Issuu

Volume 15 No 1 / December 2018

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

ASM 2018 – A COSMIC EVENT

Also Featured in this edition

The Art of Observation

Enhancing Interpretation Skills

Accreditation –

Building strong foundations

Meet the new

Dean and Councillors

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www.i-med.com.au

Editor’s Pick 5 6

The President’s Message The CEO’s Message

7 13

Accreditation – Building strong foundations ASM – All the highlights from Canberra

Targeting Cancer ramps up in New Zealand

Inside Radiology – MRI access in focus

Courses, Workshops and Events

The search for biomarkers

What are your thoughts?

Training and Assessment Reform Update

A Message from the Dean of Clinical Radiology

Clinical Radiology Training Program News

35 37

49 51 53 54

The Art of Observation Using art to enhance interpretation skills An alternative to Hysterectomy? Exploring Uterine Artery Embolisation

Meet the new FCR Dean and Councillors for 2019

A Message from the Dean of Radiation Oncology

Radiation Oncology Training Program News

Meet the new FRO Dean and Councillors for 2019 New Zealand Branch News News in Brief

If you have thoughts or comments about one of the stories you have read in this issue, we want to hear from you. The submission of letters to the editor, articles and news items are encouraged. Please email any submissions to Mark Grzic at editor@ranzcr.edu.au

ARPANSA’s new linac is coming

"Of at least intermediate status"– Wandering with the Rouse Traveling Fellow

From the Archives

Have you moved recently? Log into the MyRANZCR Portal and ensure your contact details are up to date at www.myranzcr.com

Inside News is printed on Sovereign Silk. Sovereign Silk 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 Mark Grzic

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.

Key Dates Call for Abstracts Open:

Janurary 2019

Call for Abstracts Close:

April 2019

Registrations Close:

April 2019

ranzcr2019.com

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

Introduction

Across the expanding medical universe A Message from the President

Dr Lance Lawler

Radiologists in search of their place in the universe took the unusual step this year of consulting the stars. This we did, as true practitioners of evidencebased medicine, not by consulting the horoscopes (although the recent entry by Uranus into Taurus was a worry), but through reflection on the celestial insights of Brian Schmidt, our best-known astronomer and a Nobel laureate. Prof. Schmidt—who helped make the unexpected discovery that the expansion of the universe is accelerating—delivered the Nisbet Oration at our 2018 Annual Scientific Meeting (ASM) in Canberra. Fittingly, his lecture was about the future and how we should best deal with our inability to predict it well. The ASM’s theme of ‘Our Place in the Universe’ was launched in plenary by Richard Gunderman, one of America’s best-known radiologists and medical educators. Prof. Gunderman reminded us that Röntgen’s discovery of X-rays in 1895 did not just alter medicine forever—it changed our understanding of the universe by opening our eyes to the vast electromagnetic spectrum beyond visible light. In a discussion involving supernovae, black holes and Mercury (Freddie, not the planet), he noted that ‘much of the universe would be invisible to us except for our ability to detect X-rays.’ Finding our place in a future medical universe dominated much of the discussion at the ASM this year, and, as a result, attendees no doubt gained a clearer view of their professional

trajectories and the future of our specialties. This was most evident in the talks, presentations and panel discussions devoted to interventional radiology, artificial intelligence (AI) and women in medical leadership. The Chairman of the RANZCR Interventional Radiology Committee (IRC), Dr. Nick Brown, gave an important update on the IRC’s work since its formation over 18 months ago. His update emphasised that, to achieve recognition of IR as a distinct medical specialty and a new faculty within the College, we need to better define the specialty, develop detailed standards and guidelines, establish a training pathway, and consider and explain the implications for patients. This list is no mean set of tasks and will require engagement and support from the whole profession, as well as a realignment of the College’s advocacy work with government. The ASM talks around Artificial Intelligence (AI) were especially well received, and rightly so, as few aspects of our professional future loom larger or more unpredictably in our collective vision than this. In addition to valuable technological contributions by local and overseas researchers at IBM and others, it fell to Nicola Strickland, President of the Royal College of Radiologists, to pose perhaps the crucial issue for her fellow radiologists: why we clinically need AI. In addressing the issue, Dr. Strickland noted the unmet demand for radiologists in the UK and worsening delays in the reporting of imaging studies due to government

underfunding. She argued that AI had already begun to improve workflow efficiency and reduce the drudgery of repetitive tasks, and within 10 years would help to deliver the promise of a new era of personalised medicine through radiomics. Memorably she stated, ‘The advent of AI will allow us to reinvent ourselves and behave as doctors again, and not be hived off into darkened rooms acting like battery hens turning out reports without interaction with our clinical colleagues or patients.’ Finally, this year’s ASM included, for the first time, a forum devoted to women in medical leadership and the issues facing women in our profession. The well-attended breakfast heard presentations which ranged across the #Metoo movement, maternity leave, gynaecological cancers in Botswana and the participation by women in banking and finance, as well as medicine. Later, Prof. Birgitte Offersen outlined an important Danish study into the late effects of treatments for breast cancer. I commend the ASM’s organisers, sponsors, contributors and attendees on such an inspiring event, and welcome our new fellows to the College. The universe never looked so big and bright and our place in it so clear.

Volume 15 No 1 I December 2018

Introduction

2018 achievements and 2019 plans From the Chief Executive Officer

Ms Natalia Vukolova

An increasingly large number of radiologists and radiation oncologists are volunteering for the College – defying the trend in other volunteer organisations. In 2018 the number grew to 1,619 individuals or 37% of College members. It is the opportunity to give back to the profession, the social networks and the diversity of the work that keeps the engagement high. 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 1,619 clinicians supported by expert staff. In 2018, the College has ramped up its advocacy and representation activities. We gave evidence and made a detailed submission to a Senate committee inquiry into the availability

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Members donating to our Education and Research Fund and the JP Trainor Archive Trust:

106

Inside News

and accessibility of diagnostic imaging equipment. We advocated at two roundtable discussions on radiation oncology with the Australian health minister's office and senior Department of Health staff in Canberra, as well as meetings with the shadow health minister and Labor MPs in Queensland, and another with the NZ Health Minister, David Clark, in Wellington. Over the course of the last financial year the College issued 37 media releases and 21 submissions or position statements, a list which includes the important teleradiology standards to be incorporated in the forthcoming version of the Standards of Practice for Diagnostic and Interventional Radiology. This particular achievement was followed by a presentation to the prestigious Australian Telehealth Conference outlining how we had successfully converted telehealth policy into a coherent and practical set of standards for the benefit of professionals and patients. In these initiatives and many others, the College is playing a long form of the advocacy game, working towards the goal of being a 'trusted adviser.' The results are already evident. For example, our close and

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Number of donations to our Education and Research Fund and the JP Trainor Archive Trust:

157

Participated in Special Interest Groups and Reference Groups:

1,239

careful work with Department of Health this past year helped to deliver a new funding agreement for the Specialist Training Program for 2018–20, including funds for new training posts under its Integrated Rural Training Pipeline. The College’s focus in 2019 will be on implementing our strategic plan across member engagement, advocacy, clinical excellence, education and operational efficiency. We will see substantial progress in offering improved services to our members and more opportunities for you to be engaged with the College. We will be strengthening our advocacy, public profile, and partnerships. The Australian Medical Council will be reaccrediting the College in 2019. This will bring into focus the extensive reforms we are putting in place across our training programs. There is much to look forward to in 2019 and all members are encouraged to join their peers and lend a hand. If you have any thoughts or comments, please email me on ceo@ranzcr.edu.au Warm wishes for the festive season, Natalia

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Sitting on our committees, panels and working groups:

486

Sitting on the Board and Faculty Councils:

Feature

Accreditation – Laying the foundations for our future The College’s Chief Accreditation Officers sat down with us to discuss the Training Site Accreditation process and what the future holds. RANZCR’s Training Site Accreditation process has been receiving a lot of coverage of late. Stories in the papers and more than the usual share of word of mouth tales have created a lot of discussion about one of the less well understood aspects of the College. To get to the heart of the recent improvements and to get a better overview of the process, we sat down with A/Prof John Leung from the Faculty of Radiation Oncology and Dr Mark Phillips from the Faculty of Clinical Radiology the Chief Accreditation Officers for their respective Faculties.

Why did you perceive a need for change in accreditation process? JL: There has been a proliferation of centres requesting trainees and hence accreditation over the last several years. Whilst it is excellent for training to be

“With centres seeking accreditation, we believe it is important to consistently review our processes”

A Prof John Leung

diversified from a few major centres, we must ensure these centres meet the required standard and that rotations between centres are equitable. The main aim is to guarantee optimal training for our trainees. This is dependent on trainees giving honest opinions without fear of retribution. Changes cannot be made without worthwhile feedback and the appointment of the Trainee Liaison Officer, Chris Bartley, has been vital in providing a confidential touchstone for trainees. MP: The College’s commitment to guarantee that existing policies meet the required expectations of all trainees, whilst consistently receiving the highest level of training relevant to modern medicine is at the heart of what we do. Just with centres seeking accreditation, we believe it is important to consistently review our processes to ensure that we meet the needs of current and future specialists. We also need to make certain that this training is provided without prejudice or bullying. It is our hope that through this review trainees are given ample opportunities to train in a thorough and methodical way which will equip them for the future.

How has the accreditation process changed? MP: There have been many recent changes in the modernisation of the accreditation process. The online submission process allows us to review documents as they are submitted by the sites undergoing accreditation. This allows us to be able to review the documents as they come in and if necessary, contact the sites to help them more clearly understand where there may be problems. We are also setting up the Clinical Radiology Training Accreditation Working Group known as CRTAWG. There are weekly meetings between the College’s Accreditation

Dr Mark Phillips Officers and the Chief Accreditation Officer. The aim of these meetings is to resolve whatever matters may arise quickly and efficiently where possible and provide the best outcome for all trainees concerned. Additionally, we work diligently to enact processes ensuring that we keep pace with a changing world. JL: Beyond the benefits of modernisation, the accreditation process itself has not really changed from our perspective. After an initial discussion, the site self-assessment is completed by the training site and submitted to the College. A scheduled site visit is conducted by at least two Fellows from the College and a member of RANZCR’s personnel. A detailed written report is submitted by the Accreditation Panel and reviewed by the Chief Accreditation Officer. Sites are required to provide an interim report at three years with another visit at five years. The accreditation team also investigates issues outside of the normal cycle if they are deemed important enough to affect training. continued over...

Volume 15 No 1 I December 2018

Features

What do you feel are the impacts of accreditation on the quality, standards, and effectiveness of training?

What is your vision for accreditation in the future?

JL: Currently, the Accreditation Standards reads like a “tick box” of requirements for sites and networks. The actual quality and effectiveness of training is more difficult to ascertain. For example, networks and sites may provide structured teaching with a list of lectures, but the quality and relevance of these can often only really be determined by feedback from trainees.

JL: Accreditation should continue to be an integral part of College activities. Currently, accreditation visits are a very structured and formal occurrence with sites and networks having many months to prepare for visits. We would like to have a more open approach with our training sites to allow the accreditation team ongoing interaction with all sites so that accreditation is more a collaborative continuous improvement process.

MP: Accreditation allows us to maintain effective training standards. When a trainee chooses to undergo training they usually have high expectation, which the College training sites are responsible for delivering. It is necessary to protect the reputation of each profession by ensuring that every site delivers a standardised program to provide a level of comfort that, irrespective of where a patient goes, they will receive the same professional service.

MP: We are committed to making certain that the College’s accreditation process continues to evolve in such a way as to stay current and to prepare trainees for the future by building on strong foundations. It is important to remember that the education experience of all trainees must be consistent across all training sites to ensure quality outcomes not just for the wellbeing of all trainees but for their patients.

Longevity comes from strong foundations

Inside News

Want to know more about the accreditation process or how you can be involved? Contact Bettina Brooke from the Accreditation Team at accreditation@ranzcr.edu.au or phone +61 2 9268 9777

“We would like to have a more open approach with our training sites to allow the accreditation team ongoing interaction”

Features

RO Accredited Training Site: Allan Walker Cancer Centre, Darwin We spoke with Dr Christopher Rumley and KA Giam to discuss their recent accreditation

Showcase the training program at your site.

Tell us about your experience during the accreditation process.

Northern Territory Radiation Oncology (NTRO) at Alan Walker Cancer Care Centre (AWCCC) Darwin provides radiotherapy to patients in the Northern Territory and neighboring areas. NTRO Darwin together with the major centre of the Royal Adelaide Hospital and private facility of Oncology, South Australia (Genesis Care) in South Australia forms the RANZCR SA/NT Training Network.

As with any audit there is initial trepidation as to whether documents, policies and procedures are in place, but it also provided the opportunity to showcase the different aspects of training received at NTRO that are unique to the site.

NTRO provides the latest radiotherapy treatment techniques including IMRT, VMAT, DIBH and SABR lung. NTRO Darwin rotation provides trainees with a unique experience in delivering health care in a rural and remote area serving both Non-Indigenous and Indigenous patients, many of whom present from very remote communities with late stage disease and comorbidities. Cultural awareness training allows staff to deliver appropriate care, treatment and education. Awareness of the special patient needs has seen NTRO Darwin achieve an equal radiotherapy utilisation rate of over 40% between Indigenous and Non-Indigenous patients over the past 9 years.

No real challenges were identified but the accreditation process allowed NTRO to identify what it does well, as well as reflect on areas of improvement. It also highlighted the change, progress and development that has been made throughout the period from last accreditation visit and self-assessment, all of which forms an avenue for continuous improvement.

NTRO has close professional links with other disciplines and receives direct training in aspects of surgery, radiology, pathology and physics from skilled professionals from Darwin and visiting VMO’s.

What was the most challenging part of the accreditation process?

How have the above challenges impacted your training program? Through challenge you grow. The location of the site forced us to ensure that we take full advantage of our assets. As a result, trainees often return to South Australia with a broader knowledge, confidence and sense of maturity gained through their experience in the Northern Territory and Darwin. We work hard to assist trainees in developing a greater understanding

of issues that affect patients, additionally we have well-appointed accommodation and the use of a clinic car provided whilst on rotation allowing for easy of rotation and relocation.

What are the 5 most outstanding aspects about training at your site? 1. Opportunity to work and live in a wellsupported rural and remote location receiving experience that is not attainable in a suburban site. 2. Cultural awareness and education. 3. Experience collaboration and strong networking. 4. Relaxing lifestyle in a warm environment that fosters camaraderie, together with a balanced work, study and home life. 5. Opportunity to experience the ethos and philosophies of RANZCR’s network training model through rotation to a rural and remote site combined with rotation and training at major city public hospitals and private suburban radiotherapy sites. Also – cheap flights to Bali!

Volume 15 No 1 I December 2018

Features

RA Accredited Training Site: Christchurch Hospital, New Zealand We spoke with Dr Wayne Collecutt and Dr Hugh Roberts to discuss their recent accreditation What was the most challenging part of the accreditation process? The leaders of our training program are aware that the accreditation process is part of their job and so they achieve it. The process may be time consuming but can be beneficial if one engages with it. If there is one particularly painful part, it is filling in the forms required prior to the training visit. Occasionally, new requirements of the training program do present challenges with accreditation, but with all parties determined to surmount these they are generally overcome quickly.

How have the above challenges impacted your training program? Showcase the training program at your site.

Tell us about your experience during the accreditation process.

The Christchurch Hospital RANZCR Radiology training program has recently been through the RANZCR accreditation process. Operating out of Christchurch Hospital, the allied local public sector hospitals, and the local private hospital network operated by Pacific Radiology Group (PRG). In the private network the trainees get exposure to mammography and PET, the public network provides the rest.

In healthcare, radiology and training, as with most other things, little stays still for very long. As such, the principles applied to achieving the RANZCR training program have had to be applied in an ongoing fashion to ensuring the program continues to deliver in line with the RANZCR training program. The College accreditation process has been a key part of ensuring standards in the Christchurch Hospital training program are maintained. There is flexibility throughout the training program and this encourages questioning where individuals can see room for improvement. The College accreditation process brings focus to this ongoing review, as well as an external opinion and balance. The College accreditation process is seen as an opportunity to improve and obtain external help in delivering the best possible training program. It has always been the case that when asked for help, the College has delivered it.

Inside the public component, there are 42 radiologists who currently oversee 18 trainees. Trainees rotate through a series of runs which fulfil the requirements of the RANZCR training program, undertake on call work, receive teaching / lectures in line with the College program, and are overseen in line with College and MCNZ regulations. Trainees rotate through most runs/subspecialities three times over the course of their training. All registrar reports are verified by a consultant on a sessional basis until the trainee has passed the part II examination, after which they can seek assistance as required.

Inside News

It was pleasing to receive a good report, but our reality is that our training program is what it is because of where it has come from. Over time it will be different as it is fluid, flexible, equitable and consensus driven. Equally, it will only be as good as it is now at the next accreditation visit if we continue to use the College accreditation as a check / balance and make full use of the opportunity accreditation visits provide in terms of questioning ourselves with the aim of improvement.

Education

The Royal Australian and New Zealand College of Radiologists®

CHANGES TO YOUR MEDICAL REGISTRATION REQUIREMENTS ARE YOU PREPARED? The MBA are changing their registration requirements for doctors. The changes will transform the way you maintain your medical registration by shifting the focus to tailored professional development activities, that aim to enhance patient safety.

Professional Development

Remediation

Wellbeing

Find out more: www.ranzcr.com

Professional Development

Wellbeing

Supplementary support will be provided for doctors:

Shift from attending conferences, workshops and courses to a mix of 3 categories; 1. 25% Reviewing Performance e.g. Peer review, multisource feedback 2. 25% Measuring Outcomes e.g. Clinical audit, Reviews patient records 3. 25% Education activities e.g. conferences, lectures 25% Combination of any or all the above

Remediation

• Aged 70 years Medical Board of Australia will: • Maintain contemporary professional standards e.g. update Code of Conduct

• Live in remote or isolated locations or working in professional isolation •

3 substantiated complaints that impact on patient safety against

• Foster a culture of respect across all medical professions

Doctors will need to undertake:

• Steward development and integration of wellbeing initiatives

• Health assessments, every three-years (for 70 years only)

• Regular peer reviews

Volume 15 No 1 I December 2018

What’s in Issue 6? Medical Imaging Review Article: A review of factors influencing radiologists’ visual search behaviour Corresponding author: Ms Aarthi Ganesan, The University of Sydney, 75 East Street, Lidcombe, Sydney, NSW 2141, Australia This narrative literature review aims to identify the various factors that have significant impact on radiologists’ visual search patterns. Identifying the factors that influences readers’ visual search behaviour helps to understand their perception and interpretation of medical images, which in turn could lead to the development and implementation of effective strategies that could aid in improving the ability to detect abnormalities. Databases including PubMed, MedLine, Web of Science and ScienceDirect were searched using terms ‘visual search’, ‘eye‐tracking’, ‘radiology OR radiography’, ‘mammogram OR mammography’ published since the early 1960s until June 30, 2016. Some of the factors that have been identified to significantly influence radiologists’ visual search patterns were (i) readers’ expertise, (ii) Satisfaction of Search, (iii) readers’ visual fatigue, (iv) readers’ confidence in reporting abnormalities, (v) training received and (vi) readers’ prior knowledge. Readers’ level of expertise was the factor that has been identified to have the most significant impact on their visual search pattern. Eye‐tracking studies have shown the differences in visual search patterns of readers with different levels of experience and not so surprisingly, more experienced readers have shown effective visual search strategies. Readers’ expertise has also been found to have significant impact in their confidence in reporting abnormalities and their ability to discriminate lesions from background structures in medical images.

Medical Imaging Pictorial Essay: Radiological appearance of coal mine dust lung diseases in Australian workers Corresponding author: Dr Rhiannon McBean, Wesley Medical Imaging, Level 2, 30 Chasely Street, Auchenﬂower, Qld 4066, Australia. Coal Mine Dust Lung Disease (CMDLD) encompasses a spectrum of lung diseases caused by prolonged exposure to coal mine dust. This review presents high‐ resolution computed tomography (HRCT) images from men diagnosed with a CMDLD since the resurgence of these diseases in Queensland in 2015.

Radiation Oncology Original Article: Hyperbaric oxygen treatment for the management of radiation‐induced xerostomia Corresponding Author: Dr Susannah Sherlock, Royal Brisbane and Women’s Hospital, Butterﬁeld St, Herston, Qld 4029, Australia Introduction: Hyperbaric oxygen therapy (HBOT) is widely used for the treatment of the late effects of radiation therapy. We report a prospective observational cohort study of 51 patients designed to examine the effectiveness of hyperbaric oxygen treatment (HBOT) for xerostomia following radiotherapy. Methods: Objective (saliva volume) and subjective (quality of life scoring and visual analogue scale (VAS) of discomfort) measurements associated with xerostomia were compared prior to commencement of HBOT, after 30 sessions (over 6 weeks) of HBOT at 243 kPa for 90 minutes daily for five days per week and at 6‐week review (12 weeks from commencement). Results: One hundred and one courses of treatment in 99 patients were examined. For 53 (53%) courses in 51 patients, data were recorded before and after HBOT and so could be included in the analysis. Thirty‐four (34%) of these patients had complete data for all three time points. The unit of study was per treatment course, not per person. There were no major complications to HBOT. There was a statistically significant difference in saliva volume following HBOT (P = 0.016). The mean saliva volume increase was 0.9 mL over a 5‐min collection period (95% CI 0.2–1.5). There was also a statistically significant improvement in discomfort after HBOT (P < 0.001) and QOL (P < 0.001). The mean visual analogue scale for discomfort (VAS on a 0–10 scale) score decreased by 1.4 units (95% CI 0.7–2.1), whilst the mean QOL score was 10 points lower after treatment (95% CI 5.9–14.4). Conclusion: Hyperbaric oxygen therapy may be a safe and effective treatment for symptoms of xerostomia after radiation therapy and should be considered when available.

Radiation Oncology Original Article: Utility of CT imaging in a novel form of high‐dose‐rate intraoperative breast radiation therapy Corresponding Author: Dr Shayna L Showalter, Division of Surgical Oncology, Department of Surgery, University of Virginia Health System, Box 800709, Charlottesville, VA 22908-0709, USA. Introduction: Intraoperative radiation therapy (IORT) is an alternative to whole breast radiation following breast conserving surgery. Conventional breast IORT is limited by lack of cross‐sectional imaging. In response, our institution developed Precision Breast IORT (PB‐IORT) which utilizes intraoperative computed tomography (CT) images for confirmation of brachytherapy applicator placement and for treatment planning. The purpose of this study was to determine the utility of CT imaging in PB‐IORT in the first 103 patients treated in two prospective clinical trials. Methods: We retrospectively reviewed the first 103 patients treated with PB‐IORT. All patients underwent breast surgery and placement of a multi‐lumen brachytherapy applicator. Patients had a CT scan followed by high‐dose‐rate (HDR) brachytherapy. Endpoints were the number of patients having more than one CT during PB‐IORT and the number of treatment plans having image‐based modifications. Results: After initial CT scan, 27 patients (26.2%) had findings prompting surgical applicator adjustment. One patient underwent an additional scan to localize a biopsy clip and aid in excision to negative margin. Eighty‐one patients (78.6%) had dosimetry modifications based on CT findings with 36 plans (35.0%) adjusted to protect the skin or chest wall and 45 plans (43.7%) to protect both the skin and chest wall. Conclusions: Computed tomography findings prompted treatment alterations in the majority of patients treated with PB‐IORT to enhance tissue conformity and to sculpt the radiation dose away from normal tissues. CT imaging is unique to PB‐IORT. These findings suggest the potential clinical superiority of PB‐IORT given its allowance for patient‐specific alterations.

Features

That’s a Wrap... RANZCR 69th Annual Scientific Meeting, Canberra More than 1,000 delegates joined together in Canberra for the College’s 69th Annual Scientific Meeting titled Our Place in the Universe. This was the first time the ASM was held in Canberra and the intimate surrounds of the National Convention Centre ensured ample networking opportunities. The social program included many iconic locations from the National War Memorial where the new Fellows were celebrated to the Australian Institute of Sport for the Gala Dinner. 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 meeting commenced bright and early for around 80 delegates with the ‘Women in Leadership’ Breakfast session that included presentations from Jen Dalitz, CEO of Women in Banking and Finance, Dr Surbhi Grover, Assistant Professor of Radiation Oncology, University of Pennsylvania, USA and Director of Global Radiation Oncology, Botswana-UPENN Partnership, Princess Marina Hospital, Botswana. The morning was facilitated by Prof Liz Kenny and included numerous topics of discussion and challenges being faced in the industry. The Clinical Radiology sub-themes were ‘Error’ and ‘Education’. Unashamedly, the emphasis was on edutainment. The program deliberately sandwiched proffered papers between world-class contributions by a stellar international faculty. This meant that our trainees did not miss-out on the brilliance of the expert teachers from abroad.

Moreover the trainee education day held on Saturday allowed large numbers to attend and be treated to vivas and lectures from our international visitors.

“The highlights? Who can forget Claude Sirlin’s cutting edge brilliance at demystifying magnetic resonance sequences?“ The highlights? Who can forget Claude Sirlin’s cutting edge brilliance at demystifying magnetic resonance sequences? Or his precision-guided applications of physics which unlocked the diagnostic conundrums of liver imaging? Or Mary Roddie, Chief Examiner of the UK RCR, presiding over a session with incisive brilliance

during which Prof. Richard Gunderman delivered a declamatory rejection of our current obsession with candidates’ ‘equality of experience’ in examinations. “What are our exams if they are not authentic?” he demanded. Elizabeth Dick and Jadranka Stojanovska made numerous great contributions which enlightened us about trauma, and thoracic radiology. Both explored the problems faced by women in radiology while offering immensely practical solutions. Emmeline Lee and Natalie Yang were further stunning contributors; Clyde Helms with seasoned aplomb dissected and simplified shoulder and ankle conditions; Frank Gaillard brought us up-to-date with the mighty Radiopaedia; Sandeep Bhuta on Skin cancer imaging … seemingly endless displays of excellence emphasising the unimpeachable centrality of Radiology in the medical Universe. As a parting flourish, Prof. Julie Quinlivan explored the use of Medicare items in Radiology billing.

Volume 15 No 1 I December 2018

Features

And the lowlights? Three teams of New Zealand registrars smashed their way to the finals of the ‘Battle of the Branches’ Quiz using age-old cheating methods including knowledge, genius and inspired deduction, much to the consternation of the shocked Australians in attendance. The Victorians were ultimately victorious – largely because the NZ teams had to fly home and missed the Final. Some muttered that this timing was deliberate, but Question Master Supreme Ross O’Neil gave the whingers short shrift. After all there is always Auckland 2019… The Radiation Oncology program saw one of the largest international speaker contingents in recent years thanks to the generous support of industry partners. Professor Birgitte Offersen provided a number of insightful presentations and in addition presented the ESTRO FALCON workshop on Breast Cancer. Dr Christopher Crane’s opening plenary presentation on From palliative to curative: The role of image guidance and adaptive planning in GI cancers set the scene for the four day radiation oncology program. The charismatic A/Prof Heiko Enderling addressed Integrating mathematical oncology into radiation oncology and Individual patient tumor growth dynamics to personalize radiation dose and dose fractionation. Thanks to Accuray Asia

Inside News

A/Prof Sean Collins presented on Stereotactic body radiation therapy (SBRT) for Unfavorable Prostate Cancer: Is it Ready for Primetime? and Is There Still a Role For Radiation Therapy in the Management of Melanoma Brain Metastases? The trainees in both disciplines did not fail to deliver with the radiation oncology Varian Prize tightly contested, with Dr Nicolas Bucknell taking out the coveted prize for his presentation

“The Radiation Oncology program saw one of the largest international speaker contingents in recent years.” Personalising Lung Radiation Therapy: Optimising VMAT Planning to Functional Lung Imaging to Reduce Functional Lung Dose and Escalate Dose to Primary Tumour. The Branch of Origin prize in 2018 was awarded to Dr Sheila Oh from New Zealand on her presentation for What is the value of surveying the kidneys

during pelvic ultrasound examinations? A clinical audit of 1000 patients. Abstracts of oral and exhibit presentations are now available to viewed via the online library of the Journal of Medical Imaging and Radiation Oncology (JMIRO). More than 80 new Fellows were welcomed into the College at the Annual Ceremony held on Friday evening. New Fellows and guests gathered in the Royal Theatre to welcome the official processional party including the 2018 Nisbet Orator Professor Brian P. Schmidt AC FAA FRS, Vice-Chancellor and President, The Australian National University and recipient of the 2011 Nobel Laureate Physics, who provided an inspiring presentation. Saturday saw over 100 participants head down for a morning walk/run around Lake Burley-Griffin as the sun rose for the Targeting Cancer Fun Run to see Gracie Keown and Stuart Turner 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. The night was filled with a variety of international entertainment, from the Japanese drummers, to an incredible recordbreaking kazoo orchestra. At one stage

Features

Bollywood reigned supreme, with a quick dance lesson having many guests believing they could be Bollywood's next big star! 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 23.5 RANZCR CPD points can be claimed for full attendance at the ASM (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, exhibitors, sponsors including Platinum Partner Varian and Gala Dinner Sponsor Canon for their support of the College meeting. A special thanks to the 2018 Organising Committee for their hard work and dedication to achieving a truly out of this world ASM. Be sure to mark your diary for 17 – 20 October 2019 for the 70th ASM to be held in Auckland. With a theme of Back to the Future you are sure to be transitioned back in time to the age of the Deloreon in what promises to be another stellar ASM.

Organising Committee Dr Hany Elsaleh (Radiation Oncology Co-Convenor) Dr Angela Rezo (Radiation Oncology Co-Convenor) Dr Farhan Syed (Radiation Oncology Co-Convenor) Dr Natalie Collier (Radiation Oncology Trainee Representative) Dr John Cockburn (Clinical Radiology Co-Convenor) A/Prof Rajeev Jyoti (Clinical Radiology Co-Convenor) Dr James Bain (Clinical Radiology Trainee Representative) Dr Jade Lee (Clinical Radiology Trainee Representative) Dr Chaturica Athukorala (Committee Member)

Volume 15 No 1 I December 2018

About Radiation Oncology

Radiation Therapy

Treatment By Cancer Type

Treatment Centre

Our Stories

Talking To Your Doctor

News

For GPs

Radiation therapy cures cancer and is safe

The Targeting Cancer website - a trusted source of information about radiation therapy 1 in 2 cancer patients would benefit from radiation therapy at some time during their cancer experience. However, only 1 in 3 patients in Australia and New Zealand will actually receive radiation therapy. Targeting Cancer Campaign aims to increase awareness of radiation therapy as an effective, safe and sophisticated treatment for cancer. It is designed to reach cancer patients, their families as well as health professionals, in particular general practitioners, to improve their knowledge of this (sometimes overlooked) treatment.

Visit www.targetingcancer.com.au or www.targetingcancer.co.nz Or follow us on: Radiation Oncology: Targeting Cancer @TargetingCancer Radiation Oncology Targeting Cancer

Please contact info@targetingcancer.com.au for more information.

Advocacy

Targeting Cancer increases advocacy efforts in New Zealand reducing the scourge of cancer. “We can help more people in New Zealand by increasing awareness of radiotherapy through the Targeting Cancer campaign. It will also improve access and investment in radiotherapy treatment, as it is a technology dependent treatment.” Other recent New Zealand activity has included social media promotion of the campaign among New Zealand clinicians and a recent interview with the influential New Zealand Doctor website by Dr Delaibatiki.

The College's Targeting Cancer campaign has been successfully stepping up advocacy efforts in New Zealand recently as it aims to further increase awareness among the country’s patients of radiation therapy as a treatment option. Activities have included a GP awareness evening at Wellington Blood and Cancer Centre, promotion of Targeting Cancer in key media outlets and input from several New Zealand radiation oncologists and radiation therapists into brainstorming ideas for NZ Targeting Cancer activity. Among the attendees at the Wellington awareness session, which took place at the Wellington Regional Hospital, were GPs, palliative care coordinators, hospice nurses and cancer care nurses. The event provided valuable information on patient pathways, how patients can be referred to the service and more details about radiation oncology as a treatment option. Feedback from the attendees was very positive. Targeting Cancer supporter and Media and Profile Committee member Dr Miriama Delaibatiki, a radiation

oncologist based at Tauranga, said she had realised the importance of promoting the campaign and radiation therapy. “I know the benefits of radiation therapy and that there are still quite a number of patients in New Zealand who aren’t benefiting from this treatment,” Dr Delaibatiki said. “Targeting Cancer has done some excellent work in increasing the profile of radiation therapy among both patients and health professionals. I believe helping promote the campaign in New Zealand will help achieve better outcomes for more patients in this country.” Dr Ramesh Pandey, a Radiation Oncologist and another new New Zealand-based Media and Profile Committee member, has also been enthusiastic about supporting the Targeting Cancer campaign. “Clinical trials increasingly show the benefits of radiotherapy in curing some cancers, treating oligo-metastases and palliating a myriad of symptoms,” Dr Pandey said. “It is a highly efficacious and extremely cost-effective means of

Going forward, the campaign aims to recruit a New Zealand ambassador to raise the profile of radiation therapy in New Zealand as an effective, safe and cost effective cancer treatment. Additionally the campaign will host open days and information sessions at radiation oncology centres and publish educational material in GP journal/ websites. “We’re delighted with the increasing support the campaign is receiving from New Zealand clinicians,” Targeting Cancer Clinical Lead A/Prof Sandra Turner said. “Their support and enthusiasm has been amazing. “Helping New Zealand cancer patients become more aware of radiation therapy was always one of the key aims of Targeting Cancer but it will be much easier to achieve this with the leadership of Miriama and Ramesh and their many keen NZ radiation oncologist and radiation therapist colleagues who support the campaign. “Ultimately, we want all New Zealand patients who might benefit from radiation therapy to be able to access it and understand their treatment options if radiation therapy is one of them. Any New Zealand radiation therapists, radiation physicists and radiation

Volume 15 No 1 I December 2018

Advocacy

oncologists keen to get involved or discover more information should email Philip Munro at info@targetingcancer. com.au for further details.

Officer Stuart Turner was the overall race winner, with New Zealand clinical radiology trainee, Dr Gracie Keown the first woman past the post.

Fabulous fun run

Media coverage

Targeting Cancer was delighted to host another successful fun run as part of the recent RANZCR ASM in Canberra.

In addition to the recent piece on the New Zealand Doctor website, Targeting Cancer has also helped drive recent positive media coverage of radiation therapy.

More than 100 people registered for the fun run, which saw participants either run or walk along a five-kilometre circuit adjacent to the city’s picturesque Lake Burley Griffin. The fun run has become a regular fixture of the annual ASM and aims to help raise further awareness of the Targeting Cancer campaign and its objectives. Former Wallaby and ACT Brumbies star Joe Roff graciously gave his time to open this year’s run.

In October a study by trainee radiation oncologist Dr Luke Nicholls from Brisbane’s Princess Alexandra Hospital, which highlighted a lack of radiation oncology teaching in medical schools across Australia and New Zealand, was featured in multiple Australian media outlets. In early November the results of the SABR-COMET trial were featured in a story by Channel 7.

“The run is an excellent way to unite supporters of the Targeting Cancer campaign and to help raise awareness of its activities among those attending the ASM,” Targeting Cancer Clinical Lead A/ Prof Sandra Turner said.

The trial results which were presented at the recent ASTRO meeting, underlined the potential value of Stereotactic Ablative Radiation Therapy for patients with oligometastatic disease.

“It was generous of Joe to open the fun run and we were so grateful for his assistance and inspiring words.

These pieces helped promote the importance of and need for awareness around radiation therapy to a mass audience.

“Hopefully next year’s run will be even bigger and better!” RANZCR Media and Communications

Sydney science week event Targeting Cancer was delighted to be involved in the recent Sydney Science Festival, which celebrates Sydney’s diverse and multidisciplinary innovation community. Among the 200 events featured in this year’s festival was a celebration of the 40th anniversary of Westmead Hospital, which included a public tour of radiation oncology services at the western Sydney hospital. Members of the public registering for this free event had a quick talk about

Inside News

the basics of radiation therapy - how it works, the patient pathway and experience having treatment - and were then shown the machines and other interesting parts of the department at interactive ‘stations’. A large team of radiation oncology professionals including radiation oncologists, therapists, physicists and nurses took part. A TV film crew from China chose this as one of only a few activities in Sydney to feature from the festival. It is hoped that next year the event will be extended to other radiation oncology departments around Sydney. Targeting Cancer Clinical Lead A/Prof Sandra Turner gave a talk on ‘What is Radiation Therapy’, while Targeting Cancer promotional materials were also distributed to attendees.

How you can help Targeting Cancer is always looking for radiation oncologists, radiation physicists and radiation therapists to help promote both the campaign and radiation therapy as a treatment option for cancer. The campaign, which is run by the College’s Faculty of Radiation Oncology, recently marked its fifth anniversary. “Over its five years, the Targeting Cancer campaign has made great strides promoting the value of radiation therapy,”

Advocacy

Targeting Cancer Working Advisory Group Chair Dr Lucinda Morris said. “The website attracts visitors from across the world, our social media outlets are growing in popularity and visibility and the campaign’s key messages have been seen by millions of people across the globe since it was established five years ago. “We’ve achieved much but we can still do more, which is dependent on more people helping out. “Ultimately, this is about helping save the lives of cancer patients across the world by highlighting the value of radiation therapy as a cost-effective and safe treatment for cancer. That’s why we would love more people to get involved.”

Some of the practical ways to assist the campaign are:

➢

haring articles/tweets from the Targeting Cancer Facebook S and Twitter accounts

➢

efer patients and other professionals to the Targeting Cancer website R (www.targetingcancer.com.au or www.targetingcancer.co.nz).

➢

romote the campaign through an awareness or oncology P education evening

➢

L et your colleagues and friends know about the campaign and encourage them to join

➢

ick up some of fantastic promotional materials by emailing P Philip Munro at info@targetingcancer.com.au

Please use your imagination and help get the Targeting Cancer message out there. Let us know what is happening and we can also help promote your events and educational activities!

Volume 15 No 1 I December 2018

Advocacy

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

MRI access in focus The College continues to make progress through our education and advocacy activities Access and affordability of this nonionising imaging modality has been a key focus of the College over the last year. A key strand of this advocacy work is improving consumer knowledge about the role of the radiologist and including them in discussions with referrers. To mark the occasion of the 2018 International Day of Radiology (IDoR), the College launched two interactive infographics that illustrate the MRI journey from the perspective of a patient. These infographics are designed to provide health consumers requiring imaging, including parents of children, with a fun interactive way to learn more about MRI. These infographics are now live on the InsideRadiology website. The website continues to be a great source of information with over 5,000 visitors a month viewing the MRI general information item alone. The interactive tool (pictured on the following page) charts a patient’s journey from referral, to image acquisition, analysis by a clinical radiologist, through to reporting of results to the primary referrer. Consumer research has previously indicated that patients want to know more about what radiologists do and how they help patients. This tool has been designed accordingly to break down the key role that radiology and the clinical radiologist plays throughout the treatment process.

Inside News

Relentless Advocacy Due to RANZCR’s advocacy efforts, there has been growing concern amongst stakeholders and greater political recognition of the shortcomings of access to MRI under Medicare in Australia.

“All three major Australian political parties have made important commitments to improve MRI access for patients.” The College has been strongly and successfully advocating for better access to MRI. This has resulted in MRI for prostate cancer and some cardiac conditions listed, with liver and obstetric MRI also through the MSAC application process and expected to be listed soon. RANZCR members have been instrumental in the MBS Review, calling to remove clinically unsound restrictions on patient access to MRI tests, such as the once in a lifetime restriction on pelvic MRI.

The College has also publicly voiced opposition to cuts emanating from the MBS Review such as restrictions on patients aged over 50 who will be denied a Medicare-funded MRI for knee injuries unless requested by a specialist. RANZCR believes that this recommendation is not supported by contemporary clinical evidence. Our position was supported by other groups including Consumer Health Forum, Council of The Ageing, the Australian Diagnostic Imaging Association and AMSIG. Following a series of meetings with backbench MPs, the Australian Senate initiated an inquiry in 2017 into the Availability and Accessibility of Diagnostic Imaging Equipment in Australia. Senior RANZCR representatives including then-President Greg Slater, Dr Lincoln Gillam, CEO Natalia Vukolova and Mark Nevin presented to the Senate Committee about clinical oversight of service delivery, inequities in the MRI licensing, service level restrictions under Medicare and the implications of the freeze on Medicare. The committee’s final report, published later, included recommendations which echoed RANZCR’s proposals that access be improved and the Commonwealth Government implement a clear and transparent application process for MRI machines.

Advocacy

Over the subsequent 12 months, all three major Australian political parties have made important commitments to improve MRI access for patients over the last year, with further announcements anticipated. Early in 2018 the Greens pledged $550m aimed at reducing out-of-pocket costs for patients looking to access X-rays, ultrasounds, MRI and CT scans. In the Budget Reply in May, the Opposition Labor Party announced that they would deliver 20 new MRI machines for hospitals and imaging centres in regional areas and the outer metropolitan suburbs if elected in the 2019 Federal election.

Promote InsideRadiology to Patients and Colleagues



In September, the Federal Government announced a $175m investment to improve MRI accessibility in Australia, including an extra 30 Medicare-eligible machines across the country. RANZCR welcomed these policy commitments but will continue to argue for quality improvements, better access for patients to MRI and indexation of all imaging modalities.

Better Access in New Zealand The Accident and Compensation Commission commenced a pilot on GP referrals for MRI in 2017. This is intended

Promoting InsideRadiology in your professional networks.

any  Recommending topics that could be

considered for inclusion.



to streamline the patient pathway, improve access and reduce the time taken to recovery. Whilst welcome, RANZCR advocated for improvements to clinical indications, the referral pathway and training for GPs in appropriate use of this valuable modality. The New Zealand Office is continuing to work with ACC to advance this. Over the coming year, GP referrals to MRI will be progressively rolled out across the country. The College will recommend that ACC, GPs and consumer groups utilise the interactive tool to promote better understanding of MRI.

Supplementing your hospital or practice resources using links to InsideRadiology.

 Volunteering to assist with content.

Share the InsideRadiology Video.

Volume 15 No 1 I December 2018

Education

Dictation

Experience SpeechOne The first wireless dictation headset

Available Feb 2019 in Australia

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20181107_Printadd_RANZR_Add_half_page.indd 1

Upcoming Workshops – Until March 2019 Imaging in Beaver Creek, Colorado USA, 07 – 11 Jan 2019 Australian Brachytherapy Group ASM, Brisbane Queensland, 14 – 16 February 2019 Interventional Radiology Society of Australasia, Bali Indonesia, 21 – 24 February 2019 Intensive Pelvic MRI course 2019, Melbourne Victoria, 22 – 24 February 2019 RANZCR WA Branch Meeting, Perth Western Australia, 23 – 24 February 2019 Emanuel Kanal’s MR Safety Course ANZ, Melbourne Victoria, 24 – 25 February 2019 Imaging in Jackson Hole, Wyoming USA, 25 Feb – 1 March 2019 European Congress of Radiology, Vienna Austria, 27 – 3 March 2019 Emanuel Kanal’s MR Safety Course ANZ, Auckland New Zealand, 28 Feb – 1 March 2019 ARGANZ Annual Meeting 2019, Auckland New Zealand, 9 – 10 March 2019 TROG ASM 2019, Melbourne Victoria, 12 – 14 March 2019 12th General Breast Imaging Meeting, Perth Western Australia, 13 – 16 March 2019 Radiation Oncology Trainee SMART workshop, Melbourne Victoria, 15 March 2019 ANZSNR ASM, Adelaide South Australia, 21 – 24 March 2019 AMSIG Annual Meeting 2019, Queenstown New Zealand, 30 – 31 March 2019 For more details visit the RANZCR Events page.

Inside News

13.11.2018 09:31:03

Education

2019 RANZCR Workshops, Courses and Events A number of educational activities and events are on the calendar for 2019 across clinical radiology and radiation oncology.

Statistics and Research Methods (SMART) Workshop The SMART Workshop will be taking place on Friday 15 March 2019 to coincide with the 2019 Trans Tasman Radiation Oncology Group (TROG) Annual Scientific Meeting in Melbourne. This year the workshop will take place on the last day of the ASM, with the TROG conference scheduled to run from 12 to 15 March. The workshop is aimed at post phase 1 exam radiation oncology trainees and is designed around eight short didactic presentations by biostatisticians followed by interactive sessions during which groups of five to seven trainees are guided by radiation oncologist facilitators. Each small group session links back to the minilectures, prompting discussion of the key statistics and research methods through structured question sets relating to mostly radiation oncology trial publications. Trainees attending the SMART Workshop have access to a discounted registration rate to attend the TROG ASM. Registration fee: AUD$93.50 (including GST) per delegate for the SMART Workshop only. Additional registration fees apply for the TROG ASM. Register Here: www.cmnzl.co.nz/trog2019-asm/

Phase 2 Exam Preparation Course

Phase 1 Exam Preparation Course

The Phase 2 Exam Preparation Course will be taking place between 17 – 18 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:

The Phase 1 Exam Preparation Course will be held between 20 – 23 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 2019 and will:

• Better understand the exam development process and how exams are marked • Simulate sitting the viva exam, with feedback provided immediately afterwards • Practice a written question from each paper to workshop the answers with the Phase 2 examiners, and • Develop strategies to cope with exam stress to ensure they perform to the best of their abilities.

• Provide didactic lectures in the main topic areas to supplement trainee knowledge in the four basic sciences • Provide an opportunity for trainees to ask specific questions of experts in a dedicated questions and answer session as well as informally following individual sessions • Provide specific guidance on exam preparation and technique including mock exams and • Provide an opportunity for trainees to network professionally and socially.

Phase 1 Foundation Course

RANZCR/ACR Education Center Courses

The Phase 1 Foundation Course will be held between 20 – 23 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

The RANZCR/ACR Education Center Courses next year are being held in Melbourne, Victoria at the Pullman on the Park, from 9 – 18 August. These courses are the most intensive, rewarding training for radiologists outside of North America. Course Topics: • High Resolution CT of the Chest: 9-11 August

• Provide guidance on how to approach the next 12 months of their training in the most efficient way, and

• Prostate MR #1: 10-11 August

• Provide an opportunity for trainees to network professionally and socially.

• Neuroradiology – Head and Neck: 16-18 August

• Prostate MR #2: 17-18 August

• Body and Pelvic MR: 12-14 August

Volume 15 No 1 I December 2018

Education

The search for biomakers: College Grants help fund research College awards and grants are sometimes overlooked for the impact that they can have on recipients. Awarded the RANZCR Research Grant in 2016 and 2017, Dr Sweet Ping Ng commenced a prospective study as part of her PhD (MD Anderson Cancer Center/ Peter MacCallum Cancer Centre), and has used the grant money to investigate potential imaging and blood biomarkers during radiotherapy that may improve patient stratification in patients with head and neck cancer. We sat down with Dr Ng to find out more about her work. During my training, I developed a specific interest in better patient selection and earlier detection of recurrence. A proportion of patients experienced significant side effects that often carry through to the posttreatment period. Additionally, no standard diagnostic test exists to assess the success of aggressive locoregional radiotherapy during treatment. A positron emission topography (PET) scan in 2-3 months after completion of therapy is often utilised for assessment. This wait time is required to avoid misinterpretation of treatment-related inflammation with the high metabolic uptake of cancer. Although a majority of patients exhibited interval tumor shrinkage mid-way during their radiotherapy course, some patients eventually relapsed. Currently, there is no validated method to identify patients at risk of incomplete tumor response during treatment. If recurrence occurs, the earliest this is detected is at the first scan 2-3 months post treatment in the absence of overt clinical symptoms suggesting progression. The knowledge of refractory or aggressive disease occurs too late for the clinician to alter course to salvage or palliative therapy. Therefore, biomarkers that allow more dynamic monitoring of response or progression are a huge unmet need.

Inside News

Biomarkers are diagnostic test(s) that reflect the underlying cancer biological state. They can take many forms and include changes on imaging modalities or detectable blood markers that correlate with progression or response. Current imaging using PET/CT is limited by the lack of specificity in the presence of treatment inflammation. This precludes its use during radiotherapy. Diffusion weighted magnetic resonance imaging (MRI) can differentiate between inflammation-related edema and residual tumor. Serial MRI is an attractive imaging modality that would allow informative tumor endpoints to be measured dynamically during treatment. Furthermore, circulating tumor cells

“Currently, there is no validated method to identify patients at risk of incomplete tumor response during treatment.” (CTCs) have been shown to correlate with disease recurrence in many cancer types. I believe real-time assessment during definitive, and sometimes toxic, radiotherapy will provide better results for patients. An accurate diagnostic in the form of imaging and/or blood test would translate to better patient selection. In addition, markers that correlate with disease response might identify a subgroup of patients who may be over-treated. The study of using sequential MRI and CTCs during treatment will aid in better selection of patients in addition to their appropriate therapy that follows.

I hope that this project will provide first in-human evidence on the utility of CTCs and tumor-specific functional quantitative imaging changes during treatment. Ideally the findings will provide some guide to identify the best times to obtain mid-treatment images and hematologic samples to predict response. It will provide a conceptual and technical model that could revolutionise how we assess response during treatment and adapt treatment accordingly to maximise the chance of a cure. Receiving any grant as a junior investigator wasn’t easy but is attainable, even as trainee. The RANZCR grant provided initial funding that helped kickstart this study and generate preliminary data which led to further successful grant applications. I am now a Fellow of the College, with the hopes of continuing my career as a physicianscientist. Sweet Ping Ng MBBS, FRANZCR PhD Candidate Find out more about Grants Awards Prizes and Sponsorship at www.ranzcr.com/college/ awards-and-prizes

Education

Recognising our best Tips on nominating a colleague and why you should Though we often know someone worthy of recognition, taking the next step can be forgotten due to constraints such as time and a lack of familiarity with the process. We sat down with Dr Yvonne Ho to discuss the process of nominating a colleague for an award.

Who did you nominate and why? It was an honour to nominate Professor SC (Ming) Wang for the Gold Medal in 2017 and an even greater honour to see him win it. The nomination process is straight-forward, the application form is succinct, the instructions are readily available on the College website. Ming deserves the Gold Medal - there has never been a doubt about this. He is apolitical, unprejudiced and generally, an all-round good guy. We worked together in Singapore in the 2000s where we built the first and only international accredited training centre for the RANZCR qualification outside of Australia and New Zealand. I nominated Ming to thank him for being my mentor, for his unreserved support through the years. I couldn't think of a better way to thank him. I knew that this award would also mean a lot to him and his family.

The Gold Medal Journey: Because the nominee is not supposed to know about the nomination, the hardest bit in this application was to get hold of Ming's latest CV. His wife, Jenny, and I worked together on this without his knowledge - she told him it was their son who wanted to peruse his father's CV!

met in person until much later), offered me much support for this application. Jenny introduced me to Ming's own mentor and his other colleagues. Because every colleague knew a different aspect of the nominee, he/she only wrote about the Ming Wang he/she knew. I combined all our letters, and this became our Gold Medal application.

Lessons I learned: 1. Collaboration is important. This application was the work of numerous people (his colleagues and their support staff, Jenny and other members of his family), to whom I am grateful for their unconditional support. 2. Strategise to get the nominee's CV. 3. Give yourself lots of time to compile the information for the application. 4. Spend time to find that colleague you believe in. The Awards Committee will know if it is a genuine application from the heart. 5. It is not just the nominee who gets the accolade if he/she wins. As the nominator, you receive personal satisfaction of undertaking such a positive action in your life, regardless of application outcome. Your sphere of influence will also increase - who knows where this journey will take you next ... As Ming always said, "Be generous". I agree. By Dr Yvonne Ho, AM

Dr Philip Vladica, my seconder (Ming's colleague whom I had gotten to know because of this application but had not

Volume 15 No 1 I December 2018

Gadovist®1.0M enhanced multiparametric MRI showed significantly higher specificity & accuracy, compared to Magnevist® & Dotarem®, for the detection of prostate cancer.1* *Single centre restrospective study

GADOVIST® 1.0 [gadobutrol 1.0 mmol/mL] INDICATIONS: Adults and children including full-term newborns for contrast enhancement in cranial and spinal magnetic resonance imaging (MRI); contrast enhancement in whole body MRI including head and neck region, thoracic space, breast, abdomen (pancreas, liver and spleen), pelvis (prostate, bladder and uterus), retroperitoneal space (kidney), extremities and musculoskeletal system; first–pass MRI studies of cerebral perfusion; contrast enhancement in magnetic resonance angiography (CE MRA); contrast enhancement in cardiac MRI including assessment of rest and pharmacological stress perfusion and delayed enhancement. CONTRAINDICATIONS: known hypersensitivity to gadobutrol or any of the ingredients. PRECAUTIONS: Severe renal impairment and liver transplant patients (see boxed warning); pronounced states of excitement, anxiety and pain may increase the risk or intensity of adverse reactions; 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); severe cardiovascular disease; patients with a low threshold for seizures; limited MRI studies of cerebral perfusion; evidence suggests gadolinium accumulates in the brain after repeated administration of gadolinium-based contrast agents; limited safety and efficacy data in infants under 2 years of age; sequential and/or repeat procedures in children have not been studied; no studies in paediatric patients with renal dysfunction, premature infants and patients younger than 6 days old; the potential risk for neurotoxicity and nephrotoxicity in newborns term infants ≤ 3 days of age is unknown; pregnancy (Category B3). ADVERSE EFFECTS: most common: headache; nausea; dizziness. Please refer to PI for a complete list. BOXED WARNING: 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. Cranial and spinal MRI: 0.1 mL/kg body weight given intravenously at a rate of 2 mL per second. Maximum total amount of 0.3 mL/kg body weight may be administered. CE MRI of the whole body: 0.1 mL/kg body weight. Cerebral perfusion studies: for gradient echo sequences 0.1 - 0.3 mL/kg body weight given intravenously at a rate of 5 mL per second using a powered injector. CE MRA: Imaging of one field of view: Less than 75 kg body weight: 7.5 mL, greater than or equal to 75 kg body weight: 10 mL; Imaging more than one field of view: Less than 75 kg body weight: 15 mL, greater than or equal to 75 kg body weight: 20 mL. CE Myocardial perfusion imaging and delayed enhancement: 0.05 mL/kg body weight during pharmacological stress and 0.05 mL/kg body weight at rest; for delayed enhancement only, a total dose of 0.1 mL/kg body weight. Children of all ages including full-term newborns: 0.1 mL/kg body weight for all indications. Do not exceed the recommended dose in newborns and infants up to 1 year of age. The interval for repeated administration between injections is at least 7 days. Renal impairment: Do not exceed the recommended dose. DATE OF PREPARATION: Based on PI dated 13 March 2018. Please review the full Product Information before prescribing. Approved PI available at http://www.bayerresources.com.au/resources/uploads/PI/file9345.pdf or upon request from Bayer Australia Ltd, ABN 22 000 138 714, 875 Pacific Highway, Pymble NSW 2073. AU-GAD-00049-11-2018

® Registered trademark of the Bayer Group, Germany. References 1: Hara T etal Curr Urol 2017;11:201-205

Education

Training and Assessment Reform Update The Training and Assessment Reform (TAR) project is continuing to make progress during its consolidation and implementation phase, through the 2015 ACER-Prideaux Examination and Assessment Review recommendations. There are eight program working groups in Clinical Radiology and seven program working groups for Radiation Oncology. Those working groups have been reviewing the curriculum to bring it up to date with current practice, determining learning outcomes for the programs, evaluating existing assessments aligned to the program, and developing the most appropriate assessment tools to measure performance against the learning outcomes including the introduction of Entrustable Professional Activities (EPAs). EPAs can be defined as “a critical part of professional work that can be identified as a unit to be entrusted to a trainee once sufficient competence has been reached” (Ten Cate, 2005) e.g. undertaking on-call duties, planning a radiation therapy case. The Steering Committee for each speciality overseeing the programmatic reforms has been tasked with integrating the activities and assessments of the working groups into an overall program. Key to this work is ensuring that assessments are not onerous but fit for purpose to measure identified outcomes and allow tracking of trainee progression.

What might the new training programs look like? CLINICAL RADIOLOGY New Assessments / Learning Opportunities

Principles 3 Phases

Well-defined phases of training

5 year program

Well-defined criteria to progression

Final conslidating year of sub-specialty rotations

Assessment tools based on EPAs & applicable to level of training

Written exams to be successfully completed to be eligible for Phase 2 viva

Revised Assessments

Key Conditions assessment Radiographer attachment Rapid reporting Multi-disciplinary meetings assessment Cultural competency

Programmatic Assessment incorporating EPAs Integrated Pathology/Radiology Viva One three-hour Anatomy exam

Key conditions assessment

One three-hour AIT exam

Revised Procedures logbook

DoT assessment forms tailored to each phase

Multi-disciplinary meeting involvement

Revised DOPS Single research project

RADIATION ONCOLOGY Curriculum Medical Expert x4 Streams Intrinsic x6 roles

New Assessments / Learning Opportunities

Aligned with CanMEDs Cover Cultural Competency (AMC requirement)

Oncology Sciences Learning Workshops

Proposed Change to Existing Assessment

Assessment tools with Entrustability Scale:

Case Reports renamed as Case Based Discussion - main assessment for work based activities Practical Oncology Experience (POE) requirement redefined SMART program amended Phase 2 exam to be reviewed

5 year program 2 Phases

• Contouring and Plan Evaluation Tool • Clinical Assessment Tool • Communication Assessment Tool (Kalamazoo)

Phase 1 and Phase 2 exam remain key milestones Clinical Supervisor Assessment

Director of Training Assessment Assessment form being reviewed to focus on:

Assessment form being reviewed to focus on: • Performance • Knowledge • Skills • Behaviours

• Areas of concern • Potantial for growth • Barriers to progression

Volume 15 No 1 I December 2018

Education

It is important to note that the proposed changes are subject to approval by the relevant governance bodies and that trainees in the current training program will not be impacted by the proposed changes. Further information on the individual assessments will be provided in future editions of Inside News. The Committees would like to thank all members who have contributed their time and expertise to this important project.

If you would like to provide any feedback on the proposed models or have any questions regarding the project, please contact the Educational Developers at the College: Clinical Radiology: Julie Blanchard at julie.blanchard@ ranzcr.edu.au Radiation Oncology: Legend Lee at legend.lee@ranzcr.edu.au

Imaging Workshops International

Radio Diagnosis Review 2019 29th March - 2nd April Sofitel Melbourne on Collins

“Australasia’s Premier Radiology Review Course”

RADIO DIAGNOSIS REVIEW 2019 •An excellent refresher for practising radiologists •The perfect reintroduction to general radiology for those returning to work after extended leave •Essential for those approaching the part 2 fellowship exams •Great experience for all radiology trainees: Come and see where the ‘bar is set’

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Inside News

CPD POINTS AVAILABLE

Clinical Radiology

Perspectives on the past and future A Message from the Dean

Prof John Slavotinek As the year comes to a close and with it, my term as Dean I would like to take the opportunity to reflect on past events and achievements but more importantly to look to the future. In short, I feel optimistic about the future of radiology. As radiologists we have always been at the cutting edge of technological advancement in medicine and for many years have adapted well to a continuously changing environment. I see artificial intelligence as another source of major change not just within radiology but also at a societal level. This development will bring great benefit to our profession as long as we ensure that it is adopted and managed with radiologist input, and resides within an appropriate ethical, standards and regulatory framework that maintains quality patient care as the focus. By way of review, radiology resides within a demanding sector with multiple stakeholders and other sources of complexity. This is reflected in the nature of the manifold issues managed by Faculty Council. There are far too many to cover in detail, but recent achievements of note include: • Development of the position paper ‘Image Interpretation by Radiographers– Not the right solution’ that responds to recent events and outlines our position that the appropriate knowledge and skills for those reporting imaging studies are those of a radiologist contribution made by RANZCR • The members to the Medicare Benefits Schedule (MBS) Review. This has been

a huge undertaking in which many members have generously contributed their time and expertise to influence the MBS toward best practice and funding of appropriate care for our patients establishment of the • The Interventional Radiology Committee to support members who are practicing in this increasingly subspecialised area • Establishment of a new office bearer position, the Chief of Professional Practice. During my time as Dean the challenges of the post-fellowship environment have increasingly become apparent with multiple negotiations including those relating to cardiac MRI and CTCA. This new role will manage such areas and be able to focus on ensuring that members are supported throughout their journey as radiologists • Creation of the artificial intelligence working group that will consider opportunities, matters around regulation, ethics, standards and advocacy strategy for RANZCR in this rapidly evolving field leadership RANZCR has shown • The by means of our involvement in the Choosing Wisely campaign, which principally provides guidance for patients to start a conversation with referrers about what medical tests are appropriate and necessary

lung diseases such as coal workers pneumoconiosis • Increasing consumer access to radiology via new funding for radiology with recent MRI expansion, new services and commitment from government for partial indexation • Comprehensive review of the RANZCR standards of practice including development of new teleradiology standards. These and many other achievements have only been possible with the collaboration and leadership provided by members of Faculty Council and the Board. I would like to take this opportunity to extend my thanks and appreciation to each person who has served on Council and the College Board over the past three years. Beyond Faculty Council and the Board, there are many members who make a very valuable contribution by serving on committees and joining the many activities right across the spectrum of College initiatives. I would like to thank each one of you for the very significant time and effort you so generously give it is only through members volunteering that the College can operate effectively and achieve so much.

continued over...

complex interactions with a • Managing range of new stakeholders in relation to the reemergence of occupational

Volume 15 No 1 I December 2018

Clinical Radiology

It is also important that I acknowledge and thank the many College staff who play such a critical role in supporting the activities of members and the College. These dedicated people bring a variety of skills, dedication, enthusiasm and genuine concern for the fortunes of radiology to bear upon the issues at hand. Although I cannot recognize all deserving staff, I would particularly like to thank Mark Nevin, Melissa Doyle and Kirsten Fitzpatrick with whom I have worked most closely.

Looking forward, I have every confidence in the abilities and experience of the next year’s leadership team. With Clin A/Prof Sanjay Jeganathan as Dean, Dr Meredith Thomas as Chief Censor, and A/Prof Dinesh Varma in the new role of Chief of Professional Practice I leave the Faculty of Clinical Radiology in very capable hands. It has been a privilege to serve as Dean during a busy and very productive time. I would like to again extend my thanks to all those who contribute to the College and encourage others to consider becoming involved - it is a very rewarding experience.

YOUR MEMBERSHIP MATTERS GET INVOLVED FELLOWS TRAINEES

www.ranzcr.com/fellows/general/get-involved www.ranzcr.com/trainees/general/get-involved

Inside News

Clinical Radiology

Training Program News Chief Censor in Clinical Radiology

A/Prof Dinesh Varma

Clinical Radiology offers tremendous scope for a varied career in clinical medicine, teaching and research utilising cutting-edge technology. It is an opportune time to bring research to forefront of the discussion particularly after the recent and highly successful Annual Scientific Meeting in Canberra. Research is an important component in our training program and some training sites highlight research as one of their most distinguished and competitive strengths. When trainees undertake a research project they must ensure that it is of high quality in order to produce knowledge that is applicable outside of the research setting which will help to improve future healthcare. Well conducted research requires proper time and effort and should be aimed at filling gaps in knowledge. Working on a research project will obviously be a challenging and rewarding experience, provided you put the best of your expertise and skill into it. It is an opportunity which helps you to pursue an in-depth or deep original study about any topic which interests you.

DoT Workshop and Annual Scientific Meeting

Training and Assessment Reform

The Directors of Training workshop is an important activity in the CRETC calendar of events which provides an opportunity not only for the College to share information but also for DoT’s to network and share their experiences. The attendance has continued to increase with more than forty DoTs joining us in Canberra. The session focused on the training program updates and refreshers, trainee performance and progression, an update on the Training and Assessment Review and DoT networking. The content from the recent DoT workshop is available by webcast. In 2019 they will be held on Friday 10 May in Sydney and on Wednesday 16 October at the Auckland ASM and I encourage you to diarise it in your calendar to attend. If you have any topics you would like to discuss or cover at any of the upcoming workshops, please contact Rami Elzahaby via radtaa@ranzcr.edu.au.

Progress continues to be made on the Training and Assessment Reform (TAR) project and we will continue to keep you updated regularly. The review of the curriculum, development of learning outcomes and revised assessment tools with emphasis on work based assessments is on track for completion by the end of the year. The next phase will see the development and refinement of the proposed assessments which incorporate a programmatic approach to assessment in addition to improved formats to our current examinations.

Thank-you to all the speakers including the trainees who joined us in Canberra for a comprehensive program focusing on ‘Our place in the Universe’. I would like to congratulate all the new Fellows and many of you were there to receive the certificate at the Annual Ceremony. We look forward to your contributions to the profession and I trust you will stay engaged with the College throughout your career.

The overall framework of the new training program is now close to completion with a proposed threephase, five-year model incorporating a final consolidating year consisting of sub-specialty rotations. Further information on the new training program can be found on pages 27 and 28 of this issue. I acknowledge and sincerely thank all members who willingly volunteered to assist with the TAR project in various Working Groups and on the Steering Committee. Your contribution is vital in moving the College forward. If you’d like to know more about the project, contact our Educational Developer, Julie Blanchard at Julie.Blancard@ranzcr.edu.au continued over...

Volume 15 No 1 I December 2018

Clinical Radiology

Farewell and Congratulations to Dr Meredith Thomas incoming Chief Censor As I write my final article for 2018 as Chief Censor of Clinical Radiology, I would like to take this opportunity to thank the members of the Clinical Radiology Education and Training Committee for their support and the work they have contributed to the training program over the past three years. I would also like to extend my gratitude to the members of the Clinical Radiology Examinations Review Panel, Curriculum Assessment Committee, Chief Accreditation Officer and his team, Anatomy and Applied Imaging Technology Examination Review Panel members, Directors of Training, Clinical Supervisors and Examiners. The time

and expertise you provide to ensure that we maintain the standards of our training program and keep progressing our profession in order to provide the highest standard of care to our community is very commendable. Reflecting on my term as Chief Censor I would like to think of what my contribution has been and a few come to mind. Creating the position of Deputy Chief Censors, increased membership of various examination review panel to share the workload, The Training and Assessment Reform with improvements in the examination processes and the move to the AMC National Testing Centre in Melbourne will, I hope be a solid foundation for the future. With that I am very pleased to hand over the baton to Dr Meredith Thomas

who has been working as Deputy Chief Censor and is best placed to continue the work into the future. Meredith has an excellent and comprehensive understanding of the training program after her work on Faculty Council, Curriculum Assessment Committee, TAR Steering Committees and as Branch Education Officer and formerly Network Training Director. I wish Meredith well for her term as Chief Censor starting January 2019. I wish the trainees all the best for the future both in life and as our future colleagues. I look forward to the new and exciting challenges ahead as the Chief of Professional Practice of the newly created Committee. Have a safe and festive Christmas and Holiday season.

Campaign against cuts in the national spotlight Readers would recall that earlier this year, the decision to stop patients over 50 from being referred by their GP for a Medicare-funded knee MRI was condemned by ADIA, RANZCR and other key bodies such as AMSIG and the Consumers Health Forum. Despite being well aware of the lack of scientific evidence, and the fact this change will hurt 80,000 patients a year, the MBS Review Taskforce recommended this discriminatory cut, and the Health Minister Greg Hunt went ahead with it. In response, ADIA launched a powerful new campaign to inform and engage Australians who are, or could be, impacted. Radiology clinics have been distributing flyers to affected patients outlining the decision, over 4000 of which have been returned with messages imploring the Health Minister to reverse it. Similarly, we have heard stories from thousands of social media users as we

Inside News

have rolled out the campaign across our social media platforms. The message has provoked passionate responses and consistently high levels of engagement since day one. Users who are concerned have been directed to an online petition addressed to the Health Minister, which to date has well over 11,000 signatures. The continued growth of the campaign has also attracted media attention. Adelaide’s top breakfast radio show called the decision “the purest form of discrimination”. I was invited to discuss the issue on a number of ABC radio programs. Sporting personalities Rachael Sporn and Wayne Schwass weighed in on the decision in national newspapers, saying the move may discourage older Australians from staying fit and healthy. Rachael Sporn, an Olympic basketballer, was also interviewed by Nine News in a piece that featured patients, radiologist

Dr Nick Bryant, and spokespeople for National Seniors and the RACGP. The overall campaign has shone a national spotlight on an overlooked issue and given voice to thousands of Australians who are justifiably concerned by this federal government decision. I would like to thank all practices who have participated and am pleased to report that ADIA has been able to engage directly with the Health Minister on this important issue. This is an example of what we can achieve when we work together on a consistent, clear message. Dr Siavash Es’haghi ADIA President

Clinical Radiology

Clinical Radiology Trainee Matters Research – some trainees love it, for others it’s just the thing standing between them and their letters. Radiology registrars are very busy people. The demands of our training are onerous and the breadth of things to learn in our speciality enormous. Why then, on top of all the knowledge and procedures we need to master is it so important to engage in research? Any way you look at it research shapes our careers in one way or another. Radiology is a career of lifelong learning. The rapid growth in knowledge and advancing technologies brings a richness to the practice of radiology, as well as a challenge. Research is integral to this richness. Whilst you may not need to be a good researcher to be a good radiologist, being able to understand, critique and engage with medical research and the literature is essential. The research projects and CATS (Critical Appraisal Topics) offer the opportunity to build on skills acquired during medical school and pre-vocation training. They are not the be-all and end-all of training, but aim to round off the skills needed to be a competent and efficient practitioner.

The research requirements during radiology training are very flexible, so trainees are free to peruse any areas of interest. At the recent ASM in Canberra, it was great to see all the different and varied projects trainees have been involved in. It seems that there are endless questions to answer and infinite opportunities to engage in projects big and small.

based approached to designing and standardising assessments. It also includes a thorough assessment of the current trends and attitudes in our current training course. Applying the best evidence will ensure that future trainees will continue to enjoy a robust and world leading training course, and that the public we serve can be confident that we are well trained specialists.

“To be a good radiologist, being able to understand, critique and engage with medical research and the literature is essential.”

Very soon my time as Chair of the Clinical Radiology Trainees’ Committee (CRTC) will come to an end. I have thoroughly enjoyed my time on the committee over the past 3 years, in particular meeting people from all over Australia and New Zealand. It’s been a great experience to be involved with the College, to understand the important work that gets done, and gain insights into how the organisation operates. I would encourage all trainees to get involved with College activities and committees when the opportunity arises. Finally I would like to thank the members of this year’s CRTC for all their hard work, and to also thank all the trainees who nominated and have been elected to next year’s committee for generously volunteering their time. I wish them and all trainees every success.

Research also shapes our educational experience and training course. Work on the current Training and Assessments Reforms (TAR) draws on knowledge from the medical education literature, including an evidence

Anthony Cardin

Volume 15 No 1 I December 2018

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Clinical Radiology

The Art of Observation How art is helping radiology students improve their interpretive skills Dr Cathy Beck

Art world wonders are helping veterinary radiology students in America become even more eagle-eyed – with benefits for their patients. Students at Auburn University’s College of Veterinary Medicine in Alabama have been improving how they view images by inspecting pieces of work in a nearby art museum. They then discuss what they have each seen in the paintings – and what they interpret from the images – and explore how this can be used to read radiographs and diagnostic images more accurately. “You cannot accurately interpret an image without having an accurate observation to base it on,” Dr Rachel Moon, Assistant Clinical Professor of Radiology in the Department of Clinical Sciences in Auburn University’s College of Veterinary Medicine, said. “This project helps the students learn the importance of first observing all details and then how they interpret them. “In our area (of radiology), our patients cannot talk to us, so we have to do a lot

of inferring from what we see. Having those good interpreting and visual skills is therefore vital.”

“We selected a variety of pictures, particularly ones that had various different details in them to look at,” Dr Moon said. “We then tried to relate it to radiology by giving some examples (of images) and asking students to describe what they saw in the images.”

“ Differences in interpretation are discussed, aimed at emphasising the importance of the underpinning of an interpretation with a robust and thorough description.”

Dr Moon said the visit, which was inspired by the work in this field by Melbourne-based veterinary radiologist Dr Cathy Beck, had several benefits for students.

to base it on. It’s important to first observe all the details in the paintings that can help them make an accurate interpretation.”

The students visited the Jule Collins Smith Museum of Fine Art, which is associated with the university, and looked at different paintings selected by Dr Moon and museum staff.

“The students haven’t seen loads of images at this point in their learning, so anything that helps their interpretive skills is useful,” she said. “The students also understand that you cannot have accurate interpretation unless you have accurate observations

The program run by the University of Melbourne veterinary radiologist Dr Beck in collaboration with the University’s Ian Potter Museum of Art, sees students guided through objective description and interpretation of a projection of the painting “Bushrangers” by William Strutt. Volume 15 No 1 I December 2018

Clinical Radiology

The students then split into groups and describe and then interpret reproductions of prints by artists such as Albrecht Durer and Lucas Cranach. After describing and interpreting what they see in the print, Dr Beck leads a group discussion about their findings. Differences in interpretation are discussed, aimed at emphasising the importance of the underpinning of an interpretation with a robust and thorough description. Following this Dr Beck leads a discussion of a number of radiographs drawing on the skills used during the description and interpretation of the works of art. “By using this program, they can think about their description and therefore come to the logical interpretation of what’s in front of them,” Dr Beck said. “In our field of work we put great emphasis on cognitive training, which is obviously important, but working on interpreting visual data is key as well.” Dr Beck said the scheme had not only helped students’ descriptive and interpretive skills but had helped them

William Strutt Bushrangers, Victoria, Australia 1852 c. 1887 The University of Melbourne Art Collection. Gift of the Russell and Mab Grimwade Bequest 1973. better cope with pressures when on clinical placement. “One student said she was filled with anxiety when asked to interpret a radiograph by a veterinarian, but then she thought of visual arts the program, just described everything she saw and came to the correct interpretation,” Dr Beck said. “The attending veterinarian was reportedly impressed that she clearly knew what was going on and didn’t miss anything.

“It is extremely satisfying when you get positive feedback from students and it’s very rewarding to have helped them in a different way.”

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Inside News

Clinical Radiology

An alternative to Hysterectomy? Interventional radiologist Dr Eisen Liang has published research which could provide an alternative treatment for women facing the prospect of hysterectomy to treat heavy menstrual bleeding (HMB) and period pain. Uterine Artery Embolisation (UAE) is a non-surgical procedure has already been shown to successfully shrink fibroids to alleviate HMB. A number of conservative medical treatments are available for HMB, but if these treatments fail, then women must either put up with the symptoms or opt for a hysterectomy. Research conducted by Dr Liang, however, has shown that UAE may also be an effective treatment for adenomyosis, which often results in HMB and period pain and which is also commonly treated by hysterectomy. “The implications from the research are profound,” Dr Liang said. “UAE is shown to be safe and effective in treating adenomyosis related HMB and severe period pain. “Failing conservative treatments, women now have a non-surgical option to treat adenomyosis.” An estimated 25% of Australian women experience HMB, which can be completely crippling and impair quality of life. Dr Liang, who has previously performed UAE to treat fibroids, was inspired to undertake further research after noting that UAE could also potentially treat adenomyosis. The study, which Dr Liang conducted with gynaecologist Dr Bevan Brown, followed 117 women with MRI proven adenomyosis treated with UAE. HMB control was achieved in 90% of women following UAE, meaning their periods were back to or lighter than normal. Pain reduction was markedly reduced and 95% of the women treated with UAE were spared hysterectomy.

Interventional radiologist Dr Eisen Liang (right) with gynaecologist Dr Bevan Brown. The pair have worked on the UAE procedure which offers women an alternative to hysterectomy. Dr Liang, who is based at the Sydney Adventist Hospital on the city’s Upper North Shore, said. “Compared to a hysterectomy, UAE is much less invasive, carried out under local anaesthetic and has a much shorter down time,” Dr Liang said there would be some side effects with UAE treatment, including pain, nausea, low-grade fever and lethargy and, in most cases, a onenight stay in hospital. He hopes his work would help other interventional radiologists to pursue research in their chosen areas. “When I trained as a interventional radiologist I felt great for being able to save lives and extend lives,” Dr Liang said. “It was not until I started doing UAE, treating benign disease like fibroids and adenomyosis that I realised how important quality of life is to women.

“I think as interventional radiologists we need to review and audit our work, then publish to generate evidence. We then have to let the health consumers know about what we can offer. “I know many interventional radiologists who are doing great work, but people don't know what we can do. It is not good enough to be silent achievers – we cannot help people if people didn't know that we can help. “How often do you get told that you have change someone's life?” The study was published in August 2018 issue of The Australian and New Zealand Journal of Obstetrics and Gynaecology.

“The results were very encouraging,” Volume 15 No 1 I December 2018

Clinical Radiology

Meet the new FCR Dean and Councillors for 2019 Clinical Associate Professor Sanjay Jeganathan My first involvement with the College was in early 2000’s. Professor Turab Chakera was my mentor and motivated me to get involved with College work. He always said “It is our College, and we need to be involved”. I also benefited from working closely with Professor Ming Wang during his time as Chief Censor. Past Presidents and Deans have been a great influence in motivating me to pursue my activity within the College. I have been on Council for two terms and been active with the College for almost 15 years and the experience provides me with insight into where we are heading and what we need to do to prepare ourselves for the future. AI and its impact on Clinical Radiology is a top priority. Whilst we embrace this technological disruption, we also need to safe guard the patients and the profession by ensuring proper regulatory framework exists to monitor development and implementation of AI tools. Research within Clinical Radiology is a high priority for FCR. What we publish is what we own. Most research in areas like Cardiac imaging is done by Cardiologists. This needs to change. We need to ensure the various sub-specialists within Clinical Radiology work together collaboratively. If we are divided, we will be conquered. Clinical Radiology should be at the forefront of diagnosis and treatment. This means we need be involved in predicting disease emergence before structural change could occur and for that we need to be involved in genomics related research. This cannot be achieved in 2 years, but we need to begin now. I see a future where body imaging will be coupled to cellular level diagnosis and treatment.

Dr Meredith Thomas I am honoured to have been elected as Clinical Radiology Chief Censor for 2019. I have been very closely involved with the educational pillar of the College for many years, with experience in local roles as Director of Training, Network Training Director and Branch Education Officer. I have been an examiner for a number of years, Lead Examiner in Obstetrics and Gynaecology, Chair of the CR Curriculum Advisory Committee and more recently Deputy Chief Censor. Through this experience I have developed a good knowledge of educational processes, with a recent focus on addressing the recommendations of the ACER Prideaux Examination and Assessment Review. It will be a busy and challenging period, progressing and implementing the Training and Assessment Reforms while minimising change related disruption and risk whilst prioritising trainee well-being. We need to ensure that our curriculum keeps pace with the rapid developments in our field, incorporating new technologies and their applications, and ensuring that it remains relevant to contemporary practice. We must also ensure that we are abreast of broader considerations around specialist medical training, particularly regarding non-medical expert roles, recognition of indigenous needs in training and standardisation of recruitment processes, and that we are proactive in identifying and addressing accreditation priorities of the respective Medical Councils. Ultimately I aim to further develop the work of previous Chief Censors to deliver a world recognised training program embracing modern educational theories and contemporary assessment processes, the overarching aim being to ensure development of our future radiologists, not only as integral members of the multidisciplinary medical team, but as teachers, researchers, advocates of our profession, policy influencers and leaders in health care.

Inside News

Clinical Radiology

Associate Professor Dinesh Varma I congratulate the Faculty of Clinical Radiology for instituting the Committee of Professional Practice (CPP) and I am very honoured to be appointed the inaugural Chief. This is a significant step in the right direction. External regulators are proposing changes to Professional Development Plan such as • CPD is relevant to their scope of practice • Complete a minimum of 50 hours of CPD per year with a minimum of 25 per cent (i.e. 12.5 hours) in each of the three categories of educational activities, peer review and measuring outcomes These proposed changes are anticipated to come into effect from 2021 and the shift is clearly focused on enhancing patient safety. Currently only 10 per cent of our CPD participation requires peer review or measuring outcomes. This is just one of the challenges that the Professional Practice Committee (PPC) will be faced with. Whilst a vast majority of fellows are generalists there has been a growing need for sub-specialisation. Any subspecialist training pathway must have a well-defined post fellowship program with a well-defined curriculum, appropriate experiential training requirements, supervision by well-trained subspecialists and ongoing assessments before the College can advocate for certification by the appropriate regulatory body. Beyond that there also needs to be ongoing credentialing via dedicate CPD requirements to ensure that competencies are maintained. The philosophy and role of the Committee will need to be strongly aligned with the College strategic document and in particular: Deliver best practice medical education program to ensure our members are safe, competent and current Lead the development and refinement of professional and practice standards in clinical radiology and radiation oncology Having worked very closely with the Training and Assessment Reform during my current role moving on to Chief of Professional Practice seems a natural progression. I would like to see a harmonised journey from being a trainee to transitioning to a practicing clinical radiologist, be it a generalist or subspecialist. I am looking forward to working with like-minded Fellows that will see the College at the forefront when it comes to providing the highest standard of care to our community by way of a generalist and subspecialist practice.

Please direct any questions or comments for FRA Councillors to Melissa Doyle, Executive Officer at faculty@ranzcr.edu.au

Volume 15 No 1 I December 2018

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Radiation Oncology

A Pause for Reflection and Change A Message from the Dean

A/Prof Dion Forstner In my last Inside News contribution as Dean, after over four years in the role, it is time for some reflection on where we have made gains and where we have not. Of course, there will always be a mix of successes and failures.

Successes The listing of Intensity Modulated Radiation Therapy (IMRT) on the Medicare Benefits Schedule (MBS) in Australia was a significant challenge and, despite what I still consider a very flawed Medical Services Advisory Committee (MSAC) assessment, we manage to negotiate its listing. I am sure this has contributed to greater uptake and access for our patients. We are now seeing a rapid uptake of Volumetric Modulated Arc Therapy (VMAT) offering significant benefits to our patients. This is part of the changing paradigm of how we treat metastatic disease, particularly considering recent new data on the role of radiation therapy in oligometastatic disease. Although a review of the MBS was announced prior to me becoming Dean, it was in 2015 that the current MBS review was announced. The Faculty has worked closely and productively with the relevant committee and we are in a strong position to see through a major reform of the schedule over the next year on our terms. There is still much work to be completed and I will continue to support this work. The Council and all the committees have been productive. I am grateful to the Chairs and their members for so much

hard work. I am pleased to have been able to support the Targeting Cancer advocacy campaign. Targeting Cancer is such a flagship for the Faculty - and now well-known in many corners of the world and the envy of many of our counterparts. To support and sustain the campaign, a governance structure was successfully implemented. Consumer engagement has been a high priority. I feel honoured to have worked so productively with the late Ms Sally Crossing and more recently with Ms Lee Hunt. They have taught me much and have been great advocates for our profession. I urge you all to consider where you can engage consumers more in your working lives and in your own treatment centres. I am proud that we established the Indigenous Health Working Group, which has been leading the way for the College in this space. We still have much to do in this area, but we can at least look back on some successes over the last few years, including a RANZCRwide scholarship to attract and support Indigenous trainees. Our partnership with the Trans Tasman Radiation Oncology Group (TROG) is such an important one and we now have a formal agreement that each body is represented on the others council/board by the Chair. This should ensure our activities are complementary; with the aim of greater access and recruitment to high-quality radiation therapy clinical trials across Australia and New Zealand.

Challenges We have had some big challenges. Trying to get the Radiation Oncology Practice Standards mandated by governments, particularly in Australia by the Commonwealth Government, has proved frustrating. We have not given up and I am optimistic that work done, and further work, will ultimately see their adoption including some hope of a national incident reporting system. The Radiation Oncology Health Program Grant (ROHPG) changes were probably the most disappointing single event – they came without warning and showed complete disregard for the profession and for our patients. To have removed planning systems, CT scanners, brachytherapy and networking payments from the system will have long-term (rather than immediate) impact. Changes needed to be made but to not ask those that understood the system was unacceptable. Out of this came some good. It brought the sector together and now we have twice yearly formal meetings with the most senior officers in the Department of Health – called the Radiation Oncology Roundtable. The Roundtable puts us in the strongest position we have been in in the last decade to ensure ongoing dialogue and education occurs with the sector.

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Volume 15 No 1 I December 2018

Radiation Oncology

The discourse on prostate cancer has been frustrating. It is hard to understand how some of our urology colleagues think the status quo is acceptable – it is so far removed from patient centred care. With our prostate position paper (www.ranzcr.com/college/documentlibrary/informed-decision-making-inthe-management-of-localised-prostatecancer-position-paper) we have an excellent advocacy tool for change. I think there is now an acceptance from some leaders in urology that they must move on this. Hopefully some form of regulation will help in part with the cultural change that is required. Of course, we exist in a major part to train radiation oncologists and education is an area of success and ongoing challenges. The two Chief Censors I have worked with are to be commended and recognised for the enormous effort required to run the high-quality program we have. I thank Dr Sean Brennan and A/Prof Margot Lehman for all their work. It has been pleasing to see the development of more robust Accreditation Standards. Training departments now have much clearer responsibilities. I am proud that we have taken a hard line on sites not providing adequate training or where the welfare of trainees has been compromised. Where this happens accreditation will be removed. A service job environment based on past experiences of now senior radiation oncologists with disregard of modern education requirements is not acceptable. Sadly, too often I have witnessed Directors of Training being put under enormous strain by unrealistic expectations of their colleagues. Directors of Training in accredited departments need to be considered as the second most senior management position after director of the department. I expect over time

Inside News

some departments will need to make tough calls on who is appropriate to be a clinical supervisor – only those committed to providing modern training.

Looking to the Future I am so pleased that Dr Madhavi Chilkuri is taking over. The Faculty is in the most capable of hands. Madhavi has a wonderfully diverse background and will provide great leadership for our Faculty across New Zealand and Australia. We are well represented on the RANZCR Board by Madhavi and Dr Brigid Hickey along with our President, Dr Lance Lawler, who has come to understand the fine specialty which we are. We must accept our responsibility to close the gap between indigenous and nonindigenous cancer outcomes. Please remember the Faculty is your Faculty; here for you, our members – whether working in the public sector or the private sector. I encourage you all to consider contributing in some way to RANZCR at some point in your careers. It has been a privilege and rewarding opportunity to lead the Faculty. It has only been possible with the support of the amazing RANZCR staff and the Faculty Councils I have been part of, as well as, my former colleagues at Liverpool and Campbelltown Hospitals and more recently in GenesisCare at St Vincent’s Sydney. A very special thanks to my friend and former colleague Dr Allan Fowler, who was always available to provide clinical support. Wishing you and your families much joy for the festive season and a most rewarding 2019.

If you have any questions or comments about this article please contact Philip Munro, Executive Officer, on faculty@ranzcr.edu.au

Radiation Oncology

Training Program News Chief Censor in Radiation Oncology

A/Prof Margot Lehman

The approach of the end of another year provides a timely opportunity to highlight achievements, acknowledge the contribution of all those involved in educational activities and outline the work that will continue in the new year.

1. Training and Assessment Review: In 2015 RANZCR commissioned a review of all examination and assessments processes with the aim of evaluating their quality and sustainability, identifying areas for improvement and recommending strategies to implement improvement. The resulting report contained 65 recommendations across the two Faculties ranging from examination, to governance, educational alignment and programmatic assessment. Programmatic assessment describes a training program that encompasses a “program of assessments”. The aim is that the use of multiple methods of assessment delivered at multiple time points allows a detailed picture of the trainee to emerge over the course of the program and allows decision about competency to be made on aggregate information rather than on one highstakes assessment. The assessments are designed to align with work activities – they assess what we want the trainee to be competent in on their first day of independent practice. They allow us to track how the trainee is progressing in the attainment of those competencies. At the end of 2018, significant progress has been made in our move towards the introduction of programmatic

assessment. The curriculum has been updated so that Medical Expert learning outcomes reflect current practice. Learning outcomes around symptom management, supportive and palliative care have been expanded. Learning outcomes for the intrinsic roles have similarly been reviewed and updated.

were followed. The assessments needed to be easy to use and needed to facilitate the provision of feedback between supervisor and trainee. Furthermore, in order to not overburden either trainees or supervisors, if new elements were added, other elements needed to be removed or reduced.

New work-based assessments have been developed:

Throughout 2019, the training program and assessments will be completed, and the project will move into the implementation phase. It is anticipated that this will involve widespread consultation and education around the new training program.

1. A Contouring and Plan Evaluation Tool (CPET) designed to evaluate and track the attainment of competencies in radiation therapy planning (from simulation, to target volume delineation and plan evaluation).

2. A Clinical Assessment Tool (CAT) designed to evaluate and track the attainment of competencies in patient evaluation and management and to facilitate observation of the trainee discussing aspects of care with the patient.

3. A Communication and Feedback Tool: designed to evaluate and track the attainment of communication competencies in a number of common scenarios.

In addition, Case Based Discussions (CBDs) will take the place of casebased reports. The aim of the CBDs is to provide more in-depth assessment of patient management, particularly regarding the development of an evidence-based approach In the development of the work-based assessments, a number of principles

2. Examinations: Another recommendation of the Training and Assessment Review Panel was the establishment of Deputy Chief Censor roles to support the Chief Censor. Accordingly, the role of Chief of Examinations has been created. The Chief of Examinations will have oversight over both the Phase 1 and Phase 2 examinations and will work with and support the Phase 1 and Phase 2 leads in the development and delivery of the examinations. I would like to thank Dr Sean Brennan for agreeing to take on this role. The examinations are an important part of the RANZCR FRO training program and I would like to again extend my sincere thanks to all the Examiners and College support staff whose hard work and commitment ensure the examinations are of a very high standard. continued over... Volume 15 No 1 I December 2018

Radiation Oncology

3. ROETC News I would like to thank Dr Yvonne Zissiadis and Dr Pat Dwyer for their contribution to the ROETC. Yvonne has served two terms on the ROETC during which time she was also the ROETC representation on the Radiation Oncology Research Committee. Yvonne’s clear thinking, common sense and great sense of humour will be missed. However, Yvonne will not be lost to FRANZCR as she has been elected to the Faculty Council and I know she will be a wonderful asset to them. Pat has served one term on the committee and provided valuable insights into training issues occurring in regional and rural areas. Pat has also been very much involved in the assessment review process in his role as co-lead of the SMART program working group and will continue in this role. I would like to welcome Dr Evan Ng who has been elected to the ROETC and will join in January 2019.

4. Denise Lonergan Educational Service Award Congratulations to Dr Marcus Dreosti for being awarded the Denise Lonergan Education Service Award. This award recognises outstanding contributions to education activities and assessment, above and beyond their expected educational role. Marcus’ long association with the Phase 1 examinations and Phase 1 courses makes him a very deserving recipient of this award.

Finally, I would like to thank all Fellows and College staff who are involved in the educational and assessment activities of RANZCR FRO. This work is done on a voluntary basis and is often unacknowledged. However, the provision of high quality education and training is key to the ongoing strength of our Specialty and is therefore significant and important work. In closing I would like to wish everyone a very safe, and happy festive season and extend my very best wishes for 2019.

5. Accreditation Congratulations also to Dr Vanessa Estall, who will take on the role of the Deputy Chief Accreditation Officer in 2019. I would again like to extend sincere thanks to A/Prof John Leung (Chief Accreditation Officer) and all Fellows involved in the accreditation panels and to College staff for undertaking this difficult but important role.

Radiologist - South Australia Dr Jones & Partners is an established doctor-owned Adelaide based practice that is seeking enthusiastic and highly skilled radiologists to join our growing team. The practice delivers high quality diagnostic and interventional radiology services across 4 large CBD private hospitals, an imaging research centre at SAHMRI, 13 metropolitan sites and 7 major regional locations. Our doctors comprise 49 radiologists and nuclear physicians who provide general, interventional, neurological, oncology, nuclear medicine, mammography and musculoskeletal radiology services. Dr Jones & Partners is committed to being at the leading edge with its equipment fleet that currently comprises of 11 MRI units (including three 3T, five full licenses and three partial), high end CTs (including two FLASH dual source scanner and a FORCE), breast tomosynthesis and a fleet of high quality ultrasound units.

To confidentially discuss these opportunities please contact either:

There are opportunities currently available for both general radiologists and subspecialised radiologists in a variety of fields including musculoskeletal, breast and interventional neuroradiology. The clinics are flexible and can accommodate differing hours of work with full-time, part-time and casual options available. There is no requirement for on-call or weekend work. All candidates must have FRANZCR and have current registration with AHPRA. A competitive package including relocation expenses and professional development will be negotiated with successful candidates along with future opportunities for partnership. Adelaide is consistently ranked as one of the most livable cities in the world for its relaxed lifestyle, cultural events, world class wineries, pristine beaches and outdoor pursuits.

Dr Andrew Dwyer E: Andrew.Dwyer@drjones.com.au

Doctor Led • Patient Focused • Quality Driven

Inside News

Kelly Robson Ph: (08) 8309 2230 E: Kelly.Robson@drjones.com.au

drjones.com.au

Radiation Oncology

Radiation Oncology Trainee Matters

Annual Scientific Meeting

Research Opportunities

Farewell and Welcome

This year our trainee representative Dr Natalie Collier worked with the ASM conveners to arranged a fantastic trainee learning day at our Annual Scientific Meeting (ASM) held in Canberra from the 25th to 28th of October. This included a number of prominent international speakers and covered topics including management of rectal, pancreatic and breast cancers, challenges in the delivery of Radiation Oncology in Sri Lanka and an interactive session on leadership in radiation oncology. We also heard from a number of speakers about life after our phase two examinations.

Research is an essential component of our clinical practice and involvement in research is not only a requirement to participate in the Phase 2 examination, it is also a way to strengthen our profession, advance our science and improve outcomes for our patients. As seen by the work presented at the ASM, research is incredibly adaptable to your own interests and does not have to involve working in a laboratory or studying one particular type of cancer.

This past year has sure flown by and with it comes time to hand over over to the 2019 ROTC. I have thoroughly enjoyed working with the 2018 ROTC as Chair and thank them all for their time, enthusiasm and hard work.

The quality of the presentations by trainees at the ASM links well to the topic of this edition of Inside News, Research. Trainees presented research on a wide variety of topics both inside and outside the Varian Prize Session. The wide variety of research ideas were truly inspiring and showed trainees are involved in research that is outside the scope of traditional research projects. These ranged from radiation protection considerations on a trip to Mars to gaps in the radiation oncology teaching of junior doctors and medical students which has massive implications for ensuring our patients have access to appropriate management and timely referrals.

We have put together a suggestion of some key steps for those trainees wanting to be involved in research but not knowing where to start • Approach your clinical supervisor – start with describing what interests you in research and what you would like to get out of the research. • Meet with your research mentor – each training network has allocated research mentor to help guide you into a research pathway that interests you. • Find an inspiring clinician researcher and ask them about their career.

I would also like to thank the Faculty of Radiation Oncology Council for their support throughout the year, the College staff and executive who are always receptive to discussing ways to improve the training experience the Fellows of the College for supporting our wider trainee group and finally the Trainee Liaison Officer, Mr Chris Bartley who has played a pivotal role in supporting our activities this year. I welcome the incoming committee for 2019 and wish them the best of luck. On behalf of the outgoing 2018 Radiation Oncology trainees committee, thank you for a fantastic year. Nick Bucknell

• Seek advice from other trainees about the research you are thinking of participating in and the supervision you will receive. When starting out in research, supervision is key – picking a supervisor with a strong ‘track record’ who has previously supervised trainees will improve you changes of success. • If considering the clinician scientist pathway indicate this to your training network early. For those interested, this is an excellent pathway enabling trainees to do a research higher degree concurrently with their training program. It does take a considerable amount of time to set this up and so trainees are strongly encouraged to discuss this as early as possible in your training to avoid missing out.

Volume 15 No 1 I December 2018

Advertorial

It’s a brave new world in brachytherapy Cancer is currently one of the biggest global health challenges we face. An estimated 138,000 new cancer cases will be diagnosed in Australia this year, with that number set to rise to 150,000 by 2020.1 Against this backdrop of daunting figures and global challenges, there are today more reasons to be hopeful for the future of cancer care than ever before. Over the next 30 years, some experts predict that it is entirely possible that cancer can become a manageable, chronic disease, similar to diabetes, so a cancer diagnosis will no longer hold the fear that it does today. We know that radiation therapy currently contributes to 40 per cent of all cancer cures world-wide, helps to relieve symptoms, such as pain, and improves patient quality of life.2 The oncology ecosystem that Varian is creating integrates all modes of radiation treatment that cancer patients may receive — proton therapy, external beam radiation, and brachytherapy (internal radiation therapy). When it comes to brachytherapy, Varian produce a full range of products for planning and delivering internal radiation treatment, including low dose rate (LDR) brachytherapy, high dose rate (HDR) brachytherapy, image-guided brachytherapy, and pulsed dose rate brachytherapy. “Internal radiation is incredibly effective,” said Thomas Pollatz, Varian’s Director of Brachytherapy Solutions, citing research on brachytherapy’s positive impact on patient outcomes when used in combination with other treatment modalities. The research showed the overall survival rate for women with locally advanced cervical cancer was significantly better for those who received both external beam and brachytherapy rather than external beam alone.3

Inside News

When you have confidence in your tools, it instils confidence in your patients. That’s why Varian has combined their experience in brachytherapy with clinician input to design an intuitive afterloader that enables clinicians to focus on their patients. A result of clinically driven design, developed with radiation oncologists, medical physicists, therapists, dosimetrists, service engineers and IT specialists, BravosTM has been designed and engineered to be efficient, integrated and easy to use. The afterloader features a pre-treatment checklist designed for better patient safety and treatment efficiency, as well as a comprehensive review before a procedure, to ensure all protocols are accounted for. An LED display confirms applicator connections with easy-to-read coloured indicator lights while transfer guide tubes can be the same length and provide simple connection to be used in any channel. BravosTM is easily integrated with Varian’s BrachyVisionTM 3D treatment planning system, ARIA® oncology information system and EclipseTM treatment planning system to track a patient’s progress from diagnosis to post-treatment review. BravosTM is an exciting part of Varian’s evolving ecosystem of cost-effective products and services intended to help solve the major problems facing the global cancer community. As a global leader in developing multidisciplinary, integrated cancer care solutions, Varian is committed to helping cancer centres offer personalised and adaptive care that is uncomplicated to deliver, integrated, and coordinated along the continuum from diagnosis to survivorship. In this way, they hope to play a role in bringing about a vision of a world without fear of cancer.

References 1. Cancer Council Australia. Skin Cancer. https://www. cancer.org.au/about-cancer/types-of-cancer/skincancer.html [Last accessed November 2018]. 2. The Royal Australian and New Zealand College of Radiologists. About Radiation Oncology. Benefits and Effectiveness. https://www.targetingcancer. com.au/about-radiation-oncology/benefits-andeffectiveness/ [Last accessed November 2018]. 3. Han M, Milosevic A, Fyles, et al.Trends in the utilization of brachytherapy in cervical cancer in the United States. Int J Radiat Oncol Biol Phys, 87 (2013), pp. 111-119. 4. Hoskin PJ, Rojas AM, Bownes PJ, et al. Randomised trial of external beam radiotherapy alone or combined with high-dose-rate brachytherapy boost for localised prostate cancer. Radiother Oncol, (2012), 103: pp. 217-222.

Radiation Oncology

TROG Cancer Research Speakers announced for TROG Cancer Research 2019 ASM

Clinical Interventional Oncology Symposium

Dr Nicholas van As has been announced as a keynote speaker for the 2019 TROG Cancer Research Annual Scientific Committee Meeting (ASM) to be held from 12-15 March in Melbourne. Dr van As is Medical Director of The Royal Marsden, Consultant Clinical Oncologist in the Urology Unit, and a Reader at the Institute of Cancer Research. He leads a number of clinical trials, most notably he is chief investigator for the international clinical trial PACE, comparing SBRT to image-guided radiotherapy and surgery for treating localised prostate cancer.

As part of the TROG 2019 ASM, a Clinical Interventional Oncology Symposium will be held on 14 - 15 March 2019. This symposium will focus on all aspects of clinical oncology relevant to interventional radiologists.

TROG is also excited to announce Dr Rebecca Howell will also speak at the TROG Cancer Research ASM. Dr Howell is a tenured Associate Professor at The University of Texas MD Anderson Cancer Center and a Fellow of the American Association of Physicists in Medicine. Dr. Howell is certified by the American Board of Radiology and has more than 15 years of clinical experience. The TROG Cancer Research ASM 2019 will be held at the Melbourne Cricket Ground. The program includes four days of collaborative workshops, scientific sessions showcasing clinical trials, discussion of new clinical trials, future research directions and other research developments. Find out more at www. trog2019.com

Dr Nicholas van As

The interventional radiology specific program will bring together interventional radiologists, medical oncologists, radiation oncologists, surgeons, pathologists and researchers to focus on the clinical aspects of Interventional Oncology practise. Teaching will include overviews of tumour biology, pathology, treatment options, clinical algorithms and the critical role that Interventional Oncology has to play in cancer care including diagnosis, biopsy and management. Sessions will also focus on clinical skills including procedural sedation, post-procedure analgesia, and future research areas. Interventional radiologists of any career stage are encouraged to attend and learn more about these important concepts in clinical oncology for the modern Interventional Radiologist. This symposium is also highly recommended to registrars who are interested in a future career in interventional radiology.

Guest speakers include Dr Costi Sofocleous from the Memorial Sloan Kettering Cancer Centre, Professor Andy Adam from the Guys and St Thomas’ Hospital and Professor Liz Kenny from the Royal Brisbane and Women’s Hospital.

New TROG Trial proposals open year round! Over the past few months, the TROG Cancer Research Central Operations Office, in conjunction with the TROG Board and Scientific Committee, have reviewed the pathway a study takes (i.e. from submission to completion) and implemented changes to streamline the process and to provide further support to our members. The key improvements in the pathway are: • Call for new proposals open all year round • Member voting on new proposals will be conducted via eVote (outside of the ASM) • Each study stage and key milestones clarified • Increased support and communication from subspecialty working parties and the TROG Scientific Committee More information visit www.trog.com.au

Dr Rebecca Howell Volume 15 No 1 I December 2018

Radiation Oncology

2018 TROG SMART Workshop and ASM from a Trainee Perspective As a radiation oncology trainee, the SMART workshop was a valuable opportunity to deepen understanding of vital concepts in trial setup and common statistical methods. The sessions were interactive, involved small group discussions to apply newly learned concepts, and facilitated the sharing of insightful ideas across the workshop. This workshop built on my skills in critically appraising the literature, on which the practice of radiation oncology is based on. The papers chosen for discussion in the workshop were very recent, and highly relevant to the daily practice of radiation oncology. Knowledge gained of these publications through discussion of their statistics in the SMART sessions will serve well in preparation for the Phase II radiation oncology exams. The SMART session was a strategic prelude to the TROG ASM; knowledge of statistical concepts and trial designs as well as power calculations enhanced my understanding of the trials presented. Through the TROG ASM, I have also gained an understanding on how TROG functions as a group to produce high-quality robust practicechanging data. There were sessions revolving around new trial proposals, as well as sessions on trial updates. The topics involved bore a wide range, from the dose and fractionation of paediatric

palliative radiotherapy, to the success of stereotactic ablation of early node negative lung malignancies. The passion of the presenters, and the obvious amount of work put into these trials was apparent, and certainly from a trainee point of view, boosts motivation. The Varian welcome session, and the gala dinner were enjoyable moments of professional networking, which promoted collegiality among attendees. Awards were presented to recognise and celebrate the achievements of TROG researchers. Overall, the SMART workshop, and TROG ASM has opened my eyes to the importance of clinical trials in generating high-level evidence to guide clinical practice. I walk away with a renewed appreciation of not only the practical difficulties faced by researchers, but also the vast possibilities of direction with an academic career. Dr Violet Koh Radiation Oncology Registrar, Year 3 Trainee Olivia Newton John Cancer Centre, Austin Health, Heidelberg, VIC

YOUR MEMBERSHIP MATTERS Get Involved

FELLOWS www.ranzcr.com/fellows/general/get-involved TRAINEES www.ranzcr.com/trainees/general/get-involved

Inside News

Radiation Oncology

ARPANSA’s new linac is coming This year, the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) has been preparing the Yallambie laboratories for the installation of a new linear accelerator (linac). This year ARPANSA celebrates 20 years as an agency. ARPANSA was created by an Act of Parliament, the ARPANS Act, which was passed on 10 December 1998. ARPANSA has a mandated responsibility to support the safe use of radiation in Australia. ARPANSA’s first clinical linac was installed in 2008, and some main components are now reaching endof-life. Since installation, the linac has enabled ARPANSA, and thus Australia, to maintain an internationally regarded Primary Standards Dosimetry Laboratory (PSDL) participating in numerous international comparisons. The linac has also calibrated every hospital reference chamber in the country. This work fundamentally underpins safe and accurate clinical practice throughout the country. However, due to its age and technical limitations, a new linear accelerator was necessary to ensure that ARPANSA could continue to provide services in a rapidly changing clinical environment. ARPANSA received a $5 million capital injection for the new linac during the 2017-18 financial year. A contract for the linac and building works was signed in March 2018 and demolition work began the same month. The new linac will be Elekta Versa HD linac and will provide a national resource for a decade.

A machine with many uses Dr Ivan Williams, Chief Medical Radiation Scientist Medical Radiation Services at ARPANSA welcomed the project and its various benefits for ARPANSA and Australians, "initially the new linac will be used to continue ARPANSA investigations into small field dosimetry and support the Australian Clinical Dosimetry Services audit development," he said. "Into the future we are planning to investigate the dosimetry of image guidance, dynamic phantom and eventually 4D treatment techniques."

"Forty years of building modifications prior to this reinforcement work meant that not everything was where it was expected to be. However, the experience has been fascinating to be part of and I am very happy to announce that the new accelerator installation began on Friday 28 October." Read on for a few of the highlights of the installation.

continued over...

Promoting collaboration Dr Williams also sees the new linac as an opportunity to encourage enhanced partnerships between ARPANSA and other stakeholders, "we are also reviewing the opportunity to participate in translational research, with the University of Melbourne’s Veterinary College and other interested parties. ARPANSA has participated in a number of radiation sensitivity research programs, and last year was the control arm for a synchrotronbased investigation. Suggestions for collaboration are welcome."

The installation A project with the enormity and complexity of the linac installation was not easy to execute. Dr Williams admits, "the entire process of installing a new linear accelerator into an existing building was challenging. The 700 plus tons of shielding required reinforcing the foundations.

Volume 15 No 1 I December 2018

Radiation Oncology

Removing the walls Fig 1: Making Swiss Cheese. Holes area cored through the existing walls, the wall is sawed vertically, a forklift inserts its tines into two hole and takes the weight of a block, which is then sawn out. The entire procedure surprisingly fast for a 30 cm thick (light) shielding wall.

Pouring the concrete through the roof Fig 3: This is not faked – the first concrete pour was threatened by rain storms. They held off (enough) and the work continued. This approach, a boom conveying concrete to be poured through the roof was used through-out the build process. When operational, a concrete mixer would feed, and obscure, the pumping truck.

Arrival Fig 4: Arrival and rigging in. The machine itself arrived (in parts) at ARPANSA on Friday 26 October. It has been assembled and is now being configured and setup by Elekta.

Constructing new walls Fig 2: The formwork has been prepared and buttressed for the main wall pour. The photo was taken from the floor above into the bunker space from the saw position in the previous image. The existing linac will be maintained to provide calorimetry and standard calibration services until it is not viable, at which point it will be decommissioned and the roles will transfer to the new linac. For more information on the linac project or if you have an idea for collaboration as mentioned earlier, contact Dr Ivan Williams.

Inside News

Radiation Oncology

Meet the new FRO Dean and Councillors for 2019 Elections for the Faculty of Radiation Oncology Council were held during July/August. Nine nominees stood for four positions. In addition, at the June Council meeting, Dr Madhavi Chilkuri was elected the next Dean. Each successful candidate was asked to outline their involvement with the College, why they chose to nominate for Council, and what their priorities will be during their term.

the College almost seven years ago, I was not sure that I had anything to contribute. Most of my colleagues who have volunteered at the College will tell a similar story. The lesson simply is that we all have something to give and can make a difference. Whether through active involvement in College matters or simply through our experience in day to day medical practice, each one of us can influence the quality of care that our patients receive. As I take on the position of Dean for 2019-20, I do so with humility and a great sense of responsibility. I see it as my role not only to provide leadership but to advocate strongly for our Faculty and for our patients. I look forward to communicating with our members on key issues that affect our specialty and would value ideas, opinions and feedback.

Dr Madhavi Chilkuri, The Townsville Hospital, Qld Dean, FRO (2019-20)

Why did you decide to nominate? When someone shoulder tapped me to join one of the committees at

Why did you decide to nominate? Nominating was a well thought out and timed decision. To represent the membership and show leadership, I needed to understand the field, the horizon, and the strategy soundly. It has taken many years to be grounded in this prior to nominating. I feel I am now able to assist the Faculty in the key forums / debates and to represent us to our stakeholders effectively. Beyond that, at a corporate and organisational level, an understanding of governance, compliance, risk management and strategy functions of the role is crucial. Serving on several community roles outside medicine have prepared me for this as well. What are your main priorities during your term?

What involvement have you had with the College? I have been a member of the Faculty of Radiation Oncology Council for over four years, chairing the Quality Improvement Committee during the same period. During these years, I have come to understand the valuable role of clinicians to lead and support the excellent work that is done by our College Secretariat. I have come to understand how the Faculty works, both internally and externally with partners, especially the government. Most of all, I have come to appreciate the tremendous opportunities we have to advocate for our members and patients.

have represented the Faculty externally on the Australian Institute of Health and Welfare waiting times project, which has allowed me to understand the changing position of our field and the position our College has a key player in our future existence and role.

Dr Siddhartha Baxi, Genesiscare Gold Coast, Qld FRO Councilor (2019-21) What involvement have you had with the College? I have been a member of the Quality Improvement Committee and was a rural/regional voice with the Tripartite Committee, working on several projects and position statements in that regard. I am a current member of the Indigenous Health Working Group and the Economic and Workforce Committee. I

As a team approach, the College has decided on our pathway as expressed in the College Strategy to 2021. I believe the governance and sustainability of the organisation is strong. I would like to focus my efforts in areas of engagement and advocacy, acknowledging that this cannot be done without ensuring our core function of excellence in education and practice continues. Our profession faces some strong headwinds in years to come around fiscal priorities, competing for the attention of relevant stakeholders and meeting our increasingly complex training and workforce needs. I am humbled to be given the opportunity to work in this space.

continued over... Volume 15 No 1 I December 2018

Radiation Oncology

Prof. Lizbeth Kenny, Royal Brisbane and Women’s Hospital, Qld FRO Councilor (2019-21)

Dr Ziad Thotathil, Waikato Hospital, NZ FRO Councilor (2019-21)

Dr Yvonne Zissiadis, Genesiscare, WA FRO Councilor (2019-21)

What involvement have you had with the College?

I have had several roles within the College, including Dean (2002-04), College Councilor (2004-07), and President (2005-07). More recently, I have been involved with the MBS Review, which led to me being coopted to Council (2016-18). I have also been appointed Chair of the Artificial Intelligence (AI) Working Group.

I have been involved with College committees since joining the Post Fellowship Education Committee (PFEC) in 2013, including Chairing since early 2018 when I was appointed to fill a casual vacancy on the Faculty Council. I am a member of the New Zealand Radiation Oncology Executive and have been a member of the Annual Scientific Meeting (ASM) Management Committee since 2015.

Over the last decade, I have been a member of the Quality Improvement Committee, and more recently completed two terms as a member of the Radiation Oncology Education and Training Committee and Radiation Oncology Research Committee. In addition, I have been involved in the organisation of RANZCR ASMs in the past as well as being involved in the judging of grant applications and scientific prizes. I remain co-chair of the RANZCR Breast Special Interest Group (BIG FRO).

Why did you decide to nominate? The Faculty has matured enormously over the years. I consider it a privilege to serve as a Faculty Councilor, where I can advocate for service provision, service delivery, and promoting our specialty as being a fundamental core of cancer treatment. I feel that the Faculty is in the position to lead a mind-shift in the way that government and funders look at radiation oncology and the benefits that radiation therapy offers.

Why did you decide to nominate? It was the cliché of the ‘shoulder tap’ from a senior colleague that first got me involved with the College at the Committee level. I signed up for membership of the PFEC, at the time chaired by Dr Vanessa Estall. This gave me an insight into the workings of the College that until then had just been an address in Sydney that I subscribed to.

What are your main priorities during your term?

Cementing ways to ensure we look after and support our trainees and young consultants/early career Fellows and being practicing exemplars of great professional behaviour amongst all of our colleagues. I am most keen to further the relationship between Interventional Oncology and Radiation Oncology. We both focus on local cancer treatment and this would bring about great benefits to patients, the system, and the community. The College is perfectly poised to lead the way as The Cancer College — we already have an enormous focus on people with cancer and are the only College to span the continuum of cancer care, from diagnosis, through treatment, and follow-up care.

Along with the routine work in monitoring the Continuing Professional Development (CPD) program administered by the College, I have been involved with the PFEC in developing the College response to moves by the medical regulatory authorities in both New Zealand and Australia to increase the regulatory burden on our members. This work is likely to dominate the agenda of the PFEC into the next triennium as the Medical Board of Australia (MBA) releases further details of its revised CPD framework for medical practitioners in Australia. As the PFEC representative on the ASM Management Committee, I have also been able to support and advise the local ASM organising committees and I plan to continue this support.

Inside News

Why did you decide to nominate? I bring experience in both private and public health sectors. My experiences have given me the opportunity to contribute and have input to many aspects of the College which have given me a renewed appreciation for its role and responsibilities. I would like to continue "having a voice" within the College and hope that my experience and understanding of policies regarding education, training and research will be beneficial to the Fellows. What are your main priorities during your term? Becoming a member of the Faculty Council will give me the opportunity to continue my contribution to the College and profession. My priority is to use my previous experience both in RANZCR and in other leadership roles (such as President of the Australasian Society for Breast Disease), to bring a practical, common sense approach to issues arising in future. Please direct any questions or comments for FRO Councillors to Philip Munro, Executive Officer, on faculty@ranzcr.edu.au

General Interest

New Zealand Branch News

Dr Gabes Lau

Welcome. At the ASM held recently in Canberra, the College held its first Radiology Battle of the Branches pub quiz – a high calibre intellectual exercise organised by the co-convenors John Cockburn and Rajeev Jyoti. I’m proud to announce that NZ teams won 3 of the 4 heats. Unfortunately, the semi-finals and final were held in the last session of the conference, and the NZ teams were unable to attend. Congratulations to the winning Victorian team. To maintain Trans-Tasman relations, it may have been a blessing in disguise that no NZ teams were present, as we convincingly wrapped up the Bledisloe Cup earlier in the day.

Congratulations to Sheila Oh Also at the ASM in Canberra, Dr Sheila Oh won the Branch of origin! New Zealand represent! Her competition was 5 registrars from Aussie states. In addition to her name on the plaque (and beating some Aussies), Sheila has received $5000 to attend the Royal Society of North America Conference in 2019. Ka pai Sheila.

NZ Horizon Scan In 2015, an Innovation Summit was held in Canberra to raise the profile for Radiation Oncology and Targeting Cancer. A similar event, Horizon Scan, will be held in Wellington on 9 May 2019. This is expected to be an important event with approximately 60 key decision makers attending. David Clark, the Minister of Health, has agreed to host the event.

Update on the HPCAA Amendment Bill The Health Select Committee has been considering the Health Practitioners Competence Assurance Amendment Bill. As I have previously mentioned in this column, the College made a submission during the consultation period and presented to the Health Select Committee. The Committee’s report was released on 17 September 2018. The College’s oral and written submissions requested an additional change to the Amendment Bill that would require the registration of teleradiologists. The Health Select Committee’s report does not include a recommendation to further amend the Act to require registration of teleradiologists. This is disappointing and we are currently exploring options for progressing the College’s position that all doctors who are involved in the care of a New Zealand patient must be registered.

RANZCR training site accreditation Some training units in New Zealand have been undergoing their College accreditation this year. Site visits have now been completed for Wellington, Christchurch, Dunedin and Invercargill for both radiology and radiation oncology.

Accreditation by the AMC and MCNZ RANZCR’s accreditation with the Australian Medical Council and the

Medical Council of New Zealand is currently up for renewal. College staff are currently preparing the documents for submission. The accreditation visits will take place next year.

MCNC consultation on recertification The Medical Council of New Zealand has released a consultation document titled, "Towards strengthening recertification requirements for vocationally-registered doctors in New Zealand." The document indicates that the MCNZ is still in the thinking stage of change but that we should all expect changes to our CPD requirements in the future. In RANZCR’s submission, the MCNZ was asked to rethink Regular Practice Reviews (RPR) because of their limited benefit, particularly considering how resource intensive they are to implement and support. The College also encouraged the MCNZ to align its requirements with the requirements of the Medical Board of Australia. RANZCR and other Medical Colleges would struggle to support two diverse CPD recognition schemes.

Getting involved in the College There are currently open opportunities to get involved with the College for both radiologists and radiation oncologists. If you are interested in participating on a College committee or helping assess international medical graduates for registration in New Zealand, please email Jenna Howell at nzbranch@ranzcr.org.nz.

Volume 15 No 1 I December 2018

General Interest

Australian News In Brief Branch News

ASM dominates twitter Amongst all the activity of the recent ASM in Canberra, the twitter tag, #RANZCR2018 appeared as trending topic on the Australian National Twitter Trends. Just beaten out for the number five position by the Meghan and Harry Royal visit juggernaut, it was fun to see the College making inroads into the public consciousness.

TAS The Tasmanian Branch of RANZCR has been quite active this year. We held a very successful educational meeting at Josef Chromy Winery in Launceston in May, well attended, especially by registrars. Registrar presentations were of a high standard with Dr Jessica Monkhorst winning the prize to attend and present at the RANZCR ASM in Canberra in October. Our next meeting was held in Hobart on 24 November 2018 with a Chest Imaging Theme. We were fortunate to have Associate Professor Karin Steinke from Brisbane presenting several talks. The Royal Hobart Hospital welcomed Dr Parm Naidoo as their new Director of Medical Imaging late in October, bringing with him a wealth of experience and interest particularly in registrar education and research.

Farmer Fundraising Effort Healthcare Imaging Services recently held their fourth annual national conference which included a fundraising dinner for the Buy a Bale charity. The charity works to provide assistance to rural communities that are suffering through natural disasters. Through the sale of themed costumes for the evening and proceeds from the live auction, $10,000 was raised to purchase much needed hay for farmers in the central west. (insert images provided)

Radiation Oncologist Tobacco divestment Dr Bronwyn King, radiation oncologist has been receiving favourable coverage recently for her work as the Chief Executive of Tobacco-Free Portfolios. Having seen hundreds of patients die from tobacco-related disease, she set up Tobacco-Free Portfolios in a bid to disentangle the global finance sector from tobacco. Now, $1.3 trillion in funds under management in Australia are tobacco-free. The not-for-profit organisation Tobacco-Free Portfolios, with the support of Princess Dina Mired of Jordan, recently launched the world's first "Verified Tobacco-Free" certification stamp, which will be rolled out in Australia next year. The stamp will indicate whether a financial institution is investing money in tobacco, the single largest preventable cause of early death. The stamp will be rolled out globally over the next few years.

Inside News

Support for Rural Specialists Funding Round 4 We are pleased to announce that the Support for Rural Specialists in Australia (SRSA) program Governing Committee have approved the key dates for Funding Round 4. Rural specialists who live and work in areas determined using the Modified Monash Model (MMM) system categories MM2 to MM7 are eligible to apply for grants of up to $10,000 to support participation in CPD activities. Information on the remoteness classification of any town or community in Australia can be readily provided through the Department of Health “Map Locator”. Stay tuned to the SRSA website for more information on how to apply, including the online Application Form and Guidelines. We can be contacted on: admin@ruralspecialist.org.au

RANZCR Member wins international award. Neuroradiologist A/Prof Sandeep Bhuta is the first ever Australian to become a recipient of the American Society of Neuroradiology (ASNR) Anne Osborn International Outreach Professor Program 2019. He was also a recipient of “Rouse Travelling Fellowship” prestigious award by RANZCR in 2012.

Have some news to share? Don’t forget to tell us about it. Contact Mark Grzic at editor@ranzcr.edu.au

General Interest

"Of at least intermediate status" Wandering with the Rouse Travelling Fellow College guidelines state: ‘The Rouse travelling fellow must be an active, experienced consultant of at least intermediate status’. I repeated the words ‘intermediate status’ many times during my fellowship, sometimes as a pre-emptive excuse on meeting a new audience and sometimes just as reassurance to myself. There is some comfort to be had in the word ‘intermediate’. It implied that all I had to be was ‘not-bad’ and that as long as I conveyed my enthusiasm for my favourite topics in paediatric and obstetric radiology then all would be fine. Despite this, I still couldn’t help the nagging feeling that I had a daunting legacy to live up to. The problem was that many of the NZ Rouse fellows are my local heroes: Stuart Heap, Alan List, Andrew Holden, Neal Stewart, Russell Metcalfe and Antony Doyle for example, while visitors from Australia had left a lasting impression on trainees. For example, legend tells of Bob Fabiny tricking candidates by showing chest radiographs taken with a potato in the patient’s shirt pocket. Edgar John Rouse was a radiographer, businessperson, philanthropist and honorary fellow. He was a generous supporter of our College, establishing the first chair of radiology in Melbourne. In 1960 he funded this fellowship, a Trans-Tasman exchange of knowledge for radiologists and radiation oncologists. Since 1960, exchange of information and ease of travel has changed dramatically and consequently the Rouse Fellowship has taken on a different significance, the focus shifting towards education of trainees. Like many of us, registrar teaching is a highlight of my job so this was a task I could feel comfortable with. The first stop on my trip was Perth for a superb Annual Scientific Meeting. The week leading to the ASM was spent taking registrar teaching at Princess Margaret Hospital (in its last days) with registrar-chauffeured trips to the Royal Perth Hospital and the impressive Fiona Stanley Hospital. With the ASM and

Dr David Perry

Australian and New Zealand Society for Paediatric Radiology (ANZSPR) meetings in under a week, the paediatric crew was at the height of pre-conference planning but Dr Craig Gibson and the team still had time to show me about and settle me in with a fantastic bunch of registrars. Evenings were spent spit-polishing my talks and tidying up my library of cases. The ANZSPR meeting was in spectacular Bunker Bay, Margaret River. This was a well-attended, expertly planned and run affair where a highlight was watching spouts from migrating whales in the bay from the balcony between sessions. If you haven’t been to one of the ANZSPR meetings then I can highly recommend them. This year’s meeting is in Southbank, Brisbane while next will be up amongst the mountains in Hanmer Springs, South Island / Te Waipounamu. My family joined me in Margaret River and we enjoyed a few days driving through the stunning countryside and visiting my ex-pat uncle and the cousins. Wine country comes to mind when most people think of Margaret River, but I love it for the beautiful coastline and impressive Karri Eucalyptus forests with magnificent limestone caves. Queensland was next and for this part of the trip I was graciously hosted by Dr Mark Philips of Lady Cilento Children’s and Gold Coast Hospitals. Fiona Stanley Hospital had already shown me the scale

of resource that is available in Australian hospitals and these two centres were similarly impressive. I work at Starship Children’s and National Women’s Health at Auckland City Hospital and we have little to complain about when comparing our resources to other NZ centres but the resources of these departments were still several steps above what I am used to, with highly skilled staff to match. Not for the first time, I was feeling a little like a travelling snake oil salesman in a country with more than enough snakes already. I had to remind myself of my mantra: ’The Rouse travelling fellow must be . . . of at least intermediate status”. The fellowship is a fantastic opportunity to meet new colleagues and to strengthen connections with old ones. Mark Philips had arranged a steady lineup of people to meet and talk to and I really gained the benefits of the two-way stream which comes from this kind of visit. Trips to the Royal Brisbane and Women’s Hospital and the Mater fetal medicine service followed, as well as a chance to talk through some local fetal MRI cases. As in Perth, the registrar run Uber service had me delivered about town with great company on the drive. I wish all work weeks could be as enjoyable as this one had been. continued over... Volume 15 No 1 I December 2018

General Interest

After Brisbane, my family and I took a break from travel for a while, waiting until after New Year to head off on the last section of the fellowship, to Hobart for a week and then a short stop in Melbourne. I had heard good things about Tasmania so a chance to visit couldn’t be missed. Tasmania feels like someone transplanted Australian flora and fauna to the South Island. It is both familiar and foreign and I liked it a lot. It has spectacular scenery and great whisky to go with it. Dr Ali Thomas was my guide at Royal Hobart Hospital and she quickly filled the week with talks and teaching sessions but with enough time to get away to the mind blowing and confronting Museum of Old and New Art (which is worth the trip in itself) and to head out for a weekend drive up the coast to Coles bay and inland to Cradle Mountain. Radiology departments are busy places so when talking I am always aware that the work is building up and the audience is no doubt eager to get back to it but Hobart was never hurried and they

always had time for me. They are a kind and generous group and I very much enjoyed my visit there. In my experience, sonographers make some of the most appreciative audiences and it was a pleasure to get to talk on obstetric and paediatric ultrasound to sonographers at several of the sites, with a highlight being those under the guidance of women’s imaging expert, Dr Lynn Brothers, who impressed me greatly with her skill and care. The weekend travelling around Tasmania was the tourist highlight of our adventure. We drove for hours and hours without any complaints from the kids and spent a perfectly still and clear night at the Cradle Mountain-Lake St Clair national park, sleeping soundly while a once in a lifetime opportunity to see the Aurora Australis was playing out above us. The last leg of the trip was two days at the Royal Children’s Hospital in Melbourne helped along by some familiar faces, Dr Padma Rao and Dr Karen Atkin. This facility has cutting edge tech and is a great example of how modern Australian hospitals

Radiology and Emergency Medicine.

It has been a busy year with ANZERG invited to participate at various conferences. The year started with an invitation from Oman Radiological and Molecular Imaging Society (ORMIS) to attend their scientific meeting in Muscat in March. A/Prof Dinesh Varma represented the SIG and delivered various lectures as well as held teaching sessions with local trainees. Subsequently ANZERG has been invited to hold a joint meeting with ORMIS in April 2019. A call for EOI to be a speaker has been sent out by Dr Gerard Goh. The first joint international meeting was held with Sri Lanka College of Radiologists on “Emergency Radiology – Expanding Role in Multidisciplinary Care” at their 17th Annual Academic Sessions on 25-26 August, 2018 in Colombo, Sri Lanka. ANZERG speakers comprised of Drs. Ronil Chandra, Gerard Goh, Meredith Thomas and Dinesh Varma as well as Emergency Physicians Drs. Anthony Joseph and Sally McCarthy. This interspecialty meeting was attended by over 300 delegates from

Inside News

ANZERG was also invited to participate at the Australian Trauma Society annual conference in Perth on 6 - 7 October. It is very likely that we will be asked to provide speakers and hold joint sessions at the World Trauma Congress being

held in Brisbane in 2020. The College ASM in Canberra also saw various ANZERG members deliver talks on Emergency and Trauma Radiology. We thank the Organising Committees for giving ANZERG the opportunity to contribute to the scientific program. Unfortunately, the general meeting of ANZERG was rather poorly attended at the ASM. The Chair updated the members of the recent activities and announced that Dr Sean Skea and

really know how to make the most of public spaces. I spent time with some impressive registrars and was continually running in to ex-pat colleagues from home. Those of us who are enthusiastic about radiology education know just how much work goes in to collecting cases and preparing talks for events like this but we also know how much we learn from the process. We also know the immense satisfaction that comes from taking what you have learned and successfully passing it on to others. The Rouse Fellowship was an incredible opportunity to take a brief sideways step and to see our specialty from some different angles. It is an opportunity available to any radiology or radiation oncology educator (so long as you are of ‘at least intermediate status’) and I can highly recommend it as being well worth the time and effort. Dr David Perry was the recipient of the 2017 Rouse Travelling Fellowship Find out more about the fellowship at www.ranzcr.com/college/awards-andprizes

Meredith Thomas will be completing their term on the Committee in December 2018. He thanked them for their contributions. Following an EOI Dr Rajiv Rattan from NSW will be joining the Committee from January 2019 and we look forward to working together. We are waiting on a nomination from NZ to complete the Committee membership. Dr Saqar Altai General Secretary ORMIS presented on the upcoming joint ANZERG and ORMIS conference in Muscat on April 12 and 13, 2019. The general meeting is held at every College ASM and we encourage members to attend so that we can work together to promote the subspecialty. As the year comes to an end we wish you all a very happy festive season and best wishes for 2019 Please contact Casey Vanreyk (email: casey.vanreyk@ranzcr. edu.au ; Tel 02 9268 9752) for any information about ANZERG or how to enroll as a member. Chairman: A/Prof Dinesh Varma (Vic) Committee members: Dr Craig Hacking (Qld), Dr Meredith Thomas (SA), Dr Gerard Goh (VIC), Dr Sean Skea (NZ)

General Interest

From the Archives Safeguarding our wisdom, healing and knowledge. Full of fascination and wonder telling the scientific and social memories of discovery, since 1967 the Trainor Owen Archive preserves the history of radiology and radiation oncology throughout Australia and New Zealand; by collecting, cataloguing and preserving relevant manuscripts and objects of historical interest. From its humble beginnings, the archive has had to evolve to embrace the modern world. No longer accessed at a languorous pace, the College has been busy transitioning the archive from its original form to the archive’s new home at ehive.com. The new digital platform allows the College’s rich history of radiology and radiation oncology to be open to all comers from around the globe regardless of discipline and experience. The accessibility that lies at the heart of the archives new home, makes the content available to all researchers, historians and the curious as well as preserving the accumulated knowledge for future generations. From capturing memories of our fellows, past and present, unearthing and rediscovering treasures of the individuals instrumental in establishing the collection, the archive meticulously manages these riches. Speaking to those who improved safety for patients, whose wit and perseverance have laid the foundation for all that has come since the archive continues to grow. These are the stories that capture history and bring colour to our past, advancing future education. With an increased online presence, the Trainor Owen Archive has rebranded and revamped its logo. Each interlocking triangle represents the College and the faculties whilst integrating the thunderbolts from

the original Hades representation to symbolize Odin. This modern design, with reference to Norse mythology of wisdom, healing and knowledge, will be used to brand all archives related material both online and in exhibition. From members memoirs to medical instruments of yester-year, from photographs and glass plate x-rays to College evolution, from government safety pamphlets to rare medical textbooks, the Trainor Owen collection is a treasure trove of excitement and wonder. Explore the archive at https://ehive.com/ collections/5079/trainor-owen-collection Have a memory to share? Why not participate in RANZCR Recalls, our Oral History project; https://www.ranzcr.com/ college/about/history

For RANZCR members Though the Trainor Owen Archive is accessible to all, the College makes our archivists available to members who would like assistance in combing through the archives or for those unable to access them in person due to geographical constraints. In order to make an appointment or to request assistance from Eva Stokes-Blake at archives@ranzcr.edu.au Donations to the archive are assessed on a case by case basis.

Volume 15 No 1 I December 2018

General Interest

Cardiac CT Training 2018/19

~ In Memoriam ~

We go beyond simply meeting training requirements: l

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

Participants eligible to claim 117.5 RANZCR CPD points for the 5 day course and 67 RANZCR CPD points for the recertification course.

Dr Gary Edward O’Rourke, Fellow, QLD

Maximum allowable course based live and library cases for ANZ credentialing.

Dr Merl De Silva, Fellow, TAS

Clinician led teaching by high volume operators.

Dr Pui Meng Mok, Fellow, NZ

State of the art low dose, High Definition imaging.

A/Prof Robin Danby Gibson, Life Member, NZ

2018 - 2019 COURSE DATES:

Dr Stephen Williams, Educational Affiliate, NZ

5 Day Level A Course 8th - 12th November 2018 2nd - 6th May 2019

Dr Ezra Israel Berley, Educational Affiliate, NSW

3 Day Recertification Course 10th - 12th November 2018 4th - 6th May 2019

Dr Frank George Harrison, Fellow, SA

AICC ULAR CT

T DI

Dr Jerzy Mirecki, Fellow, NSW

TITU

ASC

AUSTRALIAN

For more information and online registration log on to: www.aicct.com.au or contact us at: info@aicct.com.au

TE OF CAR

Dr Geoffrey Grant Ward, Fellow, SA Dr John Michael Cecil Davies, Fellow, Overseas

Professional Documents and Publications 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:

If you have any enquiries about professional documents, please contact Melissa Doyle at: ranzcr@ranzcr.com or phone: +61 2 9268 9777

Inside News

College Wide www.ranzcr.com/our-work/advocacy/position-statements-andsubmissions

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