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Volume 13 No 1 / December 2016

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

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In this edition 5 President’s Message 7 CEO Message Engaged Members 8 COVER STORY 2016 Annual Scientific Meeting 15 Member Profile 16 2017 Grants, Awards and Prizes Effective Governance 17 2017 Board and Faculty Councils Research 21 The Role of Research 22 Research Awards and Prizes Access to Quality Service 23 Choosing Wisely 24 Medicare Benefits Review Taskforce Update Quality Practice 25 Committees, Working Groups and Reference Groups Profile and Presence 29 International Day of Radiology 2016 30 InsideRadiology 31 Targeting Cancer 32 The Consumer Viewpoint

From the

Editor’s Desk With 2016 drawing to a close, in this edition we reflect on what has been a year of great achievements, as well as looking ahead to what the future may bring, as our President, in his message, urges us all to embrace a new partnership with technology. Our cover story highlights this year’s wonderful Annual Scientific Meeting on the Gold Coast, including a quality scientific program and entertaining social events, as well as the hugely popular Radiopaedia Case of the Day.

Dr Allan Wycherley

We congratulate all the 2016 recipients of our grants, awards, honours and prizes, and invite you to start thinking about which colleagues you might like to nominate for an award next year. It has been a great few months for raising the profile of our professions, with RANZCR co-hosting a parliamentary event that coincided with International Day of Radiology celebrations, and the launch of the Faculty of Radiation Oncology’s Choosing Wisely Australia recommendations.

Quality Training 35 Trainee Selection 38 Exam and Assessment Review Update

The results are in for the 2016 Clinical Radiology Workforce Census, and we also announce a review of the College’s Trainee Selection Guidelines to better support recruitment and retention in nonmetropolitan areas.

Clinical Radiology 43 Message from the Dean 45 Chief Censor 47 Trainee Update 48 Ground Breaking New Study – Vertebroplasty

We share the highlights from our recent interview with Sally Crossing, Consumer Representative on the Faculty of Radiation Oncology Council, about her experiences as a consumer advocate for cancer treatment.

kin, Woden, Radiation Oncology 53 Message from the Dean 55 Chief Censor g, Deakin, 57 Trainee News 59 Influencing Best Practice n, Tuggeranong, in Breast Cancer geranong, Deakin, General Interest kin, Tuggeranong, 61 New Zealand Branch 63 Australian Branches 64 From the Archives g, Deakin, Woden, 65 Meetings and Events en, Tuggeranong, g, Deakin, Inside News is printed on Titan Satin. Titan is produced in an ISO 14001 accredited facility en, ensuring all processes involved in production are of the highest environmental standards. n, FSC mixed Sources Chain of Custody (CoC) certification ensures fibre is sourced from certified and well managed forests.

Editorial Staff Editor-In-Chief Dr Allan Wycherley Sub Editors Susannah Musgrove Bertha Harvey

Progress continues to be made in implementing the recommendations from our examination and assessment review, and we bring you news of a new home for our clinical radiology viva exams. All this and more in our final edition of 2016. We would like to thank everyone who has contributed to the newsletter throughout the year, and wish you all a restful holiday season. Allan Wycherley Editor-in-Chief editor@ranzcr.edu.au The Royal Australian and New Zealand College of Radiologists Level 9, 51 Druitt Street Sydney NSW 2000 Ph: +61 2 9268 9777 Fax: +61 2 9268 9799 Web: www.ranzcr.edu.au Email: ranzcr@ranzcr.edu.au

Submissions The submission of articles, letters and news items is encouraged. Submissions should be sent to editor@ranzcr.edu.au The Editor reserves the right to make literary corrections and to withhold from publication any or part of any material submitted.

New Zealand Office Floor 6, 142 Lambton Quay Wellington, NEW ZEALAND Ph: +64 4 472 6470 Fax: +64 4 472 6474 Email: nzbranch@ranzcr.org.nz

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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Introduction

A New Partnership with Technology A Message from the

President Dr Greg Slater

It is usual at the end of a year to look back at what we have achieved and wonder how another twelve months could have passed so quickly. But I want to look forward to where our profession is headed. When the focus turns to the future it’s hard not to wonder, or for some, not to worry about the impact of new technology on the work of clinical radiologists and radiation oncologists. We are already working in a highly technical field with complex and costly tools barely conceived a generation ago. But none of us can believe the pace of technological change will flag anytime soon. At times it feels overwhelming. The medical technologist, Dr Joseph Kim summed up his view of our profession with the line, “Our next radiologist may be a computer.” That’s the sort of statement that tends to encourage pessimists, but we need to be careful about how we interpret what the futurologists are telling us. The suggestion is not that computers will make us redundant—although that’s a risk faced by all humans if you’ve been listening to Stephen Hawking on the dangers posed by smart robots. Dr Kim is simply acknowledging the continued development of clinical decision support software to reduce diagnostic errors in reading images.1 Many of you will be familiar with IBM’s Watson project, a computer software

system which in 2011 successfully won the quiz show Jeopardy! against two former champions. This was heralded as a milestone in natural-language processing and machine learning, and it grabbed headlines because losing a general knowledge test to a computer in a competition crystallises our fears about intelligent machines: it feels like it’s us against them.

“The objective is not to replace radiologists but to make us better at what we do.” What got overlooked in the news was IBM’s stated objective, which is, and I quote, to develop “a cognitive system enabling a new partnership between people and computers.”2 Note the words, a new partnership. This is not a technology designed to beat us at something. It’s a tool designed to turn all of us into quiz champions or polymaths, experts in many areas. IBM has a software project titled AviCenna which the company recently claimed can read medical images, identify abnormalities and suggest possible diagnoses.

The stated objective, if you accept it, is not to replace radiologists but to make us better at what we do—for example, by compensating for a tendency the radiologist might have to over-focus on a particular diagnosis, without full consideration of alternatives. IBM is looking to improve the accuracy of the AviCenna software. It’s buying billions of medical images and anonymised electronic health records and using data analytics or data mining to generate image-processing algorithms which automate a part of what the clinical radiologist does every day. This project, and others, have produced promising results already.3 But observers say such initiatives still need to demonstrate their value in the real world where software tools must be integrated with existing IT systems and, crucially, must be able to create a net economic benefit. The College does some star-gazing of its own from time to time—it is a vitally important part of the College’s work on behalf of members. In 2015 we issued position papers on image-guided radiation therapy and heavy particle therapy—two areas which have progressed rapidly in the last 15 years. Then in April this year we published the findings of a comprehensive horizon scan on the techniques and technologies currently in use in radiation oncology. continued over... Volume 13 No 1 I December 2016

Introduction

It is evident that radiation oncology is inhibited by a degree of misunderstanding of the technological advances in this field and by the mechanisms used to assess these advances. As a result, utilisation rates of radiation therapy in Australia and New Zealand are below the optimum, which we all know translates into poorer health outcomes, an increased burden of pain and suffering and lives lost. This year’s horizon scan noted, for example, that despite the growing weight of evidence supporting the use of heavy particle therapy for certain cancers, and over 50 centres providing this therapy worldwide, the therapy is not currently available here. In recent times we have come to accept many new radiological technologies, including robotic radiosurgery, fourdimensional CT scanning, optical imaging, molecular breast imaging and intensity-modulated radiation therapy. On the horizon we can see many new technologies with potential, including fluorescent tumour imaging, microbeam therapy, motion adaptation techniques and the use of heavy ions such as carbon. These are exciting hardware developments that promise to make clinical radiology and radiation oncology more powerful and accurate than we could have imagined just a decade ago. But even modest initiatives such as workflow orchestration software are bringing material change by dynamically optimising the work processes of radiologists. And there is more to come. Professor Paul Chang, Vice Chairman of Radiology Informatics at the University of Chicago School of Medicine says the software in use in radiology is 10 years behind where industries outside health care are at in leveraging IT to optimise workflow and mitigate what he calls “the liabilities of humans.”4 The liabilities of humans. Have you ever considered how easy your job would be without the liabilities of humans? A senior executive at the global consulting firm Accenture said recently the healthcare industry was moving away from a world driven by labour and enabled by technology towards a world driven by data and enabled by humans.

Inside News

The leading businesses in this bold new world would be those that ‘put people first,’ using machines to ‘liberate’ the healthcare worker and put the ‘care’ back into health care.5 I don’t know how you feel, but I’m a little sceptical, especially when it’s coming from a consulting firm that earns AU$40 billion a year. However, despite my initial misgivings, the vision offered by Accenture is a good one. This is how we want health care to be—a world in which clinicians are highly informed and expertly assisted by machines but doing what humans do best, which is dealing with the liabilities of their fellow humans with compassion, sensitivity and trust. When I look ahead at what the future is bringing, in particular for our new graduates, I think we will all need to be adept in preparing for the many challenges ahead. Central to these challenges will be how our profession demonstrates its unique value in the company of skilled technicians, pushy administrators and intelligent robots, and how well we learn to use new and brilliant tools to improve our practice and enhance what we contribute to patient care. Best wishes to you all for the coming year.

References 1. Joseph Kim, “Automated diagnostics: how supercomputers fit in radiology’s future,” SearchHealthIT.com, 20 December 2013, http://searchhealthit.techtarget.com/feature/ Automated-diagnostics-How-supercomputersfit-in-radiologys-future 2. IBM, “Meet Watson,” webpage metatag, www.ibm.com/watson/ 3. Tom Simonite, “IBM’s automated radiologist can read images and medical records,” MIT Technology Review, February 4, 2016, www.technologyreview.com/s/600706/ibmsautomated-radiologist-can-read-images-andmedical-records/ 4. Jeannette Sabatini, “Reengineering Workflow,” Radiology Today, vol. 17 No. 7 (July 2016), 12, www.radiologytoday.net/archive/ rt0716p12.shtml 5. Kaveh Safevi, “The future of healthcare is not people versus machines,” TechCrunch, July 11, 2016, www.techcrunch.com/2016/07/11/thefuture-of-healthcare-is-not-people-vs-machines/

Introduction

A Year of Great Achievement From the

Chief Executive Officer Ms Natalia Vukolova

The story of the College is a story about the extraordinary commitment and generosity of clinical radiologists and radiation oncologists in setting and improving the standards of patient care for Australians and New Zealanders. In over 80 years of its existence, the College has harnessed the creative and hard-working minds of members to establish our current standards, training programs and advocacy campaigns.

Our strength today remains our members In 2016, over 1000 members committed their time, expertise and support to the College. They are members like you, whose care and commitment makes a positive, lasting impact every day and whose ongoing support we rely on to carry out our vital work. We had an outstanding response to our inaugural member survey, with 1,125 members sending their feedback, and many elections for College committee positions have been hotly contested.

It’s been a year of great achievement An outstanding Annual Scientific Meeting in the Gold Coast closed a fantastic year in which we have started implementing a pivotal review of our training programs. Extensive membership involvement, combined with world-class medical education and examinations expertise, will see to the success of this initiative and will put our College into a leading role for medical

education best-practice. The College has also announced the establishment of the Interventional Radiology Standing Committee within the Faculty of Clinical Radiology, which will give proper recognition to this exciting area of practice.

Our vision for 2017 is to continue pursuing excellence across all College programs, and to inspire the next generation of members to bring their energy and intellect to volunteer for their profession. Happy festive season!

Our capacity to advocate to governments has increased dramatically and has been bearing fruit, as much in delivering outcomes that we think are appropriate (as with the MBS Review and IMRT funding) and in preventing governments from making nonsensical decisions whenever possible. This year had challenges, including the difficult issue of the resurgence of pneumoconiosis in Queensland mines. Our concern is primarily with the affected miners and our focus is on ensuring that a sustainable system is in place to manage screening. Our advocacy for better patient care and responsible use of health resources has been embodied in our Australian and now also New Zealand Choosing Wisely campaigns, in the release of the much lauded Iodinated Contrast Media Guideline in clinical radiology and the Position Paper on Particle Therapy in radiation oncology. The consumer resource website InsideRadiology.com.au has been updated, despite the loss of grant funding. And, of course, our Targeting Cancer campaign for radiation therapy has been going from strength to strength.

Please write to me with any questions or comments on ceo@ranzcr.edu.au

Volume 13 No 1 I December 2016

Engaged Members

2016 Annual Scientific Meeting – It’s a Wrap! The College held its 67th Annual Scientific Meeting from 13-16 October 2016 at the Gold Coast Convention and Exhibition Centre on the Gold Coast, famous for its sun, surf and sand. Focusing on the theme of Appropriate, Collaborative and Targeted, the meeting attracted over 1,200 delegates across clinical radiology, radiation oncology and allied health professions, with participants travelling from as far as the US and Europe to partake in the diverse and informative program and workshops over three and a half days. Highlights of the radiology program included Radiopaedia’s Case of the Day, which was held in partnership with the College for the first time, with international speakers covering neuroimaging, MSK, oncology, liver, breast and paediatric imaging as well as showcasing the enormous breadth and depth of Australian and New Zealand based speakers. In addition, a number of excellent workshops were held as part of the extensive program including the

well-recognised Breast Test and CPR workshops. Radiation oncology was not to be outdone with a program that included international speakers from the US and Europe who presented on a variety of topical issues. The launch of the inaugural FROLIC (Faculty of Radiation Oncology Lung Interest Cooperative) Lung Contouring Workshop was well received and provided participants with the opportunity to contour two lung cancer cases prior to the meeting, at which they were then given an opportunity to compare their contours with the experts in the field to improve/ validate their contouring skills. The scientific sessions generated so much interest that great discussions were conducted not only during the breaks, but also on social media. In the days leading up to the conference and during the event, the #RANZCR2016 was mentioned in over 2,000 tweets and generated over 3.3 million impressions. There were also many exchanges using

the highly popular #RADgold which was trending on Twitter! Thank you to everyone who took part in these conversations and tweeted pictures. In addition to social media, technology played a great role during this meeting. The EPOS™/Webcasting and Internet Lounge in the Exhibition Hall provided access to these resources during the meeting. Scientific presentations were recorded during the meeting, so if you missed a particular presentation, we encourage you to visit the College Webcast Catalog at webcast.ranzcr. edu.au/Mediasite/Showcase/default/ Channel/ranzcr-asm-2016 and take advantage of the free access to these recordings. The meeting e-posters are also available to view at www.ranzcr.edu.au/epos This year once again saw the publication of abstracts via the Journal of Medical Imaging and Radiation Oncology (JMIRO) online library. They can be viewed at www.ranzcr.edu. au/research/jmiro The 2016 ASM conference app was a valuable and informative tool for delegates and industry alike, and will be utilised at future ASMs. Apart from learning, the meeting was also a great chance for delegates to network at the enticing social program put together by the Organising Committee. Highlights included Dr David Schlect, as Nisbet Orator at the Annual Ceremony, and the Targeting Cancer Fun Run, which included a scenic loop around Pratten Park running along the ocean foreshore near the Kurrawa Surf Club. The Gala Dinner was the social function highpoint of the conference. With a touch of bling, many delegates took the opportunity to dress in theme and enjoy a fabulous night of fine food, wine and entertainment including a dance off between the two

Inside News

Engaged Members

RANZCR announces longterm partnership with Varian Medical Systems specialties! Needless to say there were many disappointed faces on the dancefloor when the lights came on to wrap up the evening. Delegates will have received their certificates of attendance by now, so don’t forget to claim your CPD points via CPD Online. A maximum of 22.75 RANZCR CPD points can be claimed for full attendance at the scientific meeting (additional CPD points are claimable for attendance at workshops). The College would like to take this opportunity to thank everyone who attended, and in particular speakers, sponsors and exhibitors for attending and continuing to support the College meetings. A special thanks to the 2016 Convenors Drs Jonathan Corness and Sanjay Dhupelia (clinical radiology) and Drs Catherine Bettington and Jim Jackson (radiation oncology) and the local organising committee for presenting a successful and memorable conference.

The College is delighted to announce that Varian Medical Systems is the first organisation to partner with the College in committing long-term support towards our educational events and activities. At the recent 2016 ASM on the Gold Coast, Varian and College representatives signed a three-year agreement for Varian to provide sponsorship to the end of 2019. The agreement marks the largest financial contribution an organisation has dedicated to the College, and sets a solid foundation for a collaborative, innovative and exciting partnership. The sponsorship agreement covers a number of areas across the College’s portfolio including, but not limited to, the national and New Zealand Annual Scientific Meetings, trainee educational grants, NSW Radiotherapy Club meetings and the award-winning Targeting Cancer campaign. Dr Greg Slater, President of the College, expressed his gratitude: “To have a long-standing supporter such as Varian sign up as the first long-term sponsor of RANZCR is a very exciting prospect. I would like to personally thank Varian, and especially Chris Cowley, Managing Director, for the support and generosity towards the College’s activities.”

Representatives from Varian and RANZCR at the Annual Scientific Meeting 2016.

Volume 13 No 1 I December 2016

Engaged Members

2016 ASM Prize Recipients Radiology Philips Healthcare Australasia Scientific Paper Prize

I-Med Best Emergency Radiology Scientific Exhibit Prize

Wiley Best Exhibit Award – Radiation Oncology

Dr Gabrielle James

Dr Natalia Mitina

Dr Nicholas Brown

P-EASY Trial: Prostate Artery Embolisation Assessment of Safety and Efficacy Toshiba Scientific Paper Presentation Prize

Review of Methods of Streamlining Emergency Department Radiology Studies as Part of a Clinical Redesign Project Toshiba Scientific Exhibit Prize Dr Wei Che Tsai

Dr Gregory Tarr

Salvage External Beam Radiotherapy for Biopsy Proven Prostate Cancer Recurrence after Initial Low Dose Rate Brachytherapy Treatment - Single Institution Case Series Chris Atkinson Award – Best Radiation Oncology Scientific Paper Presentation Prof Michael MacManus

MRI of Perianal Fistulas in Crohn’s Disease Grey Level Texture Features on CT Head Predict Death and Disability Following Intracerebral Haemorrhage

Radiation Oncology

Branch of Origin

Varian Prize

Dr Gregory Tarr

Dr Eunji Hwang

Trauma related Pseudopneumoperitoneum – Costochondral Vaccum Phenomenon Wiley Best Exhibit Award – Radiology

Treatment with Six Cycles of CVP or R-CVP After Involved Field Radiation Therapy (IFRT) Significantly Improves Progression-free Survival Compared to IFRT Alone in Stage I-II Low Grade Follicular lymphoma: Results of TROG 99.03 / ANZLG NHLLow5 Elekta Award – The Advances in the Use of Technology in Radiation Therapy Dr Mark Sidhom Early Results of Australian Multicentre Phase 2 Trial of Stereotactic “Virtual HDR” Radiation Therapy for Intermediate and High Risk Prostate Cancer David Wigg Prize for Radiobiology Research

Dr Leanne Du

Dr Myo Min Variations in Breast Cancer Histology and Treatment Patterns between the Major Ethnic Groups of South West Sydney Radiologist Workload and Workforce Modelling: Application using Gold Coast Hospital and Health Service Medical Imaging Service

Inside News

Early Results of a Prospective Study Evaluating the Predictive Utility of Pre-Treatment Multi-Parametric MRI (Diffusion-Weighted and R2*) in Patients with Head and Neck Cancer Treated with Radiation Therapy

Engaged Members

2016 College Prizes, Awards and Honours College Honours Gold Medal – Prof Gillian Duchesne

Roentgen Medal – Dr Matthew Andrews

Roentgen Medal – A/Prof Sandra Turner

Prof Duchesne is a radiation oncologist of international renown and has made a tremendous contribution to genito-urinary oncology through her involvement in education and research, both in Australia and the United Kingdom.

Dr Andrews has made outstanding contributions to the work of the College, with more than a decade served on the College Council (now Board), including two years as President. He has also been an integral member of many College committees, responsible for achievements such as the College’s first ever Standards of Practice.

A/Prof Turner has been involved with many educational activities of the College and, as Chief Censor in Radiation Oncology (2010-2013), played an integral role in re-shaping the radiation oncology training curriculum into a competency based program.

Prof Duchesne has also contributed significantly to the College and was a key leader in the governance restructure in 2013 whilst serving as Dean of the Faculty of Radiation Oncology.

Dr Andrews has represented the College on a number of government committees, most recently the Medicare Benefits Schedule Review Taskforce.

As the current Chair of the Faculty of Radiation Oncology’s Media and Profile Committee, A/Prof Turner guides the Targeting Cancer campaign, for which she has been the champion and Clinical Lead since its launch in 2013. Further information about these recipients is available on the College website. www.ranzcr.edu.au/members/awards-aprizes/college-honours

Life Membership

Dr Robert Allen

Denise Lonergan Educational Service Award

Dr Jayasingham Jayamohan The following prize recipients were unable to attend the meeting:

A/Prof Roger Allison

A/Prof Martin Berry

Dr Bernard Mason

Dr Peter Pratten

Examination Prizes C.E. Eddy Prize – Radiation Oncology

C.E. Eddy Prize – Clinical Radiology

H.R. Sear Prize – Clinical Radiology

M.G.F. Donnan Prize

Dr Yuvnik Trada

Dr Nicholas Begg

Dr Samuel Kruger

Dr Amir Rezaee

Life Membership Dr Colin Bull Dr Geoffrey Robey Dr Swithin Song

Clinical Radiology Educational Service Award Dr Geoffrey Robey

Thomas Baker Fellowship Dr Chris Rogan Please see page 22 for the 2016 Research Prize winners. Volume 13 No 1 I December 2016

RANZCR PERTH 2017

68th Annual Scientific Meeting

explore the

extraordinary extraordinary explore the

19 – 22 October 2017 Crown Perth Convention Centre Western Australia www.ranzcr2017.com Key Dates Call for Abstracts Open:

January 2017

Call for Abstracts Close:

April 2017

Registrations Open:

April 2017

Sponsorship and Exhibition Opportunities Now Available Contact EECW for further details or to tailor a package to suit your marketing objectives (08) 9389 1488, ranzcr@eecw.com.au

Keynote Speakers Radiology Prof Jeff Geschwind, Yale University School of Medicine, USA Prof Suresh K. Mukherji, Michigan State University, USA Prof Michael P. Federle, Stanford University Medical Center, USA Prof Mark J. Kransdorf, Mayo Clinic College of Medicine, USA Radiation Oncology Prof Brian O’Sullivan, Princess Margaret Cancer Centre, University of Toronto, Toronto Prof Lena Specht, Rigshospitalet, Copenhagen University Hospital, Denmark

Engaged Members

Invitation to RANCR 2017 in Perth We invite you to ‘Explore the Extraordinary’ and join us in Perth from 19–22 October 2017 for the College’s 68th Annual Scientific Meeting. The 2017 ASM will take on a fresh look with the Crown Perth selected as the venue. The complex boasts three hotels onsite including the new six-star Crown Towers, Crown Metropol and Crown Promenade, an array of restaurants, bars and a casino. The Crown Metropol is particularly conducive for families, with facilities including water slides by a lagoon style swimming pool, sure to keep your family occupied for hours while you hear from some of clinical radiology and radiation oncology’s leading thinkers. The 2017 clinical radiology line-up includes lead author of the abdominal STATDX books Dr Michael Federle from Stanford University. Dr Suresh Mukherji from Michigan State University is a world authority in head and neck cancer imaging, and is the author of hundreds of peer reviewed papers and a dozen book chapters. Dr Mark Kransdorf is a leading musculoskeletal radiologist from the Mayo Clinic and past President of the Society of Skeletal Radiology, and his lectures are renowned for rad-path correlation. To round out our international line up we have Dr Jeff Geschwind, an interventional radiologist from Yale University.

The new 6-star Crown Towers, one of 3 hotels onsite at the host venue Crown Perth.

A world leader in the field of liver cancer, Jeff was previously Chief Researcher of Interventional Radiology at Johns Hopkins University.

We are working hard to build on the success from previous ASMs and create social events that will captivate and enchant you.

Radiation oncology has a spirited line up and we are honoured to have Professor Brian O’Sullivan, Head and Neck Oncology Program Chair at Princess Margaret Cancer Centre. Professor O’Sullivan is best known for the randomised trial of preop vs postop radiotherapy for sarcoma, which shapes our practice to this day, and has published 300 papers, 50 book chapters, and has written or been editor of six oncology textbooks.

So don’t delay. Book your leave today! Stay a little longer and explore what Western Australia has to offer. Dr Kevin Ho Clinical Radiology Convenor Dr Suki Gill Dr Eugene Leong Radiation Oncology Co-Convenors

Professor Lena Specht is the Head of Oncology at Copenhagen University and Vice President of the International Lymphoma Radiation Oncology Group (ILROG). She has 200 publications, two books and 22 book chapters, including ESMO guidelines on peripheral T-cell lymphomas and cutaneous lymphomas, and ILROG guidelines on radiation therapy for lymphomas. She is also a FALCON contouring teacher.

68th Annual Scientific Meeting 19 – 22 October 2017 Crown Perth, Australia

Dr Jeff Geschwind, Interventional Radiologist, Yale University.

Prof Lena Specht, Head of Oncology, Copenhagen University.

explore the

extraordinary

explore the

extraordinary

www.ranzcr2017.com

Volume 13 No 1 I December 2016

Engaged Members

ASM 2017 Paper and Exhibit Prizes We are pleased to offer the following awards and prizes for the scientific component of the meeting. Please refer to the meeting website for full details: http://www.ranzcr2017.com/abstract-information

Clinical Radiology Wiley Best Exhibit Prize I-Med Australia Best Emergency Radiology Scientific Exhibit / Oral Presentation Exhibit Prize

Radiation Oncology Varian Prize Chris Atkinson Award – Best Radiation Oncology Scientific Paper Presentation Elekta Award – The Advances in the use of Technology in Radiation Therapy Presentation Prize Wiley Best Exhibit Prize The David Wigg Prize for Radiobiology Research

Inside News

The Results Are In: Member Survey Summary Report Now Available The inaugural RANZCR member survey, conducted earlier this year, has been a hugely valuable exercise for the College. The survey has provided confirmation that the strategic scope of the College is aligned with members’ needs, whilst bringing to light areas where the College may need to direct more resources. The College is taking a considered approach in responding to key findings and issues highlighted in the survey data, and this response will be shared with the membership throughout 2017, in future issues of Inside News. In the meantime, members can now download a brief report summarising the survey results from the College website www.ranzcr.edu.au/news-aevents/latest-news If you have any questions or would like to provide further feedback, please contact Susannah Musgrove, Manager, Member Liaison, at the College on members@ranzcr.edu.au

Engaged Members

Dr Rajiv Rattan Clinical Director, Medical Imaging at the Central Coast Local Health District, NSW 2017 Elected Councillor, Faculty of Clinical Radiology

Dr Rajiv Rattan

Background

Why I Am Involved

Having trained and worked overseas in radiology, I have spent nearly all of the last decade as a staff radiologist at Gosford Hospital in the picturesque Central Coast of NSW, where I am the Clinical Director leading an enthusiastic and talented team. Though I am a general radiologist, I have a subspecialty interest in emergency and chest imaging.

How does one give back to the profession that has given one so much?

My involvement with the College began a few years ago when we were seeking accreditation for a radiology registrar program at the Central Coast Local Health District (CCLHD). Since then we have established a thriving training program and embarked on creating radiology training networks across NSW, with CCLHD becoming a constituent of LAN1 as “the newest kid on the block”. Exciting times indeed! We have now established a tradition of radiology education by conducting radiology foundation courses and offering a structured mock viva exam to registrars in Australia and New Zealand for the FRANZCR Part 2 exams. My interest in teaching and training has led me to various roles within the College, including alternate Branch Education Officer, Part 2 Examiner and an International Medical Graduate assessor. I sincerely believe that the best way to keep learning is to teach! Outside of radiology, music, painting, photography and theatre keep life interesting for me.

To be able to contribute and give back to our specialty, in howsoever small a measure, is a privilege and an honour. We are all part of an exciting frontline medical discipline with radiologists increasingly seen as decision makers in health care. The technological advances in radiology in the last few decades are unprecedented. We now have a window into the workings of the human body like never before.

“By contributing to our college we can actually be a part of the change that we would like to see.” Despite our skills and the cutting edge technology at our disposal, the community at large is not aware of our contribution to health care. Strong, meaningful and sustained advocacy of our profession is the only way to ensure that future generation of radiologists derive the same satisfaction and pleasure from practising radiology as we do.

The future of our profession depends on us – providing the highest quality of care to our patients and referrers, constant innovation, forging links with radiologists across the globe and being accessible to our referrers when they need us most will determine the trajectory of radiology in the years to come. The Faculty of Clinical Radiology has championed and promoted our cause and has effectively reached out to the community and successive governments. I am hoping to “chip in” and help our parent organisation and discipline in whatever way I can.

Encouragement to Others Aristotle said “Together the whole is more than the sum of its parts.” The College will be whatever we make it to be! The College is the lynchpin and guiding force of radiology in Australia and New Zealand. By contributing to our college we can actually be a part of the change that we would like to see. The College is for us and more importantly “by us”. So join in and make it happen!

Volume 13 No 1 I December 2016

Engaged Members

Grants, Awards and Prizes 2017 In January 2017 the College will invite nominations and applications for the following awards, honours and Fellowships, to recognise outstanding contributions and service by members to their professions, and to support deserving members to further their knowledge and expertise by travelling overseas. Please visit the College website for guidelines and application forms www.ranzcr.edu.au/members/awards-a-prizes

College Honours Gold Medal The Gold Medal is the highest accolade to be awarded by the College. It honours a Fellow who has rendered outstanding service or benefactions to the development, teaching or practice of clinical radiology or radiation oncology in Australasia and/or Singapore.

Sponsored Honours and Education Fellowships Thomas Baker Fellowship The Thomas Baker Fellowship supports a qualified clinical radiologist or radiation oncologist (up to six years postFRANZCR) to further their knowledge by studying abroad.

Rouse Travelling Fellowship This Fellowship enables a continuing exchange of ideas and information between members across Australia and New Zealand by providing an opportunity for a clinical radiology or radiation oncology Fellow from Australia or New Zealand (on an alternating cycle) to attend the Annual Scientific Meeting in the other country. In 2017, a clinical radiology Fellow from New Zealand will travel to Australia to attend the Annual Scientific Meeting in Perth from 19–22 October 2017.

Details of the 2016 research prizes can be found on page 22.

Roentgen Medal The Roentgen Medal is awarded to Fellows who have made a very valuable contribution to the affairs of the College over a significant period of time.

Life Membership Life Membership can be awarded to Fellows who have made a significant contribution to clinical radiology, radiation oncology and/or the College above and beyond a long and successful career in clinical radiology or radiation oncology.

Applications and nomination for these awards, prizes and Fellowships open at the end of January 2017 and close on Monday 10 April 2017. Guidelines and nomination forms can be downloaded from the College website www.ranzcr.edu.au/members/ awards-a-prizes/college-honours

Honorary Fellowship The College may recognise a person who has contributed to the advancement of clinical radiology or radiation oncology and allied sciences, either through original research or by special services to the College, by admitting that person as an Honorary Fellow of the College.

Denise Lonergan Educational Service Award The Denise Lonergan Educational Service Award recognises a radiation oncology Fellow or Educational Affiliate who has made exceptional contributions to educational activities in relation to training, assessment and pastoral care to trainees above and beyond their expected educational role.

Clinical Radiology Educational Service Award Mirroring the Denise Lonergan Educational Service Award, the Clinical Radiology Educational Service Award is awarded to a clinical radiology Fellow or Educational Affiliate who has demonstrated outstanding contributions to educational activities in relation to training and assessment, above and beyond their expected educational role.

Nominations for the above honours should be submitted to your Branch Committee. Please see page 63 for Branch contact details. Nominations close on Monday 10 April 2017.

Inside News

Further Information If you need any further information or have any questions, please contact Chris Bonaventura, Administrator, Membership at the College on gaps@ranzcr.edu.au or +61 2 9268 9721

Effective Governance

2017 Board of Directors President Dr Greg Slater MBBS (Hons) FRANZCR, GAICD Fellowship 1994; Board member since 2013

QLD

Dean, Faculty of Clinical Radiology Prof John Slavotinek MBBS, BSc, ECFMG, FRANZCR Fellowship 1992; Board member since 2015

Dean, Faculty of Radiation Oncology Dr Dion Forstner MBBS (Hons) FRANZCR, GAICD Fellowship 2003; Board member since 2014

NSW

Chair, New Zealand Branch Dr Lance Lawler MBChB FRANZCR, PLD (Harvard) CDC Fellowship 1995; Board member since 2013

2017 Faculty of Clinical Radiology Council

Elected Fellows Dr Brigid Hickey MBBS DRACR FRANZCR Fellowship 1997; Board member since 2015 Dr Tom Snow BM BCh Oxford, MRCP, FRCR, FRANZCR, GAICD Fellowship 1998; Board member since 2014 Dr Peter Pratten MBBS (Hons) FRACP FRANZCR FRCR (London) GAICD Fellowship 1984; Board member since 2014 Non-Fellow Prof Vin Massaro BA, PhD (Monash) Company Director’s Diploma FAICD, FAIM, Hon FATEM, MACE Non Fellow Board member since 2014

QLD

VIC

2017 Faculty of Radiation Oncology Council

RANZCR President Dr Greg Slater QLD

Dean Prof John Slavotinek SA

Dean Dr Dion Forstner NSW

Chief Censor Clin A/Prof Dinesh Varma VIC

Chief Censor A/Prof Margot Lehman QLD

Elected Fellows Prof Alan Coulthard QLD Prof Jens Froelich TAS Dr Gerard Goh VIC Dr Yvonne Ho VIC Dr Sanjay Jeganathan WA A/Prof Ross O’Neil ACT Dr Katherine O’Connor NZ Dr Rajiv Rattan NSW Dr Meredith Thomas SA

Elected Fellows A/Prof Chris Atkinson NZ Dr Raphael Chee WA Dr Vanessa Estall VIC Dr Madhavi Chilkuri QLD Dr Carol Johnson NZ Prof Michael Poulsen QLD A/Prof Thomas Shakespeare NSW A/Prof Sandra Turner NSW Dr Keen Hun Tai VIC

Trainee Member New member for 2017 to be confirmed

Co-opted Member Dr Liz Kenny QLD

Consumer Representative New representative for 2017 to be confirmed

Trainee Member Dr Kimberley Nguyen NSW Consumer Representative Ms Sally Crossing AM NSW Others A/Prof Farshad Foroudi QLD (TROG President)

Volume 13 No 1 I December 2016

What’s in Issue 6? Medical Imaging Original Article: Magnetic resonance imaging features of gemistocytic astrocytoma Corresponding author: Dr Paul M Simkin, Radiology Department, Royal Melbourne Hospital, Parkville, Vic. Australia. Introduction: Gemistocytic astrocytoma is the second most common subtype of World Health Organization grade 2 astrocytoma, but has a worse prognosis than other grade 2 lesions. We aim to describe the MR imaging features of histopathologically proven gemistocytic tumours. Methods: Ethics approval was obtained from both institutions. Patient consent was not required for this retrospective study. We reviewed MR imaging findings of 16 consecutive cases of histopathologically proven gemistocytic astrocytoma and anaplastic astrocytoma with gemistocytic features. Results: Average patient age was 48 years, with a 3:1 male to female ratio. The typical appearance of a gemistocytic astrocytoma is a large, heterogeneous mass most commonly supratentorial and lobar. Regions of cyst formation, partial signal suppression on FLAIR images and contrast enhancement are all common features. Additionally, contrary to previous literature that describes gemistocytic astrocytoma as a purely supratentorial lesion, we present two cases of gemistocytic astrocytoma involving the brainstem. Conclusions: The possibility of gemistocytic astrocytoma should be considered in patients presenting with large heterogeneous tumours that have regions of cyst formation, partial FLAIR suppression and contrast enhancement. This may be especially useful in reconciling a lesion with high-grade MR imaging features with low-grade histopathology. An infratentorial location does not preclude the diagnosis of gemistocytic astrocytoma.

Medical Imaging Review Article: Imaging features of immunoglobulin G4-related disease Corresponding author: Dr Jonathan Dillon, Medical Imaging Department, St Vincent’s Hospital Melbourne, Fitzroy, Vic., Australia. Immunoglobulin G4-related disease (IgG4-RD) is a fibroinflammatory condition that was first recognised as a systemic disease in 2003, when patients with autoimmune pancreatitis were found to have extrapancreatic manifestations. Since 2003, IgG4-RD has been described in a diverse range of other organs including the biliary tree, orbits, lacrimal glands, salivary glands, lungs, kidneys, aorta, retroperitoneum, lymph nodes, pachymeninges, prostate and pituitary gland. The disease frequently occurs in the absence of pancreatic involvement. The imaging manifestations of IgG4-RD are broad and variable depending on the organ involved. The majority of individual organ appearances are non-specific and differentiation between IgG4-RD and potentially more serious conditions is not usually possible based on radiological findings in one organ alone. However, if there are simultaneous findings typical of IgG4-RD in multiple organs then this is a key diagnostic clue and IgG4-RD should be considered as one of the main differentials. This review article examines the spectrum of imaging appearances of IgG4-RD. Increased awareness of the spectrum of radiological appearances of IgG4-RD throughout the body and subsequent consideration of the condition may potentially avoid invasive treatment and lead to more prompt corticosteroid therapy.

Radiation Oncology Original Article: Prevalence and predictors of bias in the reporting of primary efficacy and toxicity endpoints in randomized clinical trials of radiation oncology Corresponding author: Dr Yu Yang Soon, Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore. Introduction: To determine the prevalence and predictors of bias in reporting of primary efficacy and toxicity endpoints in randomized trials (RCTs) of radiation oncology. Methods: We searched MEDLINE for eligible RCTs published from January 1994 to October 2014. Bias in reporting of primary efficacy endpoint was defined as reporting that treatment was beneficial based on secondary endpoints despite a statistically non-significant difference in primary endpoint. Bias in reporting of toxicity endpoint was defined as not reporting toxicity findings in the abstract, discussion or results table. Logistic regression multivariate models were used to determine predictors of biased reporting. Results: We found that 13% of 323 RCTs have bias in the reporting of primary efficacy endpoint with non-cooperative group trials as a significant predictor of bias (odds ratio (OR) 2.04, 95% confidence interval (CI) 1.03–4.00, P = 0.04). Thirty-five per cent of 279 RCTs were judged to have bias in the reporting of toxicity endpoint with trials not listed in Clinicaltrials.gov as a significant predictor of bias (OR 3.23, 95% CI 1.43–7.14, P = 0.004). Conclusion: The prevalence of bias in reporting of primary efficacy and toxicity endpoint for radiotherapy RCTs was 13% and 35% respectively. Non-cooperative group trials were more likely to have bias in the reporting of primary efficacy endpoint.

Radiation Oncology Original Article: Changing attitudes towards management of men with locally advanced prostate cancer following radical prostatectomy: A follow-up survey of Australia-based urologists Corresponding author: Ms. Bernadette Brown, Implementation Research Group, The Sax Institute, Haymarket, NSW, Australia Introduction: This study examined whether there has been change among Australia-based urologists’ knowledge, attitudes and beliefs relating to guidelinerecommended adjuvant radiotherapy for men with adverse pathologic features following radical prostatectomy, investigating associations between attitudes

and treatment preferences. Methods: A nationwide survey of Australia-based urologist members of the Urological Society of Australia and New Zealand. Results: Ninety-six respondents completed the 2015 survey (30% response rate) compared with 157 (45% response rate) in 2012. There was no significant change in awareness of national clinical practice guidelines for the management of prostate cancer. When considering adjuvant against salvage radiotherapy, urologists were significantly less favourable towards adjuvant radiotherapy in 2015 than in 2012 for two of three hypothetical clinical case scenarios. In 2015, urologists were less positive overall towards the recommendation for post-operative adjuvant radiotherapy for men with locally advanced prostate cancer than in 2012, reflecting a significant change across a number of attitudes and beliefs. Conclusion: In 2015 Australia-based urologists were less favourable towards adjuvant radiotherapy over watchful waiting for men with high-risk pathologic features post-prostatectomy than in 2012. We could find no new published research that precipitated this change in attitude.

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!

Workforce Planning

Volume 13 No 1 I December 2016

Research

How You Too Can Become a Radiation Oncology Researcher

Prof Gillian Duchesne

As a senior radiation oncologist nearing the end of my career, I would like to share my philosophy about the role of research in our professional lives. I believe that it is a fundamental component and underpins one of the College’s seven strategic pillars, that our two professions are recognised as having a strong and competitive research ethic. One of the most satisfying aspects of advancing through one’s career is to see those who you have helped to train develop their skills and become independent and accomplished practitioners. Indeed, perhaps best of all is when they surpass your understanding and expertise, and prepare to mentor the subsequent generation. Nowhere is this more important than in research. Much is made in our new curriculum of the importance of training in research methodology, and although this may be viewed as daunting at the outset, and a hard path to climb, it is an essential part of becoming a rounded specialist; being able to interpret reports of advances and innovations, to integrate the findings into clinical care, and to nurture ongoing interest and curiosity in the field. The perception of research as being something separate from day to day practice needs to be firmly debunked. The initial steps in learning ‘research’ are

taken by everyone, whether or not they will pursue an active research career into the future. I ‘wrote’ my first research paper as a registrar in training at the Royal Marsden Hospital, mentored by Professor Michael Peckham, and was a co-author on a related paper. Having no idea how to approach the task initially, and therefore needing to re-write it several times, the “Results of treatment”2 paper was published after the more exploratory secondary analysis1, although we had planned for it to happen the other way round! As a result of my first experience, and despite the tribulations, I was inspired to try again, and the data handling, asking for advice, and understanding and collaborating with other disciplines all gradually became easier. The same process applies to learning how to write a successful grant application, a task that seems impossibly daunting to the novice. The importance to trainees of having a supportive mentor in this phase cannot be over-emphasised, to teach the basic structure and approach, to guide past the potential pitfalls, and to demonstrate how important it is to have a good multi-skilled team to collaborate with. The development of the Network Research Mentors scheme is an excellent initiative, and trainees should know how to make full use of this source of expertise when undertaking their research.

contributing to research, however small or large. The ultimate benefits are two-fold: the maintenance of life-long curiosity and career satisfaction, and most importantly, optimising the care we deliver to our patients.

The pay-off from research training even for those who do not plan a research career is still enormous, gaining the expertise to interpret the literature, to collaborate in clinical investigations and to hold their own with colleagues in other disciplines. To return to the principles of the seventh strategic pillar, we can all demonstrate a strong research ethic by putting our research experience to work in our daily practice, using our training to advance our practice and to be comfortable

References

Professor Gillian Duchesne Professor of Radiation Oncology Research, Peter MacCullum Cancer Centre 2016 RANZCR Gold Medal recipient

1. Yarnold, J., Horwich, A., Duchesne G., Westbrook, K., Gibbs, J., Peckham, M. Chemotherapy and radiotherapy for advanced testicular non-seminoma. The influence of sequence and timing of drugs and radiation on the appearance of normal tissue damage. Radiotherapy and Oncology, 1 (2) : 91-99, 1983. 2. Duchesne G. and Peckham, M. Chemotherapy and radiotherapy for advanced testicular nonseminoma. Results of treatment. Radiotherapy and Oncology, 1 (3) : 207-215, 1984.

Volume 13 No 1 I December 2016

Research

Research Awards and Grants Research Prize and Grant Recipients 2016 Congratulations to the following members who received research awards and grants in 2016. Faculty of Radiology Oncology Bourne and Langlands Prize Dr David Chang

Research Awards and Grants 2017 The College is pleased to offer the following research awards, grants and fellowships in 2017. Clinical Radiology Early Career Researchers Award A prize of AU$1,000 is available to award a clinical radiology trainee or junior Fellow (within two years post-FRANZCR) who is the primary author of a paper that has been accepted for peer review by the Journal of Medical Imaging and Radiation Oncology or another peer-reviewed journal. Faculty of Radiation Oncology Bourne and Langlands Prize

Genito-Urinary Fellowship Grant Dr David Chang Clinical Radiology Early Career Researcher’s Award Dr Robert Goetti Bill Hare Travelling Fellowship Dr Andrew Dwyer Withers and Peters Grant Dr Joseph Sia Windeyer Fellowship Dr Linus Benjamin Radiation Oncology Research Grants: Dr Jennifer Chard Dr Kim-Lin Chiew Dr Mike Dally Dr Sweet Ping Ng Dr Simon Tang Clinical Radiology Research Grants: Prof Alan Coulthard Clin A/Prof Donna Taylor Research Prizes and Grants not awarded in 2016: Ferring Pharmaceuticals Grant

Inside News

The prize provides candidates with a greater incentive for excellence, and a sense of achievement. The AU$1,500 prize will be awarded in the case of an exceptional trainee research requirement manuscript. Varian Medical Systems Educational Grants Varian Medical Systems has generously supported radiation oncology trainees to take part in the College’s 2017 Annual Scientific Meeting in Perth. Eight grants towards meeting registration and other expenses are on offer, and for 2017, the value of the prize has been increased from AU$800 per grant to AU$1,500. In addition, new for 2017, Varian are offering one grant of $1,500 to support a New Zealand radiation oncology trainee to attend the New Zealand Annual Scientific Meeting in Nelson. Ferring Pharmaceuticals Grant This year RANZCR is inviting applications for two grants of AU$25,000 each or one grant of AU$50,000 to support the Faculty of Radiation Oncology research program for research in prostate cancer (including other urological malignancies). This grant is for Fellows within five years post-Fellowship. Genito-Urinary Fellowship Grant A grant of $12,500 is available to support the Faculty of Radiation Oncology’s most able and committed Fellows within five years post-Fellowship to carry out a significant genito-urinary research project. Windeyer Fellowship This Fellowship enables a trainee (postPhase 2 Examination) or Fellow no more than two years post-Fellowship in radiation oncology to undertake a 12-month Clinical

Research Fellowship at the Mount Vernon Cancer Centre in the United Kingdom, under the broad supervision of Professor Peter Hoskin. It entails clinical work with a number of senior clinical oncologists within several subspecialty sites, as well as the conduct of clinical research projects. Bill Hare Fellowship The primary purpose of this Fellowship is to allow a qualified diagnostic radiologist to further his/her knowledge of an acknowledged subspecialty, in which there is a recognised shortage, by study in Australia, New Zealand or overseas. A grant of AU$30,000 is available. Applications for all above research grants and awards open at the end of January 2017 and close on Monday 10 April 2017. RANZCR Research Grants 2017 – Clinical Radiology and Radiation Oncology The College’s research grants are to support Fellows, Educational Affiliates and student members of the College engaged in research. Recipients will be determined by the Research Committees for clinical radiology and radiation oncology. Applications for RANZCR Research Grants open at the end of January 2017 and close on Monday 12 June 2017. Trans-Tasman Radiation Oncology Group (TROG) Grant TROG is generously providing sponsorship to support five accredited radiation oncology trainees to attend the 2017 FRO SMART Workshop and TROG Annual Scientific Meeting (ASM), taking place in March 2017 in Auckland. See page 58 for further information. Applications for the TROG Grant are open now. Guidelines and application forms can be downloaded from the College website www.ranzcr.edu.au/ members/awards-a-prizes/researchawards-a-grant

Further Information If you need any further information or have any questions, please contact Chris Bonaventura, Administrator, Membership at the College on gaps@ranzcr.edu.au or +61 2 9268 9721

Access to Quality Services

Choosing Wisely: Faculty of Radiation Oncology Recommendations The Faculty of Radiation Oncology’s five Choosing Wisely Australia® recommendations were launched by NPS MedicineWise on 13 October, along with recommendations from three other bodies. Dr Dion Forstner, Dean, Faculty of Radiation Oncology, also announced the launch during the Faculty Forum at the College Annual Scientific Meeting. What is Choosing Wisely? The Choosing Wisely initiative seeks to encourage open dialogue between patients and medical practitioners. In recognising that unnecessary or inappropriate practices divert from effective care, Choosing Wisely provides patients with five simple questions to ask their doctor. Colleges, associations and societies have assisted by providing recommendations. New Recommendations With the discovery of new treatments, the management of cancer has become more challenging and complex, and radiation treatment should be used within clinical decision making

guidelines, where they exist, so it is appropriate and accountable. Patients and their families require information and conversations to ensure they can make wise healthcare decisions during cancer treatment. Recommendation Development Choosing Wisely (US) and Choosing Wisely Canada radiation oncologyrelated recommendations were circulated among the Faculty of Radiation Oncology Council to determine which recommendations were applicable in Australia and New Zealand. The selected recommendations were then put to the Quality Improvement Committee and the Economic and Workforce Committee, with each being asked to rank the recommendations. The five highest-ranked recommendations were then put to the radiation oncology membership for consultation. For further information on Choosing Wisely Australia visit the Choosing Wisely website at www.choosingwisely.org.au

Choosing Wisely New Zealand The College will be involved in the Choosing Wisely New Zealand campaign, being run by the Council of Medical Colleges (CMC). The development of both Faculty of Radiation Oncology and Faculty of Clinical Radiology recommendations for the Australian initiative took into account the landscape in Australia and New Zealand, and included consultations with New Zealand members. As such, the same recommendations will be put forward. Visit the brand new Choosing Wisely New Zealand website at www.choosingwisely.org.nz

Faculty of Radiation Oncology Recommendations

Don’t initiate whole-breast radiation therapy as a part of breast conservation therapy in women age ≥50years with early-stage invasive breast cancer without considering shorter treatment schedules

Don’t initiate management of low risk prostate cancer without discussing active surveillance

Don’t routinely use extended fractionation schemes (>10 fractions) for palliation of bone metastases

Don’t routinely add adjuvant whole-brain radiation therapy to stereotactic radiosurgery for limited brain metastases

Don’t routinely use extensive locoregional therapy in most cancer situations where there is metastatic disease and minimal symptoms attributable to the primary tumour

For more information, please contact Philip Munro, Manager, Quality and Standards at the College on philip.munro@ranzcr.edu.au or +61 2 9268 9763

Volume 13 No 1 I December 2016

Access to Quality Services

Medicare Benefits Review Taskforce Update The review of the Medicare Benefits Schedule (MBS), established by the Minster of Health in 2015, is continuing. The main objective of the review is to modernise the MBS by progressively reviewing the evidence for all 5,769 MBS items, as well as the rules and legislation governing their application. This will ensure that items are evidence-based, fit for purpose and reflect contemporary medical practice and, as such, facilitate better health outcomes for patients. The review of the MBS items is clinicianled and being carried out by a range of clinical committees, supported by working groups focusing on specific items or groups of items.

The Faculty of Clinical Radiology made submissions to:

Diagnostic Imaging

All College submissions can be viewed on the College website www.ranzcr.edu. au/advocacy/submissions

Items in the Diagnostic Imaging Service Table (DIST) are being reviewed by the Diagnostic Imaging Clinical Committee (DICC). With close to 500 items in the DIST to review, the process requires a significant commitment of clinical radiologist resources. Radiation Oncology An Oncology Clinical Committee (OCC) has been established to review all oncology related items and a Radiation Oncology Working Group (ROWG) has been established under the OCC to look specifically at the radiation oncology items. Recommendations from each clinical committee are published for public consultation before being finalised. In September, the College made submissions to a range of consultations.

Inside News

• First report from the Diagnostic Imaging Clinical Committee – Low Back Pain • Second report from the Diagnostic Imaging Clinical Committee – Bone Mineral Densitometry • First report of the MBS Principles and Rules Committee The Faculty of Radiation Oncology made a submission to: • First report of the MBS Principles and Rules Committee

The College would like to thank the clinical radiologists and radiation oncologists who are contributing to the MBS Review, both by directly serving on committees and working groups and by providing input to College submissions to the review. Further information about the review can be obtained at www.health.gov.au/ internet/main/publishing.nsf/Content/ MBSReviewTaskforce

If you have any questions or comments, please contact Melissa Doyle, Manager of Policy at the College on melissa.doyle@ranzcr.edu.au or +61 2 4268 9766

Quality Practice

Safety, Quality and Standards Committee As part of the Faculty of Clinical Radiology Governance Review, it was recommended that the Quality and Safety Committee (QuaSC) and the Standards of Practice and Accreditation Committee (SPAC) be dis-established. From this, the Safety, Quality and Standards Committee (SQSC) was formed. The SQSC aims to support the College in developing policies and position statements to inform and influence governments and other decision-makers about the importance of a viable and sustainable clinical radiology profession. Each of the Faculty of Clinical Radiology modality-based reference groups report to the SQSC. These groups play a key function in supporting the aim of the committee by providing advice, assisting with the development of professional documents, and reviewing standards. As well as the oversight of these groups, SQSC is involved with clinical radiology recommendations for Choosing Wisely (Australia and New Zealand). Since meeting for the first time in August, the safety, quality and standards area has been productive: • Holding the Appropriate Use of Medical Imaging forum at the College’s Annual Scientific Meeting • Developing a review schedule for professional documents • Embarking on the review of the Standards of Practice for Diagnostic and Interventional Radiology • Overseeing the work of the Teleradiology Standards Working Group and the Quality Radiology Written Report Working Group (see page 27).

How You Can Get Involved Are you looking to give back to the profession? Have you been thinking about joining a College committee or reference group? Do you have an interest in standards? Do you have an interest in a particular modality? If the answer is yes to any of these questions, consider submitting an Expression of Interest for one of two positions (standards) on the SQSC or for one of the reference groups. For more information, visit www.ranzcr.edu.au/ members/get-involved

Committee Members • Prof Stacy Goergen, VIC (Chair) • Prof John Slavotinek, SA (FCR Dean) • Dr Kate O’Connor, NZ (FCR Council rep) • Dr Pramod Phadke, NSW (CRETC rep) • Dr Felix Paterson, SA (CRTC rep) • A/Prof Taryn Bessen, SA • Dr Fraser Brown, TAS • Dr Kim McAnulty, NZ

For more information or to get in touch with the Safety, Quality and Standards Committee contact Philip Munro, Manager, Quality and Standards at the College on philip.munro@ranzcr.edu.au or +61 2 9268 9763

For more information on reference groups, please contact Daisy Garling, Senior Projects Officer, Quality and Standards at the College on standards@ranzcr.edu.au or +61 2 9268 9764

Volume 13 No 1 I December 2016

Quality Practice

Breast Imaging Reference Group The Breast Imaging Reference Group (BIRG) provides advice to the Faculty of Clinical Radiology’s Safety, Quality and Standards Committee (SQSC) on emerging issues in quality, safety and standards of practice related to the provision of breast imaging in Australia and New Zealand. The BIRG has given advice on matters that relate to advances in technology or are current in the media, and acts as an advocate for the best practice of breast imaging for its colleagues. 2015 and 2016 has been a busy time in breast imaging. The BIRG has been involved in addressing a number of issues including: • The clinical role of Digital Breast Tomosynthesis (DBT) • A review of monitor standards for the interpretation of mammographic images • Development of the College’s Position Statement on Breast Density • Risk and appropriateness of gadolinium-enhanced MRI as a breast screening tool for high risk women • “More than the Mammogram”, an article in RANZCOG’s O&G Magazine • International Day of Radiology (IDoR) activities, including an expert interview with the European Society of Radiology. The College’s Position Statement on Breast Density can be downloaded from the College website www.ranzcr.edu.au/ advocacy/statements Dr Michelle Reintals Chair, Breast Imaging Reference Group reintals@internode.on.net

Inside News

An extract from the College’s Position Statement on Breast Density “Increased breast density, along with other factors like age and family history, is associated with increased risk of developing breast cancer. Increased breast density also reduces the ability of cancer to be detected by mammography. However, having two-yearly screening mammograms is currently the most effective way to detect breast cancer early in asymptomatic women above 50 years of age, regardless of their breast density. It is also important for women of all ages to be aware of the normal look and feel of their breasts because breast cancer can develop at any time and personalised diagnostic pathways are available for women with symptoms or concerns about their risk factors. The Royal Australian and New Zealand College of Radiologists supports awareness of medical risks by medical and consumer groups and is strongly supportive of the growth and stimulation of research and advances in technology that result in improved cancer detection rates and improved morbidity and mortality rates in association with screening for breast cancer.”

Reference Group Members • Dr Michelle Reintals, QLD (Chair) • Dr Nalini Bhola, NSW • A/Prof Jennifer Cawson, VIC • Dr Peter Downey, SA • Dr Jill Evans, VIC • Dr Helen Frazer, VIC • Dr Sanjay Jeganathan, WA • Dr Gudrun Peters, TAS • Dr Jill Wilkie, VIC • A/Prof Liz Wylie, WA

For more information or to get in touch with the Breast Imaging Reference Group, please contact Leanne Wilson, Projects Officer, Standards at the College on leanne.wilson@ranzcr.edu.au or +61 2 9268 9737

References - Risk and appropriateness of gadolinium-enhanced MRI as a breast screening tool for high risk women Inside news September 2015, www.ranzcr.edu.au/ resources/newsletters/613-past-editions -“More than the Mammogram” www.ranzcr.edu.au/advocacy/statements - International Day of Radiology (IDoR) activities, including an expert interview with the European Society of Radiology www.internationaldayofradiology.com/press-pr/ expert-interviews/

Quality Practice

Teleradiology Standards Working Group

Quality Radiology Written Report Guidelines Working Group

The Teleradiology Standards Working Group aims to update the College’s current teleradiology position statements with new standards.

The Quality Radiology Written Report Guidelines Working Group aims to assist in the development and implementation of an interactive module to educate trainees around writing quality clinical radiology reports, based on the recommendations in the Radiology Written Report Guidelines. Such a module will be of particular use to trainees and international medical graduates (IMGs) new to Australia.

Working Group Members

The working group is guided by the following objectives:

• Dr Anusha Naidoo, VIC/UK (Chair)

1. To review existing international teleradiology standards that may be of relevance to patients in Australia and New Zealand

• Prof John Slavotinek, SA (FCR Dean)

2. To assess the key principles that should frame the provision of teleradiology services to patients in Australia and New Zealand 3. To provide an independent and unbiased review and critique of the existing College position statements and advise on what should replace them 4. To seek views from the College membership, relevant committees and stakeholders with regard to their current needs and expectations with respect to teleradiology standards 5. To provide advice and recommendations to the Safety, Quality and Standards Committee and the Faculty of Clinical Radiology. The Teleradiology Standards Working Group has completed the first draft of the new teleradiology standards and invites members and stakeholders to provide comment on these. Consultation is available through the College website www.ranzcr.edu.au/ resources/professional-documents/ consultations

• Dr Kate O’Connor, NZ (FCR Council rep) (CRWP rep) • Dr Andrew Varnava, NSW (CRWP rep) • Dr Charles Lott, NSW/UK • Dr Neha Singh, NSW • Dr Martin Marshall, WA

For more information, please contact Camilla Baker, Projects Officer, Quality and Standards at the College on quality@ranzcr.edu.au or +61 2 9268 9741

The working group has completed a review of the current guidelines and is in the process of developing an eLearning module for release on the RANZCR Learning Portal in 2017. This project is being funded through the Department of Health Specialist Training Program.

Working Group Members • Dr Felicity Pool, SING (Chair) • Dr Pramod Phadke, NSW (CRETC rep) • Dr Felix Paterson, SA (SQSC & CRTC rep) • Dr Aparna Baruah, WA • Dr Miranda Siemienowicz, VIC • Dr Kirsti Lee, NSW • Dr Kim McAnulty, NZ

For more information, please contact Camilla Baker, Projects Officer, Quality and Standards at the College on quality@ranzcr.edu.au or +61 2 9268 9741

Volume 13 No 1 I December 2016

Profile and Presence

International Day of Radiology 2016 The International Day of Radiology (IDoR) is observed on 8 November annually to celebrate the anniversary of Wilhelm Conrad Roentgen’s discovery of X-rays in 1895. The annual event is celebrated around the world to build a greater awareness of the importance of radiology in the community and the significant advances that have been achieved in the healthcare system through diagnostic imaging. Each year has a unique theme and this year’s theme is breast imaging. The Faculty of Clinical Radiology (FCR) has been working in partnership with the Australian Diagnostic Imaging Association (ADIA), the Peak Imaging Coalition (PIC) and the Faculty of Clinical Radiology Media and Profile Working Group to prepare for the 2016 IDoR celebrations. The College and ADIA co-hosted a Parliamentary event in Canberra on 9 November. A round table discussion, chaired by Professor John Slavotinek, took place with a range of breast imaging stakeholders including representatives of the Australian Sonographers Association, Medical Imaging Nurses’ Association, Australian Society of Medical Imaging and Radiation Therapy, Australian College of Physical Scientists and Engineers in Medicine and Breast Care Network Australia. The aim of the round table discussion was to produce a joint call to action for the government to reduce barriers to access for breast imaging under Medicare. A series of meetings with politicians took place following the round table discussion to advocate for improved access to breast imaging for consumers. Attendees at the event discussed issues such as access to breast imaging, breast MRI, funding and indexation as well as

Professor John Slavotinek, Dean and Mark Nevin, Senior Executive Officer, Faculty of Clinical Radiology with ADIA members Chris Kane and Pattie Beerens pictured with other Round-table attendees. RANZCR and ADIA were co-hosts of the parliamentary IDoR event in Canberra on 9 November. professional supervision rules in line with the Quality Framework. Politicians who met with the members of the round table included; the Hon Dr David Gillespie (Assistant Minister for Rural Health and National Party MP), Mr Andrew Garrett (Chief of Staff to Hon Catherine King, Shadow Minister for Health and Labor MP), Mr Tony Zappia (MP, Shadow Assistant Minister for Medicare), Senator Richard Di Natale (Leader of the Australian Greens), Senator Sam Dastyari, (Senator for NSW) and Ms Maria Vamvakinou (MP). This gathering of doctors and allied health professionals involved in the breast care journey was highly successful and was a valuable opportunity to advocate on behalf of patients with a united message for government on reducing barriers to access for patients for breast imaging under Medicare. As in previous years, a variety of promotional materials were distributed

to over 280 practices in Australia and New Zealand. A new poster and InsideRadiology leaflet for breast care patients was prepared by the FCR in association with the Faculty’s Media and Profile Working Group to provide information for breast imaging consumers. Social media activity leading up to the day was increased in 2016 via Twitter and Facebook and has resulted in increased interest in resources. The College has actively encouraged members to become involved in celebrating IDoR. Practices can access IDoR 2016 resources by contacting Talitha Clague at the College on fcr@ranzcr.edu.au If you have any questions or comments on any of the above, please contact Neena Mairata, Senior Advocacy Officer at the College on fcr@ranzcr.edu.au

Volume 13 No 1 I December 2016

Profile and Presence

Redesigned Website Get involved with InsideRadiology:

▲

Promoting InsideRadiology in your professional networks.

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Supplementing your hospital or practice resources using links to InsideRadiology.

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Recommending any topics that could be considered for inclusion.

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Volunteering to assist with

content.

The last few months have seen a lot of behind-the-scenes work carried out on the InsideRadiology website. This work culminated in the soft launch of the redesigned website at the Appropriate Use of Medical Imaging Forum at the College’s Annual Scientific Meeting in October. With a fresh layout and look, the new site contains all the information about medical imaging tests and procedures from the previous site, but will also host additional College resources for health consumers and referring health professionals. Take a look at www.insideradiology.com.au or www.insideradiology.co.nz

In November, InsideRadiology was proudly involved with the College’s International Day of Radiology (IDoR) activities. With the theme, Screening and Beyond, information on breast imaging from InsideRadiology formed the basis of a flyer that was included in the College’s IDoR packs. InsideRadiology has developed several items on breast imaging over the years, including breast ultrasound, mammography, interventional procedures used for biopsy and surgical guidance and a new information item on breast tomosynthesis. InsideRadiology’s resources on breast imaging can be found at www. insideradiology.com.au/breast-imaging

If you need further information or have any questions, please contact Camilla Baker, Projects Officer, Quality and Standards at the College on quality@ranzcr.edu.au or +61 2 9268 9741

Inside News

Profile and Presence

Targeting Cancer Campaign to Focus on Advocacy for Prostate Cancer Since its launch in 2013, the Radiation Oncology Targeting Cancer campaign has made steady progress in various areas. It was considered timely to review the original objectives of the campaign and to determine an optimal strategy moving forward, with the aims of maximising impact, using resources efficiently, attracting additional funding and providing robust measures of the desired outcomes. Over the next 12-18 months, the campaign will focus on advocacy for prostate cancer, considering the potential gap for men receiving radiation therapy and the problem of accessing radiation oncology opinions for definitive (curative) treatment in this disease. Palliative radiation therapy indications (especially bone pain) will be the next area of focus. Metrics will need to be developed to measure the progress of the campaign in these specific areas. The campaign team will continue its collaboration with Tonic Health Media (THM) in early 2017 to develop a number of promotional videos highlighting the need for men to fully investigate their prostate cancer treatment options. These videos will be broadcast through the THM GP Clinics Network and other channels in 2017. This initiative is generously supported by Varian Medical Systems Australasia.

The GP Oncology Education Evenings continue to be the mainstream activity for the campaign. We would like to thank our members and the teams from those sites for organising these events. If you are interested in hosting a GP Oncology Education Evening, please contact us at faculty@ranzcr.edu.au and we will provide all the materials to assist you.

Thank You to All Participants in the Targeting Cancer Fun Run The Targeting Cancer Fun Run/Walk was another successful and fun social event at the 2016 Annual Scientific Meeting with close to 100 participants, including radiologists, radiation oncologists and allied health professionals, together with their family and friends. Thank you to Genesis Cancer Care and Queensland X-Ray for their support of the event, and the campaign. We were fortunate to have Jana Pittman, Olympian and two time World Champion, with us at the fun run. Jana is now an official ambassador for the Targeting Cancer campaign.

As a medical student herself, and training in surgical gynae-oncology, Jana has become a passionate advocate for broader awareness of the importance of radiation therapy as a highly effective treatment option for cancer patients.

How YOU Can Get Involved We are always looking for patient stories/photos and good news stories that will help raise the profile of our profession and of radiation therapy as a treatment option. Please contact us at faculty@ranzcr.edu.au if you would like to share your stories. Like Targeting Cancer on Facebook, or follow @targetingcancer on Twitter, and help us spread the word. Please help us make Targeting Cancer THE brand to promote our fantastic treatment!

If you have any questions about the Targeting Cancer campaign or would like to get involved, please contact Legend Lee, Senior Projects Officer at the College on faculty@ranzcr.edu.au

GP Education Programs The Campaign continues to reach out to the larger GP community to improve their knowledge of radiation therapy. This has been achieved through presentations at Health Ed events across five capital cities (over 2000 GPs), and The Royal Australian College of General Practitioners Annual Scientific Meeting (many hundreds of GPs).

Participants at the Targeting Cancer Fun Run

Volume 13 No 1 I December 2016

Profile and Presence

The Consumer Viewpoint: An Interview with Sally Crossing Sally Crossing AM is the founder of Breast Cancer Action Group NSW and Cancer Voices Australia. Through Cancer Voices, she facilitates the Australian Cancer Consumer Network, a group of 30 consumer related cancer organisations. Sally is the consumer representative on the College’s Faculty of Radiation Oncology (FRO) Council. Initially diagnosed with early stage breast cancer over 20 years ago, Sally continues to fight the disease today. RANZCR Archivist, Eva StokesBlake recently interviewed Sally about her experiences as a consumer advocate for cancer treatment. Here are some of the highlights…

Did you set out to become an advocate for cancer care? SC: The cancer “just happened” to me, and it made me realise it just happened to other people too, [some of whom are] less able to access information and advice. It’s not just cancer care. Cancer care is terribly important of course, but it’s everything else that goes in support of the good cancer outcome, for example access to information right through to consumers being involved in research. There’s a great range of aspects that go to support a good cancer outcome and experience. Having got cancer, I decided it was a worthwhile thing to give up my paid career and start this new career, which is voluntary, in advocacy for people affected by cancer.

During your appointment on FRO Council you have legitimised consumer approval on latest treatments for patients, the education of GP’s etc. Can you explain why you thought this was necessary? SC: During meetings of the Council, issues would come up that will affect people with cancer, for example informed financial consent and treatment consent. Some patients want to know what supports good cancer treatment, and they should be reassured that proper processes are followed by people who practise the specialty.

“The involved, engaged, informed patient working with the involved, engaged, informed health professional is the best way.” Ms Sally Crossing at the Annual Scientific Meeting

Inside News

Profile and Presence

Can you tell us a little about ‘Consumers Included’, the logo branding concept launched by Cancer Voices in April this year? SC: ‘Consumers Included’ is like a heart tick, but for cancer, for those organisations which hold conferences and events. If they include consumers, for example, by supporting them financially, enabling some participation and inviting them in the first place (there are five criteria in total), then they get this seal of approval. RANZCR was the first big organisation to take that up very enthusiastically [at the 2016 ASM] and there have been ten others already.

What is your perspective on the College since your involvement as consumer representative? SC: [The College is] Very inclusive, very willing to listen. They always seek my advice and often take it, and even better, appreciate it. I do it because it has become a passion and a commitment to put [forward] the voice of people affected by cancer, but when you actually see it working and you’re accepted as a necessary and welcomed part of the team, it’s really good on both sides, I think. Listen to the full interview at bit.ly/ranzcrrecalls

Where do you see the future of patient treatment? SC: I’d like to see all cancer patients treated at comprehensive cancer centres (whether it’s in the public or private system) with multi-disciplinary care, where the surgeons, medical oncologists and radiation oncologists all talk to each other to decide what’s the best path or action of treatment that they are going to offer the patient, not give the patient. The shared decision-making concept is the important one. When you take responsibility for your own treatment, you will be much more alert to what’s happening and how to manage it. The involved, engaged, informed patient working with the involved, engaged, informed health professional is the best way.

Volume 13 No 1 I December 2016

Quality Training

Revalidation – The Latest News ‘The process by which doctors have to regularly show that their knowledge and skills are up to date, and fit to practise medicine’ – IAMRA 2016 The Medical Board of Australia (MBA) and their appointed Revalidation Expert Advisory Group (EAG) held meetings with the medical colleges in August 2016. The MBA and EAG presented their Interim Report and Discussion Paper on Revalidation at both meetings. The Discussion Paper proposed two distinct components: • Strengthened continuing professional development • At risk and poorly performing medical practitioners. The Discussion Paper considered performance review, by means of peer review and multi-source feedback tools as recommended voluntary activities. ‘Category 7 – Maintenance of Professional Standards’ was included in the College’s CPD program for the new triennium 2016-2018, in preparation for revalidation and this program has been recognised by the MBA as a strengthened and robust program. The College commenced a member consultation of the Discussion Paper and Interim Report on 20 September 2016. A revalidation booth, attended by representatives of the College staff and volunteer Fellows, was present at the Annual Scientific Meeting on the Gold Coast. This provided an opportunity for attendees at the ASM to ask questions or discuss the implications and their concerns. Members were also encouraged to complete the revalidation feedback form. The member consultation closed on 23 October 2016, with much interest and comment.

Inside News

Laina De Winne, Head of Member Engagement with Dr Catherine Mandel who volunteered to meet colleagues and answer questions about revalidation. The College collated the feedback from the member consultation and submitted this to the MBA on 30 November 2016. The submission is available on the College website www.ranzcr.edu.au/ adovcacy/submissions The EAG will collate all feedback received from the consultation and propose a final report on their findings to the Medical Board of Australia in July 2017. Further information can be found on the MBA website www.medicalboard.gov. au/Registration/Revalidation.aspx

Further member consultation will continue throughout the coming year. The College will keep you informed. If you have any questions or comments about revalidation, please contact Laina De Winne on members@ranzcr.edu.au

Quality Training

What Makes a ‘Good’ Clinical Radiologist and Radiation Oncologist? How can we improve trainee selection? Selecting the optimal doctors in our training programs will have a strong influence on the future of our specialties. Whilst the majority of the time we get it ‘right’, the College recognises that its selection processes have room for improvement and is committed to ensuring that selection into the training programs is conducted in a reliable and valid way. The Trainee Selection Guidelines were introduced in 2014 and are now up for review. The aim of the review is to align the selection criteria with the curriculum, to undertake consultation with our members and to ensure that selection is underpinned by a sound evidence base. In a complementary development, the RANZCR Rural and Regional Needs Assessment Report (2015) highlighted issues with selection that were contributing to the current geographic maldistribution of our workforce. In order to address this, the College needs to better support recruitment and retention in non-metropolitan areas. One of the report’s recommendations, accepted by both Councils, was for the College to review the Trainee Selection Guidelines to enable it to support a skilled and sustainable clinical radiology and radiation oncology workforce in non-metropolitan areas. The College recognises that there is a growing need to better understand the knowledge, skills, abilities and attributes required to be an effective clinical radiologist and radiation oncologist, and to link these to trainee selection criteria. In addition, our competency-based training programs recognise that there are many other facets of the clinical radiologist’s and radiation oncologist’s roles that contribute to the ‘ideal’ specialist in our disciplines, outside of being medical experts. Although academic achievement is a reasonable predictor of subsequent performance,

it is not the case that those with high academic ability alone can be trained to become competent clinical radiologists and radiation oncologists. Hence, we should examine methods that reliably evaluate other (and in some cases more) reliable predictors of specialist performance. This will include some non-academic personal attributes, values and motivational qualities. Consideration needs to be given to what can be ‘taught’ during training and what attributes one should possess at the point of entry into the training program. This will also widen access to training. College members are questioning how to combine merit-based selection with the need to include candidates who will go on to be actively involved in research, education, leadership and regional practice. It is expected that during the review process, some answers will arise to help ensure effective future leadership within both professions and to address current workforce issues. The College has held discussions with members. It has also commissioned Work Psychology Group (WPG), an international, research-led consulting practice, with expertise in medical education and training selection and assessment, to advise us. WPG recommend that the cornerstone of an effective selection system is by a thorough analysis of the relevant knowledge, skills, attributes and other personal qualities, beyond clinical knowledge and academic achievement, associated with successful performance in the professions. This process is called a Job Analysis and enables accurate identification of criteria to be targeted as part of selection into training. The Job Analysis will result in a competency framework being developed for each specialty, which will be validated by the membership. Once the competency framework is

accepted by our Education and Training Committees and Councils, it will be used to update the Trainee Selection Guidelines. In 2017, members will be invited to participate in the validation survey, the aim of which is to validate the competencies identified during the Job Analysis and provide an opportunity for you to identify any additional knowledge, skills and attributes not yet identified. The validation survey will be open in February and March 2017 to all members to complete online. We are excited about this project and believe that the Job Analysis will strengthen the entire selection process. We strongly encourage you to be part of defining the future of our specialties through the completion of the survey and/or providing other input. For further information about the Job Analysis, its methods and the project group members, please visit www.ranzcr.edu.au/training/overview/ trainee-selection-review

If you have any questions or comments regarding the trainee selection review, please contact Danielle Callahan, Executive Assistant to CEO, at the College on danielle.callahan@ranzcr.edu.au or +61 2 9268 9757

Volume 13 No 1 I December 2016

Quality Training

CPD Submission Deadline 31 January 2017 Record your CPD activities for 2016 using CPD online via the Learning Portal on the RANZCR website. To access CPD online you will need your Member ID and password. Click on the RANZCR Learning Portal icon on the top right hand corner of the website. The Clinical Radiology and Radiation Oncology CPD Handbooks are a useful source of information and contain details of each category and the evidence you will need to provide for your CPD activities. The handbooks are available for download from the College website or in CPD online in the RANZCR Learning

Portal www.ranzcr.edu.au/cpd/overview

Taking extended leave during the 2016-2018 Triennium? CPD participants who are taking extended leave from practice and are unable to participate in CPD activities may be eligible for pro rata CPD points. CPD participants can request exemption in writing from CPD for special circumstances such as maternity leave, parental leave or sick leave. All requests for exemption from CPD for special circumstances should include: • The reason for requesting exemption (for example, maternity leave, parental leave, sick leave)

• The start, and if known, the finish date of the period for which an exemption is being requested; and • Any other information relevant to having the exemption granted. For further information please refer to the relevant CPD Handbook

If you have any questions about CPD activities, please contact Elaine Shao, Project Officer, CPD at the College on cpd@ranzcr.edu.au or +61 2 9268 9708

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Volume 13 No 1 I December 2016

Quality Training

Examination and Assessment Review Update The College’s formal examinations are a core component of both Faculty training programs, and have long been a primary focus of trainees as they work towards the goal of admission to RANZCR Fellowship. The findings of the 2015 Examination and Assessment Review recommended the transition towards a programmatic approach to assessment, in which the examinations and work-based assessments undertaken by trainees are considered as part of an overall program, rather than as unique events. Information on competency will therefore be made progressively and holistically, and the full depth and scope of training can be reviewed and considered when determining a trainee’s suitability to continue or complete training. It is important to recognise that this transition will not diminish the importance of formal barrier examinations in defining and measuring a benchmarked standard for progression. The exams provide College members the opportunity, as experts in their field, to become involved in the assessment of those endeavouring to become their colleagues and peers. The Australian Council of Educational Research (ACER) has been working with the College since late 2014 to review all our examination processes and ensure they are transparent, consistent, fair and defensible. After delivering a set of recommendations for improvement to the College Board and Faculty Councils in mid-2015, ACER have consulted with the College to identify four work packages to implement those recommendations, which are being rolled out over a two year period.

Inside News

Examination Development

Data Collection and Reporting

(commenced January 2016)

(commenced July 2016)

The development of examination content commences with blueprinting, which maps out a framework for each exam to ensure a representative sampling of topics across the curriculum. In both Faculties, the processes for blueprinting have undergone improvements to become more collaborative, centralised and systematic.

A key aspect of the implementation plan is the provision of more detailed feedback to trainees with their examination results, as well as the development of new practice materials to assist with study. As an early step, ACER spoke with Directors of Training at their DoT Workshop on 12 October at the College’s Annual Scientific Meeting, and gathered feedback on the type of information that would be most useful to help trainees prepare for their exams and remedy areas of deficiency.

Creating high quality exam content has been covered in workshops with the various Examination Panels, in which ACER has provided training on marking templates and question design. ACER have also assisted with the implementation of more detailed psychometric analysis of exam data. This includes equating processes that allow for minor adjustments to be made, based on differences in exam difficulty or cohort ability across series. This enables the College to maintain a consistent performance standard for all candidates.

Examination Review (commenced January 2016) In 2016 the College increased the frequency of meetings for a number of Examination Panels to facilitate more robust processes for examination review. This includes more detailed analysis of exam and candidate performance using ACER’s psychometric reporting, with a comprehensive review of borderline candidates and any potentially problematic items. For some exams, a statistical error band has been applied around the pass mark, and this process will be rolled out more broadly. In addition, ACER has led groups of examiners through standard-setting exercises to validate the expected performance standards.

Scoring Processes (to commence January 2017) In 2017, ACER will assist the College in a number of initiatives related to ongoing consistency in scoring, including calibration processes and training modules for examiners, further improvements in marking template designs, and systemic review systems for viva examiners. Another new initiative for 2017 is the move to the Australian Medical Council’s National Test Centre for the Clinical Radiology Viva Examinations. The College would like to thank its examiners for their time and commitment to the examinations. Thank you also to Dr Jacob Pearce and Mr Daniel Urbach from ACER for their continued assistance.

If you have any questions regarding the project, please contact the Chief Censors c/o Adam Rayment, Manager Special Projects, at the College on adam.rayment@ranzcr.edu.au or +61 2 9268 9706

Quality Training

Viva Examinations on the Move The Clinical Radiology Viva Examinations will be moving from their current hotel format to the Australian Medical Centre (AMC) Vernon C Marshall National Test Centre in Melbourne in May 2017. The move to the training centre is part of the College’s examination and assessment review (see previous page for more information) and will assist in improving the quality, efficiency and transparency of our viva assessments and streamline the delivery of the examinations. See next page for more detail. The AMC Test Centre is a purposebuilt facility to conduct clinical examinations and is the only one of its kind in Australia. Located in Melbourne’s CBD, the centre will provide state of the art examination facilities, which will minimise cross contamination of examiners and candidates. The centre uses advanced multimedia technology with CCTV recording capability and the ability to monitor the performance of individual components of the examination in real time. The centre will enable the College to develop the examinations into the future. All examination sessions will be recorded to improve the candidates’ and examiners’ overall experience.

The Clinical Radiology Viva Examinations will now be held across two sittings over four days, with candidates allocated to either Sitting A or Sitting B: Sitting A: Tuesday – Wednesday Sitting B: Thursday – Friday Candidates will attend one of the sittings and be able to continue to complete their examination series over two days.

If you have any questions regarding the change of exams, please contact Shane Bryan, Senior Project Officer, Specialty Training, at the College on shane.bryan@ranzcr.edu.au or +61 2 9268 9742

These new sittings will allow the College to cater for the increased number of candidates sitting in each series without extending the examination day or putting undue pressure on examiners. There will be other operational changes that candidates and examiners will encounter such as: • New registration process • Lockers for securing of small personal belongings (luggage storage not available) • Improved examination briefings. Further details regarding the operational changes to the examination will be available to candidates closer to the examination and information will be available on the College website www.ranzcr.edu.au/training/exams/ radiology-examinations/exam-fees

At this stage, there will be no changes to the method by which the viva exams are conducted, with the continuation of the use of lightboxes, films and digital images for pathology vivas. There will still be a paper assessment of all candidates.

Volume 13 No 1 I December 2016

Quality Training

2017 RANZCR Workshops, Courses and Events The College is delighted to offer a number of educational activities and events for its members across clinical radiology and radiation oncology in 2017. Statistics and Research Methods (SMART) Workshop – Registration Now Open 6 March 2017 The SMART Workshop will be taking place to coincide with the 2017 Trans Tasman Radiation Oncology Group (TROG) Annual Scientific Meeting at the ANZ Viaduct Events Centre, Auckland, New Zealand. The workshop is aimed at post phase 1 exam radiation oncology trainees and is designed around eight short didactic presentations by biostatisticians followed by interactive sessions during which groups of five to seven trainees are guided by radiation oncologist facilitators. Each small group session links back to the minilectures, prompting discussion of the key statistics and research methods concepts through structured question sets relating to (mostly radiation) oncology trial publications. It also provides an opportunity for trainees to stay on to see their new knowledge “in action” in subsequent clinical trials. Trainees attending the SMART Workshop have access to a discounted registration rate to attend the TROG ASM. Cost: NZD $89.00 GST exclusive per delegate for SMART Workshop only. Additional registration fees apply for the TROG ASM. Register: www.trog2017.com Phase 2 Exam Preparation Course – Registration Opening Early 2017 12–13 May 2017 The Phase 2 Exam Preparation Course will be taking place at Rydges World

Square, Sydney, NSW. The course is designed for trainees as they approach exam readiness. The course aims to provide trainees an opportunity to: • Better understand the exam development process and how exams are marked • Simulate sitting the viva exam and receive feedback immediately afterwards • Practice a written question from each paper, workshopping the answers with the Phase 2 examiners • Develop strategies to cope with exam stress and ensure they perform to the best of their abilities. Cost: AU $880.00 incl. GST per trainee Phase 1 Foundation Course and Exam Preparation Course – Registration Opening Early 2017 15–18 June 2017 The Phase 1 Foundation Course and Exam Preparation Course will be taking place at Rydges World Square, Sydney, NSW. The course is designed for Phase 1 trainees who are aiming to sit the Phase 1 exams. The course aims to: • Provide didactic lectures in the main topic areas to supplement trainee knowledge in the four basic sciences. • Provide an opportunity for trainees to ask specific questions of experts in a dedicated questions and answer session as well as informally following individual sessions. • Provide specific guidance on exam preparation and technique including mock exam on the Sunday. • Provide an opportunity to network professionally and socially. Cost: Foundation Course - AU $880.00 incl. GST per trainee Phase 1 Exam Preparation Course – AU $1,100.00 incl. GST per trainee

RANZCR/ACR Educational Courses – Registration Now Open The College, in partnership with the American College of Radiology (ACR) will be offering educational courses on Musculoskeletal, Abdominal, Neuroradiology and High Resolution CT of the Chest in 2017. The courses will take place at the Amora Jamison Hotel, Sydney, NSW. 11–13 August • Musculoskeletal • Neuroradiology 14–16 August • Abdominal MR • Neuroradiology 18–20 August • High Resolution CT of the Chest Cost: AU $5432.90 incl. GST per delegate per course. Register now and pay 10% deposit to secure your place. Full payment due in January 2017. Register now at www.ranzcr.edu.au/ news-a-events/courses FROLIC Workshop – Save the Date 1 September 2017 Radisson Flagstaff Hotel, Melbourne “Targeting treatment for advanced lung cancer”. More details will be available in future editions of Inside News.

For further information, please contact RANZCR Conferences and Events Team events@ranzcr.edu.au or +61 2 9268 9777, or visit the College website at www.ranzcr.edu.au/newsa-events/courses

Volume 13 No 1 I December 2016

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Clinical Radiology

A Message

from the Dean

Prof John Slavotinek As we come to the end of 2016, it is worthwhile to reflect on a busy, and I believe productive, year for the Faculty of Clinical Radiology (FCR). We continue to make progress in key areas such as the MBS Review and Quality Framework and have established new bodies within the Faculty to progress important activities. I am pleased to see that new members have taken up opportunities to become involved and engaged in the Faculty’s work. We also had a great response to the expression of interest for the new Interventional Radiology Committee from both New Zealand and Australia. In early 2017, the FCR Council will reassess key priorities for 2017 and determine a program of work across the Faculty. The RANZCR Iodinated Contrast Media Guideline represents a valuable resource for clinical radiologists across Australia and New Zealand and has received positive feedback from a wide variety of members in clinical practice. I am most grateful to the members that have contributed to this guideline and also the new Written Report Guidelines and Teleradiology Standards that are close to finalisation. It would be remiss of me not to mention the fantastic new InsideRadiology website that was launched following a College-funded redesign to make it more user-friendly and provide New Zealand specific pages. The website contains information regarding a wide variety of procedures that patients may encounter in radiology and also provides education about the profession of clinical radiology and what clinical

radiologists do. I encourage all of you to take a look and do all you can to promote the use of this excellent resource for our patients and referring doctors. Visit www.insideradiology.com. au or www.insideradiology.co.nz

Annual Scientific Meeting There is much elsewhere in this edition of Inside News about the recent Annual Scientific Meeting on the Gold Coast. I very much enjoyed the opportunity to converse with office bearer counterparts from the USA and Europe, and learned a lot during the process. I would like to extend my thanks and gratitude to the meeting conveners and College staff; you have certainly set the bar very high for future meetings. I also appreciated the contributions from a range of RANZCR members, external speakers and other stakeholders who participated and added a great deal of value to the meeting. I think the attendance of multiple external stakeholders at sessions such as the forum on Appropriate Use of Medical Imaging is testament to the major focus the Faculty has placed on external advocacy, with the College seen as a highly respected partner across the healthcare systems of Australia and New Zealand.

International Day of Radiology (IDoR) This year the International Day of Radiology brought a range of new materials that were made available to practices to celebrate the theme of breast imaging. In Canberra, RANZCR and ADIA co-hosted a round-table

discussion, followed by a series of meetings with members of parliament to lobby for better access to breast imaging under Medicare. We raised concerns about increasing gaps, impediments in the Medicare rules, and the highly restricted breast MRI Medicare items.

Quality Framework Work continues apace on the Australian Minister for Health’s election commitment to implement the Quality Framework reforms to diagnostic imaging under Medicare. The Faculty is engaged with the Department of Health and Diagnostic Economic Committee on an almost weekly basis to finalise proposals. We are also preparing communications to guide Fellows through the implementation of the first phase of the Quality Framework.

Allied Health Professionals within the Clinical Radiology Team I am grateful to the New Zealand Branch Executive for taking the lead on a response to the consultation from the Medical Radiation Technologists Board of New Zealand on the competency framework for medical imaging practitioners under their purview. I encourage all interested readers to have a look at the College’s response on the submissions page of the website, which outlines the key role of teamwork in clinical radiology and the importance of understanding our respective clinical boundaries and roles. continued over... Volume 13 No 1 I December 2016

Clinical Radiology

This consultation response reflects the position the Faculty of Clinical Radiology has taken and illustrates how working across both countries allows refinement of policy and advocacy work.

Digital Health With the advent of the Australian Digital Health Agency, I am hopeful that we can make progress on major digital health initiatives that have the capacity to connect relevant aspects of patient care across clinical boundaries. The Agency recently issued a consultation on its strategy and has prioritised diagnostic imaging for this financial year. The Faculty has been approached by the Agency and we will feature strongly in the overarching governance of its work on diagnostic imaging. We have communicated our key priorities for health informatics in diagnostic imaging and signalled our willingness to build on the work we did with NEHTA and the Department of Health beforehand. We look forward to making progress to implement transfer of diagnostic imaging reports to the My Health Record and improving access to historic images across the Australian healthcare system.

Inside News

If you have any questions or comments about this article, please contact Mark Nevin, Senior Executive Officer, Faculty of Clinical Radiology on fcr@ranzcr.edu.au

Clinical Radiology

Chief Censor in Clinical Radiology

A/Prof Dinesh Varma

The end of the year is approaching and as I reflect on a productive year, I am proud of what has been achieved in 2016 and optimistic about the road ahead in 2017.

Annual Scientific Meeting The scientific program at the Annual Scientific Meeting (ASM) on the Gold Coast was exemplary and I trust that all members of the College who were in attendance enjoyed the keynote speakers, workshops and social events. As you are aware, this was the largest gathering of speakers from Australia and New Zealand that had been assembled for a single meeting. Congratulations to the new Fellows, many of whom were awarded their Fellowship at the Annual Ceremony. I am already looking forward to the next ASM in Perth in 2017.

Melbourne Exams As I write the final Chief Censor Report for 2016, the Series 2 Viva Examinations are being delivered in Melbourne at the Novotel, St Kilda. This is the first phase of the transition to the Vernon C Marshall National Testing Centre, a purposebuilt testing centre that will assist the College delivering robust, high quality examinations from Series 1, 2017. I would like to thank all the members and College staff who have planned and carried out this series and I look forward to next year’s Part 2 viva examinations at the new centre. More information about the exams can be found on pages 38 and 39.

Training Program Requirements A trainee must remain in an accredited training position until all the training program requirements have been completed. The training requirements include all of the below: • Five years of training time • Part 1 and 2 examinations • Project 1 and 2 • Direct Observation of Procedural Skills • Mini-Individual Patient Exercise • Critically Appraised Topics • Experiential training requirements including Logbooks & new CTCA, CTC and BMD requirements • Trainee Assessment of Training Site • Director of Training (DoT) Assessment • Multi-source Feedback These requirements, including the number of assessments for each year of progression, can be found on your profile in the Trainee Information Management System (TIMS) and on page 14 of the Clinical Radiology (Radiodiagnosis) Training Program Curriculum, Version 2.

Project 2 Further to the training program requirements, it is important that trainees be aware that final approvals for Project 2 Proposals can take between four to six weeks from the date it has been approved by the Director of Training (DoT). Therefore, I would encourage any trainee who is reaching this point in their training to factor this into their plan. Research Leads are responsible for approving proposals. Case reports and

pictorial essays are not accepted. Please refer to the College website for more information www.ranzcr.edu.au/training/ resources/current-trainees/resources-forradiology-trainees/assessments

System Focused Rotations and Advanced Training Positions The Clinical Radiology (Radiodiagnosis) Training Program Curriculum, Version 2, states that “Trainees must complete the full 5 years of training before fulltime subspecialty fellowships can be commenced” (Page 15). This includes all the learning components, experiential training and assessments as per page 14 of the Curriculum. Any anomalies regarding a trainee’s TIMS portfolio or training environment that the College may encounter will be audited. These audits may include a trainee having to provide evidence through their Director of Training that they are completing any component of the curriculum that is not formally assessed. Where it is found that a trainee has not adhered to the training curriculum it may result in the trainee receiving a pause in training or unaccredited time.

Director of Training Workshop The (DoT) Workshops held in Melbourne, Wellington and, prior to the ASM, on the Gold Coast have been very well-received and an excellent opportunity for DoTs to seek clarification on key issues in the training program.

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Clinical Radiology

Thank you to all of the DoTs who attended, and I would also like to remind the new DoTs that your role description requires you to attend at least one workshop per calendar year. The Gold Coast DoT workshop focused on the ACER/Prideaux Review. I would like to thank Professor David Prideaux and Mr Daniel Urbach for their presentations and discussions.

Communique from CEO – Policy Update In September, a communiqué was sent to all members affiliated with the training program regarding the updates to the Consideration of Special Circumstances Policy and Grievance Policy. These updates were effective from the date of the communiqué and trainees are required to read the policies at their earliest convenience. The changes in the Consideration of Special Circumstances Policy relate to the time and process for submitting a consideration of special circumstances. Trainees will also be required to sign and attest that they are fit and well to sit an examination on the day. The Grievance Policy is a key instrument that all trainees should be aware of. We urge you to report any and all incidents, whether experienced or observed, through the relevant channels. The College has appointed Grievance Officers in Australia and New Zealand and further details can be found in the policy document www.ranzcr.edu.au/ resources/professional-documents/ policies

Specialist Training Program Expression of Interest The Department of Health recently announced that the Specialist Training Program (STP) will continue for 2017 and that an Expression of Interest (EOI) process is to be undertaken to assist specialist medical colleges in addressing

Inside News

unfilled posts and identify potential sites for the new Integrated Rural Training Pipeline (IRTP) posts in 2017 and 2018. Applications have now closed. If you have any questions or would like more information regarding STP please contact Shane Bryan at shane.bryan@ ranzcr.edu.au or Pamela Spoors at pamela.spoors@ranzcr.edu.au

Clinical Radiology Trainee Committee I would like to congratulate all members of the Clinical Radiology Trainee Committee (CRTC) for their hard work throughout 2016. The CRTC members have participated in many different committee meetings highlighting the trainees’ perspectives on a wide range of issues. I was privileged to attend the Trainee Learning Day at the ASM and meet with the committee and the trainees. I look forward to working with the CRTC again in 2017.

Retiring Committee Members On behalf of all members I would like to thank the following members and non-members for the valuable contribution that they have made during their terms on our Specialty Training Committees; Mrs Pamela Bell and Dr Sanjay Jeganathan from the Curriculum Assessment Committee and Dr John Heggie from the Applied Imaging Examination Panel. I look forward to bringing you more updates in 2017 and wish everyone a safe and festive holiday season.

If you have any questions or comments on any of the above, please contact Pamela Spoors, Head of Specialty Training on radtaa@ranzcr.edu.au

Clinical Radiology

Clinical Radiology Trainees Committee Update The Trainee Learning Day held at The Annual Scientific Meeting is set aside for trainees to learn from Australian and international leaders in various fields of radiology. This year’s sessions were aimed at exam preparation and a successful result on the day but were also very relevant for day-to-day clinical activities. It was great to see so many trainees in attendance and a big thanks to all involved in putting it together. This year the trainees’ forum was held as a lunchtime session, with the floor opened to questions from trainees to College officials including the previous Chief Censor, Dr Gabriel Lau and current Chief Censor, Dr Dinesh Varma. It is an important element of the day where trainees are able to pose questions directly and hopefully gain better insight into the background thinking and workings of the College. The social events were well attended and, for the first time, included trainees from both the clinical radiology and radiation oncology training programs. It was a fun evening. Special thanks to Pacific Radiology Group for their continued support. Congratulations to all the prize winners over the weekend (see page 10 for further information). The Branch of Origin participants were all funded to attend the College ASM and the winner will be supported financially to present at the Radiological Society of North America (RSNA) meeting in 2017. The Branch of Origin session delivered some very interesting research pieces on topics ranging from pseudopneumoperitoneum on trauma scans, machine learning and artificial intelligence in the radiology space and several interesting pieces relating to interventional radiology (IR).

The Trainee and Junior Consultants Reception at the College’s 2016 Annual Scientific Meeting

Finally, congratulations to the newly elected members of the Clinical Radiology Trainee Committee. There was unprecedented interest in the 2017 positions, with elections taking place in five branches across Australia and New Zealand. Trainee involvement in the College is critical to ensuring the needs of trainees are adequately considered and factored in to the College’s plans for the future.

Thank you to all the outgoing members for your hard work over the past year. It has been a pleasure working with everyone and a very rewarding experience. I wish next year’s committee the best of luck and success. Dr Jules Catt Chair, Clinical Radiology Trainees Committee

This year’s committee members represented trainees on several College committees, including the Faculty of Clinical Radiology Council, the Curriculum and Assessment Committee and the Education and Training Committee. They have also been involved in a range of College projects and working groups such as the Rural and Regional Needs Analysis, where their contributions have been widely appreciated and valued.

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Clinical Radiology

Ground-Breaking New Study Offers Relief for Acute Back Pain Sufferers Acute back pain sufferers may take comfort from the results of a groundbreaking study by Australian researchers, led by interventional radiologist, Dr William Clark. The research was published in the world-renowned medical journal, The Lancet in August. The procedure known as vertebroplasty, an injection of medical-grade bone cement into a fractured spinal bone, has been proven to be effective in reducing the patient’s pain, disability and the length of hospitalisation, in a randomised controlled trial. Conducted in four hospitals across Sydney, the randomised, doubleblind, placebo-controlled trial over six months found that vertebroplasty provides effective analgesic relief for patients suffering poorly controlled back pain from spinal fractures due to osteoporosis. The procedure needs to be performed within six weeks of the fracture occurring. Spinal fractures due to osteoporosis affect approximately 1.4 million people worldwide each year. A significant number of sufferers, particularly elderly patients with osteoporosis, develop difficulty performing normal daily tasks and severe pain that is non-responsive to standard pain relief treatments. Dr William Clark says that osteoporosis is an epidemic and a growing concern for the ageing population of Australia and the world. Spinal fractures are a common problem in osteoporosis especially as the bones weaken with age. These fractures can cause terrible pain and many sufferers are unable to cope at home, requiring hospitalisation. The findings of the study show that vertebroplasty is an effective treatment for these fractures when treated early and has the ability to eliminate this pain and allow the patient to recover more quickly.

Inside News

The use of vertebroplasty within the first six weeks of fracture also has the potential for significant savings in the health care system. By treating the fractures in the first six weeks, there is a reduced need for hospitalisation which could provide savings to the health care system as our population continues to age. Vertebroplasty is not currently funded by Medicare, but is available in Australia and New Zealand.

To view the full article in the Lancet visit www.thelancet.com/ journals/lancet/article/PIIS01406736(16)31341-1/fulltext If you have any questions or comments about this article, please contact Neena Mairata, Senior Advocacy Officer at the College on neena.mairata@ranzcr.edu.au or +61 2 9268 9717 Figure 1. Percentage of patients in each group with low pain scores after the procedure.

Figure 2. 74 year old male with 10 day old L1 fracture. Vertebroplasty has restored vertebral height.

Figure 3. 83 year old female with 2 week old L1 fracture at baseline (left) and 6 months (right) showing interval collapse and retropulsion following placebo intervention.

Clinical Radiology

ADIA Update Welcome Progress

In the months following the federal election, meaningful progress has been made in turning the Government’s welcome commitments to radiology into real-life improvements for all of us – radiologists, providers and patients alike. Thanks to the ongoing understanding, collaboration and trust between RANZCR and ADIA, we are advancing on many fronts, albeit with some uncertainty about timing. After years of policy development and advocacy, the first phase of the Quality Framework – supervision of CT services and contrast administration – will be ready to be introduced next year. RANZCR and ADIA are currently working with the Department of Health on transition arrangements and on developing the formal regulations, which balance quality practice with efficient service provision. There is a clear understanding that the new rules will only cover metropolitan practices initially, as the complexities facing regional practices are still being worked through. Meanwhile, the Department of Health is overseeing an independent evaluation to assess the commercial environment in which comprehensive diagnostic imaging practices operate, including the sustainability of providing bulk billed services under rebates which haven’t been indexed for 18 years. The evaluation includes, among other things, recommendations on how a reinvestment of AU$50 million into Medicare rebate funding would be best allocated. We expect that the increased rebates would be available at the same time as changes to eligibility for the bulk billing incentive come into effect (the Government has scheduled this to occur on 1 January 2017). The bulk

billing incentive will be limited to patients under 16 and Commonwealth concession card holders. The evaluation includes an examination of the broader commercial challenges faced by comprehensive diagnostic imaging practices, to identify structural roadblocks and identify reforms to drive efficiency. As I mentioned in the last Inside News, the agreement with the Government includes a commitment to reinstate indexation of radiology rebates when the GP indexation freeze concludes (scheduled for 2020).

Dr Wriedt

ADIA is continuing to make the case that radiology indexation should be brought forward to address the urgent need created by the freeze of nearly two decades. It is absolutely essential if the Government is committed to retaining the current rates of bulk billing. ADIA is also advocating for a HICAPSstyle payment option, to recognise the very high upfront costs associated with complex radiology services. Deloitte Access Economics found that such a system would not put inflationary pressure on gaps and would particularly benefit financially disadvantaged patients. Their report, Mind the Gap, can be found on ADIA’s website. While progress is being made there remains much to do, not only in bringing the Government’s commitments to reality, but in the wider, ongoing push to ensure the policy and funding framework supports a sustainable radiology sector which can provide all Australians with affordable access to essential health services. Dr Christian Wriedt ADIA President

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Clinical Radiology

Interventional Radiology Society of Australasia The Royal Australian and New Zealand College of Radiologists (RANZCR) invited expressions of interest for a revised Interventional Radiology Standing Committee recently. It is very pleasing for IRSA, and all interventional radiologists, that a number of College members have submitted applications. It is encouraging that interventional radiology holds such a prominent place in radiologists’ working lives that they show enthusiasm in support of their specialty.

IRSA ASM 2017 The Annual Scientific Meeting will be held in Port Douglas from 9-15 July 2017. Drs Nigel Mott, James Burnes and their team are assembling an outstanding series of lectures and social activities not to be missed!

EBIR Examination The EBIR examination will be held before the main IRSA meeting, on 9-10 July. Registration for this important examination will be open soon on the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) and IRSA websites.

IRSA Stroke Meeting Recent developments in stroke treatment have taken the world by storm. This disruptive technology compels all doctors to prepare themselves. The inaugural IRSA Stroke Meeting on 14-15 July will follow the main IRSA meeting. The Faculty includes Drs David Sacks and Jeff Carpenter. Dr Sacks was the convener of the SIR CLOTS course which has now evolved into the SIR Stroke Course. Clinical lectures will be delivered by world renowned neurologist and Co-Principal Investigator of the EXTEND-IA Trial, Dr Bruce Campbell from RMH.

Inside News

Given the success of the mediation meeting between IRSA, ANZSNR and RANZCR earlier this year, we keenly await a reply from ANZSNR regarding a collaborative effort in this critically important educational experience for all radiologists, interventional radiology (IR), interventional neuroradiology (INR) and diagnostic alike. IRSA supports the recent Conjoint Committee in Interventional Neuroradiology (CCINR) initiatives and this meeting serves to expand knowledge, educate and inform all radiologists about the vital elements of stroke therapy.

IRSA and the Council of Procedural Specialists IRSA has joined the Council of Procedural Specialists (COPS), whose mission is to lobby the Federal Government regarding the Medicare Benefit Schedule and Private Health Policy. COPS aims to have a seat on the Private Health Ministerial Advisory Committee. Achieving this will demonstrate major progress in IR being recognised as an important group of procedural doctors in our healthcare system. This is the first time any radiological body has been invited to take a seat at this table!

Interventional Radiology Fellowships and Training IRSA is compiling a list of IR Fellowships in Australia and New Zealand in preparation for formal accreditation assessment in 2017. Once completed, an expression of interest will be sent to sites who currently offer IR Fellowships to comment on the draft documents. A pilot program will be initiated, followed by formal Accreditation Standards for IR Training. This is another vital step in gaining specialist recognition for IR in Australia and New Zealand.

IRSA Foundation The IRSA Executive are planning the creation of a Benevolent Trust that will underpin a Research and Education Foundation. This key development is essential in our modern political landscape where sponsorship of medical educational activities by the corporate world is closely monitored. Planning is underway for the foundation to be eligible for tax deductible donations. Dr John Vrazas IRSA President

Clinical Radiology

Dr Liz Kenny Receives Unique Honour CIRSE Distinguished Fellow helped modify it, in order to meet the requirements of interventional oncology. She worked closely with Dr Keith Ison, Head of Medical Physics, and Dr Shahzad Ilyas, Consultant Interventional Radiologist, both at Guy’s and St Thomas’ Hospital in London, to produce a draft document. She then chaired a two-day workshop in Vienna, at which some of the most senior interventional oncologists in Europe finalised the framework. This document was piloted in two hospitals in Europe, one in Singapore and one in New Zealand. The results of the pilots are being analysed and will be used by CIRSE, under Dr Kenny’s guidance, to create a credentialing system for interventional oncology.

Prof Andy Adam, Dr Liz Kenny and Prof Elias Brountzos – President CIRSE

It doesn’t happen every day. In fact, it has never happened before. The Cardiovascular and Interventional Radiological Society of Europe (CIRSE), which has 7,000 members and is the largest organisation in the world in the field of interventional radiology, has awarded Distinguished Fellowship to a non-European doctor who works in another specialty. Dr Liz Kenny, past-President of RANZCR, has been awarded this unique honour for her outstanding contributions to interventional oncology, which will have a global impact. Interventional oncology is now a very important part of interventional radiology and is very likely to determine the future of this discipline. The effective practice of interventional oncology requires not only technical skill but also a good understanding of the biology of cancer and of other oncological disciplines. An interventional oncologist must have some knowledge of chemotherapy, radiation therapy and surgical oncology, in order to practise

effectively. Dr Kenny was invited to join the Oncology Alliance Subcommittee of CIRSE, which advises the Society on matters relating to education, research and clinical practice in cancer care. Her vision, and her deep knowledge of oncology shaped many of the policies of CIRSE in the field of cancer care and had great influence on several research and educational initiatives. She is an important contributor to the ongoing project of creating an interventional oncology curriculum, which aims to guide interventional oncologists not only in the techniques they use but also on how to practise as true clinicians. Perhaps the greatest contribution of Dr Kenny has been the creation of a quality assurance framework for interventional oncology. This is an achievement in which RANZCR can take pride too, because the CIRSE framework is based on the Radiation Oncology Practice Standards, created by the Tripartite Committee and published in 2011. Dr Kenny made that document available to CIRSE and then

The magnitude of Dr Kenny’s achievements are easier to understand when placed in the context of interventional oncology. This discipline has emerged as a set of minimally invasive, image-guided techniques used to treat cancer, without the infrastructure for clinical practice, or a comprehensive educational base. Dr Kenny’s background as a senior practising radiation oncologist, as well as past-President of RANZCR, with its dual membership of radiation oncologists and clinical radiologists, helped her to realise at an early stage what needed to be done. But the task was not easy. When she first mentioned the need for a quality assurance system to the Oncology Alliance Subcommittee of CIRSE, its members assumed that she was talking only about the need to ensure that equipment functioned properly, and were reluctant to get involved in what they saw as a rather tedious subject. It took several meetings for them to fully appreciate that what she had in mind was a comprehensive system that dealt with all aspects of practice in this field. continued over... Volume 13 No 1 I December 2016

Clinical Radiology

Liz’s deep knowledge of oncology, her tact, her diplomatic skills, and her infinite charm, won the day, and led to the creation of the first comprehensive, global system of quality assurance in interventional oncology. Dr Kenny received her award in Barcelona on Saturday 10 September. It was wonderful that Liz’s daughter Sophie, was in the room, as that really made Liz’s day. It was also wonderful that Dr Greg Slater, RANZCR President, and Natalia Vukolova, RANZCR CEO, as well as several Australian and New Zealand interventional radiologists were present during the ceremony. The photograph on the previous page shows Dr Kenny receiving the award, standing between Professor Brountzos, the President of CIRSE, and the author of this article, who read the citation. The adjacent photograph shows Dr Kenny on the rooftop terrace of her hotel immediately

Inside News

after the ceremony, with the Basilica of the Sagrada Familia in the background. Liz is a very modest, self-effacing person who will hate this article. However, I thought that the Fellows of RANZCR should read about this unique honour, as it also reflects on their own efforts, channelled through a past President, which have helped to shape an important new discipline in the field of cancer care, and to create the first global system of quality assurance in interventional oncology. I would buy Liz a beer by way of an apology for embarrassing her in this way, but she doesn’t touch the stuff. Perhaps a glass of shiraz will serve as well. Prof Andy Adam Chairman of the Oncology Alliance Subcommittee of CIRSE

Dr Liz Kenny

Radiation Oncology

A Message

from the Dean

Dr Dion Forstner

As we reach the end of the year, it is a time to reflect on what we have accomplished. I believe we have made good progress towards our strategic priorities, but of course there is always more to be done. The priority area for the Faculty of Radiation Oncology in the last 12 months was to engage with the Department of Health (DoH) to advocate for our members on the reviews of the Medicare Benefits Schedule (MBS) and the Radiation Oncology Health Program Grants (ROHPG). The Faculty has developed a productive relationship with the DoH staff. We have made progress in many areas, including advocacy and government engagement, professional development and revalidation, and implementation of the recommendations from the ACER/ Prideaux review of the training and assessment program, to name just a few. I would like to thank all the members on the Faculty of Radiation Oncology Council, standing committees, special interest groups and working groups, in particular the Chief Censor and other committee Chairs for their hard work and dedication. I would also like to thank Fellows and the secretariat for their commitment to the College throughout 2016 and wish you all a very enjoyable festive season. I look forward to working with you in 2017 towards our strategic goals.

Profile and Presence of Radiation Oncology The Media and Profile Committee recently reviewed the Targeting Cancer campaign strategy and developed an action plan focussing on advocacy for prostate cancer for the next 12-18 months. Please see the article on page 31 in this edition for more details. The Faculty Council is very supportive of the plan, considering the big gap in utilisation rate and the problem of accessing radiation oncology opinions for definitive (curative) treatment in prostate cancer. New evidence was released recently to support the view that modern radiation therapy is equally as effective at curing prostate cancer as surgery. I encourage all our members to get involved in the campaign and to contribute to raising the profile of our profession and our treatment.

Funding of Radiation Therapy The review of the radiation oncology items within the MBS is well underway. Through the Faculty’s MBS Review Working Group, the Faculty has provided advice to the Oncology Clinical Committee (OCC) in the following areas: • Obsolete items within the schedule • Funding model—recommending that a two-part payment model (planning/ dosimetry, and per attendance treatment/verification) with added

levels of complexity would be appropriate • Draft proposal on levels of complexity for planning and treatment • Draft MBS item descriptors for radiation oncology services. I am confident that the new items and descriptors will reflect contemporary practice in the radiation oncology sector. Public consultation on the suggested MBS items and descriptors for radiation oncology is expected to commence in the near future. I strongly encourage members to provide feedback when the opportunity arises as we were not permitted to take the proposed changes to our members prior to the public consultation. I am indebted to Dr Liz Kenny, Chair of the Working Group and Complexity Group, and all the other members of the group for the enormous amount of time and high-quality work they have invested in this area. Particularly I wish to note the work of Aldo Rolfo from Genesis Cancer Care.

Training and Research for Radiation Oncology The Faculty Council recently approved a number of newly developed or revised policy documents on education, training and accreditation for radiation oncology. Those policy documents aim to streamline the process and to facilitate the better delivery of our training program. continued over... Volume 13 No 1 I December 2016

Radiation Oncology

A Memorandum of Understanding (MoU) has been agreed upon between the College and Trans-Tasman Radiation Oncology Group (TROG) to formalise the close relationship between the two organisations. It covers governance, membership, the sharing of information and resources, promoting research and supporting each other’s work. A closer collaboration between the College and TROG will help foster a stronger culture of research in radiation oncology.

Stress and Burn Out in Medical Professionals Following the work undertaken in 2014 amongst radiation oncologists, Dr John Leung, on behalf of the Economic and Workforce Committee, conducted a Stress, Satisfaction and Burnout (SSB) survey amongst radiation oncology trainees. A significant proportion (49.5 per cent) of trainees in Australia and New Zealand scored high on emotional exhaustion and/or depersonalisation. Mental health concerns are not unique to radiation oncology. The 2013 National Mental Health Survey of Doctors and Medical Students in Australia found that doctors reported substantially higher rates of psychological distress and attempted suicide than the Australian population and other Australian professionals. The issue of doctors’ health is recognised as a concern across all medical specialties. This has been discussed in some detail at Council level and it has been agreed that we should raise the awareness amongst our members of the prevalence of stress/ burnout in doctors, and encourage them to seek help when needed. We are also exploring options for providing members with information and support in helping them to deal with stress/burnout. We will keep you informed of any developments in this area.

Inside News

Resources 2013 National Mental Health Survey of Doctors and Medical Students: www.beyondblue.org. au/docs/default-source/research-project-files/ bl1132-report---nmhdmss-full-report_web

If you have any questions or comments on any of the above, please contact Sonja Cronjé, Senior Executive Officer, Faculty of Radiation Oncology on faculty@ranzcr.edu.au

Radiation Oncology

Chief Censor in Radiation Oncology

A/Prof Margot Lehman

The second half of 2016 has seen much activity. In summary:

Accreditation Standards The Accreditation Standards and Criteria for Training Network and Sites have been reviewed and updated and will shortly be available on the College website. The revised document includes new standards that more clearly set out the expectations of the College in relation to support for the training program, particularly the provision of support for an Education Support Officer in each Training Network and support for trainee well-being, which is in line with the updated Australian Medical Council Standards for Assessment and Accreditation of Specialist Medical Programs. My sincere thanks to Dr John Leung, Chief Accreditation Officer and members of the Accreditation Team, in particular Sandra McDonald and Tanja Samardzic, for undertaking the work involved in this project.

Policies Two policies were released in September and are now available to download from the College website www.ranzcr.edu. au/resources/professional-documents/ policies

Consideration of Special Circumstances Policy This policy outlines the criteria and mechanisms by which trainees or international medical graduates

undertaking formal assessment may advise the College of, and the College may consider, special circumstances or disability that may adversely impact on their clinical training assessment, examination or other evaluation processes. In particular, the new policy provides clearer definitions on the processes when applying for special circumstances under the following categories: medical, compassionate, permanent and/or chronic illness or disability and religious observance.

• A Withdrawal from Training Policy to support trainees who are not progressing.

Grievance Policy

SMART Original Research Requirements

The Grievance Policy defines bullying, discrimination and harassment and the related offences of victimisation and defamation. It also informs College members about the process for raising a grievance related to bullying, discrimination and/or harassment and the consequences if a member engages in bullying, discrimination and/or harassment. The current Trainee in Difficulty Policy has also been reviewed. The initial review by an external consultant recommended the current policy be changed to three separate policies: • A Performance and Progression Policy, which would provide a framework to oversee and guide the monitoring and management of trainee performance during training and their progression through training • A Remediation Policy

My thanks to the members of the Policy Working Group (Drs Marcus Dreosti, Rahul Mukherjee and Mark Sidhom) for reviewing each policy and providing feedback. Work has commenced on a practical guideline to accompany these policies and it is expected that the policies and guidelines will be in place for 2017.

In response to a request that the SMART research requirements be more flexible, and following input from both the SMART Committee and the Radiation Oncology Research Committee (RORC), the following additional pathways will be incorporated as being allowed to meet SMART assessment requirements: • Cochrane Protocols/Reviews (provided that the topic is oncology related and the trainee can demonstrate having made a substantial contribution to the process) • Protocols for Prospective Studies (provided that they are either accepted for publication in a peer reviewed oncology journal with the trainee as the first author or the protocol has attracted competitive grant funding or is supported by a collaborative trials group). continued over... Volume 13 No 1 I December 2016

Radiation Oncology

These additional pathways will be available to trainees in 2017.

ACER- Prideaux Review Professor David Prideaux provided an overview of Constructive Alignment and Programmatic Assessment during his presentation “The Future of Medical Education” in the Faculty Forum at the ASM. In addition, face to face meetings of the Steering Committee have identified program areas or streams to be developed. The streams are the framework on which the work-based assessments will hang. Priority areas have been identified around radiation oncology technical skills (anatomy, contouring and plan evaluation) and foundation sciences (with the aim of replacing or utilising the clinical assignments in a different way). The next step is to form small working groups to progress this work in 2017.

Examinations The second series of the Phase 2 exams were held in Townsville in September. My thanks to Dr Susan Hewitt for hosting this series and to Dr Alex Tan for undertaking the role of the exam site co-ordinator. I would also like to extend my thanks to the examiners and College support staff, in particular Julia Snedic, for ensuring that the series ran very smoothly. The Phase 1 examination series has also been completed. Thanks to all the Phase 1 assessors, in particular I would like to acknowledge the enormous contribution made by the Phase 1 Leads Drs Marcus Dreosti and Claire Hardie. I would like to encourage other sites that may be interested in facilitating the Phase 2 examinations in the future to contact Julia Snedic via email at julia.snedic@ranzcr.edu.au

Inside News

The College values the contribution of accredited training sites in providing a venue to deliver the examinations to a high standard.

Director of Training Exam Application Endorsement Over recent years, there has been an increasing incidence of trainees either not completing all training and assessment requirements or completing these requirements but not updating TIMS home and assessment pages to confirm their completion prior to submitting their examination application form. The burden placed on College staff in trying to ensure that there are no outstanding requirements has been significant. As a consequence, the examination application form has been modified. The Director of Training (DoT) or Training Network Director (TND) now needs to sign to confirm that all requirements have been completed and that the DoT (or TND) has verified this fact by checking the trainee’s TIMS profile.

Denise Lonergan Educational Service Award Congratulations to Dr Jayasingham Jayamohan for being awarded the Denise Lonergan Educational Service Award for 2016. This award recognises radiation oncology Fellows and Educational Affiliates of the College who have demonstrated outstanding contributions to the educational activities in relation to radiation oncology training and assessment, above and beyond their expected educational role. All who have had the pleasure of working with JJ agree that he is a very deserving winner of this award.

Radiation Oncology Education and Training News At the final face to face Radiation Oncology Education and Training Committee (ROETC) meeting held in October, we had the opportunity of thanking the Fellows who have completed their terms on the ROETC. I have been extremely fortunate to work with Drs Melissa James, Rahul Mukherjee and Apsara Windsor for a number of years and am very grateful to them for their hard work, vision, wise counsel and friendship. I would like to acknowledge and thank Dr Eunji Hwang for her contribution as the RO trainee rep on the committee.

2016 Annual Scientific Meeting It was another fantastic Annual Scientific Meeting on the Gold Coast and I trust that all radiation oncology members who were in attendance enjoyed the program. I would like to congratulate all the trainees who were awarded their Fellowship and hope you remain actively engaged with the College and the training program in the future. It was a privilege to meet with the trainees and the ROTC at the Trainee Learning Day. I would like to offer my very best wishes for the upcoming festive season and wish everyone a happy and healthy 2017.

If you would like further information on any of the above topics, please contact Pamela Spoors, Head of Specialty Training on ronctaa@ranzcr.edu.au

Radiation Oncology

Radiation Oncology Trainees Committee Update 2016 Annual Scientific Meeting The College Annual Scientific Meeting was held on the sunny Gold Coast from 13-16 October. The Radiation Oncology Trainee Learning Day was superbly organised and executed by Dr Esther Sim. We were privileged to hear from both local and international experts. Prof William Mendenhall gave a succinct overview on altered fractionation and chemotherapy for head and neck cancer. Dr Lizbeth Kenny provided a local perspective on the use of modern techniques in the management of head and neck cancer. Dr Michael Poulsen’s talk on staying motivated and avoiding burnout was insightful, informative and timely. The panel discussion on Managing Complex Breast Cancer Patients was without a doubt the highlight of the Trainee Learning Day. Thanks to our expert panel including Drs Marie Burke, Silvia Formenti, Carmen Hansen and Brigid Hickey. The Varian Prize session was as inspiring as ever; it was great to see so many trainees engaged in a range of research activities. Congratulations to Dr Eunji Hwang who won the prize for her research on Variations in Breast Cancer Histology and Treatment Patterns between the Major Ethnic Groups of South West Sydney. The Trainee Forum provided a platform for all to discuss concerns around examinations, accreditation and workforce issues, all of which were taken on board by the Faculty. The Faculty of Radiation Oncology Dinner and the Annual Gala Dinner were both stand out social events. Congratulations to all the graduating radiation oncology trainees who were accepted as Fellows of the College at the Annual Ceremony. Finally a shout out to the Targeting Cancer 5km Fun Run male and female

winners, Drs Andrew Oar and Rachel Effeney. Congratulations to you both on flying the radiation oncology trainee flag high!

It is inspiring to be amongst so many driven and capable trainees. I encourage everyone to stay engaged and strive for the best outcomes for our patients, trainees and profession.

Mentorship Survey Update A recent survey by the College demonstrated significant stress and burnout amongst radiation oncology trainees. Although these findings were not inconsistent with those seen amongst the entire medical profession, the College is looking at strategies to address this issue.

Dr Gina Hesselberg Chair, Radiation Oncology Trainees Committee

The ROTC proposed that one potential tool to combat stress and burnout would be a mentorship program. As such, we recently sent out a survey to all trainees to investigate whether this would be a worthwhile endeavour. Whilst the results are yet to be formally available, 41 per cent of trainees responded with the majority stating that their attitude to mentoring was very positive or positive. Most trainees agreed that mentoring is effective for developing a doctor’s potential as well as helping to manage stress and burnout. Thank you to the trainees who participated in the survey. We will keep you up to date with further results and any developments that arise from this.

Farewell & Welcome Finally, it is with much sadness that I step down from my role as Chair of the ROTC. It has been a privilege to be a member of this committee and work with so many fantastic trainees and Fellows. The ROTC of 2016 put in a huge amount of work and I would like to take this opportunity to thank them all for their time, effort and enthusiasm. I welcome the incoming committee for 2017 and wish them the best of luck.

Volume 13 No 1 I December 2016

Radiation Oncology

TROG Update

Early stage lymphoma breakthrough In a world-first breakthrough for early stage low-grade lymphoma, set to change the management of the disease worldwide, TROG 99.03 has found that patients live longer without a relapse with immuno-chemotherapy plus radiotherapy treatment rather than radiotherapy alone. The results of the trial were presented in September during a plenary session at the 2016 American Society for Radiation Oncology (ASTRO) Annual Meeting in Boston, USA. The primary aim of the trial, which was a collaboration between TROG and the Australasian Leukaemia and Lymphoma Group (ALLG), was to see whether, by adding immunochemotherapy to the standard treatment of radiotherapy alone, outcomes could be improved for patients with stage I-II low-grade follicular lymphoma. Patients were randomised to one of two arms; radiotherapy alone or radiotherapy followed by six cycles of Cyclophosphamide, Vincristine, Prednisolone (CVP) or in the later part of the trial, Rituximab and CVP (R-CVP). Australian Trial Co-Chair and Peter MacCallum Cancer Centre Radiation Oncologist, Professor Michael MacManus, said that the multi-centre international study, which accrued 150 participants across Australia, New Zealand and Canada, was the first of its kind to be conducted and will help define the standard of care for these patients. “The role of effective additional multi-agent drug or ‘systemic’ therapy combined with radiotherapy has never been effectively studied before, despite the pressing need for a study like this,” Professor MacManus said. “It is clear from the trial results that radiotherapy plus R-CVP is associated with a much better chance that patients

Inside News

will survive to ten years without a relapse. It is likely to mean that the cure rate will be much higher.

Radiation Oncologist at the Memorial Sloan Kettering Cancer Centre in New York.

“No group anywhere in the world has ever managed to complete a trial comparing radiotherapy alone with radiotherapy and multiagent chemotherapy or immunochemotherapy before. The long natural history of the disease makes it very difficult to perform randomised trials in these patients, because it takes many years to know if their treatment has been effective. Few trial groups can sustain a trial over the more than 15 years that would be required to answer the question. Our trial has run for 16 years.

Visit TROG2017.com for more information and to take advantage of early bird rates.

“Overnight, this trial will transform our knowledge of the comparative effectiveness and toxicity of two very different treatment strategies for these patients. The results of this trial will immediately inform every discussion of treatment strategy for every patient with stage I-II follicular lymphoma in the developed world.”

TROG 2017 ASM Registrations are now open for the 29th Annual Scientific Meeting (ASM) to be held from 6-9 March 2017 at the ANZ Viaduct Events Centre in Auckland, New Zealand. The event will provide a unique opportunity for all health professionals with an interest in radiation oncology to collectively discuss and influence the direction of current and future cancer clinical trials. The theme for our 2017 meeting will be, ‘Radiation Oncology: Precise Treatment, Quality Research’. Drs Giuseppe Sasso and Laura Ciurlionis will co-convene the event and international speakers will include Professor Andre Dekker, Medical Physicist at MAASTRO Clinic in the Netherlands and Dr Nancy Lee,

We look forward to seeing you in Auckland next March. Joan Torony CEO, TROG

TROG is providing sponsorship to support five accredited radiation oncology trainees to attend the 2017 FRO SMART Workshop and TROG ASM in Auckland with a grant of $1,000 each. Applications are now open. Visit the College website for further information www.ranzcr.edu.au/members/ awards-a-prizes

Radiation Oncology

New Cancer Australia Statement Identifies ‘What Ought to be Done’ in Breast Cancer While survival for people with breast cancer in Australia is among the highest in the world, there is evidence that not all patients are receiving the most appropriate care. This unwarranted variation has the potential to have an impact on patient outcomes and experience, as well as use of health resources.

Importantly, the resulting statement is not only underpinned by evidence, but has the support of all key clinical, cancer and consumer organisations. The collaboration and multidisciplinary approach that was central to the development of the statement will continue to play a key role in its implementation.

To address this variation and support improved and informed practice in breast cancer, Cancer Australia has led the development of a landmark statement. The Cancer Australia Statement – Influencing best practice in breast cancer identifies 12 appropriate and inappropriate practices in breast cancer from diagnosis to palliative care, highlighting what ‘ought to be done’ in breast cancer care to maximise clinical benefit, minimise harm, and deliver patient-centred care.

“There are a number of practices in the Cancer Australia Statement that are of particular relevance to our membership,” said Dr Dion Forstner, Dean, Faculty of Radiation Oncology.

Launch of Cancer Australia Statement – Influencing best practice in breast cancer at the Pink Ribbon Breakfast

“RANZCR looks forward to continuing to work with Cancer Australia to identify optimal approaches to promote awareness and drive uptake of the statement.” CANC ER AUST RALIA STATE MENT

Influencing be

C A N CE R AU S T R A L I A S TAT E M E N T

Influencing best practice in breast cancer

3 4

st practice

AppRopRI ATE to offer genetic counselling to women with a high risk at or aroun familial d the time diagnosed that they are with breas t cancer, with view to gene a tic testing to inform decis making abou t treatment ion .

ri br ate ea a st nd ca in nc ap er pr pr opr ac ia tic te es

pr op

#makeastat ia

AppRopRI ATE to of either breas offer a choice t conserving followed by surgery radiotherapy, to patients or a mastectom diagnosed y with early cancer, as breast these treat ments effective in terms of survi are equally val.

AppRopRI ATE to offer patients with early breas t cancer the opportunity for their follow -up care to between a be shared primary care physician and a specialist, to provide more acces whole-person sible, care.

@CancerAustral

AppRopRI ATE to consi der and discu fertility and ss famil premenopausa y planning with l undergo breas women before they t cancer treat ment.

AppRopRIA TE to offer a short intense cours e of radiothera er, more (hypofracti py onated radio therapy) as alternative an to convention al radiothera for patients py with early breast cance r who: are aged

ement YouTube.com/can ceraustralia

in breast ca

AppRopRI ATE to of breast cance ensure optimal fixat ion r specimens pathologic for accurate al examinatio n and biom assessmen arker t.

50 years and over; have a cance r at an early pathologica N0, M0); and l stage (T1-2, have undergone breast conse rving surger clear surgical y with margins.

The statement encourages health professionals to reflect on their clinical practice to ensure it is aligned with the evidence and delivers value to patients and the health system. It also aims to empower people with breast cancer to engage with their health professionals and make informed, evidence-based decisions that deliver the best outcomes for them. All practices should be considered in the context of clinical judgement for an individual patient.

Ke y

The release of the statement represents the culmination of a rigorous evidence review and prioritisation process. Cancer Australia brought all key clinical and cancer organisations together with women affected by breast cancer to agree the priority areas of practice. RANZCR was a key contributor to this important body of work from the outset, participating as a member of the Breast Cancer Expert Group that developed the statement.

ncer

AppRopRIA TE to offer palliative care early in the manageme nt of patients symptomatic, with metastatic breast cance improve symp r to tom control and quality of life.

AppRopRI ATE to consi der the pre-operat ive use of chemother hormonal thera apy or py (systemic, therapy) infor neo-adjuva med by horm nt receptor statu one and HER2 s, for all patie these thera pies are clinic nts where ally indicated.

NoT AppR opRIATE to confi a diagnosis of breast cance rm or exclude undertakin r without g the triple test, which involves: taking a patien t history and clinical breast examination ; imaging tests (mammogra m &/or ultraso and und);

biopsy to remov e cells or tissue

11 12

for examination

NoT AppRopRI ATE to perfo mastectom rm a y without first discussing the patient with the delayed breas options of immediate or t reconstruc tion.

NoT AppR opRIATE to perform inten testing (full sive blood count , biochemist tumour mark ry or ers) or imag ing (chest pET, CT and X-ray, radionuclide bone scans part of stand ) as ard who have been follow-up of patients treated for cancer and early breas who are not t experiencing symptoms.

For more information on the Cancer Australia Statement – Influencing best practice in breast cancer and to access supporting resources, visit canceraustralia.gov.au/statement

NoT AppR opRIATE to offer a senti node biops nel y to patients diagnosed DCIS (duct with al carcinoma in situ) havin breast conse g rving surge ry, unless clinically indic ated.

2016 09/16

If you have any questions or comments about this article, please contact Neena Mairata, Senior Advocacy Officer at the College on neena.mairata@ranzcr.edu.au or +61 2 9268 9717

Volume 13 No 1 I December 2016

Radiation Oncology

GOROC Update

FROGG News

The Gynaecological Oncology Radiation Oncology Collaboration (GOROC) recently held its bi-annual meeting at the College’s Annual Scientific Meeting. The position paper, “Image Guided Cervical Cancer Brachytherapy”, has been completed and is currently available for comments from the radiation oncology community, before it is submitted to the Faculty Council for approval. There was strong support for the scientific merits of the questions being asked from the randomised trial PORTEC-4a trial. GOROC requested that PORTEC-4a be further considered by the Australia New Zealand Gynaecological Oncology Group (ANZGOG) for activation as a collaborative trial within the ANZ Gynae-Oncology community. GOROC members also discussed the complexity descriptors and table of gynaecological brachytherapy items as proposed by the MBS review panel, and provided feedback to the panel. The next meeting will be held in Melbourne at the ANZGOG ASM from 29 March to 1 April 2017.

FROLIC Update The Faculty of Radiation Oncology Lung Interest Cooperative (FROLIC) held a successful Lung Contouring Workshop at the College’s 2016 Annual Scientific Meeting. 30 participants registered to learn about volume delineation for target and organs-at-risk for a locally advanced lung cancer and early stage lung cancer for stereotactic radiotherapy. Expert advice was provided by Radiologist / PET Physician Dr Peter Jackson in conjunction with members of the FROLIC Executive. The recently published “FROLIC consensus guidelines for the use of advanced technologies in the radiation therapy treatment of locally advanced non-small

Inside News

FROGG Executive members at 2016 College ASM

The Faculty of Radiation Oncology Genito-Urinary Group (FROGG) Executive Committee is busy planning for our next workshop titled “Biochemical relapse following definitive treatment of prostate cancer”. It aims to address important clinical questions such as: • Who needs a PSMA PET scan? • How do I manage oligometastatic disease? • What to do about pelvic nodes? • What is the role of systemic therapy in relapsed prostate cancer?

and will be supported by a host of engaging local faculty representing radiation oncology, medical oncology and urology. A/Prof David Christie is the convenor, ably assisted by Dr Tanya Holt, who has recently joined the Executive. The workshop will take place at Peppers Resort in Noosa, 30 March -1 April 2017. Early bird registrations are now open. Register at www.frogg.com.au

We have invited Professor Brian Davis from the Mayo Clinic who specialises in the management of oligometastatic disease. Prof Davis is a dynamic speaker

cell lung cancer” was promoted at this workshop. We hope this publication is helpful to those who could not attend the workshop. We thank Drs Catherine Bettington and Adeline Lim for their superb organisation of this workshop. Feedback received was very positive. FROLIC also met face-to-face at the ASM. Dr Jeremy Ruben provided an email update on the SABR registry project which is progressing slowly. New issues discussed included the need for standardised reports for lung cancer imaging and the lack of eviQ protocols for SABR treatment. A/Prof Shalini Vinod will be working on these issues. In 2017 FROLIC is organising an educational workshop titled “Targeted treatment for advanced lung cancer”. Topics will include stereotactic

radiotherapy and immunotherapy in the setting of advanced lung cancer. Further details will be available in future editions of Inside News. A/Prof Vinod has had preliminary discussions with Dr Kwun Fong to enable future meetings to be combined with the Australasian Lung Cancer Conference. Congratulations to all the FROLIC members who participated in the Targeting Cancer Fun Run at the ASM. The next face-to-face meeting will be at the TROG ASM.

For further information on special interest groups visit www.ranzcr.edu.au/organisation/ special-interest-groups

General Interest

New Zealand Branch News

Dr Lance Lawler

It has been said that the average male has enough energy in his fat stores to run non-stop for three days at 24km per hour. That’s pretty fast considering about 10-12km per hour is the average pace general punters run at. I’m not recommending you try, or stating it as fact, but I did enjoy my recent run after the Branch Chair’s meeting in Sydney last month. In fact, it was more enjoyable than the evening’s dinner due to the level of support I received for a month’s abstinence from hops. Enough said. We are at a crossroad. At one level, technology marches at a pace that cannot be ignored. Telehealth changes medical frontiers that increase efficiency and effectiveness producing real benefits for patients. On the other hand, legislation such as the Health Practitioners Competence Assurance Act 2003 does not advance with the same zeal. Enter the situation where the regulator cannot compel overseas doctors practising on New Zealand patients to be registered. Teleradiology is a problem that has never quite been put to bed, and is unlikely to go away soon. However, the exciting proposition is that clinical radiology stands at the frontier of many developments within healthcare. Next year a lot of energy will be spent dealing with these latest issues; seeking to ensure registration, but yet allow the advance of technology and associated benefits to flow to patients. The Branch meeting in Auckland on 22 September provided an opportunity to

explore the topic of what the College is, along with what clinical leadership looks like. With reference to the former, the College is its membership. Members stand or do not stand for office. Members do or do not contribute to committees, and members do or do not provide technical expertise to advocacy and policy development. The thing with “do not” is that, in accordance with one of Darwin’s theories, vacuums get filled. Clinical radiology as a referred specialty can be vulnerable. Hence, as traditional barriers of medical specialties change, it is important that members participate in the College activities and seek to proactively create the future that is coming, irrespective of whether it is welcomed, or wanted. As the season approaches when typically a large amount of us take leave to recuperate from the year that was, it is important that we reflect on burnout. The New Zealand Association of Salaried Medical Specialists (ASMS) survey on burnout in New Zealand’s Senior Medical Profession is not pretty reading. The first survey conducted in New Zealand using the Copenhagen Burnout Inventory presents burnout being prevalent at a median of 42 per cent.

Radiation oncology was not publicly listed due to a low sample size. At 15 responses, that equates to a reasonable 25 per cent of the workforce, and thus a reasonably important statistic. As for overall burnout, a response of 80 per cent was achieved, 47 per cent for work-related burnout, while perhaps unsurprisingly, patient-related burnout was 27 per cent. It should be noted that the return for patient-related burnout was the second highest only to psychiatry. The ASMS report should not be taken in isolation, but we do well not to ignore these things. As always, I am happy to talk to anybody about Branch matters or issues that they might have. Please feel free to contact me at lance.lawler@ranzcr.org.nz Do have an enjoyable holiday season! Dr Lance Lawler Chair, New Zealand Branch

Critically, clinical radiology scored above the median at 47.2 per cent for workrelated burnout. When considering all forms of burnout, for example patient and personal, clinical radiology, at 58.9 per cent, was one of the highest of the medical specialties listed.

Volume 13 No 1 I December 2016

General Interest

RADIO DIAGNOSIS REVIEW 2017 7-11 April, Melbourne

RDR2017 is the essential preparatory course for Radiology trainees and an excellent refresher for practising Radiologists, including those returning from extended leave.

REGISTER NOW www.imagingworkshops.net -Approx 360 exam focused cases in viva format on Chest, Abdo, Neuro, MSK, O&G, Brst & Paeds -”What you need to know lectures” and more...

INTENSIVE PELVIC MRI COURSE 27-29 October 2017 | MELBOURNE 3 full days of case review on individual workstations including: • Full day of staging of rectal cancer MRI including TRG post treatment cases • Full day of Prostate MRI including Prostate MRI biopsy • Full day of GYN MRI including a broad range of pathologies

Early bird and group discounts available Earn up to 38 RANZCR CPD points

E: lisamc@imagingworkshops.com.au M: 0408 008 078

Conference Manager: Kathy Nightingale E: kathytni@gmail.com M: +61 418 515 090 Register online today at:

www.tni-australia.com

Cardiac CT Training 2017 We go beyond simply meeting training requirements: • Participants eligible to claim 124.75 RANZCR CPD points for the 5 day course and 72.5 CPD points for the recertification course. • Maximum allowable course based live and library cases for ANZ credentialing. • Clinician led teaching by high volume operators. • State of the art low dose, High Definition imaging. • Unrivalled venue and catering optimises the learning experience. 2017 Course Dates: 5 Day Level A Course 27th April – 1st May 2017 3 Day Refresher Course 29th April – 1st May 2017 For more information and online registration log on to: www.aicct.com.au or contact us at: info@aicct.com.au

Inside News

INTENSIVE BREAST MRI COURSE 2–4 August 2017 | HONG KONG Melbourne workstation based Breast MRI course turns 7 next year and is celebrating the occasion in Hong Kong! There will be a new set of cases and a new session of contrast enhanced digital mammography—a good match with many synergies. We look forward to seeing you there.

Conference Manager: Kathy Nightingale E: kathytni@gmail.com M: +61 418 515 090 Register online today at:

www.tni-australia.com

General Interest

Australian Branch News Branch Contacts 2017 ACT Chair: A/Prof Murali Guduguntla E: Murali.Guduguntla@act.gov.au Honorary Secretary: Dr Mervyn Despois E: mervyn.despois@act.gov.au Meeting Convenor: Dr John Cockburn E: john.cockburn@act.gov.au NSW Chair: Vacant Honorary Secretary: Dr Chee-Chung Hiew E: chee-chung.hiew@sesiahs.health.nsw.gov.au Meeting Contact: Ms Fidye Westgarth E: Fidye.Westgarth@health.nsw.gov.au NSW Radiotherapy Club Ms Sarah Hall E: sarah.hall@ranzcr.edu.au

NZ Chair: Dr Lance Lawler E: lance.lawler@ranzcr.org.nz Honorary Secretary: Dr Ben Wilson E: ben.wilson@southerndhb.govt.nz

VIC Chair: Prof Stephen Stuckey E: slstuckey@mac.com Honorary Secretary: Dr Gerard Goh E: G.Goh@alfred.org.au

QLD Chair: Dr Mark Phillips E: ausphillips66@yahoo.com.au Honorary Secretary: Dr Peter Zheng E: secretaryranzcrq@gmail.com

MSM Convenor: Dr Bhaveen Marne and Dr Wayland Wang E: msm.convenor@gmail.com WA Chair: Dr Neil Powers E: neil.powers@health.wa.gov.au Honorary Secretary: Dr Richard Ho E: richard.ho@health.wa.gov.au

SA Chair: Dr Chris Pozza E: cpozza@usa.net Honorary Secretary: Vacant TAS Chair: Dr Rajendra Doolabh E: Rajendra.Doolabh@regionalimaging.com.au Honorary Secretary: Dr Jonathan Shulman E: Jonathan.Shulman@regionalimaging.com.au

11th GENERAL BREAST IMAGING MEETING 5-8 April 2017 | Queenstown

Meeting Convenor: Dr Fiona Bettenay E: Fiona.Bettenay@health.wa.gov.au For more information about Branch activities and events, please visit www.ranzcr.edu.au/organisation/ australian-branches or contact Sarah Hall on sarah.hall@ranzcr.edu.au or +61 2 9268 9752

Education

Virtual Colonoscopy Course INVITED FACULTY Liane Philpotts | Francesco Sardanelli David Clouston | Erica Whineray Kelly PLUS RENOWNED AUSTRALIAN & NEW ZEALAND FACULTY

Join us prior to the ARGANZ 2017 meeting for the Philips Virtual Colonoscopy Course. In partnership with internationally recognised experts in their field, this two day course is intended for Radiologists and Radiographers with an interest in gastrointestinal imaging. This workshop comprises a number of lectures and hands-on learning. A selection of 50 library cases will be reviewed during the training workshop.

Dates: Thursday & Friday, 9th - 10th February 2017

Venue: Sofitel Sydney 61-101 Phillip Street, Sydney NSW 2000

Conference Manager: Kathy Nightingale E: kathytni@gmail.com M: +61 418 515 090 Register online today at:

Registration & enquiries: For full program details and to register please visit www.philips.com.au/education or contact tania.marczenko@philips.com for more information.

www.bigmeeting.com.au Volume 13 No 1 I December 2016 164717 Colonoscopy 1/4 page ad_ART.indd 1

24/11/2016 11:52 AM

General Interest

From the Trainor/Owen Collection Transitioning to an online archive

Horn, used to listen for fetal heartbeats during pregnancy. I did eventually become accustomed to the diverse range of radiology equipment in use during the twentieth century, especially the many different sizes and types of X-ray tubes.

Rebecca Lush, Intern/volunteer, RANZCR Archives From August to October this year I interned at the College with the Trainor/ Owen Collection, documenting and researching over 450 objects contained in the archives. This has been for the Masters of Museum and Heritage Studies course I am undertaking at the University of Sydney. During my 20 day placement I experienced firsthand the day-to-day running of an archive. Interning in a small institution was incredibly beneficial as I was able to gain practical experience across a broad range of areas. The most exciting part was having the opportunity to dabble in collection management, conservation, photography, and object research. The main aim of my internship was to prepare the entire Trainor/Owen Collection for online publication onto the database system eHive. Objects ranged from long and heavy X-ray tubes to syringe needles and everything in between. After writing a thorough description, I then measured, photographed, and labeled each object. Some were particularly challenging and required copious amounts of research. For example, I came across what looked like a silver drinking chalice. After some research, I discovered it was actually a type of stethoscope, termed a Pinard

Inside News

The objects I most enjoyed cataloguing were those with an associated social history. For example, there are three academic gowns in the collection that have been donated by various individuals. Perhaps I was most attached to these as I will be graduating this year and attending my own ceremony soon! Each day delivered something very different from the previous. I never quite knew what to expect when opening an unlabeled box in the archive. Although the majority of my time was spent in the archives, I did have the opportunity to change the display case in the foyer of the College. Designing this small display was a great way to finalise my internship and reveal more of the wonderful and intriguing Trainor/ Owen Collection.

Although my formal internship has ended I will be continuing to volunteer with the archives and see my project through to its completion. I would like to thank my supervisor, Eva StokesBlake, for supporting me throughout the internship. It was a rewarding experience learning from a dedicated and passionate archivist. Rebecca Lush Intern/volunteer, RANZCR Archives

Trainor/Owen Collection display at the RANZCR offices

Member Participation Opportunity Do you enjoy discovering stories or solving mysteries? Why not volunteer to help with the Trainor/Owen collection.

Interested in Learning More? Want to learn more about the Trainor/Owen Collection or other collections in the College archives? Why not make an appointment to visit this unique archive, museum and library recording the history of clinical radiology and radiation oncology.

Contact Please contact Eva Stokes-Blake, Project Officer, Archivist, at the College for more information on archives@ranzcr.edu.au or +61 2 9268 9725

General Interest

Australasian Meetings 2017

International Meetings 2017

February

March

ARGANZ 2017 Sydney, NSW 11-12 February 2017 www.arganzmeeting.com Australasian Brachytherapy Group ASM Melbourne, VIC 23-25 February 2017 www.abg2017.conferenceworks.com.au

March TROG ASM Auckland, NZ 6-9 March 2017 www.cmnzl.co.nz/trog-2017-asm/home/

April ILROG 2017 Melbourne, VIC 7-8 April 2017 www.ilrogmelbourne2017.org

RANZCR Annual Scientific Meeting Dates NZ Branch ASM 2017 4-6 August 2017 Nelson, New Zealand www.ranzcr2017.co.nz ASM 2017 19-22 October 2017 Perth, WA www.ranzcr2017.com

For full details of College meeting dates please see College website www.ranzcr. edu.au/organisation/governance

Australian Pain Society 37th ASM Adelaide, SA 9-12 April 2017 www.dcconferences.com.au/aps2017/

~ Death Notices ~

May

The College notes with regret the death of the following members:

AMSIG ASM Melbourne, VIC 6-7 May 2017 www.amsig.org/amsig/amsigmelbourne-2017/ Radiology Asia Singapore, 19-20 May 2017 www.radiologyasia.com

Professional Documents and Publications

ECR 2017 Vienna, Austria 1-5 March 2017 www.myesr.org

April ESER/BSER ASM London, UK 25-26 April 2017 www.eser-society.org ARRS 2017 New Orleans, USA 30 April – 5 May 2017 www.arrs.org/am17

May ESTRO 36 Vienna, Austria 5-9 May 2017 www.estro.org/congresses-meetings/ items/estro-36 ESPR ASM Davos, Switzerland 30 May – 3 June 2017 www.espr2017.org

Dr Kenneth Cramer – Fellow, NSW Dr Veena Chari – Fellow, NSW

Professional documents are developed by the College to support the specialties of clinical radiology and radiation oncology in Australia and New Zealand. They define the standards of training and practice that guide the provision of quality and safe patient care. The documents are reviewed regularly to ensure they reflect best practice. The College also releases major reports and other publications that inform governments, healthcare organisations and members of the public.

All College standards, policies and guidelines are available on the College website www.ranzcr.edu.au/resources/ professional-documents All College position statements and reports can be found here: www.ranzcr.edu.au/advocacy/statements If you have any enquiries about these documents, please contact the College on +61 2 9268 9777

Volume 13 No 1 I December 2016

Courses and Workshops Classifieds

MRI in Practice The course started life as the famous Oxford MRI Course in 1992 and has been running continuously ever since engaging and educating thousands of radiographers, radiologists, physicists, researchers, technicians, engineers, nurses, assistant practitioners, veterinary surgeons and anyone with an interest in the exciting world of MRI.

3 - 6 February 2017 RANZCR CPD points can be claimed for attendance Venue: Novotel MenziesSydney Hotel, Sydney Central, Sydney Early-bird registration fee $1500 www.mrieducation.com/australasia

INTENSIVE PELVIC MRI COURSE

INTENSIVE BREAST MRI COURSE 2–4 August 2017 | HONG KONG • •

NEW set of cases NEW session: Contrast enhanced digital mammography

Conference Manager: Kathy Nightingale E: kathytni@gmail.com M: +61 418 515 090 Register online today at:

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AICCT Cardiac CT training 2017 5 Day initial certification course April 27 – May 1 3 day recertification course April 29 – May 1

27-29 October 2017 | MELBOURNE 3 full days of case review on individual workstations. Register online today at:

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11th GENERAL BREAST IMAGING MEETING 5-8 April 2017 Queenstown

Royal Motor Yacht Club Point Piper Sydney Register on line – www.aicct.com.au Contact us – info@aicct.com.au Dr Daniel Friedman FCSANZ, FSCCT

Breast and Pelvic Radiology Conferences 2017 • 11th GENERAL BREAST IMAGING MEETING 5-8 April 2017, QUEENSTOWN • INTENSIVE BREAST MRI COURSE 2–4 AUGUST 2017 | HONG KONG • INTENSIVE PELVIC MRI COURSE 27-29 OCTOBER 2017 | MELBOURNE

Conference Manager: Kathy Nightingale E: kathytni@gmail.com M: +61 418 515 090

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We are Intelerad. #1 in Enterprise Workflow. Learn more or book a demo at intelerad.com.au/ranzcr4 Australia: 1300 700 333 | New Zealand: +61 3 9863 7530 asiapacific@intelerad.com