Inside News December 2017

Volume 13 No 1 / Dec 2017

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 Exploring the Extraordinary: 2017 ASM Wrap Up 11 7 Essential Lessons from the Member Survey 13 2018 Grants, Awards and Prizes Research 16 Taking on the Clinician-Scientist Pathway 18 A Look Through the History of JMIRO Profile and Presence 21 Targeting Cancer 23 InsideRadiology 26 Our First Clinical Radiology Advocacy Video Access to Quality Services 29 Developments in My Health Record Quality Training 32 Training and Assessment Reform 34 ESTRO-CARO-RAZCR Joint Teaching Course Clinical Radiology 37 Message from the Dean 39 Chief Censor 41 Trainee News Radiation Oncology 49 Message from the Dean 51 Chief Censor 53 Trainee News General Interest 57 Indigenous Health Awareness 58 New Zealand Branch 59 Australian Branches 61 From the Archives 63 CRM Update 65 Meetings and Events

Inside News is printed on Titan Satin. Titan is produced in an ISO 14001 accredited facility ensuring all processes involved in production are of the highest environmental standards.

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 Sarah Hall Susannah Musgrove

From the

Editor’s Desk In the final edition of 2017, our President for the past two years reflects on his time in office and our CEO discusses the importance of member engagement within our organisation.

We bring you some of the incredible highlights of this year’s annual meeting – Exploring the Extraordinary in Perth, as well as congratulate all the prizes, grants, awards and honours recipients in a first-ever Awards and Honours pull out keepsake.

Dr Allan Wycherley

We focus the essential lessons learnt from the member survey in 2016, and update you on the concerns we have addressed and outline the steps the College has taken in light of your responses.

In 2018, we will invite new nominations and applications for a range of awards, honours and Fellowships to recognise outstanding service by members to our professions. Take a look at page 13 to find out which award you or your colleagues might be eligible for.

We delve into Our Place in the Universe with an update on the 2018 Annual Scientific Meeting being held in Canberra. We welcome you to find out more about this exciting meeting. Canberra will not disappoint.

The College is delighted to showcase its first Clinical Radiology advocacy video and we take a look at the video launch and information into each version.

We also take a further look into the developments of My Health Record, the Government’s successor to the Federal Government’s Personally Controlled Electronic Health Record.

Along with the President, we wish you all the best for the holiday season and the New Year.

Allan Wycherley Editor-in-Chief editor@ranzcr.com

The Royal Australian and New Zealand College of Radiologists Level 9, 51 Druitt Street Sydney NSW 2000 Ph: +61 2 9268 9777 Web: www.ranzcr.com Email: ranzcr@ranzcr.com

Submissions The submission of articles, letters and news items is encouraged. Submissions should be sent to editor@ranzcr.com 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 Email: nzbranch@ranzcr.com

All rights reserved. No part of this publication may be reproduced or copied in any form or by any means without the written permission of the publisher.

Publication of advertisements and articles submitted by external parties does not constitute any endorsement

by The Royal Australian and New Zealand College of Radiologists of the products or views expressed.

Inside News © 2017 The Royal Australian and New Zealand College of Radiologists® (RANZCR®)

IN ASSOCIATION WITH

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Introduction

A Message from the

President

Dr Greg Slater

Colleagues and friends, it is my pleasure as your outgoing President to address you in the final edition of Inside News for 2017. It has been an honour and a privilege to serve as your President for the past two years. I trust that I am leaving the role having contributed to the betterment of the College.

Firstly, what a fantastic annual meeting we had in Perth this year. The registrants and speakers from this year’s program were outstanding—a global network of colleagues working together for the advancement of clinical radiology and radiation oncology in medical innovation and practice. The theme for the meeting was ‘explore the extraordinary,’ a reference to the extraordinary pace of technological change which blesses and often bedevils our specialities. Many thanks at the outset to the support of our Platinum Partner, Varian, and all our other sponsors.

However, I would like to highlight a different type of extraordinary—the extraordinary work of the College over the last few years in relation to the training and regulation of clinical radiologists and radiation oncologists, and in the ceaseless demand for advocacy and communication on their behalf.

As an organisation we stand today at the conclusion of a four-year strategy that set out in 2013 to elevate the College as a leader in standards for patient care, lift the visibility of our members and enhance the respect shown by others towards our profession.

The Strategy to 2017 has worked well and the ‘spade work’ undertaken early on by the Board and Faculty Councils laid the foundation for many significant achievements. Among these, I list the implementation of the recommendations of the Training and Assessment Reform, which are primarily aimed at improving how we maintain high standards for trainees, and which includes assessment and accreditation of training sites.

The criticality of the reform process in education and training was brought home to us again with the release in September by the Council of Australian Governments (COAG) Health Council

“The College works tirelessly in advocacy to ensure the profession thrives and continues to deliver excellent patient outcomes.” of its National Registration and Accreditation Scheme (NRAS) review report on the accreditation of health professions, and the unwelcome implications this report has for medical education in Australia.

The College does not support ‘onesize-fits-all’ proposals for a single national accreditation body for health practitioners. The specialist nature of

each discipline demands specialist expertise to determine what is best practice, and—while the creation of a single generic educational accreditation body might save money—it would also weaken the needed specialisation.

Nor do we support any plan to remove the independent role of the Australian Medical Council (AMC) and replace it with a large government bureaucracy.

The AMC currently provides strong regulatory oversight of the medical colleges. Why try to fix something that ain’t broken?

The College’s views, which I have conveyed in writing to the independent reviewer, are in accord with the sentiments expressed by Professor Talley, Chair of the Council of Presidents of Medical Colleges, who said after the release of the draft report that Australia’s current medical education and training sector was ‘a trusted and respected model of regulation.’

Which is not to say we cannot do better.

We can, and that is what the Training and Assessment Reform is working to achieve in our own specialities.

The College is hard at work again on a new four-year strategy, intended to guide our way to 2020 and whatever that promises to bring. Aspects of the current plan are givens: member engagement, for example, will always be a strategic focus for the organisation. continued over...

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Introduction

within the College the importance and evolving role of this area of practice.

What is already apparent from our preparations for the 2020 plan is a need to focus on responsiveness to change or, to use the Prime Minister’s briefly favourite term, agility. (The Prime Minister’s current favourite term is probably survival).

X-ray and ultrasound. We have also had a long-running campaign to persuade the Australian Government to continue the Radiation Oncology Health Program Grants (ROHPG) scheme in some form to help support investment in the timely replacement of our linacs.

I would also like to mention the advocacy work of the College during my term as President. Much of this work goes on behind the closed doors of government, so it is difficult for anyone outside to appreciate the level of commitment needed to prevent public servants from making nonsensical decisions.

Advocacy on these and a few other fronts continues. It is essential core work on behalf of the membership and I can assure you the Board, Faculty Councils and College staff work tirelessly in this space to ensure the profession thrives and continues to deliver excellent patient outcomes.

Finally, as my Presidency nears its conclusion, I offer my heartfelt gratitude to my colleagues for the support I have received over these two years. The Board has acted with wisdom and a determination to get things right, and collectively we have enjoyed the support and dedication of some outstanding office-bearers, volunteers and a firstrate, skilled senior management team.

This has been a deeply rewarding journey as President and one I will always value dearly.

Internally, the College is today in better shape than it was two years ago.

Operations have been streamlined and the organisation is structurally better able to represent all members and their professional interests.

It’s been my honour to serve at the head of a great organisation, and I look forward to working with Lance Lawler, our incoming President, the first New Zealand resident in the job since 1995, and a Board member since 2013.

In 2015–16 the College worked hard in response to the MBS Review to achieve a raft of improvements to the Schedule, including new MBS items for intensity-modulated and imageguided radiation therapies. What we have yet to achieve is a fulfilment of the Coalition’s election promise to fully index the Medicare rebates for MRI,

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Inside News

I’m particularly pleased with the establishment of a standing committee on interventional radiology. Its creation formally and functionally recognises

Introduction

More of you than ever are Active in the College From the

Chief Executive Officer Ms Natalia Vukolova

No priority is higher for a memberbased organisation than members’ engagement with the organisation and its activities.

The experts and clinician-leaders who volunteer their time and proffer their knowledge make our College a formidable, respected and innovative enterprise. But just how many of you are there?

Now, for the first time, we have the data to tell us exactly how many members are actively volunteering with the College—it’s 1,545 or an astounding 36 per cent of the membership. The work of the College ranges across advocacy to governments, the development of clinical standards and the education of registrars. The breadth of responsibilities borne ably every day by the College demonstrates its reputation as the go-to organisation in radiology and radiation oncology in our region. This reputation is no happy accident, it’s the aggregated outcome of the generous and continuing contributions of those 1,545 clinicians.

A further third of the membership participate in our world-class professional development courses, conferences or other College services and communication channels. In the last financial year, 1,146 members attended conferences and events organised by the College.

Overall, a large majority—65 per cent— of members are currently involved with the College in one way or another, helping our organisation achieve its aims and keep our profession strong. We now even know why so many are choosing to be involved by volunteering, attending and engaging—primarily it is because their involvement imparts a sense of being part of something bigger, about contributing to the profession, sharpening clinical skills and keeping in touch with peers.

“The level of involvement is outstanding by any comparable yardstick.”

These data make me feel proud of the organisation we manage on behalf of the members. So, let me take this opportunity to say thank you. In spite of the many demands on your time and energy in your practices and lives, the level of involvement is outstanding by any comparable yardstick.

And so it must remain. I assure you member engagement is our key priority and will always be.

Which brings me to the sting in the tail of this, my final message to members in 2017—the truth is we still need more

clinicians to help out. The scope of work by the College continues to widen as we seek to become more active and influential in our work with governments to ensure health care is sustainable, to realise our ambitious reforms in education and examinations, and to maintain our internationally-recognised work in setting practice standards.

The hard reality is that, as quickly as doctors step up to the challenge, the situation evolves, and more clinical leadership and expertise is required.

So if you feel you want to play a role in improving the present or shaping the future of your profession, make 2018 the year to join over 15 hundred of your peers by volunteering.

So, again, thank you for a stellar year.

We look forward to seeing you around the College in the new year.

It’s Your College

36% of members

volunteer their time

65% of members participate

95% complete CPD

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Engaged Members

Exploring the Extraordinary – 2017 Annual Scientific Meeting Wrap Up. More than 1,100 delegates joined together in Perth from 19–22 October for the College’s 68th Annual Scientific Meeting titled Explore the Extraordinary.

From the moment the delegates entered the new facilities at the Crown Perth complex, the venue set the standard for what was an extraordinary, thought provoking and engaging program.

The program included some of the brightest experts in the field of clinical radiology and radiation oncology, with our international speakers travelling from the USA, Denmark, the Netherlands and Canada.

Complementing the international guest faculty, the meeting program was well populated with highly regarded invited speakers from Australia and New Zealand.

The clinical radiology scientific program was a standout success, with talks by our three international keynote speakers filling their respective lecture theatres with delegates. Professor Suresh Mukherji started proceedings on Thursday with a lively case-based question and answers interactive session on spinal imaging, and followed through the rest of the meeting with standout lectures on head and neck imaging for the general radiologist. Professor Mark Kransdorf’s series of lectures on benign and malignant osseous lesions and soft tissue tumours were well received by medical students and sub-specialist musculoskeletal radiologists alike.

Professor Michael Federle delivered informative liver and pancreatic imaging lectures with advice on how best to derive expert differential diagnoses and imparted on us his considerable imaging experience with bariatric surgical complications.

This year, the ASM was punctuated with lively discussions regarding the evolution of radiology that big data and

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Inside News

artificial intelligence offers, with talks by Rohan Williams Travelling Professor Dr Declan O’Regan, IBM Chief Scientist Dr Tanveer Syeda-Mahmood, and panel discussion amongst invited guests Professor Enrico Coiera and Professor Richard Ehman during the clinical

“The ASM was punctuated with lively discussions regarding the evolution of radiology that big data and artificial intelligence offers.” radiology Faculty Forum. The Medicolegal Forum on Friday facilitated

by A/Prof Sanjay Jeganathan brought to many a reality check, with panel members Dr Fiona Bettenay, MDA national lawyer Pip Nash and lawyer

Julian Johnson. Excellent lectures from local faculty provided updates on interventional radiology, women’s imaging and emergency radiology.

Innovation and research in radiology remains strong, with yet another strong showing of proffered papers. The clinical radiology meeting was rounded out by several talks from our non-radiologist specialist colleagues providing clinical correlation.

The radiation oncology scientific program was an interesting and varied series of lectures and workshops with international and national speakers highlighting important research and advances in the field. Professor Brian O’Sullivan provided a perspective from the UICC and AJCC on the recently updated TNM cancer staging system and future directions in this continuously evolving space. Professor Joost Nuyttens discussed the expanding role of stereotactic radiosurgery and the role of the Cyberknife to deliver such treatments. Professor Vincent Grégoire updated us on recently developed

Engaged Members

guidelines in the delineation of CTVs for the primary tumour in head and neck cancers. Professor Peter Duncsombe reminded us of the importance of quality measures and health economics in radiotherapy, which are not always at the forefront of clinicians’ minds.

The FALCON lymphoma workshops conducted under the guidance of Professor Lena Specht and Professor Umberto Ricardi were well attended and provided useful training for trainees and Fellows in this relatively uncommon cancer subtype. The Faculty Forum was, as always, an entertaining debate and this year debated the merits and otherwise of the proton facility currently under development in Adelaide.

The trainees in both disciplines did not fail to deliver with the radiation oncology Varian Prize tightly contested, with third year trainee Dr Luke Nicholls from Queensland taking out the prestigious prize for his presentation An Assessment of the Clinical Impact of Same Day MRI Prior to Gamma Knife Stereotactic Radiosurgery. The Branch of Origin prize in 2017 was awarded to second year radiology trainee Dr

Nicholas Cheung from Tasmania for his presentation Crohn’s Disease Evaluation with Diffusion Weighted Imaging.

Abstracts of oral and exhibit presentations are now available to be viewed via the online library of the Journal of Medical Imaging and Radiation Oncology (JMIRO).

More than 90 new Fellows were welcomed into the College at the Annual Ceremony held on the Friday evening. New Fellows and guests gathered in the Crown Ballroom to welcome the official processional party, including the 2017 Nisbet Orator, Winthrop Professor Fiona Wood AM, who provided an inspirational presentation on turning clinical skills and training into people-centred solutions with innovation as a core doctor skill.

generated over 2.1 million impressions.

There was also sharing of knowledge via the Technology Zone located in the exhibition space. This provided delegates with the opportunity to view the electronic exhibits via the EPOSTM system alongside the session recordings on the webcasting platform, now available for general viewing at www.webcast.ranzcr.com/Mediasite/ Showcase/ranzcrasm2017

Technology is proving to be the way forward. The ASM meeting app, supported by Comrad, was downloaded by 869 participants and more than 34,864 sessions were favourited by attendees creating their own agendas during the meeting. The #RANZCR2017 had more than 1,500 tweets and continued over...

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Engaged Members

One of the important aspects of a face to face meeting is the opportunity to network with fellow delegates and reconnect with old friends. The Perth ASM certainly provided ample opportunities for delegates to socialise, commencing with the welcome reception and the Faculty of Radiation Oncology dinner on the Thursday evening. The traditional celebratory Annual Ceremony reception was held poolside at Crown Metropol and included a themed children’s zone and activities including balloon making, arts and crafts.

Saturday saw over 80 participants head down to the banks of the Swan River as the sun rose for the Targeting Cancer Fun Run, to see Drs Rachel Effeney and Jeremy Bates take out the prize for the fastest female and male runners.

The gala dinner that evening was the highlight of the social program and included the presentation of a number of prizes and awards. Following the handover from the 2017 Organising

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Inside News

Committee to the 2018 Canberra Organising Committee, Perth’s top band Proof took to the stage with the dance floor jam-packed early in the set.

There was no time to stop with a DJ keeping guests entertained between band breaks: if this was the final night of the event there was no sign of fatigue in guests as they danced the night away.

Delegates will have received their certificate of attendance by now, so don’t forget to claim your CPD points via CPD Online. A maximum of 23.25 RANZCR CPD points can be claimed for full attendance in the ASM lectures (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 their support, including Platinum Partner Varian. A special thanks to the 2017 Organising Committee for their hard work and dedication to achieving a truly extraordinary meeting.

Dr Suki Gill (Radiation Oncology Co-Convenor) Dr Eugene Leong (Radiation Oncology Co-Convenor) Dr Hendrick Tan (Radiation Oncology Trainee Representative) Dr Kevin Ho (Clinical Radiology Co-Convenor) Dr Lisa Ramakrishnan (Clinical Radiology Co-Convenor) Dr Matt Van Wyk (Clinical Radiology Scientific Program Convenor) Dr Jeremy Ong (Clinical Radiology Trainee Representative) Dr Melanie Robert (Committee Member) Dr Yuranga Weerakkody (Committee Member) Dr Trina Whittaker (Social Program)

Engaged Members

7 Essential lessons From the RANZCR Member Survey In 2016 over 1000 of you took part in the first RANZCR member survey. Since then, we have shared several short items in Inside News and Faculty eNewsletters relating to specific feedback raised in your survey responses, as well as a report summarising the overall survey findings.

We take member feedback very seriously, and have been working hard to address concerns and consider suggestions identified through the results. One year on, we take a look at the some of the key learnings from the survey and outline the steps the College has taken, and will take in the future, in response.

YOU SAID… … It’s very important that our professions are recognised and valued by politicians and the public We recognise that the College plays an important role in advocating for all members, and continue to work tirelessly in this area.

We have been disappointed by the Australian Government’s failure to deliver so far on pre-election promises for indexation of Medicare and the proposed Quality Framework for clinical radiology, but continue to engage productively with the Health Minister, MPs from all major parties and senior staff from the Department of Health.

This year, we have also been working closely with the Government following changes to the Radiation Oncology Health Program Grants scheme.

We have joined forces with other stakeholders to present a united front and have made it clear that cuts

to radiation oncology funding are unacceptable, meeting with Minister Hunt to raise these issues personally.

courses for clinical radiology, and the new courses for radiation oncology through our partnership with ESTRO.

The College was active during the recent New Zealand election; during the build-up we submitted manifesto asks to all of the major parties and met with then Health Minister and opposition health spokesperson, and we have already reached out to welcome the new Government.

Our Radiation Oncology Practice Standards and Standards of Practice for Diagnostic and Interventional Radiology set a benchmark for a minimum standard to ensure the safe delivery of these services in Australia and New Zealand. Both flagship publications are currently being reviewed to ensure that they remain relevant and appropriate to today’s practice.

We make regular submissions to governments and other agencies on issues that matter to our members, with recent examples of the Australian Digital Health Strategy and the practitioner requirements for teleradiology in New Zealand. Moreover, our specialties are well represented on several important government committees, such as the Medicare Benefits Review Taskforce.

Activity has also intensified on our InsideRadiology and Targeting Cancer campaigns, raising the profile of our professions with other health professionals and the public. … Maintaining standards is the biggest challenge facing the profession The College is committed to maintaining rigorous standards across our professions.

Our training and assessment reform – currently in progress – will ensure that we maintain a world class standard for training and assessment of trainees and international medical graduates. Our new trainee supervision guidelines will facilitate safe and appropriate supervision of trainees during work hours, after-hours and when on-call.

Since the survey we have brokered partnerships with international organisations to provide members with access to world class training and development including the ACR

… RANZCR must do more to develop and foster a culture of research Research has been a key strategic priority for the College since 2014. Our recently published Research Strategy will guide the development of our research investment and policy into the future.

Supporting the development of research skills and experience in next generation of specialists is a key aspect of our work in this area, and our Research Mentor program, currently in development, along with our well-established Clinician Scientist Pathway and SMART Workshops for radiation oncology trainees, all facilitate this. … Workload and burnout are an area of concern – for Fellows but particularly for trainees and those in teaching roles.

Promoting the importance of wellbeing among our members is an area of focus for the College, particularly for our trainees.

continued over...

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Engaged Members

Our Trainee Liaison Project Officer provides an additional line of support for trainees, and our Interrupted and Part-time Training Policy offers flexible arrangements for trainees whose circumstances have changed and/or who need to take a break from the training program.

Our recently established radiation oncology mentoring working group is developing a mentorship program for trainees that will provide support to combat stress and burnout.

We also acknowledge the significant pressure felt by trainers and assessors and our accreditation standards for training sites and networks include a mandatory requirement for protected time for all Directors of Training. As part of our training and assessment reform we are working on closer alignment of clinical practice with training requirements and reducing the administrative burden for both trainees and supervisors.

Visit the new wellbeing pages on our website for further information and links to useful resources from trusted sources. …Member volunteers deserve greater recognition We are deeply appreciative of the many members who devote their time and expertise to supporting the work of the College, and since the survey have been making every effort to find new ways of acknowledging these volunteers.

In addition to profiling a wider range of volunteers in Inside News, we are also developing a more formal recognition program for those members who have shown great commitment, with the presentation of a certificate of appreciation and an exclusive pin bearing the RANZCR crest.

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Inside News

Beginning this year with our Board, Councils, office bearers and a few other key roles, we will extend this program to a wider group of member volunteers in future.

CPD is the most important benefit of being a RANZCR member, but we want more online learning opportunities and a better system for recording activity

Our Roentgen Medal, Educational Service Awards and Life Membership all recognise outstanding service, and we encourage members to nominate their colleagues in 2018. See page 13.

Our online Webcast Catalogue is home to hundreds of recorded presentations from previous RANZCR annual scientific meetings and members can claim CPD points for watching these presentations.

However, increasing access to online CPD opportunities, particularly for our members in more remote areas, is something the College is seriously considering.

…Maintaining quality and advancing clinical radiology is a big challenge facing the profession The College understands that there are threats to the quality of imaging services from inadequately trained practitioners seeking to report.

We are constantly scrutinising proposals relating to role extension, making a stand where appropriate, for example regarding Queensland Health’s recent proposal to expand the scope of practice for allied health practitioners.

Also ongoing is our collaboration with organisations that represent other specialties to ensure that clinical radiology services are delivered to a consistently high standard. Our work on practice standards and the Medicare Benefits Schedule Review ensures that our patients’ interests are well represented in this critical arena.

In early 2017 we established an Interventional Radiology Committee to foster the development of this emerging subspecialty and steer the direction of the College’s work in this area.

A review of the RANZCR Learning Portal has been scheduled, and we will keep members posted as this project progresses.

We will continue to seek your feedback and will be conducting focus groups and other activities in the coming year. If you have any comments or suggestions in the meantime please contact Laina De Winne, Head of Member Engagement at members@ranzcr.com

Engaged Members

Grants, Awards and Prizes 2018 In January 2018, the College will invite nominations and applications for a range of awards, honours and travelling Fellowships, to recognise outstanding service by members to their professions, and to support deserving members to further their knowledge and expertise by travelling overseas.

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

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

Life Membership Life Membership 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.

Honorary Fellowship Honorary Fellowship recognises individuals who have contributed to the advancement of clinical radiology or radiation oncology and allied sciences, either through original research or by special services to the College.

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

Bill Hare Fellowship This Fellowship enables an experienced clinical radiologist to further their knowledge of an acknowledged subspecialty by study in Australia, New Zealand or overseas.

Rouse Travelling Fellowship This Fellowship enables a continuing exchange of ideas and information between members 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 2018, a radiation oncology Fellow from Australia will travel to New Zealand to attend the annual scientific meeting in Queenstown in August 2018.

Details of the 2018 research prizes can be found on page 22.

Applications and nominations for these awards, prizes and Fellowships open at the end of January 2018 and close on Monday 9 April 2018.

Visit the College website for more information www.ranzcr.com/college/awards-and-prizes

Denise Lonergan Educational Service Award This 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, this award is given 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.

Sally Crossing Award for Consumer Advocacy (NEW for 2018) The Sally Crossing Award for Consumer Advocacy acknowledges outstanding commitment and passion of consumers involved in health care advocacy. The award honours the memory of the late Sally Crossing AM, in recognition of her exceptional contributions to advocating for cancer patients.

Further Information If you have any questions, please contact Chris Bonaventura, Administrator, Membership on gaps@ranzcr.com or +61 2 9268 9721

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exhibitors scientific Program international sPeakers WorkshoPs

RANZCR CANBERRA 2018

25 - 28 October National Convention Centre

6 9 t h A N N uA l S C i e N t i f i C M e e t i N g

netWorking events 1000+ delegates social Program Key Dates

Call for Abstracts Open: January 2018

Call for Abstracts Close: April 2018

Registrations Open: April 2018

www.ranzcr2018.com

Engaged Members

Our Place in the Universe The RANZCR 2018 ASM will take us to Lonely Planet’s third best city to visit in 2018, Canberra, to explore the theme Our Place in the Universe.

Referring to where we are currently at as specialists, clinical radiologists and radiation oncologists in Australia and New Zealand are poised to be regional leaders in delivering modern, evidence-based and appropriate cancer treatments and diagnostic imaging.

Within the Asia Pacific region there are rapidly developing economies and health services, and we all live in countries in which there are disparities in access to medical treatment.

This current period of evolving and even disruptive technological development can bring opportunities to do even more for our patients within our communities, bringing innovative solutions to reduce disparities in health care access regionally.

This meeting will be clinically focused with the overarching theme. We look forward to reading abstracts exploring advances in imaging and radiation therapy, abstracts on innovative service delivery, and welcome all abstracts from early-career clinical radiologists and radiation oncologists.

Clinical Radiologists: Are You Up For The Challenge?

RANZCR 2018 in Canberra is for the general radiologist who is up for a challenge. It will be a showcase: a platform for showing off all that is new and exciting in diagnostic radiology.

The showcase is all about cases hundreds of them over the three and a half days. From case-based reviews to the inaugural ‘Branch of Origin’ quiz between consultants and trainees, attendees will be thrust into a hive of radiological case-conundrums.

International and national experts in neuroradiology, thoracic imaging, emergency radiology, abdominal imaging, head and neck, women’s imaging and MSK will all descend on the National Convention Centre to inform, educate and entertain. The major radiology equipment manufacturers have agreed to send their brightest and best scientists to explain what is coming and why. They have been asked to present technical evolution in context, embedded in academic sessions so that we can see how future developments will have an impact on our patients.

The international expert symposium on error will highlight how we can minimise our mistakes, and learn from those of others. There will be an international poster exhibition showing the best posters from around the world.

For trainees there will be a Mock Part 2 MCQ along with the learning day viva sessions, and a focused MCQ technique session. A further novel item is the “Life after RANZCR Part 2 - Public, Private or Corporate Radiology:” an interactive session for trainees and young radiologists who are contemplating taking the next big step.

And all the while we will be asserting ‘Our Place in the Universe’ – Australian radiology showcasing its best and brightest.

The Canberra ASM will be one to remember!

Dr Angela Rezo and A/Prof Hany Elsaleh A/Prof John Cockburn and A/Prof Rajeev Jyoti Radiation Oncology Co-Convenors Clinical Radiology Co-Convenors

Radiation Oncology – The Role of the Specialist in Place and Time Radiation oncologists in Australia and New Zealand are regional leaders in delivering modern, evidence-based and appropriate cancer treatments. In this time of rapidly evolving and even disruptive technology, opportunities arise to improve patient outcomes and to use innovative solutions to reduce disparities in health care access.

We welcome you to attend this exciting meeting with world leaders in their fields including Professor Birgitte Offersen and Professor Chris Crane, amongst other international and national guests.

The program will include contouring workshops in breast and lung cancer, as well as numerous interactive sessions. The ASM, as always, will be a brilliant opportunity to meet industry representatives and learn about exciting new technologies, and Canberra will not disappoint.

Volume 13 No 5 I December 2017

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Research

Taking on the Clinician-Scientist Pathway the limited hours I have not been able to develop as much rapport with clinical colleagues or be involved in multidisciplinary meetings as I would like.

“Lab life” also required adjusting to.

Because cells and mice don’t wait, there has been a blurring of the weekday/ weekend routine, which can be at times disorienting. However, I view these more as adjustments rather than downsides.

Part of the team helping me with my PhD project.

From left: Dr Jim Hagekyriakou (medical physics), myself, Dr Nicole Haynes (PhD supervisor)

I write this report hoping to help shed some clarity for other trainees who may be considering the Clinician-Scientist Pathway. Questions I have been asked during this journey generally regard four aspects – how did I get this organised, why I am doing this, how am I coping financially, and what are some of the challenges and highlights?

I am currently in my second year of a preclinically-focused PhD project with the University of Melbourne in the cancer research laboratories in Peter MacCallum Cancer Centre, investigating the impact of radiation therapy on the host anti-tumour immune response using mice models. I started this shortly after completing my Phase II Fellowship examinations in 2016. At the time, I had eight months of training time left, but through the Clinician-Scientist pathway I was able to accredit my research time as training time. Planning for PhD studies started well before that, nonetheless. Approaching various research laboratories to enquire about PhD opportunities (I was fortunate to be able to do this with another trainee), and then applying for scholarships, took about a year altogether.

16

Inside News

Why did I choose to do a pre-clinical PhD? Upon hearing my decision, someone asked if I liked suffering.

Needless to say, research is vital to advancing clinical practice, but I also believe that pre-clinical research tackles a fundamental, albeit different, set of questions. In that regard I wanted to at least learn more about the science that undergirds so much of what we do in medicine.

I am extremely grateful to the College for awarding me the Withers and Peters Grant for 2016 and 2017. The financial hit when pursuing full-time research is well-recognised, and part of this grant goes towards stipend-use. It is undoubtedly an incentive to carry on with a higher research degree when finances are less of a worry. The other part of the grant goes toward researchrelated costs. This has given me greater flexibility in making purchases, without having to worry too much about using my supervisor’s funding!

I must mention some challenges along the way, to paint a balanced picture. I am very fortunate to still be able to do 0.2 EFT clinical work, but by nature of

While it was a daunting step to take, so far I am very thankful to be doing what I am doing. One of the greatest enjoyments is being able to bridge in my mind the two worlds of clinical and pre-clinical research. We truly stand on the shoulders of the incredible amount of scientific work accomplished before us. Learning how to refine a question that cannot at the moment be tested in the clinic into a testable hypothesis in the lab, and being able to then examine the hypothesis and review the results, is exhilarating. I will be the first to put dampers on all grandiose delusions, but the thought that I am contributing (in whatever degree) towards a clearer understanding of an important unanswered question makes the long hours in the lab worth it.

All in all, I must once again thank the College and the Department of Radiation Oncology at Peter MacCallum Cancer Centre for the flexibility and support they have offered me in this ongoing journey.

Dr Joseph Sia

Applications for the 2018 Withers and Peters grant open in January.

Visit www.ranzcr.com/college/ awards-and-prizes for more information

Research

Continuing Professional Development

Category 7.3 – Audit Record your CPD activities for 2017 using CPD Online via the Learning Portal.

Category 7.4 – Peer Review (RA)/Peer Review Audit Tool (RO only) Category 7.5 – Database Log Book (RO only) Category 7.6 – Patient Satisfaction Survey (RO only)

New CPD Category: 7 – Maintenance of Professional Standards

MCNZ Requirements

The Continuing Professional Development Committee and the Post-Education Fellowship Committee, who oversee Continuous Professional Development (CPD) for clinical radiology and radiation oncology have noted that few members have logged CPD in Category 7 – Maintenance of Professional Standards. This category was introduced for the 2016 to 2018 triennium and includes tools and templates for the six sub-categories.

Members are encouraged to claim CPD points under these new categories:

• A minimum of one audit per year • A minimum of 10 hours of peer review activity per year • A minimum of 20 hours of educational activities per year

Category 7.1 – Practice Profile and Professional Development Category 7.2 – Multi-source feedback (assesse only)

The Medical Council of New Zealand (MCNZ) requires all New Zealand Fellows, Educational Affiliates and CPD participants to meet the requirements of the CPD program which includes:

Members registered to practice in New Zealand should also note that MCNZ conducts an annual random audit of 15 per cent of medical practitioners each year. For more information on MCNZ requirements: www.mcnz.org.nz/ maintain-registration/recertification-andprofessional-development

Have your Member ID and password ready, click on the Learning Portal button which appears when you move your mouse over the Member Login button at the top right hand corner of the RANZCR website.

Annual CPD submissions for 2017 are due by 31 January 2018.

Visit the Learning Portal here https://lp.ranzcr.edu.au.

If you have any questions about CPD activities, please contact Elaine Shao via email: cpd@ranzcr. com or phone +61 2 9268 9708

Radiodiagnosis Review Course 2018

“INSPIRE”

6-10 April, Melbourne

HRCT & CHEST IMAGING COURSE

- Don’t miss the most comprehensive pre – exam course in Australasia - See, and hear detailed feedback on over 300 exam-quality cases, plus lectures, in all aspects of the radiology curriculum - Delivered by a faculty of expert radiologists and educators - Essential for radiology trainees, IMGs, residents wanting to pursue a career in Radiology - An ideal refresher for practising radiologists—CPD points available!

-5 star venue and catering in the world’s most liveable city!

26-27 May, Melbourne - Following on from his outstanding series of lectures (Inspire 2016), Prof Jeff Galvin returns to Melbourne with A/Prof Gerry Abbott and Dr Teri Franks to deliver a captivating series of talks on CT of lung disease with unique insights into pulmonary pathology - Innovative and immersive multimedia experience includes CT images, pathology and brilliant graphics and animations to enable a deeper understanding of pulmonary radiology - Go beyond pattern recognition and learn how to interpret chest CT like the experts - Earn CPD pts and visit Melbourne in Autumn!

For information and registration, visit our website at www.imagingworkshops.net

Volume 13 No 5 I December 2017

17

THE LIFE AND TIMES OF Celebrating 60 years of Publications 1959

In the beginning….

Dr Meredith Gordon Francis Donnan, Second Editor (1959)

The primary purpose of the Journal was to publish papers and keep members informed of College proceedings.

1966

Journal name changes to Australasian Radiology

1957

First publication of Proceedings of the College of Radiologists of Australasia

Proceedings of the College of Radiologists of Australasia

“The Journal is gaining considerable strength, growth and prestige”, President Rutherford Kaye Scott, 1959

College News is added to the back of the Journal

Early 1962

Dr James Ryan, Fourth Editor (1962-1987) Longest standing editor with 25 years of service

1972

Publishing moves to Wattle & Bull Printing Co

Late 1959

The College discontinues supply of British Journal of Radiology to all members

Journal name changes to Journal of the College of Radiologists of Australasia

1957

Printing house burns down destroying the type set for the December issue

Journal of the College of Radiologists of Australasia

1965

July 1954

1974

Production increases to 4 issues per year

Dr Bernard Francis Vaughan, Third Editor (1959-1962)

Dr William Pook, First Editor and Founder (1957-1959) During these early years the Journal’s financial fortunes fluctuated; changes in editor and printing firms brought unavoidable delays.

For more information visit www.ehive.com/collections/5079/trainor-owen-collection or contact archives@ranzcr.com

1973

Publishing moves to New Era Printing Co

1977

College activities move to Lower Fort Street, Sydney – Journal office takes residence in one of the rooms

1970s

College News becomes its own publication, freeing the Journal to be purely scientific Publishing moves to Bloxham and Chambers

THE RANZCR JOURNAL 1989

2007

Editorial Board established to sharpen the focus of the Journal

1995

2014

A global celebration marking 100 years of Roentgen’s discovery of the x-ray.

Journal portrays Roentgen on the cover for two years.

Journal receives an Impact Factor over 1 1.7

Journal Impact Factor

Silver Anniversary Edition

1895 1995

2008 2000

Journal starts to move towards digital formatting Vol 44, Issue 1

1.42 1.109

1.13 0.947 0.85

0.981

0.951

2012

2013

0.868

1.182

1.189

2015

2016

0.602

0.57 0.28 0 2008

2009

2010

2011

2014

JCR Years

Journal name changes to Journal of Medical Imaging and Radiation Oncology (JMIRO) to better reflect the content of the publication

Impact Factor over time, since 2009 1200 1000

Total Cites

1982

Prof David Ball, Seventh Editor (2007 – present)

945 830

800 638 600 484 373

400 171

200 0

13 2008

237

65 2009

2010

2011

2012

2013

2014

2015

2016

JCR Years

total number of citations each year over a similar period

Journal of Medical Imaging and Radiation Oncology

Australasian Radiology

1993

Moves to Blackwell Scientific Publication Pty Ltd. Along the way, the publisher undergoes a series of name changes; WileyBlackwell Pty Ltd (2007) and Wiley Pty Ltd (2014)

2017

1999

JMIRO celebrate 60 years of publications

Journal has a remarkable growth in size from 400 pages to over 600 pages, in response to increased submissions for publication Prof Michael Sage, Sixth Editor (1999 – 2007)

The future of JMIRO

1987

A/Prof Frederick John Palmer, Fifth Editor (1987 – 1999) The Revolutionist

“Paper will be a thing of the past; certainly observing how my younger colleagues access information, it will all be electronic in the not too distant future. This will provide a flexible and accessible forum to continue to publish on matters that affect the education of radiologists and radiation oncologists in Australia and New Zealand.”

– Prof David Ball

Research

Research Awards and Grants 2018

The College is pleased to offer the following research awards and grants in 2018.

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-Fellowship) 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 peerreviewed journal.

Faculty of Radiation Oncology Bourne and Langlands Prize 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 generously supports first and second year radiation oncology trainees to take part in the College’s Annual Scientific Meetings (in both Australia and New Zealand) by providing a number of grants to assist with the costs of meeting registration and other expenses.

In 2018, eight grants of AU$1,200 are available for attendance at the RANZCR ASM in Canberra, and one grant of AU$1500 is available for attendance at the New Zealand ASM in Queenstown.

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Inside News

Withers and Peters Grant The Withers and Peters Grant supports Fellows (up to five years post-Fellowship) and trainees (post Phase 2 exams) to carry out significant research projects.

A grant of AU$25,000 is available.

Visit the College website for more information www.ranzcr.com/ college/awards-and-prizes

Applications for the above research grants and awards open at the end of January 2018 and close on Monday 9 April 2018.

If you have any questions, please contact Chris Bonaventura, Administrator, Membership on gaps@ranzcr.com or +61 2 9268 9721

RANZCR Research Grants 2018 – Clinical Radiology and Radiation Oncology RANZCR research grants provide financial support for Fellows, Educational Affiliates and student members in both clinical radiology and radiation oncology. Applicants who are students must be supervised by a Fellow of the College.

Grants are awarded for sums between AU$5,000 and AU$20,000.

Applications for RANZCR Research Grants open at the end of January 2018 and close on Monday 11 June 2018.

Further Information

Windeyer Fellowship The Windeyer Fellowship is a 12 month position that provides an opportunity for a trainee or junior Fellow in radiation oncology to undertake a clinical research immersion at the Mount Vernon Cancer Centre in the United Kingdom. This exciting position is under the broad supervision of Professor Peter Hoskin.

The Fellowship commences every January. Applications are accepted up to 18 months of advance of the recipient taking up the position.

For more information visit the RANZCR Jobs website http:// jobs.ranzcr.com

Profile and Presence

Targeting Cancer – From Strength to Strength

Definitive Radiation Therapy for Prostate Cancer In the last 12 months, the campaign efforts have been focused around radiation therapy options for men with prostate cancer. As expected, progress is slow in terms of policy change, though cut-through on our media/social media platforms has been pleasing.

Successes in General Practitioner Awareness Dr Gina Hesselberg (our new General Practitioner (GP) subcommittee Chair) and Dr Sean Hassan (intern at Coffs Harbour) represented the Targeting Cancer campaign at the 2017 Rural Medicine Australia Conference in Melbourne. The pair did a ‘soap box’ presentation about radiation therapy as an underused cancer treatment option – for prostate cancer, in palliation and in many other clinical indications. This is

of particular relevance for rural/regional Australia where access is becoming more challenging in many places.

Furthermore, it highlighted exciting developments in radiation therapy. The talk sparked lively discussion amongst audience members and helped prompt further conversations about the strong role that GPs play in advocating for their patients to get optimal multidisciplinary cancer care.

Based on a survey undertaken by Dr Lucinda Morris among 174 GPs who have attended one of our GP education evenings, an article on ‘Targeting general practitioners: Prospective outcomes of a national education program in radiation oncology’ has been published in the Journal of Medical Imaging and Radiation Oncology (JMIRO). This national standardised GP education program increases GPs’ understanding of core radiation therapy

concepts and improves their knowledge and confidence around referral pathways to radiation oncologists. The survey results suggest this model of interactive on-site GP education may influence patient referrals for radiation therapy and improve GP confidence in advocating for their patients through shared decision-making.

I am very grateful to everybody who has been promoting radiation therapy and Targeting Cancer to GPs. For those who are not active yet in this area, I strongly encourage you to join in through hosting a GP education evening, pushing for radiation therapy to be properly integrated into Health Pathways (we can help), or by seeking opportunities to talk about radiation therapy at GP conferences or educational events. continued over...

Volume 13 No 5 I December 2017

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Profile and Presence

Campaign Engagement in New Zealand

The 2017 Targeting Cancer Fun Run in Perth

With support from members of the New Zealand Radiation Oncology Executive Committee, we are making real progress across the Tasman, in particular around GP education. The Targeting Cancer website has been listed under Radiation Oncology Resources in the Canterbury HealthPathways. Targeting Cancer resources are also published on the GP extranet and e-newsletter of Pegasus Health, a primary care network performing the function of a Primary Health Organisation, as well as supporting general practices and community health programs. Thanks go to Drs Melissa James and Claire Hardie especially. A presentation to radiation therapists at the ASM of the New Zealand Institute of Medical Radiation Technology (NZIMRT) was well received and many radiation therapists have been recruited to the virtual Targeting Cancer family.

The Targeting Cancer Fun Run/Walk at the College ASM has become an annual fun event, and this year in Perth was no exception. Nearly 100 people participated, including radiologists, radiation oncologists, trainees, allied health personnel, as well as their friends and family members. Congratulations to our winners, Dr Jeremy Bates and Dr Rachel Effeney! Start training now for next year’s event on the shores of Lake Burley Griffin in Canberra. Thanks to GenesisCare for sponsoring the event, and Perth Radiological Clinic for sponsoring the winners prizes.

22

Inside News

Business as Usual In the meantime, we continue promoting the general Targeting Cancer messages around the safety, quality, sophistication and effectiveness (and cost-effectiveness) of modern radiation therapy through on-site and external education activities for general practitioners (GPs), patients and the community. We also work on

continuous updates and improvements of the website and supporting any other opportunities for showcasing radiation therapy and Targeting Cancer.

It is pleasing to note that our campaign is now well recognised by several key international bodies, including (most recently) the American Society for Radiation Oncology (ASTRO), as a great initiative to improve the public perception of radiation oncology as an innovative specialty. It is also exciting to see our website has been accessed from most of the countries in the world.

I’d especially like to thank Ms Legend Lee, who is the powerhouse behind the Campaign in the College office and as always, Ms Sonja Cronjé for her invaluable advice and support.

A/Prof Sandra Turner Chair, Faculty of Radiation Oncology Media and Profile Committee Clinical Lead, Targeting Cancer Campaign

Profile and Presence

InsideRadiology is an Australasian resource on clinical radiology tests, procedures, and interventions, providing up-to-date information to health consumers and health professionals and improving doctor-patient communication. www.insideradiology.com.au

Promote InsideRadiology to Patients and Colleagues



Promoting InsideRadiology in your professional networks.



Supplementing your hospital or practice resources using links to InsideRadiology.

 

Recommending any topics that could be considered for inclusion.

Volunteering to assist with content.

Share the InsideRadiology Video.

Topics

Statistics Transarterial Chemoembolisation (TACE)

TACE is a procedure performed by interventional radiologists where chemotherapy and embolic agents are delivered directly into primary or secondary liver cancers via catheters placed in the hepatic artery. TACE is generally indicated in the setting of unresectable hepatocellular carcinoma. Where curative options for hepatocellular carcinoma (such as resection, liver transplant, or percutaneous or open ablation) are not feasible; for example with advanced disease or multifocality, then patients may be treated with TACE.

Updated Items Several items have also been updated following review, including: - Nuclear Medicine Cardiac Stress Test - Ultrasound - Transvaginal ultrasound - Plain radiograph/X-ray - Computed tomography - Arthrogram. ➜ If you would like to propose a new test or procedure for the InsideRadiology website, please contact the InsideRadiology team.

Total traffic to the InsideRadiology site was initially stable; however, increased steadily from June, with 154,381 visits recorded in September. This delivered a record annual high in traffic over the past 12 months.

The following search queries drove the most traffic from search engines to InsideRadiology: • • • • •

VQ scan - 1,385 MRI - 1,372 Gadolinium MRI - 1,094 MRI with contrast - 1,042 Coronary calcium score – 926

The site ranked first on Google for the keyword “MRI”. Following this trend, the keyword “magnetic resonance imaging” improved to second. Overall, InsideRadiology ranks in the top five for 38 per cent of all benchmark terms.

The InsideRadiology Editor-in-Chief, Professor Graham Buirski, would like to thank all those who have assisted in developing new or reviewing existing items throughout the year. ➜ Don’t forget to follow us on Twitter and Facebook (@InsideRadiology) and refer your patients to the consumer information on the InsideRadiology website. This helps us promote the resource to consumers.

Further information about InsideRadiology can be found at www.insideradiology.com.au/aboutradiology/about-insideradiology/

If you need further information please contact Philip Munro on: insideradiology@ranzcr.com

Volume 13 No 5 I December 2017

23

What’s in Issue 6?

Medical Imaging - Radiation Oncology Review Article: Imaging after treatment in uterine malignancies: Spectrum of normal findings and most common complications Corresponding author: Dr Maura Miccò, Department of Radiological Sciences, Fondazione Policlinico Agostino Gemelli, Rome, Italy Uterine malignancies account for the majority of gynaecologic cancers. Different treatment options are available depending on histology, disease grade and stage. Hysterectomy is the most frequent surgical procedure. Chemotherapy and radiation therapy (CRT) represents the preferred therapeutic choice for locally advanced uterine and cervical malignancies. Imaging of the female pelvis following these treatments is particularly challenging due to alteration of the normal anatomy. Radiologists should be familiar with both the expected post-treatment imaging findings and the imaging features of possible complications to make the correct interpretation and avoid possible pitfalls. The purpose of this review is to show the expected computed tomography (CT) and Magnetic Resonance Imaging (MRI) appearances of the female pelvis following surgery and CRT for uterine and cervical cancer, to illustrate the imaging findings of early and delayed most common complications after surgery and CRT, describing the suitable imaging modalities and protocols for evaluation of patients treated for gynaecologic malignancies.

Medical Imaging Pictorial Essay: MRI findings in deep infiltrating endometriosis: A pictorial essay Corresponding author: Dr Anitha L Thalluri, Department of Radiology, Level 3, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia Endometriosis is an important gynaecological disorder which can impact significantly on an individual’s quality of life and has major implications on fertility.

Deep infiltrating endometriosis is a severe form of endometriosis which can cause obliteration of anatomic compartments. Laparoscopy remains the gold standard for diagnosis of endometriosis, although is an invasive procedure that has the potential to be hindered by obliterative disease. Ultrasound is often employed as the first-line imaging modality when endometriosis is suspected, however, MRI is more accurate in assessment of complex disease. Pre-operative MRI is highly specific in the diagnosis of endometriosis and characterization of disease extent, and plays a key role in guiding surgical management. MRI findings in deep infiltrating endometriosis are described.

Radiation Oncology Original Article: High-dose palliative radiotherapy for malignant pleural mesothelioma Corresponding author: Associate Professor Farshad Foroudi, Department of Radiation Oncology, Austin Health, 145 Studley Road, Heidelberg, Vic. 3084, Australia.

Introduction: High-dose radiotherapy to the hemithorax for patients with malignant pleural mesothelioma is a controversial treatment. Between 2003 and 2013 our institution had a policy of giving hemithoracic radiotherapy to at least 45 Gy. This retrospective study reports survival, progression and toxicity associated with this policy.

Methods: Seventy-one patients with pleural mesothelioma were irradiated with doses of 45–60 Gy. Conformal radiotherapy (3D-CRT) to the lower hemithorax was used for 17 and intensity-modulated radiotherapy (IMRT) to the whole hemithorax for 54 patients. All patients have been followed up for at least 2 years from commencement of radiotherapy.

Results: Sixty-four patients (90%) completed planned radiotherapy and seven stopped early, usually due to progressive disease. Median overall survival was 9.5 months (95% CI: 7.7–12.4) and median progression-free survival was 4.9 months (95% CI: 4.4–5.8). Eighty-seven per cent of patients progressed or died within 2 years: 25% in-field, 49% outside the RT field and 13% died without progression. Severe toxicity (grade 3–5) was observed in 53% of 3D-CRT and 78% of IMRT patients, most commonly pulmonary fibrosis 27%, radiation dermatitis 18%, dyspnoea 11%, GGT increased 11%, pneumonitis 10%, pleuritic pain 8% and fatigue 8%. There were two, possibly three, treatment-related deaths.

Conclusion: High-dose radiotherapy to the hemithorax caused significant toxicity to most patients with no improvement in survival. Lower doses of radiotherapy to limited volumes may be useful for palliative purposes.

Radiation Oncology Original Article: Feasibility of spacers to facilitate postoperative radiotherapy for retroperitoneal sarcomas Corresponding author: Dr Jessica Reid, Department of Surgery, University of Adelaide, Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA 5011, Australia.

Introduction: The role and timing of postoperative radiotherapy (PORT) in the management of retroperitoneal sarcoma (RPS) remains controversial.

Method: This is a retrospective cohort review of patients undergoing curative resection for RPS at a single institution between January 2011 and July 2016.

Patient selection was through the South Australian Soft Tissue Tumour Multidisciplinary Group (MDT) based at Royal Adelaide Hospital. An individualised approach, including assessment of resectability, histopathological grade and subtype, and radiotherapy considerations, was taken for each patient. Patients offered preoperative radiotherapy or palliation were excluded. A saline-filled spacer was inserted following operative resection. Radiotherapy commenced postoperatively. Patients underwent laparotomy to remove the device approximately 6 weeks post completion of PORT. Primary endpoints were technical feasibility, perioperative morbidity and radiation toxicity. Secondary endpoints were local recurrence (LR), distant recurrence (DR) and death.

Results: During the study period, 40 patients with RPS were managed through the MDT. Twelve patients (ages 33–78) underwent PORT utilising spacers. Radiotherapy toxicity was reported in four patients and extensive adhesions observed in another four patients during spacer removal. Median follow-up was 35 months (range 4–60). Seven patients remain alive and disease free. Four patients developed LR, three developed DR. Three patients died; two with DR and one with LR. Two patients with recurrent/progressive disease are alive; one with DR and one with LR. Conclusion: Use of intraoperative spacers to facilitate PORT is feasible, with acceptable toxicity following resection of RPS. Patient selection for this approach remains to be determined.

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!

Profile and Presence

International Day of Radiology 2017 As noted on page 26, the Faculty of Clinical Radiology has produced a promotional video for InsideRadiology to celebrate IDoR 2017. All three versions of the video were made available to all members to use in their practices and hospitals as a tool to promote the consumer resource and explain what clinical radiologists do.

The sixth International Day of Radiology (IDoR) was celebrated on 8 November.

The theme for 2017 was emergency radiology.

As in previous years, more than 150 radiology-related professional societies from around the world participated in IDoR, holding a range of different events to celebrate, such as public lectures, department open days, national media appearances, and press events.

Following on from recent themes such as paediatric imaging and breast imaging, this year the focus was on clinical radiology in emergency settings.

The College also promoted InsideRadiology on Facebook, Twitter and LinkedIn. The videos are designed to be used beyond IDoR, so if you have not already, we encourage you to share the video through your own social media accounts.

If you are interested in supporting emergency radiology, the Faculty of Clinical Radiology has a dedicated Special Interest Group - the Australia and New Zealand Emergency Radiology Group (ANZERG). For more information, visit www.ranzcr.com/ special-interest-groups/anzerg

Further promotional materials were also shared with members including the IDoR 2017 posters, banner and press release; InsideRadiology flyers for consumers and professionals; and for Targeting Cancer.

To keep up to date with the latest announcements about IDoR, visit the International Day of Radiology Facebook page www.facebook. com/internationaldayofradiology or the IDoR website www. internationaldayofradiology.com

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Volume 13 No 5 I December 2017

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Profile and Presence

The College’s First Clinical Radiology Advocacy Video The Faculty of Clinical Radiology is delighted to present the Faculty’s first clinical radiology promotional video. This video has been produced by health media experts Tonic Media Health, in collaboration with key Faculty committees, and targets consumer audiences in Australia and New Zealand. While designed to promote InsideRadiology as a reliable source of consumer information about diagnostic tests or radiology procedures, the video also highlights the role and value of the clinical radiologist in patient care.

• Rachel felt lightheaded, dizzy and was clammy with heart palpitations.

She also experienced chest pain.

This presentation can be a medical emergency called pulmonary embolism. The imaging study showed the clot, which was then treated immediately using a catheter inside the blocked artery in the lung.

Three versions of the video are available, in long format (three minutes) with two clips, one featuring Susan’s case and the other featuring Dirk.

The video was launched at the Faculty of Clinical Radiology Council dinner in September, where Branch chairs were invited. Professor John Slavotinek, Dean of the Faculty of Clinical Radiology, introduced the evening and thanked the Media and Profile Working Group, Tonic Media and our actors Dr Kate O’Connor, Dr Gerard Goh and Dr Rajiv Rattan for their input and producing an excellent promotional video.

The video takes you through the experience of three patients that have accessed radiological services and used the InsideRadiology website.

• Susan found a lump in her breast.

To have it diagnosed she had a combination of state of the art digital mammography, ultrasound and MRI scanning. The radiologist also took a targeted biopsy. The patient knew what to expect because her doctor referred her to the InsideRadiology website, which told her what she needed to know, whilst waiting for her biopsy results.

• Dirk had a headache and a pain at the back of his head. He can’t remember much after that. Dirk had a subarachnoid hemorrhage. A tiny coil was used in the artery to block it off and stop the bleeding.

26

Inside News

The video was also screened for attendees at the RANZCR ASM in Perth and has been running at 750 GP practices across Australia through October across the Tonic Media Health network. It is available to radiology practices and hospital departments.

➜ To watch the video, go to the InsideRadiology website, or use the QR codes below.

Inside Radiology Full Video

InsideRadiology (Short) Subarachnoid Hemorrhage cut

InsideRadiology (Short) Digital Mammography cut

Access to Quality Services

Prof Stacy Goergen on Safety and Quality Work Undertaken by the College Safety is Key! The College leads on matters of safety and quality for clinical radiology. This is done through the Safety, Quality and Standards Committee (SQSC). SQSC is responsible for providing advice to the Faculty of Clinical Radiology Council, College committees, members and external stakeholders on safety, quality, standards and associated matters relating to diagnostic and interventional radiology.

The SQSC also develops policies and position statements to inform and influence governments and other decision-makers about the importance of a viable and sustainable clinical radiology profession in Australia and New Zealand.

What Has Been Keeping the SQSC Busy?

Since the first meeting in August 2016, the SQSC has been hard at work with a myriad of tasks—both internal and external. Some of the key activities have included: Internal • Commenced a review of the Standards of Practice for Diagnostic and Interventional Radiology (in conjunction with the modality-based reference groups). The new version of the Standards is on target for release in the second quarter of 2018. The SQSC’s role in the review has been to provide guidance for the revision of the modality-based Standards, with the review process undertaken by other relevant reference groups and working parties, and to primarily undertake revision of generic standards 1 through 7.

• Working with reference groups to update the Faculty’s professional document library. This has involved

revision, replacement and archiving of the entire professional document library that contains position statements and guidelines relating to quality and safety aspects of radiological professional practice.

• Supporting the development of new professional documents (e.g.

Role of the Clinical Radiologist in Multidisciplinary Team (MDT) Meetings1) • Approval of new appointments to (and within) reference groups.

External • Responding to external consultation requests.

• Responding to enquiries, both from members and external individuals/ organisations and the general public regarding safety and quality issues.

• Responding to recommendations from the New Zealand Health and Disability Commissioner and Australian coronial reports.

• Reviewing recommendations from other colleges, societies, and associations for the Choosing Wisely initiative (www.choosingwisely.org.au or choosingwisely.org.nz) and Evolve program (www.evolve.edu.au).

• Liaising with other specialist medical colleges on joint activities to improve quality or data collection: o RANZCOG third trimester fetal ultrasound reporting o RACS Audit of Surgical Mortality, where imaging is involved.

• Providing representation into the review of the ACHS Radiology Clinical Indicators www.achs.org.au/ programs-services/clinical-indicatorprogram

Faculty of Clinical Radiology Council for approving a consumer representative to sit as a member of the Committee.

Recruitment of the inaugural consumer representative is underway and we will welcome them to the SQSC in early 2018.

Membership ➢ Prof Stacy Goergen (Vic), Chair ➢ Prof John Slavotinek (SA), FCR Dean, ex officio ➢ Dr Kate O’Connor (NZ), FCR Council representative ➢ Prof. Graham Buirski (ACT), Editor-in-Chief, InsideRadiology ➢ Dr Pramod Phadke (NSW), CRETC representative ➢ Dr Dean Topham (SA), CRTC representative 2017 ➢ Dr Fraser Brown (Tas) ➢ Dr Colin Chong (Qld) ➢ Dr Kim McAnulty (NZ)

continued over...

The Committee has a strong focus on patient-centredness and supporting radiology professionals to provide highquality, safe services to the people of Australia and New Zealand. With this in mind, we were very grateful to the

Volume 13 No 5 I December 2017

27

Access to Quality Services

What’s Next?

2018 will see the SQSC finalising the new Standards and also embarking on a refresh of the Faculty’s accreditation scheme in conjunction with NATA. This is the natural next step to ensure the hard work that has gone into the Standards update benefits patients and recognises and rewards excellence in professional practice. In addition, our routine work of advocacy and representation for the College in all things quality and safety will continue.

How Can You Help?

College members spend a lot of time and energy developing various professional documents (guidelines, position statements and documents, standards) to help guide safe,

appropriate and high quality clinical practice in the field of medical imaging.

These documents are put out regularly for consultation. SQSC would encourage you to keep an eye out in the FCR eNewsletter and on the College website for such consultations, and to review and provide feedback on these.

Members are also often sought for various committees and groups—as opportunities arise, these are made available on the College’s Get Involved page on the website www.ranzcr. com/college/volunteering. Consider volunteering your skills and experience on these bodies.

For more information on the SQSC, or to contact the Chair, please contact Philip Munro, Manager, Quality and Standards on philip.munro@ranzcr.com or +61 2 9268 9763.

References 1. www.ranzcr.com/search/ranzcr-position-on-the-roleof-clinical-radiologist-in-multidisciplinary-team-mdtmeetings

Prof Stacy Goergen Chair, SQSC

Process Update for Nuclear Medicine Graduates To improve the process for clinical radiologist graduates of the joint Royal Australasian College of Physicians (RACP) and our College’s Nuclear Medicine Training Program, the RACP and the RANZCR have now created a jointly signed letter that will be issued to graduates of the program. In previous years, graduates had experienced difficulties with the Australian Health Practitioner Regulation Agency (AHPRA) requiring separate notice from the RACP and the RANZCR, causing confusion for those involved and resulting in an unnecessary double-up of paperwork.

This letter will be signed by both Presidents and will be provided to graduates directly from the RACP, ensuring clinical radiologists will only need to provide AHPRA with one letter, along with evidence of their Fellowship, in order to gain official recognition as a nuclear medicine specialist.

28

Inside News

The RACP will then advise our College of all clinical radiologists that have completed nuclear medicine training and the College will record it on the individual’s file.

If trainees have any difficulties regarding their nuclear medicine training they are encouraged to contact the RACP in the first instance on NuclearMedicine@racp.edu.au

Quality Practice

Developments in Australian My Health Record The My Health Record (My HR) is the successor to the Federal Government’s Personally Controlled Electronic Health Record (PCEHR). Preparations for its use in the diagnostic imaging sector are progressing steadily. To maximise the benefits of digital communication and shared records in enhancing patient care, the College is updating members at key stages of this process.

The Story So Far Subsequent to the September Inside News article ‘The Future for Digital Health’, further updates from the Digital Health Agency (the Agency) regarding the national roll out of the My HR have become available.

Previously, members were informed that: - My HR is a secure online summary of a patient’s medical history and health information, which is accessible to the patient (thus patientfriendly terminology is advised), and potentially to any healthcare professional responsible for the care of that individual.

- The records anticipated to be uploaded to My HR include shared health summary, event summary, discharge summary, medication record and specialist reports, including those from diagnostic imaging (DI).

- These records should not be considered as a substitute for practice clinical records, but rather as a supplementary aid to communication between different treating healthcare professionals.

- In 2018, the My HR will be moving from the current opt-in system to opt-out, a move which may have profound implications for DI services.

- A limited number of public hospitals (in the Northern Territory) have started uploading DI reports to the My HR. Australian Capital Territory,

New South Wales, Queensland and Tasmania are projected to engage in 2017/18.

- Queensland X-Ray (a subsidiary of Sonic Healthcare) recently became the first private company to connect with the My HR test environment.

Latest Developments The Agency’s Diagnostic Imaging Software Industry Offer concluded on 7 July 2017, with 16 contracts awarded to RIS providers; these contracts were then signed in September 2017. It is anticipated that major DI software providers will make My HR compatible versions of RIS available to their client practices by early 2018. This will prepare the ground for input to My HR by hospitals and radiology practices.

The Agency is working closely with state and territory health systems to ensure that public radiology practices are connected to My HR. At present, roll out is expected through 2018, with the timeframes for each state provided below. By December 2018, the Agency has projected that software capable of connecting to My HR and uploading reports will be accessible to over 95 per cent of all radiology practices (public and comprehensive private).

Radiologists should expect targeted communications from your hospital in advance of uploads being commenced.

Program Timeline to Upload Reports in Public Hospitals by State First Half 2018

Second Half 2018

Australian Capital Territory

South Australia

Tasmania

Western Australia

New South Wales

Victoria

The Connectivity Cost for Private Practices The Faculty of Clinical Radiology has worked closely with the Australian Diagnostic Imaging Association to estimate the costs involved in connecting to My HR, and training staff accordingly to manage the process and respond to patient queries. As members will realise, this is against the backdrop of frozen rebates for the past 18 years.As outlined above, funding is available to RIS providers to upgrade their software packages, however there are a range of other costs anticipated for private practices and hospitals.

Although no other monetary costs have been specified, the Agency has acknowledged to the Faculty of Clinical Radiology and ADIA that administrative, training and management costs will be incurred by any participating practice.

Some of these will be incurred upfront including: - Registering as a My HR participant and obtaining appropriate Healthcare Provider Identifier(s) for their organisation; - Developing new, and updating current, policies and procedures relevant to My HR (templates are made available by the Agency); - Training and up-skilling of staff to be competent with using My HR, particularly on procedures regarding withdrawal of patient consent (which is currently undergoing development).

continued over...

Queensland

Northern Territory

Volume 13 No 5 I December 2017

29

What is your Future?

Where will you be?

When and how often will you report?

Surf in Cornwall Christmas in London

Vancouver

New York for fun Summer in Sydney

Cape Town for Cricket Auckland for Rugby

Now is the time to do something different. Reporting as much or as little as you like in Australia, UK, USA, Europe, Ireland, South Africa, Israel, New Zealand. Move around, keep still. You decide.

Keep your existing job or give it up. Join us for part or all of your sabbatical, fellowship or holiday. Report regularly, report sometimes.

Flexible hours

Great teams and support

Multiple locations

Interesting, diverse cases

Week on - week off. You choose.

State of the Art IT

Daylight reporting 24/7

>40,000 reports per month >100 Radiologists >500,000 reports per year.

Where will you go? We offer uniquely rewarding teleradiology roles for FRANZCR radiologists worldwide. Contact us today: opportunity@everlightradiology.com.au Australia United Kingdom New Zealand

everlightradiology.com.au

Quality Practice

A number of ongoing costs are also envisaged, chiefly training time and other logistics in administration.

However, accessing or uploading reports to My HR incurs no fee. The College and ADIA have commissioned an independent research institution to explore these costs and will present the findings to the Agency. There has been a common misconception that the electronic steps required to participate in My HR and upload DI reports are time consuming. This should not be the case once staff are trained and the technology is in place. Advice is available from the Agency to clarify the process involved (refer to Further Reading).

Other Developments

Further Reading

Sharing of patient information has raised the prospect of implementing electronic referrals, a goal raised many times by the College to improve the quality of patient care. We are working together with the Agency, and other relevant organisations, to advocate for the method of e-Referral that best facilitates patient choice, and the sharing of information reliably and securely. The College will also work closely with the Agency to develop bespoke continuing professional development training materials for radiologists on the use of My HR.

A range of useful materials are already available to prepare practices and doctors for My HR, including:

Processes involved in withdrawal of patient consent have still not been fully established. Further work has commenced to resolve this prior to roll out.

- The Australian Medical Association (AMA) www.ama.com.au/article/amaguide-using-pcehr Guidance for practitioners on how to use My HR The Digital Health Agency www. digitalhealth.gov.au/home/using-themy-health-record-system/trainingresources Guidance and templates to assist with practices transitioning to implement My HR - For information regarding privacy obligations for HCWs please visit www.oaic.gov.au/myhealthrecord

If you have any questions or experience of My Health Record that you would like to share, please contact Silvia Park on fcr@ ranzcr.com or +61 2 9268 9764.

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Volume 13 No 5 I December 2017

31

Quality Training

Training and Assessment Reform – Year in Review The College’s Training and Assessment Reform has made substantial progress in 2017, as we continue to work through the recommendations of the 2015 ACER-Prideaux Review.

Examinations In clinical radiology, almost half of the original 34 examination recommendations are now complete, with the remainder in progress.

With the ongoing guidance of the Australian Council for Education Research (ACER), the Part 1 (Anatomy and Applied Imaging Technology) and Part 2 (Radiology and Pathology) Examination Review Panels have all now completed a fully expanded exam cycle in 2017. The new protocols incorporate comprehensive and rigorous review of exam content, passing standards and candidate performance, ensuring that pass/fail decisions are fair, robust and reliable.

Information to candidates and supervisors regarding exam performance has been improved throughout 2017, with more detail provided on passing standards and scores, and additional examiner feedback supplied on failed components. Additionally, the move to the AMC National Testing Centre for the Part 2 viva examinations has made possible a number of recommendations related to security, consistency, and examiner training at the vivas.

In radiation oncology, action is underway on most recommendations, and work in 2017 has focused on improving marking template design, refining exam blueprints and using formal standard setting to verify the expected performance standards. The Phase 1 Exam has been reviewed and the Pathology component will be removed,

32

Inside News

effective 2018. Along with a change to the scoring rules this will improve the overall reliability and efficacy of the exam. Both Phase 1 and 2 Exam Panels will consolidate their expanded review processes in 2018.

At the College ASM in October, ACER ran a number of informative sessions for Directors of Training and interested members, including an insightful look at the College’s new exam processes for each Faculty, and workshops on how to write quality multiple-choice questions (MCQs). These and other sessions are available to view on the RANZCR webcast library.

Programmatic Assessment A number of College members attended a workshop conducted by the AMC in November on Medical Education Assessment for 21st Century Health Systems. Topics covered included: • an understanding of the fundamentals of programmatic assessment • common problems and innovations to understand alignment with programmatic assessment concepts and AMC standards • practical strategies on how to design and implement a programmatic approach to assessment • various case studies highlighting national and international innovations in assessment across the medical continuum relating to programmatic assessment.

Presenters and the expert panel comprised of Professor Cees van der Vleuten, School of Health Professions Education, University of Maastricht, Netherlands who is the founder of programmatic assessment theory, Professor Lambert Schuwirth from Flinders University and many others.

We are one of the first few specialist colleges to have embarked on this journey and are very fortunate to have the ongoing support of Professor David Prideaux to take us through this innovative reform. In each Faculty, the respective Steering Committees have overseen the formation of working groups to develop programmatic assessment frameworks for the various curricular streams identified in late 2016.

In clinical radiology, the Competencies for Early Training program was the first to be completed and will, importantly, include an assessment of Key Conditions in Year 1 to adjudge trainees’ readiness for after-hours work. Three other radiology working groups are close to finalising their recommendations.

The Anatomy group has worked on the format of the anatomy exam and considered ways to assess the application of Anatomy into clinical practice beyond Year 2. The Research group has considered the required balance between research methods and critical appraisal skills, and the Image Reading and Analysis / Clinical DecisionMaking group has been defining the core clinical skills of a radiologist to develop a continuum of learning and assessment across the full five years of the training program.

The radiation oncology working groups have made good progress in curriculum review and program design, and two of these groups have now largely completed their recommendations. The Oncology Sciences group are proposing a series of network-based workshops, as part of a two-year learning and assessment program aimed at building a solid foundation of scientific knowledge.

These workshops will effectively replace the Clinical Assignments, which are nonmandatory from 2018. The Anatomy, Contouring and Plan Evaluation team

Quality Training

has developed a new work-based Contouring and Plan Evaluation assessment tool that will be used to track the ongoing development of key radiation oncology clinical skills. This tool uses the ‘Entrustable Professional Activity’ model of assessment, in which supervisors make judgements of competency based on the level of supervision required by trainees when performing a task.

As the draft documents for these and other programs are approved by the Steering Committees, Education and Training Committees and Councils, they

will be made available on the College website for review by trainees and Fellows.

The reform project is an enormous body of work, and would not be possible without the ongoing commitment of a large number of stakeholders, including Fellows, trainees, non-member examiners, external consultants and staff. The College is indebted to all who have contributed in 2017 to making our training programs an exemplar of best practice medical education for the 21st century.

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.com or +61 9268 9706.

BREAST IMAGING MASTERCLASS Sat 3rd – Sun 4th February 2018 with Dr Michael Linver MD (aka Mammo Mike)

RANZCR CPD 24 points Crown Promenade, Melbourne

Registration Open Now! www.breastmasterclass.com.au

Volume 13 No 5 I December 2017

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Quality Training

First Joint ESTRO-CARO-RANZCR Teaching Course: Foundations of Leadership in Radiation Oncology The Foundations in Leadership for radiation oncology course has been created to fill a gap that had become increasingly apparent over recent years. This first-ever joint European Society for Radiotherapy and Oncology (ESTRO), Canadian Association of Radiation Oncology (CARO) and the Royal Australian and New Zealand College of Radiologists (RANZCR) course is designed to equip participants with the knowledge, skills and attributes considered as building blocks for effective leadership. The course is directed at professionals who are interested in developing expertise in leading teams, advocacy and positively influencing the future of radiation oncology within local and international settings. The course has been developed against a backdrop of a global movement around the need for health professionals across the board to step up and take more responsibility for shaping the future of health systems.

It was recognised that bureaucrats and non-clinical managers may not be in the best position to direct patient-centred healthcare and improvements relating to patient processes.

This ‘call to action’ lead to the recognition that in order to change this situation, training around leadership skills needed to become more integral to training curricula and programs, starting with junior health professionals.

Central to this philosophy are the findings that effective leadership (like all other skills) can be taught and that early recognition of the responsibility for leadership and change sits with all of us. The principles of team-based or ‘shared’ leadership and less hierarchical leadership models underly modern views on leadership.

Radiation oncology is an ideal area of patient care in which trainees

34

Inside News

and more senior staff can work in established inter-disciplinary teams to drive improvements in patient care.

Team environments are also ideal for learning the tools to ensure success in quality improvements and other areas of leadership. Through an educational collaboration, ESTRO has been part of developing an international curriculum aligned with the new CanMEDS2015 Leader Role. The course will apply this to guide learning. Within the new Foundations for Leadership course, the focus is on so-called ‘little l’ leadership for less senior radiation oncology health professionals, to start equipping them with the knowledge, skills and behaviours to effectively lead improvement projects within their workplace. It is hoped that the attendees will continue to develop their leadership journey after the course to become ‘big L’ leaders who help shape the future of radiation oncology to reach its full strength and potential in patient care.

Learning Outcomes The new course will use blended learning, with online, virtual classroom and live components, and will contain self-directed, team-based and didactic elements. It will be very practical and focus on learning for application to day-to-day workplace situations. The participants will hopefully see immediate relevance to their current and future careers.

The overarching learning objective is that after completion of the course, participants should be able to: - Examine and reflect on their own behaviors, reactions and interactions with team members - Describe basic leadership theory and styles as they might apply to practical situations - Describe the foundations of effective change management and negotiation - Explore strategies to establish and lead effective teams - Apply basic quality improvement tools to approach an improvement process.

Teacher Selection Course Directors: Drs Kim Benstead, Meredith Giuliani, A/Prof Sandra Turner Teaching Faculty: Drs Barbara-Ann Millar, Jesper Eriksen, Alessandro Cortese, Lucinda Morris The teachers for this course were selected for their demonstrated expertise and enthusiasm in the areas of medical education, teaching of leadership and quality improvement topics. They represent the major collaborating groups for this tribranded course; from ESTRO, CARO and our College, RANZCR. ESTRO’s own CEO, Alessandro Cortese, will bring his expertise in innovative management to the teaching panel. Key issues around leadership in radiation oncology are common across the world yet approaches may vary. The global perspectives of the teaching faculty (and participants) will provide richness to this educational experience.

Quality Training

Who Should Attend?

The target group for this course consists of senior trainees or junior Fellows (approximately first five years after training) across all the radiation oncology professions. Potential attendees must be motivated to become effective leaders in their workplace, now and in the future.

They need to commit to engaging actively with all components of the live

and digital course. They should have good communication skills and be enthusiastic about learning in multidisciplinary teams with participants they do not know. Course numbers will be strictly limited and a formal application process will apply including potential participants submitting a ‘Statement of Interest & Motivation’.

The ESTRO-CARO-RANZCR Course is being held in Europe throughout 20 March 2018 - 15 May 2018. More details can be found on the College website: www.ranzcr.com/whats-on/events

Foundations of Leadership in Radiation Oncology NEW IN 2018

A Joint ESTRO-CARO-RANZCR Course From March to May 2018

SPECIAL FORMAT: a combination of online and live

education with live sessions at ESTRO 37, preceded and followed by e-learning sessions

COURSE DURATION

8 weeks including: • Online programme to start around 20 March 2018 • Live sessions at ESTRO 37 in Barcelona: on 20 April 2018 (as a pre-meeting workshop) and 2 lunch meetings on 21-22 April 2018.

COURSE AIM

This new, very practical course will equip you with knowledge, skills and attributes for effective leadership, immediately applicable to day-to-day workplace situations and relevant to your current and future career.

LEARNING OUTCOMES

After completion of the course, you will be able to: • Examine and reflect on your own behaviors, reactions and interactions with team members • Describe basic leadership theory and styles as they might apply to practical situations • Describe the foundations of effective change management and negotiation • Explore strategies to establish and lead effective teams • Apply basic quality improvement tools to approach an improvement process.

More information mid-September on www.estro.org

Volume 13 No 5 I December 2017

35

Quality Training

2018 RANZCR Workshops, Courses and Events A number of educational activities and events are on the calendar for 2018 across clinical radiology and radiation oncology.

Radiation Oncology Trainee SMART Workshop The SMART Workshop will be taking place on Monday 19 March 2018 to coincide with the 2018 Trans Tasman Radiation Oncology Group (TROG) Annual Scientific Meeting in Hobart.

This full-day workshop is directly designed to enhance trainee knowledge and skills in: • Statistical methods • Critical appraisal of the medical literature • Research methodology The workshop will have interactive small group sessions, guided by radiation oncologists and biostatisticians, to discuss actively recruiting and published cancer clinical trials. The SMART Workshop is an opportunity for trainees to meet with local researchers within TROG, and international researchers.

Trainees are strongly encouraged to stay on for the TROG ASM, which will be an excellent opportunity to put into practice skills learnt at SMART Workshop, and develop networks with TROG researchers.

Register: www.trog2018.com

Phase 2 Exam Preparation Course The Phase 2 Exam Preparation Course will be taking place between 18 – 19 May at Rydges World Square, Sydney. The course is designed for trainees as they approach exam readiness and aims to provide trainees with an opportunity to: • Better understand the exam development process and how exams are marked

36

Inside News

• Simulate sitting the viva exam, with feedback provided immediately afterwards • Practise a written question from each paper to workshop the answers with the Phase 2 examiners, and • Develop strategies to cope with exam stress to ensure they perform to the best of their abilities.

Registration fee: AU$880 (including GST) Register: registration open early 2018

ESTRO Basic Clinical Radiobiology Workshop The ESTRO Basic Clinical Radiobiology Course is being held from 10 – 13 May 2018 at the Radisson on Flagstaff Gardens, Melbourne. The course is designed to be an introduction to radiation biology as applied to radiotherapy, focusing on technology, biology and molecular oncology. It represents a valuable opportunity for radiation oncology professionals to learn from an international faculty of expert radiobiologists and clinicians in Australia.

Registration fees: ESTRO Member - RANZCR Trainee: AU$1,315.05 ESTRO Member - Radiation Oncologist: AU$1,699.50 ESTRO Member - Radiation Therapist/ Physicist/Radiobiologist/other members in training: AU$1,502.05 Non ESTRO members - all categories: AU$1,898.05 Register: www.ranzcr.com/whats-on/ events

Phase 1 Foundation Course The Phase 1 Foundation Course will be held between 15 – 16 June at Rydges World Square, Sydney. The course is designed for Phase 1 trainees who are in the first six months of training and will: • Inspire trainees to learn for life rather than for the exams • Provide trainees with an opportunity to ‘check’ their knowledge with the help of experts to know that they are on the right track • Provide guidance on how to approach the next 12 months of their training in the most efficient way, and • Provide an opportunity for trainees to network professionally and socially.

Register: Registration open early 2018

Phase 1 Exam Preparation Course The Phase 1 Exam Preparation Course will be held between 15 – 16 June at Rydges World Square, Sydney. The course is designed for Phase 1 trainees who are aiming to sit the Phase 1 exams in September 2018 and will: • 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 question of experts in a dedicated questions and answer session as well as informally following individual sessions • Provide specific guidance on exam preparation and technique including mock exams on the Sunday, and • Provide an opportunity for trainees to network professionally and socially.

Register: Registration open early 2018

Clinical Radiology

A Message

from the Dean

Prof John Slavotinek

Artificial Intelligence and the Perth ASM The recent Annual Scientific Meeting (ASM) features heavily in this issue, however I would like to provide some of my own reflections on Perth 2017.

Firstly, credit must go once again to the Convenors and ASM Management Committee for a superb line up of speakers, a first rate venue and superb organisation. A not insignificant number of sessions were standing room only, reflecting the calibre of speakers and level of interest in the topics being presented. We welcomed several new exhibitors to the ASM and held very productive meetings between College office bearers and our international partner organisations. The quality of research presentations was again high, including at the Branch of Origin, helping to develop the discipline’s research culture.

Artificial intelligence has been a focal point at a number of recent international meetings and it was timely and appropriate that there be a number of excellent presentations on this topic at the recent ASM. These included a very well received lecture by Dr Declan O’Regan in the opening plenary session and another by Dr Tanveer SyedaMahmood. The topic was brought into focus during the Faculty of Clinical Radiology Forum where the potential, hype, likely progression and risks of artificial intelligence were analysed by an expert panel after presentations by Prof Enrico Coiera and Dr Tom Snow.

The consensus was that significant change may take five to ten years, will

be task specific in nature and will assist radiologists, whereas ‘human-like’ general purpose intelligence is likely to be at least 20 years in the future.

Irrespective of the above it is important to note that radiology is already a highly innovative discipline, and has for some time been accustomed to adapting to modality and Picture Archiving and Communication System (PACS) related technological advances. This aspect of our experience and culture will serve us well in the future as our (perhaps more clinical) role in healthcare evolves. We must continue to adapt, embrace the future and the Faculty of Clinical Radiology will support and advise clinical radiologists as these new horizons emerge. I will take this discussion back to the Faculty of Clinical Radiology and key committees throughout 2018.

For those who could not make it to the ASM, I highly recommend that you look through the program and watch as many sessions as you can on the RANZCR webcast library. In summary, the Perth ASM was truly extraordinary and raised the bar further from an excellent ASM at the Gold Coast. I look forward to even bigger and better things in Canberra 2018.

Medicare Benefits Schedule Review The MBS Review continues apace.

Members will have seen that the Faculty responded to consultations during September, with several more due in before the end of the year.

Tailored communications will be shared

with members when changes to item descriptors take effect.

I would like to take this opportunity to thank again those clinical radiologists who have participated in the MBS Review. They have been instrumental in advocating from within to ensure that as far as possible, our patients continue to have good access to essential radiology services.

Faculty of Clinical Radiology Council The Faculty of Clinical Radiology (FCR) Council has a busy agenda for the remainder of the year. We hope to sign off the Australian and New Zealand reports on the Workforce Census; our new teleradiology standards following extensive stakeholder consultation and legal review; engagement on digital health in Australia (please see the My Health Record article on page 29); and the initial results of the inaugural survey on interventional radiology practice.

It is also opportune to thank FCR Councillors retiring at the end of 2017, Dr Greg Slater (President and former Dean) and Dr Yvonne Ho (who has been elected to serve on the College Board). In particular, we owe Dr Slater a great deal of gratitude for his untiring commitment to the discipline of clinical radiology, his efforts to establish the Faculty and his exemplary service to the College over a very long period. continued over...

Volume 13 No 5 I December 2017

37

Clinical Radiology

Following the recent cycle of elections, Drs Ross O’Neil and Gerard Goh will return to serve another term on Council, Dr Catherine Mandel will return in 2018, and Dr Lance Lawler will join as the new College President. I would like to congratulate all on their successful election.

InsideRadiology for IDoR 2017 As you will see elsewhere in this edition, the Faculty commissioned a promotional video for InsideRadiology for the 2017 International Day of Radiology, which centred on the theme of emergency radiology and the key role of clinical radiology in modern medical practice.

The video is designed to promote and explain what clinical radiologists do to audiences in Australia and New Zealand.

The full video and two 30 second clips are available for hospitals and practices to use in your waiting areas.

One of the findings from the Profile of a Clinical Radiologist Survey in 2016 was that members did not feel that the public understood what they do. This video, designed to address just that, is screening in over 700 GP clinic waiting rooms through Tonic Media Health and I encourage you to share it across your networks.

Inside Radiology Full Video

If you have any feedback or comments on any of the above, please email fcr@ranzcr.com

International Day of Radiology – not just celebrating When Wilhelm Conrad Röntgen discovered x-rays in 1895 he could not have conceived the benefit his revelation would bring humanity.

Röntgen is rightly considered the father of modern radiology, a specialisation which today lies at the very heart of our medical system. Every day radiologists helps save thousands of lives across Australia and around the world, while improving the lives of many, many more.

So, on 8 November, the anniversary of Röntgen’s discovery, the Australian Diagnostic Imaging Association (ADIA) rightly joined radiology professionals globally in marking the sixth International Day of Radiology.

Celebration were muted by the overwhelming need to remind people – particularly our politicians – that radiology in this country is facing a crisis.

The simple fact is that many Australians can no longer afford these lifesaving services, because Medicare rebates for radiology haven’t been indexed in almost 20 years.

38

Inside News

Instead of being available to all, radiology is now the hardest of all primary care services to access.

to radiology practices around the country, with patients encouraged to wear them.

Radiology has the highest upfront cost, the highest patient gaps and the lowest bulk billing rate.

Of course, ADIA’s activities around 8 November were part of our larger, ongoing campaign to end the freeze on Medicare rebates for clinical radiology.

As a sector, we know that people with life-threatening conditions, including cancer, are now declining radiological services because they just can’t afford them.

It’s a dire situation which has to be addressed, so on International Day of Radiology ADIA sent balloons and cards to federal MPs reminding them that it is their responsibility to fix our ailing Medicare system and reinstate indexation for radiology rebates.

This mail out was followed up by broadcasting supporting messages on digital screens throughout Canberra airport where travelling MPs couldn’t fail to notice.

Also, thousands of pins proclaiming ‘Radiology Saves Lives” were distributed

The Turnbull Government made a preelection promise to deal with the issue, and the issue won’t go away. On behalf of Australian patients, we won’t let it.

Dr Christian Wriedt President, Australian Diagnostic Imaging Association

Clinical Radiology

Chief Censor in Clinical Radiology

A/Prof Dinesh Varma

At this time of year, I have the pleasure of reflecting on the College’s achievements in education and training.

First of all, I would like to congratulate the new Fellows, many of whom were awarded their papers at the Annual Ceremony in Perth. We look forward to your contributions to the profession and I trust you will stay engaged with the College throughout your career.

This time 12 months ago and after years of planning, the College staff and members were preparing to transition the Part 2 viva examinations to the Australian Medical Council National Test Centre in Melbourne. We have since delivered two high quality and robust series of examinations at the centre and the feedback from both examiners and candidates has been extremely positive.

During 2017, we have improved the feedback to candidates, particularly for written examinations, where passing standards and scores are now incorporated. The changes to the feedback process are part of the comprehensive Training and Assessment Reform. Please refer to page 32 for more information.

Clinical Radiology Training Accreditation Working Group The Clinical Radiology Training Accreditation Working Group (CRTAWG) was established to monitor and make recommendations to training sites regarding the appropriate facilities, capability, resources and governance required to deliver training. This working group is critical in maintaining

accreditation processes in the College and I would strongly recommend applying to join. For more information on the roles please refer to the ‘Get Involved’ section on the website: www.ranzcr.com/fellows/general/ get-involved/current-opportunities or contact accreditation@ranzcr.com

Director of Training Workshops The Director of Training Workshops in 2017 have continued to grow, with each workshop having vast array of knowledge and experience in the room.

This led to productive conversations and it was fantastic to have representatives from remote areas attend the workshop at the College ASM to share their perspectives. We would like to see these workshops continue to be utilised and grow and I would like to remind everyone that it is an accreditation requirement for at least one workshop to be attended on an annual basis. The content from the previous workshop in Perth is now available at www.webcast. ranzcr.com

Trainee Learning Forum at Perth ASM 2017 Congratulations to the Clinical Radiology Trainee Committee for facilitating the Trainee Learning Forum, which was very positively received. I, along with the Deputy Chief Censors Drs Barry Soans and Meredith Thomas appreciated the opportunity to address common issues and topics important to the trainee cohort. Should any trainee require clarification on any issues please

contact the College in the first instance through radtaa@ranzcr.com, or speak with your trainee representative or Chris Bartley, Trainee Liaison Officer during site visits. Thank you to all the trainee representatives who have completed their service this year, you have been an asset to the College, and welcome to the new representatives for 2018.

Specialist Training Program The College continues to work closely with the Department of Health (DoH) to deliver the wider objectives of the Specialist Training Program (STP) and Integrated Rural Training Pipeline. The new funding agreement from 2018–2020 will be operational from February 2018.

In moving forward, the DoH has outlined an increased focus on auditing and data.

Over the coming months College staff will be contacting sites with STP funding to obtain information to complete the audit. Furthermore, I would like to remind all existing STP sites and sites who expressed an interest that STP funded posts must be a rotation of three months or more. Although it is yet to be confirmed, the College is anticipating another expression of interest process to be undertaken during this funding period and I would encourage all networks to consider any regional or private opportunities that may be available.

continued over...

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Clinical Radiology

Retiring Committee Members I would like to close my final report of 2017 by thanking those who are moving on from various education and training posts at the College. As you are aware, the College relies on the efforts of its members who tirelessly volunteer and contribute to making our training and in turn our profession world class. It would be remiss of me if I did not use this opportunity to extend an invitation to anyone interested in undertaking a post at the College.

At the recent Anatomy Examination Review Panel (AERP) meeting Prof Timothy Buckenham announced he will retire at the end of the year having served the College as Chief Anatomy Examiner for over 15 years. It was very interesting listening to him recollecting what it was like in those days when he singlehandedly not only set the examinations but also marked the papers. He has been instrumental in bringing about some changes along the way. Dr Gabriel Lau has also stepped down from the AERP as 2018 will see him in various other roles within the College. We would like to thank you both for your tremendous contributions.

The panel elected Dr Craig Hacking as the Chair subject to ratification by the Clinical Radiology Education and Training Committee (CRETC). The AERP is being formalised within the educational structures reporting to the CRETC. An expression of interest will also be sent out to fill other vacancies on the panel and I would encourage you to apply.

A/Prof David Lisle, Co-Lead Examiner for Neuro, Head and Neck Radiology has also stepped down from the Clinical Radiology Examination Review Panel (CRERP), however he has assured us that he will continue to be an

40

Inside News

examiner. Dr Meredith Thomas and Dr Pramod Phadke have also stepped down from their roles on CRERP and CRETC respectively to focus on other roles within the College. Finally, congratulations to Mr John Cormack and Prof John Heggie on receipt of Honorary Fellowship of the College for their significant contribution to the College and its AIT examinations over very many years.

Every organisation goes through such stages of stalwarts stepping down and leaving behind a legacy. I would like to extend a personal thank you to those stepping down and to those taking on new roles.

I am excited about the next steps in 2018 and I will continue to provide updates throughout next year. Have a safe and festive holiday season.

Please contact Pamela Spoors, Head of Specialty Training with any training enquiries on radtaa@ranzcr.com or +61 2 9268 9704

Clinical Radiology

Clinical Radiology Trainees Committee The final months of 2017 are upon us, bringing with them an opportunity to reflect upon the year that has passed.

The past year has seen several positive changes take place relating to clinical radiology trainees. May 2017 saw the first sitting of the Part 2 viva examinations at the Australian Medical Council’s National Testing Centre in Melbourne. Changing the exam location from hotel rooms to a purpose-built medical assessment facility has been a welcome change for both trainees and examiners. Further, the addition of CCTV recording is a positive step towards a more transparent examination process, which is certain to benefit future trainee cohorts, as well as ensure the maintenance of consistency and quality amongst examiners.

In addition to a change of viva exam venue, this year has also seen the provision of more detailed feedback to trainees with their examination results.

This improved feedback is vital to allow trainees to adequately prepare to resit examinations, by allowing them to target their revision towards specific areas of knowledge deficiency.

I’d like to commend and thank my fellow members of the Clinical Radiology Trainee Committee for 2017. Together

Past and Present CRTC we have sought to voice the collective opinion of the trainee body, to ensure that the best interests of trainees are considered at all levels of College decision-making.

group is crucial to ensure that future changes to our training program – and our profession – are in the best interests of us as trainees of today, and of the radiologists we will become.

Being a member of the Clinical Radiology Trainee Committee is a great opportunity to meet registrars from different training regions across Australia and New Zealand. I urge all trainees to consider joining the Trainee Committee in coming years. Having a vocal trainee

Dr Cara Odenthal Chair and QLD Representative 2017 Clinical Radiology Trainee Committee

The 2017 CRTC signing off

Volume 13 No 5 I December 2017

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Clear Direction.

The Direct Way to Confidence in Liver Imaging

MINIMUM PRODUCT INFORMATION PRIMOVIST® [disodium gadoxetate 0.25 mmol/mL] INDICATIONS: Enhancement of magnetic resonance imaging (MRI) of focal liver lesions in adults. CONTRAINDICATIONS: known hypersensitivity to disodium gadoxetate or any of the excipients. PRECAUTIONS: Impaired renal function and liver transplant patients (see boxed warnings); impaired hepatic function; anaphylactoid/hypersensitivity or other idiosyncratic reactions (higher risk in the case of previous reaction to contrast media, history of bronchial asthma, history of allergic disorders); intramuscular administration; severe cardiovascular disease; risk factors for arrhythmias; evidence suggests gadolinium accumulates in the brain after repeated administration of gadolinium-based contrast agents; not recommended in children below 18 years of age; pregnancy (Category B3). INTERACTIONS WITH OTHER MEDICINES: rifampicin; interference with diagnostic tests (serum iron).

ADVERSE EFFECTS: common: headache; nausea. Please refer to PI for a complete list. BOXED WARNINGS: NEPHROGENIC SYSTEMIC FIBROSIS: Gadolinium-based contrast agents increase the risk of nephrogenic systemic fibrosis (NSF) in patients with: acute or chronic severe renal insufficiency (glomerular filtration rate <30 mL/min/1.73m2; or acute renal insufficiency of any severity due to the hepato-renal syndrome or in the perioperative liver transplantation period. DOSAGE AND ADMINISTRATION: The lowest effective dose should be used. 0.1 mL/kg body weight given as an intravenous injection at a flow rate of about 2 mL/sec. DATE OF PREPARATION: Based on PI dated 20 October 2017.

Please review the full Product Information before administering. Approved PI available at http://www.bayerresources.com.au/resources/uploads/PI/file9412.pdf or upon request from Bayer Australia Ltd. Bayer Australia Ltd, ABN 22 000 138 714, 875 Pacific Highway, Pymble NSW 2073. ® Registered trademark of the Bayer Group, Germany. AU-PRV-00001 November 2017.

Clinical Radiology

Abdominal Radiology News

ARGANZ Returns to Melbourne in 2018 The Abdominal Radiology Group Australia and New Zealand (ARGANZ) will be celebrating its 10th annual meeting, to be held at the Crown Promenade Hotel on 24-25 March 2018.

Our invited guest speakers are two eminent and highly regarded teachers from London. Prof Anwar Padhani, from The Institute of Cancer Research, is a member of the PI-RADS committee and an expert in prostate and whole body diffusion imaging. Prof Paul Sidhu, from King’s College Hospital, is past president of the British Medical Ultrasound Society with a keen interest in ultrasound, including contrast ultrasound. They will be joined by a highly regarded faculty of national and local speakers.

Given the positive feedback following this year’s workshop, we will again offer a full day workshop on Friday 23 March, running two concurrent streams for introductory and more advanced abdominal topics. Delegate numbers will be limited to 50 to 60 per stream, so we encourage you to book early to avoid disappointment.

ARGANZ has a commitment to fostering research in abdominal imaging. In 2017, the annual research prize was named in honour of Prof Richard Mendelson, one of the founding members of ARGANZ and an important mentor to many of those in abdominal radiology. First prize is a trip to the annual European Society of Gastrointestinal and Abdominal Radiology (ESGAR) meeting and finalists have the experience of presenting to the main auditorium. In 2018, we will be including a paper poster section to allow us to accept more submissions.

“I attended the European Society of Gastrointestinal and Abdominal Radiology Conference in Greece in June this year. This was by far and away the largest international conference I had ever attended.” “I am extremely grateful for this experience. The information and practical tips I learnt I have taken back and utilised in my everyday practice as now a Consultant Radiologist. I highly recommend this competition to all trainees, and once again thank the executive for its dedication to motivating research and significant generosity in awarding such a prize.” said Dr Harris.

As we approach our 10th annual meeting, I would like to acknowledge the determination and foresight of the founding ARGANZ executive who co-ordinated the inaugural meeting at Coogee in Sydney. Prof Richard Mendelson, A/Prof Andrew Holden, Prof Robert Gibson, A/Prof Andrew Little, Dr Max Kupershmidt and Dr Helen Moore are to be congratulated for establishing a special interest group that continues to grow and prosper.

With a program designed to appeal to both general radiologists and subspecialty abdominal-pelvic radiologists, we hope you will join us in Melbourne in 2018.

Dr Kirsten Gormly Chair, ARGANZ

The 2016 winner Dr Nicole Harris attended the ESGAR 2017 meeting in Athens.

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24-25 March 2018

Crown Promenade Melbourne, Australia

ARGANZ Abdominal Radiology Group Australia and New Zealand Key Dates

MEETING 2018

14 January 2018: Submissions Close

Keynote Speakers

4 February 2018: Standard Registration Fee Applies

Prof Anwar Padhani, Institute of Cancer Research, London

22 March 2018: Late Registration Fee Applies 23 March 2018: Workshops

Prof Paul Sidhu, Kings College Hospital, London Paper Submission and Online Registration Now Open

www.arganz.org

Clinical Radiology

Emergency Radiology News

Since we last reported, the Australian and New Zealand Emergency Radiology Group (ANZERG) executive committee members were invited to New Delhi, India in August to present at the 4th Annual Meeting of the Society of Emergency Radiology, held in conjunction with the AsiaPacific Congress of Interventional Oncology. ANZERG Chair, A/Prof Dinesh Varma from the Alfred Hospital in Melbourne spoke on emergency radiology integration into emergency departments, Dr Gerard Goh from the Alfred Hospital in Melbourne discussed new drugs for adjunct therapy after endovascular recanalization and management of acute mesenteric vascular ischemia and Dr Craig Hacking from the Royal Brisbane and Women’s Hospital presented some Australian emergency radiology cases and spoke on the CT diagnosis of acute mesenteric ischemia.

We are in discussion with Australian and New Zealand Rural Radiologists Special Interest Group (ANZRRSIG) on the prospect of holding a joint conference sometime in 2018.

The ANZERG executive committee would like to congratulate the organising committee and convenors of the College 2017 ASM for putting together a very successful meeting.

We would also like to thank them for providing our group the opportunity to present talks on emergency and trauma radiology. The sessions were very well attended, which is a testament that emergency radiology adds value at such conferences and is of great interest to the Fellows and trainees. Various topics were covered in the sessions by Drs Meredith Thomas, Sean Skea, Gerard Goh and Dinesh Varma.

however minutes of the meeting will be sent to ANZERG members. There were quite a few ideas were put forward for the committee to take on board and work on in 2018.

As the term of the Chair came to an end this year, nominations were sought from the floor and A/Prof Varma was nominated and voted to serve as Chair for a second two year term. He thanked the members for their support and agreed to serve for another term.

It was also suggested that a database of potential speakers be created amongst ANZERG members, which can be used in the future to source speakers when we receive invitations to participate at various conferences and educational activities.

We are in discussion with 2018 ASM organising committee in Canberra to give us a dedicated emergency radiology session and they have expressed support.

Member engagement is always challenging and we are hoping to make this our top priority for the new year. The executive committee will endeavour to look at various initiatives to improve this.

If you have any suggestions, please feel free to write to us on anzerg@ranzcr.com A/Prof Dinesh Varma, Chair Executive Committee: Dr Meredith Thomas Dr Sean Skea Dr Craig Hacking Dr Gerard Goh

Our annual general meeting was held on Saturday 21 October. Unfortunately, the attendance was rather thin

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Clinical Radiology

IRSA Update The Interventional Radiology Society of Australasia (IRSA) continues to advocate for interventional radiology (IR) in Australia and New Zealand and much work has been undertaken in the last few months.

Progress has been made with the IRSA standards for IR Fellowship/advanced trainee programs and this document has been shared with The Cardiovascular and Interventional Radiological Society of Europe (CIRSE) and the College.

The setting up process of the IRSA foundation is also progressing well with numerous educational and research initiatives that will hopefully come to fruition over the next year. IRSA has also continued to monitor and support several vascular and non-vascular MSAC application items ensuring that the best interests for patient care are maintained.

Recently expressions of interest were sought for the organising committee for the IRSA registrar’s conference for 2018 and 2019 as well as for the IRSA annual

ANZSNR Update MBS Listing of Mechanical Thrombectomy for Acute Ischaemic Stroke On 1 November, a new item number (35414) was listed on the Medicare Benefits Schedule, which was the result of ongoing consultation between the Australian and New Zealand Society of Neuroradiology (ANZSNR), the Conjoint Committee for Recognition of Training in Interventional Neuroradiology (CCINR) and the Royal Australian and New Zealand College of Radiologists (RANZCR).

This recognises the overwhelming

scientific meeting in 2019. Drs Warren Clements (Alfred Health), Tim Joseph (Alfred Health) and Julian Nguyen (Western Health) are the successful applicants for the organising committee for the IRSA registrar’s conference, in a joint bid from Melbourne. Drs Cosmin Floresceau (Western Health and St Vincent’s Hospital, Melbourne) Ashu Jhamb (St Vincent’s Hospital, Melbourne) and Jim Koukounaras (Alfred Health) will form the organising committee for the 2019 IRSA ASM. Congratulations to all!

IRSA will be hosting the Asia Pacific Society of Cardiovascular and Interventional Radiology (ASPCVIR) 2018 scientific meeting in Auckland on 8-11 March 2018. There is an impressive list of international and local faculty and we would encourage all to attend. Details can be found at www.aspcvir2018.com The fourth running of the Australia/ New Zealand European Board of Interventional Radiology (EBIR) examinations will take place on the 7-8 March 2018, just before the ASPCVIR 2018 meeting. Applications are still open and IRSA encourages all to consider sitting the EBIR examination to join the 57 Australian and New Zealand holders of the EBIR and 600+ international EBIR holders.

benefit for patients with large vessel occlusion who receive reperfusion with mechanical thrombectomy, when performed by specialist interventional neuroradiologists who are recognised by the CCINR, in appropriate centres with staffing, processes and equipment to provide 24/7 access to a multidisciplinary team. ANZSNR applauds the rapidity with which the Australian Government and Minister of Health have achieved this outcome, so early after the Australian and international trial results were published, and expect more patients otherwise facing significant disability to receive this intervention.

2018 ANZSNR ASM The 2018 ANZSNR annual meeting will be held in Hobart, Tasmania during 15–18 March, 2018. A/Prof Jens Froelich,

IRSA has been invited to participate as a partner society at the annual scientific meeting of the World Congress of Phlebology 2018 to be held on 4-8 February. IRSA will be running some lectures/workshops and we would encourage anyone interested in venous disease to attend this reputed international meeting. www.uip2018.com The SA branch of IRSA recently hosted Prof Mary (Vicki) Marx, President-elect of the Society of Interventional Radiology (SIR) at the SA IRSA branch meeting, which I was fortunate enough to attend.

Prof Marx gave some good insights into training and accreditation for IRs from her experience in the USA and was keen on maintaining the close ties between IRSA and SIR. I wish you all a happy festive season and we look forward to the busy year ahead.

Yours sincerely, Dr Gerard Goh President IRSA Chief Examiner EBIR Australia/New Zealand

A/Prof Andy Whyte and Dr Catherine Mandel are developing an engaging and innovative program, which includes diagnostic neuroradiology, head and neck radiology and neurointervention.

The meeting will be of interest to anyone who reports this work or performs these tests and treatments.

ANZSNR Strategic Review A Strategic Review was held on Monday 14 August, with the executive and small group of members in attendance, facilitated by Governance Matters. The full day meeting was constructive, has provided insights into future directions and strategies, and will be discussed with council and at the AGM. Professor Peter Mitchell President, ANZSNR

Volume 13 No 5 I December 2017

47

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Radiation Oncology

A Message

from the Dean

A/Prof Dion Forstner

The Faculty of Radiation Oncology (FRO) Council has been very productive this year, with some of our achievements including increased government engagement, raising awareness of our profession through Targeting Cancer, a review of the Radiation Oncology Practice Standards, closer collaboration with the Trans-Tasman Radiation Oncology Group (TROG), and advocating for Indigenous health. There has been significant progress on the implementation of recommendations from the training and assessment review by our Chief Censor, A/Prof Margot Lehman and her team of very hardworking volunteers. I thank the Faculty Council, especially the chairs of FRO Committees, the Special Interest Groups, Working Groups and all those involved in education, for their support of our organisation.

It was pleasing that Drs Carol Johnson and Keen Hun Tai were re-elected to the Faculty Council for 2018-2020. We also welcome Dr Johann Tang from Singapore. I acknowledge A/Prof Chris Atkinson, who finishes his term on Council at the end of this year, for his many years of involvement with the College and the radiation oncology sector in New Zealand and Australia.

Of course, there have also been challenges this year. Following the Government’s announcement of changes to the Radiation Oncology Health Program Grants (ROHPG), the Faculty and consumer groups spent many hours and days advocating against these changes, which would in the long run be

detrimental to patient access to quality radiation therapy services. We anxiously await the announcement of the Mid-Year Economic and Fiscal Outlook (MYEFO), to see if our efforts have had an impact.

It is now two years since the College Code of Ethics1 was released. I ask all members to remind themselves of this.

I know the vast majority of members meet the standards required, but unfortunately there have been a number of instances this year where I was saddened to learn of behaviour that would struggle to comply with the code.

No doubt 2018 will hold many challenges and opportunities. The public consultation on the final report of the Oncology Clinical Committee of the MBS Review Taskforce should be available for consultation early next year, and we will advocate strongly for extensive modelling of the MBS Review recommendations prior to implementation. We will also continue our efforts to raise awareness of radiation therapy, advocate for national adoption of the Radiation Oncology Practice Standards and work towards national coordination of particle therapy implementation.

Sincere thanks to all Faculty members and staff for their commitment to the College throughout 2017, with special acknowledgement to Ms Sonja Cronjé and Ms Legend Lee. I wish you all a very enjoyable festive season and a prosperous 2018.

Profile and Presence of Radiation Oncology The Targeting Cancer campaign has been continuing its activities around education programs for general practitioners, the website and social media activities.

It is also pleasing to see more campaign activities in New Zealand, as discussed on page 22 in this edition.

Government Engagement The Australian Minister for Health’s office hosted a roundtable discussion with the College and several other stakeholders in the radiation oncology sector on Tuesday 31 October at Parliament House. It was a productive discussion around sector-wide priorities, which we hope will lead to improved understanding by the Government of the critical role of radiation therapy in cancer care. The Minister and Secretary of the Department of Health are also committed to more regular discussions, to help improve national coordination of radiation oncology services.

Now that a Labour government has taken office in New Zealand, we look forward to engaging with the new Health Minister to follow up on the priority issues we identified and made them aware of before the election, namely funding for radiation oncology, attracting more trainees to radiation oncology, and establishing local fellowship positions.

continued over...

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Radiation Oncology

Particle Therapy in Australia Following the Government announcement of a proton therapy centre for Australia, the Faculty established a Particle Therapy Working Group, with representation from Australia and New Zealand, to drive the policy and advocacy work relating to particle therapy in the coming years. We are indebted to A/Prof Verity Ahern for her great leadership and tireless work in this area.

If you have any feedback or comments on any of the above, please email faculty@ranzcr.com

References 1. www.ranzcr.com/search/ranzcr-code-of-ethics

A National Particle Therapy Symposium was held in Adelaide on 6 November, with broad attendance, to discuss the way forward. It is essential that particle therapy is introduced in Australia in a collaborative way, for the ultimate benefit of patients in Australia and New Zealand.

1 in 2 people with cancer would benefit from radiation therapy Greater awareness that radiation therapy is safe and provides good clinical outcomes will improve utilisation.

Sign up at targetingcancer.com.au to show your support. @TargetingCancer

50

Inside News

RadiationOncologyTargetingCancer

Radiation-Oncology-Targeting-Cancer

Radiation Oncology

Chief Censor in Radiation Oncology

A/Prof Margot Lehman As the end of 2017 approaches, it is timely to reflect on activities undertaken and progress made and to highlight changes to be implemented in 2018. In summary:

Changes to the format and structure of the Phase 1 exam, commencing 2018 Following consultation between the Phase 1 examination leads, Phase 1 examiners, representatives from the Australian Council for Educational Research (ACER) and members of the Oncology Sciences working group, the following changes to the structure and format of the Phase 1 exam have been recommended to and subsequently approved by the Radiation Oncology Education and Training Committee (ROETC) and the Faculty Council:

Anatomy, Physics and Radiation and Cancer Biology

(ii) As per current format, there will be two papers, 2.5 hours each, sat on one day.

(iii) Each paper will have six questions with each question worth 15 marks (subparts of each question can have varying marks)

(iv) Each question will examine one subject only (Anatomy, Physics, or Radiation and Cancer Biology)

(v) There will be four questions per subject with a total of 12 questions over the two papers

(vi) Each subject will have a total of 60 marks

(vii) To pass the Phase 1 examination, trainees will be required to pass all three subjects, with a pass for each subject requiring a mark greater than 36/60 (e.g. 60 per cent)

a. Pathology will no longer be examined within the structure of the Phase 1 examination.

This recommendation was based on the following: (i) as part of the curriculum update, pathology content previously covered in Phase 1, is now encompassed in Radiation and Cancer Biology (an alternate learning tool is being developed by the Oncology Sciences working group to cover those few areas of Phase 1 Pathology not incorporated in RCB). (ii) The incorporation of Pathology questions into the Phase 1 exam was not discriminatory. b. The Phase 1 examination format and passing requirements will

(i) Questions will be subject based:

(viii) Supplementary oral vivas may be offered in a trainee passes 2/3 subjects and receives 55 per cent or more in the third subject.

Removal of Clinical Assignments as a mandatory eligibility requirement to sit Phase 1 (applicable to all current and new Phase 1 trainees)

they were originally intended and the marking of the assignments placed a significant burden on Clinical Supervisors and Directors of Training. Therefore, after careful consideration, it has been decided that the CAs will be withdrawn as a mandatory assessment requirement and will no longer be regarded as an eligibility requirement to sit the Phase 1 examination. However, the CAs will remain available to trainees as a resource to add value to their examination preparation. The supervisor versions of the assignments (password protected) will still be available to those DoTS whose trainees wish to complete the assignments as a means of preparing for the Phase 1 examination.

Policies The following policies have now been updated and are available to download from the College website: www.ranzcr. com/college/document-library (i) Radiation Oncology Performance and Progression Policy (ii) Radiation Oncology Remediation Policy (iii) Radiation Oncology Withdrawal from Training Policy (iv) Interrupted and Part-Time training Policy

The Clinical Assignments (CAs) are acknowledged as an excellent educational resource for trainees.

However, for a variety of reasons, the CAs are not being utilised in the way

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Radiation Oncology

Accreditation Congratulations to A/Prof John Leung whose application to be appointed as Chief Accreditation Officer for the term 2018-2020 was endorsed by the Faculty Council. I would like to extend my sincere thanks to John, all Fellows involved in the accreditation panels and to College staff (particularly Tanja Samardzic) for undertaking this very important, and at times, challenging role.

Examinations 2017 saw the successful completion of two Phase 2 examination series and one Phase 1 series.

I would like to extend my sincere thanks to all the Phase 1 and Phase 2 examiners and College support staff (in particular Julia Snedic) whose tireless contribution ensures our exam processes are transparent, robust and of a very high standard.

In particular I would like to acknowledge the enormous contribution made by the Phase 1 leads Drs Marcus Dreosti and Claire Hardie and to welcome Dr Carminia Lapuz into the Phase 1 leadership team.

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Inside News

I would also like to thank Dr Anne Capp who, after many years as a Phase 2 examiner, has decided to step down.

Anne’s kindness, common sense and good humour will be greatly missed.

Training and Assessment Reform Update Throughout 2017, representatives from ACER have undertaken workshops with both the Phase 1 and Phase 2 groups and have attended Board of Examination meetings. Their recommendations around refining our processes with regard to marking criteria and standard setting are being adopted into standard practice.

Progress towards a programmatic approach to assessment has commenced. Updates were provided at the DoT meeting held at the ASM. The curriculum has been reviewed and relevant updates have either been completed or are in process. The Oncology Sciences working group led by Dr Matthew Seel, has developed a number of workshops to replace the CAs. It is anticipated that these workshops will be piloted in 2018. The anatomy, contouring and planning evaluation tool (led by Dr Andrew Potter and Dr Ben Chua) have developed a contouring and planning evaluation tool which will also be piloted in 2018.

ROETC News Congratulations to Dr Yaw Chin for his election to the ROETC. Yaw has been involved with the ROETC for a number of years and his insight and thoughtful opinions are very much appreciated.

I would also like to acknowledge and thank Dr Nicholas Buckness for his contribution as the trainee representative on the committee.

Denise Lonergan Educational Service Award Congratulations to Melissa James for being awarded the Denise Lonergan Educational Service Award. This award recognises outstanding contributions to educational activities and assessment, above and beyond their expected educational role. All who have had the pleasure of working with Melissa agree that she is a very deserving winner of this award.

Finally, I would like to wish everyone a very safe and happy festive season and extend my very best wishes for 2018.

Please contact Pamela Spoors, Head of Specialty Training with any training enquiries on radtaa@ranzcr.com or +61 2 9268 9704

Radiation Oncology

Radiation Oncology Trainees Committee

Annual Scientific Meeting The College Annual Scientific Meeting was held in Perth from 19–22 October.

The Radiation Oncology Trainee Learning Day was superbly organised and executed by Dr Hendrick Tan and was, without a doubt, one of the highlights on our Radiation Oncology Trainees Committee (ROTC) calendar!

We were privileged to hear from A/Prof John Leung on a topic of great interest and relevance to trainees – employment for radiation oncologists in Australia and New Zealand. This reassuring session was followed by informative presentations on the modern management of brain metastases from A/Prof Michael Izard, Dr Tim Clay, Dr Jeremy Croker and Mr Peter Podias.

We were also lucky enough to have Dr Peter Chung, Radiation Oncologist and Director of the Fellowship Program at Princess Margaret Cancer Centre speak to our group about Fellowship opportunities at PMCC. 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 our very own Dr Luke Nicholls, who won the prize for his research on “An assessment of the clinical impact of same day MRI prior to Gamma Knife Stereotactic Radiosurgery”!

The day was capped off by the Trainee Forum, which provided a platform for all to discuss concerns around accreditation, our curriculum and workforce issues, all of which were taken on board by our Faculty.

The Faculty of Radiation Oncology Dinner and 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.

Additionally, this year in a College organised venture, our trainees were able to interact and advise medical students and junior doctors about our experiences of training in radiation oncology at the RANZCR Hub. It was a great experience for our trainees and interested doctors and medical students alike and we hope this will be continued on in future.

The ROTC enjoying the RANZCR 2017 Gala Dinner

Finally, a shout out to the Targeting Cancer fun run female winner, Dr Rachel Effeney. Congratulations to you on flying the radiation oncology trainee flag high for the third year in a row.

Farewell and Welcome This past year has sure flown by and with the end of the year comes a changing of hands for the ROTC. It has been such a privilege to be the Chair of such a wonderful committee and I cannot thank everyone who has been involved enough for their time, enthusiasm and hard work.

I also thank the Faculty of Radiation Oncology Council and all the Fellows of the College who sit on affiliated committees for tirelessly supporting both this year’s ROTC and our wider trainee group. I’d like to express a special mention to our College Trainee Liaison Officer, Mr Chris Bartley who has played a pivotal role in supporting our activities this year.

I welcome the incoming committee for 2018 and wish them the best of luck.

Past and Present ROTC (not present: Dr Sena Han, NZ and Mihir Shanker, QLD.)

Signing out, Kimberley Nguyen

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Radiation Oncology Advertorial

Focusing on Cybersecurity Within a day of the massive ransomware attack on May 15th this year, more than 230,000 computers in over 150 countries were reportedly affected. Britain’s National Health Service (NHS) was among the many global bodies impacted by the notorious “WannaCry” attack, which targeted computers running the Windows operating system by encrypting data and demanding ransom payments in the Bitcoin cryptocurrency.

The scale of this attack reinforced the need for healthcare systems to be protected by cybersecurity tools, due to the value of patient data for cyber criminals. Vast amounts of sensitive patient information reside today in the modern healthcare provider network, and these are increasingly targeted by “bad actors” such as hackers and other criminals who exploit vulnerabilities in these networks. Healthcare data is believed to have a higher value for cyber criminals than banking data. Consequently, cybersecurity has become a top priority for Varian and others in healthcare.

Varian’s software products have historically been developed with a focus on quality and patient safety. The assumption was that these products functioned inside a secure IT perimeter set up at the institutional level, and that people accessing the information would be authorised users.

“Today, that’s an assumption we can no longer make,” says Ken Khouri, Varian’s director of software support and managed services.

To address this issue, Varian has launched an initiative to develop a long-term cybersecurity plan. An office of information security has been established, staffed by employees from Varian’s product engineering and information technology departments. “They are collaborating with cybersecurity experts and IT stakeholders from customer sites to identify risks and plan security enhancements,” says Khouri.

Today, Varian’s cybersecurity program is monitored at the highest levels within the company.

A hallmark of the program is tight collaboration across all of Varian, customers, and outside security experts.

The latest version of Varian’s ARIA® oncology information system (Version 15) has a strong focus on cybersecurity and the company has also created a cybersecurity interest group within the OncoPeer™ community, a new cloud-based resource for knowledge sharing among oncology professionals.

“Cybersecurity – like patient safety – is going to come down to an effective collaboration between vendors and healthcare providers,” concludes Khouri. “Varian takes this issue very seriously and we look forward to working with others to minimise the danger of data security breaches.”

“The world has changed and so has the magnitude of the threats. There is close to one reported breach of healthcare data every day somewhere in the world.”

KEN KHOURI, VARIAN’S DIRECTOR OF SOFTWARE SUPPORT AND MANAGED SERVICES

Radiation Oncology

TROG Cancer Research Update TROG 2018 ASM: Call for Abstracts The Trans-Tasman Radiation Oncology Group (TROG) is inviting submissions of abstracts from any area of radiotherapy cancer research for oral presentations at the 2018 Annual Scientific Meeting (ASM). The due date for submission is Friday 15 December 2017.

The 2018 TROG ASM will be held from 19-22 March in Hobart, Tasmania. For the first time, TROG is offering full members a 10 per cent registration discount. Affiliate and non-members are invited to become full members to take advantage of this special offer.

Delegates can also take advantage of discounted rates through our popular group registration option when registering for two or more people from one centre. Visit www.TROG2018.com to find out more and register now.

Potential for a Productive Partnership – Interventional Oncology The momentum for the addition of interventional oncology to TROG SubSpecialty Groups continues to grow, this has been taken up very positively and included in the 2018 ASM program. This collaboration will provide opportunity to facilitate future research in this area.

This year TROG has received two new proposals in the area of interventional oncology and they will be presented at the TROG ASM for review and discussion. Medtronic have also kindly provided an Education Travel Grant to support the attendance of Professor Andreas Adam as an invited international speaker for our meeting.

Professor Walter Curran is also an invited international speaker.

A/Prof Andreas Adam

The inaugural Interventional Oncology Sub-Specialty Group session will be held on 20 March from 3:30pm–5:00pm. Visit www.TROG2018.com to register.

CORE Trial Launched A new trial which will examine whether the addition of a new type of targeted radiation treatment is more effective for patients with advanced lung, breast or prostate cancer, is now up and running.

“For people with metastatic disease radiotherapy is generally used in low doses to help when symptoms such as pain arise. The CORE trial uses a much higher dose of targeted radiotherapy (SBRT) with the aim of eradicating early metastatic deposits when they first emerge,” said A/Prof Pryor.

“The treatment can be delivered in only a few short outpatient treatment sessions. We hope this new treatment will allow people to continue enjoying a good quality of life and ultimately give them more time free from their cancer.”

The CORE trial will involve 50 patients in Australia.

Joan Torony CEO, TROG

TROG Cancer Research will lead the trial in Australia, collaborating with researchers from the United Kingdom.

The TROG 16.03 CORE trial will examine if adding a novel type of treatment called stereotactic body radiotherapy (SBRT) to standard treatment is more effective for patients with early metastatic spread.

A/Prof David Pryor from the Princess Alexandra Hospital in Brisbane is the Australian co-chair of the trial. He said doctors are looking for better ways to help patients with advanced cancer.

A/Prof David Pryor

“Treating the visible metastatic tumours with stereotactic radiotherapy may reduce the risk of the cancer coming back and may allow our current drug treatments to work better for longer.”

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Radiation Oncology

Asia Pacific News Australia Awards Fellowship 2018 The Asia Pacific Radiation Oncology Special Interest Group (APROSIG), together with the College, have been awarded the Department of Foreign Affairs and Trade (DFAT) Australia Awards Fellowship for their project ‘Strengthening the Capacities of the Cambodian Oncology Professionals through Advanced Immersive Learning’.

The Australia Awards are international scholarships funded by the Australian Government, aiming to build capacity and strengthen partnerships between

Australian organisations and partner organisations in developing countries.

The $147,000 awarded will be used to fund a delegation of Cambodian health professionals from the newly-built National Cancer Centre in Phnom Penh to undergo education and training in hospitals within Sydney, the University of Sydney (through the Office for Global Health) and the Cancer Institute NSW. The Cambodian Fellows will include a radiation oncologist, radiologist, pathologist, paediatric oncologist, haematologist, health informatician, cancer registry manager and oncologic surgeon. Each will undergo placement for a month’s duration. The aim will be for the Cambodian Fellows to be able to ultimately apply the skills learnt in Australia back in Cambodia, for the benefit of the Cambodian cancer patient population. The fellowship period will be from February to June 2018.

Học Mãi - APROSIG Partnership Continues Dr Trần Văn Tôn, radiation oncologist from Hanoi Vietnam, with staff from Macarthur Cancer Therapy Centre

APROSIG has a long-standing partnership with the University of

Gynaecology Oncology News

document developed by our group has now been published as a position paper for the College – a highly recommended resource.

GOROC ASM 2017 A select group of gynaecology oncology radiation oncologists attended the AGM breakfast meeting (foregoing the Targeting Cancer fun run) with three further members dialling in. The meeting was chaired by the new Chair, Dr Carol Johnson along with the new vice chair, Dr Philip Chan.

The past Chair, Dr Viet Do and his team should be congratulated on the work of the Gynaecology Oncology Radiation Oncology Collaborative (GOROC) to date. The Image Guided Brachytherapy for Cervical Cancer

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The Endometrial Cancer Guidelines paper is nearly complete with final adjustments deliberately delayed to include contribution from both Portec III and GOG 258 and 259 trials. This should be completed in the next few months with the aim of having our consensus document reviewed by both gynaecology oncology surgeons and medical oncologists prior to presentation at the Australia New Zealand Gynaecological Oncology Group (ANZGOG) ASM. We have Prof Mike Milosevic from Princess Margaret Hospital in Toronto locked in for the ANZCOG ASM and Drs Pearly Khaw and Viet Do are working on the radiation oncology programme.

Sydney’s Office for Global Health and the Học Mãi, Australia-Vietnam Medical Foundation. In August, Dr Tr n Văn Tôn, a radiation oncologist from the Oncology and Nuclear Medicine Center at Military Hospital 103, Hanoi underwent a two month observership placement at Liverpool Cancer Therapy Centre and the Chris O’Brien Lifehouse in Sydney.

After undergoing these placements and learning from the Australian experience, Dr Ton’s aims for his department in Hanoi are to institute a multidisciplinary meeting, increase human resources (especially in radiation therapists) and develop a longer term goal to institute intensity modulated radiotherapy.

Are you interested in potentially hosting radiation oncology or radiology observers from low and middle income countries in the Asia Pacific? Please contact Dr Iain Ward on Iain.Ward@cdhb.health. nz or Dr Mei Ling Yap on mei.yap@ sswahs.nsw.gov.au to discuss.

New Work GOROC will run a Patterns of Care survey over the management of cervical stromal positive stage II/III endometrial cancers using a selection of cases – an area where we expect to see variation in practice. GOROC has endorsed a pilot study to be conducted in Wellington of a radiation therapist accredited specifically for vaginal vault cylinder insertion.

Next meeting will be held on Friday 6 April 2018 in Brisbane at the GOROC workshop within the ANZGOG ASM.

General Interest

Raising Awareness of Indigenous health in the provision of cancer care we acknowledge our ability to increase equity and accessibility for Aboriginal and Torres Strait Islander peoples to the service we provide” said Mr Middleton.

Last year, the Icon Group, Australia’s largest dedicated cancer care provider, released a Reconciliation Action Plan (RAP Reflect). This outlined the company’s public commitment to setting stronger foundations that establish relationships built on respect, and to strive diligently for equity in outcomes between Aboriginal and Torres Strait Islander peoples and the broader Australian community. Icon’s RAP aims to improve the health outcomes of Indigenous Australians and their families and to continually strive to ‘Close the Gap’ in health through their services, as well as creating equal employment opportunities for Aboriginal and Torres Strait Islander peoples through future scholarship and mentorship programs.

In line with Icon’s RAP document, the company encouraged employees to learn about Indigenous culture and take part in both National Reconciliation Week (NRW) and (National Aborigines and Islanders Day Observance Committee) NAIDOC Week. Mark Middleton, the Icon Group’s CEO, believes it is important to recognise the owners of this land and improve health outcomes for Indigenous peoples.

“Our company encourages all team members to develop knowledge of Indigenous health issues and to embrace cultural competency in their day to day roles. As a national leader

NRW’s 2017 theme of ‘Take the Next Steps’ was embraced by Icon centres across the country. NRW events ranged from attending cultural workshops, holding bush tucker morning teas, decorating centres with Indigenous artwork and reconciliation messages, inviting local Indigenous representatives to come and talk to staff and creating posters and information sheets to help educate staff and patients on the significance of local Indigenous culture and history. The Icon Group head office held a traditional weaving workshop facilitated by Amanda Hayman (the local Indigenous artist who provided the artwork for Icon’s RAP) and Freja Carmichael, using natural fibres and ribbon to create stars for the Million Stars Project.

System Biarah after consulting their local elders. Biarah is one of the few surviving Jarowair words and means ‘mountain’.

This represents a positive move toward reconciliation and helps to reinforce the relationship with the local Indigenous community.

“Helping to close the gap is a big part of Icon Group’s mission to provide exceptional cancer care to as many people as possible. Raising awareness and increasing knowledge within our organisation about the Traditional Owners will help us serve our patients better, and through our actions make a real difference in the health sector” CEO Mark Middleton.

Icon Group

Similarly, NAIDOC week saw sites supporting and learning about Indigenous culture through local activities based around the theme ‘Our Languages Matter’, aiming to emphasise and celebrate the essential role that Indigenous languages play in cultural identity. Each site displayed a word cloud depicting several local Indigenous languages and teams were encouraged to learn how to say hello in the Indigenous language of the land their site is on. Several centres took the initiative to raise funds for the Indigenous Literacy Foundation by holding morning teas and free dress days where teams came to work in the colours of the Aboriginal and Torres Strait Islander flags.

In line with the Icon Group’s commitment to reconciliation, Radiation Oncology Centres (ROC) in Toowoomba recently named their new Varian Halcyon

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General Interest

New Zealand Branch News

Dr Lance Lawler

It is with much satisfaction (and a little sadness) that I am able to present my final report as Chair of the New Zealand Branch.

Much has changed in the last five years, and I am satisfied that at the hand over to the incoming Chair, Dr Gabriel Lau, the Branch is in good shape. Well, for the most part in good shape—we are still looking for a convener for the College 2019 ASM in Auckland, although I understand that increased pressure is being applied and I expect someone to crack soon.

The College as a whole has changed and evolved over the last five years, and the relationship with the NZ Branch has vastly improved as a result. Whilst we are all part of the same College, the Australian states and New Zealand operate in different regulatory, legislative, accreditation and funding environments, and often ‘one size’ doesn’t fit both. Fortunately, the underlying principles of quality, access, competency and standards of practice are universal, so we are usually only talking about jurisdictional matters rather than fundamental differences.

It follows that it is vital we have organised New Zealand representation in College governance matters. The underlying principle is that we have democratic representation on the Faculty Councils and the Board, but left to itself this system makes it hard for minority groups to get on these bodies (specifically New Zealand and radiation oncology for the Board) so we ring fence one position for each of these to ensure

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a balance is achieved. This is quite a common practice in both commercial and not for profit organisations, and works well. We need all of the major stakeholders to be involved; we have much to learn from each other. We know that our current set up needs tweaking, unfortunately our first attempt at doing so was voted down at the 2017 AGM. Two things stand out for me as success stories in the last five years. Firstly, the establishment of our Branch MSK working group and relationship with ACC. This group meets several times a year with the ACC team responsible for clinical radiology (and the interface of this with treatment plans and outcomes), which is chaired by the ACC Medical Director, Dr Peter Robinson. We may not always get the results we desire, but over the years we have built up a good relationship with the ACC team—a relationship that is now much more transparent and engaging. I knew we had achieved what we wanted when Mr Alex Brunt, New Zealand Branch Manager and I were invited by the New Zealand Orthopaedic Association (NZOA) to share our experience and views on how to maintain a successful relationship with ACC...

Secondly was the ‘realignment’ of International Accreditation New Zealand (IANZ) practices with what our members felt were changing practice environments in New Zealand.

There was a feeling that IANZ had drifted slightly from what many of us considered to be core concerns, and this was causing increasing difficulties

during accreditation reviews. Similar to our process with ACC, we revamped our Radiology Professional Advisory committee (RADPAC) membership, presented our concerns to IANZ (reflecting the underlying quality of the IANZ organisation). This led to good robust discussion that was followed by a much improved quality focus for the clear benefit of our patients.

Of course, these outcomes as well as many others, were achieved by a large supporting cast from both the College Executive and our New Zealand members. If I had the space to name you individually I would, but know that I am extremely grateful for all your efforts. There is one person I do want to mention—Mr Alex Brunt. Alex, you have made this role so much more enjoyable, achievable and effective and I will miss working with you.

As they say, ‘over and out’.

Dr Lance Lawler, New Zealand Branch Chair

General Interest

Australian Branch News ACT Branch News Canberra has been named by Lonely Planet as the World #3 city to visit in 2018.

The ACT RANZCR Branch believes that, had RANZCR 2018 been included in the deliberations, it would have achieved the #1 spot.

Preparations for the 2018 conference are well underway and all ACT Branch members are invited to come forward for local committee positions. Interested parties are requested to email the convenors: Radiation Oncology: angela.rezo@act. gov.au or hany.elsaleh@act.gov.au Radiology: jyotirvan@gmail.com or john. cockburn@act.gov.au

The next meeting was organised by St George Cancer Centre at the Park Royal on Wednesday 22 November. We have had good attendance from the younger members but I would encourage more senior colleagues to come along for the Faculty updates, interesting scientific presentations as well as the excellent food and wine.

Queensland Branch News

college for their volunteer work and presented with RANZCR gold pins.

Queensland Radiology Training Network

The Queensland Radiology Training Network (QRTN) held a strategy day meeting in July 2017 at the Gold Coast University Hospital which was attended by the Branch Chair, Branch Education Officer, Medical Directors, the Directors of Training and the Network Coordinator Officers. We had a fruitful discussion regarding various matters important for the Network and planning for the future.

The Network held interview sessions for new registrars on 31 August and 1 September at the Royal Brisbane Women’s Hospital. Twelve candidates were chosen for the 2018 February intake and have been offered jobs at various hubs. The interview panel consisted of the Branch Education Officer, DoTs of various hubs and a trainee representative.

NSW Radiation Oncology Chapter The Chapter has been experimenting again with having some of our meetings at hospitals rather than all at the Park Royal in the City. The July meeting was held at the new Nelune Comprehensive Cancer Centre at Prince of Wales Hospital giving a chance to tour the new building. The talks were on the Nano-X project by Prof Paul Keall and research on nanoparticles and hyperthermia by Dr David Chang.

Accreditation visits are planned to various hospitals across Queensland in the next few months.

The Queensland ASM was successfully held at the Sunshine Coast in June 2017.

The Uhr Clarke Bursary awards for 2017 were awarded to Dr Dean McCoombe (Clinical Radiology) and Dr Esther Sim (Radiation Oncology).

Dr Mark Phillips (The College Chief Accreditation Officer and Branch Chair) and Dr Umesh Shetty (Branch Education Officer) have been recognised by the

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General Interest

Victorian Branch News On 6 September, the inaugural Victorian branch dinner meeting was held at GG’s restaurant in East Melbourne, with a musculoskeletal theme. The evening was convened by Dr David Wang with A/Prof John Troupis hosting as master of ceremonies. It was an outstanding success and with a full house of close to 100 registrars and radiologists, travelling from all parts of the city to attend.

With a social atmosphere, there was ample time for people to catch up with colleagues and friends in an informal setting.

Opening presentations consisted of registrar presentations given by

Dr Kenneth Sim and Dr Heather Pascoe from the Royal Melbourne Hospital on a variety of cases including intraneural ganglion, crowned dens syndrome and calcification of the longus colli muscle. Dr Daniel Saddik and A/ Prof John Troupis continued with the musculoskeletal theme with their presentations on knee and shoulder imaging respectively.

from the members. We look forward to continuing this very successful event on a regular basis and expect the next evening to be held in the early part of the new year. This event was only possible with the sponsorship from Toshiba medical systems, and the support and co-ordination of the Branch committee, ably chaired by Prof Stephen Stuckey.

In order to embrace the social aspect of the evening, John hosted the final section of the evening, which consisted of a table versus table trivia competition, with the theme of “Do you know your branch?” This was a first for the branch and was warmly received with much interest, involvement and merriment

In other activities recently, expressions of interest were sent to all VIC Branch members to join the VIC Branch Committee including the positions of chair and treasurer. The registrar’s presentation night was run on Thursday 16 November at the Royal Melbourne Hospital.

Australian Branch Meeting Dates Overview 2018

NSW

NSW RO Chapter

Branch Committee Meeting Wednesday 14 February 2018 Wednesday 16 May 2018 Wednesday 15 August 2018 Wednesday 7 November 2018

Teleconference Teleconference Teleconference Teleconference

Branch Committee Meeting Wednesday 14 March 2018

Westmead Hospital and Teleconference

Academic Night Wednesday 14 March 2018

Westmead Hospital

Meeting dates are subject to change. For further information about Branch activities and event locations please visit our events section of the website or contact Mereana Pokai on: Branches@ranzcr.com or Ph: +61 2 9268 9738

Branch Contacts 2018 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: Dr Pramod Phadke E: ppphadke@yahoo.com Honorary Secretary: Dr Chee-Chung Hiew E: chee-chung.hiew@sesiahs.health.nsw.gov.au Meeting Contact: Ms Caroline Kovacic E: caroline.kovacic@health.nsw.gov.au

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NSW Radiotherapy Club Ms Mereana Pokai E: branches@ranzcr.com NZ Chair: Dr Gabriel Lau E: gabes.lau@pacificradiology.com Honorary Secretary: Dr Ben Wilson E: ben.wilson@southerndhb.govt.nz QLD Chair: Dr Mark Phillips E: ausphillips66@yahoo.com.au Honorary Secretary: Dr Peter Zheng E: secretaryranzcrq@gmail.com SA Chair: Dr Chris Pozza E: cpozza@usa.net Honorary Secretary: Dr Melissa Lea (acting in role)

TAS Chair: Dr Rajendra Doolabh E: Rajendra.Doolabh@regionalimaging.com.au Honorary Secretary: Dr Jonathan Shulman E: Jonathan.Shulman@regionalimaging.com.au VIC Chair: Prof Stephen Stuckey E: slstuckey@mac.com Honorary Secretary: Dr Gerard Goh E: G.Goh@alfred.org.au MSM Convenor: Davig 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 Meeting Convenor: Dr Fiona Bettenay E: Fiona.Bettenay@health.wa.gov.au

General Interest

FROM THE RANZCR ARCHIVES MYSTERY OBJECTS

YOUR COLLEGE NEEDS YOU!

Can you name any of these objects or describe their use? Scan the QR codes to submit your comments MISCELLANEOUS SET 2016.16

MISCELLANEOUS SET 2016.19

MISCELLANEOUS SET 2016.37.1

MISCELLANEOUS GAUGE 2016.42

MISCELLANEOUS OBJECT 2016.45

MISCELLANEOUS OBJECT 2016.40

X-RAY CONTROL PANEL 2016.73

FLUOROSCOPY DOSE WHEEL H28

MISCELLANEOUS OBJECT H4488

MISCELLANEOUS OBJECT H13196

These objects can all be found in the RANZCR Archives online museum at www.ehive.com/collections/5079/trainor-owen-collection

DO YOU HAVE ANY INDUSTRY OBJECTS OF SIGNIFICANCE?

Contact archives@ranzcr.com Volume 13 No 5 I December 2017

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RANZCR NZ ASM Millennium Hotel 3-5 August 2018

www.ranzcr2018.co.nz

General Interest

Professional Documents and Publications Release of New Radiation Oncology Training Policies Three new radiation oncology training policies were released on 1 November 2017 which replace the Radiation Oncology Trainees in Difficulty Policy.

• Performance and Progression (Radiation Oncology) Policy • Remediation (Radiation Oncology) Policy • Withdrawal from Training (Radiation Oncology) Policy Assessment, management and monitoring of trainees is an essential component of the training program and as such it is required that trainees participate in regular reviews to monitor their performance and progression through the training program. These reviews provide trainees with an opportunity to discuss their learning needs and objectives, evaluate their knowledge and skills and receive feedback on their performance. Should a trainee experience difficulties for any reason and not be performing and progressing to the standard outlined in the training program, these policies provide a framework to manage any

issues in a transparent and supportive environment while working towards a positive resolution.

All radiation oncology trainees, Directors of Training and Training Network Directors are asked to please familiarise themselves with these policies. Further communication from the College regarding these policies has also been sent to those involved in the radiation oncology training program.

The policies can be downloaded from the RANZCR website at: www.ranzcr.com/trainees/rad-onc/ training-program Should you have any questions or require further information please contact the College at ronctaa@ranzcr.edu.au .

Release of the New RANZCR Interrupted and Part Time Training Policy (Clinical Radiology and Radiation Oncology)

This policy is a combined clinical radiology and radiation oncology policy and replaces the individual Interrupted and Part-time Training Policies for Clinical Radiology and Radiation Oncology. Any trainee wishing to vary their training time is asked to please refer to this policy when submitting an application to the College.

All trainees, Directors of Training, Network Training Directors/Training Network Directors and Education Support Officers are asked to please familiarise themselves with this policy.

Should you have any questions or require further information please contact the College by email: Clinical Radiology Training – radtaa@ranzcr.ed.au Radiation Oncology Training – ronctaa@ranzcr.edu.au

A new RANZCR Interrupted and Part Time Training Policy was released on 1 November 2017.

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 here: Clinical Radiology www.ranzcr.com/fellows/clinical-radiology/professional-documents Radiation Oncology www.ranzcr.com/fellows/rad-onc/professional-documents All College position statements and submissions are available on the College website here: College Wide www.ranzcr.com/our-work/advocacy/position-statements-andsubmissions

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General Interest

MyRANZCR: Our New and Improved Member Portal Have you logged in yet?

RANZCR Supporters

Our new online member portal launched earlier this month, forming the latest stage of the College’s digital transformation strategy and providing members with an improved online self-service experience.

TNI Pty LTD www.tni-australia.com

MyRANZCR is very easy to use and allows members to complete all the same tasks as our previous member portal, including making payments, updating contact information and accessing the Learning Portal.

MyRANZCR also has some great new features: 1. Invoice download function, allowing you to keep your tax records up to date with a single click 2. Multi-currency payments, enabling our New Zealand members to pay fees in their local currency 3. Option to add areas of practice and interest, helping us to share information and opportunities that are most relevant to you.

Additional online services will be added in future.

For convenience, the new portal requires members to log in using their email address, rather than their RANZCR member ID. All members have received an email inviting them to create this log in. It’s a quick and simple three step process, and we encourage all members to log in and explore what MyRANZCR has to offer.

If you have any difficulty logging in or navigating the portal, you can access help information and user guides at www.ranzcr.com, or contact the Member Services team at members@ranzcr.com or on +61 2 9268 9777.

Able MedicoAdvisor www.ablemedico.com.au Everlight www.everlightradiology.com.au I-Med www.i-med.com.au Bayer Australia Ltd www.bayer.com Sectra www.sectra.com/medical Integral Diagnostics www.integraldiagnostics.com.au Deutsch Medical Pty LTD www.deutschmedical.com.au Varian Medical Systems www.varian.com Wiley Publishing www.onlinelibrary.wiley.com Being a RANZCR Supporter entitles you to the following benefits: • Discounted advertising opportunities • A RANZCR Supporter logo to display on your website • A RANZCR Supporter listing on the College website, in Inside News and in the Annual Report • The College’s quarterly newsletter - Inside News • The College’s bi-monthly scientific journal - Journal of Medical Imaging and Radiation Oncology • The College’s monthly electronic newsletters – Faculty of Clinical Radiology and Faculty of Radiation Oncology and other associated electronic newsletters • The College’s Annual Scientific Meeting brochure • An electronic version of the College’s Annual Report.

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General Interest

Australasian Meetings 2018 March AAFITN 2018 Sabah, Malaysia – 7-9 March www.aafitn2018malaysia.com IRSA/APCCVIR Conference Auckland, New Zealand 8-11 March 2018 www.irsa.com.au/meetings ANZSNR ASM Hobart, TAS – 16-18 March 2018 www.anzsnr.org.au TROG ASM Hobart, TAS – 19-22 March www.cmnzl.co.nz/trog-2018-asm ARGANZ Annual Scientific Meeting Melbourne, Victoria – 24-25 March 2018 www.arganz.org/index.php/ meeting-2018/home.html

April World Federation of Nuclear Medicine and Biology Congress Melbourne, Victoria – 20-24 April 2018 www.wfnmb2018.com

RANZCR Annual Scientific Meeting Dates NZ Branch ASM 2018 3-5 August 2018 Queenstown, New Zealand www.ranzcr2018.co.nz ASM 2018 25-28 October 2018 Canberra, ACT ASM 2019 October 2019 Auckland, New Zealand

International Meetings 2018 January AOCR Conference 2018 Mumbai, India – 25-28 January www.aocr2018.org

April ARRS Annual Meeting Washington, USA – 22-27 April www.arrs.org/AM18

June

College Meetings 2018

Imaging in England London, United Kingdom – 3-6 June www.globalradcme.com/ imaginginengland2018

Board 26 March 13 April 2 May (telco) 12 June (telco) 17 August 28 August (telco) 22 November

May AMSIG ASM Melbourne, VIC – 5-6 May www.goldcoast2018.amsig.org ISFRI Congress Melbourne, VIC – 10-12 May www.isfri2018.com

June CNSA Annual Congress Brisbane, QLD – 21-23 June www.cnsacongress.com.au

Correct at time of print. For an updated list of events, please visit our events page on the College website at www.ranzcr.com/whats-on/events.

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General Interest

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.

32 - 56 February 2018 2017 RANZCR CPD RANZCR CPDpoints pointscan canbebeclaimed obtained forfor attendance attendance Venue: Novotel MenziesSydney Hotel, Sydney Central, Sydney Early-bird registration fee $1600 $1500 www.mrieducation.com/australasia

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~ In Memoriam ~ The College notes with regret the death of the following members: Dr John Niblett, Fellow, WA Dr Peter Durward, Fellow, NZ Dr Robert Buick, Fellow, QLD

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Inside News

MRI

COURSES

2018 INTENSIVE

PELVIC MRI COURSE

INTERNATIONAL FACULTY: SVETLANA BALYASNIKOVA, FERGUS COAKLEY CONVENOR: CLAIR SHADBOLT 1 DAY RECTAL, 1 DAY PROSTATE, 1 DAY GYN. INDIVIDUAL MAC WORKSTATION BASED. NEW CASES ADDED SINCE 2016 SINGAPORE COURSE.

5-7 SEPTEMBER 2018 SINGAPORE Conference Manager: Kathy Nightingale E: conferences@tni-australia.com M: +61 418 515 090

Register online today at:

www.tni-australia.com

RECTAL

CANCER MDT MRI INTERNATIONAL FACULTY: PROF GINA BROWN LOCAL FACULTY: HERIOT, PRICE, FARMER, NG, CROXFORD, TRAN. CONVENOR: KIRSTEN GORMLY

22 FEBRUARY 2018 MELBOURNE

BREAST MEETINGS 2018/2019

INTENSIVE

BREAST MRI COURSE

INTERNATIONAL FACULTY: DR JULIA CAMPS-HERRERO CONVENOR: ALLISON ROSE THE PREMIER INTENSIVE, INDIVIDUAL WORKSTATION BASED COURSE AVAILABLE IN ASIA-PACIFIC. 2.25 DAY INTENSIVE COURSE NOW IN ITS 9TH YEAR. APPROX 100 CASES AVAILABLE FOR REVIEW.

18-20 MAY 2018 MELBOURNE

BIG OF

RANZCR 12 GENERAL MEETING TH

THE PREMIER BREAST IMAGING AND MANAGEMENT CONFERENCE IN ASIA-PACIFIC. IN ADDITION TO THE MAIN CONFERENCE, A NUMBER OF WORKSHOPS RUN CONCURRENTLY INCLUDING THE BREASTSCREEN READER TEST.

CONVENOR: HELEN FRAZER

13-16 MARCH 2019 PERTH

Conference Manager: Kathy Nightingale E: conferences@tni-australia.com M: +61 418 515 090

Register online today at:

www.tni-australia.com