Congratulations to Dr Christopher Williams on winning the annual Varian Prize. Best wishes, Dr Mihir Shanker Chair Radiation Oncology Trainee Committee
Radiation Oncology
TROG Cancer Research celebrates 30 years of outcomes through collaboration This year, TROG Cancer Research is celebrating three decades, during which the organisation has facilitated hundreds of clinical trials for cancer patients. Over the last 30 years, both the team based in Newcastle and their members who are found worldwide, have contributed tremendous breakthroughs in the way radiation therapy is used to treat and improve quality of life for different cancers. TROG Cancer Research’s clinical trials have been run in more than 200 hospitals and cancer centres in urban hubs and regionally around the world. CEO, Susan Goode, said it was hard to believe that 30 years has passed since the organisation was founded. Susan acknowledged the unwavering support of the medical and Australian/ New Zealand community in particular, as a significant contributor to the organisation’s success. “We’ve come a long way since our humble beginnings in 1989 when members of seven radiation therapy centres across Australia and New Zealand formed a clinical trial group to advance the study of cancers that could be treated with radiation therapy,” Susan said. “Today we have medical professionals approaching us from around the world
with new ideas on how to use radiation therapy to improve quality of life and treatment of a specific cancer disease. One in two cancer patients will benefit from radiation therapy, so the research we conduct is vital. “By collaborating and bringing to life these concepts in a managed environment, we’ve been able to achieve great advancements in cancer patient care and outcomes that have changed the way patients are treated worldwide.” Tapping into the world brain for improved outcomes Radiation Oncologist and Associate Professor Jarad Martin, is one of many long-term TROG Cancer Research members who have had a significant impact on cancer treatment worldwide through radiation therapy research. Jarad has contributed to research into an approach that has improved options for patients with prostate cancer. Jarad’s findings are now being used by medical facilities globally and have resulted in a reduction of treatment time from eight weeks to just four weeks with five medical visits for prostate cancer patients.
thirty years. Their approach to clinical trials that focuses on collaboration over competition is being emulated by other organisations,” Jarad said. “TROG encourages and harnesses new ideas and brings people together virtually from around the world so we can tap into what I call the world brain to produce real results for patients.”
Congratulations goes to the TROG Cancer Research Community • TROG Cancer Research recently welcomed Medical Physicist Professor Annette Haworth and experienced CEO and practiced Accountant, Denis Byron to their Board. • TROG Cancer Research member Professor Paul Keall was highlighted in the ASTRO Fellow designation and ASTRO’s 61st annual meeting.
“There’s a real legacy from what TROG Cancer Research has achieved over
TROG Cancer Research’s 2020 Annual Scientific Meeting – registration open TROG is holding its 32nd ASM over 16-19 March 2020 at the International Convention Centre, Sydney.
interventional oncologists, medical physicists and clinical trials personnel.
The 2020 ASM will host a number of internationally and nationally renowned keynote speakers alongside key TROG cancer researchers and clinicians. More than 300 delegates attend the meeting including leading Australian and New Zealand radiation oncologists, radiation therapists,
The three-and-a-half-day program incorporates collaborative workshops, scientific sessions showcasing radiation oncology clinical trials, discussion of new trial concepts, future research directions and technological advancements. To register visit asm.trog.com.au.
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Advertorial
RapidPlan machine learning brings intelligence to cancer care In 2014, Varian introduced RapidPlan™ knowledge-based treatment planning software based on machine learning (ML) algorithms. RapidPlan helps clinicians reduce treatment planning time and improve plan consistency for intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT). The software uses dose and anatomy information from existing high-quality plans to predict a more optimal dose distribution for new patients, based on their contoured anatomy. Five years after the introduction of RapidPlan, ML and artificial intelligence (AI) continue to expand to help cancercare teams make better and faster decisions, accelerate treatment, and reduce patient stress. For clinics around the world, RapidPlan is at the forefront of this advancement, and has proven an effective tool in working toward a world without fear of cancer. Here, we talk with clinicians using RapidPlan, to learn how the software has lived up to its promise and about the surprises along the way. Improved efficiency and reduction in plan variation were two of the reasons Colin Hornby, radiotherapy advisor to the Health and Wellbeing Division of the Department of Health and Human Services in Melbourne, proposed a statewide collaborative in Victoria. As a result of that proposal, government-funded radiation oncology clinics in Victoria began a statewide implementation of Varian’s RapidPlan™ knowledge-based treatment planning software and began providing each other with mutual support, sharing techniques and models. The goal was to improve the quality of radiotherapy treatment by using RapidPlan to predict treatment and plan outcomes and then use these predictions to optimise
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intensity-modulated radiotherapy plan parameters, according to Hornby. “RapidPlan was a game changer,” says Hornby, “You don’t see such potential for significant improvement every day, so I proposed the state government purchase RapidPlan licenses for eight Eclipse public treatment sites across Victoria. From there, we started building models in RapidPlan and using them at every Eclipse site (now nine) to help reduce the many variables in patient care across rural and metropolitan areas.” In a recently published joint paper, the collaboration authors describe the development of this multicenter model in planning prostate treatment. The consortium also has been able to build models out of shared data pools—about 10,000 treatment courses combined— expanding from prostate to head and neck, brain, anus, and rectum. Anus cancer is not that common, Hornby says, but with cases pooled from several sites, the model is relevant and turned days of planning into a few hours. It’s also being used by some sites as a model for vulva cancer treatment planning. “Since RapidPlan uses machine learning to extract knowledge, it’s made it possible for a lot of people to get together and share their expertise,” Hornby says. “Now those sites are collaborating, they’re also thinking more broadly about radiation oncology and aligning other efforts.” Phillip Moloney is a radiation therapist at Barwon Health’s Andrew Love Cancer Center in Geelong. The center, which treats about 85 patients a month, is part of the statewide collaborative cooperating to improve the quality of radiotherapy treatment by using RapidPlan knowledge-based treatment planning.
“RapidPlan immediately sped up our planning process and improved the consistency of plan quality,” Moloney says. “Not only did we save contouring time, but the junior dosimetrists typically got to the optimal plan after just one run through, even without previous experience of a particular scenario.” Moloney also notes that over time, the plan quality has improved and as models are updated, machine learning in RapidPlan helps the clinic create even better plans. “It’s reassuring to use a RapidPlan model and know that we’re using similar plans to the US or Europe, even if it’s something that we may only see once or twice a year,” he says. “It gives us the confidence that we’re meeting the standard of a world-renown cancer center.” The information captured herein represents the genuine experience of the attributed individuals and may not necessarily represent the views of Varian or the above referenced institution. Individuals were not compensated for their participation. Radiation treatment may not be appropriate for all cancers. Individual results may vary.
Radiation Oncology
Election outcomes Faculty of Radiation Oncology Council In July, calls for nominations for three elected positions to the Faculty of Radiation Oncology Council were sent to members. As three nominations were received for the three positions, the nominees were duly elected to Council for terms commencing 1 January 2020.
New Councillors (2020-22) Dr Gerard Adams (Bundaberg, Queensland) I have been a radiation oncologist in Australia since 2013, living and working in Bundaberg for the last six years. Since 2015 I have been part of the Quality Improvement Committee (QIC). I have been involved in producing documents such as Establishing and Sustaining Regional, Rural and Remote Radiation Therapy Centres Position Paper and Quality Guidelines for Volume Delineation in Radiation Oncology as well as the Faculty Choosing Wisely statements. Radiation oncology is changing with more patients able to receive treatment closer to home. This brings great opportunity, but also risks, unless we as a faculty manage this transition well. As well as the geographic and clinical differences between regional and metro there can be other variations (publicprivate partnerships versus traditional separate public or private funding models) that can have significant impact on how we deliver services and that need to be understood when planning for the future. Faculty Council plays a key strategic role in developing the future of our specialty and it is important that the membership reflects the full range of members and their practice. Dr Angela Allen (Brisbane, Queensland) I gained my fellowship in 2014 after training in Melbourne at the Peter MacCallum Cancer Centre. My first consultant position was in Hamilton,
New Zealand at Waikato Hospital. After three years my husband and I returned to Australia. I spent a short period at the Gold Coast University Hospital before settling in Brisbane in October 2016. I currently work at ICON Cancer Centre treating public and private patients. The experience I gained while working across a number of public, private, metropolitan and regional centres across Australia and New Zealand has given me an appreciation of the unique issues that impact different sites. I believe it is important for Faculty Council to continue to represent the interests of all of our members and address the diverse needs that exist. I have been actively involved in education and advocacy during my training and as a consultant. As a registrar I was the trainee member on the Education and Training Committee, and I was the trainee representative on many of the new curriculum projects. After gaining my fellowship, I mentored trainees as a Director of Training in New Zealand. I also served as a member of the Media and Profile Committee as the New Zealand representative. More recently I have been a member of the Oncology Sciences Working Group, which has focused on reviewing and updating content for our phase 1 curriculum. I have recently returned from maternity leave and I am excited to be involved in College activities again. I am passionate about promoting the health and welfare of our members. There are a number of recognised reasons why Radiation Oncologists and trainees have high levels of burnout. Traditionally individual-focused interventions have been the main source of developing resilience. However, I think it is vital that we start to explore ways in which the college can assist its members in this way. I look forward to making a positive contribution to our specialty.
Associate Professor Sandra Turner (Sydney, New South Wales) I am excited to have been re-elected to FRO Council. My involvement with College activities spans more than 20 years and has mostly centred on education and training, curriculum development and implementation, and media and advocacy. With this background my focus will be to continue to build the profile of radiation oncology across all domains. We’ve come a long way in raising awareness of radiation therapy amongst patients, health professionals and the community in recent years. The Targeting Cancer campaign and aligned activities, (e.g, GP programs, partnerships with advocacy/radiation oncology professional groups and ambassadors to name a few,) are shifting the dial in the right direction. Nonetheless, the central role of our speciality and (increasingly) effective therapy is still woefully underrecognised, to the detriment of Australian/New Zealand society. There are un-tapped opportunities to ensure all patients who may benefit from radiation therapy know about it, are able to make fully informed treatment choices, and have equitable access to high quality treatment. In part by pursuing these opportunities, I look forward to continuing to support the Faculty’s work to improve cancer patient care across our countries.
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Radiation Oncology
Chief Censor (2020-22) At the June Faculty of Radiation Oncology Council meeting, Dr Yaw Chin was appointed Chief Censor in Radiation Oncology for a three-year term commencing 1 January 2020. Dr Yaw Chin (Sydney, New South Wales) I am currently working as a radiation oncologist at both St. George Hospital, Kogarah, as well as GenesisCare, Waratah Private Hospital, Hurstville. I have been working at St. George Hospital since my return to Sydney as the RANZCR Windeyer Fellow at the Mount Vernon Hospital between 2004 and 2006, subspecialising in urological brachytherapy and breast and lymphoproliferative malignancies. My application for Chief Censor in Radiation Oncology has been underpinned by a background in medical education theory (Master of Public Health majoring in medical education); ‘on-the-ground’ practical experience as a Director of Training and Training Network Director of the Southern NSW/ACT Training Network; in-depth knowledge in the upcoming enhanced curriculum and work-based assessments, as part of the Training and Assessment Review (TAR) committee; and a consolidated understanding of College policies, organisational structure and priorities from being involved in the Radiation Oncology Education and Training Committee (ROETC), as well as being an assessor for the International Medical Graduate (IMG) program.
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I believe in a strong consultative and collaborative approach in team-leading, having implemented and led quality improvement and clinical research programs. My wider experience in education and training includes involvement in undergraduate medical teaching as a Phase 2 clinical examiner for the University of New South Wales and affiliated oncology education and training program as the co-Chair for NSW HETI’s Basic Sciences of Oncology Course (BSOC). My aims as the next Chief Censor are to: • maintain and reinforce a world-class education and training/assessment program to ensure delivery of safe, high-quality and patient-centred care; • facilitate increased education and training engagement with Clinical Supervisors and other members of the radiation oncology community; and • develop and streamline ongoing curriculum review processes and frameworks in a constantly changing educational environment. We extend our thanks to Prof Michael Poulsen, who has completed three terms on Council; Dr Claire Phillips, who filled a casual vacancy in 2019 and opted not to re-stand at this time; and A/Prof Margot Lehman, who has completed her term as Chief Censor in Radiation Oncology and chose not to re-nominate for another. As with all College bodies, the time given up by volunteers is very much appreciated.
Radiation Oncology
Faculty of Radiation Oncology Facilities Survey The Faculty of Radiation Oncology has recently completed the 2019 biennial facilities survey with a 100 percent response rate from facilities across Australia and New Zealand. The survey enables the Faculty to develop a robust in-house dataset about physical and human resources available in both countries. The Faculty thanks all facilities for their participation and contribution to the data collection. The aggregated data from the facilities survey is used widely and frequently to inform key
Faculty projects, including workforce and infrastructure projections, radiation therapy techniques and technologies Horizon Scan development, and the Faculty’s advocacy work around the Medicare Billing Schedule review and the New Zealand Health and Disability system review. If you have any comments about this article, please contact Tan Nguyen, Projects Officer at faculty@ranzcr.edu.au
Faculty of Radiation Oncology Facilities Survey Facilities
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Linear Accelerators (linacs)
Australia: 95 New Zealand: 10 Public: 43 (45.3%) Public: 6 (60.0%) Private: 52 (54.7%) Private: 4 (40.0%) MMM1: 71 (74.7%) MMM2-3: 24 (25.3%)
Australia: 208 Average per facility: 2.2
Staffing (FTE*)
Australia 2001-05: 0.5% 2006-10: 25.5% 2011-15: 41.8% 2016-19: 32.2%
Australia RO: 318.1 RO trainees: 135.3 RT: 1769.8 ROMP: 421.6 Nurses: 327.0 Admin: 293.8
New Zealand RO: 58.9 RO trainees: 26.0 RT: 244.4 ROMP: 197.3 Nurses: 20.7 Admin: 46.2
* FTE includes filled positions + vacant positions as of 31 March 2019
New Zealand: 32 Average per facility: 3.2
240
Year of linac installation
New Zealand 2001-05: 3.1% 2006-10: 40.6% 2011-15: 31.3% 2016-19: 25.0%
Courses per linac Australia Total: 360.5 New: 324.5 (90.0%) Retreatment: 36.0 (10.0%) IMRT/VMAT: 202.7 Stereo: 22.6
New Zealand Total: 422.3 New: 414.5 (98.2%) Retreatment: 7.7 (1.8%) IMRT/VMAT: 149.8 Stereo: 18.9
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Interventional Radiology
Interventional Radiology Committee update It has been another busy and productive year for the Interventional Radiology Committee (IRC) as the College continues towards its goal of attaining specialty recognition for Interventional Radiology (IR) and Interventional Neuroradiology (INR). Achieving this status will not only help to secure the future of IR and INR but will strengthen the whole of clinical radiology and provide tremendous opportunities across the profession.
Specialty Recognition The pathway to specialty recognition is clearly defined by the Australian Medical Council and Medical Board of Australia, requiring complete compliance with a full range of professional, practise and training standards. RANZCR is uniquely placed and recognised by government to co-ordinate this work, and has committed to a collaborative approach across the profession and with key stakeholders. This requires a systematic approach, and the early work of the IRC has involved laying the groundwork for specialty recognition and ensuring the College has the correct processes and strategies in place to succeed.
Standards of Practice for Interventional Radiology A key achievement this year, and an important element of achieving specialty recognition, has been the development of the IR and INR standards of practice. This document establishes the minimum acceptable practice standards for facilities and staff providing IR and INR services. The Interventional Radiology Standards Working Group was formed to lead this important work, and the group has worked effectively to develop standards that reflect contemporary practice. We acknowledge the work of this group and thank them for undertaking this significant task in a timely and professional manner. All College members will have an opportunity to provide feedback on the draft standards in early 2020.
IR Standards Working Group Prof Winston Chung (Chair) Dr Nick Brown (IRC Chair) Dr Gerard Goh Dr Jim Koukounaras Dr Con Phatouros Dr Andrew Cheung Dr Ronil Chandra Dr Martin Dobes Dr Colin Chong Dr Matthew Lukies Mr Murray McLachlan
White Paper The IRC has spent the last 12 months drafting and refining A White Paper on Interventional Radiology, to articulate the importance of Intervention Radiology as a specialty and the benefits that this will bring for the whole of Clinical Radiology. The IRC and Faculty Council incorporated feedback received from college members and stakeholders earlier this year. The final version of the White Paper is due for release soon, and will present a roadmap for the future of IR and INR.
Advanced Scope of Practice and Training Pathways for IR and INR The next major task for the IRC along the pathway to specialty recognition will be to work with the Professional Practice Committee and other key stakeholders to define an advanced scope of practice, curriculum and training pathways for Interventional Radiology and Interventional Neuroradiology. This work will commence in early 2020, with invitations to IRSA and ANZSNR to participate in this crucial work.
Acute Stroke Working Group The Faculty of Clinical Radiology established a working group (ASWG) to advise the Faculty Council on issues relating to acute stroke in Australia and New Zealand, which produced a draft Framework for Recognition of Training in Percutaneous Stroke Intervention. The IRC collaborated with the ASWG
to finalise this document in 2019, after receiving feedback from members and stakeholders. We would like to thank everyone who contributed. The college is currently co-ordinating with key stakeholder groups to manage its implementation and ensure that high quality stroke services are accessible by patients across Australia. Acute Stroke Working Group Dr Stefan Brew Dr Peter Mitchell Prof Alan Coulthard Dr John Vrazas Dr Catherine Mandel Dr Ross O’Neill
Advocacy A key part of our role is to be the College voice for interventional radiology and interventional neuroradiology across the ever expanding spectrum of clinical radiology for internal committees, government agencies, departments, other medical colleges and societies. This has seen increasing requests for expert IR and INR input, and the IRC has worked hard to ensure the value and voice of IR/INR is included in future plans and services, including: • MBS Review Taskforce o Vascular Clinical Committee (RANZCR’s response can be seen here) o Pain Management Clinical Committee o General Surgical Clinical Committee o Urological Clinical Committee • Medical Services Advisory Committee (MSAC) evaluating new medical services and providing advice to Government on public funding of procedures o Vertebroplasty o Cryoablation for renal tumours • National Cancer Care Plans • Development of College frameworks and position statements
continued on page 56...
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News from the Professions
Genito-urinary News FROGG Workshop 2019 - A Radiation Oncology trainee’s perspective The FROGG 2019 meeting in Cairns was a great opportunity to join the leaders in Australian GU Radiation Oncology in sunny QLD. The program was well balanced and opened each day with UK Prof Ananya Choudhury presenting updates on biomarker and genomics research in Bladder and Prostate cancer. Local talent from all corners of Australia presented clinical outcome and patterns of practice data, as well as great practical content in relation to planning and optimal treatment delivery. Day 1 ended with spirited discussion with respect to the evolving FROGG consensus guidelines for management of bladder cancer - watch this space. Day 2 toured through the controversies in prostate cancer management including the role for ADT, elective nodal RT and IGRT in the post-prostatectomy setting and optimal management of node positive disease. Prof Scott Williams provided an update on novel anti-androgen therapy and current trials, and Prof Jeremy Millar discussed the ANZ Prostate Cancer Outcome Registry. One of the most entertaining sessions saw competitive debate between Prof Jeremy Millar, Prof Andrew Kneebone and Prof Tom Shakespeare with respect to the rationale for and against dose escalation in high risk prostate cancer - all three were compelling and the crowd vote seemed evenly split between brachytherapy, EBRT or not at all! A practical discussion of SBRT in the prostate and renal setting rounded out the meeting. From a trainee point of view, FROGG definitely delivers a great meeting format that is unique in its ability to highlight relevant and controversial topics in GU Radiation Oncology. I would wholeheartedly encourage Radiation Oncology trainees and fellows to attend future FROGG meetings.
FROGG Report December 2019 The FROGG committee is pleased to welcome several new members; Drs Sarat Chander, Renee Finnigan & Braden Higgs. The FROGG Workshop held in Cairns was a great success and attended by over 100 radiation oncologists/trainees/RT’s from Australia & New Zealand. A new initiative was the introduction of FROGG trainee travel grants, with five successful trainees attending: Drs Aaron Kent, Wee Loon Ong, Luke Nicholls, Patrick Horsley and Violet Koh. Drs Mark Sidhom and Michael Cardoso presented draft bladder cancer radiation therapy guidelines for discussion as well as outcomes of the bladder cancer survey following the workshop. The FROGG 2019 Guidelines for Radiotherapy for node-positive prostate cancer were published by Dr Hester Lieng et al, and are available on the college website at www.ranzcr. com/special-interest-groups-frogg. We extend our grateful thanks to Tan Nguyen for serving as the FROGG secretariat over the past years and welcome Mariam Ghuneim into the role. We wish Tan well in his new role in the college. FROGG Committee: Amy Hayden (Chair), Tanya Holt (Deputy Chair), Andrew Kneebone, Guiseppe Sasso, Mark Sidhom, Thomas Shakespeare, David Christie, Sarat Chander, Renee Finnigan, Braden Higgs Dr Aaron Kent
Photos courtesy of Dr John Violet
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General Interest
continued from page 13
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Communication is Key
The work undertaken in 2019 has consolidated the role of the IRC and highlights the many opportunities and paths yet to be explored in this space. This represents an exciting time for the profession and the IRC, and there will be increasing opportunities for all members to contribute to this important work. The IRC will be putting out an EOI for membership before the end of the year, so please look out for the call or email interventional@ranzcr.edu.au to express your interest.
The RANZCR website includes information, assistance and new tools to support Fellows when completing CPD activities and meeting the changes to your medical registration requirements. We encourage members to find out more by visiting: www.ranzcr.com. If you have any questions, comments or concerns about the upcoming changes to your medical registration requirements, please send them to cpd@ranzcr.com we are always here to help.
I would like to wish everyone a safe and festive holiday season and I would like to thank the members of the IRC for their contribution and dedication in 2019. Yours sincerely, Nick Brown Chair, Interventional Radiology Committee
College Life – Behind the scenes 13 Special Interest Groups, 197 Committees, Councils and Working Groups. Five Social media accounts; several websites and platforms, training courses and general day to day management of member needs are just some of the roles undertaken by College staff. These are their stories…
Diane Ramisch
Administrator, reception and office support officer. Though her official title is a mouthful, when asked, Diane Ramisch says she simply does reception and admin. Just over 2 years ago Diane arrived at the College as a temp, working with the Member Services team. She moved into a permanent role in reception and hasn’t looked back since. As Diane recalls, when she arrived for her interview she knew the College was the place she wanted to work. Her working career has been very colourful, starting off as an accounting machine operator for a finance company dealing with the debtors and creditors. From there she was promoted to the IT team and worked as a Girl-Friday eventually becoming a computer operator and ultimately rising to the role of operations supervisor for the company’s Honeywell mainframe.
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Diane’s career has covered many industries and afforded her many skills. A beer puller from back in the day, she still rates hospitality as a way to build life skills and dealing with people, both drunk and sober. There was brief flutter at Rosehill racecourse where she ended up as a bar manager her previous work in an Orthodontic practice was noted as a highlight because of the constant interaction with kids. An avid outdoor fan who loves driving around the country. A favourite stomping ground being the Gardens of Stone near Lithgow and around Capertee. Though the plan is for a long drive across the Flinders Ranges she assures me that it is a while off. In the meantime, you will find Diane greeting you as you walk through the doors of the College, call the College, email the College … preferably not all at the same time.
For GPs
What’s in Issue 6? Medical Imaging Original Article: Radionuclide lung scans for suspected acute pulmonary embolism: Single photon emission computed tomography (SPECT) or hybrid SPECT/CT? Corresponding author: A/Prof George Lacos, Department of Nuclear Medicine and Ultrasound, Westmead Hospital, Sydney, NSW, Australia Introduction Hybrid single photon emission computed tomography (SPECT) with CT (SPECT/CT) may improve diagnostic accuracy in suspected acute pulmonary embolism, but further research is needed. We evaluated whether the use of attenuation correction and/or the depiction of lung pathology with hybrid SPECT/CT could significantly reduce potentially false‐positive ventilation–perfusion (VQ) SPECT studies or obviate the need for a ventilation study. Methods Two specialists (S1 and S2) reviewed prospectively acquired VQ SPECT/CT in 165 patients. Studies were reported using standard criteria and compared to VQ SPECT and Q SPECT/CT. Results S1 and S2 recorded positive VQ SPECT in 54 (32.7%) and 42 (25.6%) cases, respectively. Hybrid SPECT/CT showed non‐embolic pathology in 41 (S1) and 46 (S2) patients, but compared to VQ SPECT, neither hybrid SPECT/CT nor attenuation correction SPECT/CT had significantly fewer positive studies. Intra‐observer agreement with VQ SPECT/CT was almost perfect (k = 0.91 for S1 and k = 0.95 for S2; P < 0.001), but not with Q SPECT/CT (k = 0.4 for S1 and k = 0.62 for S2; P < 0.001). Inter‐observer agreement was moderate for VQ SPECT (k = 0.65) and VQ SPECT/CT (k = 0.63). Conclusion In our study, hybrid VQ SPECT/CT did not reduce the number of potentially false‐positive VQ SPECT, nor did the CT obviate the need for a ventilation study. Thus, the routine use of hybrid SPECT/CT for suspected pulmonary embolism is not justified.
Medical Imaging Review Article: Vertebroplasty for acute painful osteoporotic vertebral compression fractures: An update Corresponding author: Dr Anthony Lamanna, Austin Hospital, Heidelberg, VIC, Australia Vertebral compression fractures (VCFs) are a common cause of back pain and disability and are usually osteoporotic in nature. Therapy aims to adequately control pain and allow early mobilisation and return of function while preventing additional fractures. A proportion of patients do not achieve adequate pain relief using conservative measures alone. Unwanted adverse effects from medications may also ensue. Vertebroplasty represents an alternative treatment option for VCFs. Patients with acute VCFs (≤6 weeks old) may gain the most benefit from vertebroplasty as healed fractures are not as amenable to cement injection. High‐quality studies have reported conflicting results regarding the use of vertebroplasty in the treatment of acute VCFs. Despite high‐quality evidence, varying study designs and heterogenous patient cohorts make interpretation of this data difficult. Only one sham‐controlled randomised controlled trial (RCT) has evaluated vertebroplasty exclusively in patients with acute VCFs, reporting favourable results. Pooled data from RCTs also suggest vertebroplasty to be safe. This article provides a concise and critical review of the current literature regarding vertebroplasty for the treatment of acute VCFs.
Radiation Oncology Review Article: Recent clinical applications of external beam radiotherapy for hepatocellular carcinoma according to guidelines, major trials and meta‐analyses Corresponding author: Prof. Jinsil Seong, Department of Radiation Oncology, Yonsei Cancer Center, Seoual, Korea External beam radiotherapy (EBRT) for hepatocellular carcinoma (HCC) has not been widely used due to lack of high‐level evidence, despite its potent local therapeutic effect. While clinical evidence has accumulated and meta‐analyses of observational studies have provided integrated information to help in clinical decision‐making, a recent randomized trial demonstrated the benefit of EBRT in cases of HCC with major vessel invasion. Based on these trends, the efficacy of EBRT has been better recognized, and EBRT has been more frequently recommended in several international treatment guidelines newly updated in 2018. This review examined the key issues of EBRT in the guidelines updated in 2018 as well as recently published noteworthy randomized trials and meta‐analyses. Ongoing trials to identify the trends and direction of future research on EBRT for HCC were also reviewed.
Radiation Oncology Original Article: Nodal CTV selection according to primary tumour location and pT stage for biliary tract cancer Corresponding author: Dr Joanna Socha, Department of Radiotherapy, Military Institute of Medicine, Warsaw, Poland Introduction To assist radiation oncologists in determining the elective nodal CTV for biliary tract cancer, we aimed to provide the rules for selection of the CTV for each subsite of biliary tract with respect to the pT stage, based on the analysis of the incidence and location of metastatic lymph nodes. Methods Systematic review and meta‐analysis was performed to determine the rate of pathological nodal involvement of each individual lymph node station (LNS) as a function of the primary tumour pT stage (pT1‐2 vs. pT3‐4) separately for right intrahepatic cholangiocarcinoma (rIHC), left/hilar intrahepatic cholangiocarcinoma l/hIHC), proximal extrahepatic cholangiocarcinoma (pEHC), middle extrahepatic cholangiocarcinoma (mEHC), distal extrahepatic cholangiocarcinoma (dEHC) and gall bladder cancer (GBC). A 5% or higher risk of involvement was assumed to justify inclusion of the LNS in the CTV. Results Coeliac LNS, which is usually included in the CTV in clinical practice, has a low risk of involvement and can presumably be omitted for pT1‐2 GBC, for dEHC irrespective of pT stage and for mEHC. Para‐aortic and superior mesenteric artery (SMA) LNS that are usually omitted have a high risk of involvement. Para‐aortic LNS should be considered for inclusion for all the subsites except for pT1‐2 dEHC, and SMA LNS for all the subsites except for pT1‐2 dEHC, pT1‐2 GBC and pEHC. Left gastric artery, lesser curvature and paracardial LNS should be considered for inclusion for l/hIHC. Conclusion This systematic review provides an evidence‐based strategy for nodal CTV selection in biliary tract cancer according to primary tumour location and pT stage.
Access your College journal online If you are a member of the Royal Australian and New Zealand College of Radiologists, access JMIRO free online. - Go to www.ranzcr.edu.au - Log in using your College username and password = FREE access to all JMIRO current and digitised backfile content from volume 1, 1957!
News
New Zealand Branch News
Dr Gabes Lau
Cancer Action Plan The Ministry of Health (MoH) has developed the Cancer Action Plan (the Plan) in consultation with stakeholders to work collaboratively to prevent cancer and improve detection, diagnosis, treatment and care for all New Zealanders. The Plan sets out actions required over the next ten years to ensure better cancer outcomes. It has four main goals: • New Zealanders have a system that delivers consistent and modern cancer care • New Zealanders experience equitable cancer outcomes • New Zealanders have fewer cancers • New Zealanders have better cancer survival. The Plan is currently light on detail – it is not clear what it means for radiologists and radiation oncologists. The College’s submission in response to the Cancer Plan is available on the College website.
Health and Disability Review In 2018, the Minister of Health announced a review of New Zealand’s Health and Disability System. This is a big review and is likely to result in significant changes to New Zealand’s health care system. The Interim Report was released in September 2019 and recognises key priority areas raised by the College in its submissions, including:
• workforce pressures and the need to address projected shortages • implementation of data standards, data stewardship, identity management and interoperability between systems • current funding models and allocations for capital projects which may not be sufficient to meet the future scale of investment required across old and new technologies • implications of advances in technology such as telehealth and AI. Alongside operational challenges within the system, the interim report addresses global and regional shifts that the Panel believes will continue to shape New Zealanders’ health and wellbeing. These include: • changing models of care (moving away from a “western medical model” focused on treating illness, rather than promoting wellness) • building the cultural competence of the workforce and reducing institutional racism • the health effects of climate change. At the time of this writing, a response to the interim report is being prepared.
Auckland ASM The ASM in Auckland was an enormous success. Thanks to those who assisted with the organising and to those who attended. Highlights from the event included the much-discussed cultural competence session, the interactive faculty forum, Mike King’s speech at the
Annual Ceremony and the Delorean. We were all sorry to hear about the recent fire at the venue but are pleased nobody was hurt. I wish Sky City the best of luck in rebuilding their convention centre.
ASM Awards The Obex award was won by Dr Gregory Tarr for Factors associate with change in management due to inclusion of pre-operative staging PSMA PET CT in patients with high-risk prostate cancer. Dr Tarr also competed in the Branch of Origin and won that too! The Branch of Origin has now been won by a Kiwi three out of the last four years. Dr Tarr will now be able to present at RSNA next year. Proffered paper, which is sponsored by NZRET, was won by Dr Jane Peart for Lipiodol HSG – Back to the Future. Poster prize, which is also sponsored by NZRET, was won by Dr Khirul Missa Binti Mohd Amin for: The use of CT KUB in evaluation of suspected renal colic in emergency department; secondary care hospital experience.
2020 New Zealand ASM The New Zealand ASM for 2020 will be held 07 - 09 August at the Intercontinental in Wellington – please put it in your diaries.
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News
NSW Health and Specialist Medical Colleges Roundtable: A respectful culture in medicine require volunteers from the respective stakeholders to continue to drive change. For information on College wellbeing activities, including links to useful resources to support your health and wellbeing, please visit the ‘Your Wellbeing’ page on the College’s website ranzcr.com/trainees/general/ your-wellbeing.
On Friday 11 October 2019, College representatives Dr Morgan Schulze, Clinical Radiology Trainee Committee, and Chloe Visser, Senior Project Officer – Specialist Training Program, attended a NSW Health and Specialist Medical College Roundtable at The Royal Australasian College of Physicians (RACP). The day was hosted by The Hon. Brad Hazzard, NSW Minister for Health and Medical Research, and gathered respective stakeholders of various specialty groups to discuss progress on the 2017 Junior Doctor Wellbeing and Support Plan, together with improving medical culture and accreditation processes. Key presentations were given by Dr Tessa Kennedy (Australian Medical Association Council of Doctors-inTraining), Mr Phil Minns (NSW Health), Mr Tony Sparnon (The Royal Australasian College of Surgeons (RACS)), Dr Teresa Anderson (Sydney Local Health District) and Ms Robyn Burley (RACP). In particular, an in depth progress report was delivered by RACS on their
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‘Operating With Respect' initiative. Collaborative sessions were held to formulate common approaches to underlying issues by the multiple stakeholders, with questions and feedback taken and given from the Health Minister. The afternoon session was devoted to a panel discussion on accreditation processes, with contributions from the Australian Medical Council, various specialist medical colleges and local health districts. The day concluded with the offer from the NSW Ministry of Health to continue trying to coordinate the medical specialties to increase knowledge and information sharing, in an attempt to create common policies and approaches to a range of issues affecting the wellbeing of junior doctors. A key message being that we must all consider the changing workforce demographic and experiences, as well as the expectations of staff and patients. Progress is ongoing and will
Purposefully designed wellbeing workshops were piloted in some networks during 2019. These aimed to provide trainees with tools and strategies to manage professional and personal stressors associated with specialty training. Participants were also encouraged to share workplace related issues and, together with facilitators discussed strategies to assist, and seek help. The College plans to roll out future sessions across all training networks.
General Interest
Grants, Awards And Prizes 2020 In January 2020, the College will invite nominations and applications for a range of awards, honours and Fellowships, to recognise outstanding service by members to their professions, and to support members to further their knowledge and expertise by travelling overseas. Applications and nominations open at the end of January 2020.
COLLEGE HONOURS Gold Medal The Gold Medal is the highest accolade to be given by the College. It honours a Fellow who has rendered outstanding service or benefactions to the development, teaching or practice of clinical radiology or radiation oncology in Australia, New Zealand or Singapore.
Roentgen Medal The Roentgen Medal is awarded to Fellows who have made a very valuable contribution to the College over a significant period of time.
Life Membership Life Membership is awarded to Fellows over the age of 65 who have made an unusually significant contribution to their field or the College.
Honorary Fellowship An Honorary Fellowship recognises individuals who have contributed to the advancement of clinical radiology or radiation oncology and allied sciences, either through original research or by special services to the College.
Denise Lonergan Educational Service Award This award recognises members who have demonstrated outstanding longterm commitment, participation and leadership in training and education in radiation oncology.
Clinical Radiology Educational Service Award This award recognises members who have demonstrated outstanding longterm commitment, participation and leadership in training and education in clinical radiology.
Sally Crossing Award for Consumer Advocacy The Sally Crossing Award for Consumer Advocacy acknowledges outstanding commitment of consumers involved in health care advocacy. The award honours the memory of the late Sally Crossing AM, in recognition of her exceptional contributions to advocating for cancer patients.
For more information visit www. ranzcr.com/college/awards-andprizes or email gaps@ranzcr.edu.au
EDUCATIONAL FELLOWSHIPS Thomas Baker Fellowship This Fellowship enables a clinical radiology or radiation oncology member up to six years post-Fellowship to further their knowledge by studying abroad for between three and 12 months. It is supported by a grant of AU$20,000 from The Baker Foundation.
Bill Hare Fellowship This Fellowship supports a Fellow more than five years post-Fellowship for a period of intensive or overseas study (three to 12 months) or for attendance at an international short course (two weeks to one month) with a grant of AU$30,000.
Rouse Travelling Fellowship In 2020, this Fellowship is available for a Clinical Radiology Fellow from New Zealand to attend the Annual Scientific Meeting in Melbourne. The Fellow is also expected to visit and present in their field of interest in three training centres in Australia, with the support of an AU$8,000 grant.
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General Interest
Research Awards And Grants 2020 The College is pleased to offer the following research awards and grants in 2020. These are available to support research projects and foster a culture of research at the College. Applications open at the end of January.
For more information visit www.ranzcr.com/ college/awards-and-prizes/research-awardsand-grants or email gaps@ranzcr.edu.au
RANZCR Research Grants
Windeyer Fellowship
RANZCR research grants provide financial support for Fellows, Educational Affiliates and student members in clinical radiology and radiation oncology to conduct research.
This is a 12 month position for Fellows up to two years post-Fellowship or trainees post-Phase 2 exams that provides clinical research opportunities at the Mount Vernon Cancer Centre in the United Kingdom. The position is under the broad supervision of Professor Peter Hoskin.
Grants are awarded for sums between AU$5,000 and AU$30,000.
Clinical Radiology Early Career Researchers Award This prize recognises a clinical radiology trainee or junior Fellow who is the first author of a paper accepted for publication by JMIRO or another Medline Indexed peer-reviewed journal.
Faculty of Radiation Oncology Bourne and Langlands Prize
ADVERTISE WITH US
This AU$1,000 prize is awarded to a trainee who has written an exceptional trainee research requirement manuscript.
Withers and Peters Grant This AU$25,000 grant supports Fellows up to five years post-Fellowship and trainees post-Phase 2 exams to carry out significant research projects.
Opportunities available to advertise in Enquire today! Email editor@ranzcr.edu.au or phone 02 9268 9777
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General Interest
NEW!
RANZCR Member Rewards The College is committed to delivering maximum value for your membership subscription fees. One aspect of this is providing a member rewards program with exclusive offers and savings. Announced in September 2019, our new RANZCR Member Rewards program offers a selection of exclusive and valuable rewards through partnerships with providers of products and services in financial, insurance, legal, travel and lifestyle categories. In this article, we feature the first of these providers. Stay tuned for more exclusive offers to be announced over the coming year. If you have any questions about the new RANZCR Member Rewards Program, or would like to suggest a potential member rewards partner, please contact Dr Munish Verma, Head of Member Engagement and Services at members@ranzcr.edu.au.
Travel The Accommodation Brokers
The Accommodation Brokers are a personalised “end to end” travel booking service who use their brokering buying power to obtain the best possible market rates for accommodation and other travel services. With access to over 800,000 hotels and apartments worldwide, we are delighted to be partnering with The Accommodation Brokers to offer members and their families a competitive leisure travel program. By utilising this trusted concierge service, members will be able to enjoy significant savings in both
time and money when booking their accommodation, both for professional and personal travel.
Insurance NobleOak Life Insurance (Australia)
Access the offer Simply contact The Accommodation Brokers to request and organise your bookings: • Phone: Call your dedicated travel professional on +61 2 9802 2074 • Email: bookings@ theaccommodationbrokers.com.au • Find out more on our website
Car Rental Europcar
Europcar operates the world’s largest car rental network with more than 1.2 million vehicles and 13,500 locations around the world. Europcar is pleased to offer RANZCR members a 10% discount on rental rates worldwide, as well as access to the Europcar Privilege Loyalty Program, with benefits including priority service upon collection (providing a full profile is complete with drivers credit card details), pre-allocated vehicles and secured reservations (vehicle held for two hours post nominated collection time). Access the offer Contact the College on +61 2 9268 9777 or members@ranzcr.edu.au for your unique contract ID, then making your booking:
NobleOak is an Australian independent life insurer with over 140 years of heritage and the most awarded Direct Life Insurer of 2019. NobleOak believes in bringing RANZCR members Life Insurance the way it is meant to be - combining quality, no-surprises cover with personal service and lower premiums. NobleOak offers RANZCR members and their families a 10% discount on usual premium Life cover rates, meaning you could save 22% on average compared to other major insurers.* Access the offer • Online: Find out more and get an instant quote at www.nobleoak. com.au/ranzcr • Phone: Call one of NobleOak’s friendly specialists on 1300 108 490 and mention the code “RANZCR” *Visit www.nobleoak.com.au/ranzcr for full terms and conditions including details of savings but note the savings referred to here contain adjustments to include the 10% discount for members.
An equivalent life insurance offer for our New Zealand members will be available soon
continued over...
• Phone: Call 1300 555 242 • Find out more on our website • Email: reservations@europcar.com.au
Volume 16 No 1 I December 2019
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General Interest
Car Purchasing For all car purchasing offers: When you’re ready to make a purchase you will require an authorisation letter from the College to access the corporate benefits. Email members@ranzcr.edu.au to request this letter.
Tesla Corporate
Access the offer • Online: Visit www.mercedesbenz.com.au/corporate or www. mercedes-benz.co.nz/corporate • In person: Contact the dedicated Corporate Sales Consultant at your preferred Mercedes-Benz dealer.
BMW and MINI Corporate (Australia)
• Complimentary first year BMW Motor Vehicle Insurance • Multi-year BMW Motor Vehicle Insurance available, with the benefit of fixed premiums for years 2 and 3 • Genuine BMW Accessories and Lifestyle voucher valued at $1,000 (incl. GST). Access the offer • Online: Visit www.bmw.co.nz • In person: Contact the dedicated Corporate Sales Manager at your preferred BMW Dealer.
Audi Corporate (Australia) Tesla is a world leader in the production of all electric vehicles, and we are pleased to be able to provide RANZCR members with access to the Tesla Corporate program, with exclusive benefits and convenience services for new Tesla purchases, including a complimentary 3-Year Maintenance Plan and waived delivery fee. Access the offer • Email: Write to CorporateSalesANZ@tesla.com to schedule a test drive, and to discuss how to trade in your current car or select the best financing option. • Online: Visit www.tesla.com to find out more and make your order.
Mercedes-Benz Corporate
The Mercedes-Benz Corporate Program is designed to make ownership easier and more beneficial, with RANZCR members able to access: • Three years complimentary scheduled servicing (four years for New Zealand members) • Reduced retailer delivery fee • Total of 4 years Mercedes-Benz Road Care nationwide • Complimentary pick-up and drop-off or access to a loan car when servicing your vehicle. New Zealand members may also be eligible to access preferential finance rates and tailored insurance solutions through Mercedes-Benz Financial.
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BMW and MINI Corporate is not just about making it easier to own a BMW or MINI. It’s about enhancing the whole driving experience. Representing significant value, BMW and MINI Corporate is a great way to lower the cost of ownership and enjoy exclusive benefits with the purchase of a new BMW or MINI. BMW and MINI Corporate offer RANZCR members and their spouses the following benefits: • A free Service inclusive for 3 years or 60,000kms. • Complimentary use of a BMW/MINI during scheduled servicing. • Reduced Dealer delivery of $1,850 excluding taxes. • Reduced rate on a BMW Driving Experience course. Access the offer • Online: Visit www.bmw.com.au/ corporate or www.mini.com.au/ corporate • Phone: Call 1800 635 750 • Email: Write to corporate@bmw.com.au • In person: Contact the dedicated Corporate Sales Manager at your preferred BMW Dealer or MINI
BMW Corporate (New Zealand)
An Audi vehicle guarantees luxury, quality and a progressive design. With access to Audi Corporate, members can access to exclusive benefits to lower the cost of Audi ownership as well as discounted car rental rates, including: • Complimentary scheduled servicing for up to 3 years or 45,000kms • Maximum recommended Dealer delivery fee of $1,995 (excluding taxes) • AudiCare 24/7 roadside assistance~ for the duration of the new car warranty • Complimentary pick up and drop off of your vehicle to a maximum 20km from the servicing dealer or complimentary access to an Audi loan vehicle during servicing • Complimentary enrolment to the Hertz Gold Plus Rewards Program including discounted rental rates • Access to additional benefits and events through Audi Experience Access the offer • Online: Visit www.audi.com.au/ au/web/en/the-audi-corporateprogram • Email: Write to customerassistance@ audi-info.com.au • In person: Contact the dedicated Corporate Sales Consultant at your preferred Audi Dealer.
BMW Corporate Advantage represents significant value and is a great way to lower the cost of ownership and enjoy exclusive benefits with the purchase of a new BMW, including:
Terms and conditions apply for all of our member rewards providers. View full terms and conditions for each offer at www.ranzcr.com/ college/member-rewards
General Interest
In Memoriam
Prof Geoffrey Benness AM – 03/05/1928 to 03/07/2019
Prof Geoffrey Benness Geoffrey Thomas Benness was born in Nowra in 1928 and found himself the man of the household at 16 when his father, a hotelier died. Although his family moved often throughout the Depression, he had a loving childhood within a close-knit family. After a brief career as a GP/ Obstetrician, he started his Radiology in 1957 at St Vincent’s Hospital. He won first prize in both the Part I and Part II radiology examinations and in 1961 was awarded the Baker Fellowship to study cardiac radiology. He visited the UK and Scandinavia but it was with Mason Sones that Geoff finally found what he sought. Declining an offer to work with Sones in the USA, Geoff returned to Australia and was instrumental in setting up cardiac angiography units in Sydney and Melbourne. Geoff was very adept at coronary angiography which he performed with cine and cut film angiography in about 10 minutes from start to finish.
He left the St Vincent’s Hospital after 7 years to work with Professor John LoEwenthal at the University of Sydney as a Research Fellow where he developed his interest in contrast media and became close friends with John Dammery, CEO of Schering AG, Australia. Geoff published widely on contrast media for urography, cholangiography and angiography and became a regular visitor to RSNA. His international contacts were very helpful when non-ionic contrast was introduced in the 1980s and he and John Palmer surveyed the Australian adherence to guidelines for non-ionic contrast media use which was a world first initiative. Geoff became the inaugural Professor of Radiology at Flinders University in Adelaide and brought a wealth of talent, radiologists, radiographers and researchers to Flinders Medical Centre. Geoff started FIFO Radiology to Port Lincoln, Port Pirie and Alice Springs in response to requests for radiology services from the SA Health Department. From his international contacts, he brought a succession of radiology thought leaders to Flinders Medical Centre for the Mark Oliphant Lecture. These included Charles Dotter (interventional radiology), Robert G Fraser (chest radiology) and Sir Mark Oliphant himself. He established the Flinders Medical Research Foundation and worked tirelessly to find funding for research in radiology. In a benign way he disrupted the Adelaide Medical status quo and produced an element of competition in a previously staid establishment particularly in cardiac services. The unique Flinders Radiology conferences at Hayman Island were the inspiration for the formation of IRSA, the Interventional Radiology Society of
Australasia. Geoff was never happier than when teaching medical students and radiology registrars. Unfortunately, Geoff had a myocardial infarction and after a coronary bypass in 1982 was advised to retire. He returned to Sydney where, years later, he had a second bypass operation. There he acted as an advisor to the St Vincent’s Hospital Group. He married physiotherapist, Pamela Foote, in 1952. Pam and Geoff had 4 children, 12 grandchildren and 6 great-grandchildren. On many summer evenings he could be found at the bbq grill on the aft end of his yacht with one of his grandchildren, with whom he shared stories of early Australian maritime history, one of his many passions. Family, contacts, colleagues and friends were very important to Geoff and he kept in touch until his death by phone and letters, often written on the back of pictures of Australian Lighthouses. Geoff was awarded an Order of Australia (AM) in 1993 for services to medicine. Vale Geoff Benness, your legacy of clinical excellence, teaching and research truly enriched Australasian Radiology and your friends will always remember you fondly. Professor Ken Thomson MD, FRANZCR, FRCR, FSIR, EBIR.
Prof Benness and Prof Thomson Volume 16 No 1 I December 2019
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General Interest
News in Brief New Dean of Otago Medical School College member, neuroradiologist and nuclear medicine physician Professor Rathan Subramaniam has been named the new Dean of the University of Otago Medical School. He will start at Otago in February next year, serving as Dean of the Otago Medical School – which encompasses each of the University’s three main campuses – as well as heading the Dunedin Medical Campus.
ASM 2019 Trends on Twitter The ascension of the RANZCR ASM Twitter feed saw the annual event climb
from 2018’s high of number 5 to number 3 at the 2019 ASM in New Zealand. This was a tremendous effort as we only lost out to the 2019 Rugby World Cup and the glorious land of New Zealand as well.
Doctor in Training Scholarship awarded for silicosis research Dr Hari Wimaleswaran, a trainee respiratory medicine physician from Victoria, was recently awarded an Avant Foundation grant to support his research into acute and accelerated silicosis: identification of disease biomarkers and potential therapeutic targets.
Dr Wimaleswaren’s research focuses on the cellular and molecular pathways, including biomarkers which are not well defined and may provide direction to potential therapeutic targets. Since 2012 the Avant Doctor in Training Research Scholarship Program has provided support for life changing research. For more information on the program and 2019 recipients, please visit www. avantdifference.org.au/dit-scholarship
~ In Memoriam ~ MRI PRO
The College notes with regret the death of the following members:
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