Inside News June 2016 RANZCR

Volume 12 No 3 / June 2016

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

INTERESTING TIMES IN RADIOLOGY Dean, Prof John Slavotinek, discusses challenges and opportunities

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In this edition

From the

5 President’s Message 6 COVER STORY Challenges and Opportunities in Clinical Radiology

Editor’s Desk

Engaged Members 9 2016 Annual Scientific Meeting 10 Member Profiles

If you feel there is a lot going on at the College right now, there is, and this edition of Inside News provides insight into what’s keeping us all so busy.

Research 15 A Career in Research 16 Research Grants in Action

We start with the President’s message, which presents the findings of research conducted last year into the perceptions of clinical radiology in the community.

Profile and Presence 17 InsideRadiology 19 Targeting Cancer

Our cover story is an opinion piece by Prof John Slavotinek on the challenges and opportunities in clinical radiology, which all members will find interesting.

Access to Quality Service 21 Choosing Wiseley Quality Practice 23 Peer Review – A Learning Opportunity 24 Radiation Oncology Practice Standards 26 Health and Safety at Work 27 App Reviews 29 RaER Case Study Quality Training 31 Exam and Assessment Review Update 32 RANZCR Courses and Workshops 35 Training Site Accreditation 36 Trainee Liaison Officer Clinical Radiology 37 Message from the Dean 38 Trainee News 39 Chief Censor Radiation Oncology 45 Message from the Dean 47 Chief Censor 49 Trainee News General Interest 53 New Zealand Branch 54 Australian Branches 57 From the Archives 61 Meetings and Events Inside News is printed on Titan Gloss. Titan is produced in an ISO 14001 accredited facility ensuring all processes involved in production are of the highest environmental standards. FSC mixed Sources Chain of Custody (CoC) certification ensures fibre is sourced from certified and well managed forests.

Editorial Staff Editor-In-Chief Dr Allan Wycherley Sub Editors Alex Zandstra Bertha Harvey

Dr Allan Wycherley

The College was a founding member of the Australian Choosing Wisely campaign—a global movement to improve health care. The second wave of the campaign was launched recently and it provided us with the opportunity to promote our efforts to improve the appropriate use of imaging.

The College has a goal of having our Radiation Oncology Practice Standards mandated in Australia and New Zealand and a newly formed working group will ensure there is progress in this area.

The Specialty Training Unit is working towards implementation of the recommendations of the exam and assessment review. There are also many other training activities and developments currently taking place.

In addition to all the above, work continues on the MBS Review, the Faculty of Clinical Radiology governance review and our College-run courses and conferences, and we update you on progress in these areas.

Our members are central to our ability to achieve our goals, and we highlight several individuals who have contributed their time to the College and their profession.

Thank you to all members who have shown interest in contributing to Inside News, keep your ideas coming.

Allan Wycherley Editor-in-Chief editor@ranzcr.edu.au The Royal Australian and New Zealand College of Radiologists Level 9, 51 Druitt Street Sydney NSW 2000 Ph: +61 2 9268 9777 Fax: +61 2 9268 9799 Web: www.ranzcr.edu.au Email: ranzcr@ranzcr.edu.au

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

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

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

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

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

Inside News © 2016 The Royal Australian and New Zealand College of Radiologists® (RANZCR®)

What does this radiologist see?

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Introduction

Research Illuminates Perception of Radiologists

Dr Greg Slater

A Message from the President How radiologists are valued in the medical community, and by the public at large, is an issue never long from the thoughts of anyone working in clinical radiology, and it is a common cause of general dissatisfaction. Most of us agree that our clinical role today is undervalued by referring doctors and patients.

To better understand the issues, and to explore paths for lifting the profile of our specialties, last year the College commissioned research involving interviews with key stakeholders and online surveys of hundreds of radiologists, referrers and patients in Australia and New Zealand. The research has tapped some valuable insights into perceptions of our profession and I am pleased to share some early findings here.

Among the most pleasing outcomes was that over 90 per cent of referrers (chiefly GPs and surgeons) perceived radiologists positively as fellow clinicians, rating them as ‘excellent’ or ‘adequate,’ and acknowledging their respect for the specialists’ advice and contribution to patient care. In fact, the referrers’ stated respect for radiologists was significantly more widespread than what the radiologists themselves felt they received from the referrers—just over half of the radiologists surveyed felt respected as fellow clinicians.

Surveys have their shortcomings, of course, and it is easy to imagine that a respondent might say one thing and do another, but the disparate finding on respect implies that lack of effective two-way communication may be playing a role in this. And so the disparities continued. About 30 per cent of radiologists felt perceptions of clinical radiologists among referrers had improved in the last five years, but only 10 per cent of referrers agreed, while another nine per cent felt their

“Of the five most positive factors influencing perceptions, four of them relate to communication—with referring clinicians, with patients or in multidisciplinary meetings.” perceptions had declined. Over half of the patients surveyed felt their understanding and awareness of the clinical radiologist was adequate or better, a view strongly disputed by the radiologists, of whom fewer than seven per cent agreed. Indeed, in our stakeholder interviews it was claimed by both referrers and patients that it was not important for the patient to understand the role of the radiologist in reaching a diagnosis.

Perhaps most telling among the findings were the factors thought to affect the referrer’s view of the clinical radiologist. The factor that recorded the most positive influence was interaction between the specialist and the referrer (80 per cent of referrers listed this as a positive). Of the five most positive factors influencing perceptions, four of them relate to communication—with referring clinicians, with patients or in multidisciplinary meetings. One respondent, a doctor working in hospital emergency, offered the comment that radiologists ‘don’t go to the tea room’ enough to share their views.

Among the negative factors affecting perceptions of radiologists among referrers, by far the most common was the ‘corporatisation of practices,’ with almost half of the referrers listing it as a factor. But this is a topic best left for another day.

A lesson we can draw from the College’s research is just how much of our perception in the medical community and among patients depends on our opportunities and perhaps even our willingness to communicate. We may be frustrated by the attitude of some referring doctors and by the lack of awareness among patients—clearly many of us are. But if we really want to do more than complain and try to improve our working lives, the research suggests that spending designated time building relationships with referrers and talking more to our patients is as good a place to start as any.

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Introduction

Challenges and Opportunities in Clinical Radiology Prof John Slavotinek

The role of clinical radiology in medical practice has increased substantially in recent years, primarily due to the much greater anatomical, functional and diagnostic information provided by this discipline. The introduction and growth of multiple imaging techniques such as CT, MRI and PET is largely responsible for this but the increasing scope of interventional radiology has also greatly influenced patient care and has attracted much attention from healthcare providers and other clinical disciplines.

Beyond image interpretation, clinical radiologist roles now extend to advice regarding further imaging investigations when an abnormality is detected, consultation with doctors and patients regarding the potential role of biopsy and interventional radiology, and participation in discussions of patient investigation, management and followup. The clinical value of radiology is exemplified by the increasing trend toward multidisciplinary meetings, where radiologists are now at the forefront of decision making. While the above make this discipline exciting, clinical radiology and its practitioners face continuing change and this will bring many challenges and opportunities as I discuss briefly below.

The Overall Context Clinical radiology is conducted within the context of broader healthcare systems and is significantly influenced by them. At the outset, it therefore seems appropriate to mention some of the challenges being faced by healthcare systems in countries similar to those in New Zealand and Australia

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before focusing more closely on clinical radiology.

These global challenges include: • An ageing population with evolving disease patterns and an increasing burden of chronic illness • Rapid evolution of technology and increasing focus upon assessment of health technologies • Expansion of medical knowledge and available therapies • Rising demand for services partly due to increasing patient and societal expectations • Greater focus upon patient safety and quality of care • Problems with health workforce supply and distribution • Rapid rise in healthcare costs in an environment of cost containment • Increasing interest by governments to transition from fee for service payment systems to alternative systems such as value based care.

Innovation in Technology The rate of innovation and technological change in radiology exceeds that of many other specialties. Significant contributors to this include the development of new technologies and an increase in their clinical scope. By way of example ultrasound elastography, digital breast tomosynthesis and PET are examples of technologies in different stages of evolution, the latter being relatively well established. An ongoing

challenge faced by clinical radiology within Australia and New Zealand is access to funding for imaging studies that are supported and a part of routine clinical care in other countries. Reliance upon demonstration of evidence of cost effectiveness using the same framework as that used to assess medical therapies is unlikely to prove fruitful for imaging and the Medical Services Advisory Committee process has been problematic for many years.

Improvements may be forthcoming as a result of the MBS Review process but funding of new technology is likely to remain challenging for many years.

Beyond the increasing range of imaging modalities and the physical principles they exploit, increasing computer power now enables rapid image processing as well as development and use of more sophisticated algorithms. These algorithms are beginning to impact upon the perceptual phase of image interpretation, for example, in the setting of lung nodule detection on CT images.

While this may be welcome in view of the burgeoning number of images radiologists are exposed to daily, others who have a simplistic understanding of clinical radiology may regard matters differently. Such developments may be regarded as an opportunity to potentially replace clinical radiologist skills, utilise other disciplines to make cost savings and even deploy computers to interpret images in future.

Continuing this theme, centralisation of clinical data and improved connectivity between radiology systems, electronic medical records, laboratory and other hospital information is increasingly

Introduction

being pursued. I see this ‘big data’ related development as an opportunity to further improve patient care, recognising that there are significant issues around implementation and connectivity. As this improves it will increase our understanding of each patient’s clinical situation and thereby enhance the quality of our opinion, our recommendations and optimally guide patient care. Setting the sizeable topic of teleradiology aside, along with the trend to demonstrate increased value for patients and referrers, it seems likely that text only reports will gradually be superseded by multimedia enhanced radiology reports. These combine text and relevant images so that referrers and patients are more easily able to understand our findings.

At the far end of the spectrum of developments afforded by sophisticated algorithms, increasing computer power and perhaps quantum computing, the potential for machine learning is attracting considerable attention.

Confident advocacy for the future potential of artificial intelligence has been present for 40 years and has been particularly active recently. In my opinion substantial short-term impact seems unlikely but in the more distant future radiologists may again need to adapt to disruptive change and find new ways to demonstrate the value they provide to patients and referrers.

The Interest of Other Disciplines One of the challenges that clinical radiology faces is the increasing interest by non-medical disciplines in reading and reporting on imaging studies and even performing imageguided procedures. This interest is often assisted by the limited understanding of others who may view image interpretation as little more than perception of abnormalities.

It is important to remember that clinical radiologists are highly trained specialist doctors and unlike a number

of other non-medical disciplines, have training in anatomy, physiology and pathology with significant experience in clinical medicine in addition to an understanding of imaging techniques and image interpretation.

It is therefore critical that we respond to this challenge and effectively communicate the difference between simple perception of an abnormality and what clinical radiologists actually do.

Specifically, when interpreting images we integrate our image interpretation with our knowledge of medicine, anatomy, pathology, physiology and the clinical

“I believe that focus upon the quality of care we provide our patients and the value we add to care in the eyes of our referrers will be the most significant determinants of our long-term future as clinical radiologists” context to provide an expert medical opinion. The capacity to undertake this process is the source of the added value that clinical radiologists provide when reporting imaging studies or participating in multidisciplinary team meetings. Importantly, such capabilities are usually not within the scope of those who would seek to move into our field and this point is often not clear to decision makers in health care.

The challenge is perhaps even more acute where other medical disciplines express an interest in image interpretation or performance

of image-guided procedures. One of the principal advantages available to clinical radiologists is dedicated training in the full range of imaging techniques and well developed perceptual and interpretive skills. In this context it is also important that radiologists maintain their knowledge at the forefront of areas such as informatics, various imaging modalities and their evolution, contrast media and where appropriate, devices used in interventional radiology.

To demonstrate their value, clinical radiologists should engage positively with other clinicians in settings such as multidisciplinary team meetings where the value of clinical radiology is readily apparent. In the setting of major interventional procedures it is important where possible to see patients before and after therapy and truly act as a clinician managing care in order to compete effectively. At the same time we will need to respond to another challenge and try to manage the tension between reporting workload or workflow pressures and the importance of engaging with our clinical colleagues and patients.

Current Activities and RANZCR Advocacy Targeted and unrelenting advocacy by College office bearers, College staff and active participation by its members is vital to ensure that the interests of members and optimal patient care are well represented in a wide variety of settings. In terms of current significance and activity, the MBS Review is a worthy example. This review is well underway and although it will be some time before outcomes are clear, the College, a significant number of its senior Fellows and the Faculty of Clinical Radiology team, ably led by Mr Mark Nevin and capably supported by Ms Daisy Garling, are making very substantial efforts on behalf of College members. At the same time that we seek to improve the Medicare system in a way that benefits

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Introduction

our patients, government interest will likely persist in new models such as bundled payments and attempts to transition reimbursement from a fee-forservice structure to payments that are increasingly guided by quality related and patient experience metrics. Effective advocacy that demonstrates the role and value of clinical radiologists will be essential in this environment.

A strong position in the interest of patient care and College members has been taken in other areas such as sonographer performance of musculoskeletal injections in Australia and physiotherapist performance of injections in New Zealand. Another important role of the College is to support the practice and expertise of College members by providing guidance and clinically useful information. The recently released Iodinated Contrast Media Guidelines are invaluable and I would like to express gratitude for the outstanding work of all those involved during their development. The College has also been proactive in the Choosing Wisely initiative as an inaugural member in Australia and more recently as an early participant in New Zealand. In view of the significant progress we have made relative to other colleges, we were again invited to participate in the Australian Choosing Wisely second wave media launch to discuss implementation of educational modules and a mobile application that provides free access to evidence-based clinical decision rules at the point of care.

Furthermore, as an entity that sets standards of practice, provides guidance for training, accredits training sites and leads assessment of trainees, the College is well positioned for challenges in the future as we enter the implementation phase following a review of our education and assessment processes.

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Conclusion We face many challenges and only a few of these have been outlined above.

These threats may vary in degree but are relevant to all radiologists in New Zealand and Australia, in public and private sectors and in the rural and metropolitan context. How we respond and the guiding principles we apply when facing these challenges will vary depending on the context in which we find ourselves. While judicious use of technology, being willing to accept change and a responsive approach will be important, I believe that focus upon the quality of care we provide our patients and the value we add to care in the eyes of our referrers will be the most significant determinants of our long-term future as clinical radiologists.

In concluding, I believe there are good reasons to feel optimistic about the future. The quality of our training and skills as Australian and New Zealand clinical radiologists are the envy of many, we have strong and dedicated College staff, office bearers, President, CEO and Councillors, and are fortunate to benefit from the efforts of many members who volunteer to participate in College activities. I look forward to supporting College members as we address various challenges during my term as Dean.

If you have any feedback or comments on any of the above please contact the College on fcr@ranzcr.edu.au Prof John Slavotinek Dean, Faculty of Clinical Radiology

Engaged Members

Join RANZCR on the Gold Coast for the 2016 ASM Registration now open – take advantage of the discounted rates On behalf of the Organising Committee we are excited to welcome you to register for the 2016 ASM to be held on the beautiful Gold Coast from 13–16 October. Please join us for a conference that includes an inspirational list of international speakers who, together with world-class local presenters, will share their vision of modern imaging and radiation therapy.

You can register now at ranzcr2016.com to obtain the discounted early bird registration rates and secure your place in the exciting workshops that are on offer as part of this year’s program. Also, don’t forget to book your place at the social and networking functions that complement the scientific program.

The call for abstracts has now closed with a total of 272 submissions received, comprised of 192 within radiology and 77 in radiation oncology. Successful abstracts will be incorporated into the program along with presentations by the outstanding keynote and invited speakers. The program will reflect the committee’s belief that strong collaboration with clinical colleagues is fundamental to the appropriate and targeted use of modern imaging and radiation therapy to produce the best patient outcomes. To view the program please visit ranzcr2016.com/scientificprogram The highly successful BREAST Workshops will be on offer again in 2016

as well as CPR Workshops. Places are limited, therefore we encourage you to register early to avoid missing out!

Please refer to the meeting website for full details including workshop fees at ranzcr2016.com/workshops.

Radiologists attending the event will enjoy presentations by keynote speakers Dr Russell Fritz, Professor Fiona Gilbert, Professor Meng Law, Dr Claude Sirlin as well as international guest speaker Associate Professor Mahesh Thapa.

These will stand alongside a large list of outstanding national presenters.

Highlights of the radiation oncology program will include presentations from keynote speakers Dr Silvia Formenti, Dr Colleen Lawton and Professor William Mendenhall. The exciting program will also feature presentations from the current ESTRO President Professor Yolande Lievens, interventional radiologist Professor Andy Adam and a host of invited national presenters. Program sessions will focus on the management of head and neck, genitourinary and breast cancers, as well as the emerging role of immunotherapies used in combination with radiation therapy.

The social program is shaping up to be an excellent opportunity to catch up with old friends and network with new industry colleagues at the numerous social functions. Keeping within the glitz and glamour of the Gold Coast,

the theme for the Gala Dinner this year is ‘A touch of bling’, with delegates encouraged to come dressed to impress!

For those looking to keep fit while at the conference, the Targeting Cancer Fun Run is on the Saturday morning starting at Pratten Park Broadbeach at 6 am. The cost to participate is $30.00 including GST per person, and is open to delegates and guests of delegates (colleagues, family, friends, etc.). You can register for the fun run when completing your conference registration.

For all the latest updates and hot-offthe-press information on the ASM, don’t forget to follow the College on Facebook, Twitter and LinkedIn using #RANZCR2016, #RADgold or visit the meeting website ranzcr2016.com for more information. We look forward to welcoming all radiologists and radiation oncologists to the sunny Gold Coast in October.

Dr Jonathan Corness Dr Sanjay Dhupelia Radiology Co-Convenors

Dr Catherine Bettington Dr Jim Jackson Radiation Oncology Co-Convenors

MODERN IMAGING AND RADIATION THERAPY: RANZCR 2016

APPROPRIATE, COLLABORATIVE AND TARGETED

67th ANNUAL SCIENTIFIC MEETING | GOLD COAST, AUSTRALIA | 13 – 16 OCTOBER 2016

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Engaged Members

Dr Ziad Thotathil Radiation Oncologist, Waikato Hospital Member of the Post Fellowship Education Committee, Annual Scientific Meeting Management Committee and the Faculty of Radiation Oncology New Zealand Executive Committee

Dr Ziad Thotathil

Background I am a radiation oncologist at the Regional Cancer Centre, Waikato Hospital in Hamilton, New Zealand.

I completed my oncology specialty training in India, working in regional cancer centres in Bangalore and Mumbai. I then moved to Kuwait to join the team at the Kuwait Cancer Control Centre.

I landed in Hamilton, New Zealand, in 2005 to take up an advanced trainee position in medical oncology at the Waikato Hospital, as part of my training towards the Fellowship of The Royal College of Radiologists in Clinical Oncology. I joined the Department of Radiation Oncology as a radiation oncologist in 2007 and have been there ever since. My subspecialty interests include CNS, lung and gynaecology.

I also have an interest in research, although it is difficult to pursue this when working in a very busy public hospital.

Why I Am Involved It would read better if I said that I had a dream that inspired me to take up a position on one of the College committees. But that’s not what happened. As the cliché goes, I was tapped on the shoulder a few years ago by Dr Carol Johnson, New Zealand Councillor on the Faculty of Radiation Oncology Council, and asked if I wanted to take up the vacant New Zealand representative position on the Post Fellowship Education Committee (PFEC). I turned to her in bemusement

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Inside News

as I was not a ‘Fellow’ of the College.

How could I possibly contribute to the post-fellowship committee? Not having trained locally, I was referred to as an ‘educational affiliate’ member of the College.

After some enquiries that confirmed my eligibility, I was accepted. The post had been vacated by a senior New Zealand member and I knew I had big shoes to fill. However, I must say that my

“I turned to her in bemusement as I was not a ‘Fellow’ of the College. How could I possibly contribute to the post-fellowship committee?” introduction to the administrative side of the College did not feel daunting at all and I am grateful for the support I received from the College staff and the PFEC Chair. The membership of the PFEC was quite varied, and I felt that I could make a contribution as an ‘outsider’. As a member of a College committee, I was co-opted to the RANZCR New Zealand Executive Group. I am also the PFEC nominee on the Annual Scientific Meeting (ASM) Management Committee that offers support to the local ASM organising committees.

One of the big projects that the PFEC

has worked on recently is related to the issue of revalidation. This subject has caught the attention of the regulatory bodies both in New Zealand and Australia, and the College believes that it is in the best interest of the membership to take a proactive role in determining our approach to this concept. We have looked at revalidation systems around the world and decided to adopt some aspects that would work here. The results of this work are visible in the latest version of the continuing professional development program.

We look forward to receiving member feedback on this, as that will influence how we take this forward.

I was introduced to the College in 2007 when I attended the assessment interview required for all IMGs. In 2012, I became a member of a College committee. A meteoric rise indeed!

I felt honoured to have been granted the opportunity, and would like to think that I have made some contribution.

Perhaps it was the ‘external’ viewpoint that helped. But what I learned is that the College welcomes everyone working in the radiology and radiation oncology fields in Australasia.

Encouragement to Others There are challenges that lay ahead for our specialties. Not only increased workload, but also likely increased scrutiny for medical practitioners from the authorities and the public. Many hands make light work as the saying goes, and I invite more members to give their time to the College for the satisfaction it can bring.

Engaged Members

A/Prof Tom Shakespeare Associate Professor, University of New South Wales Rural Clinical School; Senior Radiation Oncologist, Port Macquarie, Coffs Harbour and Lismore Base Hospitals; Director of Radiation Oncology, Mid North Coast Cancer Institute and North Coast Cancer Institute; Director of Cancer Services Mid North Coast and Northern NSW Local Health Districts

A/Prof Tom Shakespeare

Elected Fellow on the Faculty of Radiation Oncology Council

Background

“One of the things I hope to bring to the Faculty Council is an understanding of the challenges faced by the many radiation oncologists working in small units, in both rural/regional and metropolitan settings.”

I have had the fantastic opportunity to work as a radiation oncologist in major tertiary referral hospitals in Sydney, help build and staff radiotherapy units in Singapore, and help build, staff and now oversee the three public integrated cancer centres in Port Macquarie, Coffs Harbour and Lismore (in rural NSW).

I have worked in both public and private practice, and have had the amazing experience of auditing radiotherapy facilities of countries in Asia and South America for the International Atomic Energy Agency, as well as auditing regional and metropolitan centres as part of the Australian Single Machine Unit Trial evaluation.

The portfolios I have held in the departments I have worked in include Director of Training, Head of Quality, Head of Research, and now Director of Cancer Services for the Mid North Coast and Northern Rivers of NSW. I have been a generalist (when I was the only radiation oncologist in Western Singapore, servicing a population of two million with a single linac!), and over time subspecialised to my current sites of urogenital and breast. Some of the most fulfilling work I have ever done though, is via the 15-year-old sister-site relationships we have formed with the Department of Radiation Oncology at Cho Ray Hospital, Vietnam. An hour spent educating the staff there cascades to benefit thousands of patients a year, and the thanks from the Vietnamese radiation oncologists and their staff is simply overwhelming.

My involvement with the College over the years has reflected my portfolios and passions. I have been on various committees including the PostFellowship Education Committee, Quality Improvement Committee, the Asia-Pacific Radiation Oncology Special Interest Group and Faculty of Radiation Oncology Genitourinary Group. When I was asked if I would like to nominate for the Faculty Council I was honoured, but I also experienced some trepidation.

My fear related to how I would fulfil this role adequately given my other roles, my involvement in the other dozen or so committees I am on (including the Cancer Institute NSW, EviQ and within our Local Health District), as well as just having commenced a PhD (in prostate cancer outcomes). After much contemplation I agreed, as I hoped I could bring a balanced contribution to the varied issues the Faculty currently faces.

Why I Am Involved One of the things I hope to bring to the Faculty Council is an understanding of the challenges faced by the many radiation oncologists working in small units, in both rural/regional and metropolitan settings. Without working in these settings, particularly living in a small rural town, it is difficult to fully comprehend the difficulties with staffing and operating these centres, as well as conducting research and training.

These challenges can be overcome with innovative approaches which I hope to share, including telehealth, the comprehensive use of electronic medical

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Engaged Members

records, role innovation, and networking with larger centres.

Another area of experience I hope to bring to the Council is a broader international perspective. Although we will always need to advocate for better local resources, we are truly blessed with world-class radiotherapy facilities in Australia, New Zealand and Singapore.

I hope to encourage the Faculty to support and enhance ongoing efforts in our less developed neighbouring countries to improve radiation oncology facilities and training. My view is that we are an international community, and our responsibilities do not stop at our own borders.

Finally, I would also like to see radiation oncology increase its profile among other specialties and among general practice and the public. For some reason we always seem to be the poor cousin to our surgical (and sometimes medical oncology) colleagues, despite having the most technologically advanced treatments available in medicine. We face great challenges in increasing our public profile and it is reassuring to see efforts such as Targeting Cancer starting to address this.

Encouragement to Others Our College is a key supporter of every aspect of our practice, whether it be patient care, advocacy, research, education or quality initiatives. This is only possible through the incredible support provided by volunteers for the many committees within the College and our Faculty. I am sure many radiation oncologists consider themselves too junior to put their hand up for these committees or perhaps assume they have nothing to offer.

Nothing could be further from the truth: our Faculty represents each and every radiation oncologist, and our voices are vital to its ongoing success. I would encourage each and every radiation oncologist, no matter how junior or busy, to consider how they might play a role in our success!

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Inside News

28% of Members Complete Member Engagement Survey Earlier this year we asked you to share your thoughts about your profession and the way the College supports it by taking part in the College’s inaugural member engagement survey. We were delighted with the level of response, with over 1,100 members completing the survey.

We would like to thank all the members who took the time to participate. Your insights will be instrumental in directing future College activities and will help us to more effectively support your needs.

The survey results will be shared with members in the next edition of Inside News.

“I think it is a great initiative from the College & will benefit the profession.” ~ RANZCR member

Engaged Members

Dr Meredith Thomas Consultant Radiologist at Royal Adelaide Hospital

Dr Meredith Thomas

Background I came to radiology by an unconventional pathway after having spent 14 years in clinical medicine, initially in surgical training, followed by emergency medicine. I had also worked in general practice and as a cardiac medical officer in the private sector.

With this broad clinical background I ambitiously undertook radiology training in my late 30s with a young and growing family, demonstrating that with enough resolve (and a supportive family), anything is possible. I have never regretted that decision, and I have never missed clinical medicine.

Following training, I followed my passions of obstetrics and gynaecology and emergency and trauma imaging, undertaking Fellowships in women’s imaging and MRI, before accepting consultant positions at the Royal Adelaide Hospital (RAH) and the Women’s and Children’s Hospital in Adelaide.

When I accepted the role of Director of Training at RAH, the new curriculum had recently been introduced, there were many new acronyms (TATS, DOPS, CATs, MSF, IPX) and I spent many hours poring over the ‘Blue Book’ trying to understand the curriculum and its assessment tools. The more I read, the more I felt a need to become involved with the College that had enabled my specialist training.

Since that time I have become increasingly engaged with the

Chair Curriculum Advisory Committee, Network Training Director South Australian Radiology Training Network, Lead Examiner Obstetrics and Gynaecology, Committee Member Clinical Radiology Education and Training Committee, Committee Member Clinical Radiology Examination Review Panel, Executive Member Australian and New Zealand Emergency Radiology Group

educational pillar of the College, particularly in relation to curriculum, and in relation to the implementation of network training, being a member of the Network Training Steering Committee, the Radiology Network Training Policy Committee, and the more recent Network Accreditation Standards Working Group. I have been an examiner in obstetrics and gynaecology for some years and I am a Lead Examiner in this field, being a member of the hard-working Clinical Radiology Examination Review Panel.

With a particular interest in curriculum, I joined the Clinical Radiology Curriculum Advisory Committee several years ago, and I am privileged to have recently been elected Chair. With my background in emergency medicine I am also proud to be a founding member of the recently formed College special interest group, the Australia and New Zealand Emergency Radiology Group.

Why I Am Involved As radiologists we are doubly privileged, having been professionally trained initially as doctors, and subsequently as radiologists. We have opportunities for employment, usually in a geographical location and in a work environment of our choosing. We can be generalists or, increasingly, we can subspecialise.

We are well remunerated, and we often have opportunities for travel. In this environment I felt an obligation to offer my time and commitment to the College that had trained me in radiology, and more recently, to the university where

I completed my medical training. I am committed to ensuring the highest training standards are maintained through our curriculum, and through anticipated strengthening of our training and assessment processes following the recent ACER Prideaux Examination and Assessment Review.

Encouragement to Others Ultimately the time and energy I commit to the educational pillar of the College is to benefit the trainees. As a specialty training college, we are attracting high achieving and ambitious medical graduates, and these trainees are the College’s greatest assets going forward.

Personally I have gained a great deal; I have been privileged to work alongside many clever and dedicated Fellows and members of the College secretariat, and I have met many wonderful trainees whose contributions to the various College committees are invaluable.

There will be ongoing evolution of training and assessment processes in coming years, and it is an exciting time for Fellows with an interest and passion for education to become involved. The recent review of College committees and their governance and terms of reference will ensure opportunities for new Fellows to serve on these committees, and there are opportunities for involvement through local Branches and Networks, as examiners, or as Directors or Supervisors of Training.

Volume 12 No 3 I June 2016

13

Hepatobiliary contrast agent for MRI¹ Primovist® – enhanced MRI facilitates the differentiation of Focal Nodular Hyperplasia (FNH) from Hepatocellular Adenoma (HCA)2

MINIMUM PRODUCT INFORMATION PRIMOVIST® [disodium gadoxetate 0.25 mmol/mL] INDICATIONS: Enhancement of magnetic resonance imaging (MRI) of focal liver lesions in adults. CONTRAINDICATIONS: known hypersensitivity to disodium gadoxetate or any of the excipients. PRECAUTIONS: Impaired renal function and liver transplant patients (see boxed warnings); impaired hepatic function; anaphylactoid/hypersensitivity or other idiosyncratic reactions (higher risk in the case of previous reaction to contrast media, history of bronchial asthma, history of allergic disorders); intramuscular administration; severe cardiovascular disease; risk factors for arrhythmias; not recommended in children below 18 years of age; pregnancy (Category B3). INTERACTIONS WITH OTHER MEDICINES: rifampicin; interference with diagnostic tests (serum iron). ADVERSE EFFECTS: common: headache; nausea. Please refer to PI for a complete list. BOXED WARNINGS: NEPHROGENIC SYSTEMIC FIBROSIS: Gadolinium-based contrast agents increase the risk of nephrogenic systemic fibrosis (NSF) in patients with: acute or chronic severe renal insufficiency (glomerular filtration rate <30 mL/min/1.73m2; or acute renal insufficiency of any severity due to the hepato-renal syndrome or in the perioperative liver transplantation period. DOSAGE AND ADMINISTRATION: 0.1 mL/kg body weight given as an intravenous injection at a flow rate of about 2 mL/sec. DATE OF PREPARATION: May 2012.

Please review the full Product Information before administering. Approved PI available at http://www.bayerresources.com.au/resources/uploads/PI/file9412.pdf or upon request from Bayer Australia Ltd. ABN 22 000 138 714, 875 Pacific Highway, Pymble NSW 2073. ® Registered trademark of the Bayer Group, Germany. L.AU.MKT.DI.03.2016.0073 March 2016 Reference: 1. Australian approved product information: 3 September 2015. 2. Grazioli L, Bondioni MP et at. Hepatocellular Adenoma and Focal Nodular Hyperplasia: Value of Gadoxetic Acid - enhanced MR Imaging in Differential Diagnosis. Radiology: Vol 262: Number 2 – February 2012.

Research

A Career in Research – Prof Jim Denham OAM chemo-radiation in oesophageal cancer.

He went on to receive his RANZCR Fellowship in 1986 and continued his research interests at the Mater Hospital (Newcastle) in 1987 as its Director of Radiation Oncology. For these efforts Prof Denham was awarded his Conjoint Professorship title by the University of Newcastle in 1992.

Prof Jim Denham OAM

Prof Denham was awarded a Medal of the Order of Australia in the 2016 Australia Day Honours for service to medicine, and to medical research.

Prof Jim Denham’s main research field is clinical oncology, in particular the design and conduct of multicentre clinical trials involving radiotherapy, treatment delivery and radiation toxicity.

Prof Denham’s research career began in London with a thesis addressing the natural history of the Follicular Non-Hodgkin’s Lymphomas. For this he received his MD diploma in 1984 from the University of London and was equipped with the necessary scientific temperament and skills to pursue a lifelong clinical research career.

After moving to the Royal Adelaide Hospital, he continued his interest in clinical research with pilot studies of

Jim Denham played an important role in establishing Australia and New Zealand’s (ANZ) multicentre trials group, now known as the Trans Tasman Radiation Oncology Group (TROG). He became its first President from 1994 to 2000 and oversaw its initial growth phase. Over its first 25 years, TROG had conducted 21 Phase 2 trials and 26 randomised controlled Phase 3 trials (nine involving international collaborations).

Prof Denham and his longstanding colleagues played a major role in the design and direction of ANZ’s two largest cancer trials. These were for men with locally advanced prostate cancer.

The TROG 96.01 trial enrolled 818 subjects between 1996 and 2000 and reported its findings in 23 publications.

The TROG 03.04 (RADAR) trial enrolled 1,071 subjects between 2003 and 2007 and to date has 25 publications. Both trials demonstrated that statistically significant improvements in cancer related outcomes could be achieved without clinically important increases in treatment-related morbidity.

Prof Denham’s publications include over 200 articles. His lifetime research funding amounts to $10.3M from national competitive sources (including 15 NHMRC project grants), $7.7M from industry and $1.3M from institutional sources. His research activities were recognised locally in 2006 with the Hunter Medical Research Institute Sparke-Helmore Award for Research

Excellence, and in Europe in 2007 with honorary membership of ESTRO. In 2013, the University of New England awarded him the title of Honorary Professor.

In 2005, NSW Cancer Registry data indicated that the Hunter had NSW’s highest prostate cancer mortality rate.

Together with community groups, Prof Denham worked to improve awareness and over 18 months this campaign succeeded in lifting the Hunter’s detection rate from the lowest in NSW to the highest! In 2013 he was recognised for these and other community based efforts with a NSW Government Community Service Award.

Tip for Trainees Trainees with an interest in research should remember that medicine is still in its infancy and that we know much less than we actually know.

Research topics are therefore easy to find.

Prof Denham’s most important tip is to consider the sample size issue very carefully when designing a new research project. If there are not going to be enough events then another project must be selected.

Volume 12 No 3 I June 2016

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Research

RANZCR Research Grants in Action The College offers grant funding to support radiology and radiation oncology research projects. In 2013, I was fortunate enough to receive funding for a project titled, ‘Comprehensive non-contrast-enhanced MRA evaluation of peripheral arterial disease in Type 2 diabetes’.

Type 2 diabetes is increasing in prevalence due to the global obesity epidemic, and peripheral vascular disease (PVD) is a common complication. PVD contributes to diabetic foot ulceration, which limits patient mobility and can lead to limb loss and ultimately death in severe cases. Imaging the lower limb arteries is vital in the management of diabetic patients with PVD, to assess the location and severity of narrowing, plan for surgical bypass or endovascular revascularisation, and to identify patients who might be best managed conservatively, potentially saving them from an invasive diagnostic angiogram.

Contrast-enhanced CTA is fast and comprehensive, and is commonly used to image PVD. However, it can be challenging in diabetic patients where renal impairment is common, making potentially nephrotoxic iodinated contrast agents undesirable. PVD manifests as calcified plaque and affects the vessels below the knee in diabetic patients, rendering CT assessment difficult. Magnetic resonance angiography (MRA) offers a radiation free alternative, and a number of noncontrast-enhanced MRA techniques have recently been developed in response to concerns about the toxicity of gadolinium-based contrast agents.

The main aim of the project was to assess the accuracy of one such noncontrast MRA method in Type 2 diabetic patients presenting with symptomatic peripheral arterial disease, comparing it to the gold standard, digital subtraction

16

Inside News

angiography (DSA).

There were a number of secondary questions, including determining how confident two radiologists were at interpreting the images, how reliable the test was if looked at by different readers, and how acceptable the non-contrast MRA was to patients.

Over 18 months, we recruited 30 patients planned for diagnostic or therapeutic DSA, who were imaged with a non-contrast MRA prior to DSA. Patients were also surveyed on their MRA and DSA experience after each examination.

Our results were interesting. 28 patients completed the study—one could not fit completely within the MRI due to morbid obesity, and one patient could not complete the MRA due to discomfort. Overall, the non-contrast MRA was most accurate in assessing the iliac and femoral vessels, with accuracy decreasing for the more distal vessels, particularly the pedal arteries.

However, readers felt more confident in assessing the calf arteries with MRA than with DSA, highlighting some of the challenges of DSA, where the distal vessels can be difficult to visualise due to technical or patient factors. They were least confident in interpreting imaging of the feet, where vessels are small and motion is common. As might be expected, patients reported less overall pain and anxiety with MRA compared with DSA. Results from different facets of the project have been presented to our peers at the Radiological Society of North America, the International Society for Magnetic Resonance in Medicine,

the Asian Society for Cardiovascular Imaging, and shared with our vascular surgery colleagues at the Australian and New Zealand Society for Vascular Imaging, with one manuscript submitted and a second one in preparation.

Research is at times challenging and results not something that are achieved overnight. It is undoubtedly a team effort, involving nursing, administrative, radiography and medical staff. Not to mention patients who kindly give their time for the promise of improved care for future patients. However, it is a potentially educational and extremely rewarding experience—apart from myself, this project also provided trainees with invaluable research experience, of vital importance to the future of our discipline.

This project would not have been possible without the support of my department and the College. I would encourage anyone with an interesting idea to take advantage of the opportunity a research grant offers.

A/Prof Ruth Lim Austin Health

Profile and Presence No, none of it 2% Yes, some of it 32%

Word on the Web

Yes, all of it 66%

®

What are users saying about InsideRadiology?

InsideRadiology (insideradiology.com. au) is a multidisciplinary, evidence-based resource developed and managed by RANZCR. It has been online since 2009 and covers close to 100 topics, with specific information targeted at both consumers and referring clinicians for most items.

As part of the ongoing development process, users are asked to undertake a short survey based on their experience of using the website and resources.

This is a voluntary exercise, but one that provides the InsideRadiology team with valuable insight into what the end users are seeking from the website.

‘Explained in plain uncomplicated medical terms that are easily understood.’

P romoting InsideRadiology in your professional networks.

Supplementing your hospital or practice resources using links to InsideRadiology.

Recommending any topics

Unsure 14%

Unlikely/Very Unlikely 4%

Likely/Very Likely 82%

WHO ARE THE USERS?

63%

Consumers

Volunteering to assist with

20%

Health Professionals

17%

No Response

that could be considered for inclusion.

▲

‘When facing a confusing medical condition, having an easily accessible website to answer questions is great.

Thank you. My question was answered in detail and I’m feeling much better based on what I learned here.’

WHAT IS THE LIKELIHOOD THAT YOU WILL VISITYes THE 95% WEBSITE AGAIN?

Get involved with InsideRadiology by:

▲

‘I was looking for specific information to answer a personal query, which I found quickly and which was presented in an easy to understand yet authoritative and reassuring manner.’

Not sure 4%

‘The information [is] well laid out and very easy to understand without much medical jargon. Well done and thank you.’

▲

Two-thirds of survey respondents identify as health consumers, and a further 20 per cent as health professionals. A mix of responses have been received, including constructive feedback, which has been used to inform website development. The majority of visitors (98 per cent) report that they have found the information they were seeking and, of those that have, 95 per cent have found it useful.

‘I was looking for an in depth explanation to help my understanding of the treatment. This does it very nicely. Thanks!’

▲

The optional survey has had in excess of 1,000 responses in the 2016 calendar year to date (Jan–Apr), and approximately 9,000 since the survey was introduced in early 2011.

‘Thank you for your web site. I am having a nuclear stress test on Monday.

I was frightened of the side effects but this eased my fear after reading from your site. Very helpful and professional.’

No 1%

content.

With over 80 per cent of survey respondents reporting that they are likely or very likely to return to the website, InsideRadiology appears to be meeting the needs of its target audience.

For more information on InsideRadiology visit insideradiology.com.au or contact the Project Officer, Quality and Safety at the College on quality@ranzcr.edu.au or +61 2 9268 9741.

Volume 12 No 3 I June 2016

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MODERN IMAGING AND RADIATION THERAPY: APPROPRIATE, COLLABORATIVE AND TARGETED 67th ANNUAL SCIENTIFIC MEETING | GOLD COAST, AUSTRALIA

KEYNOTE SPEAKERS Radiology

Radiation Oncology Dr Silvia Formenti New York Presbyterian Hospital New York, USA

Professor Fiona Gilbert Cambridge University Hospitals Cambridge, UK

Professor William Mendenhall University of Florida Florida, USA

Dr Claude Sirlin University of California San Diego, USA

ranzcr2016.com

Registrations Now Open!

Dr Russell Fritz National Orthopedic Imaging Associates San Francisco, USA

Professor Meng Law University of Southern California Los Angeles, USA

RANZCR 2016

Dr Colleen Lawton Medical College of Wisconsin Wisconsin, USA

Details published are correct at the time of design and are subject to change without notice.

For up to date information please visit ranzcr2016.com

Earlybird deadline Friday 7 July.

Workshops are now available to book via your registration.

Register quick to avoid missing out.

Preliminary program is now available!

For further information on registration, workshops and the program – please visit the Meeting website www.ranzcr2016.com

INTERESTED IN SPONSORING AND/OR EXHIBITING? Contact Helen McGowan at Helen@wsm.com.au or +61 3 9645 6311

13 – 16 OCTOBER 2016 GOLD COAST CONVENTION & EXHIBITION CENTRE ranzcr2016.com

Profile and Presence

Targeting Cancer Raises the Profile of Radiation Oncology First Documentary about Radiation Therapy

Congratulations to Dr Peter Goryski whose abstract ‘Targeting Cancer: Results of a National Radiation Oncology Advocacy Platform aimed at General Practitioners (GPs) and Consumers’ has been accepted for an oral presentation at GP 16—the annual scientific meeting of The Royal Australian College of General Practitioners, which is being held at the Perth Convention and Exhibition Centre from 29 September to 1 October 2016.

This is a great opportunity to reach out to a larger GP community and improve their knowledge of radiation therapy.

Targets in GP Waiting Rooms You may recall that late last year Targeting Cancer entered into a partnership with Tonic Health Media (THM), an evidence-based patient education and entertainment system for GPs, other clinicians and hospital waiting areas. The aim of this project was to direct more people to our website and encourage more conversations between patients and GPs on whether radiation therapy is a suitable treatment option.

Throughout November 2015, February and March 2016, The Targets video was played 55,524 times in waiting rooms across Australia on the THM Networks across 954 sites from where over 5,300 GPs operate. It is estimated that the video has reached an audience of over 3.6 million people.

Earlier in the year, we worked in collaboration with THM to produce a documentary called Below the Radar.

This first documentary about radiation therapy was broadcast on ABC News24 on 6 and 7 February, and was viewed by more than 92,000 people, and on ABCTV iView 24,400 times.

Please visit www.targetingcancer.com.au or www.targetingcancer.co.nz to watch the videos and share within your network to spread the word on radiation therapy.

ESTRO 2016 Dr Lucinda Morris (radiation oncology trainee) showcased the Targeting Cancer GP Education program at ESTRO 35 which was held in Turin, Italy between 29 April and 3 May. Lucinda’s presentation, ‘Targeting General Practitioners: Prospective Outcomes of Nationwide GP Education Program’ reported on the learning outcomes of a national education program aimed at improving GP knowledge about radiation therapy and referral pathways to radiation oncologists.

The GP education evenings, an initiative of the Targeting Cancer public awareness campaign, were developed and launched in 2014. The two-hour sessions were held in radiation oncology departments and consisted of an interactive case-based learning session, followed by a guided physical tour of the radiation oncology department.

Pre and post session surveys were administered to 174 participating GPs at 18 sessions held at different centres across Australia.

The survey assessed four key domains: objective knowledge about radiation therapy, satisfaction regarding referral

pathways to radiation oncologists, self-reported referral behaviours and feedback on the session itself.

Of note, prior to attending 96 per cent of GPs reported their knowledge of radiation therapy required improvement.

Post-session 95 per cent rated their knowledge as ‘excellent’, ‘above average’ or ‘competent’. The proportion of GPs correctly answering objective knowledge questions rose from 50 per cent to 82 per cent.

96 per cent felt it was the GPs’ role to refer cancer patients to relevant specialists to discuss treatment options.

However before the session nearly half the GPs indicated they were not comfortable referring directly to a radiation oncologist. Following the session 92 per cent felt they would be comfortable referring directly to a radiation oncologist. Overall, more than one-third of GPs were not aware of the location of their local radiation oncology department and three-quarters reported their patients would benefit from having clearer referral pathways to radiation oncologists.

100 per cent of respondents felt the session improved their understanding of the role of radiation therapy and would recommend the session to colleagues, and all were interested in attending similar future sessions. Dr Morris and co-authors A/Prof Sandra Turner and Dr Peter Gorayski concluded that a national standardised GP education program can significantly improve GP knowledge of the core radiation therapy concepts and likely influence patient referrals for radiation therapy.

If you are interested in hosting a GP Oncology Education Evening, please contact us on faculty@ranzcr.edu.au

continued over...

Volume 12 No 3 I June 2016

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Profile and Presence

City to Surf – Registrations Now Open Do you want to challenge yourself and have fun while promoting radiation therapy and Targeting Cancer? The 2016 City2Surf will be held on Sunday, 14 August 2016 and we are looking for participants to join our team. Ms Julie McCrossin, our ambassador, will be walking with us.

Dr Najmun Nahar – radiation oncologist, Stephen Bali – Blacktown Mayor, and Olympian Jana Pittman

Help us spread the word to colleagues, family, friends and patients. All are welcome to join the team. To register visit http://tinyurl.com/City2SurfTC For further event details visit www.city2surf.com.au

Targeting Cancer Fun Run at College 2016 ASM Following the successful inaugural Targeting Cancer fun run at RANZCR 2015 ASM, the event will be held again at this year’s annual scientific meeting on the Gold Coast. We look forward to seeing many more participants supporting this exciting and highly anticipated event.

The fun run will be held on Saturday 15 October and is open to delegates and their guests (colleagues, family, friends, patients). For further details and to register visit www.ranzcr2016.com/ social-networking-program/

Blacktown Mayor Launches Targeting Cancer GP Education Evening Blacktown Mayor Stephen Bali visited the newly opened Blacktown Hospital on Wednesday 25 May 2016 to launch the Targeting Cancer campaign GP Oncology Education Evening.

More than 20 GPs from around western Sydney attended the session, which provided them with a face-to-face opportunity to discuss cancer management issues, in particular the role of radiation therapy in everyday general practice.

Olympian and Western Sydney University medical student, Jana Pittman, was also at the event to lend her support.

Volunteer radiation oncologists and healthcare professionals were on hand to present an

20

Inside News

interactive program that included a presentation covering the basic principles of radiation therapy followed by two clinical cases. The session proved popular, with the GPs becoming very engaged in discussions about common case scenarios.

The GPs were also given a tour of the hospital’s brand new radiation oncology clinic which displayed the sophisticated technology and modern radiation machines that are used to treat cancer.

The opening of the radiation oncology clinic at Blacktown Hospital in April means that for the first time, cancer patients will be able to have radiation therapy at Blacktown, avoiding the need to travel too far for this treatment.

Access to Quality Services

Choosing Wisely Australia: The Next Wave Event Launch

Targeting Cancer ambassador, Julie McCrossin, was emcee for the launch

The Next Wave launch provided an opportunity for colleagues and peers to hear about the progress of this major healthcare initiative.

On 16 March, NPS MedicineWise launched the next wave of Choosing Wisely recommendations. The College was invited to the event, where the Faculty of Clinical Radiology promoted its work in supporting implementation of the initiative at the front line.

The College was an inaugural member of Choosing Wisely in Australia and is

therefore one of the founding medical specialist Colleges.

The Faculty of Clinical Radiology’s six recommendations of medical tests, treatment and procedures clinicians and consumers should question, were launched at the first Choosing Wisely Australia launch in April 2015.

Peak medical colleges, societies and associations also announced 61 recommendations of tests, treatments and procedures that may not be necessary and could cause harm to Australian patients.

Not all tests, treatments and procedures are in the best interests of the patient.

The goal of Choosing Wisely Australia is to start conversations between consumers and clinicians about unnecessary tests, treatments and procedures; enhancing the quality of care; and where appropriate, reducing unnecessary care. continued over...

Volume 12 No 3 I June 2016

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Access to Quality Services

On behalf of the Faculty of Clinical Radiology, the Dean, Prof John Slavotinek, CEO, Natalia Vukolova, and Senior Executive Officer, Mark Nevin, attended the launch and were pleased to see that the Choosing Wisely Australia campaign has broadened to include an additional 14 Australian colleges, societies and associations.

Participants responding enthusiastically at the Next Wave launch

The event was a fantastic opportunity for the College to promote and receive positive feedback on the College’s Educational Modules for Appropriate Imaging Referrals and the Imaging Clinical Decisions Rules (CDRs) app that supports the modules.

It was great to see the many health professionals and consumer advocates leading conversations about appropriate imaging and health care during the Next Wave launch and that other colleges and societies were echoing many of our College’s recommendations.

At the event, Faculty of Clinical Radiology Dean, Prof John Slavotinek, talked about the progress the College has made since it signed on to the campaign 12 months ago.

He highlighted the rapid increase in the number and complexity of medical imaging tests and outlined the efforts of the College to improve the appropriate use of imaging and ensure that resources are used as effectively as possible.

The Faculty of Radiation Oncology has finalised its five recommendations and these will be submitted as part of a future wave of the Choosing Wisely initiative.

Videos from the launch are available at www.choosingwisely.org.au/resources/ videos.

22

Inside News

Choosing Wisely Australia Focused on high quality care, Choosing Wisely Australia is led by Australia’s medical colleges and societies and facilitated by NPS MedicineWise.

Choosing Wisely Australia is part of a global movement to improve health care. It began overseas in 2012, when the American Board of Internal Medicine Foundation, Consumer Reports, and nine medical specialty societies launched the Choosing Wisely campaign.

The response far exceeded expectations and the Choosing Wisely initiative has spread to over 15 countries, including Australia, and hundreds of evidence-based recommendations have been translated into consumer-friendly language and used by tens of millions of consumers.

The initiative enables clinicians, consumers and healthcare stakeholders to start important conversations about tests, treatments and procedures where evidence shows they provide no benefit and in some cases, may lead to harm.

Quality Practice

Peer Review – A Learning Opportunity Not To Be Missed

Radiologists are required to provide diagnostic support in a timely manner to help improve the care of patients. On occasion, due to error or the subsequent presence of additional information, retrospective review may lead to a differing opinion than that expressed in the original report. Systems that minimise the risk of error, and a system to help minimise repetitive error, have the potential to improve the quality and safety of the medical imaging services we deliver.

Peer review meetings have become a compulsory part of continuing professional development and revalidation within the UK. The Royal College of Radiologists formally proposed peer review meetings in 20011, and subsequently produced educational and governance objectives in 20072 and have since published Quality assurance in radiology reporting: peer feedback in 20143. This publication proposed that “all departments should aim to implement systematic review of 5% of reports by 2018”.3 In the UK, the name of the meetings has recently changed to Learning from Discrepancies Meetings (LDMs) to reflect the main focus of the meeting.

The opportunity for peer review may occur through three avenues: during routine work (reporting/MDT preparation); as part of a systematic review of reports, wherein a radiologist will be given a number of cases to review per month; or following review by a medical practitioner from another speciality.

A system should be devised to allow a discrepancy that one would not want to occur in future to be fed back to the original reporter. A regular departmental meeting can then provide the medium to share these learnings. To set up such a meeting, several principles need consideration:

1. The environment needs to be nonthreatening and non-judgemental.

The key to this is to run an anonymous meeting, with patient identifiers, referring clinician and reporting doctor not disclosed. The meeting should not be a test for observers, but rather a vehicle for case discussion in the hope that the learning episode will decrease the chance of the same error occurring again. Calculating error rates and the use of grading systems have been shown to be counter-productive and are not recommended.4,5

As medical specialists, we are always striving to improve patient care through technological innovation and research.

Learning from our mistakes is crucial to improve patient safety.

Dr Simon Prowse

2. Following the meeting, a short PowerPoint presentation could be made with screenshots to email to all those in attendance, and those that were not able to attend, to summarise the learning points.

3. By involving as many as possible, rather than just individuals we are striving to improve performance via the modern approach to the performance curve.6 The major impediment to implementation of a routine peer review /discrepancy meeting system is the time involved in setting up a discrepancy notification system and organising the materials for the meeting. Without administrative support and a team effort, such meetings can easily lose momentum over time. A novel method of peer review has recently been trialled in the UK of loading cases for review onto a database. Radiologists were given a three-week period to review the cases. This method showed significantly higher participation than traditional discrepancy review meetings and also elicited positive feedback.7

References 1. To err is human: the case for review of reporting discrepancies. The Royal College of Radiologists, 2001.

2. Standards for Radiology Discrepancy Meetings. London: The Royal College of Radiologists, 2007.

3. Standards for Learning from Discrepancy meetings, London: The Royal College of Radiologists, 2014.

4. Eisenberg RL, Cunningham ML, Siewert B, Kruskal JB. Survey of faculty perceptions regarding a peer review system. J Am Coll Radiol. 2014 Apr;11(4):397-401. Epub 2013.

5. Prowse SJ1, Pinkey B, Etherington R. Discrepancies in discrepancy meetings: results of the UK national discrepancy meeting survey.

Clin Radiol. 2014 Jan;69(1):18-22.

6. Larson DB1, Nance JJ. Rethinking peer review: what aviation can teach radiology about performance improvement. Radiology 2011 Jun;259(3):626-32.

7. Carlton Jones AL, Roddie ME. Implementation of a virtual learning from discrepancy meeting: a method to improve attendance and facilitate shared learning from radiological error. Clin Radiol. 2016 Feb 27 (epub ahead of print).

Volume 12 No 3 I June 2016

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Quality Practice

Radiation Oncology Practice Standards Update

The Faculty of Radiation Oncology recognises the important role that practice standards play in supporting the delivery of safe and high-quality radiation oncology services. We are duly proud of the Radiation Oncology Practice Standards (the Standards) which were published in 2011 as a Tripartite initiative.

It has always been our goal that the Standards be comprehensively implemented in all centres in Australia and New Zealand and the Faculty has been advocating for governments to mandate the Standards for many years. This advocacy effort has proved successful in Queensland where the state government has mandated compliance with the Standards; however, it still falls short of our goal of having the Standards mandated in Australia and New Zealand at the federal level, or at least in every state and territory.

To progress this goal in 2015, the Tripartite Committee formed a working group to proactively progress implementation of the Standards. The Radiation Oncology Standards Working Group is focused on developing a standards implementation process that supports quality improvement, is aligned with the National Safety and Quality Health Service (NSQHS) Standards as much as possible and does not unduly overburden facilities.

As a first step, the working group has developed a self-assessment tool to assist centres to reflect on their own quality management systems and assess their current status against the Standards. It is hoped that this will trigger a greater awareness of the Standards. The process of implementing standards and demonstrating compliance can be resource intensive but the process is very beneficial as it illuminates both strengths and weaknesses in the service

24

Inside News

and ultimately provides reassurance to both practitioners and patients of the safety and high quality of the services provided.

Following on from the self-assessment tool, the working group is exploring an opportunity to partner with the Australian Council on Healthcare Standards (ACHS) to integrate accreditation of radiation oncology centres against the Standards at the same time that the hospital/centre is being accredited against the NSQHS Standards. Currently 73 of the 74 centres in Australia are accredited against the NSQHS by ACHS. This is an attractive model that would avoid duplication and streamline the accreditation process, rolling it into the hospital/ centre’s current accreditation activities.

This program will first be available to Australian centres on a voluntary basis with the possibility of expanding to New Zealand centres in the future.

It is hoped that presenting a successfully functioning program, which is profession-led, will make mandating the standards a much easier decision, ideally for the federal government or at least for each state and territory government.

News on the progress of this working group will follow in future issues of Inside News.

Dr Brigid Hickey Chair, Radiation Oncology Tripartite Committee Chair, Radiation Oncology Practice Standards Working Group

2011

RADIATION ONCOLOGY PRACTICE STANDARDS A TRIPARTITE INITIATIVE

Quality Practice

Implementing the Standards How are radiation oncology centres tracking?

Does your organisa-on conform with the Radia-on Oncology Prac-ce Standards?

Yes -­‐ our conformity with the Radia-on Oncology Prac-ce Standards has been formally assessed (please add a comment describing how assessment was done) Yes -­‐ but no formal assessment No -­‐ but we ARE progressing towards demonstra-ng conformity No -­‐ we ARE NOT progressing towards demonstra-ng conformity No -­‐ we eCancer lect to conform to other radiotherapy-­‐specific standards instead (was please a add a comment describing the standards) Practice Standards.

5. There difference of opinion Coast Institute (NCCI), I don't know

2 9 14 1 0 Tripartite 0

The North group can play a pivotal role in regarding the need for additional NSW Health, published on its funding encouraging/facilitating full compliance experience of implementation to of all Australian ROTCs and through demonstrate voluntary conformity Does your organisa-on ith Standards the Radia-on 6. Byconform reading w the and Oncology Prac-ce Standards? the working group will achieve that with the Radiation Oncology Practice reviewing the checklist, every ROTC 0 2 4 6 8 10 12 14 16 objective.

Standards (the Standards) in 2015. could have claimed to be working Through the publication process, the towards the(please Standards.

Yes -­‐ our conformity with the Radia-on Oncology Prac-ce Standards has been formally assessed add authors received mixed reviews on a comment describing how assessment was done) Dr Andrew Last and the relevance and challenge of the The survey has demonstrated that there Mr Stephen Manley undertaking, indicating that attitudes is a high level of awareness and desire Yes -­‐ but conform no formal assessment to demonstrate Does your oAustralian rganisa-on with ROTCs the towards demonstrating conformity North Coast Cancer Institute for Radia-on Oncology Prac-ce Standards?

-­‐ our conformity ith othe Radia-on Oncology Prac-ce formally assessed (please add a comment describing how assessment was done) 2 with the Standards were variable within Yes Does ywour rganisa-on conform with the Standards has been conformity with the Radiation Oncology RO Practice Standards Working Group Yes -­‐ but no formal assessment 9 Radia-on Oncology Prac-ce Standards?

No -­‐ but we ARE progressing towards demonstra-ng conformity Yes -­‐ our conformity with the Radia-on Oncology Prac-ce Standards has been formally assessed (please add a comment describing how assessment was done) 14 2 the radiation oncology professions.

No -­‐ we ARE NOT towards demonstra-ng conformity 1 Yes p-­‐rogressing but no formal assessment 9 No -­‐ we elect tNo o conform to ther radiotherapy-­‐specific standards instead (please add a comment describing the standards) 0 -­‐d bemonstra-ng ut we AoRE progressing towards demonstra-ng conformity 14 -­‐ but we ARE progressing towards conformity NCCI subsequently partneredNo with I don't know No -­‐ we ARE NOT progressing towards demonstra-ng conformity 0 1 No -­‐

w e e lect t o c onform t o o ther r adiotherapy-­‐specific s tandards i nstead ( please a dd a

c omment d escribing t he s tandards) 0 the Tripartite Committee to conduct I don't know 0 a survey of all Australian radiation Does your organisa-on conform with the Radia-on Oncology Prac-ce Standards?

2 4 6 8 10 12 14 16 oncology treatment centres (ROTCs) toprogressing towards demonstra-ng conformity No -­‐ we ARE NOT Does your organisa-on conform 0 with the Radia-on Oncology Prac-ce Standards?

0 2 4 6 8 10 12 14 16 assess the current status of conformity Yes -­‐ our conformity with the Radia-on Oncology Prac-ce Standards has been formally assessed (please add a comment describing how assessment was done) Yes - our conformity with the Radiation Oncology Practice with the Standards and attitudes Yes -­‐ our conformity with the Radia-on Oncology Prac-ce Standards has been formally assessed (please add Standards beena comment formally assessed (please describing how assessment was done) add a comment No -­‐ we mandating elect to conform to compliance. other radiotherapy-­‐specific standards instead (please add has a comment describing towards describing how assessment was done) the standards) Yes -­‐ but no formal assessment

A survey was developed by NCCI staff Yes -­‐ but nassessment o formal assessment Yes - but no formal No -­‐ but we ARE progressing towards demonstra-ng conformity and Tripartite Committee members I don't know and distributed to the Directors of -­‐ but we ARE demonstrating progressing towards demonstra-ng conformity No - but we ARE progressing No towards conformity Radiation Oncology, Chief Medical No -­‐ we ARE NOT progressing towards demonstra-ng conformity No - we ARE NOT progressing towards demonstrating Physicists and Chief Radiation Therapists No -­‐ we ARE NOT progressing towards demonstra-ng conformity conformity No -­‐ we elect to conform to other radiotherapy-­‐specific standards instead (please add a comment describing representing the 73 ROTCs that were the standards) Please Evaluate these statements No - we elect to conform to other radiotherapy-specific -­‐ we elect to conform to otther radiotherapy-­‐specific standards instead (please aS dd a comment describing clinically operative at the timeCof Every Radia-on Oncology Treatment entre should demonstrate No conformity with he Radia-on Oncology rac-ce tandards standards instead (please add aPcomment describing the standards) ® with the Radia-on Oncology Prac-ce Standards Addi-onal funding 2015). is required for our centre to conform the standards) distribution, (May SurveyMonkey I don't know Assessment of conformity with the Radia-on Oncology Prac-ce Standards must be done by an accredited assessor was the survey tool used with a single know I don’tI don't know introduction page followed by a single Please Evaluate these statements page of six questions.

Every Radia-on Oncology Treatment Centre onformity with the Radia-on 0 should demonstrate c5 10 Oncology Prac-ce Standards 15 Analysis of the survey findings showed that:

30/05/16 Agree

5 0

10 5

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Agree Disagree Neither agree or disagree 30/05/16 0 3 25 23 14 Agree 7 Disagree 5 Neither agree or disagree 19 2 23 5 0 3 14 7 5 19 2 5

20

Addi-onal funding is required for our centre to conform with the Radia-on Oncology Prac-ce Standards Assessment of conformity with the Radia-on Oncology Prac-ce Standards must be done by an accredited assessor 0

0 7 2

30/05/16

Addi-onal funding is rEequired our statements centre to conform with the Radia-on Oncology Prac-ce Standards Please valuate ftor hese Assessment of Every conformity with Otncology he Radia-on Oncology Prac-ce Standards must cbonformity e done by waith n atccredited assessor Radia-on Treatment Centre should demonstrate he Radia-on Oncology Prac-ce Standards

Every Radia-on Oncology Treatment Centre should demonstrate conformity with the Radia-on covering 75 perPrac-ce centStandards of 1. Responses Oncology Every Radiation Oncology Treatment Centre Australian centres were received Every Radia-on Oncology Treatment Centre should demonstrate conformity with the Radia-on should demonstrate conformity with the

Disagree 23 14 19

15 10

20 15

25 20

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Oncology Prac-ce Standards

2. All centres were aware of the Standards

Radiation Oncology Practice Standards

Every Radia-on Oncology Treatment Centre should demonstrate conformity with the Radia-on Oncology Prac-ce Standards

Additional funding is required for our centre to

3. The vast majority would like to be Addi-onal funding is required for othe ur centre to conform with the Radia-on Oncology Prac-ce conform with Radiation Oncology Practice Standards Addi-onal funding is required for our centre to conform with the Radia-on Oncology Prac-ce Standards compliant, the remainder who were Addi-onal funding is required for our centre to conform with the Radia-on Oncology Prac-ce Standards Standards equivocal possibly not wanting to have to take on the work without Assessment of conformity with the Radiation additional support Assessment of Oncology conformity with the Radia-on Oncology Prac-ce Standards must be ddone one by an Practice Standards must be

Agree Agree Disagree

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accredited assessor

by an accredited assessor

Assessment of conformity with the Radia-on Oncology Prac-ce Standards must be done by an 4. A significant majority stated that accredited assessor compliance should Assessment of conformity with be the Rconfirmed adia-on Oncology Pvia rac-ce Standards must be done by an external accreditation accredited assessor

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Quality Practice

Your Health and Safety at Work: FCR Council Working to Help You At its meeting in February 2016, the Faculty of Clinical Radiology (FCR) Council endorsed a proposal to develop standards relating to workplace health and safety for radiologists.

Over the last decade our workplace has changed beyond recognition. Gone are the days of viewing boxes and heavy bags of films. No longer do we use dictaphones and tapes. We no longer walk to collect piles of films, stand to put up films or walk to put tapes and request forms aside for typing. Instead we sit for hours in front of a computer and a set of screens.

While our backs may no longer be at risk from carrying loads of films, we face a new set of workplace health issues: those related to constant sitting and keyboard use. These include repetitive strain injuries to our wrists and hands and musculoskeletal strain to our necks, backs and upper limbs. We also face issues, only just being recognised in the occupational health and safety literature, related to our increasingly sedentary work style.

Occupational health and safety related to computer use has been recognised as a risk for computer-based workers for many years and there are standards for keyboard operators. These are not always recognised as being applicable to radiologists and all too often a ‘one-size-fits-all’ workplace is provided, rather than the recognised occupational health and safety requirements to fit a keyboard operator’s workplace to her/ him.

The Royal College of Radiologists (RCR) in the United Kingdom recognised this issue in 2008 when it published ‘Ergonomics’ as part of a set of guidance documentsi on information technology in the radiology workplace.

In this document they describe the need to fit the workplace to the radiologist.

Guidance is given on the appropriate

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Inside News

layout of computers and peripherals and the importance of noise, lighting and temperature in a safe workplace.

Examples of the guidance provided include advice on: • Reducing musculoskeletal strain and injuries o seating: fully adjustable back, height and arm o monitors: at arm’s length o breaks: time for regular breaks from computer use o peripherals: keyboard and pointing devices (e.g. mouse) placed to avoid poor static postures • Lighting o monitors: individually dimmable for optimal viewing of radiology images o papers: focused lighting for reading documents • Temperature o heat reduction: computers and monitors emit heat: air-conditioning is needed to maintain a safe ambient temperature • Noise o extraneous sound: using noise reducing materials in rooms o equipment: reducing noise from cooling fans.

A well-designed workplace not only protects radiologists’ wellbeing, it also improves efficiency and reduces error.

The Faculty of Clinical Radiology Council has agreed that we need our own standards for safe workplaces to assist our members. Until we have developed this document we commend the RCR standards and in Australia the work health and safety legislation in each state/territory which can be accessed via the Safe Work Australia websiteii and in New Zealand via WorkSafe New Zealandiii, for your review and reference.

Dr Catherine Mandel

References i Ergonomics, BFCR(08)3 The Royal College of Radiologists 2008, London United Kingdom https://www.rcr.ac.uk/sites/default/files/docs/ radiology/pdf/BFCR(12)7_Ergonomics.pdf ii Safe Work Australia http://www. safeworkaustralia.gov.au iii WorkSafe New Zealand http://www.business. govt.nz/worksafe

Quality Practice

Diagnostic Imaging Pathways App Review The Diagnostic Imaging Pathways (DIP) app (http://dipapp.info/) is a decision support tool to guide clinicians in the appropriate and evidence based usage of medical imaging. For a range of common and important clinical scenarios, the app provides both an overview of the recommended imaging pathway, as well as a step-bystep interactive guide to choosing the most appropriate imaging modality or management. The app is intuitive to use, simple in its appearance, and would be able to readily be used in the clinical environment.

The app would be ideal to use in the primary care and emergency department settings, and is designed in a way that facilitates adaptation for the individual patient situation. It would also be ideal for radiologists to refer to in determining which investigation to recommend in a particular clinical scenario or which follow-up investigation to recommend.

The app would have value for trainees in both radiology and other specialties and can facilitate their learning about the role of medical imaging in diagnostic work-up of patients, and highlights some of the ways in which findings of radiology studies impacts on subsequent management. When used appropriately, the app’s guidelines and decision support tool can help to minimise unnecessary and inappropriate imaging. For example, the ‘low back pain’ pathway emphasises the need to assess for the presence of ‘red flags’ prior to deciding on whether imaging is indicated, and then encourages the appropriate use of MRI rather than the generally inappropriate, but still commonly performed, lumbar spine CT. Attempting to have a clinical decision support tool which is applicable in a wide variety of different healthcare settings is a challenge. Availability of resources, funding arrangements,

Medicare guidelines, patient and clinician preference, and local practice could make implementation in some settings difficult. Also, some of the guidelines seem a little out of date or try to over-simplify areas that are more complex. For example, the prostate cancer staging pathway recommends TRUS-guided prostate biopsy as the initial imaging test, and recommends endorectal MRI if prostate cancer is probably locally advanced. In most instances, prostate MRI (without an endorectal coil) is considered to have a more expanded role in the investigation, staging and management of suspected prostate cancer. Although the app is simple to use and the pathways easy to follow in most instances, this may come at the cost of detail or accuracy, particularly in more sub-specialised clinical scenarios. Staying up to date may be difficult in some instances, and although I recently downloaded the app, it seems that some of the guidelines are several years old and do not reflect the updated guidelines on the main website.

referrers to ensure appropriate and evidence based imaging. It does have its limitations which may pose challenges to its more widespread implementation, but it is an excellent resource, which will continue to be further refined and expanded.

Dr Mitchell Raeside

In summary, the DIP app could play an important role in clinical practice. Its accessibility and easy-to-use format will encourage its adoption into day-to-day practice. It is a valuable tool for referrers to have on hand and could facilitate discussion between radiologists and

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Quality Practice

New App Supports Reduction of Radiation Exposure from CTs for Children Children are more sensitive to the effects of radiation because their bodies are still developing and the use of CT scans in children has been linked to a slight increase in the chance of developing cancer later in life1. It is estimated that more than 80,000 CT scans are performed on people under the age of 20 each year in Australia2.

The Australian Commission on Safety and Quality in Health Care (the Commission) and the Western Australian Department of Health have developed the DIP 4 Kids app to support a reduction in unwarranted exposure to radiation from CT scans for children.

The DIP 4 Kids app supports clinicians in evidence-based decisions about imaging options for young people and children, including when to use CT scanning. The app provides clinicians and parents and carers with

assistance in decisions on paediatric CT for over 20 clinical conditions and injuries occurring in children and young people, and provides links to a range of other resources developed by the Commission. It also includes information on the level of radiation used by each imaging type.

The app was developed by the Commission, in partnership with the Western Australian Department of Health, and is based on the paediatric decision aids in the Department’s Diagnostic Imaging Pathways (DIP).

The DIP 4 Kids app is free and can be downloaded from the app store on iTunes or from Google Play.

More information on reducing radiation exposure to children and young people from CT scans, is available at: www. healthdirect.gov.au/ctscansforkids.

Mathews JD et al. Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ.2013;346:2360.

1

2013/14 Medicare data. Figures include cone beam CT used by dental practitioners.

2

Appropriate Use of Medical Imaging Forum Saturday 15 October at the Annual Scientific Meeting on the Gold Coast ‘Appropriateness’ is a hot topic in relation to medical imaging. In essence, it is about providing the right test or procedure to the right person at the right time in a safe, efficient, and cost-effective manner. It is about the patient, and sometimes the community in general, receiving a net health benefit from the procedure.

• How do we define what is appropriate and who should do that?

• Who is responsible for making decisions about appropriate care when it comes to medical imaging?

• What are the best ways to change the culture, behaviours and practices of the public, patients, referrers and providers to improve appropriateness and thus reduce expenditure that confers little health benefit?

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Inside News

• How can professional organisations that set standards and governments that develop and enforce legislative systems for healthcare delivery best influence appropriate delivery of care that involves medical imaging?

The answers to these questions are pivotal to the way that the medical practice of clinical radiologists will change over the next decade.

Get involved in the discussion and hear from a multidisciplinary group of local and international speakers on Saturday morning (8.30 am – 12.30 pm) at the 2016 Annual Scientific Meeting.

Enrol when you register – attendance is free of charge www.ranzcr2016.com/registration/

Quality Practice

Reducing Puncture Site Complications Following Angiography Anyone working in medical imaging can enter a near miss or adverse event by following the link from the website. It only takes 5 to 10 minutes and will help to inform practice and improve patient safety in medical imaging. Enter a report and help make a difference (www.raer. org.au).

Although this report is of a complication of a coronary angiogram, the lessons are relevant to radiologists as radiologists also perform femoral artery punctures and our patients are at risk of the same complications.

Coronary angiography and cardiac catheterisation are invaluable tests for the detection and quantification of coronary artery disease, identification of valvular and other structural abnormalities, and measurement of haemodynamic parameters1. Likewise catheter angiography and catheterguided treatment by radiologists provides patients with safe, effective care via a minimally invasive approach.

The degree of risk and potential complications can be associated with the patient’s co-morbidities and the skill and knowledge of the radiologist or other proceduralist (a cardiologist in our case report). Bleeding complications after angiography are associated with prolonged hospitalisation, increased hospital costs, patient dissatisfaction, morbidity, and increased one-year mortality2, so ‘getting it right’ is vital.

Major bleeding complications among patients undergoing percutaneous coronary intervention (PCI) have decreased over time. Bleeding, haematoma or false aneurysm occur in <5 per cent of angiograms; 1 in 100 people having angiograms will require observation in the hospital overnight, and fewer than 1 in 500– 1000 will require another procedure, surgery or blood transfusion to correct the bleeding3. Although there are

The following adverse event reported to RaER (www.raer.org.au) has been edited by Australian Patient Safety Foundation staff so as to remove potential identifiers. All data in RaER has had any potentially identifying information removed so that it is anonymous at the point of analysis. RaER has statutory immunity which protects cases reported to RaER: they cannot be used in litigation. Errors or misconceptions in the original report are retained, but once commented on may further inform readers. RaER is not able to follow up cases to obtain more detail.

Presentation: angina: had a diagnostic catheter coronary angiogram via femoral artery approach Incident Description: 3 days after the angiogram we were asked to investigate a groin lump and haematoma with ultrasound: this demonstrated a large pseudo-aneurysm. We were then asked to treat the patient for the cardiologists by using our US machine and probe to compress the neck of the pseudo-aneurysm Contributing Factors: cardiologist did not compress the puncture for very long and relied on a sandbag to finish the compression Action Taken: nil: it was too late to do anything Prevention: proper compression of the puncture site Factors that reduced the outcome: otherwise well and healthy Consequence/Outcome: none long term but this sort of haematoma is avoidable Reporter: Specialist Radiologist

no absolute contraindications to performing angiography in older age, renal insufficiency, uncontrolled diabetes mellitus, morbid obesity and underlying cardiovascular problems (for example, coronary artery disease, congestive heart failure with low ejection fraction, recent stroke or myocardial infarction, bleeding propensity) can all contribute to increasing the risk of complications1.

The procedure being performed, be it a diagnostic coronary angiogram or a PCI, also affects the risk to the patient.

The use of iso-osmolar contrast media, lower gauge catheters, measures to reduce the incidence of bleeding, such as, extensive operator experience reduce the already low incidence of complications1. Major complications are uncommon, and these procedures can be performed in critically ill patients with relatively low risk1.

Complications range from minor problems with rapid resolution to life threatening situations, if urgent care is not provided1. Major complications are uncommon occurring in less than 2 per cent of the treated population, with mortality of less than 0.08 per cent1.

Vascular access site complications are among the most common complications and are the most significant contributor to morbidity and mortality of the procedure1. In the earlier days of cardiac angiography, the incidence of vascular complications was reported to be between 0.7-11.7 per cent4. Bleeding/ bruising at the groin puncture occurs in approximately 3–5 per cent of cases.

This can be a problem requiring further treatment to either stop the bleeding or, less commonly, to repair an injury to the vessel wall (e.g. a pseudoaneurysm or fistula)5. Worsening stenosis of the continued over...

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Quality Practice

femoral artery may also occur. The artery may occlude completely in approximately 1 per cent of cases5. Over the past decade, significant advances in anticoagulant and antiplatelet therapies have assisted in decreasing the incidence of major cardiovascular events but are associated with an increased risk of bleeding1 thus potentially reversing the trend of lower complication rates.

Heparin Induced Thrombocytopenia (HIT) is a serious immune-mediated complication of heparin administration from flushing catheters with heparinised saline. Although the risk will not be manifest during the procedure, the clinical symptoms that develop in the days after the procedure can have potentially devastating thromboembolic complications in patients with prior exposure to heparin1. Roughly 1-3 per cent of patients who receive unfractionated heparin will develop a serious form of immune mediated thrombocytopenia with associated venous and arterial thrombosis1.

Vascular closure devices (VCD) are now in common use. The evidence regarding their effectiveness is not consistent.

Applegate et al6 reported in a significant decrease in vascular complications: for diagnostic angiograms post-procedure bleeds decreased from 1.7 to 0.2 per cent, and after PCI from 3.1 to 1.0 per cent, respectively6. Schwartz found that manual compression remains the ‘gold standard’ for achieving haemostasis

at the puncture site7. In the absence of specific puncture site-related risk factors, the use of VCDs does not seem to affect complication rates. Of concern, Schwartz’ study found that VCD use increased the risk of leg ischemia, groin infection, and complications requiring surgical repair, which are rare with manual compression6. The safety of VCD use remains unclear7.

Angiography is a relatively safe procedure with few complications.

Although advances in medical management and equipment design are associated with a significant reduction in the already low incidence of complications, operator awareness and appropriateness of response remain the most important predictors of adverse outcomes1. With each angiogram the potential benefit of the procedure should be weighed against the established risks given the welldefined morbidity and mortality of the procedure1. The guiding principle of health care, ‘first do no harm’ (primum non nocere), should apply to catheterguided treatment and investigations.

Anita Deakin, Australian Patient Safety Foundation

References 1. Tavakol M, Ashraf, S., Brener, SJ. Risks and Complications of Coronary Angiography: A Comprehensive Review. Global Journal of Health Science. 2012;4(1):65-93.

2. Dauerman HL, Rao, S.V., Resnic, F.S., Applegate, R.J. Bleeding Avoidance Strategies: Consensus and Controversy. Journal of the American College of Cardiology. 2011;58(1).

3. Yu JC, J. Anigiography - Consumer Information 2013. Available from: http://www. insideradiology.com.au/pages/view.php?T_ id=80&ref_info 4. Babu SC, Piccorelli, G. O., Shah, P. M., et al.

Incidence and results of arterial complications among 16,350 patients undergoing cardiac catheterization. Journal of Vascular Surgery.

1989;10(2):113-6.

5. Clark W, Lyon, S., Revell, A. & Russell, G. Angioplasty and Stent Insertion - Consumer Information 2015. Available from: http://www. insideradiology.com.au/pages/view.php?T_ id=84 6. Applegate RJ, Sacrinty, M.T., Kutcher, M.A., Kahl, F.R., Gandhi, S.K., Santos, R.M., Little, W.C. Trends in Vascular Complications After Diagnostic Cardiac Catheterization and Percutaneous Coronary Intervention Via the Femoral Artery, 1998 to 2007. JACC Cardiovascular Interventions. 2008;1(3):317-26.

7. Schwartz BG, Steven Burstein, S., Economides, C., Kloner, R.A., Shavelle, D.M., Mayeda, G.S. Review of Vascular Closure Devices 2011 [cited 19 7]. Available from: http://www.cathlabdigest. com/articles/Review-Vascular-Closure-Devices.

Dr Catherine Mandel, Swinburne University of Technology

Patient & Referrer Information in one convenient website: • Information about radiology tests and procedures • Items written for consumers and health professionals

• Fully searchable with printer friendly downloads • Written by experts and reviewed by GP and consumer writers

Developed and maintained by the RANZCR

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Inside News

Quality Training

Examination and Assessment Review College Board gives ‘green light’ to implement the strategy for renewal of our training programs As many members will be aware, Emeritus Professor David Prideaux of Flinders University and Dr Jacob Pearce and Mr Daniel Urbach of the Australian Council for Educational Research (ACER) conducted a full review of the College’s assessment and examination processes for Fellowship training in 2015. The review involved extensive consultation with College stakeholders and thorough observation and analysis of our examination and assessment processes.

In early February, the College held Specialty Training planning days for both clinical radiology and radiation oncology. In total, these events brought together over 70 clinicians who contribute to the College including Board members, office bearers, committee members, examiners, directors of training and trainees. Attendees discussed the current strengths and challenges of their respective Faculty’s Specialty Training programs and considered the College’s strategy for their continued improvement and renewal over the next few years.

At its March meeting the College Board approved the budget and work plan identifying the priorities for the implementation of the examination and assessment recommendations made by Prof David Prideaux and ACER, in their external review of the College’s training programs and from the planning days.

The review will be overseen by a Task Force comprised of: • The President (Chair) – Dr Greg Slater • Chief Censor in Radiation Oncology – A/Prof Margot Lehman • Chief Censor in Clinical Radiology – A/Prof Dinesh Varma • CEO – Natalia Vukolova • Head of Specialty Training – Pamela Taylor

The Task Force met for the first time on 31 May 2016 and discussed project governance, progress on examination improvements, programmatic assessment implementation, risks, communication, infrastructure and resources.

The Task Force discussed the recommendations and agreed that the Chief Censors should work with Prof Prideaux to develop a model to support the implementation of the reviews in the short term.

The review also indicated that the workload for the College’s examinations was significant and that the College should look for ways to increase member involvement and thus provide better transparency for examination development.

The Task Force supported the recent progress in implementing the recommendations which included changes within the Clinical Radiology Examination Review Panel (CRERP), extending its membership to include two co-leads in each body system and Pathology. In addition to the increase of membership, additional initiatives to be undertaken by the Panel included increased responsibility for Lead Examiners in managing and liaising with respective examiner groups, observation and back up for Viva examinations by Leads where possible and proposed changes to the examiner training pathway, including dedicated training days.

In radiation oncology, the Phase 1 Leads and Chief Censor have instigated a more collaborative process for blueprinting, and for both the Phase 1 and Phase 2 examiners, work has commenced on improving detail in the exam marking templates.

While formal work is yet to commence on the recommendations related to constructive alignment and

programmatic assessment, the Task Force considered initiatives and strategy to recruit members to oversee and facilitate this project.

In radiation oncology, the continuum of training for Anatomy, Contouring and Planning had been identified as the recommended exemplar to commence programmatic assessment and following the RO Planning Day the Phase 1 competencies currently assessed via Clinical Assignments was also identified as a potential avenue for initial development of a programmatic approach.

A small subcommittee within Clinical Radiology has been established to review the research training and assessment program and has been identified as an opportunity to implement Prof Prideaux’s recommendations in the research component of the training program, including the formation of learning outcomes. These will underpin the various assessment and teaching tools, to develop a robust and well-targeted assessment framework. It is anticipated that the Research review will work concurrently with the image reporting exemplar of programmatic assessment originally proposed by Prof Prideaux.

Mr Adam Rayment has been appointed as Manager, Special Projects, to lead the project team that will work on implementing the recommendations while overseeing and maintaining the current activities of our examinations and assessments.

The Task Force will meet again in August.

If you have any questions regarding the review, please contact the Chief Censors c/o Mr Adam Rayment, Manager, Special Projects, at the College on adam.rayment@ranzcr.edu.au

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Quality Training

RANZCR Courses and Workshops SMART Workshop Wrap Up The 2016 Faculty of Radiation Oncology Statistical Methods, Evidence Appraisal and Research for Trainees (SMART) Workshop was held on Monday 14 March at the Brisbane Convention and Exhibition Centre to coincide with the Trans Tasman Radiation Oncology Group (TROG) Annual Scientific Meeting.

The annual 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. This year’s workshop saw 26 trainees attend from across Australia and New Zealand.

The workshop was facilitated by the following statisticians and radiation oncologists: Prof Val Gebski, Ms Kristy Mann, Ms Lucy Davies, Dr Renee Finnigan, Dr Brigid Hickey, Dr Puma Sundaresan, Dr David Pryor, Dr Rahul Mukherjee, Dr Giuseppe Sasso, Prof Geoff Delaney and international guest speaker from the USA, Dr Antonio Fojo.

Trainees are reminded that 10 SMART points can be claimed for first time attendance at this interactive workshop.

The SMART Workshop will be held again at the 2017 TROG ASM on Monday 6 March at the ANZ Viaduct Events Centre, Auckland, New Zealand. Details will be available via the College website or by emailing the Conferences and Events Team at events@ranzcr.edu.au

Trainees Learn to “Stay Calm and….” at the Faculty of Radiation Oncology Phase 2 Exam Preparation Course The Phase 2 Exam Preparation Course was held from 13 to 15 May at Rydges World Square, Sydney, NSW. The annual course is designed for trainees as they approach exam readiness, with this year hosting 28 trainees over the three-day event.

The Friday program focused on demystifying the Phase 2 exams, with presentations from both an examiner’s and trainee’s perspective on passing the examinations, as well as the practicalities

Trainees were encouraged to stay for the TROG ASM to see their new knowledge ‘in action’ in subsequent clinical trials and to assist in cementing research career aspirations. Trainees attending the SMART Workshop had access to a discounted registration rate to attend the TROG ASM, with TROG generously providing five $1,000 grants to support RANZCR trainee attendance at the 2016 FRO SMART Workshop and ASM. Workshop Convenor Dr Renee Finnigan would like to thank sponsor Astra Zeneca for their generous support, and also extend thanks to the statisticians, radiation oncologists and College staff for their time in order to run the program.

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Phase 2 Exam Preparation Course

of the exam process. The program also concentrated on developing strategies to cope with exam stress and ensure trainees perform to the best of their abilities. Special guest speakers Dr Susan Johnson, clinical psychologist, and Dr Paul Heinrich, a professional actor with a PhD in Theatre and Drama, provided expert views on managing exam anxiety and performing on the day. Breathing exercises and the mantra of “stay calm and…” taught by Dr Heinrich was sound advice for the trainees as they mentally prepared for the mock exams on Saturday.

Saturday’s program simulated sitting the viva exam, with trainees allotted to streams and rotated through seven exam stations receiving feedback immediately afterwards. The course wrapped up on Sunday with practice written questions across all papers followed by workshopping the answers with the Phase 2 examiners.

It wasn’t all work and no play over the three days though. Trainees, facilitators and sponsors came together in an informal setting on the Friday night to

Quality Training

network over drinks and canapes at the Cidery Bar and Kitchen.

It wasn’t all work at the Phase 2 Course

Course Co-Convenors Drs Alex Tan and Apsara Windsor would like to thank sponsors AbbVie and Ferring Pharmaceuticals for their generous support, and also extend their thanks to the facilitators, speakers and College staff for their time in order to run the program.

The Phase 2 Exam Course will be held again in May/June 2017. Trainees preparing to sit their Phase 2 exams are strongly encouraged to attend the course to assist in preparing for your upcoming exams. Details will be available via the College website or by emailing the Conferences and Events Team at events@ranzcr.edu.au

Evidence Based Radiation Oncology Course – Registration Now Open

EVIDENCE BASED RADIATION ONCOLOGY

HOW TO EVALUATE THE SCIENTIFIC EVIDENCE AND APPLY IT TO DAILY PRACTICE

19th – 22nd November 2016

PARKROYAL DARLING HARBOUR, SYDNEY, AUSTRALIA

The Royal Australian and New Zealand College of Radiologists (RANZCR) is pleased to present ‘Evidence Based Radiation Oncology: How to evaluate the scientific evidence and apply it to daily practice’ from 19–22 November at the Parkroyal Hotel, Sydney, Australia.

This clinical refresher course is jointly hosted by the European Society for Therapeutic Radiology and Oncology (ESTRO) School, the premier organisation for radiation oncology education in Europe, and the RANZCR Faculty of Radiation Oncology. This is the first time that the course will be held in Australia.

The four-day course will be a fantastic opportunity for current Fellows and trainees to review and discuss the latest evidence in the literature with both international and local radiation oncology experts. The course will explore the evidence basis behind the indications for radiotherapy, and the RT techniques for commonly occurring malignancies. Illustrative cases will be integrated into each sub-site session and will form the basis for discussion.

In addition, this year will be the first year in the course history to include the sub-sites, skin and CNS. The course is aimed at trainees who are preparing for their Phase 2 examinations and Fellows

who wish to review and refresh their knowledge.

Register before 31 August to secure the early bird rate! Registration is available via the course website at www.ebro2016sydney.com We look forward to welcoming you to Sydney in November.

Dr Penny Mackenzie Convenor

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2017 FELLOWSHIP POSITIONS AVAILABLE Integral Diagnostics has exciting opportunities in Queensland and Victoria for 12 month fellowships in the areas of breast, musculoskeletal, body and nuclear medicine imaging, commencing 2017.

These fellowship positions offer the opportunity to work alongside a quality focused, supportive peer group, in modern public and private environments.

WHO WE ARE Integral Diagnostics is Australia’s fastest growing clinician driven provider of quality, patient focussed medical imaging.

We oversee three clinical brands in varied geographical locations.

South Coast Radiology is based on the Gold Coast, Toowoomba and Northern Queensland. Lake Imaging operates in metropolitan and regional Victoria (including Ballarat, Geelong and Melton). Global Diagnostics is located in Western Australia (including Bunbury and Bussleton).

WHAT WE OFFER At our specialist imaging centres and locations, we are seen as the preferred imaging provider by specialist clinicians in the subspecialty areas of our fellowship offerings.

Gold Coast, Queensland

As the preferred specialist provider in these areas we see a wide range of patient presentations, and work closely alongside referring clinicians, encouraging participation in multidisciplinary meetings, to ensure the imaging we provide meets their needs.

Working alongside a supportive, collaborative team of experienced consultants, we will provide flexibility to tailor the relevant fellowship program to meet the individual’s needs, incorporating a mix of the chosen subspecialty with general radiology.

Bellarine Peninsula, VIctoria

www.integraldiagnostics.com.au For further information on joining Integral Diagnostics please contact:

Mr Greg Hughes - Chief Operating Officer Email : hughesg@integraldiagnostics.com.au

imaging

Quality Training

Clinical Radiology Training Site Accreditation: What is an acceptable workload?

RANZCR’s innovative development to support training sites The issue of workload for clinical radiology training site accreditation stems back to at least 2007, when the upper individual metric was increased from 7,500 to the current 12,000 examinations per annum, per FTE consultant radiologist. Concerns have been raised regarding the value of this metric as an indicator of workload; particularly as it does not consider the complexities of various reports. A new metric, designed to more accurately reflect clinical radiologists’ workload has been developed—your opinions are now sought on the methodology.

Background In 2014, the College agreed that the development of a workload measurement method, in the context of supervision and teaching of trainees, was needed to replace the existing metric. A working group was convened under leadership of Prof Mark Khangure (Past Chief Accreditation Officer) and Dr Greg Slater (Past Dean, Faculty of Clinical Radiology) to consider and test the various methods of measurement.

Methodology A methodology has been developed for clinical radiology training sites to use to determine the ability to fulfil the recommended requirements. This methodology requires a variety of inputs, including non-reporting times (procedures, meetings, teaching, administration) and reporting times.

Consensus Reporting Times

Bi-national reporting times

For the first time, reporting times have been developed that can be applied across both Australia and New Zealand.

These consensus reporting times were developed by the working group, largely using the work of Prof Alex Pitman (Body Systems Framework) and Dr Ian Cowan (Christchurch Hospital). Times were compared alongside reporting times made available by members of the working group. Any identified discrepancies were discussed by the entire working group before agreement was reached. Nuclear medicine / PET consensus times were developed later following additional work by a sub-group.

Following the extensive work undertaken by the working group, the new consensus reporting times will be an integral part of the methodology developed to determine the capacity of a training site to deliver adequate teaching.

A New Metric The working group agreed that the existing metric is no longer valid. A new metric was agreed by the working group that proposes to replace the number of examinations with the following timebased requirements: •H alf-hour per trainee per day of formal teaching within the trainee’s own department or training network •O ne hour of consultant radiologist time per trainee per working day for apprenticeship model teaching.

The proposed change will be presented to the Clinical Radiology Education and Training Committee for consideration.

For more information on the clinical radiology training site accreditation workload project contact Philip Munro, Manager, Quality and Safety at the College on philip.munro@ranzcr.edu.au or +61 2 9268 9763.

What you can do Provide feedback on the proposed amendment to the Accreditation Standards for Radiology Training and the training site accreditation workload methodology via the College website.

Next Steps All members of the Faculty of Clinical Radiology are invited to comment on the proposed amendment to the Accreditation Standards for Radiology Training and the methodology developed for determining the workload of clinical radiology training sites via Current College Consultations at www.ranzcr.edu.au/resources/ professional-documents/ consultations.

Consultation closes July 31.

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Quality Training

Additional Support for Trainees Trainee Liaison Project Officer

Mr Chris Bartley

The Trainee Liaison Project Officer is a newly created position which aims to be a conduit between the College and the trainees. My role is to seek feedback regarding training related issues from the trainees and highlight important information that relates to the training curriculum. The position will be an additional line of support for trainees.

I commenced my employment with the College in February this year after working in similar roles for the past five years in the education sector. I began my career as a School Teacher, and later moved onto higher education including working at an online university where I developed programs and systems for people to engage in education and training.

Over the past two months at the College, I have started to visit accredited training sites in New South Wales, Australian Capital Territory, Queensland, Victoria and Northern Territory and will be visiting sites in

South Australia, Western Australia and New Zealand in the coming months.

The scope of the role includes all sites within Australia and New Zealand for both disciplines with a focus on rural and regional sites. I will also attend various College events including, but not limited to, Branch Meetings, Directors of Training Workshops, Phase 1 and 2 Exam Preparation Courses and the Annual Scientific Meetings in Australia and New Zealand.

If you would like to schedule a visit please contact me at the College on +61 2 9268 9713 or chris.bartley@ranzcr.edu.au.

For any matters that relate to the training curriculum, trainees are encouraged to contact the College.

For clinical radiology please contact radtaa@ranzcr.edu.au and for radiation oncology please contact ronctaa@ranzcr.edu.au.

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AIRP – June 2016 Inside News_v2.indd 1

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Inside News

5/27/16 9:25 AM

Clinical Radiology

A Message

from the Dean

Prof John Slavotinek

Medicare Reforms in Australia RANZCR has been working hard behind the scenes with government to progress structural reforms and adequate Medicare funding for diagnostic imaging services in Australia. We are particularly concerned that inadequate funding has negative implications for patient access, particularly among low income and at risk groups, and the delivery of safe and quality services. We recently expressed disappointment that government missed its original Quality Framework reform deadlines, however we continue to make representations at all levels of government for adequate funding and to progress long overdue reforms to the sector.

International Day of Radiology – 8 November 2016 I am pleased to announce that the International Day of Radiology (IDoR) 2016 will focus on breast imaging and the essential role that radiology plays in detection, diagnosis and management of breast diseases.

For IDoR 2016, the European Society of Radiology (ESR), the Radiological Society of North America (RSNA) and the American College of Radiology (ACR) are producing a publication on the important role that radiology plays in breast disease. The College was invited to nominate an expert to participate and I would like to thank Dr Michelle Reintals, Chair of the Breast Imaging Reference Group for contributing to this work on behalf of the Faculty.

We have commenced preparation for this important event over the past few

weeks, and look forward to providing information and collaborating with you all for IDoR 2016. Updates about the campaign will be sent to members and made available at www.ranzcr.edu.au/ radiology/idor.

If you wish to be involved in the campaign, please contact Neena Mairata, Senior Advocacy Officer on + 61 2 9268 9771.

FCR Governance Review Update In the September 2015 edition of Inside News, Dr Greg Slater provided an overview of activities of the Governance Review Working Group. Their aim was to review Faculty of Clinical Radiology (FCR) committees, their governance and suggest ways of optimising them to support core College business and the College’s Strategy to 2017.

despite the workload associated with the MBS review, we have: Developed generic terms of reference • for committees, working groups, special interest groups and reference panels • Abolished the Independent Practice Group, the Cardiovascular Imaging Group and the Nuclear Medicine Group • Created the Safety, Quality and Standards Committee—a new standing committee in the Faculty • Ensured that Faculty Councillors are represented on FCR standing and advisory committees to provide effective communication with FCR Council.

We are presently working to align the terms of reference of each current FCR committee with generic templates and remove any inconsistencies.

The Governance Review Working Group, consisting of Dr Greg Slater, Dr Catherine Mandel, Sandra Keogh, Mark Nevin, Scott Raymond (until March 2015) and Daisy Garling, developed a clear list of recommendations and a short and long term implementation strategy to apply these recommendations. The report was approved by the FCR Council and Board of Directors in July 2015.

However, implementation was placed on hold until early 2016 due to the Minister for Health’s announcement of the Medicare Benefits Schedule (MBS) Review in Australia.

From the perspective of members, this work will ensure a more consistent operation of committees across the Faculty, greater diversity of committee membership and a more transparent process during expressions of interest (EOI) to elect committee members and committee chairs. After a transition phase, a third of the committee members will be replaced or reappointed every calendar year to allow for even rotation of the membership while providing continuity in decision making. I strongly encourage any of you with an interest to respond to EOIs for College committees as they arise.

With Dr Slater’s election to the position of President, I stepped into Greg’s role on the Governance Review Working Group in February as work commenced on implementation. To date, and

The full Governance Review Report was circulated to the membership via a Dean’s communique recently. If you have any feedback or questions, please contact the Faculty team via fcr@ranzcr.edu.au.

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Clinical Radiology

Clinical Correlation Required – A Radiological Truism A claim so obvious or selfevident as to be hardly worth mentioning We’ve all read them, perhaps we’ve written them. Three pages long with sentences morphing into paragraphs. Finely worded and artful but obfuscation and hedging nonetheless. Enhancement in the deltoid; query infection. The sub-centimetre nodes in the retroperitoneum; TB is suggested. The emergency registrar couldn’t rule out a pulmonary embolus, well neither could you.

A group at Stanford University has developed a computer-based review system utilising natural language processing, which they used to examine

Emergency Radiology Special Interest Group

I am pleased to inform you that the Executive Committee of the Australian and New Zealand Emergency Radiology Group (ANZERG) had its first telephone conference on 26 February 2016.

We have reached out to various international emergency radiology societies as well as the Australasian College for Emergency Medicine, the Royal Australasian College of Surgeons, the Australasian Trauma Society and other Australian/NZ colleges informing them of the establishment of our special interest group. We had a very positive response from the British Society of

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Inside News

almost one million radiology reports over a period of five years. Validated with a sensitivity and specificity of over 97 per cent and 99 per cent respectively, the analysis identified uncertain or hedging statements in 30.9 per cent of reports. Perhaps unsurprisingly, trainees were even more likely to make ambiguous comments.

From hazy mesenteries, to architecturally distorted apicies and fuzzy posterior fossae, the aspiring radiologist regularly encounters findings that resist characterisation. Yet recognising the normal and sorting out the relevant from the inconsequential is at the heart of imaging interpretation and a key skill of radiologists. Formulating and communicating a coherent diagnosis to help chart a path forward is tougher still.

The smudge of soft tissue in the neck or the blotch of hypoattenuation in the brain can be a bewildering trap. Too often the result is no judgement and no value-add.

Emergency Radiology who are keen to collaborate with us.

The committee members will work towards developing the ANZERG web page which is on the College website www.ranzcr.edu.au/organisation/specialinterest-groups/anzerg. We are also putting together a registry of ANZERG members. If you have not yet expressed your interest, you can do so by writing to Sarah Hall, Administrator, Member Support, at the College office on sarah.hall@ranzcr.edu.au. Any suggestions from the wider membership are welcomed.

Currently there are big variations in the way first year key conditions are taught.

Drs Perry Cleland and Craig Hacking are putting together a survey that we will be sending out to Directors of Training and Branch Education Officers. The intention is to gather information on how the key conditions are taught at various departments and what assessment processes are in place to ensure that first year registrars are ready to go on afterhours rosters.

Importantly for patient care, a group from Beaumont Health in Michigan, who presented at RSNA in 2015, showed that follow-up rates for patients decrease significantly when ‘conditional’ statements (read hedges) are used by radiologists. By withholding judgement we may avoid risk and retribution but we also do our patients a disservice. To do so regularly cedes the titles of specialist and doctor.

So to the trainee radiologist; water infrequently and prune often. Hedges obstruct the view and should be planted sparingly.

Clinical correlation required.

Dr Jules Catt Chair, Radiology Trainees Committee

Dr Craig Hacking is putting together a program for the Training Learning Day at the Annual Scientific Meeting on the Gold Coast. The ANZERG Committee is planning other educational sessions on emergency and trauma radiology which will be advertised to the broader group of trainees and Fellows when finalised. We recognise that almost every radiologist is faced with acutely unwell patients within or outside of the emergency department cohort of patients and such sessions will be valuable to our Fellows and trainees.

ANZERG is also proud to contribute to the Australasian Trauma Society’s regular member newsletter. In the first article, Dr Craig Hacking presented the CT findings of pancreatic trauma. We look forward to providing regular imaging educational content with ATS. A/Prof Dinesh Varma Chair, ANZERG

Clinical Radiology

Chief Censor in Clinical Radiology

A/Prof Dinesh Varma

I am pleased to inform you that the Board of Directors has approved the plan and the budget to roll out the proposed improvements based on the ACER/ Prideaux review and recommendations.

A Task Force chaired by President Dr Greg Slater and comprising of Chief Censors, the CEO and Head of Specialty Training Unit has been set up to oversee the implementation of this work. The Task Force will determine priorities for action and plan for immediate and longer-term change. There will be regular bulletins to Fellows and trainees to update on the progress of this major work being undertaken by the College in the Specialty Training Unit since the implementation of the new curriculum.

The 2016 Series 1 examinations are taking place as I write this article.

I would like to extend a thank you to all the examiners for their hard work and assistance before, during and after the examinations. The examinations were well supported by the team from the College. Dr Jacob Pearce and Mr Daniel Urbach from the Australian Council for Educational Research also provided assistance by facilitating workshops and will continue to do so throughout 2016.

Fellowship For our Year 4 and Year 5 trainees, there continues to be some confusion in regards to terminology used at various sites. Since 2009/2010 the Advanced Training Position has no longer existed.

A Fellowship is considered to be a period of subspecialty advance training

undertaken once the person has become a Fellow of the College. A Fellowship position within Australia, New Zealand or overseas cannot be undertaken by a trainee, unless they have completed the five-year clinical radiology training program and have been awarded the FRANZCR.

System Focused Rotations System Focused Rotations (SFRs) have been a requirement of the Clinical Radiology (Radiodiagnosis) Curriculum since its implementation in January 2010 (Australia and Singapore) and December 2009 (New Zealand). Registrars will spend a minimum of 4–6 sessions per week (on average) training in a designated ‘system’.

Year 4 trainees should be rostered for four lots of three-month rotations and in Year 5 for either four lots of threemonth rotations or two lots of six-month rotations.

A System Focused Rotation is NOT intended to be a subspecialty rotation.

The intention is that more senior trainees get at least part of the rostered clinical week (not all) attached to specific specialists that report predominantly (not all) in one system or area of radiology.

The rest of the rostered week is intended for general clinical work, on-call duties, learning activities and other training/ service requirements. Please contact Sandra McDonald, Manager, Training and Education at the College on sandra. mcdonald@ranzcr.edu.au if you have any questions. For more information see

Implementing System-Focused Rotations on the College website www.ranzcr.edu. au/component/docman/?task=doc_ download&gid=1961

Director of Training Workshop The Director of Training (DoT) workshop was held on 6 May 2016 in Melbourne and was well attended. Dr Meredith Thomas, Chair Curriculum Assessment Committee updated the attendees on some of the recent additions to the experiential requirements. A very interactive and informative session was conducted by a team from the largest medical defense organisation, Avant.

Their main emphasis was on how to manage trainees requiring extra support during the training program. Later in the afternoon A/Prof Nick Stephenson, Chair Clinical Radiology Workforce Committee, facilitated a discussion panel which focused on rural and regional workforce, recognition of maldistribution of specialists and how regional health delivery differs from city-based practices and hospitals. Subsequent group discussions highlighted how training might be different, understanding the challenges and opportunities for trainees working in regional areas and discussion of strategies that could be adopted to achieve suitable outcomes.

The next DoT workshop is planned during the New Zealand Branch Annual Scientific Meeting (ASM) in August 2016 with another to be held at the College Annual Scientific Meeting on the Gold Coast on 12 October 2016. I would encourage as many DoTs to attend, as

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Clinical Radiology

this is a good forum to network and get a better understanding of the processes around training and assessments and maintaining of accreditation requirements. You can register your attendance through radtaa@ranzcr.edu.au

Specialist Training Program The Australian Department of Health’s initiative, the Specialist Training Program (STP) is currently being reviewed. Many training departments will be familiar with the STP program but as a brief reminder, it provides support to enable medical specialist trainees to rotate through an expanded range of settings beyond traditional public teaching hospitals, in pursuit of becoming a Fellow of a recognised specialist medical college. The College has a number of training positions funded through STP in clinical radiology and radiation oncology. Additional information related to the program can be found on the Department of Health website www. health.gov.au/internet/main/publishing. nsf/Content/work-spec

Integrated Rural Training Pipeline Recently the College received correspondence that indicates that the Department of Health intends to move forward with the continuation of STP with some reforms and a new initiative, known as the Integrated Rural Training Pipeline (IRTP).

IRTP is different from the traditional STP model in that, to be eligible, training sites must meet different criteria such as: • These will be new training positions.

• Sites that intend to put in EOI should be accredited for training or in the process of being accredited.

• The funding will follow the trainee rather than being tied to one post.

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Inside News

• The IRTP trainee must spend at least 75 per cent of training time in an RA2-RA5 setting.

• The post would be linked to a ‘regional training hub’.

• The appointed IRTP trainee must have a commitment to working in a rural area, which could be evidenced by having a rural background, or have attended a rural clinical school or regional university or demonstrated an interest or commitment to rural work in their application for the post.

The IRTP is planned (though not confirmed) to commence in 2017 with an additional 50 training positions (2017) and 50 training positions in 2018 across all Colleges.

The Department of Health is preparing a submission to the Minister for Health setting out its recommendations for the 50 IRTP positions for 2017. The College has been working to identify suitable sites and a workable model. This is a great opportunity for regional sites to consider putting in EOI as and when they are announced. The College will disseminate information as soon as it becomes available. If you have any questions please contact Pamela Taylor, Head of Specialty Training at pamela. taylor@ranzcr.edu.au or +61 2 9268 9704.

Trainee Liaison Role Mr Chris Bartley has been appointed as Trainee Liaison Project Officer and will be visiting various training sites and meeting with the trainees. This will provide a great opportunity for trainees to discuss matters at the coalface. Chris has made his way down through QLD, NSW and is currently in VIC and TAS. He will then move around to SA, NT, WA and NZ. Chris’ role is outlined on page 36. I am sure you will all make Chris feel

welcome in your department. Chris can be contacted directly at chris.bartley@ ranzcr.edu.au if you would like to discuss a visit with your site.

If you would like any further information or would like to comment on any of the above, please contact radtaa@ranzcr.edu.au

Clinical Radiology

ARGANZ News

ARGANZ 2016 Fremantle The Abdominal Radiology Group Australia and New Zealand (ARGANZ) annual scientific meeting was held at the Rydges Esplanade Hotel in Fremantle from 1 to 3 April. The meeting was very well attended with over 260 registrants.

It was the first time that ARGANZ has visited the West since its inception as a Special Interest Group of the College in 2009—the trip was long overdue.

Professor Yves Menu from the Department of Radiology at Saint Antoine Hospital, Pierre and Marie Curie University in Paris was our international guest speaker. His presentations were clear and precise and leavened with humour. Prof Menu is a master communicator, even in his non-native tongue of English. He gave six lectures of a very high standard and an entertaining challenging case presentation, putting Drs Mendelson, Goodwin and Sutherland under the microscope on Sunday.

Looking Forward to ARGANZ 2017

Professor Richard Baron, University of Chicago

Dr Nicole Harris from the Royal Melbourne Hospital won this year’s ARGANZ research prize for her research on Acoustic Radiation Force Impulse Imaging. She receives an all-expenses paid trip (registration, airfare and accommodation) to attend either ESGAR 2016 conference in Prague or ESGAR 2017 in Athens. The quality of the various presentations was of a very high standard and augers well for the future of abdominal imaging research in Australia.

For the first time, a 90-minute teaching/ examining session was conducted for the radiology trainees on Sunday morning by current abdominal imaging examiners – ‘The School of ARGANZ’.

Cases were shown to the wider audience by projection and to a pre-examination candidate using a hot seat in front of a desktop computer. The candidate was thoroughly tested with the case conducted as a mock viva after which the candidate’s performance and the case were discussed to the benefit of the wider audience. It proved to be an

Dr Nicole Harris receiving the 2016 ARGANZ Research Prize from A/Prof Andrew Little invaluable session for all who attended and will become a feature of all future meetings.

A/Prof Andrew Little Chair, ARGANZ

ARGANZ will return to Sydney on 11-12 February at the Four Points

by Sheraton in Darling Harbour.

Resonance. Professor Baron will be supported by a strong local and national faculty. Mark the date in your diary.

We are very excited and privileged to have as our guest speaker, Professor Richard Baron, Chairman Emeritus of the Department of Radiology, The University of Chicago. Professor Baron is a highly regarded researcher and educator in the field of hepatobiliary imaging and his research and exhibits have received numerous awards worldwide. He is the current President of the Radiological Society of North America, past President of the Society of Gastrointestinal Radiology and the Society of Computed Body Tomography and Magnetic

We look forward to seeing you in Sydney in 2017!

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Clinical Radiology

ADIA Update Breast cancer pilot study proposed for MBS Review experience of the current system and have offered to assist the MBS Review working groups to ensure the study is comprehensive and effective.

The ongoing Medicare Benefits Schedule (MBS) Review will define how our health system operates for years to come.

That is why The Royal Australian and New Zealand College of Radiologists and three other peak bodies – Breast Surgeons of Australia and New Zealand, Breast Cancer Network Australia, and the Australian Diagnostic Imaging Association – are urging the Federal Health Minister to commission a pilot study into how to improve the effectiveness of breast cancer imaging from a patient’s perspective.

Breast cancer is now the most common cancer affecting Australian women.

But crucially, this pilot study would not only help improve the rates for early diagnosis and treatment of breast cancer patients, it would also provide insight and benefits that could be applied to virtually any patient group.

Simply put, the concept is to detail the patient’s journey, identify the hurdles they face and devise ways of eliminating or minimising these problems – it’s about being smarter in how Medicare supports patients.

Breast cancer patients struggle with a range of issues – these include understanding the technologies involved, unfair high out-of-pocket costs and up-front bills, restricted access to qualified services, unnecessarily repeated imaging, limits on the imaging which can be done in the same day, and the need for MRIs which aren’t Medicare funded.

The four groups urging the pilot study have intimate knowledge and

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Inside News

The need for this pilot study is even greater if the next round of cuts is taken into account.

With the federal government unwilling to rule out plans to slash $100 million a year from patient rebates for diagnostic imaging, costs for many breast cancer patients will rise even further.

So it is inevitable that faced with these additional expenses, more people will walk away from the system. Instead of early diagnosis and treatment, their condition will worsen. This is terrible for them and counterproductive for the health system as patients will eventually require more intense and much more expensive treatment.

The MBS Review is a rare opportunity to provide sick and worried people with a less challenging journey through the health system by improving the efficiency of Medicare through changes to rules and funding.

Dr Christian Wriedt ADIA President

ANZSPR Annual Scientific Meeting 2016 16-19 October – Gold Coast, QLD The Organising Committee is delighted to invite you to ANZSPR 2016 Annual Scientific Meeting to be held 16-19 October 2016 at the Sheraton Mirage Resort and Spa on Queensland’s beautiful Gold Coast.

Join us for a three-day program featuring local and international speakers, focusing on topics including musculoskeletal, gastrointestinal and genitourinary imaging. The program and content is suitable for radiologists, radiology registrars and Fellows, radiographers and specialists with an interest in imaging.

Along with the academic program, delegates will be able to enjoy a social program comprising a welcome reception at Glass Dining and Lounge Bar and the conference dinner to be held at Fellini Restaurant, both conveniently located at the Marina Mirage Shopping Centre just a fiveminute walk from the resort.

The beachfront Sheraton Mirage Resort and Spa is ideally located to take advantage of the Gold Coast’s many tourist attractions and theme parks. Explore the stunning beaches, take in the view from the Q1 observation deck or escape to the Gold Coast hinterland where you’ll discover boutique wineries, local arts and crafts and numerous walking trails.

We look forward to seeing you on the Gold Coast. For more information, visit www.anzspr16.com ANZSPR 2016 Organising Committee

The views expressed are those of ADIA and publication of this article does not in any way constitute an endorsement by The Royal Australian and New Zealand College of Radiologists (RANZCR).

Clinical Radiology

Australasian Musculoskeletal Imaging Group Dear AMSIG and College members I have had the utmost pleasure and honour of serving as the Australasian Musculoskeletal Imaging Group (AMSIG) Vice President and President over the last four years and it is with great pride that I have had the opportunity to lead this wonderful society. During this time, I have been fortunate to work with a dynamic executive that has contributed to taking AMSIG to a new level that we can all be proud of.

AMSIG has matured far beyond the previous ‘one meeting, one dinner’ special interest group that it appropriately once was. It has now become a voice for musculoskeletal imaging advocacy, given the ever increasing consultation with the College, Medicare and the Department of Health (DoH). In particular, the executive team has been passionate about delivering quality of care to our patients by opposing the recent issue of ultrasound guided musculoskeletal injections courses aimed at training sonographers, voicing our concerns to Medicare regarding the withdrawal of the autologous blood and PRP injection item codes, as well as consulting with working groups with respect to the appropriateness of clinical criteria for imaging.

ASMIG membership is at an all-time record, along with attendance at the past three meetings. Research grants are offered for relevant projects that are deemed important to advancing the field of musculoskeletal radiology.

Our annual scientific meeting is something we can be truly proud of.

The strength of these meetings is the informal, interactive nature of the presentations, which are brief, relevant and to the point. Panel discussions and audience participation is always popular with sessions consistently running overtime.

We have been fortunate to overhaul our website, so that becoming a member (or renewing membership) is automated.

For AMSIG members, the site is an invaluable resource for announcements, keeping in contact with colleagues, as well as having the ability to review past meetings which have all been recorded and are available to view online. Furthermore, Skeletal Radiology has become our official journal, and with it come benefits from the publisher, Springer, in respect to discounted textbook purchases.

I invite you all to Melbourne next year from 6 to 7 May, where Dr Tim Dickson and I welcome you as convenors of the 2017 AMSIG Annual Scientific Meeting, with the theme, Imaging of the Foot and Ankle—a relevant and topical one, I am sure you will all agree.

Best wishes.

Dr George Koulouris President, AMSIG

Finally, I have been a strong advocate of improving liaison with other skeletal societies, for which success has been achieved with the South African Musculoskeletal Imaging Group, as well as positive preliminary discussions with the European Skeletal Society, the British Skeletal Society, the International Skeletal Society and the Society for Skeletal Radiology. The outcomes of these discussions will ultimately be reciprocity, so that AMSIG members can attend the other societies’ meetings at their member rate and vice versa.

These and many other tasks and issues face our new executive, ably led

by Dr Sanjay Dhupelia, who I thank enormously for his support as Vice President over the last two years, and wish him all the best. I look forward to seeing AMSIG provide further educational opportunities for its members outside of the annual scientific meeting (such as the radiofrequency ablation course recently held in Sydney), as well as specific intensive workshops, categorical courses and potentially becoming more involved with the College to assist in the training of registrars and Fellows.

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Radiation Oncology

A Message

from the Dean

Dr Dion Forstner

Advocacy The Faculty has been actively engaged with the Department of Health (DoH) in Australia during this critical time when both the Medicare Benefits Schedule (MBS) and the Radiation Oncology Health Program Grants (ROHPG) are being reviewed. In early April, Ms Sonja Cronjé, Senior Executive Officer of the Faculty and I met with key staff from the Radiation Oncology Section of the DoH to discuss our priority issues, including the intensity modulated radiation therapy and image guided radiation therapy item numbers, the ROHPG review and the future of the Australian Clinical Dosimetry Service (ACDS).

The MBS Review Oncology Clinical Committee has been established, and we are fortunate that three Faculty members (Prof Michael Barton, Prof Liz Kenny and A/Prof Chris Milross) are members of that committee, which had its first face-to-face meeting on 29 April in Sydney.

can review the MBS Newsletters at www.health.gov.au/internet/main/ publishing.nsf/Content/MBSRnewsletters

Profile and Presence of Radiation Oncology Congratulations to Dr Peter Gorayski, whose abstract ‘Targeting Cancer: Results of a National Radiation Oncology Advocacy Platform aimed at General Practitioners and Consumers’ has been accepted for an oral presentation at GP16, the 2016 Annual Scientific Meeting of The Royal Australian College of General Practitioners. It is a great opportunity to reach out to the wider GP community and to improve their knowledge of radiation therapy.

Five sessions of presentations on radiation therapy are planned through HealthEd (a private GP education provider). These sessions will take place from August to November this year, and are estimated to reach about 2,500 GPs.

The Faculty also formalised an MBS Review Working Group, under the leadership of Prof Liz Kenny, to be the advisory body to the Faculty on changes or proposed changes emerging from / related to the MBS Review. I am confident that with the support and input from these members, the Faculty will be able to advocate for an improved funding structure for radiation oncology in Australia.

I encourage all members to participate in Targeting Cancer activities, to help raise the profile of our profession, and ultimately increase the utilisation rate of radiation therapy. For more information about the Targeting Cancer campaign, please see the article on page 19 in this edition.

If you have any views or comments on the MBS review, please contact us on faculty@ranzcr.edu.au. Anyone who is interested in keeping up to date with the activities of the MBS Review Taskforce

Tripartite Radiation Oncology Practice Standards

Please contact faculty@ranzcr.edu.au if you are interested in getting involved.

Since the Tripartite Radiation Oncology Practice Standards (the Standards) were

published in 2011, the Faculty has been advocating for the implementation of the Standards in all facilities in Australia and New Zealand. However, only Queensland has formally adopted the Standards.

In response to the MBS Review Consultation, the Faculty listed mandatory national implementation of the Standards as one of the priorities for government consideration.

Last year a tripartite working group was formed to proactively progress the implementation of the Standards. As a first step, the group has developed a self-assessment tool to assist facilities to reflect on their own quality management systems and assess how well they currently comply with the Standards. I encourage all radiation therapy practices to use the tool for self-assessment, which is available from the College website at www.ranzcr.edu.au/quality-a-safety/ radiation-oncology/tripartite-radiationoncology-practice-standards The Standards Working Group is also exploring the possibility of working with the Australian Council on Healthcare Standards (ACHS) to map the Radiation Oncology Practice Standards against the National Standards, and develop an accreditation plan. We will keep our members informed of the progress.

Scope of Practice for Radiation Oncology The Faculty has recently established a Radiation Oncology Scope of Practice Working Group with members who have an interest in the sustainability of the profession, clinical practice and quality and safety in patient care.

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This working group will develop and advise on the Scope of Practice which can be used to assist College Fellows, other organisations and professions to provide guidance on policies, guidelines and procedures related to credentialing and defining the range of practice of a radiation oncologist.

If you are interested in joining the group, or have any suggestions/ideas, please write to us at faculty@ranzcr.edu.au

2015 Position Paper on Technologies and Techniques The aim of the Faculty’s regular Position Paper on Technologies and Techniques (Horizon Scan) is to inform cancer professionals, health professionals, health administrators, consumers and interested individuals about the techniques and technologies used for safe delivery of high quality radiation therapy.

The Horizon Scan was updated in 2015 with the latest data and evidence, the format has been simplified and the two versions for Australia and New Zealand were merged into one. The final document is now available on the College website at www.ranzcr.edu.au/ advocacy/statements, with the next update planned for 2017.

Training and Research for Radiation Oncology The Faculty Council is committed to producing excellent radiation oncology specialists, and appreciates the need for continuous improvement of the training curriculum and assessment tools.

We recognise the enormous voluntary contribution by Fellows in teaching.

Directors of Training (DoTs) are vital to the success of our training program.

The College understands this is a really

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challenging role, trying to balance the service and teaching requirements of trainees.

In many cases, our DoTs are relatively junior members in a radiation oncology team. I would like to encourage all departments, and especially department heads to provide strong support to your own DoTs, especially when they need to manage trainees in difficulty or where they are dealing with performance issues.

The Faculty remains committed to fostering a culture of research in radiation oncology. We are keen to continue our close collaboration with the Trans Tasman Radiation Oncology Group and work is underway to formalise that relationship.

A research strategic planning day is scheduled to take place in July this year, with the aim of developing a Collegewide research strategy.

The Faculty is also proud to be a supporter of the 2016 Australia and Asia Pacific Clinical Oncology Research Development (ACORD) Workshop of the Medical Oncology Group of Australia (MOGA). This workshop is an excellent career-enhancing education program in clinical trial design and development, and this year saw a record number (19 out of 1623) of radiation oncology applicants. We expect details of successful applications to be made available soon.

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

Radiation Oncology

Chief Censor in Radiation Oncology

A/Prof Margot Lehman

The first half of 2016 has a seen lot of activity on the education, assessment and accreditation front.

Exam and Assessment Review In early February a planning day was held to inform representative Fellows involved in training, examination and assessment activities of the findings of and recommendations from the Australian Council for Educational Research (ACER)/Professor Prideaux Review. It was pleasing to note that the findings of the review were positive, but areas for refinement were identified. Accordingly, with particular reference to the Phase I and Phase 2 examinations, plans have been made for representatives from the ACER team to lend their expertise during the regular exam writing workshops. Professor Prideaux’s recommendations centred around the introduction of programmatic approach to teaching and assessment with particular emphasis on anatomy, contouring and plan evaluation. Work on this element is anticipated to commence in the latter half of this year.

In March, the SMART workshop was held prior to the Trans Tasman Radiation Oncology Group meeting. This workshop was, once again, well attended with 26 participants involved. I would particularly like to thank the organisers, faculty and facilitators for their commitment to making this workshop such a success.

In April, the Phase 2 exam series was held in Wellington. Hosting an exam series can be disruptive for a department but an ‘exit’ exam is an essential component in our Fellowship program and I am very thankful to Dr Carol Johnson for agreeing to hold the series in Wellington. I would especially like to thank the local Co-Directors of Training, Dr Anna Nicholson and Dr Nichola Naidoo, for giving up so much of their time to assist in ensuring the series ran very smoothly.

In terms of accreditation, A/Prof Phil Yuile tendered his resignation from the role of Chief Accreditation Officer (CAO) at the February Radiation Oncology Education and Training Committee meeting. On behalf of the Specialty Training Unit, I would like to thank A/Prof Yuile for his commitment to this position.

All who had the pleasure of working with him admired the sincerity, calmness and common sense he brought to the role. Dr John Leung has now stepped in to fill the role of CAO and since taking up this position has overseen a review of the Accreditation Standards and commenced the first of many planned accreditation visits.

One of those visits was to the National University Cancer Institute in Singapore in April, which has two radiation oncology campuses—the National University Hospital Medical Centre and the Tan Tock Seng Hospital, currently with five accredited trainees, rotating between the two sites. Singaporean trainees also rotate to Australian and New Zealand centres. The accreditation

team would especially like to thank the Head of Department, Dr Ivan Tham and the Director of Training, Dr Jeremy Tey for the warm reception we received.

The first half of 2016 has also seen the appointment of Mr Chris Bartley as Trainee Liaison Project Officer. Chris’ role and the skills he brings to this role are outlined in his profile in this edition of Inside News on page 36.

Finally, education and assessment activities are fundamental aspects of the work of the College. These activities are numerous and their success dependent on the involvement, commitment and hard work of volunteer Fellows. I would like to extend my sincere thanks to all those involved in these important College activities and encourage others to consider becoming involved.

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

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Radiation Oncology Trainees Committee Update 2016 is well and truly underway and the year has kicked off to a busy start.

The foremost event for trainees, the first Phase 2 examination series, was held in February and April this year in Wellington. Congratulations to those trainees who were successful—your hard work and sacrifice over the past months has paid off! Thank you to the College and in particular, the Education and Training Committee for the huge effort that goes into coordinating our examinations and all the elements of our training.

Education and Workforce Update From an economics and workforce perspective, the major global issue facing our specialty is the government’s MBS review. The funding arrangements for radiotherapy centres will have a direct impact on the feasibility of adding new staff, and thus trainees’ employment prospects. The formal review is yet to take place for oncology, but we will ensure that trainees are informed of any relevant outcomes.

The Australian Medical Association Trainee Forum that was held in Melbourne in March revealed that employment of fellows was a preeminent concern for specialist trainees across a wide range of medical disciplines. This is consistent with the concerns expressed by many radiation

oncology trainees. As mentioned in previous updates, the College will be conducting a survey of recent graduates regarding their employment situations post-fellowship. There is anecdotal evidence of individual difficulties in gaining consultant positions, but there is at present a paucity of firmer data.

We hope that this survey provides both the College and trainees with a more realistic insight into the current employment landscape.

Fellowship Database The Radiation Oncology Trainees Committee (ROTC) is aiming to develop a comprehensive fellowship database that will be accessible to all trainees.

The aim of this database is to collate the details of all relevant past and current fellowship positions, both locally and internationally. The information we are hoping to include will pertain to the type of fellowship (for example clinical, research, site-specific etc.), the hospital location and contact information for further details. If you are aware of any fellowship opportunities at your centre please email any of the ROTC members with these details. Providing increased information on fellowship opportunities to all trainees will ultimately translate into improved employment prospects for us all.

Mentorship Program Proposal We are currently investigating the utility of establishing a mentorship program for trainees. This project is in its development phase but we will likely be canvassing all trainees via an online survey in the near future to assess the wider cohort’s perspective on the value of such an initiative. Please take the time to participate in the survey and help us invest in initiatives that are valuable to you all.

Upcoming Examinations Over the next three months, trainees will be sitting the Phase 1 examination and the second Phase 2 examination series.

Balancing work, study, research and personal commitments is a demanding task. I encourage any trainee who is feeling overwhelmed or stressed to access the support available to you via your director of training, education support officer and/or ROTC members.

Wishing you all the best of luck!

Dr Gina Hesselberg Chair, Radiation Oncology Trainees Committee

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TROG Cancer Research In exciting news, TROG Cancer Research launched the TROG 15.01 SPARK clinical trial in March, which will use revolutionary KIM technology to improve targeting accuracy for patients undergoing radiotherapy for prostate cancer—cutting treatment time from 40 visits to just five.

The SPARK trial (www.trog.com. au/TROG-1501-SPARK) studies an Australian-developed technology, Kilovoltage Intrafraction Monitoring (KIM), which assesses the position of the cancer in real-time, and enables the treatment team to redirect the radiation beam if the cancer moves even by a few millimetres.

A standard course of radiotherapy for prostate cancer involves treatment five times a week for around eight weeks.

Although the side effects are generally mild, the length of the regimen can be difficult for some men to manage.

Steve McCluskey (pictured with A/Prof Jarad Martin) is one of the first people in the world who will access the novel KIM treatment at Calvary Mater Newcastle.

He decided to join the SPARK trial after being recently diagnosed with prostate cancer and said the reduced number of

hospital visits will make life a lot easier.

“I am a great believer in new technology and I loved the idea of only having five visits with minimal chances of major side effects. I cannot wait to get the treatment behind me as quickly as possible and get on with my life,” Steve said.

Trial Co-Chair, Prof Paul Keall, said the innovative technology has the potential to be transformative for men with early stage prostate cancer, significantly decreasing their treatment time.

“The KIM technology will enable safer radiation dose intensification, and therefore the SPARK trial cancer patients will be treated in five treatment sessions over two weeks,” he said.

“Potential patients are enthusiastic about the increased accuracy and the shorter treatment time. There are economic benefits to shorter treatment times also, reducing hospital workload and costs, as well as the time off work and transport for patients and their families.

“KIM is a technology being developed and pioneered in Australia, and is applicable to other cancers affected by motion, including lung, liver, kidney

and pancreas cancers. This Australian technology could become the global standard of care for many cancer patients.”

A/Prof Jarad Martin is the clinical CoChair of SPARK, and is excited to be able to offer this promising treatment option for men in Newcastle and beyond.

“Radiotherapy is already a safe and effective treatment option for men with prostate cancer. SPARK is another step in us exploring novel ways to make a good treatment even better,” he said.

SPARK will recruit 48 patients around Australia and researchers expect the efficacy of the KIM technology to be known in late 2017. The trial is coordinated by TROG Cancer Research, co-funded by Cancer Australia and the Prostate Cancer Foundation of Australia and sponsored by the University of Sydney.

Art4TROG The opening night of the inaugural Art4TROG exhibition was held on Friday 6 May and was an enjoyable and successful event, raising both funds for the TROG 07.01 breast cancer trial and awareness of radiotherapy clinical trials research. We are grateful to the 17 emerging and established artists from the Hunter area who participated in the exhibition, creating an array of works based on their experiences with cancer and donating a portion of any proceeds from the sale of work to TROG. The silent auction held on the opening night was also successful, with generous bids placed on all items, including a limited edition Charles Blackman print and a portrait sitting with Archibald Prize finalist, Jocelyn Maughan.

For further information on TROG Cancer Research visit www.trog.com.au

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Radiation Oncology

FROGG Executive Update The Faculty of Radiation Oncology Genito-Urinary Group (FROGG) Executive Committee has been busy with a number of projects.

•D r Kirsty Wiltshire is contributing radiation therapy information to the Prostate Cancer Foundation of Australia website.

•D r Amy Hayden continues to work with the Urological Society of Australia and New Zealand and the Medical Oncology Group of Australia on tripartite prostate cancer management guidelines.

•A /Prof Kneebone is the FROGG representative on the organising committee for the Pan-Pacific Prostate Conference in Melbourne later this year.

•A /Prof David Christie has agreed to be the convenor for the next FROGG workshop titled ‘Relapse following definitive treatment of prostate cancer’. It will take place from 24-25 March 2017 so pop the dates in your diary now.

On a sad note for us, A/Prof Margot Lehman has decided to step down from the FROGG Executive to concentrate on her responsibilities as Chief Censor.

We would like to thank Margot for her many years of service to our group.

Margot has helped organise many of our conferences and is the first author on a number of publications arising from our FROGG workshops. Her quiet assuredness, steadying influence and willingness to help in any way will be very much missed.

We are inviting applications for membership of the FROGG Executive Committee. If you have a GU subspecialty interest and are willing to contribute please write to legend.lee@ ranzcr.edu.au. Also do not hesitate to contact Andrew Kneebone (Andrew. kneebone@health.nsw.gov.au) or myself (Marketa.Skala@ths.tas.gov.au) if you would like more information about what the role entails.

The Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP) has enlisted FROGG’s assistance in finding a representative for ANZUP’s Scientific Advisory Committee (SAC). Over the last four years A/ Prof Jarad Martin has made us proud as the FROGG representative and now needs to hand the reins over. Dr Scott Williams is Chair of the Prostate Subcommittee and is our other radiation oncologist representative on the SAC. As a consequence of Jarad standing down, FROGG would like to put forward a suitable nominee who would share the research principles of ANZUP and actively engage and contribute to ANZUP’s research agenda. The main purpose of the ANZUP SAC is to provide a mechanism for the development of new concept proposals, prioritisation and incorporation of key translational and research questions into active and proposed trials. It also includes the monitoring of ongoing trials and establishing research priorities. The SAC meets via teleconference three times per year and has a face-to-face meeting at the Annual Scientific Meeting (ASM).

Please contact Margaret McJannett, Chief Executive Officer for more

information about the position on margaret@anzup.org.au or phone +61 2 9562 5033. The FROGG executive would like to finalise our nomination to ANZUP by June in time for the July ANZUP ASM. Finally I would like to thank my Co-Chair A/Prof Andrew Kneebone and committee members David Christie, Amy Hayden, Ben Hindson, Tom Shakespeare, Mark Sidhom and Kirsty Wiltshire for all their support and time with continuing FROGG’s important work.

Dr Marketa Skala Co-Chair, FROGG

Member Participation Opportunities Membership of the FROGG Executive Committee If you have a GU subspecialty interest and are willing to contribute please write to legend.lee@ranzcr. edu.au. Also do not hesitate to contact A/Prof Andrew Kneebone (Andrew.kneebone@health.nsw.gov. au) or Dr Marketa Skala (Marketa.

Skala@ths.tas.gov.au) if you would like more information about what the role entails.

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Gynaecological Oncology Radiation Oncology Collaboration are involved in the management of endometrial cancer. GOROC members discussed and voted on the endometrial cancer guidelines, and will forward the draft guidelines to a wider gynaeoncology community for comments. The aim of the evidence-based guidelines is to be adopted as standard practice in Australasia.

GOROC Meeting GOROC members also had their second face-to-face meeting, and commenced discussion and work on the ImageGuided Cervix Cancer Brachytherapy Guidelines.

Dr Viet Do Chair, GOROC

ANZGOG Meeting 2016

Endometrial Cancer Workshop at ANZGOG 2016 Recent publication of the American Society for Radiation Oncology (ASTRO) guidelines, in conjunction with the American Society of Clinical Oncology endorsement, and European Society for Radiotherapy & Oncology (ESTRO) guidelines, for the management of endometrial cancer have heralded the start of a more streamlined approach to the care of women with high intermediate and high risk disease.

The half-day workshop was held on Friday 15 April, as part of the Australia New Zealand Gynaecological Oncology Group (ANZGOG) annual scientific meeting held in Sydney. Professor Anuja Jhingran of the MD Anderson Cancer Center, Houston USA, opened the workshop by providing the framework of both the ASTRO and ESTRO guidelines. The workshop was well attended by members of Gynaecological Oncology Radiation Oncology Collaboration (GOROC) and other important stakeholders who

Members of GOROC

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

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

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RadiationOncologyTargetingCancer

Radiation-Oncology-Targeting-Cancer

General Interest

New Zealand Branch News

Dr Lance Lawler

Staring through the windows of our new offices, I’ve reflected on where clinical radiology might be heading as a profession. The recent work with the Medical Council of New Zealand (MCNZ) on telehealth has reaffirmed for me not only that telehealth will be a major part of radiology over the next 20 years, but also how much things have changed from my days as a young registrar in Christchurch; now a very long time ago.

On 18 April the Ministry of Health (MOH) launched a new health strategy which can be found on the MOH website. The strategy outlines the high-level direction for New Zealand’s health system from 2016 to 2026, laying down a proportion of the challenges/opportunities the systems faces. While the strategy identifies five strategic themes, it does not directly integrate radiology or radiation oncology. That responsibility will fall to us as clinicians and the College over the coming years. It will thus be important that we continue to advocate strongly as a profession and tell our story.

Recently the College was advised that the Physiotherapy Board of New Zealand (PBNZ) would commence an Injection Therapy Trial on 9 May 2016. This trial was based on the PBNZ decision that injection therapy sits within the general ‘scope of practice’ for a physiotherapist. Fundamentally this raises serious issues of patient safety, medico-legal issues and what

process regulatory agencies should follow to amend scopes of practice.

While one would think that to change a scope of practice, clearly documented evidence outlining what training has been provided to the clinician, along with a robust consultation process should be available; in this particular case neither has transpired so far. While the individual case is serious, it also highlights the need for regulatory reform of the Health Practitioners Competence Assurance Act 2003 to meet the challenges of ‘scope extension’ that is likely to continue in the future.

On another note, the Health Workforce New Zealand (HWNZ) Board and the Medical Workforce Taskforce have concluded that the model for allocating HWNZ funding to support medical vocational training is unstable. HWNZ believes that the continuation of the current model will lead to ongoing shortages in workforces and severely compromise the ability of the system to meet healthcare needs in the future. Because clinical radiology is not considered a priority specialty, it is likely that the District Health Boards will receive a lesser funding allocation. Thus the College is working very hard with HWNZ to outline the challenges being faced and reverse this situation.

demand arithmetic, and need to be a factor in HWNZ modelling. Pleasingly, radiation oncology has been identified as a vulnerable specialty, per College advocacy. This allows the NZ Radiation Oncology Executive to mount a cogent business case that can target investment into the problem areas, so as not to treat the symptom, but the problem.

Lastly, I hope you all have the dates for the 2016 NZ Branch Annual Scientific Meeting (ASM) taking place at Te Papa in Wellington from 5–7 August 2016 in your calendar. The ability to continue to generate sponsorship for conferences has become significantly challenging over the last couple of years. It therefore becomes essential that the profession supports the event, otherwise we risk losing this valuable opportunity to network as a profession. However, it is pleasing that radiation oncologists are taking part in the ASM again this year, and the high quality scientific program will ensure a good meeting.

As always, I am happy to talk to anybody about Branch matters, or issues that they might have. Please feel free to contact me at lance.lawler@ranzcr.org.nz

A myriad of significant changes in the future such as a national bowel cancer screening program will impact on the demand for radiology. These variables sit outside simple workforce supply and

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General Interest

Australian Branch News In this edition, we continue to introduce some of the people who work hard in our Branches, with profiles of NSW Branch Chair, A/Prof Lourens Bester, and ACT Branch Chair, A/Prof Murali Guduguntla.

NSW Branch A/Prof Lourens Bester Chair, NSW Branch

I am a retired interventional radiologist and retired Director of Clinical Radiology at St. Vincent’s Hospital Sydney currently pursuing an academic career as Head of Clinical Radiology at the University of Notre Dame Sydney campus.

I have recently been elected as the Branch Chair for NSW Branch of the College.

My passion is interventional radiology, especially interventional oncology and all procedures related to it. As a retired Director I have a fair amount of experience in managing radiology departments and dealing with the Australian Health Practitioner Regulation Agency (AHPRA), Medicare and other issues related to health care in general.

I am also a member of the Faculty of Clinical Radiology (FCR) Council of the College and a member of the CPD Committee with contributions to the International Medical Graduates assessment program, Media and Profile Working Group and a reviewer for the Journal of Medical Imaging and Radiation Oncology. Being involved

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in these committees at a College level allows me to represent and to convey the ideas and concerns of the Fellows.

As a member of the FCR team, under the guidance of President, Dr Greg Slater, I believe I can play an important role in the decision-making process as well as strategising and advising the College.

Under the chairmanship of Dr Robin Harle, the CPD Committee currently plays a very important role as AHPRA is planning to roll out a recertification program. The intention is for the CPD Committee to develop frameworks and activities that will be in line with AHPRA guidelines to support Fellows in maintaining the highest standard of practice throughout their clinical careers.

I am looking forward to representing NSW and would like to encourage all NSW Fellows to advise me of their needs and concerns. Please feel free to contact me anytime on the details below.

Contact details: Lourensb@bigpond.net.au; Lourens.Bester@nd.edu.au Mobile: 0438237837

ACT Branch A/Prof Murali Guduguntla Chair, ACT Branch

I have been the Clinical Director of the Department of Medical Imaging at the Canberra Hospital since 2012

and have provided diagnostic and interventional radiology services since 1998. My other subspecialty interests are in cardiovascular and neuroimaging. In 2004 I received the Bill Hare Fellowship to undertake three months Fellowship in Cardiac MRI from CMR Academy, Berlin, after which I have introduced cardiac MRI services at the Canberra Hospital. I am actively involved with registrar education and training. Dr Rob Allen and I were responsible for the introduction of an advanced training position in interventional radiology at the Canberra Hospital in 2000.

I have been involved with College activities for about 16 years now, and my various roles have included Branch Secretary, Branch Education Officer, Journal Review Committee, Associate Editor of JMIRO, Curriculum Advisory Committee, CPD Committee, RVU Committee and member of MSAC reference 27 – Vertebroplasty and kyphoplasty. Over the last decade there have been several enhancements in the College curriculum, fellowship exams, IMG assessments, JMIRO, communication strategies and governance structures. I am proud to have been an active participant in all these enhancements.

My current roles with the College include Chair of the ACT Branch, College Examiner and member of the IMG Committee. I have completed Associate Fellowship in Medical Administration from RACMA (Royal Australian College of Medical Administrators) to enhance my managerial and leadership skills.

I work collaboratively with the Director of Training, Branch Education Officer and clinical colleagues to ensure the best possible training is provided to radiology trainees at the Canberra Hospital and their needs are met.

Recently we secured an e-film library for

General Interest

the radiology department which will be operational soon.

I look forward to continuing collaboration between the Branch and the College in advancing the specialty.

I can be contacted through my work email Murali.Guduguntla@act.gov.au

TAS Branch

A further meeting is in the planning phase for later this year. If it is not held in Hobart, it may well be held in the spectacular location of Freycinet.

The registrar training program is going well with a full complement of trainees spread across the five years and while based in Hobart, there are secondments across the state and interstate and exposure to private practice radiology.

Dr Jonathan Shulman RANZCR TAS Branch Secretary

WA Branch Careers Expo RANZCR members at the TAS Branch Meeting at Josef Chromy Vineyard in Launceston.

The Tasmanian Branch of the College has been quite active over the last six months with two clinical meetings held.

The RANZCR WA Branch joined 30 organisations including specialty colleges, sponsors and primary employing health services at the Postgraduate Medical Council of Western Australia Medical Careers Expo in April 2016. The event was attended by approximately 350 medical students.

On 7 November 2015, a very successful meeting was held in Hobart The theme was head and neck and the invited speakers were A/Prof Andy Whyte and Dr Gavin Chapeikin. The talks were well received and attended by radiologists from across the state and some from interstate. The College kindly recorded these talks and they are accessible by visiting. www.youtube.com/ranzcr The second meeting was held on 7 May 2016 in Launceston in the idyllic setting of Josef Chromy Winery. It was also very well attended and excellent talks were presented by several local members and included four registrar presentations of a very high standard. Dr Naomi Anning won the prize for her talk on a five-year retrospective review of coiling of ruptured intracranial aneurysms in Tasmania.

Retirement of Prof Turab Chakera

RANZCR Fellow Dr Trina Whittaker and Radiology trainee Dr Jeremy Ong representing the WA Branch

A retirement dinner was held for Prof Chakera at the University Club, Nedlands, on Saturday 14 May. We wish him the very best. There will be more on this, along with some photos in the next edition of Inside News.

Prof Chakera Award for Excellence in Radiology Teaching

Dr Kay-Vin Lam was born in Singapore and educated in Perth. We are the beneficiaries of his family’s emigration to Perth. Presently he is the Senior Diagnostic and Interventional Thoracic Radiologist at Royal Perth Hospital. For many years now I have used Kay-Vin as the ‘man to go to’ whenever I needed help with difficult thoracic cases.

He is an excellent teacher to all. His tutorials are appreciated by students and our trainees, in particular senior trainees preparing for the Part 2 Fellowship exams. I am not surprised that he has been selected the winner of the Prof Chakera Award, he is a most deserving recipient.

Prof Turab Chakera Volume 12 No 3 I June 2016

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Australian Branch Meeting Dates Overview 2016

NSW

QLD

WA

Academic Meeting (ACI Lecture Series) Tuesday 26 July Tuesday 8 November

Branch Committee Meeting Thursday 21 July Monthly Professional Meeting (MPM) Wednesday 20 July Wednesday 17 August Wednesday 21 September Wednesday 16 November

Location Kerry Packer Lecture Theatre RPA Hospital Missenden Road, Camperdown, NSW 2050

Teleconference Location Bruce Hunt Lecture Theatre Block A, Level 2, Royal Perth Hospital 197 Wellington St, Perth WA 6000

Meeting dates are subject to change. For further information about Branch activities and event locations please visit: www.ranzcr.edu.au/organisation/australian-branches or contact Sarah Hall on: sarah.hall@ranzcr.edu.au Ph: +61 2 9268 9752.

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If you wish to participate, you can access the survey by following this link: https://qau1.au1.qualtrics.com/SE/ ?SID=SV_bexVmU4TqPYIGrP If you have any questions, please contact Tom Holman, Director, Customer Focus, Pty Ltd +61 412 566 425

Branch Contacts 2016 ACT Chair: A/Prof Murali Guduguntla E: Murali.Guduguntla@act.gov.au Honorary Secretary: Dr Mervyn Despois E: mervyn.despois@act.gov.au Meeting Convenor: Dr John Cockburn E: john.cockburn@act.gov.au NSW Chair: A/Prof Lourens Bester E: lourensb@bigpond.net.au Honorary Secretary: Dr Chee-Chung Hiew E: chee-chung.hiew@sesiahs.health.nsw.gov.au Meeting Contact: Ms Annie Hutton E: Annie.Hutton@aci.health.nsw.gov.au NSW Radiotherapy Club Ms Legend Lee E: faculty@ranzcr.edu.au

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

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

QLD Chair: Dr Jonathan Corness E: jon_corness@yahoo.com Honorary Secretary: Dr Sanjay Dhupelia E: secretaryranzcrq@gmail.com

MSM Convenor: Dr Bhaveen Marne and Dr Wayland Wang E: msm.convenor@gmail.com

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

WA Chair: Dr Neil Powers E: neil.powers@health.wa.gov.au Honorary Secretary: Dr Richard Ho E: richard.ho@health.wa.gov.au Meeting Convenor: Dr Fiona Bettenay E: Fiona.Bettenay@health.wa.gov.au

General Interest

From the Trainor/Owen Collection Another box, more stories to tell With each new technique, new technological advancement and new diagnosis, the history of radiology and radiation oncology is being created.

Capturing this history as it is happening on the frontlines makes for a unique collection.

The Trainor/Owen Collection recently acquired over 10,000 35mm slides kindly donated by retired radiation oncologist, Dr Colin Bull. These slides have been collected over a lifetime of practice and teachings across the globe. From the United Kingdom, to the United States of America, throughout the Middle East and in Western Sydney, the Bull Collection covers a career full of learning, teaching and discoveries, giving grassroots illustrations of the development of new techniques.

The collection captures moments such as inventing protocols for the trials and initial treatments of breast cancer in the

United States of America. It portrays the challenges of treating patients alongside differences in local cultural identities and social acceptance sensitivities in the Middle East; and solving congenital mysteries never before captured in Western Sydney. Each slide tells a story and as a collection it becomes a history full of curiosity.

Presently, the archive is fortunate to have Dr Bull regularly volunteering. Together we are unearthing stories of radiology and radiation oncology in Australian and New Zealand. His knowledge of radiation oncology is an invaluable resource, especially now he has the opportunity to describe and catalogue his own works.

If you are interested in learning more about the Bull Collection, or other collections, including NH Korner, HR Withers, HA Van Den Brenk, DG Maitland or JF Ryan, why not make

1a

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21a

Member Participation Opportunity Do you enjoy discovering stories, always having an anecdote ready to go or solving mysteries? Why not volunteer to help with the Trainor/ Owen collection. Please contact Eva Stokes-Blake, Project Officer, Archivist, at the College for more information on +61 2 9268 9725 or email archives@ranzcr.edu.au

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an appointment to visit the Trainor/ Owen Collection. It is a unique archive, museum and library recording the history of radiology and radiation oncology. Contact the College Archivist on the details below to make an appointment.

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Slides: 1a - Lymphosarcoma - skin infiltration of the back; 4c - Diffuse Histiocytic Lymphoma - fungating groin nodes, right; 5c - Diffuse Histiocytic Lymphoma - neck nodes, right; 7e - Diffuse Histiocytic Lymphoma - fungating neck nodes, posterior view; 9 - Lymphoma Ovary - Mediastinum Metastases, initial diagnosis was dysgerminoma; 21a - Pancoast Cancer of Lung - CT Scan upper Chest; 21b - Pancoast Cancer of Lung - Plan X-ray of chest; 23a - Malignant Pericardial Effusion - PA and Lateral X-rays show pericardial effusion Volume 12 No 3 I June 2016

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What’s in Issue 3?

Radiology Article Review Article Evaluation of the effect of double reporting on test accuracy in screening and diagnostic imaging studies: A review of the evidence Corresponding author: Dr Richard E Pow, Faculty of Health Sciences, The University of Sydney, NSW Diagnostic error in radiology is not uncommon, with rates of clinically significant error reported to be as high as 20%. Radiological errors are often multi-factorial, however, perceptual factors are thought to be mainly responsible. One way of reducing perceptual error is that of double reporting, which refers to the interpretation of radiological investigations by two observers, with strategies of arbitration and consensus available to settle discordant reports. Independent double reporting, where observers have no knowledge of each other’s reports, is generally considered to be the most effective form. The impact of double reporting on diagnostic efficacy has been primarily explored in screening mammography, where it has consistently been shown to improve sensitivity, cancer detection rate and depending on local policy, have a positive influence on recall rates. Subsequently, the adoption of double reporting is reported as standard practice in many national and regional breast cancer-screening programmes. To a lesser extent, the impact of double reporting has also been investigated for neuroradiology, thoracic and gastrointestinal imaging, with small-scale studies in these fields showing promising results. With the widespread implementation of digitisation and the ease of access to images, the efficacy and cost-effectiveness of double reporting for other common radiological investigations requires attention. The review will evaluate the evidence regarding the effect of double interpretation of diagnostic imaging studies on test accuracy.

Radiology Article Pictorial Essay Imaging of tarsal navicular stress injury with a focus on MRI: A pictorial essay Corresponding author: Dr Guy Harris, Radiology Department, Concord Hospital, NSW Predominantly diagnosed in athletes, stress fracture of the tarsal navicular is becoming increasingly recognised by clinicians as a cause of midfoot pain. Delayed diagnosis can increase the significant morbidity associated with this condition. Consequently the role of MRI is increasing, given the potential to identify a stress reaction in the navicular prior to the development of a discrete stress fracture. It is necessary for radiologists to be familiar with the typical and atypical appearances of this important condition.

Radiation Oncology Article Original Article Definitive intensity-modulated radiotherapy concurrent with systemic therapy for oropharyngeal squamous cell carcinoma: Outcomes from an integrated regional Australian cancer centre Corresponding author: Dr Reza Masoud Rahbari, North Coast Cancer Institute Lismore, Radiation Oncology, NSW Introduction: Oropharyngeal squamous cell carcinoma (OPSCC) incidence has increased over the past two decades largely because of an increase in human papilloma virus (HPV)-related OPSCC. We report here outcomes of definitive radiation therapy for OPSCC with simultaneous integrated boost intensity-modulated radiotherapy (IMRT) in a regional Australian cancer centre.

Methods: We retrospectively reviewed electronic medical records (EMR) of all patients treated with IMRT for head and neck cancer. We included patients who received a curative intent IMRT for OPSCC (2010–2014).

Results: Of 61 patients, 80% were men, and the median age was 57 years. Ninety percent of our patients received concurrent systemic therapy, and 68% were p16 positive.

The median radiotherapy dose received was 70 Gy in 35 fractions. The median follow up for surviving patients was 22 months. Twenty-four month actuarial data show that the loco-regional recurrence free, metastasis-free MFS, cancer-specific (CaSS) and overall survival percentages were 98.3%, 92.6%, 91% and 90.3%, respectively. We did not observe grades 4 or 5 acute or late toxicities, and 10 patients (16.2%) exhibited persistent grade 3 toxicity 6 months after completing the treatment.

Conclusion: The results from curative IMRTs for OPSCC delivered in a regional cancer centre are comparable with results published by tertiary referral centres. A long-term follow up of this patient cohort will continue for further analyses and comparisons with tertiary centres.

Radiation Oncology Article Original Article What is the viva experience of phase 2 Radiation Oncology examination candidates? Survey and advice for future candidates Corresponding author: Dr Hilde M Kleiven, The Canberra Hospital, Garran, ACT Introduction: Medical speciality examination is a very stressful event in medical careers. We aimed to determine the subjective experience of Radiation Oncology Royal Australian and New Zealand College of Radiologists (RANZCR) oral examination candidates. It was hoped the results would provide reassurance and advice for future candidates.

Methods: We distributed an anonymous online survey through the RANZCR membership database to Radiation Oncology Trainees and fellows who may have sat their oral examination within the last 3 years.

Results: There were 21 responses, yielding a response rate of 21%. Nineteen percent of respondents were moderately or very surprised during their viva and the most frequently noted cause was the demeanour of the examiners. The clinical cases and clinical examination station were rated very fair by over 80% of responders while the planning cases were rated very fair by 57%. During the viva, 33% thought they passed and 71% of these candidates were successful. Forty-three percent felt they were borderline, and all of these respondents passed. Five participants (24%) failed in the first attempt and four described being unable to convey their actual knowledge.

Candidates found mock examinations to be the most useful examination preparation activity. The most frequently given advice was to focus on the planning examination.

Conclusions: The majority of this select group of candidates indicated that the oral examination cases were very fair. Candidates rated the planning exam as least fair, indicating this may be the area that would benefit most from better preparation.

Access your College journal online If you are a member of the Royal Australian and New Zealand College of Radiologists, access JMIRO free online.

- Go to www.ranzcr.edu.au - Log in using your College username and password = FREE access to all JMIRO current and digitised backfile content from volume 1, 1957!

General Interest

Congratulations to Prof Jim Denham OAM

Congratulations to A/Prof Sandra Turner ESTRO Honorary Membership

Prof Jim Denham was awarded a Medal of the Order of Australia in the 2016 Australia Day Honours for service to medicine, and to medical research.

At the recent ESTRO35 meeting in Turin, Italy, A/Prof Sandra Turner was awarded Honorary Membership of the European Society of Radiotherapy and Oncology (ESTRO) for ‘Exceptional Contribution to Radiotherapy and Oncology’.

Research…a privilege and a pleasure for Jim “It was a massive honour to receive an OAM for my research efforts,” said Prof Jim Denham. “However it must be pointed out that research is almost never a one-man show and my collaborators and research teams have played enormous roles in my achievements, as has the support of the institutions I work for and belong to.”

When it came to developing an interest in research Prof Denham could not help following the example set by both family members and professional mentors at the Middlesex and Mount Vernon Hospitals.

See page 15 for a full article on Prof Denham’s research career.

Honorary Membership awardees are either non-European radiation oncologists or other radiation professionals, or European medical specialists from other disciplines who are deemed as having made major contributions to oncology.

Sandra has been instrumental in formalising the educational and scientific collaborations between RANZCR and ESTRO resulting in two MOUs being signed between the groups over recent years. She has also established a productive global collaboration in radiation oncology education (GRaCE) linking leaders in education and training in several European countries through ESTRO with those in Australia, New Zealand and Canada.

The award was presented by ESTRO past-President, Prof Vincenzo Valentini, and immediate past-President, Prof Philip Poortmans, following a symposium featuring talks by the three 2016 awardees. Sandra’s presentation was entitled “Evidence-Based Medical Education: Radiation Oncology’s Forgotten Foundation”.

In Prof Vincenzo’s introduction, he mentioned Sandra’s contributions to ESTRO’s educational developments and her radiation oncology advocacy work through Targeting Cancer as reasons for her receiving the award.

Volume 12 No 3 I June 2016

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General Interest

Professional Documents and Publications

Corporate Members of the College Alpenglow Pty Ltd www.alpenglow.com.au Bayer Australia Ltd www.bayer.com.au Brainlab Australia www.brainlab.com/en/ ChoiceOne Pty Ltd www.choiceone.com.au Comrad www.comrad.co.nz EIZO www.eizo-apac.com/medical Elekta Pty Ltd www.elekta.com

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

All College standards, policies and guidelines are available on the College website www.ranzcr.edu.au/resources/ professional-documents All College position statements and reports can be found here: www.ranzcr.edu.au/advocacy/statements If you have any enquiries about these documents, please contact the College on +61 2 9268 9777 Pacific Radiology Group www.prg.co.nz Philips Healthcare www.philips.com.au/healthcare Quantum Health Group www.qhealthcare.com.au Sectra www.sectra.com/medical/ Tolmar Australia Pty Ltd www.tolmar.com.au/ Toshiba Medical www.medical.toshiba.com.au Varian Medical Systems www.varian.com Wiley Publishing Asia http://au.wiley.com/WileyCDA/

Everlight Radiology www.everlightradiology.com.au Everx www.everx.com GE Healthcare www.gehealthcare.com.au/ Health Imaging Solutions www.healthimaging.com.au Hologic Australia www.hologic.com/ Integral Diagnostics www.integraldiagnostics.com.au I-MED Network Radiology www.i-med.com.au Ipsen Pty Ltd www.ipsen.com.au Lightbox Radiology Education www.lightboxradiology.com.au/

Clinical Bone Densitometry Course Adelaide 8th - 9th October 2016

Education

Cardiovascular CTA

Expert Users Course

The Cardiovascular CTA Expert Users Course is a two day course intended for Cardiologists and Radiologists who wish to add to their experience in viewing and reporting Cardiac CTA examinations.

Participants will have the opportunity to review 50 mentored cases over the 2 days.

Dates: Wednesday & Thursday, 20th - 21st July 2016 Venue: Sofitel Gold Coast 81 Surf Parade, Broadbeach QLD 4218 Tuition Fees: AUD $2,500.00 inc GST* Please visit www.philips.com.au/education for full program details. *Tuition fees do not include flights or accommodation.

Please ask us about discounted accommodation rates at the Sofitel Hotel

This well established clinical densitometry training course, with faculty drawn from leading densitometry practitioners within Australia, is intended for both physicians and technologists. Material includes patho-physiology of osteoporosis, principles & practice of bone densitometry (covering routine & paediatric scanning, body composition, quality assurance, pitfalls, interpretation & reporting).

You should consider the course if you are: • a current DXA operator seeking more formal training or advanced update of your work practices • a medical specialist with responsibility for bone density testing and reporting • seeking deeper knowledge of the technological & quality assurance aspects of bone densitometry measurements Course Structure • This intensive 2 day course includes manufacturer specific interactive workshops utilising the latest and legacy software • Participants are provided with an online course handbook prior to the course & should read through all the material before they attend • An online multiple choice examination is held two weeks after the course • Upon course completion & achievement of a pass mark in the examination, participants will be awarded a Certificate of Completion in Clinical Bone Densitometry • Participants may also seek ANZBMS Densitometry Accreditation after the course by submitting specified material Venue: Royal Adelaide Hospital,

North Terrace, ADELAIDE, South Australia 5000

Accepted for CPD by AIR, ANZSNM, RANZCR and RANZCP (and affiliates)

Cost (including GST)

Online until 9-Sep-2016 Mail or Fax until 9-Sep-2016 Online only from 10-Sep-2016

Cost includes: • lunch & refreshments for both days • course handbook & follow-up material online • examination fee Registration • Closes 9-Sep-2016 (or earlier if fully booked) • Late registrations accepted (late fee) until 30-Sep-2016 (no exceptions) • Secure online registration (Mastercard or Visa required) More details & registration at

AUD$650 AUD$675 AUD$750

www.anzbms.org.au/anzbms-bone-densitometry-course.asp

60

Inside News

General Interest

Australasian Meetings 2016 July 2nd Australian Breast Conference Auckland, NZ – 7-10 July 2016 www.asbd.org.au RADaim 2016 Gold Coast, QLD – 22-24 July 2016 www.phoenixconf.com/RADaim2016.htm

August IRSA Meeting Queenstown, NZ – 2-4 August 2016 www.irsa.com.au State of the Art Radiotherapy Conference Byron Bay, NSW – 5 -7 August 2016 www.startxconference.com Asia-Pacific Prostate Cancer Conference Melbourne, VIC – 31 August – 3 September 2016 http://prostatecancerconference.org.au

September ASNO COGNO 2016 Sydney, Australia – 11-14 September 2016 www.asnocogno2016.org.au

October ANZSPR 2016 Gold Coast, QLD – 16-19 October 2016 www.anzspr16.com ANZHNCS Annual Scientific Meeting and IFHNOS 2016 World Tour Auckland, New Zealand – 25-27 October 2016 www.ifhnosauckland2016.org ASUM 2016 Brisbane, QLD – 28-30 October 2016 www.asumconference.com.au

November 8th Multidisciplinary Breast Cancer Conference Perth, WA – 19-20 November 2016 https://air.eventsair.com/breast-cancerconference-2016/registration/Site/ Register

RANZCR Annual Scientific Meeting Dates ASM 2016 Gold Coast, Queensland 13-16 October 2016 www.ranzcr2016.com 2016 NZ Branch Annual Scientific Meeting Wellington, New Zealand 5-7 August 2016 www.ranzcr2016.co.nz

International Meetings 2016 August AOCR 2016 Beijing, China – 18-21 August 2016 www.aocr2016.org

September

ASM 2017 19-22 October 2017 Perth, WA

ASHNR 50th Annual Meeting Washington DC, USA – 7-11 September 2016 http://ashnr.edusymp.com/product/ details/46

College Meetings 2016

ISS 2016 Annual Meeting Paris, France – 7-9 September 2016 http://internationalskeletalsociety.com/ home.aspx

Board 5 August 13 September (telco) 17-18 November

RCR 2016 London, UK – 12-14 September 2016 www.rcr.ac.uk/college/annual-scientificmeeting-2016

Annual General Meeting 13 October 2016

ICR 2016 Buenos Aires, Argentina 21-24 September 2016 www.icr2016.org/

Faculty Council – Clinical Radiology 7-8 July 1 September (telco) 29-30 September Faculty Council – Radiation Oncology 22 July 2 September (telco) 21 October

~ Death Notices ~ The College notes with regret the death of the following members: Dr David Brallier – Educational Affiliate, New Zealand Dr Jan Vaclavek – Fellow, Andorra Dr Philip Cappe – Fellow, NSW

ASTRO 2016 Boston, USA – 25-28 September 2016 www.astro.org/Meetings-and-www.astro. org/Meetings-and-Events/2016-AnnualMeeting/Index.aspx

October ESTI Thoracic Summit Krakow, Poland – 23-24 October 2016 www.myesti.org/congress-2016 UICC World Cancer Conference Paris, France – 31 October – 3 November 2016 www.worldcancercongress.org/

November RSNA 2016 Chicago, USA – 27 Nov – 2 Dec 2016 www.rsna.org

December 17th World Conference on Lung Cancer Vienna, Austria – 4-7 December 2016 http://wclc2016.iaslc.org/

Volume 12 No 3 I June 2016

61

Courses and Workshops Classifieds

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

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

Neuroradiology Update 2016

S M T W T F S

MELBOURNE August 27

RANZCR 6.5 CPD Points

/courses

PET/MRI: Proof & Progress 2016 International speakers, clinicians and researchers gather at the Translational Research Institute to outline their experiences & innovations, many using the first clinical PET/MRI in the southern hemisphere, hosted at the PA Hospital.

Brisbane 16 & 17 Sept 2016

Intensive Radiologist Workshops Ovarian Incidentalomas Prostate Neuro

17.25 CPD per day workshops

www.tri.edu.au/PET-MRI

Casselman, Coakley, McCollough

Princess Alexandra Hospital

www.radaim.com

B R I S B A N E • AU S T R A L I A

2ND INTERVENTIONAL NEURORADIOLOGY WORKSHOP 12 October 2016 8.30am - 5.00pm NEURORADIOLOGY COURSE 13 - 14 October 2016 8.30am - 5.00pm

Small groups and live models used to maximise interactive learning AIR-Approved | Suited to all levels of experience

Venue Tan Tock Seng Hospital Theatrette, Level 1 11 Jalan Tan Tock Seng Singapore 308433

2016 Dates: Saturdays - 30 Jul | 20 Aug | 17 Sep | 8 Oct | 12 Nov

For the latest updates, visit our website: http://www.nni.com.sg/Education/Documents/16ANC.html For enquiries, please email: sin_leong_tien@nni.com.sg Organised by

Nominal Sponsors

CPD Mammography Workshops

Supported by

Time

: 9:00am - 1:30pm

Venue

: MMI, Ground Floor 3 Technology Place Macquarie University 2109

Cost

: $379 (incl. GST)

Enquire about group discounts for three or more attendees from one employer Enquiries : enquiries@mqmi.com.au

Advertising submitted by third parties does not constitute endorsement by The Royal Australian and New Zealand College of Radiologists.

MAKE THE MOST OF YOUR RANZCR MEMBER BENEFITS

Enjoy exclusive savings on dining, accommodation, shopping, airline lounge memberships, package tours, insurance services and more.

For more information, connect with RANZCR Member Advantage: 1300 853 352 (AU) | www.memberadvantage.com.au/RANZCR | 0800 453 244 (NZ)

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