Inside News December 2020 by RANZCR

Volume 17 No 1 | December 2020

Quarterly publication of The Royal Australian and New Zealand College of Radiologists

THE MANY FACES OF RANZCR 2020

Also Featured in this edition

Medicare Changes Empower Men with Prostate Cancer

Windeyer Fellowship 2019-2020

Dr Shreya Armstrong

Our Journey to Engage Indigenous Communities

“We connect and communicate.” At I-MED Radiology, we are united by a vision to be the most respected and trusted medical imaging specialists in the world. Working together with our referrers, hospitals and other stakeholders, our commitment is to deliver high quality and expert care to our patients. We may be Australia’s largest medical imaging network, but we are also strong believers in connecting locally. If you’d like the opportunity to work with the best, and join a team of radiologists who share their collective knowledge and expertise, then talk to us today. We look forward to hearing from you. Contact our careers team T: +61 2 8274 1080 E: careers@i-med.com.au www.i-med.com.au/careers

Editor’s Pick 5 7

A Message from the President A Message from the CEO

8 10 11

A Special Thanks to our 2020 RANZCR Volunteers Medicare Changes Empower Men with Prostate Cancer Windeyer Fellowship, Dr Shreya Armstrong, 2019–2020

Our Journey to Engage Indigenous Communities

Medicare Compliance Targeted Campaigns Explained

A Look Back on the Training and Assessment Reform during 2020

What are your thoughts?

28 33 38

RANZCR2021: Elysium Diagnostics and Therapeutics (Now and in Future) with AI

53 54 56

From the Faculty of Clinical Radiology Clinical Radiology Trainee Matters

41 46 47 49

2020 Research Grant and Award Recipients

From the Faculty of Radiation Oncology

Telehealth in the Context of a Pandemic Radiation Oncology Trainee Matters MBS Review for Radiation Oncology

Quality of Care in Radiation Oncology

Obituary: Dr John A Violet Obituary: Dr Colin Bull Achievements of the Interventional Radiology Committee From Ireland to Melbourne as an Interventional Radiologist

5 8 861

Obstetrics & Gynaecology Ultrasound Workshop

New Zealand Branch News

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 is encouraged. Please email any submissions to editor@ranzcr.edu.au

News: Special Interest Groups, ANZERG

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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.

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Occupational Radiation Dose Interventional Radiology A review of the literature also demonstrates that scatter radiation is not only absorbed by the operator but also nursing and radiography staff. This shows that, despite recent changes in practice, lead screen, aprons and everyone’s best efforts, there is still a significant occupation risk.

Reducing radiation dose within the interventional lab has been the primary goal of the angiography industry for over 30 years. The concern for patient dose are well-studied with the “linearno-threshold” model for risk generally accepted, meaning there is no safe level of radiation for the patient. However, what is often overlooked is the risk of radiation exposure to interventional staff, exposed to scatter radiation every day over potentially a 40-year career. In 2013, a study by Roguin et al raised concerns regarding radiation exposure-induced malignancies in interventionalists. It documents an increased incidence of malignancies in interventionalists and a disproportionate number of tumours on the left side of the brain, the region of the head known to be more exposed to radiation and least protected by traditional shielding1.

Innovative dose reduction technology and improvements in image quality play an important role in reducing patient dose during interventional procedures. However, it is important to note that any reduction in patient dose is also a reduction in operator dose. A study by The St George Hospital found that use of advanced Dose Reduction Technology (DTS) resulted in a 46% reduction in peak skin dose3. DTS is a patient-centric model that live records the patient’s skin dose according to c-arm angle, field of view, tube current and imaging mode to give the most accurate demonstration of dose received during an examination. Researchers at St George confirmed that ongoing real-time dose feedback is a critical factor in the successful modification of operator behaviour to reduce radiation dose.

Without changing workflow or method of procedure, Queen Elizabeth Hospital in Adelaide have demonstrated an 84% reduction in radiation dose by using SpotROI. It is an alarming finding that proves that radiation exposure is not only an important consideration for patients, but also for interventional staff. Vano et al (2013) investigated ocular radiation doses and the prevalence of lens opacities in a group of interventional professionals and found posterior subcapsular lens changes characteristic of ionising radiation exposure in 50% of interventionalists. and 41% of nurses and technicians2.

https://anz.medical.canon

The unique collimation filters of SpotROI allow the operator to reduce dose to surrounding anatomy while simultaneously ensuring full image quality in the area that matters most. This allows the interventionalist to monitor the position of the guide wire and the surrounding anatomy, though not at full dose. Dose reduction techniques should not come at the cost of examination time, workflow or ergonomics.

Flexible Lateral Isocentre (FLIC) allows the lateral arm of a biplane system to be height adjusted independently, enabling patient anatomy to be kept at isocentre. In a study by Borota and Patz (2017), the use of FLIC led to a 25% reduction in dose, whilst improving ergonomics and range of table heights and increasing angulation ability on the frontal arm4. Interventional departments have a responsibility to take every effort to reduce radiation dose to patients and to minimise the occupational dose received by staff. While there is no safe amount of radiation to receive in the lab, by reducing the dose to the patient using Canon Medical’s industry-leading dose-reduction technologies, staff can take control of the occupational safety of the lab. Canon Medical, for over 25 years, have facilitated a steady decline in radiation dose with the launch of pioneering products that expand our commitment to reducing patient and staff dose. The new Alphenix family of interventional systems provide comprehensive dose management solutions including DTS, SpotROI and FLIC to prioritise the safety of our customers and their patients. Ricky Davidson ANZ Manager – X-Ray and Angiography Canon Medical Systems ANZ Pty Limited

References 1 Roguin A., Goldstein J., Bar O., et al. Brain and neck tumors among physicians performing interventional procedures. Am J Cardiol 2013; 111:1368–1372. Vano E., Kleiman N J., Duran A., et al. Radiationassociated Lens Opacities in Catheterization Personnel: Results of a Survey and Direct Assessment. J Vasc Interv Radiol 2013; 24: 197-204.

Wilson S, Prasan AM, Virdi A, et al. Real-time colour pictorial radiation monitoring during coronary angiography: effecton patient peak skin and total dose during coronary angiography. EuroIntervention 2016;12: 939–47.

Borota L, Jangland L, Aslund PE, et al. Spot fluoroscopy: a novel innovative approach to reduce radiation dose in neurointerventional procedures. Acta Radiol. 2017;58(5):600-608.

Introduction

A Message from the President Farewell to 2020

Dr Lance Lawler

I have been looking forward to writing my last official message for 2020. Or at least I think it is, 2020 has developed a nasty habit of asking for more. It seems as though the whole year has seen us lurching from one crisis to another. It was almost exciting initially, but after a short while, just exhausting. COVID has upended almost every program and process we have, most significantly our assessment and examination schedule. Knowing that we could not run our usual exam timetable, we were determined to hold at least one sitting in 2020. This has placed a tremendous burden on those involved, all the while with one eye on the unfortunate RACGP and RACP missteps—just to turn the heat up even more. Despite the stresses and unknowns, I am humbled by the collective efforts of everyone involved to run largely uneventful exams. This has been a mammoth effort, and much appreciated. I am not saying that the process was perfect, communication at times fell below the standard we expect, but we can learn from this and move on. I wish the best of luck to all of our 2020 candidates. I have been very impressed with the overall performance of our executive and administrative teams. Their working environment has been totally disrupted with the effective closure of our Sydney head office. All usual timeframes and safeguards have been thrown out of the window but expectations have not.

On behalf of all our members I want to give a heartfelt thanks to Mark Nevin, our interim CEO, his team and all of our staff. I know how much this work means to them, they set very high standards and feel it acutely when things do not go as smoothly as expected. Let’s hope for a more even playing field in 2021, they deserve a break. 2020 has shown that we can operate effectively in quite different ways. This gives power to the view that we need to go even further in our reviews and revisions. Technology and our ability to leverage it may be the key to future, but this cannot simply be the replacing of current practices with electronic ones. Our assessment and examination platforms are inordinately resource and time intensive. The numbers of trainees sitting increases each year, and we are close to the limit in how much more our processes can be scaled. Sometimes it’s like we are Cinderella’s ugly sisters’ feet—being squeezed into smaller and smaller slippers.

Nevertheless, as a famous engineer from the future once said, “You canna change the laws of physics”. Sooner rather than later our foot just will not fit into that glass slipper. Our challenge is to find bigger slippers or get smaller feet. I will leave the details to you. A final best wish to you all. We have had enough of 2020. Enjoy the holiday season, overindulge if you choose. Come back next year refreshed. We have more work to do.

To compound this, our curriculum continues to grow. The training demands for FRANZCR are increasing, as are those for interventional radiology, theranostics and nuclear medicine (not to mention AI). One solution is to simply add years to the training program, but even a cursory thinking through of that suggests this is not practical. The other alternative is to adjust the curriculum in other areas and make some parts optional. I can hear the screams now!

Volume 17 No 1 I December 2020

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Introduction

A Message from the CEO Our Focus in 2021

Mark Nevin, CEO

This has been a challenging year for so many people across the globe. Australia and New Zealand have also faced upheaval, however due to the proactive approach taken by our governments, the resilience of our populations and quality of care you provide, we have fared substantially better than most Western countries. It has also been a significant year of change for the College, adapting to new ways of working and a new CEO. I know many of you well from my prior role heading up the Policy and Advocacy Unit. After six years of service, I had departed the College for a short time with a view to moving to a role in Canberra. A move interstate was looking rather complicated by mid-year, therefore I was delighted to be appointed as interim CEO from September for twelve months. The College is a solid organisation with a purpose and strategy I believe in, highly engaged members, dedicated staff and fascinating subject matter. In fact, our previous CEO Natalia Vukolova transformed the College and I recognise the significant achievements reached during her tenure. Although it was taxing, the College has many accomplishments to be proud of this year, particularly supporting members to deliver front line care through the COVID pandemic and successfully running examinations in entirely new formats. We have also continued to run most of our core business and progress a range of

strategic initiatives. This year and the College’s agile response to it will certainly feature in the next iteration of the College’s history!

Key Areas for 2021 There are four key areas which I will give particular focus to during the next twelve months. Firstly, as members will appreciate, we are working to upgrade our systems to support your continuous professional development with a new learning management system. That will help you prepare for the onset of revalidation in Australia and compliance with recertification in New Zealand. Adhering to these requirements will be necessary for you to maintain registration with the Medical Board of Australia (MBA) and the Medical Council of New Zealand (MCNZ). Secondly, as a medical college, the College must meet a number of requirements set by the AMC and MCNZ. We were recently accredited for another four years, however there is a range of conditions we must deliver on through 2021, mainly relating to the reforms to our training program and refinements to examinations. Another key requirement is supporting members to engage with Māori, Aboriginal and Torres Strait Islander communities and grow the number of Indigenous clinical radiologists and radiation oncologists. You can read more about our plans for this area on page 13.

Thirdly, and also related to our training program, we took the necessary decision this year to postpone implementation of the Training and Assessment Reform by one year due to the pandemic. Through 2021, the College team will focus on implementation of the new training curricula for clinical radiology and radiation oncology, and the move to programmatic assessment. Finally, any organisation’s greatest asset is its people. That is no less true for the College. Our staff across Australia and New Zealand have diverse and valuable skills that support the breadth of our functions. They work collaboratively with hundreds of clinical volunteers each month through our committees, training program and examinations. I plan to focus on retention of staff and further developing the College’s workforce to deliver on the multiple high stakes projects we have on the go at any one time. I would like to end on a note of gratitude to all of our clinical volunteers and the College staff for your enormous contributions this year. We could not have got through this year without you. Wishing everyone season’s greetings and a well-deserved rest.

Volume 17 No 1 I December 2020

A SPECIAL THANKS TO OUR With International Volunteers Day taking place earlier this month, we can think of no better time to thank the College’s community of member volunteers around Australia, New Zealand and in Singapore for their outstanding work and commitment to our college. This year has tested us all as we have dealt with a global pandemic, an onslaught of natural disasters and a slowing economy. During these extraordinary and challenging times, it is more important than ever to recognise and appreciate the work that our volunteers do each and every day. The value of volunteering is immense, irreplaceable, and profoundly important. Over the past 12 months over 1300 of our members have given their time and expertise to support the work of the College. Whether you have been involved in training and education, examinations, reviewing and setting standards, advocacy, or governance, your contribution has been instrumental. In these challenging times, good people stand out, and generosity, kindness and strength will always bring us together. This year, our volunteers have gone “above and beyond”.

Are you ready to get more involved with the College? View current volunteering opportunities at www.ranzcr.com/college/volunteering or update your MyRANZCR profile by logging in at www.myranzcr.com with your interests to be informed when relevant opportunities become available. 8

Inside News

2020 RANZCR VOLUNTEERS… We would like to give every volunteer a big and sincere “thank you” from everyone at the College for your hard work. Governance Board and Faculty Councils Committees and working groups Reference groups/panels Special interest group executives Training and assessment Examiners and all those involved in the 2020 exams Branch education officers Directors of Training Training Network Directors/Network Training Directors IMG assessors Training site accreditation assessors Research mentors Publications JMIRO associate editors and reviewers Inside News contributors Events Webinar hosts and speakers Plus All those who have taken the time to respond to our consultations, take part in our surveys and contribute to our work in other ways.

We look forward to 2021! PAGE 2

Features

Medicare Changes Empower Men with Prostate Cancer From 1 November 2020, two new radical prostatectomy items became available on the Medicare Benefits Schedule (MBS), along with a new explanatory note recognising the multi-disciplinary management of prostate cancer and encouraging men to see both a urologist and a radiation oncologist to discuss their treatment options. The College joined with the Urological Society of Australia and New Zealand (USANZ) and Prostate Cancer Foundation of Australia (PCFA) to welcome the new Medicare guidance. Prostate cancer is one of the most commonly diagnosed cancers in men in Australia1. It is estimated that the number of new cases of prostate cancer diagnosed in 2020 will be more than 16,500—an estimated 22 per cent of all new male cancer cases diagnosed2. Most recent estimations say that one in six Australian men will be diagnosed with prostate cancer before the age of 853. At present, the majority of men are treated by a surgical procedure called radical prostatectomy. A range of clinicians are involved in the treatment of newly diagnosed prostate cancer, particularly GPs, urologists and radiation oncologists. The changes to Medicare mean that urologists will have more time to discuss the complexities of treatment with patients, men will consult with both a radiation oncologist and a urologist, and complex cases will have the benefit of multi-disciplinary team review. In a media release sent following the introduction of the new MBS items and explanatory note, College President Dr Lance Lawler said, “Men diagnosed with prostate cancer are at the centre of decision-making about what treatment will be best for them when urologists and radiation oncologists work together as a consultation team. “Best practice is for men diagnosed with prostate cancer to have a consultation with both a urologist and

Inside News

a radiation oncologist so that they can fully understand the advantages and disadvantages of both surgery and radiation therapy. “Surgery and radiation therapy are both equally effective but do cause very different side effects. Patients, surgeons and radiation oncologists together need to inform these decisions and men must be empowered to have input into their preferences.”

“The changes to Medicare mean that urologists will have more time to discuss the complexities of treatment with patients, men will consult with both a radiation oncologist and a urologist, and complex cases will have the benefit of multidisciplinary team review.” USANZ President Dr Stephen Mark said, “We support men receiving appropriate information in order to make an informed decision regarding management of a newly diagnosed prostate cancer. Some men will be best served by active surveillance whereas others will benefit from active treatment whether surgery, radiation or radiation with hormonal therapy. Treatment decisions should be individualised based on cancer risk and consideration of potential consequences of treatment.” PCFA CEO Professor Jeff Dunn AO welcomed the new guidance and said,

“This guideline will help to ensure men and their families can make fully informed decisions about treatment for prostate cancer. This move aligns with world’s best practice and reinforces Australia’s reputation for delivering world leading strategies to improve prostate cancer survival outcomes and quality of life throughout survivorship.” The College made extensive inputs to the MBS Review recommendations which aim to improve patient care and experiences and ensure that the MBS is modern and simplified to align with professional standards. The addition of explanatory notes will ensure that patients diagnosed with prostate cancer receive the necessary information to make an informed decision on their cancer management and treatment options. The College will continue to monitor referral data to ascertain whether the new explanatory notes are supporting men with this deeply personal choice. An overview of the changes to Medicare-funded urology services is available on the Department of Health’s website at www.mbsonline.gov.au/internet/ mbsonline/publishing.nsf/Content/ Factsheet-Urology-Nov20 If you have any questions please contact Executive Officer, Faculty of Radiation Oncology, Wendy Stamp at wendy.stamp@ranzcr.edu.au

References 1. Cancer Council Australia, May 2019 www.cancer.org. au/about-cancer/what-is-cancer/facts-and-figures.html 2. Cancer Australia, October 2020, www.ceraustralia. gov.au/affected-cancer/cancer-types/prostatecancer/statistics 3. Australian Institute of Health and Welfare, 2020 www.aihw.gov.au/reports/cancer/cancer-data-inaustralia/contents/cancer-rankings-data-visualisation

Features

Windeyer Fellowship Dr Shreya Armstrong, Windeyer Fellow 2019–2020

Grounds of Mount Vernon Cancer Centre

I am honoured to have had the opportunity to undertake the Windeyer Fellowship in 2019–2020. The position is based at Mount Vernon Cancer Centre in the United Kingdom and is open for application to fellows of RANZCR (and within two years post completion of Phase II exams). The origin of the fellowship relates to Sir Brian Windeyer, an Australian born professor, who played a key role in establishing radiology as a specialty and expanding the role of radiation in the management of malignancies. He obtained his medical degree in Sydney, and while working as a radium registrar at the Royal Prince Alfred Hospital, developed an interest in the use of radiation in the treatment of cancer. He did further training at Fondation Curie and in the UK. He was appointed professor in therapeutic radiology to the Middlesex Hospital

in 1943. To honour Sir Brian Windeyer’s distinguished career, the Windeyer Fellowship was established in 1993 as a legacy to continue the UK/Australian radiation oncology connection. The fellowship is currently under the broad supervision of Professor Peter Hoskin. The post has a strong brachytherapy focus but maintains a good balance between clinical duties and research. From personal experience having just completed the fellowship, I can recommend it highly.

What was different? Perhaps the two aspects of working in the UK that were most daunting to me was having to understand a new healthcare system and having to manage patients on systemic therapies. Similar to working in different hospitals through training, it

was only a short matter of time before I adapted to the differences in the medical record, pathology, radiology and electronic prescription systems. At the same time there were a lot of comforting similarities, as Mount Vernon used the Pinnacle and Eclipse platforms for external beam and brachytherapy planning. I realised early during my time at Mount Vernon that managing systemic therapy toxicities was made less daunting by an army of support from consultants, fellow registrars and experienced clinical nurse specialists who made every effort to ensure I never felt out of my depth. continued over...

Volume 17 No 1 I December 2020

Features

What did I gain? One of the biggest highlights from my time at Mount Vernon was having the one-on-one opportunity to work with world experts on gynaecological and urological brachytherapy. The brachytherapy practice was very busy and consistent, where we routinely treated 6–10 patients on a weekly basis, and maintained this flow even through the difficulties and disruptions due to COVID-19. I would like to make special mention of one of my supervisors Dr Roberto Alonzi, who was instrumental in teaching me the art of brachytherapy and who gave me the guidance to enable me to perform brachytherapy independently during the last few months of my fellowship. Under Professor Hoskin’s supervision, I was presented with multiple research opportunities, and have one publication and two further submissions in peer-reviewed journals. Following abstract submission, I was invited to make an oral presentation at the combined World Congress of Brachytherapy 2020 and the European Society for Radiotherapy and Oncology ESTRO 2020 Congress in Vienna in April. Lastly, I also had the opportunity to be involved in setting up a prospective clinical trial investigating fertility following brachytherapy or stereotactic ablative radiotherapy for prostate cancer, a trial that is now open for recruitment.

2019 brachytherapy team (left to right): Dr Hannah Tharmalingam, Dr Shreya Armstrong, Professor Peter Hoskin, Dr Roberto Alonzi, Dr Stephanie Brown

Inside News

It is also worth mentioning that another advantage to living on the other side of the world was that I had plenty of opportunities to attend various international conferences and courses. I attended five courses and conferences during my time in the UK, and undoubtedly would have attended even more if the globe hadn’t been halted by a pandemic. Although brachytherapy is an important component to this fellowship, the landscape for radiation oncology has changed significantly since the fellowship commenced in 1993. Given the technological advances in radiotherapy, the job description is under review yearly with possibilities to incorporate stereotactic radiotherapy as part of the program, and opportunities to spend time in other UK centres to observe specialist techniques including proton beam therapy and MRI based radiotherapy for future fellows. Overall, I am very humbled to have been awarded the Windeyer Fellowship. All my experiences and achievements would not have been possible without the support and opportunities provided to me by my supervisors. I leave with the experience of having worked alongside world experts in radiotherapy, a new oncology network, new friends and a lifetime of memories. @ShreyaArmstrong

“ I would like to make special mention of one of my supervisors Dr Roberto Alonzi, who was instrumental in teaching me the art of brachytherapy and who gave me the guidance to enable me to perform brachytherapy independently during the last few months of my fellowship.”

Read Dr Armstrong’s co-authored paper with Prof Peter Hoskin on ‘Complex Clinical DecisionMaking Process of Re-Irradiation’ in Clinical Oncology, free access to RANZCR members to 30 December 2020: www.clinicaloncologyonline.net/ article/S0936-6555(20)30317-4/ fulltext

Features

Our Journey to Engage Indigenous Communities RANZCR acknowledges Traditional Owners of Country throughout Australia and recognises their continuing connection to lands, waters and communities. We pay our respect to Aboriginal and Torres Strait Islander cultures; and to Elders both past and present. RANZCR acknowledges the principles of the Treaty of Waitangi, and the bicultural foundations of Aotearoa New Zealand. Over recent years, the College as an organisation has been reflecting on what it can do to make a positive impact on health outcomes for Indigenous people in Australia and New Zealand. We recognise that we have a significant and important journey ahead. Making a positive impact starts with gaining knowledge and having respect for Aboriginal, Torres Strait Islander and Māori peoples and their cultures. That is the foundation of meaningful engagement with Indigenous communities: to help us to grow the Indigenous clinical radiology and radiation oncology workforce; better support Indigenous doctors; and foster culturally safe and competent practice among our membership. Delivering change requires effective governance with expert Indigenous voices at its core and to work in partnership with Indigenous communities and leaders in New

Zealand and Australia. This must be complemented by effective advocacy and policy leadership to improve Indigenous health outcomes and realise more equitable access to care. We are pleased to announce that the College’s Māori, Aboriginal and Torres Strait Islander Executive Committee (MATEC) is now operational and had its inaugural meeting in October. This Committee reports directly to the Board of Directors and will be the driver of Indigenous initiatives and support change in close collaboration with the two Faculties. The College understands there are differences in the current circumstances and histories of Australia and New Zealand. A bi-national committee with equal Māori and Aboriginal and/or Torres Strait Islander membership, as well as Board and Faculty Council representation, will provide strategic advice to senior decision-makers in the College. MATEC will also facilitate the College’s work to support more equitable health outcomes as well as enabling the College to comply with the AMC standards related to Indigenous health, community engagement and workforce. MATEC’s initial focus for the first half of 2021 will be on developing an Indigenous Action Plan based on its terms of reference and compliance with the AMC and MCNZ’s

requirements. The Indigenous Action Plan will ensure the College puts in place achievable, meaningful and measurable goals that lead to improvements over time. The action plan will focus the College’s efforts and as well as providing guidance on projects from the Faculties. The action plan will be structured around four pillars which will guide the College’s work on Indigenous health initiatives and activities: Education • Trainees (via the curriculum) • Consultants (via CPD) Networking/relationship-building/ collaboration Selection of trainees entorship of our Indigenous M trainees and fellows. If you are Māori or Pasifika or identify as Aboriginal and/or Torres Strait Islander, we are keen to listen to your experience/s and invite you to talk to the College about what extra support is available. We also invite all our members to raise any ideas or insights into how the College can make a more positive impact in this area. If you have any ideas, suggestions, feedback or potential initiatives we can consider which you think would provide better support to our Indigenous trainees, members and/or consumers please get in touch. To do so, or to ask any questions about this work, please contact Madeleine d’Avigdor at madeleine.davigdor@ranzcr.edu.au.

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MEETING 2021 27 - 28 MARCH BRISBANE CONVENTION & EXHIBITION CENTRE

The ARGANZ Executive are delighted to announce that they are planning for a hybrid meeting with on-site attendance at the Brisbane Convention Centre, and the opportunity to attend the meeting virtually. In addition, there will be a satellite hub in New Zealand. The ARGANZ program will include presentations by Australian and New Zealand speakers in live and pre-recorded format. There will also be virtual presentations during the program from our impressive international faculty of imaging experts, with live Q&A.

INTERNATIONAL INVITED SPEAKERS PROF SEONG HO PARK University of Ulsan College of Medicine, Asan Medical Center South Korea Rectal & MRE

DR JONATHAN RICHENBERG Brighton and Sussex University Hospitals NHS Trust United Kingdom Prostate and Scrotal

PROF CLAUDE SIRLIN

Pre Meeting Virtual Workshops Saturday 13 and Saturday 20 March Limited attendee numbers, with live Q&A Topics: MRI Rectum; MRI Prostate; MRI Crohn’s Imaging; MRI GU Tract

Scientific Posters

All radiologists are invited to submit a paper poster relating to abdominal imaging. Share your research or present a review topic.

Mendelson Research Prize

UC San Diego Health USA

All RANZCR radiology registrars and fellows in training are invited to submit an abstract for the Mendelson Research Prize 2021. Oral presentations will fulfill the requirement for sign off of the RANZCR Project 2.

LI-RADS

KEY DATES 24 January 2021:

Abstract Submissions Close

8 February 2021:

Notice of Submission Acceptance

15 February 2021:

Standard Registration Fee Applies

New Zealand Hub – Auckland Saturday 27 and Sunday 28 March

Connect with ARGANZ

Visit the website for further information.

www.arganz.org

Search for arganz radiology @arganz_online

Features

Medicare Compliance: Targeted Campaigns Explained The Australian Department of Health aims to protect Australia’s health payments system through the prevention, identification and treatment of incorrect claiming, inappropriate practice and fraud by healthcare practitioners and suppliers.

Medicare Provider Compliance Strategy

In recent times, the Department has expanded its focus to encompass a more educational approach to compliance activities. The compliance program has been structured to ensure that activities are: targeted to the identified practitioner behaviour; informed by understanding practitioner behaviour; and responsive to enable proactive rather than reactive compliance. The Department of Health has informed the College that a number of targeted letter campaigns will be conducted in the coming months and next year. The following questions and answers aim to provide RANZCR members with a better understanding of the process.

“The Department of Health has informed the College that a number of targeted letter campaigns will be conducted in the coming months and next year.”

What does a targeted letter campaign look like in clinical radiology or radiation oncology? The Department identifies a particular billing behavior that has raised concerns and analyses the billing data of all practitioners within a set period of time. In recent times, the Department has conducted a targeted campaign directed at co-claiming item 104—specialist consultation with a diagnostic imaging service. Another campaign looked at the frequency of claiming item 55850—diagnostic ultrasound + ultrasound guided procedure in comparison with item 55848—ultrasound guided procedure (without diagnostic ultrasound). For radiation oncology a campaign looked at practitioners who frequently claimed Radiation Oncology Treatment with IGRT item 15275 multiple times during a single course of treatment.

Who gets a letter? In each targeted campaign the Department will identify outliers in the indicated billing behavior, and these outliers will receive a letter. Outliers are generally identified due to higher billing volume or ratio of billing relative to peers. The number of outliers identified will vary and

there are no set percentages, however it is typically somewhere around the top two to ten per cent of providers, depending on the campaign.

What does the letter normally say? The letter will set out the billing behavior that is being reviewed, the period of review and provide context of the practitioner’s billing behavior in comparison with peers. The College encourages the Department to also set out what both appropriate and inappropriate billing of that item looks like. A billing schedule may accompany the letter, or advice will be provided on how to access an electronic schedule. The letter will ask the practitioner to do a self-review of whether items on the billing schedule were clinically relevant and met the Medicare Benefits Schedule item requirements. Practitioners will be provided instructions on what to do following the self-review. These include options such as making a Voluntary Acknowledgement of Incorrect Payments or providing an explanation of the billing circumstances. Unlike other compliance options such as audit, investigations or professional review, targeted campaigns are a voluntary activity. continued over... Volume 17 No 1 I December 2020

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To find out more about whether a career with Everlight Radiology is for you, visit everlightradiology.com/homehub

Features

What is a Voluntary Acknowledgement of Incorrect Payments? The Department recognises incorrect billing is often unintentional and has occurred due to a misunderstanding rather than any intentional wrongdoing. In conducting the self-audit, you may come to realise that your billing behaviour did not meeting the rules of the Medicare Benefits Schedule. In conducting the self-review, you may come to realise that your billing behaviour did not meet the requirements of the Medicare Benefits item/s descriptor. A Voluntary Acknowledgement of Incorrect Payments is a no-fault system that allows practitioners to repay the incorrectly billed amount to the government.

What if I don’t think my billing is wrong? Practitioners sometimes have an area of speciality or practice model that means they will provide a larger volume of a particular service and be identified as an outlier yet have an appropriate clinical justification for the billing. In such cases, it would be open to the practitioner not to respond or, alternatively, provide a clinical justification in writing to the Department.

What happens next? The Department will reanalyse the billing data around 12 months after the original targeted letter campaign. It will particularly focus on those who received a targeted letter and expect to see a change in billing behaviour.

No change would be expected if the billing is supported by a clinical justification. If sustained incorrect billing is identified, the Department may escalate its compliance activities.

Where do I go for help? Some practitioners are concerned when they receive a compliance letter. The College recommends that members speak with their employers, seek advice from their medical indemnity provider, the Australian Medical Association or independent legal advice before proceeding with Voluntary Acknowledgement of Incorrect Payments or providing a response (if any). The Department of Health has enhanced its advisory capacity and recommends that practitioners who are unsure of the Medicare rules in general or the rules for claiming any particular items contact: AskMBS@health.gov.au

“The College recommends that members speak with their employers, seek advice from their medical indemnity provider, the Australian Medical Association or independent legal advice before proceeding with Voluntary Acknowledgement of Incorrect Payments or providing a response (if any).”

What is the College doing? The College is supportive of identifying inappropriate billing and we are pleased to see the Department of Health taking an educational approach which prevents the need for escalation to more punitive compliance action. We recognise that the Medicare Benefits Schedule is complex and confusing, and work with the Department of Health to provide clinical context to Medicare billing patterns aiming to ensure that the practice of clinical radiology and radiation oncology is interpreted correctly.

If you have any queries for the College related to Medicare compliance, please contact Melissa Doyle, Acting Head of Policy and Advocacy, at melissa.doyle@ranzcr.edu.au

Volume 17 No 1 I December 2020

Advocacy

Supporters Get Active for Targeting Cancer The annual Targeting Cancer Fun Run is traditionally held as part of the College’s ASM, but unfortunately was not able to go ahead this year. Instead, the campaign moved the fun run online. Targeting Cancer encouraged members, stakeholders, supporters and their families and friends to get active in the name of Targeting Cancer in October and November. Participants were asked to post a video or photo on social media to enter. Many fantastic entries were received, including impressive yoga poses, Targeting Cancer outfits and even furry family members getting involved in the fun! With thanks to sponsor GenesisCare, two iPads were awarded to our winners. In Category 1 ‘Most creative photo or video entry’ the winner was Alison Brown who showed us an impressive yoga pose while wearing a hand-made Targeting Cancer shirt. The winner of Category 2 was Ronny Low who ran more than 333km during the competition period. Targeting Cancer Management Committee Chair, Dr Sid Baxi said, “This year has presented many challenges for everyone, but we were thrilled that we could continue raising awareness for radiation therapy and the Targeting Cancer campaign by moving the fun run online. “I would like to thank our members, supporters, ambassadors and the Targeting Cancer Reference Panel for their participation and efforts to continue sharing the campaign. We know that radiation therapy is a highly effective yet underutilised treatment option but by expanding our Targeting Cancer community and raising awareness we are changing that.”

Inside News

Advocacy

“This year has presented many challenges for everyone, but we were thrilled that we could continue raising awareness for radiation therapy and the Targeting Cancer campaign by moving the fun run online. I would like to thank our members, supporters, ambassadors and the Targeting Cancer Reference Panel for their participation and efforts to continue sharing the campaign. We know that radiation therapy is a highly effective yet underutilised treatment option but by expanding our Targeting Cancer community and raising awareness we are changing that.”

Dr Sid Baxi, Targeting Cancer Management Committee Chair

Online engagement with Targeting Cancer in 2020

More than 2,000 views and downloads

111,052 visits

OF THE COST OF RADIATION THERAPY IN AUSTRALIA FACTSHEET

TO THE WEBSITE

Top 5 MOST VISITED PAGES  Benefits and effectiveness of radiation therapy  Palliative care  About radiation oncology  Brachytherapy  Brachytherapy for prostate cancer

6,118

4,958

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ON FACEBOOK

ON TWITTER

Volume 17 No 1 I December 2020

ELYSIUM: DIAGNOSTICS AND THERAPEUTICS (NOW AND THE FUTURE) WITH AI

Official Presenting Partner of RANZCR2021

ranzcr2021.com

Education

A Look Back on the Training and Assessment Reform during 2020

2020 has been the year of navigating changes, disruptions, challenges and uncertainty, with many of us learning to adjust to the new ‘normal’ in every aspect of our lives. Despite all the setbacks, travel restrictions and social distancing measures, the Implementation Working Groups (IWGs) for both radiation oncology and clinical radiology have made solid progress on the Training and Assessment Reform (TAR) project, with many activities coming to fruition during this year. So, to celebrate the year that was, let’s take a trip down memory lane and look back on all the milestones that the TAR project has achieved over the course of 2020.

January–March 2020: new year, new plan In September 2019, the TAR project met its milestone of completing the draft training programs for both specialties and officially moved into the implementation phase. As a result, in early 2020 we started engaging with key stakeholders including trainees, Directors of Training (DoTs), clinical supervisors, and others involved in the delivery of training and teaching.

Radiation oncology • Auckland City Hospital: 24 February 2020 • Three sessions in NSW: o 19 February 2020 o 4 March 2020 o 9 March 2020.

Clinical radiology • Auckland City Hospital: 25 February 2020 • Christchurch Hospital: 17 March 2020. The roadshows were well-received, and feedback was overwhelmingly positive.

April 2020: hand sanitiser and toilet paper shortages—the pandemic takes over! Together with many aspects of clinical practice in general, our TAR engagement and communication plan was disrupted due to COVID-19 and the subsequent social distancing measures and travel restrictions. Our face-to-face roadshows could not continue as planned and consequently had to be cancelled.

As a result, an Online Resource Development Plan was developed that outlined the activities and resources that need to be facilitated to replace the face-to-face roadshows. In the meantime, development of the Training e-Portfolio System (e-Portfolio), which will replace the current Trainee Information Management System (TIMS), commenced. The new fitfor-purpose e-Portfolio System will support the delivery of the enhanced training programs; measure identified outcomes; and allow tracking of trainee progression.

May 2020: policy review plan developed A policy review project plan and timeline were developed to assist with updating training policies and documentation to ensure they are aligned with the enhanced training programs.

June 2020: the Training and Assessment Reform is deferred As a result of the COVID-19 pandemic, trainees and members alike were left with a sense of uncertainty around every aspect of training. continued over...

The College planned to run a series of roadshows during 2020 in Australia and New Zealand to promote the enhanced training programs and seek feedback from key stakeholders on the draft training programs. We ran a total of six roadshows between February and March 2020.

Roadshow conducted at Auckland City Hospital, New Zealand

Volume 17 No 1 I December 2020

Education

Many trainees expressed frustration and anxiety over the disruptions they had endured since the beginning of the COVID-19 crisis, and the College felt the need to dispel this sense of uncertainty as far as was practicable. Consequently, in an effort to minimise concern among trainees, in June 2020 the College announced that it had decided to postpone the introduction of the enhanced training programs for both clinical radiology and radiation oncology until 2022. A TAR deferment plan was developed and the timeline for all TAR-related activities was reviewed and updated to reflect the 2022 launch date.

July–August: training handbooks drafted The initial drafts of the training handbooks for radiation oncology and clinical radiology were developed by August 2020. The handbooks will serve as a comprehensive guide for trainees that will encompass every element of the enhanced programs from assessment tools and instructions to policies and guidelines. The draft handbooks are currently being reviewed by various College committees and working groups.

September 2020: stakeholder consultations To engage with both internal and external stakeholders and give our members an opportunity to provide input, we conducted a period of stakeholder consultation on the enhanced training program and learning outcomes for both specialties between June and September 2020. College staff collated the stakeholder feedback and the IWGs and other relevant committees reviewed the stakeholder consultation feedback and incorporated it where appropriate, to update and refine the training program and learning outcomes for both specialties.

October - November: developing online resources College staff and the IWGs worked on developing online educational resources to inform our stakeholders of the key changes to the programs and increase their knowledge of the underlying principles behind the enhanced training programs.

Inside News

December: testing of the Training e-Portfolio System Following months of hard work, a ‘testing environment’ has been developed for the e-Portfolio System. Key stakeholders will be invited to undertake testing of the system and provide feedback. At the conclusion of this process the system will be modified to be ready for piloting by mid-2021.

Looking forward, what’s next? Although we have made considerable progress on TAR in 2020, there is a lot more work to be done before we launch the enhanced training programs in 2022.

The idea is that the handbooks will be a one-stop resource for 'all things training program' and will form part of the final product to be released when the enhanced training programs are officially launched in 2022.

Transition to the enhanced training program As part of the enhanced training program all trainees will be transitioned to the new training e-Portfolio System when it is introduced in late 2021. Training time completed and progress achieved under the current program will be recognised under the enhanced program.

Communication and training activities

All trainees will receive a transcript of their progress, which will clearly outline:

The College plans to conduct more training activities in 2021. These include, but are not limited to:

• which requirements have been completed under the current training program • which training requirements need to be completed under the enhanced training program.

• online webinars addressing different components of the training program which will be led by ‘champions’ for each of the topics • information and upskilling sessions for DoTs and clinical supervisors • online Q&A and FAQ sessions to allow stakeholder engagement • e-Portfolio demonstration and training sessions.

IT infrastructure During 2021, work will continue on the training e-Portfolio System. It is anticipated that the system will be piloted at selected training sites by mid-2021. The system will be fine-tuned and finalised using the feedback from the piloting process and will be ready to go live by November 2021.

Updating of training policies and documents Over the next six to eight months, College staff will be reviewing and updating all the relevant training policies and documentation. The updated policies and documents will be released in time to support the delivery of the enhanced training programs.

Training handbooks Throughout 2021, work will continue on finalising the training handbooks for both specialties.

College staff are currently working with the IWGs to develop detailed transition plans to ensure that all trainees are transitioned over to the enhanced program as smoothly as possible. To expedite the transition, all trainees are asked to keep their relevant information and records under the current training program up-to-date in TIMS, including details of training status, rotation, training requirements, logbooks and work-based assessments. This will ensure that the transition plans and data being transferred to the e-Portfolio system are as accurate as possible for all trainees.

Stay informed and involved It is important that you read information and keep abreast of changes shared with you through College communication channels, including the College website, enewsletters, printed newsletters and direct correspondence. We would like to thank all members who have contributed their time and expertise to this important project. If you would like more information or have any questions regarding the project, please visit the TAR webpage on www.ranzcr.com/tar or contact Faeha Tashkeel, Project Officer, Training and Assessment Reform on faeha.tashkeel@ranzcr.edu.au

Education

RANZCR Workshops, Courses and Events 2020–2021 As you are aware, the COVID-19 pandemic has had a significant impact on public health, social wellbeing and the economy. There has been widespread cancellation of conferences and meetings in line with current government guidelines. The College’s COVID-19 Taskforce and the Board of Directors have been monitoring the situation closely to foresee and mitigate any risks to members, staff and general community. Unfortunately, this has meant we have had to postpone some of our upcoming events. This has been done bearing in mind that social distancing restrictions may continue well into the beginning of next year with strict restrictions on international travel as well as mass gatherings.

RANZCR Webinar Series The Conferences and Events team have run a series of successful educational webinars over the last few months. Topics included Artificial Intelligence, Imaging Emergencies of the Vascular System, Faculty Forums, Mental Health and Wellbeing, FROGG Radiation Oncology Trainee Sessions, Prostate Cancer, Silicosis and Cardiac Imaging. We have plenty more scheduled for 2021, topics and dates to be released very shortly. If you missed any of the live sessions, you can watch them on demand via the College webcast library: www.webcast.ranzcr.com/ Mediasite/Showcase/

SMART Workshop

ESTRO Radiobiology Course

The SMART Workshop will again be run in an online format and will be taking place on Monday 22 March to coincide with the TROG ASM from Tuesday 23 and Wednesday 24 March 2021.

Due to current international border restrictions we have unfortunately made the decision to cancel the April ESTRO Radiobiology Course. This course will be held again in 2022 and we are working on alternate ways of providing educational content for our trainees in 2021.

The Radiation Oncology Trainee SMART Workshop is a full-day workshop directly designed to enhance trainee knowledge and skills in: • statistical methods • critical appraisal of the medical literature • research methodology. The workshop will have interactive small group sessions, guided by radiation oncologists and biostatisticians, to discuss actively recruiting and publishing cancer clinical trials. The SMART Workshop is an opportunity for trainees to meet with local researchers within TROG, and international researchers. Trainees are strongly encouraged to stay on for the TROG ASM, an excellent opportunity to put skills learnt at the SMART Workshop into practice and develop networks with TROG researchers. There are two SMART workshops that run on alternate years: Study Design Concepts (workshop A) and Evidence Appraisal Skills (workshop B). Trainees are encouraged to attend both workshops. This year’s SMART Workshop theme is ‘Evidence Appraisal Skills’.

If you would like to suggest a webinar topic, please don’t hesitate to email events@ranzcr.edu.au

Trainees attending the SMART workshop for the first time are entitled to 10 SMART points.

RANZCR/ACR Education Center Courses

Trainees attending their second SMART workshop may claim a further five SMART points.

Due to current border closures we are unable to fly in our expert faculty from the US. We are working with ACR on alternative methods for 2021. We will communicate any updates as soon as we have them.

Trainees attending the TROG ASM following the workshop are entitled to an additional 2 SMART Points (i.e. either 12 points or seven points). For more information and to register please visit www.asm.trog.com.au/workshops/

Trainees still registered for this course will receive a full refund. If you have not heard from the RANZCR Events Team please email events@ranzcr.edu.au to organise your refund.

Radiation Oncology Trainee Phase I and II Courses The Phase I and II Courses are designed for trainees within their first six months of training and to assist trainees as they approach their Phase I and II examinations. Due to the current climate the College is working on the safest delivery method for these courses in 2021. Further information will be distributed in the new year.

NZ Branch Annual Scientific Meeting Postponed to 6–8 August 2021, held at the InterContinental Hotel, Wellington. For more information visit please our website: www.ranzcr2021.co.nz/

RANZCR Annual Scientific Meeting Postponed to 16–19 September 2021, held at the Melbourne Convention and Exhibition Centre. For more information on RANZCR2021 visit our website www.ranzcr2021.com

If you have any questions relating to any RANZCR events please don’t hesitate to contact the Conferences and Events team at events@ranzcr.edu.au

Volume 17 No 1 I December 2020

What’s in Issue 6? Medical Imaging Original Article: Long-term outcome following microwave ablation of early-stage non-small cell lung cance Corresponding author: Associate Professor Karin Steinke, Department of Medical Imaging, Royal Brisbane and Women’s Hospital, Butterfield St, Herston, Brisbane, Qld 4029, Australia. Introduction: This study aimed to evaluate the long-term outcome of microwave ablation (MWA) of early-stage non-small cell lung cancer (NSCLC), including response to treatment and survival. Methods: This retrospective study was conducted on consecutive patients who underwent computed tomography-guided MWA of earlystage NSCLC (no evidence of nodal or distant metastasis) from November 2010 to December 2014 at our institution. Data were collected from systematic review of patient charts and imaging. Procedural complications, response to treatment and survival were assessed. Results: 34 early-stage (T1a-T3N0M0) NSCLCs in 30 patients were treated with a total of 41 MWA sessions. There were no intraprocedural or 30-day post-procedural deaths. The most common complication was pneumothorax, encountered in 24 (59%) microwave ablation sessions, six (15%) of which required chest tube insertion. Over a median computed tomography follow-up period of 39 months (range 3–89), 24 (71%) NSCLCs demonstrated local control, while 10 (29%) demonstrated local progression. Nodal/distant progression was more common than local progression, with 15 of the 30 patients (50%) having nodal or distant metastases at follow-up. Patient survival status was followed up over a median period of 56.5 months (range 10–107). Median overall survival and 5-year overall survival were 56.5 months (95% confidence interval, 26-not reached) and 46.7% (95% confidence interval, 31.8–68.4), respectively. Conclusion: MWA is safe and effective at achieving local control of early-stage NSCLC and may prolong patient survival. Nodal or distant metastases were the dominant manifestations of disease progression at long-term follow-up. Medical Imaging Pictorial Essay: Acromioclavicular joint injuries: Imaging and management Corresponding author: Dr Sravanthi Mantripragada, Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore City 768828, Singapore. Acromioclavicular joint injuries are commonly encountered in the setting of shoulder trauma. Knowledge of the anatomy and biomechanics of the joint, grading of joint injuries, and understanding the capabilities and limitations of different radiological modalities will help in selecting the best management option and outcomes for affected patients. Radiation Oncology Original Article: Anatomical and dosimetric assessment of the prostate apex: A pilot comparison of image-guided transperineal ultrasound to conventional computed tomography simulation Corresponding author: Dr Mihir Shanker, Department of Radiation Oncology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia. Introduction: Inaccuracies in prostate apex contour delineation based on simulation computed tomography (CT) imaging can impact treatment outcomes and toxicity profiles for prostate cancer radiotherapy. Transperineal ultrasound (TPUS) is a non-invasive imaging modality that can improve delineation of prostate volumes. We performed a pilot analysis to assess for differences in anatomical position between conventional CT and a TPUS delineated prostate apex and determined whether these translated into a clinically significant difference in apical point dose. Methods: A 2D 5 MHz TPUS autoscan image guidance system was utilised during definitive intensity-modulated radiotherapy (IMRT) for prostate cancer. Distances were measured from a fixed reference point to prostate apex on both US and CT in the mid-sagittal plane. Differences between groups were assessed using the Wilcoxon sign rank test with a two-tailed significance of a = 0.05. Results: Fifty-nine consecutive patients were independently assessed. There was strong evidence of a difference between CT and TPUS delineated apex position (P = 0.0075). Median apex position was 3.6 mm caudal on TPUS vs. CT imaging (95% CI: 2.5–4.8 mm). There was strong evidence of a difference in point dose between CT and TPUS delineated apex (P = 0.0029). Median point dose at the TPUS contoured apex was 1.9 Gy lower than CT (95% CI: 0.7–3.1 Gy) corresponding to 98% of prescribed dose. Conclusions: This study demonstrates a difference in anatomical delineation of prostate apex position between CT imaging compared to TPUS, corresponding to a statistically significant difference in apex point dose. Further analysis will determine whether this translates to a clinically significant difference in outcomes. Radiation Oncology Guidelines: FROGG patterns of practice survey and consensus recommendations on radiation therapy for muscle invasive bladder cancer Corresponding author: Dr Michael Cardoso, Liverpool Cancer Therapy Centre, Liverpool Hospital, Corner of Elizabeth and Goulburn Streets, NSW 2170, Australia. No abstract available.

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!

Education

RANZCR2021

Melbourne will host RANZCR’s 71st Annual Scientific Meeting: Elysium Diagnostics and Therapeutics (Now and in Future) with Artificial Intelligence from 16–19 September 2021 at the Melbourne Convention and Exhibition Centre. With the current climate, the College for the first time will host the ASM as a hybrid annual scientific meeting, meaning you can be live and in-person or watch virtually and on demand. This is an exciting opportunity for the ASM to create a broader reach to an international audience and profile Australian and New Zealand members and their research. Participants will be able to access sessions in real time as well as on demand post the ASM.

"The world we find ourselves in for the last nine months has changed the way our ASM will be delivered. However, for those that can attend in person, we encourage you to join us in Melbourne to support the city, the local organising committee and, most importantly, to reconnect as a group of like-minded individuals to share our experiences."

The world we have found ourselves in for the last nine months has changed the way our ASM will be delivered. However, for those that can attend in person, we encourage you to join us in Melbourne to support the city, the local organising committee and, most importantly, to reconnect as a group of like-minded individuals to share our experiences. The Melbourne Convention and Exhibition Centre is a COVID-safe venue and the safety of our delegates is paramount. We will follow all guidelines in place by the government, with sanitising stations, temperature checks and social distancing in place. Virtual attendees will still have the opportunity to engage with speakers, delegates and exhibitors via the online platform. Registrations for the event will open in early 2021 via the ASM website www.ranzcr2021.com

Thank you to everyone who submitted an abstract for the 2020 meeting, we received a number of excellent submissions. Those who were accepted will be placed into the 2021 program with an oral or poster presentation. The organisers will be in contact with you to advise the outcome and the opportunity to update your abstract with more recent results if required. The 2021 ASM program will showcase a number of disciplines in clinical radiology and radiation oncology with the call for abstracts for 2021 launching in January.

continued over...

Volume 17 No 1 I December 2020

Education

RANZCR2021 will showcase emerging trends in radiology and radiation oncology AI software, hardware, regulatory, industry perspectives, impact on health care, expenditure, revenue and patient outcomes. A varied and engaging program of international and national speakers and an interactive program will highlight the opportunities in radiology and radiation oncology in the future. There will be a series of multidisciplinary sessions to discuss current clinical topics, an increased number of international experts and collaboration with affiliated organisations to deliver captivating sessions. We are fortunate to have support from our global radiology partners to send world renowned speakers to RANZCR2021. The RSNA are supporting a Thoracic AI speaker (TBD). The American Society of Neuroradiology (ASNR) are supporting the legendary Anne Osborn and Ramon Gil Gonzalez. The European Society of Neuroradiology (ESNR) are supporting renowned Majda Thurnher, Johan Van Goethem and Turgut Tali to speak at our meeting. There will also be speakers in other specialist areas including the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) and expert AI speakers. An innovative radiation oncology program with a range of national and international speakers is planned. International speakers will cover a range of sites including: Fiona McDonald (Royal Marsden, lung and stereotactic radiotherapy and adaptive radiotherapy); Desiree van den Bongard (Amsterdam UMC, breast and oligometastic disease); Andrew Loblaw (University of Toronto, prostate and GU cancers); and Clifton David Fuller (MD Anderson, head-and-neck and functional

Inside News

imaging). In 2021, it is expected that there will be an ASTRO speaker who is generally the immediate past ASTRO president, an ESTRO leadership representative will also be in attendance.

What’s new in 2021? We are happy to welcome our first ever ASM presenting partner, Intelerad. A note from Intelerad: RANZCR and Intelerad have a firm partnership that will emerge from the COVID-19 crisis stronger than ever. With the postponement of the Annual Scientific Meeting this year, Intelerad will proudly serve as a presenting partner of RANZCR2021. Our roots run deep in Australia and New Zealand. We’re energised and excited to be presenting partners of RANZCR2021. Through this partnership, we are reconfirming our ongoing commitment to the medical imaging and radiology community of Oceania. AI Kaggle Challenge: the College launched its inaugural artificial intelligence (AI) Kaggle challenge in December this year, the Catheter and Line Position (CLiP) challenge. The competition will be open to researchers and ‘Kagglers’ worldwide challenging them to develop algorithms which can detect the presence and position of catheters demonstrated on chest radiographs. The CLiP dataset comprises over 40,000 manually labelled and segmented chest radiographs from the publicly available National Institute of Health (NIH). These chest radiographs were curated by Dr Jennifer Tang, Dr Jarrel Seah, Mr Adil Zia and Professor Meng Law, with more than 40 volunteer radiology consultants, registrars and residents working hard to develop and label this dataset. The prize money will be a share of USD $50,000.

We believe developing an AI model to detect placement of chest x-ray lines and catheters is relevant in the ongoing global pandemic. The Challenge is open now, visit the website to get started. www.kaggle.com/c/ranzcr-clip-catheterline-classification Winners will be invited to present at the ASM in Melbourne in 2021. For the first time RANZCR2021 will feature the RANZCR Little Rascals Kids Club. On site creche facilities for your little ones. The space will include full or half day facilities so you can enjoy the full experience of the ASM. We look forward to hopefully all catching up face-to-face in Melbourne in 2021. Prof Meng Law Radiology Convenor A/Prof Farshad Foroudi Radiation Oncology Convenor

Sponsorship opportunities: for the opportunity to sponsor the RANZCR Little Rascals Kids Club or Lunch and Learn Sessions plus many more opportunities, get in touch with the team at Encanta to tailor your package today at ranzcr@encanta.com.au

Clinical Radiology

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 has experienced a drop in visitors in 2020 reflecting interruptions to health care due to the current pandemic. When comparing year-on-year figures, we are seeing 39 per cent lower traffic from the USA who normally account for 50 per cent of the site’s traffic, while Australian traffic is only down eight per cent, which is driven by lower Victorian and Queensland traffic, with NSW seeing a slight increase of one per cent. Month-to-month since August we are seeing an increase in Australian and New Zealand traffic. In September, traffic from Victoria increased monthon-month by 7.25 per cent as COVID-19 restrictions began the start of a very gradual easing.

What are our visitors reading? Key pages that delivered increases in traffic were Transvaginal Ultrasound (+six per cent), VQ Scan (+eight per cent) and Nephrostomy (+fifteen per cent), while the leading page, Gadolinium Contrast Medium was down slightly by two per cent. Health Practitioner pages saw a monthon-month increase of 18 per cent and year-on-year 11 per cent as the site continues to be viewed as more of an authority for this audience.

Promote InsideRadiology to Patients and Colleagues



August to September month-on-month data show an 30 per cent increase in traffic to the www.insideradiology.com. au/interventional-radiology/ page, which was driven by a doubling in traffic generated by the search term "interventional radiology", currently ranking first on the site. We also saw online demand for search terms revolving around this term increase.

Top 10 Consumer Information Pages: 1. Gadolinium Contrast Medium 2. Transvaginal Ultrasound 3. Interventional Radiology 4. VQ scan 5. Iodine Containing Contrast Medium 6. Varicose Vein Ablation 7. Nephrostomy 8. Bursal Injection 9. SIS 10. Coronary Artery Calcium Scoring

Top 10 Health Professional Information Pages:

Top Local Referring Sites • Spectrum Radiology • Alfred Imaging • Auckland Radiology Group • Healthdirect Australia • Pregnancy Birth and Baby (by Healthdirect) • Imaging Pathways WA • New Zealand Ministry of Health • Monash Health • Bendigo Health

➜ If you would like to propose a new test or procedure for the InsideRadiology website, please contact the InsideRadiology team. ➜ Don’t forget to follow us on Twitter and Facebook (@InsideRadiology) and refer your patients to the consumer information on the InsideRadiology website. This helps us promote the resource to consumers. Further information about

1. Computed Tomography 2. MRI 3. Angiography 4. Gadolinium Contrast Medium 5. Bone Mineral Density Scan 6. Nuclear Medicine Bone Scan 7. MIBG Scan 8. Transvaginal Ultrasound 9. Plain Radiography 10. PET Scan

Promoting InsideRadiology in your professional networks.

any  Recommending topics that could be

considered for inclusion.



InsideRadiology can be found at www.insideradiology.com. au/aboutradiology/aboutinsideradiology/ If you need further information please contact Jessica Brown, Project Officer, on: insideradiology@ranzcr.com

Supplementing your hospital or practice resources using links to InsideRadiology.

 Volunteering to assist with content.

Share the InsideRadiology Video.

Volume 17 No 1 I December 2020

Awards and Honours

2020 RESEARCH GRANT AND AWARD RECIPIENTS

Congratulations to the recipients of the 2020 research grants and awards.

Clinical Radiology Early Career Researchers Prize Dr Julian Maingard

NEW – Faculty of Radiation Oncology Quality Research Prize Dr Farshad Kasraei

“Rescue Intracranial Stenting After Failed Mechanical Thrombectomy for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis” – World Neurosurgery

“Evaluation of the introduction of a 'traffic light protocol' for dose - volume histogram constraints of organs at risk in definitive radiotherapy at Liverpool and Macarthur Cancer Therapy Centres” – JMIRO

Faculty of Radiation Oncology Bourne and Langlands Prize Dr Teng Hwee Tan “Induction chemotherapy for locally advanced nasopharyngeal carcinoma treated with concurrent chemoradiation: A systematic review and meta-analysis” – Radiotherapy and Oncology

RANZCR Research Grants RANZCR research grants provide financial support for Fellows, Educational Affiliates and student members in clinical radiology and radiation oncology to conduct research. Grants are awarded for sums between AU$5,000 and AU$30,000. Closing date 2021 Applications for the 2021 RANZCR Research Grants close on 15 June 2021. Withers and Peters Grant This AU$25,000 grant supports Fellows up to five years post-Fellowship and trainees post-Phase II exams to carry out significant research projects.

Inside News

NEW – Faculty of Radiation Oncology Indigenous Health Prize Dr Scott Carruthers “Measuring (and narrowing) the gap: the experience with attendance of Indigenous cancer patients for Radiation Therapy in the Northern Territory” – JMIRO

Withers and Peters Grant Dr Vicky Chin “Developing a predictive model for cardiac morbidity and mortality in patients undergoing radiotherapy for breast and lung cancers” The recipients of the 2020 RANZCR Research Grants will be announced in March 2021. If you would like to apply for a research award or grant, the College is now inviting applications for 2021. A variety of opportunities are available to support research projects and foster a culture of research at the College.

Clinical Radiology Early Career Researchers Prize

Faculty of Radiation Oncology Quality Research Prize

This AU$1,500 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.

This AU$2,000 is awarded in the case of high-quality research in Quality Improvement in radiation oncology being published in a peer-reviewed journal.

Faculty of Radiation Oncology Bourne and Langlands Prize

Applications for the above prizes close on 12 April 2021.

This AU$1,500 prize is awarded to a trainee who has written an exceptional trainee research requirement manuscript. Faculty of Radiation Oncology Indigenous Health Prize This AU$2,000 prize is awarded in the case of high-quality research in Indigenous health being published in a peer-reviewed journal.

For more information, or to apply, visit www.ranzcr.com/college/ awards-and-prizes/researchawards-and-grants or email gaps@ranzcr.edu.au

Awards and Honours

2020 COLLEGE HONOUR RECIPIENTS College Honours celebrate the important contribution clinical radiologists and radiation oncologists make to the health of patients across Australia, New Zealand and Singapore. It gives the College great pleasure to announce the recipients of the 2020 College Honours.

Gold Medal Professor John Slavotinek The Gold Medal 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. Prof Slavotinek was awarded the Gold Medal for his prolonged and exceptional contribution to the College over decades, having held numerous College office bearer and committee member positions including Dean of the Faculty of Clinical Radiology, Chief Censor, Chair of the Clinical Radiology Research Committee and Chair of the Quality and Safety Committee. He was also the Chairman of the South Australian branch of the College for 12 years. During Prof Slavotinek’s time as Dean and Chief Censor he was instrumental in driving the College’s standards of clinical radiology practice and the Fellowship training and examination process. He also sat on the inaugural College Board, playing a key role in driving the direction of clinical radiology in Australia and New Zealand. Alongside his contribution to the College, Prof Slavotinek is passionate about research and his interests include musculoskeletal imaging and MRI. He has attracted significant grant funding in addition to writing more than 90 publications. Prof Slavotinek was described by his nominators as “the original quiet achiever, managing to get things done and lead through hard work and persuasion while treating all with respect and honesty. The word

‘tireless’ tends to be overused when referring to a lifetime of work in aid of an organisation but it actually means something when referring to John.” 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. Professor Margot Lehman has given outstanding and valuable service to the College and registrar training over an 18-year period. Prof Lehman became Chief Censor in 2016 and played a pivotal role in the review of the current and previous training programs, and the design of the new enhanced training program. In addition to her educational roles, Prof Lehman has held a number of executive roles with two of the College’s special interest groups: FROGG and FROLIC. Prof Lehman is also an active and wellrespected clinical researcher, particularly in the area of lung cancer. She has published more than 70 peer-reviewed articles, book chapters and published abstracts, and has been invited to contribute to the Cancer Australia Clinical Practice Guidelines for the treatment of lung cancer. Nominators described Prof Lehman as “displaying exceptional leadership skills through a quiet confidence and an inimitable collaborative approach… She has the uncanny knack to be able to see and identify new and emerging talent within the Faculty and has always been a pillar of support and encouragement for new Fellows.”

Professor Michael Poulsen has held a number of College committee roles, including serving on the Faculty of Radiation Oncology Council for eight years and the Economics and Workforce Committee for four years. Prof Poulsen was also an examiner in radiation oncology for 10 years. He continues to work on the MBS review and co-chairs the Mentoring Group. Prof Poulsen has an interest in workplace culture, which has led to a major focus on work engagement and burnout in cancer workers. He has received two research grants in this area, resulting in five published works and multiple presentations. Prof Poulsen has also been instrumental in ensuring patients in regional Australia have access to radiation therapy, setting up services in regional Queensland so that patients did not have to travel to Brisbane for treatment. Prof Poulsen has been nicknamed “Merkel Poulsen” by many of his colleagues due to his enthusiastic interest in Merkel cell carcinoma. His contributions to head-and-neck cancer and skin cancer have been recognised nationally and internationally. Clinical Radiology Educational Service Award Dr George Foote This award recognises members who have demonstrated outstanding long-term commitment, participation and leadership in training and education in clinical radiology. Dr George Foote led the Auckland Regional Training Scheme and was integral to its development into the first continued over... Volume 17 No 1 I December 2020

Awards and Honours

College Honours celebrate the important contribution clinical radiologists and radiation oncologists make to the health of patients across Australia, New Zealand and Singapore.

networked training scheme in Australia and New Zealand—the model for current radiology training. Dr Foote’s training sessions, using his personal film collection, were described by his nominators as “a rite of passage for Auckland first-year radiology trainees… This somewhat legendary teaching has taken place without fail for around 40 years. There is an entire generation of radiologists (including at least one father/son pair!) taught by George, who have gone on to practise all over NZ, Australia and the rest of the world.” Denise Lonergan Educational Service Award Dr Claire Hardie This award recognises members who have demonstrated outstanding long-term commitment, participation and leadership in training and education in radiation oncology. Dr Claire Hardie has played a pivotal role in the education of RANZCR trainees in her roles as Clinical Supervisor, Director of Training, Training Network Director and Phase I assessments and examination co-lead. Dr Hardie has been responsible for the development of Phase I teaching materials and has significantly influenced the teaching and assessment of Phase I trainees in Australia, New Zealand and Singapore. Nominators stated that Dr Hardie “[inspires] confidence within her trainee group with her open and honest interactions, her commitment and her positive attitude [she] has become a luminary in the Phase I arena not only amongst the trainees, but also among the Clinical Supervisors and Directors of Training.”

Inside News

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. Dr Cheryl Bass has made an exceptional contribution to clinical radiology, especially in the fields of ultrasound, quality improvement and standards, and musculoskeletal imaging, in her capacity as a professional, teacher, volunteer, mentor and advocate. Over her 40-year career, Dr Bass has been actively involved in many facets of the profession and is best known for her 22 years as a senior partner at Victoria House Medical Imaging, where she has been integral to the development of a world class MSK imaging practice. Dr Bass is most proud of being the first person in the world to describe TFL tendinopathy. Dr Fiona Bettenay has worked tirelessly for the betterment of radiology in Western Australia for 40 years. Dr Bettenay has contributed to improving the standard of paediatric radiology in Western Australia and has also given many hundreds of hours of after-hours tutorials and mentored scores of exam candidates. She has not only contributed to public radiology service, and outstanding teaching, Dr Bettenay has been a national leader in representing radiology in the field of Medical Defence, developing Medical Defence Australia, a not-for-profit Medical Defence provider covering hundreds of Australian radiologists.

Dr John Pike transformed the practice of neurology, neurosurgery and otolaryngology at the Alfred Hospital through not only introducing crosssectional imaging, but also CR-guidance of interventional procedures that had never before been performed percutaneously at the hospital. Dr Pike held weekly CT tutorials for radiology trainees and radiologists at the Alfred Hospital that were attended by trainees across Melbourne. His nominators described his thorough knowledge of anatomy and speed at recognising an abnormality as “legendary.” A/Prof Andrew Whyte had an early career in dentistry and maxillofacial surgery before becoming a Head and Neck and Dentomaxillofacial radiologist, working and teaching in three states, in academic public hospitals and in the private sector. A/Prof Whyte holds academic appointments at the Universities of Melbourne and Western Australia and continues to teach radiology registrars in Victoria. He has lectured at more than 100 national international conferences and as the head-and-neck representative for ANZSNR, he has helped to organise and given multiple lectures at annual general meetings.

Awards and Honours

EDUCATIONAL FELLOWSHIPS

Congratulations to the recipients of the following Educational Fellowships. If you would like to nominate someone in one of the above categories in 2021, or for Honorary Fellowship or the Sally Crossing Award for Consumer Advocacy, nominations are now open. 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. 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. To find out more, or to nominate someone you know, visit www.ranzcr.com/college/grantsand-awards/college-honours or email gaps@ranzcr.edu.au

Thomas Baker Fellowship Dr Michael Chan Dr Chan received the Thomas Baker Fellowship to undertake a Cardiothoracic Imaging Fellowship at Toronto General Hospital, with the University of Toronto. Rouse Travelling Fellowship Dr Helen Moore

Windeyer Fellowship Dr Shreya Armstrong

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. 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. In 2021, two Fellowships will be available. Rouse Travelling Fellowship

The Bill Hare Fellowship was not awarded in 2020. The College offers a variety of Fellowships each year, to support members in their continuing education and to further their knowledge and expertise. If you would like to apply for any of these opportunities, visit www.ranzcr.com/college/ grants-and-awards/educationalfellowships or email gaps@ranzcr. edu.au

In 2021, this Fellowship is available for a clinical radiology Fellow from Australia to attend the 2022 Annual Scientific Meeting in Adelaide and to visit and present in their field of interest in three training centres in New Zealand. This is supported with a grant of AU$8,000. Windeyer Fellowship This is a 12-month position for Fellows up to two years post-Fellowship or trainees post-Phase II 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. There may also be an opportunity for the Windeyer Fellow to spend time at other UK centres including the Christie Hospital, Manchester, and University College London Hospitals (UCLH), where experience in subspecialty interests such as proton therapy, MR linac treatment and paediatric oncology can be provided.

Volume 17 No 1 I December 2020

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Clinical Radiology

Radiographer Role Extension: A Patient Safety Risk A Message from the Dean Clin A/Prof Sanjay Jeganathan One of the key roles of the College is to ensure that appropriate standards are in place to support safe and high-quality services for patients. In this context, the FCR Council has been concerned for some time about the patient safety risk of allied health professionals such as radiographers, who have not undergone medical and specialist training, seeking to practise beyond their scope of training. This is a serious and important issue which Council has prioritised. Tasks such as assessing the appropriateness of referrals, interpreting images and communicating findings requires medical and specialist training and can only be done by a clinical radiologist. In particular, communicating findings, however named, in whatever format or setting, to a referrer or other members of the healthcare team is the equivalent of reporting and can only be provided by a clinical radiologist. Our position is that a radiographer must always first communicate to a radiologist. Only in an emergency situation, when the radiologist is not available either onsite or remotely should a radiographer communicate findings directly to a referrer. The College recognises the vital role of radiographers as highly skilled members of the medical imaging team whose technical expertise enables them to play an essential role in image acquisition, quality assurance and patient management. Radiographers are valued members of the radiology team however, they are not trained as medical practitioners and do not study in-depth the nature, management and prognosis of disease.

We do not oppose role extension in principle but believe it must benefit patient care and service delivery.

Professional capabilities for competencies for medical radiation practitioners

There are far more suitable areas for radiographers to upskill such as procedural work or health informatics. In addition, radiologists regularly delegate certain tasks, but only where the radiographer has demonstrated the relevant skills and competencies and patient care is improved.

The Medical Radiation Practice Board (MRPB) is the national body which oversees the registrations and standards for medical radiation practitioners (radiographers). The MRPB is administered by AHPRA but actually reports to the Ministerial Council of COAG.

The College has developed a position statement on role extension titled Imaging Interpretation by Radiographers—Not the Right Solution which sets our position for advocacy on this issue.

The MRPB recently revised its document Professional Capabilities for Medical Radiation Practice (Professional Capabilities) and has described it as a guideline which sets the threshold level of professional capability needed for both initial and continuing registration for radiographers.

"Tasks such as assessing the appropriateness of referrals, interpreting images and communicating findings requires medical and specialist training and can only be done by a clinical radiologist. In particular, communicating findings, however named, in whatever format or setting, to a referrer or other members of the healthcare team is the equivalent of reporting and can only be provided by a clinical radiologist." continued over...

Volume 17 No 1 I December 2020

Clinical Radiology

We have several concerns with this document. • We believe the Professional Capabilities document extends the scope of practice of a radiographer into the domain of a medical specialist, by including tasks such as assessing referrals, interpreting imaging and communicating finding to referrers. The document outlines that the radiographer can directly communicate image findings to referrers, circumventing the supervising radiologist. This is a serious patient safety risk if a referrer makes treatment decisions based on information that is incomplete, incorrect or lacking clinical context. It also creates a serious medico-legal risk. • Secondly, we do not believe there has been appropriate levels of governance oversight of the MRPB. The MRPB is made up of radiographers, who have independently made all the decisions about the content of the Professional Capabilities document. This inherently creates a bias. The College and other stakeholders actively participated in the consultation process, providing written feedback and meeting with the MRPB, however all of our feedback and recommended amendments were effectively ignored. • We are further concerned that the MRPB and AHPRA call the Professional Capabilities document a guideline. As it sets out a minimum standard that all new and currently practising radiographers must meet, it should be correctly termed a registration standard. Under the National Law the MRPB can develop guidelines without Ministerial Council approval however publishing standards requires Ministerial Council approval. We contend that by misnaming the document the MRPB and AHPRA have sidestepped their legal responsibilities.

Inside News

What is the College doing? We continue to strongly advocate on this issue with the aim of having the Professional Capabilities document revised to appropriately reflect the scope of practice of a radiographer. We are collaborating with other stakeholders such as the Australian Medical Association and other medical colleges and will escalate our concern to both federal and state and territory governments. We wish to ensure that the role of the clinical radiologist and value we bring to patient care is recognised.

"We seek support from all our members to communicate with your colleagues both within the medical imaging team and more broadly with referrers and clinical administrators to inform them of the position of the College on this issue." Local issues The risk posed by the Professional Capabilities recently manifested in a hospital publishing a red dot protocol which stated that ‘it is the responsibility of each medical radiation practitioner to inform the appropriate medical staff of any acute abnormality or suspected abnormality detected on X-ray.’ This protocol ignores the existence of clinical radiologists. The College acted quickly to contact the hospital and health service requesting the protocol be withdrawn, which has occurred.

We seek support from all our members to communicate with your colleagues both within the medical imaging team and more broadly with referrers and clinical administrators to inform them of the position of the College on this issue. If you have experienced any radiographer role extension issues or if there are protocols being introduced to your workplace which you think inappropriate, please let us know.

Christmas message I wish to take this opportunity to express my gratitude to College staff for their resilience during this year of a oncein-one-hundred-year pandemic. Our College staff seamlessly transitioned to working from home since April this year. This has presented its own challenges of encroaching into their private time, but they carried on with great enthusiasm. I would like to thank Mark Nevin our CEO, Melissa Doyle (Executive Officer), Shellye Hanson (Head of Standards), Pam Spoors (Head of Specialty Training and all staff under their leadership. For members this has been an extremely difficult year. We take life, health and income protection insurances to protect our loved ones when tragedy strikes, but no one ever imagined that livelihoods and lives would be disrupted in this way by a virus. But we should be thankful, we had a roof above our head, with all the essential services intact, including Netflix! We will come through this experience ever stronger. I hope you all will rest well and get ready for a productive 2021.

Clinical Radiology

Looking Forward to 2021 Chief Censor’s Report Clinical Radiology

Dr Meredith Thomas

As with other professional and teaching institutions, medical specialty colleges have had a tumultuous year in 2020 focusing very much on how to continue ‘usual business’ in new and unusual ways. In the Specialty Training Unit (STU) of the College our usual business revolves around the delivery of teaching, assessments and examinations, teaching site accreditation and international medical graduate assessments. All have been affected, and the Fellows and College secretariat have worked together to ensure that training needs are met, albeit in unfamiliar ways. As we move toward 2021, it is clear that the COVID-19 pandemic and its consequences will be with us for the foreseeable future, and that we need to embed the agility we have demonstrated in our thinking and doing in 2020 into our governance structures and our practices going forward. This will enable us to address future challenges in a timely way. Undoubtedly 2021 will bring new challenges, but in considering solutions, we have the opportunity to integrate innovations into current practice. Our focus in 2021 will be guided by three interrelated priorities: • our response to the recent Australian Medical Council (AMC) accreditation • implementation of our Training and Assessment Reforms (TAR) • our response to the COVID-19 pandemic. The College participated in a full AMC accreditation assessment in late

2019, and the accreditation report will be made public in late 2020. Reassuringly, much of the work that STU and other areas of the College have been undertaking in recent years and will undertake as part of the TAR implementation, and our recent responses to COVID-19, are in line with AMC accreditation standards. This will ensure that we continue to meet these standards in the future. This work includes: • Development of consistent and sustainable training across jurisdictions, with expansion of central learning resources and a focus on emerging changes in practice • Training and assessment reforms to ensure blueprinting between learning outcomes/curriculum, work-based assessments and examinations, and provision of appropriate and timely feedback • Examination reforms to ensure exams reflect current practice, with use of standardised and digital images • A focus on trainee wellbeing, with enhanced support systems and mechanisms for timely and confidential trainee feedback • Support and education for training supervisors • Revision of various College policies, including, but not limited to the Recognition of Prior Learning Policy, the Conflict of Interest Policy, the Reconsideration Review and Appeal of Decisions Policy, and the Consideration of Special Circumstances Policy

"It is very likely that COVID-19 will continue to disrupt, not only our local delivery of training, but also our International Medical Graduates (IMGs) and their capacity to travel, and our capacity to participate in overseas education and training opportunities. We will continue to address challenges as they arise, and we will continue to stretch our imaginations in the solutions we consider."

continued over...

Volume 17 No 1 I December 2020

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Clinical Radiology

• Revision of our own accreditation standards for clinical radiology training sites and training networks, and formalisation of processes around in-cycle and out-of-cycle reviews • Creation of the Māori, Aboriginal and Torres Strait Islander Executive Committee (MATEC), with focuses including the selection and mentoring of Indigenous trainees, curriculum and education to ensure competence in cultural safety and the alignment of graduate outcomes with indigenous health needs • Creation of the cross-faculty Trainee Selection Working Group to review current jurisdictional trainee selection processes and consider models of trainee selection to ensure that we continue to meet AMC accreditation standards in this area in the future. There is a very comprehensive TAR update on page 21, and I would encourage all who are involved with training to familiarise yourselves with this. The COVID-19 pandemic disrupted our plans this year and created significant stress and anxiety among trainees and trainers about their capacity to implement change while dealing with COVID-19 related challenges. I think what we have realised this year is that we perhaps have greater flexibility and tolerance for innovation and change than we previously thought. Many of the challenges we addressed, particularly around delivery of examinations, forced us to accelerate planned TAR solutions, and consider new ones.

We have rapidly progressed implementation of a new examination platform and this will enable us to deliver our Part II Film Reading examination across multiple jurisdictions. We brainstormed solutions to enable us to deliver our viva examinations, in the process considering how we might transition from old practice to the planned TAR Objective Structured Clinical Examination in Radiology (OSCER), with a priority on more rapid implementation of standardised and electronic cases. We have worked closely with jurisdictions, developing regional support systems. We have been overwhelmed by the support offered at a local level to enable the local running of exams and facilitate trainee progression.

It is very likely that COVID-19 will continue to disrupt, not only our local delivery of training, but also our International Medical Graduates (IMGs) and their capacity to travel, and our capacity to participate in overseas education and training opportunities. We will continue to address challenges as they arise, and we will continue to stretch our imaginations in the solutions we consider. I wish every professional success and personal fulfillment to those trainees completing training. Like the 2020 Year 12 cohort, you will always be remembered for your resilience in overcoming the hurdles that COVID-19 threw at you. Congratulations and here’s hoping we can meet in person at the 2021 ASM.

With planned implementation of TAR in 2022, we will renew our focus on the change management required for trainees, fellows and training sites to ensure that it is a success. Work continues on: • The training handbook, including review of feedback received on the curriculum learning objectives and experiential training requirements • Formation of new examination panels to support the new examination structure • Trainee transition scenarios for all current trainees • Communications to and upskilling of trainers and trainees • IT infrastructure to support the delivery of the training program • Updating of training policies and documents.

Protect your health, access our wellbeing resources www.ranzcr.com/fellows/general/your-wellbeing

Volume 17 No 1 I December 2020

Clinical Radiology

Clinical Radiology Trainee Matters

the very best for the future. I hope to see you at a conference or committee meeting in the near future.

Finally, memes are great, and this was my favourite of the year. I’m sure you can all remember a situation like this in an MDM.

Survey of trainee views of integrated subspecialty training in clinical radiology

Dr Matthew Lukies Alfred Health

With examinations conducted around Australia and New Zealand recently, I hope you are all now resting, and I wish you the very best of luck with results. This year has been difficult for everyone in radiology and the broader medical community, but perhaps none more so than for trainees like yourselves who have had countless disruptions to work life, examination preparation and assessments. In November, there was a handover process to the new trainee committee for the upcoming year. I would like to take this opportunity to thank all the committee members this year for their hard work and advocacy for trainees. Dr Shoba Ratnagobal (WA) Dr Surain Rajadurai (VIC) Dr David Ong (NSW) Dr Sophie Thoo (SA) Dr Sarah Benson-Cooper (NZ) Dr Sarah Robertson (QLD) Dr Leonard Tiong (NSW) Dr Caitlin Farmer (VIC – ex officio) It has been an absolute pleasure to work with you all this year and I wish you

Inside News

Many thanks to all trainees who completed the survey exploring options about integrated subspecialty training in radiology moving forward. Overall, more than 10 per cent of all trainees completed the survey and the data will help shape discussions on the topic for years to come. In particular, thank you to those of you who provided comments and insights. These are highly valuable and provide further character beyond the data. As a summary, the overall results were as follows:

@matt_lukies

Clinical Radiology

Chief of Professional Practice Update

A/Prof Dinesh Varma 2020 has been quite a year, filled with challenges I expect few of us had encountered before. I am optimistic, whatever the new normal of 2021, as a College and a profession, we will maintain the strong position we have held this year. I know the PPC did not slow down in light of COVID-19, continuing to meet frequently online to make recommendations and develop work for the Faculty. I would like to take his opportunity to go over some of the achievements of the PPC this year.

Developed a range of practice document for clinical radiologists As the specialty of clinical radiology has grown, the need to outline the many skills of our profession became apparent. The RANZCR Clinical Radiology Range of Practice document is intended to outline the range of practice and/or types of procedures our Fellows of the Faculty are competent to undertake by way of their core specialty training, ongoing CPD and experience. The term ‘range of practice’ refers to the full range of diagnostic and procedural radiology practice, rather than an individual clinical radiologist’s scope of practice as determined by a local hospital or healthcare facility based on further skills acquired during the course of their clinical practice. The Range of Practice document has recently gone through the final stages of the College review processes and is now available for member consultation on the College website, under Consultations. I would implore all

members of the Faculty to review this document and provide their comments, as it will be a central piece within the profession. My great thanks are extended to the members within the Faculty, the PPC and College staff that worked tirelessly to have this draft completed, taking on feedback from various sources to ensure this document is representative of the great value and skills of clinical radiologists.

Revalidation and recertification The PPC has continued to work with the Medical Board of Australia (MBA) and the Medical Council of New Zealand (MCNZ) to set the College up for a smooth transition to the new revalidation and recertification programs in 2022. The recommendations from the MBA and MCNZ have enabled the PPC to begin making some key decisions, focusing mainly on the Continuing Professional Development (CPD) changes. The new program will ensure member’s CPD is aligned to the three pillars of Education Activities, Measuring Outcome and Performance Review. Some of the changes that will come with the new program include a move to a yearly cycle, away from the current triennium cycle. The program will move from a points-based system to an hours-based system, with a new yearly minimum of 50 hours across the three pillars.

The PPC will continue to act in the interest of the broader membership so that our members can get the most from their CPD participation and maintain currency of practice to provide the highest standard of care expected from our patients.

External consultations and stakeholder engagement Over the past 12–18 months, the College has been asked to provide responses to consultations from various external bodies on matters relating to public health. The PPC was well placed to provide responses, often with the expert advice of the relevant Special Interest Group (SIG). I would like to take this opportunity to thank the SIGs for their assistance with these consultations and ongoing support. The National Cancer Screening Enquiry and the Occupational Lung Dust Disease are two major consultations that the College has responded to, I am proud to see the involvement of the College in these matters, advocating for the best in patient care. Finally, I would like to wish everyone a happy holiday season. I hope you are able to take some time to relax and enjoy yourself after what has been a difficult year for many. www.ranzcr.com/our-work/consultations. Warm regards, Assoc Prof Dinesh Varma

Volume 17 No 1 I December 2020

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Radiation Oncology

My Story— Your Inspiration A Call for Regional Workforce Dr Madhavi Chilkuri As I hand over the reins of the Faculty to my very capable colleague, Dr Keen Hun Tai, I want to share my thoughts on the Faculty’s most pressing concern— sustainability of regional services, and access to safe and high-quality treatment for our regional patients. They make up a significant number of the Australian population and these people matter: we are all worse when they are worse. And the College, and its members can help make it better. I want to start by sharing my own personal and professional experience and how it has shaped my approach to regional practice. My life journey from a young age has been about embracing whatever opportunities and challenges came my way. After completing my specialty training at Tata Memorial Hospital in India in 1997, I came out full of ideals and ideas. I was sufficiently trained to practise independently including paediatric oncology and interstitial/ intracavitary brachytherapy, which had formed a significant part of my training. By the end of my training, I had married and moved to a suburb in Colombo, Sri Lanka, to work and settle there. It was the peak of the Tamil conflict. I had previously visited the over-crowded and under-resourced National Cancer Centre and saw it as my dream job. “An extra pair of hands will be helpful,” I thought. I took the Sri Lankan Medical Council examination during my first pregnancy, only to realise that there was no defined specialist pathway. I was then forced to make the difficult decision to leave my home.

Dean of the Faculty of Radiation Oncology, 1 January 2019 to 30 November 2020 With a husband in a maritime job and away at sea, I took my first job back in India in a small 10-bed, regional, not-forprofit, stand-alone cancer centre. I didn’t think managing a six-month-old on my own was impossible (if I was thinking at all). Having the accommodation just next to the hospital was attractive enough for me to accept my first job. I was one of two radiation oncologists but the only one on-site and the default on-call person. It was easy to obtain a nanny to help me with my infant son, but only during the day. Even though the region was known for its violent Maoist insurgency (the ‘Naxalites’) activity, I felt safe with my personal security in the form of a Doberman and a Great Dane. The hospital security guard often provided an additional layer of security by literally sitting by my son’s bed until I returned home from a late-night ward call. Radiation Oncology was all 2D with a stream of advanced head-and-neck, lung and cervical cancers. There was a lot of intracavitary brachytherapy too. Rural patients were well taken care of by an active social worker and on-site accommodation arrangements. Coordination of care with the local surgeons and GPs was challenging, however, efforts to build links with a tertiary centre brought some success. The most exciting part was collaborating with the local health department and health workers as we partnered to ensure access to surgical services in the region and conducted outreach cancer detections camps funded entirely by the health department. I was deeply duty driven towards my patients and

"How I got to the Caribbean is a long story, but Kingston was my next destination. Even though Kingston is the capital city, Jamaica itself is quite resource poor with a very vulnerable radiation oncology workforce. With only two Cobalt machines and two radiation oncologists for a population of 2.6 million, I was not surprised to see waiting lists of up to six months." even though it was a short stint, I learnt several life lessons that I was grateful for. As John Ruskin said, “The highest reward for a person’s toil is not what they get for it, but what they become by it.”

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Radiation Oncology

How I got to the Caribbean is a long story, but Kingston was my next destination. Even though Kingston is the capital city, Jamaica itself is quite resource poor with a very vulnerable radiation oncology workforce. With only two Cobalt machines and two radiation oncologists for a population of 2.6 million, I was not surprised to see waiting lists of up to six months. Managing waiting lists was my first lesson in Jamaica. Prostate cancer incidence was high, which meant we could prioritise other cancers such as gynecological and head-and-neck cancers. My mornings started with checking machine capacity and calls to patients. Several improvements happened very quickly. Image verification occurred at least once through treatment for four field box techniques, though on a diagnostic X-ray machine (there was no simulator or on-board imaging). It took only a few conversations with a dedicated surgical team before a head-and-neck MDT was set up at one end of the corridor of the ENT department. Appropriate planning ensured that almost all surgical patients requiring adjuvant radiation started their treatment within six weeks of surgery. Focus on other planning needs also ensured brachytherapy for gynecological cancers was completed within the optimal time from starting external beam radiation therapy. A project plan to be considered by the Ministry of Health for an additional Cobalt machine did not result in much success, mainly due to a strained economy. I was disheartened but this did not stop me from starting to contemplate how we prioritise healthcare resources when there are several competing health needs and how health sector reform can be led from within.

Inside News

Service planning, quality improvement and advocacy became companions to my usual clinical duties from then on. By the end of the first decade following my training, my ideals had not changed but my ideas had evolved. I had learnt that the quest to attain the ideal has to start by first doing the best with what we already have.

"These regional locations illustrate that there is no practical or policy reason why regional cancer centres around the country cannot have similar models of service delivery." My first regional experience in Australia was a two-month locum stint in Ballarat. The centre was accredited for training and functioned very well with a networked arrangement with The Austin (now called the Olivia Newton John Cancer Centre) and established links with the local health services. Subsequently, my time in Far North Queensland has shown me how developing local services, liaising with tertiary centres and coordination of care can influence quality of care. These regional locations illustrate that there is no practical or policy reason why regional cancer centres around the country cannot have similar models of service delivery.

Australia and New Zealand have sufficient resources and technological capabilities but there needs to be sensible allocation of funding with careful attention to service planning. In addition to the effective steps required by the Commonwealth, States and local health services, we have individual responsibilities as clinicians to respond to the needs of patients and communities for the delivery of outstanding regional cancer services. In New Zealand, there is a current radiation oncologist (RO) workforce shortage and ongoing advocacy is necessary to address this problem. In contrast, in Australia, we currently do not have a RO workforce shortage, but we do have maldistribution. Regional centres struggle to find dedicated staff. Some centres employ only a small number of locally based ROs and rely on visiting ROs, others rely solely on the latter. The risk associated with these arrangements include overworked local ROs with poor peer support, lack of adequate clinical and trainee oversight, and inadequate investment in service and quality improvement. This model can only work if there is very good planning around safety and quality of service. And yet neither of these arrangements may be currently necessary with a nominally sufficient work force. My call to all my colleagues is to commit to wholeheartedly support regional facilities. Those supporting a regional facility as a visiting RO, let’s ensure there is an agreed and documented arrangement with the locally based ROs for clinical cover and trainee oversight, while also being mindful of the capacity of the local staff. Those choosing to work beyond 1.0 FTE to cover a regional site, let’s be mindful of the impact it may have on us, our family, our peers, and our patients. For those

Radiation Oncology

I wish you all a very blessed Christmas and a safe 2021.

Dr Keen-Hun Tai commenced his term as the incoming Dean of the Faculty of Radiation Oncology on 1 December 2020.

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for upcoming Conjoint Committee approved in-person and online course dates.

TITU

As we leave 2020 (and the pandemic) behind, let this be a time for reflection. Our ideals and ideas are influenced by our experiences and our stories. To be where we are, we all have within us a core of morals, ethics, discipline, humanity, and tenacity. For me, coming from a Defence family, being an army cadet during all my teen years, and as a Christian, I naturally postured myself to three core values: service, sacrifice and discipline. Geographical and cultural boundaries have not existed for me.

This is my story and I am sure each one of you has yours. As I end my tenure, I would like to conclude with a challenge for you to consider. How can you harvest the richness of your potential and experiences and use them to positively impact patients, communities and colleagues in regional areas?

As Winston Churchill said, "We make a living by what we get. We make a life by what we give." Every doctor has a leader in them with the power to greatly influence the system they exist within and bring meaningful change to patient outcomes. We must never be slaves to inaction, lest we fail in our leadership duties and human responsibility.

ASC

"My call to all my colleagues is to commit to wholeheartedly support regional facilities."

From my mother came courage of conviction; from my father, hard work. Needless to say, I have had several role models and many mentors along the way.

centres that recruit but struggle to retain their clinicians due to their regional location, let’s motivate each other to commit to spending a few years in such a regional centre. For those unable to go to regional centres, let’s commit to supporting our regional colleagues through formal arrangements. For those currently in stand-alone small regional centres with no networking arrangement or linkages, let’s speak up and oppose this arrangement and ensure the service provider establishes pathways and linkages that enable us to provide highquality care to our patients. The Faculty has developed guidelines that we can use to fight the good fight. With new facilities planned for several regional areas, the time for serious thought is now.

TE OF CAR

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Radiation Oncology

NEW ZEALAND ASM AUGUST 6 - 8 2 021

NZ Annual Scientific Meeting Intercontinental Hotel, Wellington 6 - 8 August, 2021

I N T E R N AT I O N A L I N V I T E D S P E A K E R S

Radiology

Radiation Oncology

Professor Laurie A. Loevner

Associate Professor Corinne Doll

Chief, Division of Neuroradiology Professor of Radiology, Neurosurgery, Otorhinolaryngology: Head & Neck Surgery and Ophthalmology University of Pennsylvania Health System Philadelphia, USA

Tom Baker Cancer Center President of Canadian Association of Radiation Oncology Calgary, Canada

Associate Professor Bruno Giuffrè University of Sydney at Northern Clinical School Radiology Department, Royal North Shore Hospital Sydney, Australia

www.ranzcr2021.co.nz

Inside News

Radiation Oncology

Faculty of Radiation Oncology Chief Censor’s Report

Dr Yaw Chin

As we hurtle along towards the end of 2020, many of you will wonder how time has managed to fly past yet stand still at the same time. Despite the allembracing effects of COVID-19 on every facet of our lives, we have managed to adapt, evolve, re-adapt and re-evolve to overcome the many hurdles that have come our way. In line with the Overarching Priorities, Principles and Strategies guidelines document first established by the COVID-19 Taskforce, I am pleased to report that we have managed to realise a most significant achievement, in the successful delivery of both Phase I and Phase II written examinations. Again, I would like to take this opportunity to express my sincere thanks and appreciation to the small pool of volunteer examiners who have worked unceasingly to make this happen. All examination candidates have now been advised that due to the revised examination timetable, the examination results will only be made available on 15 December 2020 for the Phase I candidates and mid-January 2021 for the Phase II candidates. Following on from this, it is logistically impossible for the first series of the Phase II 2021 examinations to be prepared as per the usual timeline to meet the appropriate examination standards and as such, the Faculty of Radiation Oncology Council has approved the delivery of only one Phase II examination sitting in 2021, in either May/July or June/August. This has been a difficult but unavoidable decision and no doubt will cause further disruptions for trainees preparing to

sit the Phase II examinations in 2021. As advised previously, trainees who feel disadvantaged or unprepared by these changes, are encouraged to submit application for consideration of special circumstances (www.ranzcr.com/ documents-download/training/traininggeneral/4205-consideration-of-specialcircumstances-policy), as per the policy.

“I am pleased to report that we have managed to realise a most significant achievement, in the successful delivery of both Phase I and Phase II written examinations.” The Training and Assessment Reform (TAR) Implementation Working Group (IWG), now chaired by Dr Lisa Sullivan has been making significant progress to ensure that all processes and the framework of the new training program are finalised in anticipation of the commencement of its implementation in 2022.

Specifically: 1. all feedback from the external stakeholder consultation process on the learning outcomes and training program has been collated, reviewed and necessary revisions made 2. six out of a total of seven TAR video podcasts which were designed to replace the face-to-face roadshows, have now been finalised and are available on College website (www.ranzcr.com/college/tar/trainingand-assessment-reform-modules) 3. a smaller group within the IWG, together with Ms Jodie Atkin, external consultant, has now been tasked with finalising the details within the Handbook for the new training program 4. work is ongoing to ensure that all College policies are in line with the changes stipulated in the new training program. Resources for Directors of Training (DoT) this year replacing the annual DoT workshops have included the two practical upskilling webinars, conducted by an external consultant, Dr Brendan Grabau and two DoT induction webinars conducted by College staff. I am pleased to report that all these webinars have been well-attended and have had positive feedback. For those of you who have missed the webinars, all these resources are currently available on the College Webcast Catalog (www.webcast.ranzcr. com/Mediasite/Catalog/catalogs/ default).

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Radiation Oncology

Despite the improving conditions around the country with regards to COVID-19 community transmissions, many trainees continue to be affected in terms of their education and training activities and clinical supervision. The working remotely arrangement for trainees continue to be in place until the end of January 2021. As a result, a communique based on the Radiation Oncology Accreditation Standards, was sent to all trainees, Directors of Training and Training Network Directors to outline the principles of remote

supervision as a guideline for accredited departments who have this working arrangement in place.

the opportunity to attend and learned how to look after our colleagues and ourselves during these uncertain times.

In recognition of the profound impact that the COVID-19 pandemic has had on our mental health, the College has commissioned Professor Brett McDermott, a psychiatrist with many years of experience in mental health research to conduct a webinar on ‘COVID-19 and Mental Health: Lessons from 20 Years of Disaster Research’ on 4 November 2020. I hope you all had

Lastly, I would like to wish everyone a safe and joyous Christmas as they hopefully get to spend time with their loved ones and looking forward to the new year with optimism and hope.

Quality Corner

Telehealth in the Context of a Pandemic Pandemic circumstances have made a virtue out of necessity. Wide use of telemedicine has been thrust upon us. We hope the College’s position statement on ‘Patient Safety and Clinical Decision-Making for Virtual Appointments in the Context of COVID-19 Pandemic’ will be a useful go-to document for professional advice for radiation oncologists in Australia and New Zealand navigating this necessity. Telemedicine is the use of advanced telecommunication technologies to exchange health information and provide healthcare services across geographic, travel, social and cultural barriers in the healthcare system. As the threat of the COVID-19 pandemic lingers, telemedicine has become more prevalent and pervasive. Telemedicine has many potential benefits including cost effectiveness, improved access of care, and clinical effectiveness in many cases. During a pandemic, it is important to ensure the safety of both the patient and the medical staff. Telehealth promotes social distancing and reduces virus transmission, especially important in vulnerable cancer patients. However, it is important to determine which patients are suitable for telehealth services. The appropriateness, safety, and utility of virtual consultations depends on multiple clinical, organisational, regulatory, and patient factors. Physical examination, complex

Inside News

“However, it is important to determine which patients are suitable for telehealth services. The appropriateness, safety, and utility of virtual consultations depends on multiple clinical, organisational, regulatory, and patient factors. Physical examination, complex sharing of information and decision-making, privacy and preference of the patient are some examples of issues that must be considered.” sharing of information and decisionmaking, privacy and preference of the patient are some examples of issues that must be considered. Such decisions need to weigh all clinical, social, and organisational circumstances and the decisions occur in the context of resources within larger healthcare organisations that provide radiation oncology services. Ultimately, it is up to radiation oncologists, and not organisational administration officers, to determine whether a face-to-face appointment or virtual appointment is required. Face-to-face appointments have traditionally ensured patients receive the highest quality care possible. Careful selection of patients assessed as appropriate for virtual

appointments will ensure that the risk of transmission of COVID-19 is minimised while quality of care is not. The College document supports that aim. Someone famous might have said: some are born to telemedicine, some achieve telemedicine, and some have telemedicine thrust upon them. We hope the College’s position statement will help service providers and radiation oncologists achieve the opportunities for telemedicine to help us help patients. The draft of the Radiation Oncology Telehealth Principles is currently open for consultation www.ranzcr.com/ourwork/consultations and we encourage College members to submit any comments.

Radiation Oncology

Radiation Oncology Trainee Matters into the role of ROTC members, and I definitely look forward to more trainee engagement in the future! Usually, the RANZCR Annual Scientific Meeting (ASM) takes centre stage as the College’s annual highlight that provides opportunities for trainees from all over Australia and New Zealand to meet up and network, and also to present their research work, attend Trainee Education Days, and hear about fellowship opportunities among others.

Dr Wee Loon Ong This will be my final Inside News writeup as the Chair of 2020 ROTC. The year has flown by quickly as we took on the many COVID-19 restrictions in our dayto-day clinical practice and training. As we come towards the end of a disrupted and unusual year, it is timely to reflect on ROTC progress on some trainee-related activities. One of the priorities for ROTC in 2020 is trainee engagement. Along with the Specialty Training Unit, we have increased the Trainee eNewsletter frequency to monthly to provide more regular updates to trainees. And throughout this year, we also have ROTC members provide updates on their involvement in various College committees in the quarterly Inside News. In this final Radiation Oncology Trainee Matters for 2020, we have another two ROTC members, Dr Chamitha Weerasinghe and Dr Jeremy Khong telling us about their involvement in the Targeting Cancer Committee (TCC), and the Quality Improvement Committee (QIC). It is hoped that these updates will give all of you a better insight

I am sure that the organising committee for the 2021 ASM (which will still be in Melbourne) will make up for the missed 2020 ASM with exciting programs and a stellar group of international speakers! I definitely hope to see many of you in Melbourne next year! Many other training related matters have been affected in various ways this year. The Phase I and II examinations have definitely brought distress and uncertainty to many trainees. Despite that, we are thankful that both Phase I and II written examinations have been successfully held. At the time of writing, Phase II candidates are busy preparing for the clinical viva examinations in their adapted virtual format —the finishing line is definitely looming closer each day—hang in there!

And lastly, as we head towards the final weeks of the year, the 2020 ROTC is planning its handover to the 2021 ROTC, with a couple of current ROTC members continuing on in 2021 to allow a smooth transition. At the same time, it is exciting to see many new faces in the 2021 ROTC, who will bring in fresh new ideas into the committee. Congratulations and welcome to the incoming 2021 ROTC members! Finally, with the Christmas and New Year season approaching, it is definitely time for a well-deserved break for all trainees. I would like to wish all of you a safe and happy festive season, and all the very best for 2021! Dr Wee Loon Ong Chair, ROTC 2020 @weeloonong

The knock-on effect of the disrupted examination schedule this year is that there will only be one series of Phase II examinations in 2021, which will understandably affect trainees who are gearing towards sitting the Phase II examination in February 2021. Beyond that, hopefully training-related matters will transition back to business as usual. Another major trainee-related matter that is impacted by COVID-19 is the Training and Assessment Reform, which has been deferred. There will likely be more updates on it in the coming months.

continued over...

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Radiation Oncology

Target Cancer Committee (TCC) It has been a privilege to represent my fellow trainees as the ROTC Representative for the TCC. Despite the disruptions of the year, the TCC has met regularly via videoconference and offline to increase the profile of radiation oncology among patients and other healthcare professionals. The achievements of the year so far include an update of the Targeting Cancer website content and reestablishment of the Targeting Cancer Reference Panel, both of which I was delighted to be involved in. The Targeting Cancer Reference Panel has been established to allow members, particularly accredited trainees, unaccredited trainees and junior medical doctors, to be involved in action projects and activities related

to the Targeting Cancer campaign. New clinician and patient videos are also being developed as part of the website update. We have also continued the annual tradition of the Targeting Cancer Fun Run. This event would of course normally take place during the College’s ASM. Not to be deterred, we have converted this event to a virtual fun run and stayed connected by posting videos and photos to social media of us staying active in the name of Targeting Cancer.

It has been a tumultuous year, particularly for those who sat their Phase I and II exams. To my fellow trainees, I am proud to see how you have handled these uncertain times with such resilience and steadfast support of each other.

Raising awareness of radiation oncology is a valuable aspect of health advocacy. I highly recommend any trainees considering more involvement in leadership and health advocacy to apply to the Targeting Cancer Reference Panel and the TCC as a Trainee Representative.

Dr Chamitha Weerasinghe Trainee Rep (NSW-N), TCC 2020

It has been an absolute privilege to represent you this year, thank you for this opportunity to do so.

Quality Improvement Committee (QIC) The QIC promotes a quality-centred approach of the Faculty by providing policy advice and conceptual models to ensure ongoing improvement in care. Part of this role includes providing assistance in the development of clinical guidelines and providing feedback on Faculty documents. Recent items that have been reviewed include the Optimal Care Pathways and Quick Reference Guides by Cancer Council Victoria, and the Faculty’s Informed Consent document and Telehealth Position Statement. The Committee has also been working towards developing an incident monitoring system in Australia and New

Inside News

Zealand and a prostate cancer outcomes registry and quality indicator reports for radiation oncologists. Keep an eye out for these services which are sure to provide important feedback for quality assurance. The Committee normally meets four times per year, including one face-toface meeting. Between meetings, the members regularly communicate via email about any external documents that may seek endorsement, support or sharing. As the ROTC trainee representative, I liaise with other ROTC members so that awareness of these updates can be disseminated throughout the training

networks. I also keep the QIC updated on activities of the ROTC and provide a trainee perspective for incorporation into guidelines as relevant. Being part of the ROTC and QIC has been an excellent opportunity. I urge anyone who is interested in improving the quality of radiation oncology service to consider applying for the ROTC and QIC. Feel free to contact me if you would like more information about these committees. Dr Jeremy Khong Trainee Rep (SA), QIC 2020

Radiation Oncology

MBS Review for Radiation Oncology

The Faculty of Radiation Oncology Medical Benefits Scheme (MBS) Review working group has made significant progress in recent months in working collaboratively with the Commonwealth Department of Health on the resolution of new descriptors for the revised MBS schedule. This work has been done concomitantly with preparatory work for the Department’s MBS data collection exercise and cost modelling. The MBS Review working group resolved the proposed brachytherapy descriptors in September 2020 after finalising the descriptors for megavoltage earlier in the year. It was pleasing that the Department accepted a separate stereotactic body radiotherapy (SBRT) descriptor and other changes to the descriptors that followed on from a pilot data collection exercise by six centres earlier in the year. After several meetings and significant work by the MBS Review working group and brachytherapy sub-group, the Department agreed to the proposed brachytherapy descriptors and they were included in the data collection exercise. Resolving appropriate data collection sheets to properly reflect the complexities of brachytherapy clinical practice required some time-focused intensive work. Thanks go to Drs Keen Hun Tai, Carminia Lapuz, Viet Do and Sylvia Van Dyk for their expert input.

The data collection period commenced at the beginning of September 2020 and will run until January 2021 with 57 sites participating across all jurisdictions. Victorian facilities commenced their data collection in October due to COVID. Louis Huynh (ICON Cancer Care) and Aniko Cooper (Townsville Hospital) have been assisting the Department as RANZCR nominated technical contact ‘go-to people’ for practices during the data collection phase. Thanks go also to Louis and Aniko for playing this role. As Faculty Dean Madhavi Chilkuri mentioned in the enews recently please let us know if you have any questions, concerns or comments about the data collection process by emailing faculty@ranzcr.edu.au

Consideration of true course-based funding or pseudo course-based funding was not something we were in favour of at the start of this process but with the changes we are witnessing, it is an area we have commenced work on with a small window of opportunity to raise with government. The members of the MBS Working Group include Madhavi Chilkuri, Keen Hun Tai, Gerry Adams, Aniko Cooper, Viet Do, Jim Frantzis, Liz Kenny, Marcel Knesl, Carminia Lapuz, Michael Poulsen, Fergus Rourke, and Matt Sobolewski. Associate Professor Dion Forstner

Sandra Keogh, a consultant to the College and Aniko Cooper are the RANZCR nominees to the Department for expert input to the Department’s cost modelling work. We are also working on our own cost modelling against the new descriptors. The MBS review was announced over five years ago. In that time, we have seen significant change in practice, including a move to more complex treatment and more hypofractionation all aimed at improving outcomes for our patients. The working group remains very focused on the risks of changes out of this review and the need to future proof.

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Radiation Oncology

Quality of Care in Radiation Oncology

Radiation oncology is a specialty that marries humanistic attitude, clinical skills and technical expertise in the safe prescription and delivery of radiation therapy. Participation in tumour site multidisciplinary meetings and departmental morbidity and mortality meetings are some of the ways of promoting quality of care in clinical decision-making. However, as our specialty is heavily reliant on technology that is changing at a rapid rate, specific measures are necessary to ensure quality in all radiation therapy aspects of treatment. Who, exactly, is responsible to get it right? Why is this so important? Radiation therapy is said to be the most complicated treatment provided to patients in health care. In a clinical trial setting, head-and-neck cancer patients who were treated with nonprotocol compliant plans had poorer survival.1 Deviations in radiotherapy quality assurance in clinical trials are associated with increased local failure, poorer survival and increased toxicity.2,3 If poor quality care within clinical trials is associated with poorer outcomes, what happens in routine clinical practice? What measures are being taken in radiation oncology departments to ensure quality of care?

“Although OAR delineation is frequently left to radiation therapists, it is the ultimate responsibility of the radiation oncologist to check and accept these.” 50

Inside News

“To maintain consistency in radiotherapy planning and minimise errors, I recommend departments agree on a preferred dose and fractionation scheme for major tumour sites allowing some limited alternative schemes to account for different patient and tumour factors.“ Protocols and guidelines including volume delineation atlases are tools which can be used to promote quality of radiotherapy treatment. In an online survey conducted during my Faculty Forum presentation on this topic, pleasingly all respondents stated they used volume delineation protocols, with 65 per cent stating they used both departmental and external protocols. Departmental protocols for dose and fractionation are also important. While some tumour sites may only have a single established dose and fractionation scheme (eg Stage III NSCLC), others may have multiple options (eg breast cancer). To maintain consistency in radiotherapy planning and minimise errors, I recommend departments agree on a preferred dose and fractionation scheme for major tumour sites allowing some limited alternative schemes to account for different patient and tumour factors. Agreeing to relevant organs-at-risk and how they are volumed is part of this. This will avoid the need for bespoke planning for specific radiation oncologists and instead have a departmental approach to this which can and should be audited as part of ensuring quality. Radiation oncologists should then have a strong justification for treating off-protocol for their department. Peer review is the main tool we have to monitor quality of care. The Faculty updated its Peer Review Audit Tool (PRAT) in 2019 to aid with this. It

recommends that ‘the PRAT should be combined with feedback to the treating radiation oncologist… ideally provided in a peer review meeting where peers give educational and enabling feedback in order to improve radiation oncologist practice.’ In a Faculty survey of radiation oncology facilities from 2019, all respondents reported their facilities participated in peer review processes. Eighty-eight percent of respondents ‘strongly agreed’ and a further 10 per cent ‘agreed’ that peer review in radiation oncology is essential. Ninety-four percent agreed that staff in their location were keen to engage in peer review. However, 39 per cent had no protocol for scoring peer review and 37 per cent did not use the PRAT tool in any form. Slightly more negative findings were seen during the online polling undertaken during my Faculty Forum presentation however numbers of respondents were low. A systematic review of the effect of peer review of radiotherapy plans on clinical care found that this led to changes in radiation therapy plans for one in nine patients and to major changes in one in 56 patients.4 The commonest reason for change was target volume delineation (45.2 per cent), followed by dose prescription/ written instructions (24.4 per cent) and non-target volume delineation (7.5 per cent). There were some differences on impact by tumour site with head-and-neck and lung cancer plans more likely to have changes

Radiation Oncology

recommended than breast cancer plans. It would be a very resource-intensive activity to comprehensively peer review all radiation therapy plans in a department so cases should be prioritised based on the risk of patient harm and the probability of an error being detected downstream.5 I recommend that peer review for ALL cases should be performed for certain tumour sites (eg curative radiotherapy for head-and-neck cancers, lung cancers), certain treatment techniques (eg stereotactic radiosurgery,

“Forty-three percent of respondents in the online Faculty Forum survey stated that the main barrier to peer review was lack of time. While I know that we are all busy people, we need to recognise quality of care as an integral part of our job and as such make the necessary time for this in our schedules.“ stereotactic ablative body radiotherapy, image-guided brachytherapy), certain treatment indications (eg retreatment to high doses) and some patient groups (eg paediatric patients). Conversely random audit of other cases (eg breast cancer) is reasonable although, even for this tumour site, peer review of all

plans that use modulated techniques is preferable. We must not forget that radiation therapy also has an important role in palliative treatments and there should be a mechanism to randomly audit these as well. Forty-three percent of respondents in the online Faculty Forum survey stated that the main barrier to peer review was lack of time. While I know that we are all busy people, we need to recognise quality of care as an integral part of our job and as such make the necessary time for this in our schedules. Radiation therapists and physicists spend a significant part of their time performing quality assurance of radiotherapy plans. However, there is little point in that process, if the preceding step of quality assurance with respect to indication for radiotherapy, dose, fractionation, target and organ-at-risk volumes are not peer reviewed. Putting dedicated time in our calendar for peer review is just as important as all the other clinical activities we do. Clinicians can learn how this can be done with an example from private practice in Queensland, where a virtual peer review was successfully implemented to ensure quality of stereotactic radiotherapy treatment and mentor and train junior radiation oncologists.6 Of some concern, 23 per cent of respondents to the online survey stated that lack of radiation oncologist engagement was a barrier to peer review. It is clear that peer review is not seen as necessary by some radiation oncologists. It is important to realise that peer review is widespread throughout medicine and not specific to radiation oncology although the ways of doing this are specialty specific. It is a wellestablished method of assessing and maintaining competency of practice hence quality of care.7 A time will soon come when it will be indefensible for a radiation oncologist to have not

participated in peer-review if a mishap were to occur, and for organisations to not put time, and resources and checks in place to ensure peer-review is done properly. Radiation oncologists who sign and approve the treatment prescription are those exactly responsible to get it right. However, quality of care in radiation oncology is a team activity in a complex system. We all have to work together in a multidisciplinary system to ensure we are prescribing and delivering quality radiation therapy to the highest standard for our patients. We need to arrange our systems to ensure best quality of care for our patients. Peerreview is an essential part of this system.

“A time will soon come when it will be indefensible for a radiation oncologist to have not participated in peer-review if a mishap were to occur, and for organisations to not put time, and resources and checks in place to ensure peer-review is done properly.” Professor Shalini Vinod Liverpool Hospital

@shalinivinod13

References 1. Peters, L.J., et al., Critical impact of radiotherapy protocol compliance and quality in the treatment of advanced head and neck cancer: results from TROG 02.02. J Clin Oncol 2010;28: 2996-3001. 2. Ohri, N., et al., Radiotherapy protocol deviations and clinical outcomes: a meta-analysis of cooperative group clinical trials. J Natl Cancer Inst 2013;105:387-93. 3. Weber, D.C., et al., QA makes a clinical trial stronger: evidence-based medicine in radiation therapy. Radiother Oncol 2012;105:4-8. 4. Brunskill, K., et al., Does Peer Review of Radiation Plans Affect Clinical Care? A Systematic Review of the Literature. Int J Radiat Oncol Biol Phys 2017;97:27-34. 5. Marks, L.B., et al., Enhancing the role of case-oriented peer review to improve quality and safety in radiation oncology: Executive summary. Pract Radiat Oncol 2013;3:149-156. 6. Fitzgerald, R., et al., Quality and access – Early experience of implementing a virtual stereotactic chart round across a national network. J Medl Imag Radiat Oncol 2020;64:422-426. 7. Australian Commission on Safety and Quality in Healthcare. Review by peers – a guide for professional, clinical and administrative processes. Available at: https://www.safetyandquality.gov.au/sites/default/files/migrated/37358-Review-by-Peers.pdf

Volume 17 No 1 I December 2020

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Radiation Oncology

Vale Dr John A. Violet (12/2/1969–5/10/2020)

It is with great sadness that we learnt of the passing of Dr John Violet on 5 October 2020. John was a consultant in radiation oncology at the Peter MacCallum Cancer Centre's Sunshine and Parkville Campuses and had worked there for more than 10 years. John was born and educated in England and completed his clinical oncology training in London and was awarded the Fellowship of the Royal College of Radiologists, London. John then worked with Dr Clive Palmar at Royal Marsden Hospital where he first developed his passion for radionuclide therapy. He furthered his interest and research in this area by working on the development of antibodies to deliver targeted radionuclides (radioimmunotherapy) for prostate cancer at the Royal Free Hospital, London. John’s work in this area was pioneering. John and his family then moved to New Zealand where John worked for two years. Drawn by the vibrant core of nuclear medicine research at Peter Mac, John moved to Australia in 2010 taking up a consultant appointment there. John was the first campus director at the newly opened Sunshine Campus and was admitted to the Fellowship of the College in 2012. John’s research continued in earnest as he helped develop Lutetium-PSMA, a radiolabelled small molecule, which

binds with high affinity to prostatespecific membrane antigen (PSMA) enabling beta particle therapy targeted to metastatic castration-resistant prostate cancer to be delivered systemically. John’s work in this area was recognised by a co-first author publication in Lancet Oncology in 2018.1 John and colleagues at Peter Mac further developed this therapy launching the first in-human clinical trial of Lutetium-PSMA in the adjuvant setting earlier this year.

John is survived by his wife Jo, daughters Imogen and Mia and his sisters Mary and Julie, to whom we send our deepest sympathy and condolences. From all your colleagues at Peter Mac Radiation Oncology. Rest in peace, John. A/Prof Gerry Hanna Director of Radiation Oncology, Peter Mac

Outside of work, John was an avid photographer, particularly of urban street scenes. He had an amazing ability to put random subjects in the streets at ease and he had a keen eye for unique geometric angles. He held several exhibitions of his photographs and he sold a number of his pictures for cancer research charities. A few of John’s pictures are currently on exhibition in Peter Mac. On a personal level, we remember and miss John’s splendid sartorial dress sense and elegance, his sense of humour, his kindness to his colleagues and patients and his wonderfully human nature. At Peter Mac, we are heartbroken at John’s untimely departure. But we have been comforted by the many, many messages of sympathy and support we have received from friends and colleagues from around the globe.

References 1. Hofman MS, Violet J, Hicks RJ, et al. [177Lu]PSMA-617 radionuclide treatment in patients with metastatic castration-resistant prostate cancer (LuPSMA trial): a single-centre, single-arm, phase 2 study. Lancet Oncol. 2018 Jun;19(6):825-833. https://www.thelancet.com/journals/lanonc/article/ PIIS1470-2045(18)30198-0/fulltext

Volume 17 No 1 I December 2020

Radiation Oncology

Vale Colin Alexander Bull (9/3/1945–23/10/2020)

The Faculty of Radiation Oncology mourns the loss of an esteemed member. Colin obtained Fellowship of the College in January 1974. After private practice at Macquarie Street in Sydney, he spent 18 months as an expert consultant at the Radiation Oncology Branch of the National Cancer Institute, Bethesda and was also awarded Fellowship of the Royal College of Radiologists during this time. Colin then spent six years at the King Faisal Hospital in Saudi Arabia bringing a wealth of clinical experiences that kept a generation of radiation oncology trainees enthralled with him to Westmead Hospital, Sydney, in January 1985. He was instrumental in the establishment of the Nepean Cancer Care Centre which opened in 1998, lobbying for the centre from the early 1990s. He negotiated a Memorandum of Understanding between two Area Health Services to establish the Radiation Oncology Network. Colin also conducted clinics at Katoomba, dedicating the majority of his career to bringing excellent cancer care and services to the people of western Sydney. Colin’s particular areas of practice were oesphageal cancer, melanoma and gynaecological cancer. He was always ready with a project in case a surprise round of funding came about. His preparedness was instrumental to obtaining a brachytherapy suite within the radiation oncology department at Westmead Hospital which now bears his name in recognition of his enormous contribution to this field of practice.

Inside News

Colin became the Deputy Director of Radiation Oncology at Westmead Hospital in 1992 and Director of the Radiation Oncology Network (RON) in 1997, a position he held until his retirement in 2011. During Colin’s tenure as Director of RON, 26 trainees in radiation oncology obtained Fellowship of the College and many more met him as a pathology examiner for the Part II examination of the College. He treated all trainees with respect and ensured their wellbeing. Training was as important as caring for his patients. As a director, Colin offered opportunities to all staff and encouraged them to reach their potential. While patient care was always Colin’s priority, he was involved actively with the College throughout his career and a great model of giving back to the profession through the College. Colin was a founding member of the NSW Radiation Oncology Directors’ group, held for the first time in March 2000, and its chairman and secretary for many years. The group was established to provide a forum for discussion of issues affecting both public and private departments, especially when a consensus position would provide a more effective method of lobbying at local, state or national level. Colin was the Convenor of the NSW Radiotherapy Club meetings for more than seven years, bringing together radiation oncologists and trainees from across the state for both education and networking. He was also the first Chair of the Radiation Oncology Tripartite

Committee. He represented the College on the Government and Regulatory Affairs Committee from 2003–2005 and was a member of the RANZCR Overseas Trained Specialists Assessment Panel from 2005–2010. During his early retirement, Colin spent one day each week at the College offices in Sydney when not cycling or venturing to the outback in his fourwheel drive. He donated over 10,000 35mm teaching slides to the Trainor Owen collection. The Colin Bull collection was accumulated over his lifetime of practice and teachings, giving real-life illustration to the development of new techniques in radiation oncology over three decades. The Collection portrays the challenges of treating patients alongside differences in local cultural and social mores in the Middle East, North America and Australia. Colin’s care of patients and commitment to the College was wonderfully supported by his wife and his four children of whom he was so proud. Our thoughts and condolences are with them.

General Interest

Member Services 2020 What We Can Offer You Over the past year, a lot has changed at the College when it comes to member services. The team that is at the forefront of member engagement, events, publications and grants, awards and prizes has initiated many changes in the way we deliver services for our members. The College’s core focus is, of course, on setting standards, providing professional training and assessment and representing and advocating for the professions of clinical radiology and radiation oncology. However, within our team we took a closer look at how we can provide for our members as individuals.

“We have been working hard to promote our grants, awards and Fellowships to ensure that every opportunity is extended to you to shine in the research field of your choosing and further your knowledge and expertise.“

protection insurance that can save you hundreds of dollars. We are constantly working on new partnerships to extend the range of rewards available and will soon be announcing new partners in financial and business services to offer you significant savings on services such as home loans and financial planning. See page 65 for more on our member rewards.

has been a steep learning curve for the team but they have embraced it with a smile, and I am proud of the high quality webinars we have delivered in last few months. We will continue to bring you more of these webinars in the new year for your continued learning and wellbeing. See page 23 for more on the RANZCR Webinar Series.

We have been working hard to promote our grants, awards and Fellowships to ensure that every opportunity is extended to you to shine in the research field of your choosing and further your knowledge and expertise. Simplifying the application process, targeting our promotions and working with volunteer committees to refine guidelines and selection processes has been a rewarding task. In 2020, we received a record number of applications and are happy to see our members respond in this fashion. We hope to continue this momentum and achieve even better results in the years to come. See pages 28–31 for details of what’s available in 2021.

There is a lot more we wish to do. We are bound by same principles as everyone else, that is—resources need allocating according to priorities. But we are always working to ensure that for you as a member, there is support available at the College, in ways and forms that add to your lifestyle and to your wellbeing.

We have also worked hard to bring some virtual events to you in the absence of your usual conferences. It

Dr Munish Verma Head of Member Engagement and Services Unit (MESU)

Of course we are operating in a changed environment but that does not mean we can't listen to our members as usual, if you feel there are other things we can do, please reach out to me at munish.verma@ranzcr.edu.au

MESU Team 2020: Libby Ramsden, Lindy Baker, Hannah Barton, Sarah Dowd, Munish Verma, Susannah Musgrove, Scott Raymond, Sarah Hall.

First, we revamped our member rewards program. You may have noticed that there are now new partners for you to choose from. As a member, you can avail yourself of savings on the purchase of your next car with leading brands such as Tesla, Audi, Mercedes and BMW. You can book your next (local) holiday by using our leisure rewards partner The Accommodation Brokers. There are also discounts on health, life and income Volume 17 No 1 I December 2020

Interventional Radiology

Achievements of the Interventional Radiology Committee The last 12 months have been extremely productive for the Interventional Radiology Committee (IRC) as it works towards advancing Interventional Radiology (IR) and Interventional Neuroradiology (INR) in Australia and New Zealand. This year we have made several critical steps in our efforts to achieve the major goal of attaining formal recognition for IR and INR as clinical specialties.

Communications Engaging with College members through the work of the IRC and keeping members abreast of the inroads being made in Interventional Radiology and Interventional Neuroradiology are of utmost priority for the IRC. We are always seeking ways to improve our communication with members, and the need for accurate flow of information concerning our achievements, opportunities and challenges. It is equally important that there be a two-way flow of information and we strongly encourage members to provide us with any feedback, ideas or concerns. This will allow us to respond and pivot to issues that are important to College members.

Thank you I would like to take this opportunity to thank all the members of the IRC, who have worked tirelessly to advance the cause of IR and INR within Australia and New Zealand. I would like to thank all College members who have supported the work of the IRC and share the vision for a future where IRs and INRs can

On the journey to formal recognition for IR and INR as clinical specialties Laying a foundation for achieving specialty recognition is ongoing work and drives the IRC through all of its activities in 2020 Begun work on a College endorsed IR and INR training program*

Published Roadmap for Advancing IR and INR in Australia and New Zealand

Standards of Practice for Interventional Radiology†: soon to be released for consultation

Expanded the IRC: doubled the IR and INR representation

Engaged IRSA and ANZSNR on the training pathway working group

Engaged IRSA and ANZSNR on the College’s Tripartite Committee

Established IR and INR Reference Group‡ to support the IRC in policy work

Published UFE position statement: supporting MBS review recommendations

Advocating for IR: development of COVID-19 statements, Department of Heath MBS review, cancer control plans and care pathways

securely practice their craft as clinicians within a recognised specialty and for the benefit of patients.

Please get in touch at interventional@ranzcr.edu.au

If we get this right, it will provide tremendous opportunities for the College to expand clinical radiology and promote the important and evolving role of radiologists in modern medicine. These successes will require effort and input from a broad range of members across the whole profession, and the IRC looks forward to continuing to work with all stakeholders in 2021. Regards, Dr Nicholas Brown Chair Interventional Radiology Committee

* Training Pathway Working Group members – A/Prof Dinesh Varma, Dr Nick Brown, Dr Meredith Thomas, Dr Andrew Cheung (co-chair), A/Prof Andrew Holden (co-chair), A/Prof Laetitia De Villiers, Dr Hamed Asadi, Dr Nicholas Cheung, A/Prof Gerard Goh (IRSA), A/Prof William McAuliffe (ANZSNR), A/Prof Julie Ash (Medical Educationalist). † Standards Working Group members – Prof Winston Chong (Chair), Dr Nick Brown, A/Prof Gerard Goh, Dr Jim Koukounaras, Dr Con Phatouros, Dr Andrew Cheung, A/Prof Ronil Chandra, Dr Martin Dobes, Dr Colin Chong, Dr Matthew Lukies, Mr Murray McLachlan. ‡ Dr Albert Chiu, Dr Justin Whitley, Dr Hamed Asadi, A/Prof Lourens Bester, A/Prof Laetitia De Villiers, Dr Deepak Jain, Dr Arockia Doss, Dr Nicholas Cheung, Dr Murthy Chennapragada, Dr Kartik Bhatia, Dr Abysinia Sibanda, Dr Wei Che Tsai, Dr Sivasubramanian Srinivasan, Dr Matthys Van Wyk, Dr Jonathan Tibballs.

Inside News

Interventional Radiology

From Ireland to Melbourne as an Interventional Radiologist An Interview with Dr Terry Kok, FRANZCR, EBIR

Dr Terry Kok is an interventional radiologist and joined the College’s Interventional Radiology Committee this year. We find out a little more about Terry and why he joined the committee. an you tell us about your C professional background and experience? I started my career as a physician trainee and subsequently completed radiology training and an interventional radiology (IR) fellowship in Ireland before moving to the UK for further subspecialty experience. I was fortunate to have been able to train under a number of IR luminaries including Professors Michael Lee and William Torreggiani (Dublin) and the IR team at Guy’s and St Thomas’ NHS Foundation Trust (London). I also spent some time at the Royal Papworth Hospital (Cambridge) training in cardiothoracic radiology. A good friend and academic colleague, Hamed Asadi, enticed me to move to Australia with the promise of better weather with lots of sunshine and the wonderful opportunity to support a growing IR service in north Melbourne. I haven’t looked back since! hat made you decide to become an W interventional radiologist? I was attracted to IR by the innovative, progressive and minimally-invasive nature of the specialty. Contemporary IR is an intricate amalgamation of diagnostic imaging, procedural and clinical skills to offer patients diagnostic, therapeutic and palliative procedures across a wide range of

conditions. IR also presents a unique and crucial interface with many other clinical specialities, making our work very diverse and interesting. In many instances, we are able to make a difference to patients through elegant and effective treatments when other options are non-existent or unsuitable.

and knowledge of what we can offer. IR training reform and specialty recognition are other areas where there is much work to be done. hat are some of the highlights W of being involved in the IRC?

I was invited to join the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) endovascular committee a few years ago and gained valuable insight into the process of advocating for and shaping IR practice at an international level. Since moving to Australia, I wanted to make use of this experience and contribute to local efforts to advance IR practice in Australia and New Zealand.

Despite challenges posed by the global COVID-19 pandemic with regards to College activities, the College and IRC have rapidly adapted and the IRC have continued to meet regularly. The enthusiasm of my fellow IRC colleagues have allowed us to navigate these challenges and achieve many goals over the past year. Some highlights would include the publication of College position statements for IR and INR practice during COVID-19, development of the IR Standards of Practice document and ongoing work towards IR and INR specialty recognition in Australia and New Zealand.

We are very fortunate to have an excellent interventional radiology and interventional neuroradiology workforce but there are still challenges to tackle. The public awareness and recognition of IR lags behind other specialities and the impact of this can be exemplified by recent Australian data showing a disproportionately low utilisation of uterine fibroid embolisation compared to hysterectomy in women with symptomatic fibroids. Thus, many women are being denied a proven, uterine-sparing treatment which can be delivered as a day procedure. There is a pressing need to empower patients with better awareness of our specialty

IRC members Dr Nick Brown (Chair) A/Prof Dinesh Varma A/Prof Andrew Holden A/Prof Winston Chong A/Prof William McAuliffe A/Prof Warren Clements Dr Terry Kok A/Prof Ronil Chandra Dr Andrew Cheung Dr Amit Lakarraju Dr Sibtain Raza (FCR rep) Dr Paul Marovic Dr Suraindra Rajadurai (trainee rep) Mr Murray McLachlan (consumer)

What motivated you to get involved in the College and the Interventional Radiology Committee (IRC)?

Volume 17 No 1 I December 2020

General Interest

Obstetrics and Gynaecology (O&G) Ultrasound Workshop

onsite in Rotorua and a further 130 virtual attendees. The feedback from the delegates, onsite and virtual, was overwhelmingly positive.

The programme The workshop provided the opportunity to learn from experts discussing issues which can at times be very challenging to both sonographers and clinicians. The emphasis was on a team approach with lectures from sonographers, gynaecologists and radiologists dealing with the patients' journey. We don’t treat images, we treat patients!! The inaugural O&G Ultrasound Workshop – Controversies and Update was held on Saturday 12 September, under Level 2 gathering restrictions at the Novotel Rotorua, New Zealand.

Getting started Dr Barbara Hochstein began planning the workshop in late 2019 after hearing a talk from Dr Kirsten Gormly (radiologist, Adelaide) discussing the importance of the sliding sign when performing pelvic ultrasound to evaluate for endometriosis. The initial goal was to upskill regional sonographers who perform these scans. However, it soon became clear that there was interest nationwide across a broader range of issues. Local sonographers, O&G specialists and radiologists were enlisted to help develop the programme. It was very easy to organise as every speaker who was contacted said yes!!! Dr Helen Moore gave very helpful advice and support including initiating contact with consultant O&G specialist Dr Sunil Pillay.

Inside News

Enter COVID-19 Initially the workshop was to be held in May, but due to COVID-19 was postponed to September. Additional challenges were then faced with further COVID cases emerging in the Auckland community and gathering restrictions imposed during August and September in New Zealand. However, with the quickly evolving technology available, plans were developed to deliver a hybrid event—one of the first held in New Zealand—with strict venue cleaning, physical distancing and contact tracing measurements in place. The virtual conference platform provided a true conference delegate experience, with additional features including networking options, live Q&A, live polling, a meeting hub and a gamification option for the more competitive attendees! While initial pre-COVID plans estimated attendance at 50–60 maximum, this quickly grew to 80 at first postponement and then 180 for the new dates of September. The final numbers were 220 participants, including 90 delegates

“The emphasis was on a team approach with lectures from sonographers, gynaecologists and radiologists dealing with the patients' journey. We don’t treat images, we treat patients!“ Helen Moore gave an engaging talk on the inspiration for the workshop: ultrasound of endometriosis and the sliding sign. Ten per cent of New Zealand women will experience endometriosis yet diagnosis is often delayed by as much as eight years. Effective ultrasound techniques to spot deep infiltrating endometriosis and good reporting are key to improving diagnosis.

General Interest

In the last formal presentation of the day, Barbara took the opportunity to get everyone thinking about an issue of increasing concern: pregnancy ultrasound and societal pressure. Her compelling talk outlined increasing pressure from patients for cute fetal images and gender reveals, sometimes compromising the sonographers’ ability to gather important details related to health of baby and mother. These expectations are driven by reality television and social media but they do not comfortably fit in a healthcare model where obstetric ultrasounds are publicly funded. Questions from the session included: should public funders pay for souvenir scans and would the solution include managing patient expectations and setting clear boundaries prior to appointments?

Other topics included: cornual/ interstitial/angular ectopic; clinical perspective of endometriosis from a gynaecologist; IOTA or O-RADs; cervical length and SGA guidelines from an O&G specialist; caesarean scar implantation and accreta; RIF pain and ultrasound of the bowel; scanning ergonomics in obese patients; and a general review of images with a quiz. There was also plenty of lively panel discussion with our experts at the end of each session with questions and comments from both our onsite and virtual audience.

Thanks and plans for 2021 The organisers would like to thank their sponsoring partners the New Zealand Radiology Education Trust and Canon Medical for their support. Many thanks to our PCO, Jo Kelk, from Outshine who helped to make the conference a reality. The faculty included an exceptional array of expert speakers, and the organisers would like to extend their sincere gratitude to Dr Helen Moore, Dr David Perry, Dr Sunil Pillay, A/Prof Katie Groom, Martin Necas and Dr Barbara Hochstein who all provided an inspiring array of talks in line with our theme Controversies and Update. Planning for the 2021 workshop is already underway, so keep an eye out for announcements regarding dates!

Volume 17 No 1 I December 2020

Advertorial

Caring for Cancer Patients During a Crisis:

Connectivity and Cooperation are Key The COVID-19 pandemic has severely impacted the way clinical teams work around the world. And healthcare professionals have shown themselves to be among the greatest heroes of our time. As someone who works in a medical technology organisation focused on helping clinicians treat cancer—Varian Medical Systems—I have been truly inspired by the many creative adaptations that treatment centers put in place to make sure that the most vulnerable cancer patients could still receive treatment. Between April and June of 2020, Varian had the opportunity to sponsor a series of online webinars that explicitly dealt with ensuring cancer care during these challenging times. In these webinars, some very insightful, creative, and wonderful examples were discussed. Based on these examples, I would like to highlight three core themes that have greatly contributed to overcoming some of the challenges brought along by this pandemic. First, and where appropriate, it was key to find alternative solutions to surgeries. Second, many healthcare facilities switched to remote solutions to limit potential patient exposure. Third, clinical teams from across specialties set up great methods to connect with each other and to share knowledge and best practices. I would like to briefly describe what this meant in practice.

1. Providing alternatives to surgeries Surgical teams around the world were faced with limited access to operating rooms and personal protective equipment. All of a sudden, providing the conventional standard of care was not possible anymore. The risk of exposing patients to COVID-19 during surgery was just too high. We have learned that, as a response, radiation oncologists and surgical oncologists in treatment centers across the globe took a close look at their patients and assessed – together – what the best individual solution for a non-surgical alternative could be. Frequently, radiotherapy and radiosurgery were these preferred alternatives.

2. Adopting telemedicine to reduce personal contact Another trend that caught on fast was the widespread adoption of telemedicine. This helps minimise patient travel to the cancer center without interrupting the treatment. This trend is extremely important, now and in the future, particularly for those cancer patients in rural and regional Australia. This new practice not only limits travel time, it also reduces the exposure of – often immunosuppressed – cancer patients to viruses. Throughout the pandemic, we have seen more and more hospitals and treatment centers switching to telephone and/or video consultations. We were surprised to learn that many elderly patients were very open to using mobile phone applications when it came to managing their treatment schedules or their symptoms.

3. Sharing knowledge and best practices The COVID-19 pandemic also gave rise, for many, to greater inter-institutional sharing and collaboration. We have seen local, regional, national, and international networks emerge that aim to foster knowledge exchange. I had the chance to listen into a couple of network discussions, and it is just so motivating and inspiring to hear how healthcare professionals are openly sharing their challenges and successes when it comes to ensuring that cancer patients are receiving their treatment. It is often said that necessity is the mother of invention, and that certainly appears to be true, when it comes to how cancer care centers have been adapting in order to treat patients during the COVID-19 pandemic. It strikes me that all this innovation—most of which involves enhanced connectivity and collaboration between doctors and their patients, and between medical specialists caring for patients—constitutes a benefit that has come out of a bad situation. Hopefully some of this activity will be sustained beyond the acute emergency and become part of standard operating procedures.

Inside News

News

New Zealand Branch News

Dr Gabes Lau

Kia Ora. I hope this finds you, your colleagues and your families safe and well. Recent outbreaks on both sides of the Tasman now look to be under control thanks to the hard work of many. The Bledisloe Cup has been a welcome bit of athletic entertainment in a year that has been short of sporting action. The All Blacks have done New Zealand proud once again.

New Zealand election results The New Zealand Election was held on 17 October. The Labour Party led by Jacinda Ardern won the election, achieving the first majority government since MMP was implemented. Andrew Little will be moving from the Justice portfolio to be the new Minister of Health. Andrew has been an MP since 2011 and led the Labour party prior to Jacinda. Associate Ministers of Health are: Dr Ayesha Verrall (who is an epidemiologist) and Peeni Henare who will focus on Māori Health. Aupito Sio will be Minister of Pacific Peoples. The College will be contacting the new Ministers to discuss the importance of investing in our professions for the benefit of New Zealand’s healthcare system. It is expected that the next three years will see the government begin implementing some of the changes recommended by the Heather Simpson Health and Disability Report. From a College perspective, those changes will hopefully include capacity building: workforce and infrastructure (RIS/PACS, interoperable data systems, linacs,

bunkers). Although it seems we may need to be patient while they reduce the number of District Health Boards first. The College has been advocating on workforce issues for years. However, over the last year the Ministry of Health’s Health Workforce has begun presenting its workforce modelling to various groups, including some College committees. This modelling supports the College’s position that we need to train and retain more radiologists and radiation oncologists in New Zealand. As Health Workforce is currently undertaking a review of its funding model, it is possible that we may get additional funding for trainees without any assistance from the politicians. We will see.

William Cook Award Along with Hugh Roberts, NZ Branch Education Officer, I had the pleasure of judging the William Cook Award in October. In response to COVID, it was held virtually. NZ’s registrars did exceptionally well with interesting and well-prepared presentations. The winner was Dr Rishi (Devarshi) Bhattacharyya for his paper Can Diffusion-Weighted Magnetic Resonance Imaging Predict Key Biomarkers in Newly-Diagnosed Myeloma? Many thanks to Obex for providing the winning prize.

ELM Clinical Conference Otago (ECCO) The Otago University Medical Students Association held its annual conference mid-September. I stopped by for a bit to observe some of our DoTs and registrars handing out chocolate fish and doing their best to sell the training programmes. Promoting and providing a more visible profile for potential applicants regarding our specialties is an important job for the College. Thanks to those who organised the booth and participated.

Contact us The College’s Wellington office has worked mostly from home in 2020. Nevertheless, members are encouraged to make contact with the office if you have any concerns or questions. Please email nzbranch@ranzcr.org.nz Kia kaha. Stay safe, vigilant and strong.

Dr Bhattacharyya also represented New Zealand at virtual Branch of Origin. Ka Pai Rishi!

Volume 17 No 1 I December 2020

News

The International Committee on Radiological Units & Measurements (ICRU) The prestigious Gray Medal is awarded for outstanding contributions in scientific fields of interest to the ICRU and honours the late Louis Harold Gray, former member and Vice-Chairman of the ICRU and eminent medical physicist and radiobiologist. 21st Gray Medal Recipients: Professor Mary Gospodarowicz and Professor Lester Peters.

His work explored the immutable linkage of overall treatment time with radiation dose and dose per fraction in the response of head-and-neck cancers to ionising radiation; and conduct of clinical trials to address altered fractionation as well as risk stratified approaches for differential dose time prescriptions for postoperative treatment. His landmark randomised trial addressing risk stratification in 1993 remains the guiding standard by which adjuvant radiotherapy for head-and-neck cancer is administered. He also conducted a pivotal randomised trial that prospectively quantitated the effect of radiotherapy

quality using blinded assessment of protocol deviations, showing that poor radiotherapy could outweigh the potential benefit of concurrent chemotherapy, a finding that has influenced radiation oncology practice globally. The College commemorates Prof Peters for his lifetime achievements, recognised in this prestigious award.

Cardiac CT Training 2021 REMOTE ONLINE COURSE COMING...

5 Day Certification and 3 day Recertification course dates TBA Watch this space... www.aicct.com.au

for upcoming Conjoint Committee approved in-person and online course dates.

AICC

Inside News

Lester has authored more than 400 peer-reviewed articles and book chapters and has provided enduring research findings that have profoundly influenced the practice of radiation oncology, especially in head-and-neck cancer management, for radiation oncologists and patients throughout the world. His contributions include exploration of in vitro assays of response to ionising radiation; demonstration of fraction size dependence of tumour and normal tissue response to ionising radiation; and implementing the clinical iso-effect formula that included the alpha/beta ratio and need to appreciate radiation as an ablative tool in hypofractionation versus providing differential effects on tumour and normal tissue achieved through greater fractionation.

TITU

During the election campaign Labour had few new health policy announcements and indicated that they would keeping

The COVID-19 pandemic has produced many challenges, travel restrictions for the College advocacy team included. However, the team looks forward to working through these and establishing strong relationships with New Zealand decision-makers.

AUSTRALIAN

Lester Peters, former College Dean of the Faculty of Radiation Oncology, graduated from the University of Queensland Medical School in 1966, winning the University’s gold medal, and underwent radiation oncology training at the former Queensland Radium Institute in Brisbane. He completed a research fellowship in radiobiology at the CRC Gray Laboratory, London (1972–5). His first faculty appointment was in the Department of Radiotherapy at the University of Texas M D Anderson Cancer Center, Houston in 1975, where he became Professor and Chairman in 1982. In 1995, he returned to Australia to take up the inaugural Chair in Radiation Oncology at Peter MacCallum Cancer Centre in Melbourne.

The College’s priorities for both Faculties were emphatically infrastructure and workforce.

As well as calling on the new Health Minister, the College will also seek meetings with each party’s health spokesperson. This ensures that all parties receive the same messages creating consensus on the implementation of College priorities and holding the government to account if needed.

ULAR CT

Prime Minister Jacinda Ardern has announced her new ministry line up with Andrew Little appointed as the new Health Minister. There are two associate ministers for health—Peeni Henare, with

The College has sent congratulatory letters to the new Health Minister and the Associate Health Ministers and will seek meetings to discuss the College’s election priorities to gain a better understanding of Labour’s agenda for health and the radiology and radiation oncology sector in New Zealand. We seek to work in a constructive way with the new government to promote the College’s agenda to ‘front of mind’.

moving forward with their 2017 election commitments and working through the final report of the Health and Disability Review.

ASC

The New Zealand elections for 2020 have now come and gone with a landslide win for the New Zealand Labour Party. A big achievement for any party with the mixed member proportional representation (MMP) election system used in New Zealand. New Zealand Labour could have governed in their own right but have chosen to negotiate a Co-operation Agreement with the New Zealand Greens giving the Greens two ministry portfolios.

responsibilities for Māori health, and newcomer Dr Ayesha Verrall.

New Zealand Election Outcomes

TE OF CAR

ESCAPE THE BUSY CITY LIFE Welcome to Ballarat. Just 75 minutes west of Melbourne, Ballarat is the perfect blend of art, culture, dining and attractions set against an iconic heritage backdrop.

Outstanding Remuneration Opportunities Equity Participation Model Interesting case mix across all modalities Collegiate Environment Fellowship opportunities (MSK, Breast, NucMed)

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News

Australian and New Zealand Emergency Radiology Group (ANZERG) Emergency radiology has played a vital role globally during the pandemic. Following on from my last communication to our members in late March 2020, I have had regular and extensive communications from emergency radiologists around the world informing each other of the state of the COVID-19 situation in their country. With the exception of Victoria, we have been very fortunate to not have faced the extent of the pandemic seen in some countries. The challenge before us now is to normalise our services as quickly and efficiently as possible yet be prepared to revert to be able to manage any significant spread of the virus.

Australian and New Zealand Radiology Group of emergency Emergency radiology and bringing Due to the success of the(ANZERG) webinar series all other national societies and special interest groups under one umbrella. There are important resources available on the website.

the College is looking at running more webinars until we can all meet face-toface again. If you have any suggestions for topics, eminent speakers or other ideas please email the College events team at events@ranzcr.edu.au

Showcase/. CPD points can be claimed on the member portal at one point per hour under 'Web-Based Learning'. Thank you to those who stayed up in the early hours of the morning or late in the evening to attend the session.

post-COVID.

Emergency radiology has played a vital role globally during the pandemic. Foll As part of the RANZCR Webinar Series, my last communicationwetopartnered our members in late March 2020, I have had regular with Everlight Radiology on Wednesday 14 October and Unfortunately, due to the pandemic, “The challenge before communications from emergency radiologists around the world informing each delivered a virtual lecture on ‘Imaging ANZERG has not been able to us state now isoftothe normalise the Vascular System undertake any face-to-face activities COVID-19 Emergencies situationof in their country. With the exception of Victoria, Webinar’. The guest speaker was Dr but I am hoping that we will be able to ourvery services as to not have fortunate faced Clinical the extent pandemic seen in some coun John Vedelago, Director at of the hold more virtual lectures in 2021. We Everlight Radiology and an emergency are planning having a dedicated quickly and efficiently challenge before us now is to normalise our services asonquickly and efficiently radiologist. He leads the overnight session on emergency radiology at the as possible yet be team to in the United Kingdom. RANZCR2021 ASMspread in Melbourne. be prepared to revert toradiologist be able manage any significant of the virus. Cases presented covered common and prepared to revert to There is an ongoing vacancy for an less common examples of emergency ANZERG Executive Committee member, and trauma department presentations on formalising the World Federati be Meanwhile able to manage any of us a group have been working if you are interested please write to us. attributable to an acute vascular are not a member of ANZERG significant spread of pathology. Emergency Radiology (WFER www.wfer.org) asIfplease ayounot-for-profit organisation a provide your details and we will thelaunch virus.“ it next year. ANZERG 151 members joined withof thethe major register you as a member. There is no will beus live one members of WFER and a majority from Australia and New Zealand fee for joining. ANZERG you will be able advantage and 25to pertake cent from other countries. of all resources and benefits. I wil If you have any questions for me or the Meanwhile a group of us have been The overall rating of the presentation updated as we progress into establishing the global emergency rad specialplatform interest group of executive, please working on formalising the World was a whopping 9/10. If you weren’t able direct them to anzerg@ranzcr.edu.au Federation of Emergency Radiology to attend, the recording is available on bringing all other national societies and special interest groups under one umb (WFER www.wfer.org) as a not-for-profit the College webcast library: safe and let us look forward to important on the website. Stay organisation and hoperesources to launch it next available www.webcast.ranzcr.com/Mediasite/ coming back with more vigour and zeal year. ANZERG will be one of the major members of WFER and as a member of ANZERG you will be able to take advantage of all resources and benefits. I will keep you updated as we progress into establishing the global platform

As part of the RANZCR Webinar Series, we partnered with Everlight Radiology Dinesh Varma Wednesday 14 October and delivered a virtual lecture on ‘Imaging Emergencie Chair ANZERG Vascular System Webinar’. The guest speaker was Dr John Vedelago, Clinica Everlight Radiology and an emergency radiologist. He leads the overnight radi the United Kingdom. Cases presented covered common and less common exa emergency and trauma department presentations attributable to an acute vasc Inside News

General Interest

Member Rewards Program BUPA Health Insurance Bupa’s goals align with our goals—they are committed to helping people live longer, healthier, happier lives, with a focus on preventative health. Bupa Corporate offers considerable health cover savings on members’ private cover. Their aim is to give you better, smarter, and more flexible cover options from day one. We have worked together to create an exclusive offer tailored specially for members.

Our Member Rewards Program delivers maximum value for your membership subscription fee. You can now access a specially selected, exclusive and valuable rewards program which is only for members. The program has been tailored to your needs— financial, insurance, legal, travel and lifestyle products and services are included. To see all of the offers available to members in the Member Rewards Program, please go to our website at: www.ranzcr.com/college/ member-rewards

~ In Memoriam ~ The College notes with regret the death of the following members:

NobleOak Life Insurance NobleOak is an Australian independent life insurer with more than 140 years of experience. They believe in bringing members life insurance the way it is meant to be—combining quality, nosurprises cover with personal service and lower premiums. NobleOak has just been announced as the national winner of the prestigious 2020 Canstar Outstanding Value Award for its Premium Life Direct Life cover— for the fifth year in a row. College members are entitled to a 10 per cent lifetime discount on life insurance products, saving 22 per cent on average compared to other insurers. Plus, take out Life Insurance Cover with NobleOak and receive $20,000 in bonus Life cover.

• a four per cent discount on Health Insurance • the waiving of two and six month waiting periods on selected Extras when you combine Hospital and Extras cover—giving you immediate access to general dental, optical, physiotherapeutic, chiropractic services and more • no waiting periods for services you were covered for with your previous health insurer • a range of other discounts and benefits. We encourage you to compare your health plan with Bupa Corporate’s offer for members. Note that terms and conditions apply. Call 134 135 and quote RANZCR ID# 2133228, or find out more at: www.ranzcr.com/college/memberrewards

Get an instant quote or find out the conditions of the offer at www.nobleoak.com.au/ranzcr or phone NobleOak on 1300 108 490 and mention the code ‘RANZCR’.

Dr Colin Alexander Bull, Life Member, NSW Dr Andrew John Scott, Fellow, NSW Dr John Albert Violet, Fellow, VIC Volume 17 No 1 I December 2020

General Interest

The Medical Council of New Zealand (MCNZ) sets the requirements for the recertification of doctors practising medicine in New Zealand. The principle function is to protect the health and safety of the public by ensuring doctors are competent and fit to practise. This is done through setting standards of clinical and cultural competence and ethical conduct.

Cultural safety standards for New Zealand doctors There are four current standards: medical care and prescribing; communication and consent; cultural safety; and conduct and professionalism. MCNZ requires doctors to meet cultural safety standards. Cultural safety focuses on the patient and provides space for patients to be involved in decision-making about their own care and contribute to the achievement of positive health outcomes and experiences. MCNZ have published a number of useful resources to assist doctors in meeting the standards. The “Statement on Cultural Safety2” outlines what cultural safety means, why it is important and the advancement from the cultural competence of doctors to cultural safety. Within the statement, cultural safety has been defined as the need for doctors to examine themselves and the potential impact of their own culture on clinical interactions and healthcare service delivery and the effect on the quality of care provided. MCNZ recognises that cultural safety benefits all patients and communities and has a central role in health equity. It is well-documented that Māori experience significant health inequity compared to the rest of the New

Zealand population across most areas of health. MCNZ’s “He Ara Hauora Māori: A Pathway to Māori Health Equity3” is a useful resource for doctors and healthcare providers in supporting cultural safety and Māori health equity as clinicians have a responsibility to work toward eliminating health inequities. It is important for clinicians to read this in conjunction with the Statement on Cultural Safety.

“MCNZ recognises that cultural safety benefits all patients and communities and has a central role in health equity. It is welldocumented that Māori experience significant health inequity compared to the rest of the New Zealand population across most areas of health.“ Continuing Professional Development (CPD) Cultural safety requires doctors to reflect on how their own views and biases impact on their clinical interactions and the care they provide to patients and as such cultural safety, and a focus on health equity, must be embedded across, and within, all of the CPD categories: reviewing and reflecting

on practice; measuring and improving outcomes; and educational activities. This is illustrated in Figure 1. As a new and emerging area for doctors to report against, the College is actively working with MCNZ to enable you to meet the recertification cultural safety standard and have the resources available for practical application in your workplace.

Figure 1. Core requirements of recertification for vocationally-registered doctor in New Zealand4

Update from the MCNZ regarding recertification changes The MCNZ has recently confirmed members will need to complete the current audit requirements in the updated recertification programme, and record the audit under Measuring Outcomes.

If you have any questions or concerns about the upcoming changes to your continuing professional development and recertification in New Zealand and/or your Australian medical registration requirements, please send them to cpd@ranzcr.edu.au

References 1 https://www.mcnz.org.nz/our-standards/current-standards/ 2 https://www.mcnz.org.nz/assets/standards/b71d139dca/Statement-on-cultural-safety.pdf 3 https://www.mcnz.org.nz/assets/standards/6c2ece58e8/He-Ara-Hauora-Maori-A-Pathway-to-Maori-Health-Equity.pdf 4 Recertification requirements for vocationally-registered doctors practising in New Zealand (draft model April 2019) Medical Council of New Zealand

Inside News

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