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Volume 13 No 3 / Jun 2017

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

THE FUTURE OF INTERVENTIONAL RADIOLOGY

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In this edition

From the

5 President’s Message 6 COVER STORIES: A Day in the Life of a Modern Interventional Radiology Unit 9 The Future of Interventional Oncology 11 CEO Message

Editor’s Desk

Engaged Members 12 Interventional Radiology Update 13 IRC Member Profiles 19 2017 Annual Scientific Meeting

We are very fortunate to have so many members contribute content to our newsletter. Thank you. It makes for a very interesting and diverse read, as you will see in this edition.

Research 20 RANZCR Recalls: Prof David Ball talks JMIRO 22 Withers and Peters Grant: Embedding a Culture of Research Profile and Presence 25 Supporting Indigenous Health 27 A Role Model for the Indigenous Community Access to Quality Services 28 The College’s International Development Fund in action 31 Direct to Consumer Health ‘Screening’ Quality Training 32 Registration with the GMC in the UK for Fellows of RANZCR 33 Exam and Assessment Review Update 35 Courses and Workshops Clinical Radiology 37 Message from the Dean 39 Chief Censor 41 Trainee News Radiation Oncology 49 Message from the Dean 51 Chief Censor 53 Trainee News Melbourne,

VIC ne, VICGeneral Interest 60 New Zealand Branch 61 Australian VIC Melbourne, Branches 63 From the Archives ne, VIC65 Meetings and Events VIC Melbourne, Inside News is printed on Titan Satin. Titan is ne, VICproduced in an ISO 14001 accredited facility ensuring all processes involved in production VIC Melbourne, are of the highest environmental standards. mixed Sources Chain of Custody (CoC) ne, VICFSC certification ensures fibre is sourced from certified and well managed forests. VIC Melbourne, ne, VIC Editorial Staff Editor-In-Chief Dr Allan Wycherley Sub Editors Sarah Hall Bertha Harvey

In this edition, our cover stories focus on the future of interventional radiology and interventional oncology. Both formats are exciting and evolving rapidly. Drs Glen Schlaphoff and Jules Catt take us Dr Allan Wycherley on a journey into a day in the life of an interventional radiology department while Adj. Clin Prof Liz Kenny discusses the future prospects of interventional oncology. The development of IR and IO have important potential benefits for patients. We look forward to seeing how these two progress in the future. We introduce you to the new College Interventional Radiology Committee, where each member provides us with a bit of background on their careers. It is time to start planning for the 2017 Annual Scientific Meeting which is being held in Perth, Western Australia this year. We explore information about our Keynote speakers and some information about the venue. We hear from Prof David Ball, our Editor in Chief of the College Journal, JMIRO on how far it has come since inception. We discuss evidence based imaging screening programs that have potential to save patients’ lives through early detection. The Royal College of Radiologists addresses the key details Fellows of our College require if one wants to practice or do locum work in the United Kingdom. It can be a very rewarding experience to undertake overseas opportunities as we have such a diverse specialty. All this and more in our second edition of 2017. As always, I look forward to your feedback and suggestions. Please email me on the email address below. Allan Wycherley Editor-in-Chief editor@ranzcr.com The Royal Australian and New Zealand College of Radiologists Level 9, 51 Druitt Street Sydney NSW 2000 Ph: +61 2 9268 9777 Web: www.ranzcr.com Email: ranzcr@ranzcr.com

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

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Introduction

The Innovative Impact of Intervention A Message from the

President Dr Greg Slater

The trivia quiz question for this edition of Inside News is ‘What have severe epistaxis, prostate cancer and vertebral crush fractures got in common?’ Easy, you say, it’s interventional radiology (IR), which may be used to treat all these conditions1 and, of course, many others as well. But perhaps what few radiologists get right so easily is the answer to a deeper question: ‘How important is IR to our future?’ IR already influences the practices of most College members. Minimallyinvasive interventions such as guided biopsies have long characterised diagnostic radiology, but these tools were just the beginning. Radiologists such as Charles Dotter, who developed percutaneous transluminal angioplasty in the 1960s, have pioneered techniques now widely accepted in vascular surgery,2 while closer to home, the work of many of our own members, for example Greg Van Schie in the development of angiographic catheters and aortic endografts, comes readily to mind. We can be rightly proud of the contribution made by radiologists to many fields of medicine. Treatments using IR are now to the fore right across our profession—this is especially so in radiation oncology, where the overlap of the role of the diagnostician with that of the therapist is probably greatest. Interventional oncology (IO), involving the use of guided biopsy needles, ablation electrodes, intravascular catheters and other miniaturised

instruments to treat cancer, is a new horizon for us and one that I believe will greatly expand the role of IR. IO techniques to debulk tumours prior to surgery or treat patients unable to safely undergo open surgery, are increasingly improving patient outcomes and lowering hospital costs. Ultimately, the College wants IO to be recognised as the ‘fourth pillar’ of cancer treatment, alongside surgical, medical and radiation oncology. And that’s not all—interventional radiology is helping us to revise perceptions of the radiologist in the eyes of patients and referring doctors, an issue we have written and talked about here on numerous occasions. The standing of our profession suffered for years as the radiologist retreated from the examining room to the reporting room, but the trend is now reversing as many have realised they should be more closely involved with patients and other doctors. This new, welcome trend will continue, but only if we commit fully to patient consultations, daily ward rounds, admitting rights, multidisciplinary teamwork and, where appropriate, to IR. As I have said in other forums, engaging in ‘turf wars’ is self-defeating.3 It is especially misguided within our own profession where in the past some subspecialities have had difficulty working cooperatively in role management. This cannot be wise—debate within our ranks is democratic but divisiveness is deadly. More recently a refreshing mood of collegiality is guiding our decisionmaking in the College IR Committee.

Interventional radiology is showing us how our future may be secured. The IR techniques taken on, and sometimes taken over, by the vascular surgeon merely demonstrate the robustness of these tools and the clear benefit they provide to the surgeon’s patients. That’s not something to fear or condemn. We are an innovative and inventive lot— more than most medical practitioners, I believe—so the answer to the deeper question depends on our willingness to get on with innovating and inventing some more. I encourage you to do what we do best.

References 1. IR treatments for these aliments include, respectively, endovascular embolisation, brachytherapy and percutaneous vertebroplasy, to name just a few. 2. Misty M. Payne, “Charles Theodore Dotter: The Father of Intervention,” Texas Heart Institute Journal, vol. 28, no. 1 (2001), 28–38, https://www. ncbi.nlm.nih.gov/pmc/articles/PMC101126/ pdf/20010300s00007p28.pdf 3. “Gregory John Slater,” Interventional News, 1 March 2017, https://interventionalnews.com/ gregory-john-slater/

Volume 13 No 3 I June 2017

Introduction

A Day in the Life of a Modern Interventional Radiology Unit Interventional radiology (IR) has been a dynamic field since its inception over 50 years ago through the work of early pioneers in the field. In 1964, Charles Dotter described and performed the first angioplasty and in the years that followed, he and other innovators brought about a revolution in procedural medicine with the development of catheter directed therapies and other minimally invasive image guided techniques.

It’s 7:30am on Wednesday morning and the HCC meeting is about to start. The room is filled with gastroenterologists, a hepatic surgeon, oncologists, diagnostic and interventional radiologists, IR and HCC nursing staff and keen radiographers. It’s a relatively new meeting borne out of the UGI meeting that was at risk of stretching to several hours by the prospect of an everincreasing tide of chronic liver disease (viral and NASH) predisposing to HCC.

Today, modern IR and the healthcare system in which it operates is dramatically different to that of years past. While technical prowess has often been the foremost attribute of an interventional radiologist, more recently there has been a growing awareness that procedural ability is only a component of the skill set required by IRs to thrive in the modern healthcare environment.

The first patient is a 65-year-old female with cirrhosis, Child-Pugh A and ECOG 1. She’s been treated in the IR unit for several years initially having had a microwave ablation of a small lesion in her right lobe followed by a DEB-TACE

Internationally, the transformation of interventional radiology into an integrated clinical specialty is well underway. Whether through outpatient clinics, dedicated wards or primary patient responsibility, IRs are increasingly becoming and importantly seeing themselves as first and foremost clinicians. We have come full circle and are being given lessons by our colleagues in medicine, surgery and radiation oncology, which we must learn. From angioplasty and stenting to coiling and clot retrieval, embolisation, ablation and the broad suite of interventional oncology; the ways in which IRs can treat our patients has expanded dramatically and consistently and almost every branch of medicine has benefited. With so many new and compelling developments and a shifting selfperception within the profession, it is an exciting time to be an interventional radiologist!

Inside News

“Modern IR and the healthcare system in which it operates is dramatically different to that of years past.” embolisation to a subsequent lesion in segment 4a. Her one month follow up CT demonstrates a rim of enhancement at the site of recent embolisation and we discuss the possibilities of persistent disease versus post treatment inflammation. The discussion turns to her willingness for further interventional options as well as the possibility for sorafenib chemotherapy. Additional loco-regional therapy with a repeat embolisation could be warranted but the alpha fetoprotein has dropped to almost nothing and we are just not sure if that smooth rim of enhancement is definitely a tumour. The decision is made for close imaging follow up and subsequent discussion. The meeting moves on to the next patient and so it goes for the ten patients on the list,

many of them with treatment histories stretching back years. We have come a long way from an average life expectancy of seven months. By 8:30am, it’s time to get going on the first case of the day. He is a 54-yearold hypertensive vasculopath with calcified vessels and critical stenoses of his renal arteries. He was seen in the interventional clinic several weeks before for a pre-procedural assessment where he was fully worked up and paperwork completed so there are no hold ups getting him on the table. The nurses are a little anxious that his blood pressure is sitting above 200 systolic but after titrating it down with some IV hydralazine everyone is a little more settled and we can get going. The case starts with a cone beam CT on the table of the single plane, floor-mounted departmental workhorse. This is then fused to the CT angiogram to give a 3D map of the aorta and visceral vessels enabling renal artery access without a drop of contrast. Have to keep the nephrologist happy. In the biplane suite next door, the IR fellow is scrubbing for a PTC on a yellow 70-year-old woman who’s been waiting for several days for the procedure. The hold-up has been anaesthetics, not that it’s their fault. The hospital only funds two general anaesthetic lists per week and they only start after they’ve finished the electroconvulsive therapy list in theatre. Who would have thought there is that much ECT going on? So we have had to fight for this add on list and there will need to be a bus crash for us to let the anaesthetists escape back to their emergency theatre lists. We’re not sure what’s causing her biliary obstruction but cholangiocarcinoma is the most likely cause. She failed ERCP due to a previous Billroth II, it’s unclear why they attempted at all, so the only other option for decompression and a tissue diagnosis is percutaneously

Introduction

through the liver. The fellow has done this before so he’s left to himself to gain access to the biliary tree with ultrasound guidance and fluoro if that fails. Meanwhile the vascular team stick their heads in; they want to discuss a couple of cases. There are patients with carotid artery stenosis, both outpatients, who will require stenting. These are generally done as combined cases with vascular and IR and the results over the last few years have been solid. We all huddle around the Terarecon workstation as we measure the vessel size, length of the plaque and try to predict how the vessel will react to landing the stent along that curve of vessel. Satisfied the vessel won’t kink and that the embolic protection device is going to sit nicely through the procedure, we lock the cases in for next week. As this is going on, the pressure measurements across the renal artery stenoses are significant at >25mm Hg and the stents go in without issue. The post angiogram doesn’t show any renal perfusion defects so everyone is happy with a job well done. Access was with a 7F sheath via the right common iliac and given that we started him on clopidogrel in clinic, it isn’t going to be fun pressing on the groin for the next half an hour... especially as the fellow is busy next door. We decide on a closure device which deploys well under ultrasound guidance. The patient will follow up with the nephrologist and we hope to see the blood pressure significantly lower than when he arrived this morning. In the meantime, we try to get him out of the hospital and away from a blood pressure cuff before the hydralazine wears off. The IR registrar, rotating from diagnostics for three months, is back in the unit having finished the morning ward round with the resident; it always takes a couple of hours. Even though most of the patients are nursed in

the IR ward next to surgical short stay there are always a few outliers and patients with drains can be all over the hospital. The 75-year-old whose small RCC we cryo-ablated yesterday is so asymptomatic she doesn’t believe we actually did anything and the reg was hard pressed to convince her otherwise. She was admitted under the IR service

“Some fancy wirework by the director is all it takes and the catheter pops satisfyingly into the duodenum.” overnight only because she lives in a small town several hours away and couldn’t get home late in the afternoon. We’re not surprised she’s a bit confused by it all; cryotherapy is so well tolerated

patients often wake up with no more than a mild ache in their back, if at all. She’ll head home with her daughter and we’ll see her in clinic in three months time with a CT. The urologist is happy for us to follow her up and grateful she has another option to offer her patients particularly for stroppy older folk who won’t contemplate surgery. There are no other issues on the round. The uterine fibroid embolisation patient has her PCA down and is going home. She was referred by an out of area O&G and was also admitted under IR without a problem except for the middle of the night phone call to the on call IR, like clockwork at 2:00am, in regard to the patient’s cramps. All the drains placed over the past few days are either draining well or out, and at 10:30am the resident has ward chores to do and the reg is sent to consent the patients waiting in trolley bay and get stuck into some biopsies and a few more drains.

continued over... Volume 13 No 3 I June 2017

Introduction

Back in biplane the PTC is dragging on, not because of access issues but rather the tight stenosis blocking the CBD. The fellow is suggesting a sharp recanalisation option, which is perhaps a little premature even two hours in. Some fancy wirework by the director is all it takes and the catheter pops satisfyingly into the duodenum. The biliary forceps are advanced down the sheath and bite off several small pieces of tissue at the level of the occlusion. Usually deployed via an endoscope, they have found a home in our IR suite as a useful addition to the bag of tricks. There’s blood casting in the ducts on the cholangiogram and while the pathology will almost certainly return a malignant result, the decision is made to let things settle down and bring the patient back in a few days’ time for a check cholangiogram followed most likely by biliary stenting. It’s lunch time now and International Nurses Day. This of course means a departmental shut down and we take the opportunity to check out the new coffee shop recently opened in the hospital foyer. We run into the hospital General Manager and stop to chat. She’s appropriately proclaimed 2017 as the year of interventional radiology and we are hoping this translates into a few more nurses and radiographers, even if not the combined angio/CT suite and interventional MRI we are all barracking for. Lunch is interrupted by a call from the ED staff. They are helicoptering in a pedestrian vs car with almost certain pelvic fractures and a blood pressure through the floor. We advise to take them straight to IR where we’ll need to do an emergent angiogram and likely embolisation of the iliac arteries. It’s a little uncommon to get trauma cases at this time and despite how it throws out the list, everyone will be happy to do this kind of difficult case in the light of

Inside News

day. It will need to be done in the hybrid suite, which sits in IR directly next to theatre in case orthopedics need to get involved at the same time. Down the corridor, we are prepping for the prostate artery embolisation case on the chatty 63-year-old gentleman with BPH. He’s a little anxious; he flew over from New Zealand for the procedure and anyway most men are about this kind of thing. We’re hoping he’s going to be as happy as the last guy, who two weeks later proudly proclaimed he was peeing like a racehorse and had never felt better. It’s a PIRADS 2 and the MR shows the prostate pressing up into the bladder with a particularly large central zone. It’ll be radial artery access so when it’s all done he’ll be up and walking about within the hour – they are always pretty keen to get to the bathroom. We’ll follow up by phone.

The neuro IR’s are kicking off their list in biplane now as well. There’s an aneurysm to coil and a few follow up cerebral DSAs. It already feels like a full day and it’s only 2:00pm... Dr Jules Catt Consultant Interventional Radiologist Liverpool and Prince of Wales Hospitals, Sydney Dr Glen Schlaphoff Director of Interventional Radiology Liverpool Hospital, Sydney

Would you like to contribute to the feature articles of Inside News? Contact Sarah Hall on editor@ranzcr.com or +61 2 9268 9752.

Introduction

The Future of Interventional Oncology

Adj Clinical Professor Liz Kenny

Interventional oncology (IO) is an evolving branch of interventional radiology, which relies on rapidly evolving highly sophisticated equipment and precise imaging guidance to target and ablate malignant tumours. The development of this field has important potential benefits for patients and the health-care system, but as a new discipline, IO has not yet fully established its place in the wider field of oncology; its application does not have a comprehensive evidence base, or a clinical or quality-assurance framework within which to operate. In this regard, radiation oncology, which is a cornerstone of modern cancer care, has a lot of established way-with-all to offer to interventional oncology. A strong collaboration between radiation oncology and interventional oncology, both of which aim to cure or control tumours or to relieve symptoms with as little collateral damage to normal tissue as possible, will have substantial advantages for both disciplines. A close relationship with radiation oncology will help the adoption of a robust quality-assurance framework and accumulation of evidence to support the integration of interventional oncology into multidisciplinary care. Furthermore, such collaboration will bring benefits to people affected by cancer, opening hitherto unavailable options for individuals, as well as to the wider field of oncology. The world at large has concentrated for decades now on systemic treatment, and a great deal of research and expenditure has centred on drugs. Much of the lay community attributes cancer cure to chemotherapy, yet surgery and radiation treatment contribute over 90% of all cures. A recent analysis of health technology assessment reports found that new cancer drugs were associated with an overall survival advantage of 3.43 months between 2003 and 2013.

We must all play our part in helping the world refocus on the importance of local treatment and its impact both on cure and in palliation. The overwhelming majority of cancer cures come from effective local treatment – surgery and radiation treatment in particular. In this regard, ablative interventional techniques have a great deal to offer, particularly in small cancers. IO has the capacity to replace surgery in small renal cancers, or small or confined liver malignancies, with equivalent cancer outcomes, yet with less impact on quality of life and overall economic impact. We need to drive hard for robust evidence in IO and comparative effectiveness studies with sophisticated prospective registries will be an important contributor. The Trans Tasman Radiation Oncology Group (TROG) is arguably the most successful of all cancer clinical trials groups within Australia and New Zealand and it is particularly pleasing to see the formation of an Interventional Oncology subspecialty group within TROG. TROG’s amazing capacity for clinical research will be a wonderful platform for IO research development.

continued over... Volume 13 No 3 I June 2017

Introduction

I am delighted to see the Interventional Radiology Committee structure develop within RANZCR Recognition of interventional radiology as a subspecialty is an essential step and having specific assessed competencies for IO in cancer care is a requirement. Engagement of IO as full members of multidisciplinary cancer teams is essential and this has major implications both for the curricula and numbers of specialists required. There is no more expert group than the Faculty of Radiation Oncology to contribute to the IO curriculum.

It is my firm belief that the partnering of these two specialties is a natural fit. There is no value in or need for competition, when collaboration can bring so much more to everyone, patients and specialists alike. We are after all the Cancer College and our support of interventional oncology strengthens the care that we can bring to patients and to the system. Adjunct Professor Liz Kenny

Working within a quality framework with robust standards will lift IO substantially, and give us grounds on which to advocate for sufficient resources. The Cardiovascular and Interventional Society of Europe (CIRSE) has taken the RANZCR Radiation Oncology Practice Standards framework and developed a framework for Interventional Oncology. Within the College this is a natural fit and working closely with The Interventional Radiology Society of Australiasia (IRSA) will accelerate our adoption of these standards and the credentialing process to accompany them.

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Inside News

Introduction

Digital Strategy and Cyber Security From the

Chief Executive Officer Ms Natalia Vukolova

The recent global ransomware cyberattack and the ensuing chaos in the UK’s National Health Service are a stark reminder to all that digital innovation is now a necessity for any organisation. The recent amendment to the Privacy Act in Australia to introduce mandatory data breach notifications is another manifestation of how intensely the digital space is evolving. Data management and cyber-security are only two facets of broader digital strategy at the College. This strategy is about innovation, creating membercentric, secure and modern digital resources to enable the College’s core areas of work. What a goal! I am sure that any doctor who has been involved with their hospital or practice IT systems would understand that it is an area fraught with inefficiencies, pseudoexperts and a lot of impenetrable techno-speak. Here is what the College is doing to meet the demands of the digital age:

Connecting to member priorities • Have you seen the refreshed College website, launched in May 2017? We redesigned it by looking at patterns of usage of our old website. That’s right, those documents and pages that were used most by members, got to be the most prominent in the new design. • Similarly, member feedback about the website focused on wanting a modern platform and thus we focused on website use on all types of devices, meaning you can now

browse the website easily from your mobile or tablet; and on that has enhanced search and filtering functionality (because who nowadays has the time to click through multiple pages?). • In any organisation, a database of members is its beating heart. The College is rolling out a new member database later this year. How would this benefit members? Well, for starters, our New Zealand members will be able to pay in NZ dollars and not incur the transaction fees that currently plague the subscription process. Members will also be able to note their subspecialty interest areas and get specific notices for events and activities that are relevant to them.

Getting the best experts • There is a reason why two of the College’s patient-oriented websites (InsideRadiology and Targeting Cancer) have won design awards in 2016. Of course, the dedication of clinical leaders and staff in getting the best, evidence-based content was pivotal, but so was the expertise of our website partner, Butterfly Digital for design and web services. Our partnership has allowed the College to move all its websites to a more secure, more adaptable and cost effective best of breed web platform. • Since 2015, we have had one of the leading IT Security groups, Loop Technology, undertaking regular

audits of our systems, processes and approaches. The implementation of Loop Technology’s recommendations and the multi-layer security maturity model that the College has in place have allowed us to withstand a number of cyber-attacks and should give members assurance that their data is safe with the College. • Lastly, the IT Unit in the College office has grown its expertise across databases, cloud technologies and security measures. The leadership of Mr Craig Horton, the College’s Head of IT since 2014, has been indispensable. Craig’s determination to implement robust, innovative and cost-effective solutions saw him shortlisted in the top 50 Chief Information Officers in Australia and New Zealand in 2016, and the accolades don’t do justice to his contribution. Now, I am sure some of the members will point to a few existing College platforms and say ‘stop with the cool aid, College has got glitchy platforms aplenty’. And there is no denying it – the road to transforming an 80 year old juggernaut into a modern organisation is not smooth nor is it fast. What I can assure all members is that we are collecting your feedback, engaging with external experts, and making big strides in this space. We will get to every digital experience for every member and make it as smooth, safe and pleasant as possible. As ever, write to me on ceo@ranzcr.com if you’d like to comment or discuss.

Volume 13 No 3 I June 2017

Engaged Members

Update on Interventional Radiology

Interventional Radiology, in all its forms, is an exciting and rapidly evolving field that contributes to the overall value of modern radiology for referrers and patients alike. Interventional Radiology (IR) is however a complex field influenced by several subspecialty areas, the vested interest of several disciplines external to radiology and a background of innovation and technological advancement in clinical and interventional radiology. These significant challenges for a sector that has largely evolved organically and rapidly in recent years are best managed by a coordinated approach to policy and advocacy. Recent developments in policy and advocacy here (such as government funding for new IR technology) and abroad (increasing formal recognition of interventional radiology as a subspecialty) provide a unique opportunity for the College and its membership to help shape the future of the profession and the provision of interventional radiology services in Australia and New Zealand. With growing demand for interventional procedures and increasing capabilities of IR technologies and procedures to deliver better patient outcomes, it is more important than ever to ensure that interventional radiology is firmly established, is well supported and continues to make a valuable contribution to patient care. The College is the bi-national body accredited to set the standards for training and practice in radiology, including interventional radiology. Leadership in this space is imperative to ensure that clinical radiologists are trained and supported to deliver accessible best-practice interventional care to patients, and that all interventional radiology services are evidence-based, of high quality and deliver appropriate outcomes in a sustainable way.

Inside News

The Interventional Radiology Committee (IRC) has been established to provide guidance and advice to the Faculty in this important work. The profiles of the clinicians who have been appointed to spearhead this important work are presented on page 13 of this edition of Inside News. Since its establishment in early 2017 the IRC has identified several priority areas on which to focus its efforts, including workforce, training, advocacy, standards, accreditation, service provision and increasing recognition of interventional radiology. The committee will work in collaboration with relevant stakeholders, including IRSA, ANZSNR and other subspecialty craft groups, to progress interventional radiology into the future. A draft workplan has been developed, which will be circulated to the membership pending approval from the Faculty of Clinical Radiology Council. As well as new areas of work, IRC members will provide advice and participate in several existing College initiatives such as the ongoing Examination and Assessment Review for Specialty Training (specifically the Procedures assessment program) and the current review of the Standards of Practice for Diagnostic and Interventional Radiology (v10.1). Members of the IRC recognise the need to ensure that the right balance between quality service delivery and patient access is achieved for all aspects of interventional practice. Access is a key component of quality healthcare. The sector must ensure that training and credentialing requirements facilitate high quality service delivery and positive patient outcomes while enabling equitable access for patients, particularly those living outside of major metropolitan centres.

Interventional Radiology Committee

The delivery of mechanical thrombectomy for acute ischaemic stroke is a perfect example of this need for balance between quality and patient access. The Medical Services Advisory Committee (MSAC) recently approved a new Medicare item for mechanical thrombectomy (MT) for acute ischaemic stroke, and the Faculty of Clinical Radiology has responded to a consultation request from MSAC by consolidating input from the Diagnostic Economic Committee, Acute Stroke Working Group and the IRC. As evidenced by this important development for MT, clear pathways for both registrars and practicing radiologists to acquire and maintain skills, from generalist through to subspecialist, must be established. There are lessons to be learned from other disciplines and international societies, as well as from our members. The IRC will review some of these models over the coming months, and call upon the membership to provide input into this important process. If you have any questions or would like to bring relevant matters to the attention of the committee, please email interventional@ranzcr.com

Engaged Members

Meet the Interventional Radiology Committee Members Dr Nicholas Brown

Dr Ian Duncan

BSc; MBBS; MPhil; MSpMed; FRANZCR; EBIR

MBBCh(wits); FFRad(D)SA; FRANZCR

Dr Nicholas Brown

I am an interventional radiologist with particular interests in interventional oncology, thoracic interventions, sports medicine and uroradiology. My general radiology training was undertaken at The Royal Brisbane and Women’s Hospital, followed by a fellowship at St Vincents Hospital, Melbourne. I now work in both private and public practices in Brisbane, and have strong interests in research projects that will contribute to the validation of new and emerging interventional technologies. I have academic appointments with the University of Queensland, the Translational Research Institute and the University of Melbourne, and have received various college awards for research, including a RANZCR research grant, the Branch of Origin prize and Phillips Research award. Prior to radiology training I completed a Master of Philosophy in Bioscience Enterprise at the University of Cambridge, and post-graduate qualifications in sports medicine at The University of Queensland. Previous service to the College includes positions on the RANZCR Research Committee, Quality and Safety Committee, Workforce Committee and Radiology Trainee Committee. Interventional radiology is a dynamic, exciting and rewarding career, and is a great example of the value that radiology can bring to modern clinical practice. But its rapid and broadening evolution also brings unique challenges. Active engagement by the College in the IR space is critical to securing its future. As an active IRSA member, I believe it is not only possible, but essential, for the College and IRSA to work closely and cooperatively to achieve the ultimate goal of subspecialty recognition for interventional radiology.

Dr Ian Duncan

I was South African trained, and obtained my Radiology Fellowship there in 1993. I then took over the Interventional Department at Johannesburg hospital in 1995 (by default!). I entered private practice in 1996, and worked in Interventional units in Johannesburg and Pretoria until 2008, doing the full range of both general and neurointerventional procedures. I was a co-founder of the privately owned Unitas Interventional Unit in Pretoria in 1999, and whilst there was also a participant in the multidisciplinary Pretoria Vascular Malformation Unit. I completed the International Diploma in Neurovascular Diseases in 2003, and was the author/co-author of over 50 papers in South African and international journals. I spent a two year stint as the editor of the South African Journal of Radiology. After immigrating to Australia in 2008, I obtained the FRANZCR in 2010. I have worked for iMed in Wagga Wagga since 2008, doing Tier A and B procedures for both private and public patients as appropriate to the region. Although not having “grown up” within the Australian system, I applied to be the regional/rural representative for the IRC having had experience in both major centre and regional practices, as well as having had experience with the full range of interventional procedures (Tier A, B and neurointerventional). My role in the committee is to represent all current and future IR practitioners in the rural and regional centres, and present and discuss the particular difficulties faced in these areas.

Volume 13 No 3 I June 2017

It’s a good feeling

to be confident.

*Gadovist® 1.0 provides diagnostic confidence and is well tolerated 1

GADOVIST® 1.0 [gadobutrol 1.0 mmol/mL] INDICATIONS: Adults and children including full-term newborns* for contrast enhancement in cranial and spinal magnetic resonance imaging (MRI); contrast enhancement in whole body MRI including head and neck region, thoracic space, breast, abdomen (pancreas, liver and spleen), pelvis (prostate, bladder and uterus), retroperitoneal space (kidney), extremities and musculoskeletal system; first–pass MRI studies of cerebral perfusion; contrast enhancement in magnetic resonance angiography (CE MRA); contrast enhancement in cardiac MRI including assessment of rest and pharmacological stress perfusion and delayed enhancement. CONTRAINDICATIONS: known hypersensitivity to gadobutrol or any of the ingredients. PRECAUTIONS: Severe renal impairment and liver transplant patients (see boxed warning); pronounced states of excitement, anxiety and pain may increase the risk or intensity of adverse reactions; anaphylactoid/hypersensitivity or other idiosyncratic reactions (higher risk in the case of previous reaction to contrast media, history of bronchial asthma, history of allergic disorders); severe cardiovascular disease; patients with a low threshold for seizures; limited MRI studies of cerebral perfusion; limited safety and efficacy data in infants under 2 years of age*; sequential and/or repeat procedures in children have not been studied*; no studies in paediatric patients with renal dysfunction, premature infants and patients younger than 6 days old*; the potential risk for neurotoxicity and nephrotoxicity in newborns term infants ≤ 3 days of age is unknown*; pregnancy (Category B3). ADVERSE EFFECTS: most common: headache; nausea; dizziness. Please refer to PI for a complete list. BOXED WARNING: NEPHROGENIC SYSTEMIC FIBROSIS: Gadolinium-based contrast agents increase the risk of nephrogenic systemic fibrosis (NSF) in patients with: acute or chronic severe renal insufficiency (glomerular filtration rate <30 mL/min/1.73m2; or acute renal insufficiency of any severity due to the hepato-renal syndrome or in the perioperative liver transplantation period. DOSAGE AND ADMINISTRATION: Cranial and spinal MRI: 0.1 mL/kg body weight given intravenously at a rate of 2 mL per second. Maximum total amount of 0.3 mL/kg body weight may be administered. CE MRI of the whole body: 0.1 mL/kg body weight. Cerebral perfusion studies: for gradient echo sequences 0.1 - 0.3 mL/kg body weight given intravenously at a rate of 5 mL per second using a powered injector. CE MRA: Imaging of one field of view: Less than 75 kg body weight: 7.5 mL, greater than or equal to 75 kg body weight: 10 mL; Imaging more than one field of view: Less than 75 kg body weight: 15 mL, greater than or equal to 75 kg body weight: 20 mL. CE Myocardial perfusion imaging and delayed enhancement: 0.05 mL/kg body weight during pharmacological stress and 0.05 mL/kg body weight at rest; for delayed enhancement only, a total dose of 0.1 mL/kg body weight. Children of all ages including full-term newborns*: 0.1 mL/kg body weight for all indications. Do not exceed the recommended dose in newborns and infants up to 1 year of age. The interval for repeated administration between injections is at least 7 days. Renal impairment: Do not exceed the recommended dose. DATE OF PREPARATION: Based on PI dated 1 July 2016. Please review the full Product Information before administering. Approved PI available at http://www.bayerresources.com.au/resources/uploads/PI/file9345.pdf or upon request from Bayer Australia Ltd, ABN 22 000 138 714, 875 Pacific Highway, Pymble NSW 2073. ® Registered trademark of the Bayer Group, Germany. *Please note changes in Product Information L.AU.MKT.05.2017.0615 References: 1. Australian Approved Product Information – 1 July 2016

Engaged Members

A/Prof Daniel Moses

A/Prof Andrew Holden

BSc(Hons); MBBS Hons; MEngSc; FRANZCR; DABR

MBChB; FRANZCR; EBIR

A/Prof Daniel Moses

I completed my training in clinical radiology at Prince of Wales Hospital and obtained fellowships in thoracic radiology and body MRI from New York University from 2002-2005. I am currently Director of Medical Imaging at the Randwick Medical Campus (POWH/SCH/RHW) in Sydney. I have not completed an IR fellowship but on return from overseas was employed as a staff specialist at Prince of Wales and Liverpool hospitals where I began performing interventional procedures under the guidance of the incumbent interventional radiologists. Currently I perform principally general Tier A procedures in public and in private and about 1 Tier B procedure per month (e.g. ureteric stent insertion, GIT embolization). I used to perform a few more Tier B procedures many years ago, but the current lack of able IR practitioners and resources (e.g. DSA suites and staff), and also the loss of work to vascular surgery has left us with a low Tier B caseload. In fact, I find myself in a similar situation to many public hospital radiologists – pressured to “offer” higher end interventional procedures after hours (e.g. GIT bleeding) without support from administration in terms either enhancing our skills and resources, or reforming the way IR works (e.g. multihospital cover) so as to attract more experienced “Tier B” IRs. In addition, working with a paediatric hospital, it is clearly evident that there is an extreme lack of interventional radiologists willing and able to offer paediatric interventional services. I am in a good position to contribute to this committee because of my experience as director of large teaching hospital department and familiarity with IR and INR demands. I have great hope that we can all work together to develop a sustainable IR training programme so as to make our profession more able to adapt to the changing landscape of medical practice over the next few decades.

If you or your colleagues would like to get involved, share your experiences and feature in the Member Profiles of Inside News please contact Sarah Hall on +61 2 9268 9752 or editor@ranzcr.com

A/Prof Andrew Holden

I am Director of Interventional Radiology at Auckland City Hospital and Associate Professor of Radiology at the University of Auckland. I am also Co-Director of the Auckland Endovascular Service and the Vascular Intervention Research Unit. I have been a member of IRSA since its formation, President-Elect of Asia Pacific Society of Cardiovascular and Interventional Radiology (APSCVIR) and national representative of European Society of Gastrointestinal and Abdominal Radiology (ESGAR). I’m a past examiner for the College and I hold and examine the European Board of Interventional Radiology (EBIR) Diploma. I’ve enjoyed working in an academic, tertiary referral and university based hospital environment. I am the author of over 80 articles in peer reviewed journals and five book chapters. My major interests are vascular interventional procedures including advanced endovascular aneurysm repair techniques and revascularization in claudication and critical limb ischaemia. Other interests include interventional oncology and advanced liver imaging. Over the last decade, we have developed a busy Vascular Research Unit and have been involved in over 50 medical device trials, many “first in human” trials and many as Principal Investigator. There have been direct and indirect benefits of this experience including enhancing the profile of interventional radiology nationally and internationally as well as attraction and retention of excellent staff. Two tenets of success that I have tried to adhere to include the achievement and maintenance of excellent standards of care and a collegial approach to care to achieve the best patient outcomes. With this approach, we have managed to maintain and enhance the role of interventional radiology and work well with our colleagues from other specialties within the hospital. There are still many challenges for interventional radiology, including the development of clinical skills, inpatient and outpatient care and eventually the development of a fully recognised sub-specialty. The Interventional Radiology Committee provides an important vehicle to promote and develop many of these issues. In March next year, we are hosting the 2018 APSCVIR ASM in Auckland. This provides an excellent opportunity for IR colleagues throughout our region to connect in what promised to be a superb event.

Volume 13 No 3 I June 2017

Engaged Members

A/Prof Winston Chong

Dr David Brunacci

MBBS (Monash); FRANZCR

MBBS (Hons I); BMedSci; FRANZCR

Andrew Holden

I am currently the Deputy Director (Interventions) at Monash Imaging, Monash Health and Director of Interventional Neuroradiology (INR) and Head of Quality. I am an interventional neuroradiologist who also performs body/peripheral IR procedures. I was a Federal College Councillor for three terms. I was the chair of the Quality Portfolio and the Chair of the RANZCR Standards of Practice & Accreditation Committee (SPAC). My many roles in the College include being a Past President of ANZSNR and Treasurer of IRSA. I have contributed to development of World Standards in Interventional Neuroradiology (INR), including training requirements, ethics of INR and standards for endovascular stroke treatment. I have long championed the development of IR in Australia. When I was a College Councillor, I initiated the process for credentialing and training of IR in 2010 and I chaired the inaugural RANZCR Credentialing Expert Working Group comprising of ANZSNR and IRSA members. Outcomes included the joint RANZCR/ ANZSNR/IRSA document: Training Requirements in Interventional Neuroradiology Procedures which was endorsed by the College and published on the College website. In conjunction with my role as Convenor of the College IR Group, another outcome was the IR and INR standards in the College Standards of Practice document. My hope for IR and the IRC is to ensure accessible, evidence based best practice patient care and to ensure that patients are treated by suitably trained interventional radiologists. Whilst it is paramount to maintain international standards in IR/INR, we can develop a uniquely Australian IR/INR model of care to embrace our great IR/INR talents, geography and our way of radiology practice.

Dr David Brunacci

After undertaking over three years of full-time postRANZCR fellowship training in interventional radiology (one year, Sir Charles Gairdner Hospital, WA) and interventional neuroradiology (over two years, Royal Prince Alfred Hospital and Auckland City Hospital) I have a vested interest in promoting both IR and INR in Australia and New Zealand. I obtained my RANZCR Fellowship in 2013, and am currently working in Sydney as an interventional neuroradiologist. I have been trained in Tier A, Tier B and neurointerventional procedures. I am a member of IRSA and ANZSNR and have a broad knowledge of the issues facing new IR and INR practitioners in Australia and New Zealand. IR and INR are important as they offer patients under our care less invasive procedures, with shorter recovery times when compared with traditional techniques. As imagers, radiologists are well placed to be the custodians of these therapies. If we are supported in providing comprehensive clinical care, rather than just a procedure, we will continue to take the sub-specialty forward. I joined the committee to advocate for both interventional radiologists and neuroradiologists, and hope that we can move towards a formal sub-specialty recognition for interventionalists in the future.

Interventional Radiology Committee Ex-Officio Members

Prof John Slavotinek Profile featured in Volume 12, No 1, December 2015

Inside News

Dr Meredith Thomas Profile featured in Volume 12, No 3, June 2016

Engaged Members

RANZCR Unveils a New Look Website 3. A structure that is organised specifically for our most important audience – our members. With the refreshed College website going live, members will still be able to access the existing member log in page, Learning Portal and the Trainee Information Management System (TIMS) through a single sign on page, which is easily accessible from the home page.

The College has a refreshed website which is now live at www.ranzcr.com. This complements our award-winning websites for InsideRadiology and Targeting Cancer which were both reviewed and refreshed in 2016.

The College engaged and collaborated with external experts and consulted with members to design a more intuitive website with easier access to key information and resources. New features include:

The website has been redeveloped in response to member feedback and the findings from our 2016 member survey and forms part of the College’s digital transformation strategy, with more improvements to our online member portal coming later this year.

1. A responsive design that is primed for use on all types of devices, meaning you can now browse the website easily from your mobile or tablet

We will continue to enhance the website over the coming months, we invite you to have a browse and welcome your feedback. Please get in touch via the online form at www.ranzcr.com/feedback

2. Enhanced search and filtering functionality, making it easier to find events, professional documents and resources relevant to you

New advertising opportunity to promote your events online Our refreshed website allows us to offer members and other organisations the opportunity to promote their events by purchasing a listing on our online events index. This index, which also features all RANZCR events, provides members with valuable information about the CPD opportunities available to them. Find out more and purchase a listing at www.ranzcr. com/whats-on/events, or contact Bertha Harvey, Senior Administrator, Communications at editor@ranzcr.com

Volume 13 No 3 I June 2017

What’s in Issue 3? Medical Imaging Point of View: Radiologists – Threatened by a veritable identity crisis? Corresponding author: Dr Werner A Golder, Association d’Imagerie Médicale, Avignon, France. Radiologists have always found it harder than representatives of other disciplines to ensure that their patients perceive and recognize them as true physicians rather than medical technicians. They are too strongly and too unilaterally associated with the machines they operate and with their products; in many cases, they are also too far removed from the pain and anxiety that prompted the patients to see a physician. Many radiologists have come to terms with this situation, accepting their role as representatives of a paramedical science more or less uncomplainingly and trying to make the best of things. No radiologist likes to be described as an academic photographer, but this unflattering epithet cannot be rejected entirely.

Medical Imaging Review Article: Quality of referral: What information should be included in a request for diagnostic imaging when a patient is referred to a clinical radiologist? Corresponding author: Professor Alexander Pitman, Rural Clinical School, The University of Melbourne, Parkville, Victoria, Australia. Referral to a clinical radiologist is the prime means of communication between the referrer and the radiologist. Current Australian and New Zealand government regulations do not prescribe what clinical information should be included in a referral. This work presents a qualitative compilation of clinical radiologist opinion, relevant professional recommendations, governmental regulatory positions and prior work on diagnostic error to synthesise recommendations on what clinical information should be included in a referral. Recommended requirements on what clinical information should be included in a referral to a clinical radiologist are as follows: an unambiguous referral; identity of the patient; identity of the referrer; and sufficient clinical detail to justify performance of the diagnostic imaging examination and to confirm appropriate choice of the examination and modality. Recommended guideline on the content of clinical detail clarifies when the information provided in a referral meets these requirements. High-quality information provided in a referral allows the clinical radiologist to ensure that exposure of patients to medical radiation is justified. It also minimises the incidence of perceptual and interpretational diagnostic error. Recommended requirements and guideline on the clinical detail to be provided in a referral to a clinical radiologist have been formulated for professional debate and adoption.

Radiation Oncology Review Article: Efficacy of flattening-filter-free beam in stereotactic body radiation therapy planning and treatment: A systematic review with meta-analysis Corresponding author: Mrs. Thu M Dang, Radiation Oncology Mater Centre, South Brisbane, Queensland, Australia. A linear accelerator with the flattening-filter removed generates a non-uniform dose profile beam. We aimed to analyse and compare plan quality and treatment time between flattened beam (FB) and flattening-filter-free (FFF) beam to assess the efficacy of FFF beam for stereotactic body radiation therapy (SBRT). The search strategy was based around 3 concepts; radiation therapy, flattening-filter-free and treatment delivery. The years searched were restricted from 2010 to date of review (October 2015). All plan quality comparisons were between FFF and FB plans from the same data sets. We identified 210 potential studies based on the three searched concepts. All articles were screened by two authors for title and abstract and by three authors for full text. Ten studies met the eligibility criteria. Plan quality was evaluated using conformity index (CI), heterogeneity index (HI) and gradient index (GI). Dose to organs-at-risk (OAR) and healthy tissues were compared. Differences between beam-on-time (BOT) and treatment time (T × T) were also analysed. Normalized percentage ratios of CI and HI demonstrated no clinical differences among the studied articles. GI displayed small variations between the articles favouring FFF beam. The BOT with FFF is substantially reduced, and appears to impact the frequency of intra-fraction imaging which, in turn, affects total treatment time. Based on planning tumour volume (PTV) coverage, dose to OAR and healthy tissue sparing, FFF beam is clinically effective for the treatment of cancer patients using SBRT. We recommend the use of FFF beam for SBRT based on these factors and the reported overall treatment time reduction.

Medical Imaging - Radiation Oncology Pictorial Essay: Utility of 68Ga prostate specific membrane antigen – positron emission tomography in diagnosis and response assessment of recurrent renal cell carcinoma Corresponding author: Dr Shankar Siva, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. Introduction: Prostate specific membrane antigen (PSMA) positron emission tomography (PET) is an emerging imaging modality in prostate cancer. However, 68Ga-PSMA-PET may also have diagnostic utility in the setting of renal cell carcinoma (RCC). We investigate the differential role of 18F-fluorodeoxyglucose (FDG) and PSMA-PET/CT scanning in patients with oligometastatic RCC. In particular, we focus on the utility of PSMA-PET for diagnostic evaluation of isolated or limited metastases planned for local surgery or radiation, as well as the potential utility of PSMA-PET for therapeutic response assessment in patients receiving stereotactic ablative body radiotherapy (SABR). Methods: We present a retrospective series of eight patients in which comparative imaging modalities are evaluated against PSMA-PET scanning. FDG-PET and PSMA-PET scans were performed prior to definitive treatment (either surgery or SABR) of limited recurrent disease. Response assessment after SABR was performed with both PET imaging modalities at multiple time points in a subset of four patients. Results: Prostate specific membrane antigen uptake is typically more intense than FDG in RCC. In all but two cases, one of which was papillary carcinoma, FDG-PET and PSMA-PET are concordant for detection of sites of disease. We demonstrate for the first time the differential kinetics of post-treatment response using PSMA and FDG-PET, with a more rapid metabolic response observed on FDG-PET. Both modalities demonstrate response earlier than morphological appearances on CT or MRI imaging. Conclusions: Our series suggests that PSMA shows early promise as a diagnostic and therapeutic response assessment tool in patients with metastatic RCC receiving definitive local therapies.

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!

Engaged Members

Less than 6 months to go to Explore the Extraordinary at the 2017 ASM Registrations are now open for RANZCR’s 68th Annual Scientific Meeting (ASM), with early bird savings available until 7 July. The ASM will be hosted at the Crown Perth Complex from 19 – 22 October 2017, offering delegates a chance to experience the 6-star hotel accommodation at the new Crown Towers, as well as experience world-class fine dining and entertainment onsite. Planning is well underway with the call for abstracts receiving one of the highest number of submissions for an ASM, with more than 340 abstracts submitted across clinical radiology and radiation oncology disciplines. Our thanks goes to all abstract reviewers for their expertise and recommendations.

MSK related topics at the ASM including Analysis of Bone Tumors: Fundamental Concepts, The Many Faces of Osteosarcoma, and Spine Compression Fractures: When to Worry. Professor Kransdorf is the author of four textbooks, more than twentyfive book chapters and over 150 peer reviewed journal articles and has lectured extensively internationally. Prof Kransdorf is a past President of the Society of Skeletal Radiology and is currently an Editor of Skeletal Radiology.

The ASM will welcome international speakers that have not previously been seen at an ASM that include interventional radiologist Professor Jeff Geschwind. Prof Geschwind is the Chairman and Chief of the Department of Radiology and Biomedical Imaging at the Yale School of Medicine and his clinical expertise focuses on treating hepatic cancer and other malignancies. He is considered a key opinion leader in the field of liver cancer and his presentations at the ASM will focus on this including TACE for patients with primary liver cancer and the management of primary liver cancer. Prof Geschwind will also be facilitating an interventional radiology workshop during the meeting program.

For radiation oncology, the 2017 ASTRO Representative has been confirmed as Professor Bruce Haffty. Prof Haffty is Chief of Staff at the Rutgers Cancer Institute of New Jersey, Professor and Chairman of Radiation Oncology at the Rutgers-Robert Wood Johnson Medical School, New Jersey Medical School and Cancer Institute of New Jersey. Professor Haffty has a long and successful record in clinical and translational research in radiation oncology. He has focused his efforts on molecular genetic factors as they relate to radiation resistance and outcomes in patients undergoing radiation. Prof Haffty is regarded as a leader in national clinical trials. He has coauthored a number of national clinical trial papers in high impact journals and is currently co-investigator on several national clinical trials through the NRG and Alliance cooperative groups. He has published over 400 peer-reviewed articles, 30 book chapters and numerous editorials and letters.

Leading musculoskeletal radiologist Professor Mark Kransdorf, Professor of Radiology at the Mayo Clinic College of Medicine and Consultant at the Mayo Clinic’s Department of Radiology, has expertise in radiology-pathology correlation and will address a number of

Two FALCON lymphoma contouring workshops will be held during the ASM on Friday 20 October. Each two hour event is an interactive lymphoma contouring workshop with expert ESTRO teacher and President-Elect Professor Umberto Ricardi; Professor of Clinical

Oncology and Chief Oncologist at the Department of Oncology, Rigshospitalet and University of Copenhagen Professor Lena Specht; and a local expert panel. These workshops are suitable for all radiation oncology members with an interest in the FALCON platform and/or updating their contouring skills. You can book to attend these workshops during the online registration process. We encourage you to join us in Perth for what will be an opportunity to Explore the Extraordinary.

Visit www.ranzcr2017.com for more information and to register

Volume 13 No 3 I June 2017

Research

RANZCR Recalls: JMIRO Celebrates 60 Years of Publications Did you come up against much resistance moving the Journal from a solely hardcopy publication into digital management? “No. One of the things that authors expect when submitting manuscripts is for it to be handled in a timely and rapid way, it’s important for their academic careers. One of the attractions about electronic publication is that authors can publish an early view online before the paper edition. Manuscripts are issued with a Digital Object Identifier (DOI) so works can be referenced as soon as a manuscript is accepted. Prof David Ball

Having nearly been lured into the life of a physician, Professor David Ball found the light. From witnessing the installation of Australia’s first CT Machine in Melbourne to becoming a highly accomplished member of the Peter MacCallum Cancer Center. Today, Prof Ball is Chair of Multidisciplinary Lung Services and outgoing Editor in Chief of the College Journal, Journal of Medical Imaging and Radiation Oncolgy (JMIRO). College Archivist, Eva Stokes-Blake recently interviewed Prof Ball about his experiences as Editor in Chief of JMIRO. Here are the highlights

What interested you in the role of JIMRO’s Editor in Chief? “I regard myself as an academic radiation oncologist, I’ve always enjoyed writing and the process of scientifically critiquing work. It seemed this was an opportunity where the journal needed a bit of a revamp and some new thinking. It all went from there.”

Inside News

We still wrestle with the idea of when to give away paper all together, however paper will be a thing of the past, certainly observing how my younger colleagues access information, it will all be electronic in the not too distant future.”

You were instrumental in changing the name from Australasian Radiology to Journal of Medical Imaging and Radiation Oncology. Upon reflection do you think this was a good move and why? “No doubt, Australasian Radiology did not reflect the content of the journal. We see ourselves as part of a global effort and that’s reflected in the submissions we receive. By changing the name we wanted to include the two words that apply to the content, Medical Imaging. That not only includes diagnostic radiology but also therapeutic radiology and the nuclear medicine community who published and submitted a lot of manuscripts, it seems to be the natural home for their scientific work. JMIRO seems to roll off the tongue OK. The subject matter of the articles are of interest to both to radiologist community as well as the radiation oncology community.”

What do you think are the biggest challenges facing the journal now and in the future? “The biggest challenge on a day to day basis is finding reviewers and trained reviewers. It’s the one thing that delays publication of people. We are facing big challenges across the board with open access journals and with many journals now publishing for a fee. We accept an article on base of scientific integrity and interest rather than whether or not the authors will pay us.”

“The subject matter of the articles are of interest to both to radiologist community as well as the radiation oncology community.” Is there anything you would have liked to achieve but haven’t and why? “I’m very pleased with the way the journal is in its format, it’s come into the modern world with colour and I think that was a great achievement when the College agreed to cover the cost of colour reproduction, it enhances a journal so much. We can have videos but that’s not developed as much as I would have liked to, I can see that electronic versions of the journal really lend themselves to it in the not too distant future. I think we achieved all the goals we have set for ourselves at that time.”

Research

Which moment as JMIRO Editor in Chief are you most proud of? “Original goal was to achieve an impact factor of over 1. That is a reflection of what a team can do when they work together, the editorial office at Wiley Publishing (if you don’t have a great editorial manager, your journal will always struggle), my other editors and associate editors and the many reviewers who have reviewed work over the years. My thanks for what we have achieved.

Listen to the full interview on our Mediasite by scanning the QR code:

What we need to think about in the future is how to reward all those volunteers in some way whereby people can record their reviewing activity via systems such as publons.”

Are you interested in becoming the JMIRO Editor in Chief? Professor Ball is fulfilling other opportunities and has ultimately stepped down as Editor in Chief. Please visit the College website to read the position description: www. ranzcr.com/fellows/general/getinvolved/current-opportunities. We encourage any Fellow to express their interest in the role by contacting the College on branches@ranzcr.com

Expert in your field? Why not be an Expert Witness? The College receives on average 25 requests per year for a clinical radiologist or radiation oncologist to provide a report or give evidence in legal proceedings. An expert witness panel was created to connect requestors, typically law firms or government agencies, with Fellows who have experience in the condition, procedure, or modality. The role of an expert witness providing medico-legal expert evidence is to: • Examine and analyse the material provided for review and, using the skills and expertise expected of a Fellow, interpret that material and form an opinion

• Communicate that opinion to the legal counsel or statutory body that has commissioned the opinion, either in the form of a written report and/or appearance in court as an Expert Witness • Be available to provide an impartial opinion fairly and in the interests of justice. As the cases can be very specific, it is important for the College to have as many experts as possible. If you are interested in becoming an expert witness please email quality@ranzcr.com or visit the College website and search ‘expert witness’.

Volume 13 No 3 I June 2017

Research

Embedding a Culture of Research – The Withers and Peters Grant

Following completion of my fellowship exams in 2012, I was very fortunate to have been awarded the Hospira Withers and Peters Fellowship Prize. It is truly humbling to be the recipient of an award named in honour of Drs Withers and Peters who have been such influential researchers and clinicians in radiation oncology. The funding provided me the opportunity to embark on a neurooncology PhD at the Lowy Cancer Research Centre at the University of New South Wales under the supervision of A/Prof Kerrie McDonald. The majority of the PhD is laboratory based; investigating the role of metabolic modulation in combination with radiation therapy in glioblastomas and using pre-clinical MRI biomarkers of radiation response. Balancing a busy clinical load with the countless hours required for laboratory work was challenging but I was supported by my department and my supervisor. The PhD gave me an appreciation of all the work done by basic scientists and a better understanding of how we can bridge the gap between the bench and the bedside. The grant has funded some of the work performed during my PhD candidature which has resulted in several abstracts, oral presentations, publications, a book chapter and a Young Investigator Award in Basic Science from the St George and Sutherland Research Foundation. However, one of the most satisfying aspects of the PhD has been the people I have had the privilege of working with. My fellow lab colleagues and I have shared many frustrations, disappointments after experimental failures and the challenges of grant applications but also the excitement that accompanies a discovery of something entirely new. I also saw the role of serendipity as my eventual project came about via a casual conversation with Dr Han Shen who was another PhD student

Inside News

All the clonogenic assays completed as part of the PhD

in the same group at the time. Our close collaboration on investigating the role of a metabolic modulating drug called dichloroacetate and combining it with radiation therapy has formed the basis of his post-doctoral fellowship project and has resulted in a successful National Health and Medical Research Council (NHMRC) project grant of $325,000. Currently, I am planning to start a radiation biology laboratory at the Westmead Institute of Medical Research with generous contributions from the Radiation Oncology Network of Crown Princess Mary, Blacktown and Nepean Cancer Care Centres. Looking back, despite all the inherent pains in pursuing a PhD, it is something I would recommend to trainees or Fellows of radiation oncology. The Hospira Withers and Peters Fellowship prize has assisted me along this path and has encouraged me to continue to have research as a component of my career. Dr Eric Hau Radiation Oncologist

Profile and Presence

New Look – New Opportunities

InsideRadiology website wins second international award. The InsideRadiology website has won the Horizon Interactive Bronze Award for the category Health/ Health Services. Each year, the Horizon Interactive Awards receives thousands of entries from all over the world and a volunteer panel of industry professionals review the entries to determine the work that is to be recognised. This is a huge achievement for InsideRadiology— two awards within its first six months of re-launch.

Get involved with InsideRadiology: ▲

P romoting InsideRadiology

in your professional networks.

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Supplementing your hospital or practice resources using links to InsideRadiology.

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Recommending any topics that could be considered for inclusion.

▲

V olunteering to assist with

content.

InsideRadiology aims to be the leading Australasian resource on clinical radiology tests, procedures and interventions. It provides up to date information to health consumers (patients, their families and friends) and health professionals (referring clinicians and allied health professionals), and fosters and encourages doctor-patient communication. InsideRadiology is a conduit of communication between the College, health consumers, and health professionals; further promoting the role and value of clinical radiology and clinical radiologists in patient care. Interesting fact from the Sydney 2017 Patient Experience Symposium: 60 per cent of Australians whose first language is English, have ‘very poor’ or ‘marginal’ health literacy. Most people’s literacy levels are like that of a Year 6-8 student (12-14 years), this is the level we should be writing at for consumers. If we are to cover 80 per cent of the population then we need to ensure our language is aimed at the 12-14 years.

Increasing Search Results

InsideRadiology Editorial Board Due to the continued growth and global audience we are pleased to announce that we have released an Expression of Interest for our expanding Editorial Board. The InsideRadiology editorial team is looking for two clinical radiologists, one general practitioner, and a consumer representative, to join the Editorial Board. If you are interested, or know of anyone interested, in becoming a member of the Editorial Board, please visit the College website at www.ranzcr.com/fellows/general/getinvolved Further information about InsideRadiology can be found at www.insideradiology.com.au/aboutradiology/about-insideradiology Please help us promote InsideRadiology by following us on Twitter: @InsideRadiology

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

Since the InsideRadiology website re-launch at the 2016 ASM, traffic has increased on average 9.5 per cent per month. Almost half (46 per cent) of the items are ranked on the first page of a Google search, with Breast Core Biopsy and Angiography the highest ranking searches in Google. Gadolinium, which was InsideRadiology’s focus in the last Inside News issue, is still ranking 3.9 on a Google search, and continues to total 1300 searches per month. InsideRadiology’s VQ Scan item also has 1300 searches per month with an average rank of 1.9.

Volume 13 No 3 I June 2017

Profile and Presence

Targeting Cancer – Advocacy for Men with Prostate Cancer Our focus for 2017 remains around the issue of prostate cancer and promoting the Targeting Cancer messages around the safety, quality, sophistication and effectiveness of modern radiation therapy. Our targeted messages regarding prostate cancer is that we believe that all men should consult with a radiation oncologist regarding radiation therapy treatment options before undergoing definitive therapy for localised (including locally advanced) prostate cancer.

Prostate Fractionated Irradiation Trial (PROFIT) Congratulations to A/Prof Jarad Martin and his team on the publication of the results of the Prostate Fractionated Irradiation Trial (PROFIT), which showed that radiation therapy can be safely reduced from eight weeks of treatment to four weeks for some men with the same tumour outcomes. With support from the Targeting Cancer media team, and Jarad as spokesman, 30 individual media reports were generated in consumer and healthcare professional media, in print, online and television. The coverage provided an estimated 1,260,938 ‘opportunities to see’ key messages about the benefits of radiation therapy for prostate cancer patients, as well as the role of radiation oncologists in the treatment of prostate cancer more broadly. Despite the fact that modern radiation therapy is equally effective to surgery, possibly with fewer side effects, radiation oncologists recognise the problem that men do not routinely access the opinion of a radiation oncologists as part of the decisionmaking prior to active treatment. The Faculty of Radiation Oncology believes it is the profession’s responsibility to change the status quo and make sure all prostate cancer patients are fully informed by the experts, of all their treatment options including radiation therapy.

Inside News

Strategy Workshop On 20 March a workshop was held at the College, involving radiation oncologists, general practitioners (GPs), consumers, and other stakeholders with the aim of developing a strategy and formulating a high-level project plan for the next stage of the campaign – with a particular focus on prostate cancer. We are now in the process of reviewing the goals, objectives and tactics of the campaign, in an effort to ensure that men with prostate cancer have a radiation oncology consultation prior to making decisions about definitive therapy.

Stakeholder Engagement Engaging radiation oncology professional groups, government, consumer organisations, and other key stakeholders is crucial to the success in our advocacy work. We are pleased to have strong support from various consumer organisations and other key allies. Ms Lee Hunt, our consumer member on the Faculty Council, and a Cancer Voices executive member has sent information on prostate cancer treatment options to over 160 prostate cancer support groups around Australia, and has received very positive responses and support. Cancer Council Australia has joined forces with the Prostate Cancer Foundation Australia and NSW Cancer Institute to develop and endorse a Prostate Cancer Treatment Options flyer which emphasises the importance of men seeing a radiation oncologist and being fully informed by the experts, before they make any final active treatment decisions. Take a look at the flyer by visiting www.bit.ly/2r3TB9Q. Prof Ian Gardner, Principal Medical Adviser from Department of Veterans’ Affairs has written an article to encourage their members to get full advice before having prostate cancer surgery. Read the article by visiting www. bit.ly/2q4OJTF.

We will continue to engage our stakeholders to support our advocacy work around radiation therapy for prostate cancer. We are grateful to College members, as well as people outside the College, who have given their time generously to work on this cause. We will continue to request the valuable input and advice from members. In the meantime, if you have any suggestions or ideas, please write to faculty@ranzcr.com

Resources Development The Faculty of Radiation Oncology, in collaboration with Tonic Health Media (THM), managed by Dr Norman Swan, (a firm proponent of radiation therapy) has developed a number of promotional videos entitled – It’s a Big Decision – highlighting the need for men to fully investigate their prostate cancer treatment options by talking to both radiation oncologists and urologists. A tri-fold brochure has been developed to complement the video in GP waiting rooms. Both resources will be promoted to patients and GPs, through the THM GP Clinics Network and other channels. Please watch this space, and help us promote these resources. We are grateful to Varian Medical Systems for their financial support for this project. We encourage all members to share evidence, information, patient stories/ photos and local media activities with us, to help us raise the awareness of radiation therapy as a treatment option, for prostate cancer as well as all other cancers. Our general Targeting Cancer activities continue in the background and we are grateful to all College members, radiation oncology professionals, patients and College staff who make this possible. Like Targeting Cancer on Facebook, or follow @TargetingCancer on Twitter, and help us spread the word about the campaign. A/Prof Sandra Turner Chair, Faculty of Radiation Oncology Media and Profile Committee Clinical Lead, Targeting Cancer Campaign

Profile and Presence

Supporting Indigenous Health

An Interview with David Kampers

David Kampers is a lecturer in Indigenous health at the University of Wollongong, who attended the College on 16 March and gave a presentation to College staff to coincide with National ‘Close the Gap’ day. Neena Mairata, the College’s Media and Advocacy Officer, interviewed David about his thoughts on Indigenous health in Australia and the Close the Gap campaign.

What drives you to teach? “I am really driven by the opportunity to get inside the minds of young non-Indigenous Australians who are learning, sometimes for the first time, about Aboriginal and Torres Strait Islander health. I cover a broad range of topics mainly relating to the social and historical aspects of Australian Aboriginal and Torres Strait Islander health. I am passionate about being able to create critical thinkers in social justice relating to anything concerning Indigenous Australia.”

The ninth Closing the Gap report revealed there has been little to no progress on Indigenous life expectancy, mortality rates, employment rates and reading and numeracy levels. What, in your opinion will it take to see significant gains so that these targets can eventually be met? “Close the Gap’ is just another campaign that throws money at issues

in the hope that this will address health disadvantage. Until such time that the balance of power in this country is addressed, Indigenous Australians will not seek parity in employment, education, housing, health and income with other Australians. As a country we are still many generations away from this target. As I say to my students, we are still ‘a work in progress’ in terms of grasping the concepts of social justice and equality.”

How much of the issue is about having a consistent policy approach and funding and better engagement with Indigenous communities across Australia? “Governments continue to write policy and then attempt to implement them into Indigenous communities without, for the most part, consulting those communities about their needs and what they may require. There is still a lack of engagement with Indigenous communities, as governments continue to adopt a paternalistic approach to Indigenous affairs.”

Why is the Gap such a complex issue?

You have an interest in cricket; can you tell us about the project you are working on? “This project aims to identify and then evaluate the effectiveness of club, state and national programs designed to increase the participation of Aboriginal people in the game of cricket in NSW. As part of this focus, the history of Aboriginal engagement in the game of cricket in NSW will be comprehensively analysed to identify factors that have contributed to the under-representation of Aboriginal cricketers at all levels.”

Can individuals take action to support better outcomes for Indigenous people? “Yes! To be empowered to control your own destiny is a fundamental human right. One example of this already taking place is the concept of community controlled health organisations such as the Aboriginal Medical Services. In this environment, Indigenous people work alongside non-Indigenous people and have a say in programs that impact on their health outcomes in their own community, and this is making a difference.”

“In a nutshell, it’s the failure of governments to allow Indigenous Australians to control their own lives, a lack of trust to allow us to make decisions for ourselves that will impact on our lives.”

What do you find most rewarding about teaching your students? “My greatest pleasure is when they graduate and find employment, then invite me to come to their organisation to give a talk about Indigenous health. I am also grateful when students acknowledge the knowledge that has been passed on to them has helped them understand the complexity that is Indigenous health in this country.”

David with CEO, Natalia Vukolova after the successful presentation at the College office

Volume 13 No 3 I June 2017

Stepping out of the Shadows – Collaboration and Communication Rutherford Hotel, Nelson, New Zealand

Radiology Invited Speakers Professor Jeffrey Kanne MD

Chief of Radiology and Thoracic Imaging, Vice Chair of Quality, University of Wisconsin, School of Medicine and Public Health, Madison, USA

Professor Suresh Mukherji

Chairman, Department of Radiology Walter F. Patenge Endowed Chair Chief Medical Officer & Director of Health Care Delivery Michigan State University Health Team, Northville, Michigan, USA

Associate Professor Ronil Chandra

Head, Neurovascular Imaging, Monash Health Joint A/Professor Department of Surgery and Department of Medicine, Monash University, Melbourne, Australia

Radiation Oncology Invited Speaker Associate Professor Jarad Martin MB ChB, FRANZCR Director of Research Calvary Mater Newcastle, NSW, Australia

www.ranzcr2017.co.nz

Profile and Presence

A Role Model for the Indigenous Community Why Radiation Oncology? Kelly chose radiation oncology as a specialty because it provides a good mix of imaging, outpatient and inpatient consultations.

Dr Kelly Needham

Dr Kelly Needham is creating history as Australia’s first Indigenous radiation oncology trainee. Kelly hopes her success will inspire more Indigenous students to enter the medical workforce and make a difference in the lives of others.

Background Kelly was a sonographer for 10 years before deciding to go back to university to study medicine. After completing her medical degree at Western Sydney University, Kelly started a five year training program at Gosford Hospital’s Central Coast Cancer Centre last year, which is accredited by the Royal Australian and New Zealand College of Radiologists (RANZCR). “I wasn’t totally satisfied with my small role in the diagnosis component of a patient’s journey as a sonographer”, says Kelly. “I wanted to actually help and treat patients! So, I thought why not study medicine? Then I thought I was crazy, as I had 4 year old twins when I went back to university, but I got through medical school, and from my very first day of being an intern in the Gosford Hospital Emergency Department, I loved it”.

“You get to work very closely within a multi-disciplinary team and develop ongoing relationships with your patients. Any specialty training is challenging and radiation oncology is no different, even though RANZCR offers a very well supported training program. Not only are you expected to carry out your extremely busy working week, but fit in study, assignments but also exams on top of that. Not to mention making time for my family and getting my 12 year old twins to their sporting commitments. I am very lucky that I have a wonderful fiancé and very supportive parents”. “The Central Coast Cancer Centre where I have done four of my five years of training, is a wonderful working environment where I get to work with and learn from very experienced radiation oncologists. I feel very privileged to help patients dealing with cancer as it’s such a vulnerable time in their lives. Cancer is a serious problem for Indigenous people, with rates almost three times higher than the rest of the population, so it’s something that really drives me”.

I think that cancer centres should have dedicated Indigenous cancer nurses, similar to an Aboriginal liaison/ health worker for our cancer patients. They would function in the same role as a tumour-subsite clinical nurse consultant and provide a culturally safe environment.” “Although I am very proud to be the first Indigenous trainee in radiation oncology, it also saddens me. We need more Indigenous specialists! The more Indigenous doctors we have, and the more specialists we have, the more we can reach out to our communities and be role models for our young kids. I would say to any Indigenous person who is thinking about a career in medicine to absolutely go for it – it’s the most rewarding thing you can do”. RANZCR looks forward to following Kelly’s progress and hearing more about her medical journey, and we wish her all the best for an exciting career in radiation oncology. This piece was based on an interview published in the Australian Indigenous Doctor’s Association (AIDA) newsletter on 20 March 2017.

Encouragement to Others Kelly believes that there are important measures everyone can take to reduce cancer rates in Indigenous Australians. “Early detection and screening programs are vital. We need to engage the community to get our people to participate in screening programs and seek medical assistance early. Indigenous rates of participation in these screening programs is lower than it should be, and this needs to be targeted.

Volume 13 No 3 I June 2017

Access to Quality Services

College’s International Development Fund in Action An ultrasound training program was originally designed for the Solomon Islands (intended for 14-19 November, 2016) however, this was cancelled at the last minute due to a dengue fever outbreak. Fiji was quick to accept the training program, to be run in Suva and was then arranged for 27-29 November, 2016. This was coordinated at a local level by Dr Paula Bavou and Dr Sylvia Defensor (Radiologists at Suva’s Colonial War Memorial Hospital (CWMH), The training program offered consisted of a combination of lectures, discussions and practical scanning sessions. The lectures and discussions were held at the Fiji National University (FNU) campus opposite the hospital and the practical scanning and workshops were conducted in one of the ultrasound rooms in the radiology department of the hospital. A combination of volunteer patients and real hospital patients were scanned. A minimum of 20 participants attended, consisting of radiologists, radiology registrars and sonographers from many different sites across Fiji (main islands and other islands). Some of the topics covered included: • Basic physics – how to optimise ultrasound images and maximise the current ultrasound units available

Michelle providing an abdominal ultrasound presentation at FNU campus.

Inside News

including how to best use Doppler on the ultrasound units (colour, Power and Pulsed wave Doppler). Demonstrations of what all the buttons on the ultrasound unit are used for and how to optimise was covered practically. Participants were refreshed in bio-effects of ultrasound and reminded about the ALARA principle. • Emergency ultrasound (E-FAST and RUSH protocols were provided) – the participants were encouraged to train other staff and power point lectures were provided for participants to use to provide inhouse training in their respective hospitals. Practical demonstrations on these examinations were provided by Michelle Fenech. The participants practised how to scan for a pneumothorax in workshops and also how to image the heart in RUSH and FAST protocols more effectively. • Abdominal ultrasound – the basics of abdominal ultrasound were covered, and the anatomy of all structures needed to be assessed was discussed in detail – potential protocols were discussed and discussions were had about what general measurements (and their normal and abnormal values) can be undertaken. Revision of liver segmental anatomy was

conducted and we demonstrated how the liver segments can be identified on ultrasound. Practical demonstrations were provided. • Paediatric ultrasound (they were particularly interested in neonatal heads, hips (for developmental dysplasia of the hip and hip joint effusions) and gastrointestinal tract (we covered pyloric stenosis, intussusception, midgut volvulus and malrotation, Meckel’s diverticulum and appendicitis). • Obstetric ultrasound (all trimesters were covered, but they were particularly interested in growth scans) – several obstetric patients of differing dates were scanned by Paula Kinnane and participants also scanned patients. • Gynaecological examinations – these were covered in lectures and practically. Due to cultural sensitivities, transvaginal examinations are not really conducted in Fiji, so examinations are limited to trans-abdominal scanning. • Vascular ultrasound – the participants requested demonstrations and lectures on renal arteries, leg arteries, leg veins for DVT and carotid arteries and portal hypertension studies – for the DVT studies in particular, the

Paula providing an obstetric scanning workshop and providing practical tips on Doppler in growth scans at CWMH, Suva.

Access to Quality Services

need to examine calf veins and how to image and identify muscle veins was covered. The participants were keen to incorporate this into their protocols. Demonstrations of a full DVT study were conducted and a protocol was provided to them. In particular the use of colour and pulsed wave Doppler were included in these studies as currently this is not being utilised. • Superficial structures – thyroids, salivary glands were covered – demonstrations on how to scan these structures and useful tips for optimising images and identifying anatomy in these regions was included. • MSK – we touched on this briefly at their request – we provided them with an approach to looking at images from superficial to deep and what structures look like in normal and abnormal scenarios – so covered skin, subcutaneous tissues, fascia, muscles, retinacula, tendons and ligaments, cartilage, bursa, joints and bone. Demonstrations of shoulder and knee examinations were provided. • Ultrasound guided interventional techniques The attendees were all provided with electronic copies of our resources to demonstrate where the evidence used to form our protocols and current practices comes from. Some participants are very keen to improve their current practices, and we will contact the ASA – Australasian Sonographers Association to ask if they can provide some posters and journals to Fiji. We intend to maintain contact with the participants. They have our email addresses and we have encouraged them to email us to ask us for any further information they need to assist them in developing their own departmental

“Thank you so much for the educational sessions, hope you come back again” “The presentations and practicals were very informative and interesting. Really enjoyed the three days. Hoping to see you guys again” Some of the participants in the three day course. Photo in lecture theatre at FNU.

protocols. As currently no hard copy imaging is conducted, we have emphasised the need for worksheets to be incorporated into their work practice as these outline structures which need to be imaged and measured in examinations, but also allow for a good report to be generated on completion of an ultrasound examination. Worksheets for most examinations were provided to all participants. Three days of training was enough time to cover a large amount of material without participant mental fatigue. Potential future trips could include more physics, particularly optimising Doppler for vascular examinations and the use of Power Doppler (if available). Further training on leg artery examinations, obstetrics and gynaecology, and general anatomy would be beneficial as there are deficits in their anatomical knowledge as they seem to be lacking good anatomy texts. We have access to an ultrasound selfhealing breast phantom and believe it would be worthwhile taking that and upskilling them on ultrasound guided interventional techniques such as needle guidance, aspiration and injection and how to optimise seeing the needle and needle tip and determining the best line of travel of the needle into structures.

“Thanks for the presentations and very informative lectures and demonstrations. I really amazed and thankful for it” “Vinaka vakalevu (thank you very much) for imparting all this ultrasound tips and knowledge to us. Hope there will be more training of this sort in the future” We have had ongoing correspondence with some of the participants after the completion of this training program and they have informed us they have shared some of the presentations with others in their radiology departments and the emergency department in their hospital (Lautoka hospital). It is encouraging to see that they are using the resources we left them. In conclusion, Vinaka (Thank you in Fijian) for the opportunity to visit the people in Fiji and provide them with some training to allow improvements in the delivery of the ultrasound services The attendees were very grateful for this opportunity and we have confidence that they will implement changes following this training program in their own departments to allow for continued learning and also improvement in their ultrasound diagnostic scanning and reporting. Michelle Fenech and Paula Kinnane Sonographers, Royal Brisbane and Women’s Hospital International Development Fund application initiated and submitted by Prof Peter Scally, Royal Brisbane and Women’s Hospital

The feedback we received about the training provided was very positive. Some of the comments were: Volume 13 No 3 I June 2017

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Access to Quality Services

Direct to Consumer Health ‘Screening’ Evidence based imaging screening programs have the potential to save patients’ lives through early detection and treatment of disease. At the same time, unproven screening programs have the potential to induce harm from false positive and false negative diagnosis, overdiagnosis and by unnecessarily increasing patient anxiety. With the exception of recommended screening programs such as BreastScreen Australia, diagnostic imaging procedures should only be undertaken as part of a holistic investigation of a clinical problem. The College policy on The use of Diagnostic Imaging for Screening Purposes and Non-Referred Investigations can be found on the College website at www. ranzcr.com/documents/585-diagnosticimaging-for-screening-purposes/file The increasing proliferation of direct to consumer health screening services raises concerns for all members of the medical imaging team and has the potential to undermine the valuable contribution of diagnostic imaging to healthcare. Medical imaging is a valuable service that allows us the opportunity to diagnose and treat disease or injury earlier than ever before. However, imaging services need to be used in a clinically appropriate and sustainable manner. It is the role of clinical radiologists to advocate for appropriate use of imaging.

News articles have recently reported on the promotion of a screening test to assess stroke risk, which is being advertised in chemists directly to consumers. The test involves an ultrasound of the neck, supposedly checking for the build-up of plaque in the carotid artery, in patients with no symptoms suggesting stroke. This screening test has been offered in Australia but is also potentially an issue in New Zealand. There is no evidence that people without symptoms would benefit from an ultrasound screening test for stroke. The test is not endorsed by our College, the Stroke Foundation or the Australian and New Zealand Society for Vascular Surgery. As with all screening that lacks an evidence base, the possibility of false positives or false negatives in such tests may cause significant patient distress, lead to demand for unnecessary procedures that carry significant risks and may increase patient costs. In contradistinction to the above process, it is the position of the College that imaging services should only be provided in a clinical setting where the radiologist works with the patient’s doctor to determine what imaging, if any, is appropriate to achieve the best health outcome for the patient.

Fellows are advised to avoid reporting on imaging that has been done as part of an unapproved screening program. Medicare does not fund unapproved screening programs and claiming a Medicare rebate for such services is not allowed. Additionally, private insurers are also unlikely to fund such investigations. The College will continue to monitor scientific studies relating to these issues and advise members of any developments in this area.

For more information, please contact Melissa Doyle on +61 2 9268 9766 or on fcr@ranzcr.com

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Volume 13 No 3 I June 2017

Quality Training

Registration with the General Medical Council in the UK for Fellows of RANZCR capability in a country where English is the first and native language.

Working in the UK National Health Service (NHS) can be a very rewarding experience for radiologists in terms of developing their professional practice and specialty imaging interests. The demand for radiologists has increased in recent years and opportunities exist in most parts of the UK in all areas of specialisation in clinical radiology and interventional radiology. To practise in the UK, all doctors must be registered with the General Medical Council1 (GMC). We know that a number of radiologists who hold the FRANZCR want to work in the NHS for a short period – perhaps as a locum consultant or to undertake some higher level training – and you are very welcome. Applying for full medical registration with the GMC has previously involved taking the Professional and Linguistic Assessments Board (PLAB) test – a test of general medical knowledge. Now, if you have completed RANZCR approved training and obtained the Fellowship, you should be able to use this to demonstrate the level of knowledge and skills needed for medical registration, without taking the PLAB test. The GMC will also ask for other evidence to support your application, for example, evidence of an internship period and of your knowledge of English2. If you have completed RANZCR approved training, this should be relatively straightforward to demonstrate by way of references from all your employers over the last two years outlining your English language

Inside News

There is a range of information on our website for radiologists considering working in the UK at www.rcr.ac.uk/workuk, including more information about GMC registration, links to the UK Visas and Immigration website and tools and resources for those new to the NHS. The RCR does not link applicants to jobs, but from our pages you can link to websites where jobs are advertised including the dedicated RadJobs website3 and BMJ careers. To work in the NHS longer-term as a permanent NHS consultant radiologist you will need to be on the GMC specialist register. You need to apply for a Certificate of Eligibility for Specialist Registration (known as the CESR process). More information about this can be found on our website CESR process4. However, specialist registration is only necessary if you are planning to work here as a permanent NHS consultant, so you may find that your purpose is answered by using your FRANZCR to apply for full registration instead. At the time of writing, the GMC advises that the FRANZCR should be used to register with it within three years of its award. However, if you hold the FRANZCR from more than three years ago you may still be eligible to apply for registration with it, and you should contact the GMC5 in the first instance for advice on how to proceed. Your FRANZCR will make the pathway to GMC full registration smoother, and we do hope that if you are interested in working in the UK, you will consider taking advantage of this. If you would like any further information, we are happy to help at specreg@rcr.ac.uk – please send a copy of your CV with your enquiry. This article is a general overview of the process and you can find more

specific details about applying for GMC registration in your particular situation through the GMC website applying to join the medical register.6 Ruth Gibson Curriculum and Equivalence Officer The Royal College of Radiologists

Resources 1. www.gmc-uk.org/doctors 2. www.gmc-uk.org/doctors/registration_applications/ language_proficiency.asp 3. www.radjobs.co.uk 4. www.rcr.ac.uk/clinical-radiology/careersrecruitment/specialist-registration-cesr 5. www.gmc-uk.org/about/contactus/contact_2_4.asp 6. www.gmc-uk.org/doctors/registration_applications/ join_the_register.asp

Quality Training

Examination and Assessment Review Update Under the guidance of the respective Faculty Steering Committees, the College continues to forge ahead in 2017 with the transition to a programmatic assessment framework in each of the specialty training programs. Each curriculum has been divided into a number of core ‘programs’ or areas of competency, which will be independently assessed as a trainee progresses. Working groups have been tasked with the development of a framework for each program, based on the principles recommended by Prof David Prideaux in his 2015 review.

Since the frameworks were drafted, programmatic planning days have been held in each Faculty. The planning days brought together large numbers of working group personnel from the College’s membership, as well as subject matter experts in related fields such as physics and anatomy. Training committee members, Examiners, Directors of Training, Trainees and interested Fellows from across Australia and New Zealand all met to share ideas, discuss the College’s strategy and commence working on the various programs.

Clinical Radiology

Some of the progress made in two of the new programs is:

Competencies for Early Training Foundation Sciences • Anatomy • Applied Imaging Technology Pathology Image Reading and Analysis/Clinical Decision-making Procedures Research Non-Medical Expert Radiation Oncology Oncology Sciences Tumour-site Specific Knowledge • Anatomy, Contouring and Plan Evaluation • Clinical Assessment and Decisionmaking RO Clinical Oncology Leader/Health Advocate/Professional Communicator/Collaborator Scholar

Competencies for Early Training (Clinical Radiology) The Clinical Radiology Steering Committee has drafted the first exemplar program for the Faculty of Clinical Radiology, which it has titled Competencies for Early Training. The program will assess the core radiological knowledge and clinical competencies required for safe after hours practice, and is intended to be completed by the end of the first year of training. There are three main components to the Competencies for Early Training, taken from the Clinical Radiology Curriculum: • Key Conditions • Patient Safety • Report Writing Importantly, the program will formalise the assessment of a trainee’s competency to commence radiology reporting while on call without direct supervision. Informal assessments of this kind are already commonplace in many training departments. A new assessment has been designed to provide supervisors with a standardised format,

while allowing them the flexibility to assess trainees on the specific types of conditions and cases most relevant to safe practice in their workplace. In addition, trainees will continue to meet key training requirements in the areas of adverse incident reporting and through the completion of a Collegedesigned report writing module.

Oncology Sciences (Radiation Oncology) Led by Dr Matthew Seel, the Oncology Sciences working group has focused on the foundational scientific knowledge underpinning radiation oncology practice. The curricular components to be covered by this program are: • Pathology • Radiation Oncology Physics • Radiation and Cancer Biology The Anatomy component of the current Oncology Sciences syllabus will be addressed via the Anatomy, Contouring and Plan Evaluation program, as the foundational phase of a continuum of learning and assessment for radiation treatment planning. As part of the development process, all curriculum sections are undergoing thorough review to ensure the content is up to date, fit-for-purpose and wellorganised, with clearly-defined learning outcomes.

continued over...

Volume 13 No 3 I June 2017

Quality Training

Concurrently with curriculum review, the Oncology Sciences working group has considered the assessment tools currently in use during Phase 1, including the Phase examination. The group has made a preliminary recommendation for a shift from the existing Clinical Assignments to a more direct and engaging teaching-focused approach. Reduction in workload for supervisors and trainees is a key concern, along with the recognition that the learning and assessment methods used should be well-targeted, at an appropriate level of depth, and coupled with constructive and timely feedback.

Work continues on an overall program model which will be presented to the Steering Committee for consideration.

Getting Involved The programmatic working groups require the expertise and collaboration of many members from across both Faculties. There are still opportunities available to get involved, and anyone interested in being part of this exciting project is encouraged to contact the College to learn more.

30 CPD Points RANZCR “I can't say enough wonderful things about Dr. Renner's MSK MRI course. Having been to many other Musculoskeletal CME courses over the past couple of years, Dr. Renner has the best by far in my opinion!” Dr. Joseph Mazzi, Director of MSK,

Stony Book University,Winthrop University Hospital

If you would like more information, please contact Adam Rayment, Manager Special Projects, at the College on adam.rayment@ranzcr.com or +61 9268 9706.

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Inside News

Quality Training

RANZCR Courses and Workshops Trainees prepare for their final exams at the Phase 2 exam preparation course The College hosted 33 trainees at the Phase 2 exam preparation course held from 12-13 May in Sydney. This annual course is designed for trainees as they approach exam readiness to explain the exam process and provide strategies to perform at the best of their abilities. Day one provided trainees with an understanding of how exams are

Course Co-Convenors Dr Alex Tan and Dr Apsara Windsor would like to thank sponsor Experien Insurance Services for their generous support, and extend thanks to the facilitators, speakers and College staff for their time to run the program. The Phase 2 exam preparation course will be held again in May/June 2018. Trainees who are preparing to sit the Phase 2 exams are encouraged to attend to ensure they get all the assistance possible to get the best results.

ACR Educational Courses brought to you by RANZCR – limited places available!

developed and marked, and the examiner’s perspective of what is required to pass the exams. Strategies were shared to help trainees not only perform to the best of their ability, but to cope with the stress of undertaking an exam - with a different perspective offered by guest speaker Jessica Symes who delved into practical tips on mental toughness and resilience. Practice written questions were provided for trainees to undertake, with the answers workshopped with the examiners during the session. Day one ended with a cocktail reception, which was a good opportunity for trainees and facilitators to unwind.

RANZCR is pleased to be offering educational courses in partnership with the American College of Radiology (ACR) in August. The highly popular program has been extended in 2017 to include Musculoskeletal, Abdominal, Neuroradiology and High Resolution CT of the Chest, and will be delivered by leading specialists to provide intensive, interactive and targeted training to attendees. Each three-day course will take place at the Amora Jamison Hotel, Sydney. The Musculoskeletal, Neuroradiology and Abdominal courses have now sold out! There is very limited availability remaining in the High Resolution CT of the Chest course, which will not be offered in Australia in 2018. If this course is of interest to you, you’re encouraged to book soon to avoid missing out. More information about this course is detailed below.

High Resolution CT of the Chest 18 – 20 August 2017 This three-day course, led by course directors Jeffrey Kanne, MD, FCCP, and Gerald F. Abbott, MD, FACR, is designed to provide practicing radiologists with the skills and understanding necessary to interpret high-resolution CT of the chest in diffuse infiltrative lung diseases. During the program, participants will receive lectures on specific aspects of HRCT interspersed with hands-on interpretation of related cases. Faculty will provide direct supervision and assistance. The integration of clinical, radiologic and pathologic information will also be discussed. This course is aimed at general radiologists and non-thoracic imaging, fellowship-trained radiologists that are called upon to interpret HRCT studies in their practice.

continued over...

Day two’s program simulated sitting the viva exam with trainees allotted to streams and rotated through exam stations, each receiving feedback immediately afterwards.

Volume 13 No 3 I June 2017

Quality Training

Faculty of Radiation Oncology Lung Interest Cooperative Workshop – register now! Proudly supported by Varian, the Faculty of Radiation Oncology Lung Interest Cooperative (FROLIC) will be holding a one day workshop on Friday 1 September at the Radisson on Flagstaff Gardens, Melbourne, with the theme to cover targeted treatment for advanced lung cancer. The day will cover topics including: • Current and future targetable mutations and immunotherapy of lung cancer • Oligometastases in lung cancer: brain and body • Controversies in brain metastases management – who to treat and how • Systemic oligometastases – indications and appropriateness of SABR and interactions with systemic agents • A highlight will be two panel discussions around interesting and challenging cases

2017 SMART Workshop Wrap Up The 2017 Faculty of Radiation Oncology Statistical Methods, Evidence Appraisal and Research for Trainees (SMART) Workshop was held on Monday 6 March at the ANZ Viaduct Events Centre, Auckland, New Zealand to coincide with the TROG Annual Scientific Meeting. The annual workshop is aimed at Post Phase 1 Exam Radiation Oncology Trainees and is designed around short didactic presentations by biostatisticians and interactive sessions during which groups of five to seven trainees are guided by radiation oncologist facilitators. This year’s workshop saw 23 trainees attend from across Australia and New Zealand. The workshop was facilitated by the following statisticians and radiation oncologists: Professor Val Gebski, Ms Kristy Robledo, Mr Chris Brown, Dr Trang Pham, Dr Puma Sundaresan, Dr David Pryor, Dr Rahul Mukherjee, Dr Shankar Siva, A/Prof Sandra Turner, Dr Keen Hun Tai, Dr Shannon MacDonald, Dr Deborah Whalley, Dr Gerard Bengua and International Guest Speaker, Dr Andre Dekker. 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

Inside News

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 2017 FRO SMART Workshop and ASM. Workshop Convenor Dr Trang Pham would like to thank sponsor Astra Zeneca and Menarini for their generous support, and also extend their thanks to the statisticians, radiation oncologists and College staff for their time in order to run the program. Trainees are also reminded that first time attendance at this interactive workshop enables 10 SMART points to be claimed. The SMART Workshop will be held once again at the 2018 TROG ASM on Monday 19 March at Wrest Point, Sandy Bay, Hobart, TAS. Details will be available via the College website or by emailing the Conferences and Events Team at events@ranzcr.com

Clinical Radiology

A Message

from the Dean

Prof John Slavotinek This issue’s theme centres on interventional radiology but it has been an eventful quarter across the Faculty of Clinical Radiology and accordingly it is worthwhile providing members with an update regarding recent events.

Politics and Elections In Australia, we have finally had some movement on the restoration of indexation for diagnostic imaging services in the Federal budget released on 9 May. Although this falls very short of the commitments to the sector brokered by the Australian Diagnostic Imaging Association in partnership with the Faculty of Clinical Radiology, it is at least some recognition of the funding challenges faced by our sector and the out of pocket costs borne by our patients. We immediately voiced our disappointment that, as promised by the Coalition Government during the election, indexation for all diagnostic imaging services is not being restored alongside general practitioners, and only selected services are being indexed. We are presently working through the figures and quantifying their impact for patients and service delivery. Nevertheless, the Faculty of Clinical Radiology will continue to advocate in Canberra for a sustainable funding solution for diagnostic imaging. On 11 May, the Peak Imaging Coalition (PIC) met and the budget outcomes featured amongst productive discussion on a wide range of topics. This group

comprises senior office bearers from our College, ASMIRT (Australian Society of Medical Imaging and Radiation Therapy, formerly Australian Institute of Radiography), ASA (Australasian Sonographers Association), ASUM (Australasian Society for Ultrasound in Medicine), MINA (Medical Imaging Nurses Association) and ACPSEM (Australasian College of Physical Scientists and Engineers in Medicine). This group shared very similar perspectives and disappointment regarding the recent budget and a letter is being constructed to be co-signed by all PIC members to advise the Minister of our position.

“The Faculty of Clinical Radiology will continue to advocate in Canberra for a sustainable funding solution for diagnostic imaging.”

disappointing and another overdue Government commitment. On the political front in New Zealand, we have submitted our manifesto asks to the major political parties in advance of the election in the spring. We are requesting that regulations are consistently applied to medical practitioners from overseas who provide services though telehealth and that resources and other issues around the roll out of bowel cancer screening are addressed to improve detection of this aggressive cancer. Although much of our work is TransTasman, it is pleasing to see the convergence of policy activities across the two countries, with elements of policy developed for Australia being directly applicable to the New Zealand environment, and vice versa. Recent examples include telehealth, role extension, tomosynthesis and these underline the value of operating across both jurisdictions. At this juncture it is important that I note the invaluable advice and efforts of Mr Mark Nevin who has made a major contribution across the full range of advocacy activities discussed above.

We had also thought that the Coalition Government would use the health announcements in the Federal Budget to lay implementing regulations for the first phase of the quality framework before Parliament. At the time of going to press these regulations have not yet been progressed, which is most continued over... Volume 13 No 3 I June 2017

Clinical Radiology

Acute Stroke Treatment

Electronic Patient Records

The Medical Services Advisory Committee has recently completed a review of the cost effectiveness of mechanical thrombectomy with a view to listing this procedure later this year. The Faculty’s Acute Stroke Working Group, which I participate in, has been considering a range of service parameters, safety and access considerations for the delivery of mechanical thrombectomy procedures. This work has been done in partnership with the Interventional Radiology Committee and Diagnostic Economic Committee. I was delighted to see a high degree of consensus emerge in the short timeframe set by MSAC, and would like to congratulate all involved for their efforts.

Members may have seen the Federal Budget announcement to roll out My Health Record for all Australians on an opt-out basis through the Digital Health Agency. This personal health record is an area that the eHealth Reference Group and our Joint ADIA/RANZCR Informatics Working Group have been actively engaging with for some years, specifically to consider and agree the model to upload imaging reports. Needless to say, the implication of personal health records will be farreaching for the sector.

Teleradiology Standards We have had a fantastic response from members and stakeholders to the draft teleradiology standards. I am grateful to all of those who responded with their considered feedback and to the working group for their subsequent deliberations. The draft standards are in the process of being finalised before presentation to Faculty Council.

Inside News

Alongside this, we have been pressing for systemised access to historic images to be incorporated into the Australian Digital Health Agency’s workplan, in order to allow the clinical radiologist to access previous studies for comparison and prevent unnecessary duplicate tests. On a related policy strand, we are also advocating to improve the quality of referrals by means of our Medicare Benefits Schedule review asks. Taken together, these structural improvements to communication with referrers and patients are intended to support radiologists during their important clinical role.

If you have any questions or comments about this article, please contact Mark Nevin, Senior Executive Officer on +61 2 9268 9755 or fcr@ranzcr.com

Clinical Radiology

Chief Censor in Clinical Radiology

A/Prof Dinesh Varma

The College’s ACER/Prideaux Review has provided the College with valuable opportunities to improve its training program. These have included reviewing the governance that supports training, reviewing and building an assessments framework, reviewing the curriculum to ensure currency and provision of more informed feedback to trainees on training progress. I am very pleased to be able to share with you that we are now starting to enter the implementation phase of some of this work, particularly in our governance and examination areas. Earlier this year the Faculty of Clinical Radiology Council endorsed the establishment of the roles of two Deputy Chief Censors, which have been assigned to the positions of Chairs of the Clinical Radiology Curriculum Assessment Committee (CRCAC) and the Clinical Radiology Examination Review Panel (CRERP), currently held by Dr Meredith Thomas and Dr Barry Soans respectively. The role of the Chief Censor is significant with the oversight of the strategic objectives of the College as well as the curriculum, examinations, assessments, accreditation and various other training activities. The role of the Deputy Chief Censor is to support the Chief Censor in these duties and the curriculum and examination areas have been identified as key areas of activity that require regular support and oversight. For examination candidates and Directors of Training, examination result letters will change this year.

The historical pass/fail letters will be supplemented with more detailed outcome letters that will provide candidates with information on overall examination score, any component information, the passing standard, the minimum score to pass and final result. DoTs will be given more insight into the performance of candidates compared to other candidates, training sites and locations. The Review work continues to progress and more recently a programmatic

“The role of the Chief Censor is significant with the oversight of the strategic objectives of the College was well as the curriculum, examinations, assessments, accreditation and various other training activities.” planning day was held with a number of College members made up of trainees, supervisors, examiners and Directors of Training, along with non-member clinical experts. Working groups were formed to embark on designing a programmatic framework for four of the seven program areas identified for

programmatic development, the four being: Pathology, Foundation Sciences Anatomy, Foundation Sciences AIT, and Image Reading and Analysis. The Competencies for Early Training and Research programs have already commenced with the framework for Competencies for Early Training nearing completion. Its framework is being used as a template for other working groups to develop their programs. Two final programs, Procedures and Non-medical expert will commence in 2018. Implementation for the Competencies for Early Training and Research is being considered for 2018. More information about the Competencies for Early Training Program is presented on page 33 of this edition of Inside News and your feedback on the program is welcomed. This program along with the Research Program will be presented in greater detail later in the year at the Directors of Training workshop in October at the RANZCR ASM. The influence of the Review continues, with the recent Part 2 Vivas being held for the first time at the AMC National Testing Centre in Melbourne. While there were many challenges and much apprehension around the move I am very pleased to report on the success of the event. Close to 160 candidates attended the centre for their examinations over four days and two sittings, with nearly 75 examiners conducting the examinations. The facilities of the centre didn’t disappoint with many very impressed by the functionality and opportunities available for the future. continued over... Volume 13 No 3 I June 2017

Clinical Radiology

Budget Breakthrough – but the Fight Continues The logistical work that needed to be considered and carried out to achieve the move from the hotel format to the centre cannot be underestimated and I would like to thank Mr Shane Bryan, Operations and Contract Management with the College for overseeing this transition. Examinations are now being recorded, for the purposes of quality control of the examinations and education and training of examiners. Candidates are reminded that the recordings of examinations are not available for consideration as part of an examination Reconsideration or Review but rather at the discretion of the Appeals Committee at the time of Appeal as set out in the Reconsideration, Review and Appeals Policy, which has been updated and is available on the College website. The work that has taken place and will continue to take place to achieve the Review recommendations would not be possible without the commitment from many College members, clinical expert non-members, College staff, Prof David Prideaux and the team from the Australian Council for Educational Research (ACER), in particular Jacob Pearce and Daniel Urbach. I would like to thank them for their work, participation and guidance. The rest of the year is shaping up to be busy and I look forward to being able to share with you further developments in the near future. If you have any questions regarding the above or you would like to bring any concerns to my attention, please address an email to me at radtaa@ranzcr.com

Inside News

We have voiced our anger publicly and made it very clear to the new Health Minister, Greg Hunt, that we are not walking away and we are not backing down from the commitment to full indexation.

Dr Wriedt While the Federal Government has failed to keep its promise to the radiology sector, the recent Budget represents progress we should build on. By announcing that more than 50 of the radiology services on the MBS will now be indexed, the Federal Government has – for the first time in nearly 20 years – accepted our long-held position that indexation is a requirement and a necessity. Gaining indexation for a fraction of all radiology services is far from what we were promised and what is needed, but its significance should not be overlooked. This announcement puts radiology firmly on the indexation “list”, along with GP visits, surgery and other vital medical services. For the first time in two decades there is a crack in the wall, and now we need to work together to force that crack wider and wider until the whole frozen rebate edifice falls apart. This is a significant moment. Of course, it does not erase the harsh fact that the Government failed to live up to its very public commitment, prior to the last election, to unfreeze Medicare rebates for radiology across the board.

ADIA executives have interacted with Minister Hunt and his office on numerous occasions since he accepted the role, and he is clearly dedicated to the task. But he cannot walk away from the promises made by the Government he is a key part of. On that point, the Government used the Budget to tell the Australian people that it was in fact “guaranteeing Medicare”. For that ‘guarantee’ to have any meaning it must include adequate funding and a robust framework that together provide an efficient, effective and fair health system. Between now and the next budget, ADIA, our member organisations, and key partners including RANZCR, will be reminding Federal MPs – and the general public – that radiology is fundamental to that system. Dr Christian Wriedt ADIA President

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

Clinical Radiology Trainees Committee Wood. Amongst other notable accolades - including raising 6 children - Fiona’s innovative work in the area of burns treatment has earned her the incredible achievement of being named Australian of the Year in 2005. Fiona’s work has saved countless patients’ lives, and her presentation at this year’s ASM is certain to be inspirational.

The Part 2 Vivas represent the pinnacle of the Clinical Radiology Curriculum, the ultimate test of our diagnostic and clinical acumen, around which much of our training seems inevitably centred. May 2017 marks the first occasion that the Part 2 Vivas will be held at the AMC National Testing Centre in Melbourne. This means a shift from hotel rooms to a state of the art, purpose-build medical examination facility. We wish all candidates the very best for the upcoming exam sittings. The 2017 Annual Scientific Meeting is less than 5 months away, which means that it’s time to get those roster requests submitted! This year’s Nisbet Oration speaker is an exceptional Western Australian, plastic and reconstructive surgeon Winthrop Professor Fiona

The Clinical Radiology training program is ever evolving in response to changes in our healthcare systems, technological advances and the needs of trainees. I encourage senior and graduating trainees to become involved in College activities, to help mould the training program for those who follow in your footsteps.

the College structure daunting. If you need any information or clarification about Colleges activities or the training curriculum, please don’t hesitate to get in touch with Chris Bartley, the College’s Trainee Liaison Officer. In addition, the Trainee Committee representative in each state is more than happy to provide any assistance or advice when needed. Dr Cara Odenthal CRTC Chair and QLD Representative caraodenthal@yahoo.com.au

For junior trainees, the training program can at times seem overwhelming, and

For More Information: P.O. Box 350 • Springville, AL 35146; Tel. (205) 467-0290, ext. 101 or 102; Fax (205) 467-0195 • E-mail: info@iicme.net www.iicme.net

~ NeW couRSe ANNouNceMeNt ~ South Coast Radiology consists of over 20 Radiologists networked across 13 sites located throughout the Gold Coast, Tweed, Toowoomba and Mackay.

Career Opportunity Interventional Radiologist Gold Coast

General Radiologist Toowoomba For further information or to apply, please contact: Warren Berry - General Manager wberry@scr.com.au

www.scr.com.au

07 5580 8588

NeuRo/eNt IMAgINg WItH tHe MASteRS AuguSt 3 - 6, 2017 Stamford Plaza Sydney Airport FAculty: Richard H. Wiggins, III, MD, cIIP, FSIIM Anil t. Ahuja, MD, FRcR, FHKcR, FHKAM Robin cassumbhoy, MB BS, FRANZcR

25.0 AMA PRA Category 1 Credits™ This four-day course is designed to bring the practicing physician interested in imaging the head and neck a range of useful and state-of-the-art information regarding the performance of imaging exams, the important anatomy and typical and unusual imaging findings, and pathology of a broad spectrum of diseases. This practical information from some of the very best speakers and experts in their field will present to you vital information on the most common pathologies that you can use immediately in your own practice. The course has been structured to provide a wide range of lectures regarding common problems seen in an active practice. The faculty will lecture on diseases of the head and neck, and will also present interesting case sessions for active audience participation.

Register Online Now at: COmiNg iN 2018 . . . Trusted by Doctors... Preferred by Patients PART OF THE INTEGRAL DIAGNOSTICS GROUP

Neuro/eNt Imaging in Hong Kong nOvEmBEr 1 - 4, 2018 Hyatt regency Sha Tin • Faculty: Mauricio castillo, MD Program details will be updated online as available. visit www.iicme.net for more information

Volume 13 No 3 I June 2017

explore the

extraordinary extraordinary explore the

RANZCR PERTH 2017

68th Annual Scientific Meeting

19 – 22 October 2017 Crown Perth, Western Australia

Radiology Keynote Speakers

Workshops available during the ASM include:

CPR Workshops A 1.5 – 2 hour update refreshing knowledge and basic skills. The teaching will cover the BLS Algorithm – DRSABCD, cardiac compressions, basic airway management, application of AED defibrillator and defibrillation safety for adults and children

Professor Jeff Geschwind

Professor Professor Suresh K. Mukherji Michael P. Federle

Yale University Michigan State School of Medicine, University, USA USA

Stanford University Medical Center, USA

Professor Professor Mark J. Kransdorf Richard L Ehman

Professor Declan O’Regan

Mayo Clinic College Mayo Clinic of Medicine, USA Rochester, USA

Imperial College London, UK

FALCON Educase Contouring Workshop on Lymphoma This event is an interactive lymphoma contouring workshop with expert ESTRO teacher and President-Elect Prof Umberto Ricardi, Prof Lena Specht and a local expert panel. These workshops are suitable for all radiation oncology members with an interest in the FALCON platform and/or updating their contouring skills.

Breast Workshop BreastScreen Reader Assessment Strategy (BREAST) workshops provide an opportunity for readers to test their proficiency on a set of 60 mammography cases and receive immediate feedback on their performance. Delegates involved with or have an interest in mammography reading will be able to choose between three different test sets at the start of their 2-hour session.

Registration Now Open Early Bird closes 7 July 2017 www.ranzcr2017.com

Radiation Oncology Keynote Speakers

Professor Brian O’Sullivan

Professor Lena Specht

Professor Bruce G. Haffty

Dr. Joost Nuyttens

Princess Margaret Cancer Centre, University of Toronto, Toronto

Rigshospitalet, Copenhagen University Hospital, Denmark

ASTRO Representative

Erasmus MC-Daniel Den Hoed Cancer Center, Rotterdam, The Netherlands

Rutgers Cancer Institute of New Jersey, USA

Clinical Radiology

Paediatric Radiology News

2017 ANZSPR Annual Scientific Meeting The 2017 ANZSPR Annual Scientific Meeting which will take place at the 5 star Bunker Bay Resort in the Margaret River Region, Western Australia from Sunday 22 October to Wednesday 25 October, directly after the RANZCR ASM at Crown Towers in Perth. A bus has been arranged to take delegates from Crown Towers to Bunker Bay, ensuring an easy and relaxing way to extend your holiday and enjoy several days in one of the most beautiful parts of Western Australia. Our conference theme is ‘Beyond the Books’ – Our three day bespoke scientific program won’t include anything you can simply learn in textbooks. International speakers Drs Marc Keller from the Children’s Hospital of Philadelphia, Derek Roebuck from Great Ormond Street Hospital and Suresh Mukherji from Michigan State University headline a scientific program featuring cutting edge information on paediatric airways, oncology, vascular imaging, rheumatology and intervention, amongst others. For radiology trainees, the conference is introducing the ANZSPR viva school, where trainees will have the opportunity to sit practice viva exams and learn strategies for passing their Part II paediatric examination. We’ll also

have an early morning interventional workshop where delegates will gain skills and knowledge on cannulating the small baby and other forms of vascular access. It promises to be a fun and educational conference in the Margaret River region, which is well known for its amazing beaches, karri forests and limestone caves, not to mention a huge range of wineries, breweries and gourmet food providers. There will be an exciting social program where local wineries and breweries can be sampled, a perfect opportunity to catch up with old friends and make new ones. The conference is aimed at both the general radiologist and subspecialising Paediatric Radiologist and we also encourage radiographers, sonographers and anyone interested in paediatric radiology to attend. Our call for abstracts has recently opened and you can now take advantage of our early bird registration discounts. Further details can be found at www.anzspr17.com.

Upcoming ANZSPR Executive Election An election for the ANZSPR executive will be held in September 2017. We now invite nominations for the following 3 executive positions: • ANZSPR president • General executive member – 2 positions Nominations should be emailed directly to the ANZSPR secretariat, by 5:00pm EST on Friday 11 August 2017, at anzspr@ranzcr.com Results will be announced to ANZSPR members by email prior to the 2017 ANZSPR ASM Dr Jenny Bracken ANZSPR Secretary

continued over...

We look forward to welcoming you to Bunker Bay! Dr Michael Mason 2017 ANZSPR Convenor

Volume 13 No 3 I June 2017

Diagnostic Radiation and the Media Concern about radiation dose in diagnostic imaging, and especially CT, gained considerable traction with the publications of Pierce and Preston in 2000, followed by Brenner in 2001. They used data from atomic bomb survivors in 1945 to extrapolate to CT radiation dose and thereby estimate the risk of malignancy. More recently, publications by Pierce in the UK and Matthews in Australia have confirmed that children who have had a CT in childhood have a greater risk of subsequently developing a malignancy. The vast majority of publications suggest that a CT performed before 2005 had a risk of 1/1,000 to 1/10,000 of subsequently developing cancer. These publications are very important in our understanding of radiation and risk. However, when picked up by the

lay press, as occurs every 2-3 years, they can create great anxiety in patients and parents of patients who have had, or are going to have, a CT scan.

• Australia compares very favourably with other countries with the frequency and doses used in CT of children.

As radiologists, it is important to provide balanced information and advice to patients, parents and referrers to ensure that appropriate use of this technology still occurs during these times. Patients and parents should be reassured that:

Of course, these points are only true if we do truly practice ALARA. This should include ongoing auditing of CT dose and image quality and utilizing Dose Reference Levels to compare CT doses with our peers.

• Doses used in current scanners are orders of magnitude less than these studies and that the risk is therefore orders of magnitude less

Prof Michael Ditchfield ANZSPR President

• The small increased risk of cancer to a patient from a CT scan is balanced against the medical benefit to the patient • For each clinical problem, CT is only used when there is no other practical imaging alternative.

To contact the ANZSPR Special Interest Group, please email anzspr@ranzcr.com

11TH SCIENTIFIC MEETING Quandaries and Controversies for the Multidisciplinary Team 5th - 7th October 2017 Sheraton Grand Mirage Resort, Gold Coast

Featured Workshops: Breast MRI for Radiologists with Christiane Kuhl A unique opportunity! Read and interpret breast MRI with Christiane Kuhl as she presents an array of her own cases in an interactive session. She will discuss her protocols and how she interprets breast MRI. Christiane is internationally renowned for her knowledge, skill and research. She is highly published and a pioneer in the concept of short MRI for high risk women. Radiation Oncology with Charlotte Coles This half-day workshop with Dr Charlotte Coles will include an opportunity to "Ask the Expert" as well as discussions on topics such as breast IMRT, altered fractionation schedules and the role of radiogenomics.

International speakers: Monica Morrow, Surgical Oncologist, Memorial Sloan-Kettering Cancer Center, New York Sunil Badve, Pathologist, Indiana University School of Medicine, Indiana Christiane Kuhl, Radiologist, Bonn University, Germany Charlotte Coles, Radiation Oncologist, Cambridge University Hospitals, Cambridge Local keynote speaker: Dr Jemma Gilchrist, Psychologist, Sydney

ENQUIRIES: Kerry Eyles, ASBD Executive Officer info@asbd.org.au Ph: 0477330054

asbd.org.au

Clinical Radiology

Emergency Radiology News

The Australian and New Zealand Emergency Radiology Group (ANZERG) is now in its second year of existence and as with any newly created Special Interest Group, we have been busy promoting our group with a view to continued growth The executive committee has been actively seeking participation and promotional opportunities, and we were privileged to attend and present at a number of conferences throughout 2016 and early 2017. In this way, we have developed and deepened relationships with a number of national and international emergency and trauma societies. The executive committee recently held a teleconference and we are pleased to share with you some of the conference activities planned for this year. ANZERG was invited to run a radiology session at the Australian Trauma Society (ATS) meeting in April in Melbourne. Drs Craig Hacking, Gerard Goh and A/Prof Dinesh Varma presented to an audience from a variety of craft groups, with a focus on developments in trauma imaging and interventional radiology. ANZERG was also invited to present at the combined meeting of the British Society of Emergency Radiology (BSER) and the European Society of Emergency Radiology (ESER) held in London where A/Prof Dinesh Varma presented on Unique Aussie Injuries and Cervical

Spine Trauma CT. The Australasian College of Emergency Medicine (ACEM) is holding its Winter Symposium in the Barossa Valley in July and ANZERG will be represented by Drs Meredith Thomas, Mary Moss and A/Prof Varma, with a focus on traumatic and non-traumatic spine imaging as well as the use of post mortem CT in the emergency department trauma setting. We have also been invited to run sessions at the combined Asia Pacific Congress of Interventional Oncology/Indian Society of Emergency Radiology in New Delhi in August and at the RANZCR Annual Scientific Meeting in Perth in October, where Drs Gerard Goh, Craig Hacking and A/Prof Varma will be presenting.

we hope more members will express interest. As yet there is no plan to have a membership fee, however if we are to become more independent and run our own conferences, it may be necessary to do so. Our AGM will be held again at the 2017 RANZCR ASM in Perth and we invite you all to attend the meeting. Details of the meeting will be announced in the next edition of Inside News. Executive Committee ANZERG

We currently communicate with our members through the College newsletter, Inside News, however with the launch of the refreshed RANZCR website we plan to develop a more updated ANZERG page to promote our Special Interest Group and engage with our members regarding the activities of the group. Feedback from a 2015 survey suggests that ANZERG may be suitable to play a role in the development of teaching resources for the key conditions of early training, as well for emergency and trauma imaging for the broader trainee and fellow groups. Members of ANZERG are currently working on college committees regarding the key conditions. Currently our membership details are held at the College office and as fellows express interest their name is entered in the database. There are currently in excess of 85 members and

Volume 13 No 3 I June 2017

Clinical Radiology

IRSA Update

IRSA Annual Scientific Meeting, EBIR and Stroke Symposium July 2017, Port Douglas Qld The IRSA Annual Scientific Meeting (ASM) will be held on 11-13 July 2017 at the Sheraton Port Douglas. Due to the unfortunate circumstances with the recent cyclone in Queensland several other conferences are being moved to Port Douglas which means there will be an increased demand for accommodation. Accommodation is booking fast at the Sheraton, so early booking is essential to avoid disappointment. The third Australasian EBIR will be held on 10-11 July. All those wishing to register for the EBIR exam should do so as soon as possible via the CIRSE website www.cirse.org. For the first time the Australasian EBIR will be open to non-IRSA candidates so there will be an increased demand for places. Places are limited so we encourage you to register early. Following the IRSA ASM, a stroke symposium will be held on 13-15 July. Convenor Dr David Sacks from SIR, USA has compiled a comprehensive schedule encompassing clinical, diagnostic and interventional issues in the contemporary management of stroke. Convenor Dr Nigel Mott and social program coordinator Dr James Burnes have assembled an outstanding program composed of lectures, panel discussions, morbidity and mortality meeting and the annual registrar presentation session, and a host of fun activities for all members of the family. I look forward to seeing you all in Port Douglas.

Inside News

Prostate Artery Embolisation Workshop, March 2017 A highly successful workshop was held in Brisbane on 18-19 March 2017 convened by Drs Nick Brown, Duncan Walker and Glen Schlaphoff. Growing interest in this exciting new procedure has led to the planning for a second workshop in September 2017. Further details will be posted on the IRSA website soon.

IRSA registrar’s conference Dr Glen Schlaphoff’s team from Liverpool hospital will be again running the highly regarded IRSA registrar’s conference in June. An exciting program of talks and hands on experience workshops have been planned with a large faculty of IRs from Australia and New Zealand.

Accreditation of Training Sites IRSA is currently undertaking a pilot program aimed at achieving a quality supportive and consistent training platform for IR across Australia and New Zealand. The IRSA Fellowship Training Accreditation Standards documentation has been sent out to all IR training sites in Australia and New Zealand and feedback is expected by 30 April 2017. The results of the consultation phase will be presented at the AGM. A combined package of the CIRSE Curriculum, the EBIR and accreditation of training sites, is a large step towards IR being recognised as a specialty.

IRSA AGM The last two years have been a very busy time for the IRSA executive. The IRSA executive have been undertaking initiatives with setting up an IRSA foundation aimed for education and research, drafting accreditation standards for IR practice and training in Australia and New Zealand, joined the Council of Procedural Specialists, engaged the Australian government in relation to MSAC applications, been involved with feedback regarding the MBS review in Australia and are planning some exciting new ways to allow IRSA members to become involved with the society. Further details will be released at the AGM. Dr John Vrazas President of IRSA on behalf of the IRSA executive

Clinical Radiology

ANZSNR Update

Acute Stroke Management 2017 Acute stroke care, and the delivery of mechanical thrombectomy to the Australian community, has generated much interest, most recently with articles in the Medical Journal of Australia by Hwang and Gawarikar1, and an editorial by Kiernan2. While acknowledging the dramatic benefit from mechanical thrombectomy, questions were raised about access, economics, and imaging. Although “only” likely to be applicable to between 15-20 per cent of patients presenting with acute large vessel occlusions, these are the patients facing the most devastating outcomes without acute reperfusion. An effective treatment for these patients facing the most severe disability should be encouraged and facilitated. Hence I agree that there is a clear need for efficient provision of neuroimaging, to include non-contrast CT and CTA as a minimum, with short time to imaging and to reporting. Radiologists must remain involved and proactive in delivering and interpreting neuroimaging, and engaging with hospital processes facilitating timely patient treatment. The authors point out challenges in other aspects of acute stroke management with “intravenous thrombolysis rates languishing at 7 per cent. Only one in 87 stroke units qualifies as a comprehensive stroke service, only 40 per cent of stroke units routinely utilise established guidelines, care plans and protocols, and one in three patients is discharged from hospital without any preventive medications.” We should not delay access to a proven treatment for the most severe ischaemic strokes – mechanical thrombectomy – until all other aspects of stroke management have been improved.

Parallel processes are paramount in provision of timely acute thrombectomy in the angiography suite, a principle relevant to overall provision of stroke services. Kiernan refers to “training programs to assist registrars acquire interventional skills for managing stroke, additional to their usual neurology training.” Part time training during general specialty training in no way meets the training requirements recognised as necessary to protect patient safety, as recognised by the three founding societies in the Conjoint Committee for Recognition of Training in Interventional Neuroradiology.

ANZSNR Conference 2018 Dates for the 2018 ANZSNR meeting have been announced. The meeting is scheduled to take place in Hobart, Tasmania from the 16-18 March 2018. Convenors A/Prof Jens Froelich, A/Prof Andy Whyte and Dr Catherine Mandel, are working on a tripartite meeting to include, diagnostic, head and neck, and neuroradiology, the meeting includes plans for hands on workshops. Professor Peter Mitchell President ANZSNR

Improving access to comprehensive neuroradiology, safe mechanical thrombectomy by well-trained CCINR recognised operators in appropriate comprehensive facilities is achievable as evidenced by the Victorian state wide Endovascular Clot Retrieval service, as acknowledged by Hwang et al. That there may be challenges relevant to states with lower population densities should not deter efforts to provide this strikingly effective treatment to as many people as possible.

ANZSNR Conference 2017 The ANZSNR Annual Scientific meeting is fast approaching, taking place at the Darwin Convention Centre, from 6-9 July 2017. Meeting Coordinators Drs Con Phatouros and Andrew Thompson, have planned an exciting meeting with two International Speakers, Dr Christine Glastonbury and Dr Anne Osborn. References 1. Clot retrieval and acute stroke care. Yun Tae Hwang and Yash Gawarikar Med J Aust 2017; 206 (8): 333-334. 2. Transforming the management of stroke Matthew C Kiernan Med J Aust 2017; 206 (8): 342-343.

Volume 13 No 3 I June 2017

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Radiation Oncology

A Message

from the Dean

A/Prof Dion Forstner

Funding for Radiation Oncology in Australia It is disappointing that decision making on health at the federal level in Australia has such a short-term focus, and no nationally coordinated approach, when such decisions will have enormous long term impacts. While the average linac age in Australia is now five years, facilities will struggle to update CT scanners, treatment planning systems and brachytherapy equipment in the future, unless the government’s proposed changes to the Radiation Oncology Health Program Grants scheme are reversed or significantly altered. Key College staff and I met with Minister Hunt on Wednesday 24 May to discuss alternative options for savings that would not have adverse effects on access to quality radiation therapy. The Minister did give a commitment to work with us on some aspects of the proposed changes, and certainly came across as having an understanding of our sector and a number of the issues concerning us. The Faculty of Radiation Oncology will continue to strongly advocate against the cuts to the ROHPG scheme. The recent announcement of government funding for a proton facility in Adelaide brings opportunities and challenges, given our relatively small population. We trust that the Faculty’s recently established Particle Therapy Special Interest Group will be able to support this facility to have a national focus, ensuring that both treatment and research are accessible to those patients that would benefit most.

Once protons are available locally, it will no longer be possible to receive funding from the Medical Treatment Overseas Program for proton treatment abroad. There will need to be a national approach to ensure access – not only for the treatment itself, but also for other expenses incurred in having treatment a long way from home.

Code of Ethics At times, we all find ourselves in challenging circumstances, and we do not always feel we handled a situation as well as we could have. We know reflection is vital to our improved decision making and I ask members to take the time to review the College’s Code of Ethics, available on the College website (www.ranzcr.com/search/ranzcrcode-of-ethics) which was launched almost two years ago, and think about where it may have assisted in difficult situations or how it might guide you in the future. This is my second term as Dean, and I thoroughly enjoy working with so many inspiring Fellows. Of course there have been some challenges also. Thankfully, not many of these have been overwhelming, although a few have been extremely difficult, especially where I have seen colleagues in distress. When the CanMEDS framework (on which our curriculum is based) was updated in 2015, the concept of patient safety and a safe learning environment were explicitly added to the teacher component of the Scholar Role, whilst in the Professional Role there is increased emphasis on practitioner health and well-being. Both these changes fit very well with our Code

of Ethics. Let’s all make a special effort to continue provision of that safe learning environment, ensuring the well-being of our colleagues whilst delivering safe radiation therapy.

Interventional Radiology and Oncology The focus of this issue of Inside News, is interventional radiology – an incredibly exciting area with breathtaking technological advances. What an amazing opportunity we have as a College of radiologists and radiation oncologists to undertake and lead important research and education, even if we do on occasion have a difference of opinion on the most appropriate treatment option. We are fortunate to have world leaders in this area within our membership and I look forward to many discussions about developing a strategic approach to this relatively young specialised area.

continued over...

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Radiation Oncology

Profile and Presence of Radiation Oncology While the Targeting Cancer Campaign continues to work on increasing the awareness of radiation therapy in general, in recent months it has directed its focus to advocacy for prostate cancer management. Our key message is to encourage prostate cancer patients to fully explore their treatment options by talking to both radiation oncologist and urologist before making a decision. Please see the article on Page 24 for more information on our advocacy efforts.

New Zealand Election 2017 A general election in New Zealand will be held on Saturday 23 September. We are taking the opportunity to raise the profile of the College and the two disciplines with key Members of Parliament and to highlight important policy issues in our sector. In consultation with the members of the New Zealand Radiation Oncology Executive, funding for radiation oncology and workforce pressures were identified as key policy priorities for the sector, and were included in a written election submission sent to key health spokespeople from seven major political parties – seeking their support.

A/Prof Forstner and Minister Hunt

Get Involved Succession planning has been identified as a key area of work for the Faculty Council. The 2017 election for the College Board and Faculty Council will commence in July, and I encourage members to get involved.

Please be assured that being involved in College activities is a rewarding experience, and you will receive great support from the College staff.

The Faculty also has a number of Standing Committees, where vacancies are available from time to time.

Please cotact Sonja Cronjé, Senior Executive Officer on faculty@ranzcr.com with any FRO enquiries

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

Inside News

RadiationOncologyTargetingCancer

Radiation-Oncology-Targeting-Cancer

Radiation Oncology

Chief Censor in Radiation Oncology

A/Prof Margot Lehman

Approaching the midpoint of another year is a good time to take stock of the progress made in the work undertaken by the Specialty Training Unit in the examination and assessment arena. One of our biggest projects is the implementation of the Australian Council for Educational Research (ACER)/Professor Prideaux review recommendations. ACER representatives along with the Phase 1 examination leads (Drs Marcus Dreosti and Claire Hardie) and Phase 1 examiners participated in a very productive workshop dealing with exam blueprinting, standard setting and examination marking in March of this year. The ACER team’s recommendations for Phase 1 were based on theoretical considerations and practical examples derived from a statistical analysis of recent examination results. A similar workshop was conducted with the Phase 2 examiners during their exam writing workshop in May. Work on the introduction of a programmatic approach to assessment continues apace. The Oncology Sciences group (under the leadership of Dr Matthew Seel), have reviewed and updated the learning outcomes for the oncology science subjects. Their initial documents are now going out for expert review. This working group is also making progress on an alternative to the current clinical assignment requirements. The work of the Anatomy, Contouring and Plan evaluation group (under the leadership of Dr Andrew Potter) is focussing on a review of the learning outcomes for the site-specific anatomy subjects, and drafting a tool for

assessing competency in contouring and plan evaluation. Updates on the work of these two groups (in addition to that being undertaken by the other working groups) will be provided at the Director of Training (DoT) workshops and widely advertised to all Fellows.

“It is important to emphasise that the aim of the review and reform process currently being undertaken is not to add more assessment requirements but rather to streamline them and ensure they align with learning outcomes.”

Molloy, Professor in Work Integrated Learning in the Department of Medical Education, Melbourne Medical School and an expert in workplace learning and feedback, facilitated an interactive workshop at the May DoT meeting. The aim of the workshop was to provide DoTs and clinical supervisors with an understanding of how to give feedback and provide practical skills in doing it well. The established SMART program is a good example, I believe, of how a programmatic approach can function effectively. The SMART workshop held in conjunction with TROG was, once again, a great success. I would particularly like to thank Dr Trang Pham the convenor of this year’s meeting, in addition to all the faculty and facilitators for their ongoing commitment to this workshop. I would also like to thank Dr Patrick Dwyer who has agreed to take on the leadership of the SMART stream as part of the programmatic review.

continued over... It is important to emphasise that the aim of the review and reform process currently being undertaken is not to add more assessment requirements but rather to streamline them and ensure they align with learning outcomes. It is also recognised that the ability to provide constructive feedback is fundamental to ensuring the effectiveness of assessment tools. To this end, Professor Elizabeth

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Radiation Oncology

The development and conduct of examinations is core business for the Specialty Training Unit and its volunteers. The first Phase 2 exam series of 2017 was held in Liverpool, NSW. I am very grateful to A/Prof Dion Forstner for agreeing to host this series at the Liverpool Cancer Centre. I would also like to extend my particular thanks to the on-site organiser, Dr Mei Yap, for giving so generously of her time to ensure the series ran smoothly. The “exit” exam is an essential component of our Fellowship program. In an effort to share the load around, the Specialty Training Unit is always on the lookout for sites who are willing to host an examination

series. If you are interested in hosting a series, we would be very happy to hear from you. The coming months will see a number of other key educational activities take place including the Phase 2 examination workshop and the Phase 1 course (incorporating the Foundation course). The work involved in organising and running these activities is significant. I would like to express my sincere thanks to Drs Alex Tan, Apsara Windsor, Marcus Dreosti, Claire Hardie, Ms Julia Snedic and the many other volunteers whose valuable time, commitment and skill enables us to provide our trainees with high quality teaching.

Please email Julia Snedic on ronctaa@ranzcr.com with any training enquiries.

IMAGING UPDATE IN SYDNEY

September 11-15, 2017 / Four Seasons Hotel General Session: 22 credits / 7:00 am-1:00 pm Sep 11-12: Neuro, Thoracic / Sep 14-15: Breast, MSK Virtual Colonoscopy Workshop / 12 credits Sep 12: 2:00-5:00 pm / Sep 13: 7:30 am-6:00 pm HRCT of the Lung Workshop / 3 credits Sep 14: 2:00-5:00 pm https://radiology.ucsf.edu/cme/ucsf-imaging-update-2017-sydney Attendees may claim RANZCR CPD Points.

Faculty: Heather Greenwood, MD (breast); Travis Henry, MD (thoracic); Christopher Hess, MD, PhD (neuro); Priyanka Jha, MD (abdominal); Daria Motamedi, MD (musculoskeletal); Judy Yee, MD (abdominal) Department of Radiology and Biomedical Imaging University of California San Francisco

Inside News

June

Radiation Oncology

Radiation Oncology Trainees Committee 2017 is well and truly underway and the year has gotten off to a busy start. The foremost event for trainees is the Phase 2 examination Series 1, which was held in February/March in Sydney. Many congratulations to all those who sat the exams. The TROG SMART Workshop and Biennial Paediatric Radiation Oncology Courses were also held earlier this year in Auckland and Sydney. These courses were a great success with positive feedback resounding amongst participating trainees. We would like to extend a warm thank you to the College and in particular, the Education and Training Committee for coordinating these examinations and all other elements of our training; and to the TROG SMART Workshop and Biennial Paediatric Radiation Oncology Course organising teams for the enormous effort in organising these learning opportunities for trainees.

Education and Workforce Update – Australian Government Proposed Funding Changes for Radiation Therapy From an economic and workforce perspective, the major national issue facing our specialty is the Australian Government’s proposed funding changes to the Radiation Oncology Health Program Grants (ROHPG). The College is lobbying against these proposed changes as they will compromise patient access to cancer treatment. The proposed changes stipulate that only External Beam Radiation Therapy (EBRT) and linacs will be eligible for HPG funding (not brachytherapy, CT scanners, radiation therapy planning systems or network infrastructure). This not only threatens patient access to brachytherapy, which we know is essential in the treatment

of cervix cancer; but may also impact on the efficiency and effectiveness of providing EBRT. Trainees can also play a significant role in advocating for our specialty and are strongly encouraged to do so. How you can get involved: • Read and share the press release that the College issued on funding to ROHPG (press release available on the College website - www.ranzcr.com/whats-on/ news-media/134-governmentproposed-funding-changes-to-healthprogram-grants-will-compromisepatient-access-to-cancer-treatment

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 Kimberley Nguyen Chair, Radiation Oncology Trainee Committee

• Write to your local MP opposing funding cuts and encourage your colleagues/patients/other advocacy groups to do the same. Contact rotc@ranzcr.com for a College template.

Important Dates

• Follow, interact and share posts from @TargetingCancer, @FacRadOncology and @RANZCRcollege on Twitter.

Writtens: Monday 10 and Tuesday 11 July 2017

Mentorship Program A Faculty of Radiation Oncology Mentoring Working Group has been established with consultant, trainee and College representatives. Our first teleconference meeting was held last month and strategies on how to move forward with this endeavour were discussed. We will keep trainees up to date with further developments and as always, we welcome any suggestions, ideas or feedback from trainees and consultants.

2017 Phase 2 Examinations Series 2

Vivas: Monday 14, Tuesday 15 and Wednesday 16 August 2017 (Princess Alexandra Hospital, QLD) Applications closed

2017 Phase 1 Examinations Writtens: Friday 8 September 2017 Applications close: Friday 21 July 2017

Trainee Forum Friday 20 October 2017 at RANZCR 2017 ASM: 19-22 October 2017 (Perth, WA)

Upcoming Examinations Over the next three months, trainees will be sitting the Series 2 Phase 1 examination and the Phase 2 examinations. Balancing work, study,

For further information, please visit: www.ranzcr.com/trainee/rad-onc/ exams

Volume 13 No 3 I June 2017

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Radiation Oncology

Interventional Oncology and TROG The potential for a productive partnership Interventional oncology (IO) employs minimally invasive, imaging–guided procedures to treat patients with cancer. This discipline is growing exponentially around the world, and is strongly represented in several centres in Australasia. For several decades, interventional radiology (IR) has made a major contribution to the palliation of cancer patients using techniques such as percutaneous biliary drainage, tracheobronchial stenting, vertebroplasty, and percutaneous ablation of skeletal metastases. More recently, potentially curative IR procedures have been developed, which have been making an increasingly significant contribution to the field of oncology; the main potentially curative IO procedures are radioembolization of hepatic tumours and various forms of percutaneous ablation of tumours in the liver, the kidney and the lung. IO is fast becoming an essential part of contemporary cancer care, alongside medical, surgical and radiation oncology. The provision of IO procedures in Australasia is inconsistent. In most hospitals, very few such procedures are carried out. Even in major centres, the spectrum and number of IO procedures varies substantially, making it difficult to plan service provision in local tumour treatment systematically and effectively. The main reason for this is the organic nature in which IR has evolved. In many practices the resources and infrastructure necessary to support high quality IR service delivery, such as adequate clinical space and technology, outpatient clinics, resident staff and admitting rights, are still catching up to the rapid advancements made in IR. As a consequence, IO is usually not formally represented at cancer MDT meetings, leading to many patients not being considered for percutaneous ablation and other IO methods of treatment.

In August 2016, HealthPACT, which is the national body for health technology assessment in Australia, commissioned an independent evaluation of IR and IO. This review identified IO as the “fourth pillar” of cancer care, prompted by technology innovation and disease trends, and advised investment of resources in this discipline. Interventional oncology techniques and technologies have rarely have been investigated in randomised controlled trials. Thus, for even commonly used techniques, there is often no level I or II evidence. There are several, complex reasons for the lack of completed randomised trials. These include difficulties in recruitment to interventional oncology trials when the investigational treatment is already offered in clinical practice, with patients at times having a strong preference for less invasive interventional oncology techniques. Another factor limiting recruitment has been the radiologists’ position in most institutions, where they do not have a consistent presence in clinics or wards, and thus are reliant on multi-disciplinary meetings and recruitment by clinician colleagues. In addition, changes in standard of care comparators can present additional challenges. An additional factor is the rapid development of interventional oncology, which has limited the ability to develop a strong evidence base: development cycles for medical devices and techniques are generally shorter than for new drugs, and incremental innovation often occurs. Over the last three decades, the TransTasman Radiation Oncology Group (TROG) has built up extensive experience and expertise in conducting collaborative multi-centre trials and for many years has been the highest recruiting collaborative cancer trials group in Australasia. The TROG sub-speciality groups, central office and scientific committee can help

to guide and refine research proposals, from concept to trial activation. In addition TROG has grant submission specialists, central co-ordination services, statistical services and an independent data and monitoring committee. Professor Andy Adam (King’s College London) and Professor Liz Kenny (Royal Brisbane and Women’s Hospital), doyens of interventional oncology and radiation oncology, have helped to give focus to TROG forming a special interest group in interventional oncology. This development is further facilitated by the fortunate fact that both interventional oncologists and radiation oncologists are part of the Royal Australian and New Zealand and College of Radiologists, and the College is supportive of such developments. The TROG Annual Scientific Meeting in Hobart, in March 2018, will have a specific section dedicated to interventional oncology. TROG would welcome interest from interventional oncologists who would like to join a subspecialty interventional oncology group or to be involved in the annual scientific meeting. TROG can be contacted on trog@trog.com.au. The growth of IO presents great opportunities for well-conducted multicentre studies, either single arm or controlled. TROG has a long history of working with image guided radiation therapy trials and is in an ideal position to support the development of a special interest group and future collaborative trials in the area of interventional oncology. Joan Torony CEO TROG Cancer Research

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Radiation Oncology

Gynaecology Oncology News

The Gynaecology Oncology Radiation Oncology Collaborative (GOROC) held another successful bi-annual meeting in Melbourne at the Australian and New Zealand Gynaecological Oncology Group’s 2017 Annual Scientific Meeting in March. The highlight of the meeting was the workshop on the up to date management of vulva cancer. Our guest speaker was Dr Remi Nout, who presented salient features of the European Society of Gynaecological Oncology (ESGO) Vulva Cancer Guidelines, followed by a discussion of challenging vulva cases. The workshop was attended by members of GOROC as well as surgeons and medical oncologists who are actively treating gynaecological malignancies. GOROC members have endorsed the ESGO vulva cancer guidelines. The Faculty of Radiation Oncology (FRO) is currently in the final phase of preparing a position paper on Image-Guided Brachytherapy (IGBT) for Cervical Cancer. This position paper is jointly prepared by members of the GOROC and the Australasian Brachytherapy Group (ABG) and has sought wider consultation within the College membership. This position paper summarises the survey of current practice of IGBT in Australasia, provides evidence to support its use, and makes recommendations on equipment, dose, prescription, dose specification, dose reporting and techniques.

Training requirements and competency assessments for IGBT are outlined, and strategies to implement good IGBT practice are suggested in this paper The Endometrial Cancer Guidelines draft will be finalised after the presentation of PORTEC-3 (Randomized trial of radiation therapy with or without Chemotherapy for Endometrial Cancer) at the American Society of Clinical Oncology (ASCO) ASM this year. We will bring you updates in the future editions of Inside News. The next GOROC meeting will be held in Perth during the College ASM from 19 to 22 October 2017. Dr Viet Do ToGOROC contact GOROC, please Chair, email frosigs@ranzcr.com or call +61 2 9268 9765

YOUR MEMBERSHIP MATTERS Get Involved

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

Inside News

Radiation Oncology

Asia Pacific News Would you consider a short-term locum in Papua New Guinea?

Genito – Urinary News The recent FROGG workshop “Biochemical relapse following definitive treatment of prostate cancer” held at Noosa started inauspiciously. As cyclone Debbie departed the Queensland coast flights were delayed, highways closed and the welcome reception was a subdued affair as torrential rains and gale force winds lashed the resort.

ANGAU Memorial Hospital, Lae, Papua New Guinea Papua New Guinea (PNG) has a population of more than seven million, but its radiotherapy infrastructure consists of a single cobalt teletherapy unit and a Selectron LDR at the National Cancer Centre in Lae. Since January there has been no radiation oncologist at the cancer centre, so no radiation therapy is available in the country. A single radiation therapy registrar has no supervision and is currently providing basic chemotherapy and supportive care only. PNG faces many challenges, but it has motivated local doctors, a school of radiation therapy in Lae with an excess of trained radiation therapists and resources that have been set aside to develop radiation therapy in the country. There is an urgent need for a radiation oncologist or series of locum radiation oncologists, who can maintain the service in the short term so that cancer patients can be treated. It is important to appoint quickly to ensure that the radiation therapist workforce is not dispersed, which would make reestablishing the service much more difficult. There is also a need for a more experienced radiation oncologist, who can train local doctors and assist the

National Department of Health, plan for a more comprehensive service including a modern cancer centre in Port Moresby in the next 2-3 years. This is a unique opportunity for a College Fellow to make a big difference to the whole population of a neighbouring country. For more information or to express your interest, contact Dr Goa Tau (Chief Medical Officer, Department of Health; goa_tau@health.gov.pg), Dr Chris Kenyhercz (CEO, ANGAU Memorial Hospital; cjkenyhercz@gmail.com) or Dr Iain Ward (APROSIG Co-Chair; Iain. Ward@cdhb.health.nz) Dr Ward is particularly interested in hearing from radiation oncologists who might consider being a shortterm locum or volunteer for months or even a few weeks, as series of locums may be the only way to maintain the service in the immediate future. It is likely that some local support will be provided in the form of travel, accommodation and possibly a stipend.

Happily, the Friday dawned bright and the workshop started on time with excellent presentations by Prof Brian Davis and local faculty. The conference dinner at Bistro C was a lavish affair that went late into the night.

Drs Scott Williams, Kirsty Wiltshire and A/Prof Andrew Kneebone

Prof David Christie

Dr George Hruby Photographs courtesy of John Violet

Volume 13 No 3 I June 2017

Radiation Oncology Advertorial

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Inside News

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Radiation Oncology

Lung Cancer News The Faculty of Radiation Oncology Lung Interest Cooperative (FROLIC) met face to face at the TROG Annual Scientific Meeting held in March 2017. The group is keen to extend its membership to include student members. FROLIC members are happy to guide trainees in undertaking lung cancer research and help them meet other core CanMeds competencies. We have submitted an amended Terms of Reference to the College’s Faculty of Radiation Oncology Council for approval. In the meantime, FROLIC has sent an expression of Interest to the trainees and have received replies from interested trainees. Later this year FROLIC will be holding an educational workshop titled “Targeted Treatment for Advanced Lung Cancer”. This will cover indications for targeted systemic agents and immunotherapy and the treatment of oligometastases including the use of

Stereotactic Ablative Radiotherapy (SABR). The workshop will be convened by Dr Jeremy Ruben and will be held in Melbourne on Friday 1 September. We encourage all members to attend. Registrations are now open, visit www. ranzcr.com/whats-on/events/frolicworkshop for more information.

successful, this could be extended to other states. In addition, we are planning to write Lung SABR protocols for eviQ, an online service of the Cancer Institute of NSW. We hope to have the next face-to-face meeting at the RANZCR ASM, 19-22 October 2017 in Perth.

A/Prof Vinod is on the organising committee for the Australian Lung Cancer Conference (ALCC) which will be held in Sydney in April 2018. We hope to increase the presence of radiation oncology at this conference and collaborate in sponsoring an international speaker. Future FROLIC workshops may be held as part of the ALCC meeting. A number of FROLIC members are involved in developing a Lung SABR registry in NSW in collaboration with the Cancer Institute NSW. If this is

Faculty of Radiation Oncology Guidelines for Informed Consent The Faculty of Radiation Oncology has recently updated the Faculty of Radiation Oncology Guidelines for Informed Consent. This document provides guidance when seeking patients’ consent to receive radiation treatment. It highlights the underlying principles of informed consent and the importance of clear communication between doctors and their patients.

Members are encouraged to download and read these guidelines from the College website at www.ranzcr.com/ college/document-library

Feedback and suggestions for future revisions are encouraged through faculty@ranzcr.com

Dr Madhavi Chilkuri, Chair, Quality Improvement Committee

Volume 13 No 3 I June 2017

General Interest

New Zealand Branch News

Dr Lance Lawler

I spare you an in-depth commentary on recent Super Rugby results, but I do take small pleasure in the ‘team’ performance of the Hurricanes. For rugby fanatics in New Zealand, the upcoming highlight is undoubtedly the British and Irish Lions tour scheduled for June. Interestingly, the Australian coach has stated the Lions will be ideal preparation for the All Blacks prior to the Bledisloe Cup. The reason, well, playing against the best helps galvanise the ‘team’, and rugby, like radiology is fundamentally about the team!

of messages, otherwise the desired outcome of informed patients and clinicians is ruined. Recently the Branch worked with the New Zealand College of Midwives around their list interventions, some of which related to medical imaging and particularly the variance of ultrasound. While it can take up to 15 years to imbed new proven procedures, Choosing Wisely is helping to initiate conversations outside the profession, thus broadening the team. This can only be a good thing!

I was reminded of this salient point at the Choosing Wisely launch which took place in March For my sins, I was asked to give a presentation on Choosing Wisely in the Community. My take was that with 75% of medical imaging is done in the community, and with numerous patient pathways in existence such as District Health Boards (DHB’s), ACC, community schemes, and private insurance etc., a team based approach is mandatory. The reality is that the clinical guidelines/team decision support space is also cluttered, resulting in mixed messages.

This is a busy period of the year. For the New Zealand Branch who facilitate “team selection” via the centralised recruitment for radiology and radiation oncology. Team selection is always critical be it rugby or radiology. But whereas we often pick on individual brilliance, both radiology and radiation oncology require a depth and broadness of skill provision and interest within our teams. As an example, we cannot have professions that don’t have researchers unless we neglect our responsibility to future generations of patients. The same could be said for needing some with business and management capability, least we neglect the need for administrative efficiency. Consequently, the Branch has worked closely with the College in work being undertaken on Selection and Recruitment Guidelines. Currently this work is focused on establishing the respective competencies of each profession, but in time, it will look at the tools available to help select and ensure both professions have the right team balance for the future.

In order for Choosing Wisely to be successful, the recommendations need to: • apply to community providers as well as DHB’s • be of public health importance (common and potentially serious). Choosing Wisely, therefore requires acknowledging and playing a team game. It requires professions to collaborate. It requires the alignment

Inside News

I made a brief mention in my last article in Inside News, of the review underway in the Medical Imaging Workforce (focussing primarily on MRT’s) by a collective DHB working group. The College has direct representation on this group, which will help ensure we are part of the wider dialogue that is occurring. This is a time consuming, but important role that the Branch undertakes. On a pleasing note, the ‘team’ stepped up this year and nominated a number of New Zealanders for College awards. Whatever the result, all were worthy of nomination, and when we consider the talent within our professions, we have many more that are worthy of nomination. The New Zealand Branch elections occur during May and July and I encourage you all to consider standing as the Chair or as a branch member. Say whatever you like about the College, without a functioning New Zealand Branch, the profession is that much more vulnerable. Lastly, given it is rugby season, I again challenge fellow directors to wear the beloved All Blacks jersey at the College ASM in Perth, should New Zealand get up over the Wallabies. After all, we are but one wider ANZAC team. 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.com For any New Zealand Branch enquiries, please contact Alexander Brunt at nzbranch@ranzcr.com

General Interest

Australian Branch News NSW Branch

following on from the premise that spontaneous pain processing may be distinct to processing of pain elicited by noxious stimuli.

All in all, the Australian Medical Association Annual Medical Careers Expo was a well organised and fun day. The event provided a great opportunity for medical students and JMOs to learn about the various specialty training programs and allowed us as trainees to meet keen students and answer all the relevant questions such as choice of clinical rotations, courses to attend to improve their radiology knowledge and how to apply to the College.

Her research concluded that spontaneous pain processing may be distinct to processing of evoked pain, and that it possibly involves the recruitment of regions involved in affective processing.

Dr Raj Doolabh sharing with those interested in radiology.

Sajee Kulatunga with Dr Xavier Yu (RANZCR Victorian Branch Committee)

VIC Branch Congratulations to Sajee Kulatunga: Monash University Medical Imaging RANZCR Prize 2016 Dr Christina Zhou and Dr Mina Chung of Gosford Hospital engaging with students and JMOs.

TAS Branch There has been little activity in the Tasmanian Branch of the College during the first few months of 2017. The Tasmania University Medical Students Society (TUMSS) held a Careers evening recently to which RANZCR was invited. We were represented by Drs Raj Doolabh and Jonathan Shulman. We show cased some state of the art imaging on a large screen in the main foyer and managed to attract quite a few students who were interested in what a career in radiology entailed. We plan on holding a Branch Scientific Meeting as usual in November in Hobart with an interstate speaker to be invited. This will be formally advertised on the College website in due course and all College members are welcome to attend.

At the Monash University (Melbourne) Medical Imaging Student Awards Ceremony held in April 2017, Ms Sajee Kulatunga was presented the RANZCR VIC Branch prize for her work in preparing the best research presentation in her Radiography and Medical Imaging 2016 cohort. Ms Kulatunga completed her Radiography and Medical Imaging degree through Monash University in 2016 with Honours, and now works as a radiographer with MIA in Box Hill and north eastern clinics in Melbourne. Sajee’s award-winning research, “Regional brain responses associated with spontaneous ongoing osteoarthritic pain”, was supervised by Mr Michael Farrell in the Department of Medical Imaging and Radiation Sciences, Monash University. Her work in functional MRI involved obtaining regional cerebral blood flow (RCBF) estimates of patients with knee osteoarthritis using an arterial spin labelling (ASL) perfusion technique,

WA Branch Dr Jolandi van Heerden, a Fellow from Perth was awarded the Professor Turab Chakera Teaching Award for 2016. Dr van Heerden received her award at the annual WA Branch radiology registrar dinner Dr van Heerden grew up in South Africa, finishing Secondary School as Head Girl, Dux Scholar and Sports Woman of the Year.After Grade 12, Jolandi joined the South African National Defence Force. Starting as a Private (lowest military rank) she completed a year of military training. During this time, she met her husband Baren whom later became a Captain in the Airborne Special Forces. By the end of the year, she was promoted to the rank of Lieutenant. continued over... Volume 13 No 3 I June 2017

General Interest

She became a Fellow of the Royal Australian and New Zealand College of Radiologists in 2012.

L-R: Dr Robert Brazel, Dr Jolandi van Heerden and Dr Daniel McKay. The following year, she started her medical training. Jolandi was selected to study through the Military, completing her Bachelor Degree of Medicine and Surgery as well as her specialist radiology training. After 13 years’ military service, she resigned from the military with the rank of Major, prior to relocating to Australia.

Following three years of diagnostic Neuroradiology sub-speciality fellowship training both at the Neurological Intervention & Imaging Service of Western Australia (NIISwa) and The Royal Melbourne Hospital, she returned to Perth in 2014. She joined Perth Radiological Clinic in that same year, becoming a partner in 2017. In the field of neuroradiology, she is particularly passionate about acute stroke imaging, taking part in establishing the Acute Stroke Service at Midland Health Campus.

She has authored over 15 neuroradiology-related articles in international peer-reviewed journals and has presented at national neuroradiology conferences. She enjoys neuro-radiology teaching and is actively involved in training sessions aimed at radiology registrars, radiographers and referring clinicians. We congratulate Dr van Heerden on her well-deserved award. The Professor Chakera Teaching Award is named after the honorable Professor Turab Chakera to recognise his teaching efforts and work since his arrival in Perth in 1970.

Australian Branch Meeting Dates QLD

Academic Nights Tuesday 5 September

Location Hillstone St Lucia, Carawa St, St Lucia QLD 4067

NSW

ACI Education Lectures Tuesday 25 July Tuesday 14 November

Kerry Packer Lecture Theatre, Royal Prince Alfred Hospital Missenden Rd, Camperdown NSW 2050

Radiotherapy Club Meetings

July Meeting: Radiation Oncology Department, Prince of Wales Hospital Barker St, Randwick , Sydney NSW 2031 November Meeting: Cockle Bay Room, Park Royal Darling Harbour 150 Day Street, Sydney NSW 2000

Monthly Professional Meeting (MPM) Wednesday 19 July – trainee presentations Wednesday 16 August Wednesday 8 November

Royal Perth Hospital 197 Wellington St, Perth WA 6000

NSW Wednesday 19 July Radiation Wednesday 16 November Oncology Chapter

Meeting dates are subject to change. For further information about branch activities and event locations please visit www.ranzcr.com/whats-on/events or contact Mereana Pokai on +61 2 9268 9738 or branches@ranzcr.edu.au

Branch Contacts 2017 ACT Chair: A/Prof Murali Guduguntla E: Murali.Guduguntla@act.gov.au Honorary Secretary: Dr Mervyn Despois E: mervyn.despois@act.gov.au Meeting Convenor: Dr John Cockburn E: john.cockburn@act.gov.au NSW Chair: Vacant – contact branches@ranzcr.edu.au to nominate Honorary Secretary: Dr Chee-Chung Hiew E: chee-chung.hiew@sesiahs.health.nsw.gov.au Meeting Contact: Ms Anthea Temple E: anthea.temple@health.nsw.gov.au

Inside News

NSW Radiotherapy Club Ms Sarah Hall E: branches@ranzcr.edu.au NZ Chair: Dr Lance Lawler E: lance.lawler@ranzcr.org.nz Honorary Secretary: Dr Ben Wilson E: ben.wilson@southerndhb.govt.nz QLD Chair: Dr Mark Phillips E: ausphillips66@yahoo.com.au Honorary Secretary: Dr Peter Zheng E: secretaryranzcrq@gmail.com SA Chair: Dr Chris Pozza E: cpozza@usa.net Honorary Secretary: Dr Melissa Lea (acting in role)

TAS Chair: Dr Rajendra Doolabh E: Rajendra.Doolabh@regionalimaging.com.au Honorary Secretary: Dr Jonathan Shulman E: Jonathan.Shulman@regionalimaging.com.au VIC Chair: Prof Stephen Stuckey E: slstuckey@mac.com Honorary Secretary: Dr Gerard Goh E: G.Goh@alfred.org.au MSM Convenor: Davig Wang E: msm.convenor@gmail.com WA Chair: Dr Neil Powers E: neil.powers@health.wa.gov.au Honorary Secretary: Dr Richard Ho E: richard.ho@health.wa.gov.au Meeting Convenor: Dr Fiona Bettenay E: Fiona.Bettenay@health.wa.gov.au

General Interest

From the Trainor/Owen Collection The End of an Era

As outgoing Chair of the JP Trainor Trust, Dr Peter Duffy reflects on the achievements that have occurred during his appointment as a long standing trustee. In 1982 the late Paul Trainor endowed the JP Trainor Archives Trust in memory of his father, John P Trainor, whose firm, Watson & Victor Pty Ltd, provided x-ray equipment to Australia and New Zealand in the early and mid-20th Century. Paul, himself, was a founder of the Nucleus Group of companies and benefactor of Cochlear Holdings. The purpose of the JP Trainor Trust is ‘obtaining, cataloguing and preserving objects of archival and or historical interest to members’ of the College. In particular, the extensive collections assembled by radiological history enthusiast Dr Owen of Taree and Dr Bennett of Melbourne. Since those early days, the collection has been housed at the College with larger pieces of radiological equipment transferred to the Powerhouse Museum. The original Trustees; Drs Bennett, Owen and Verco, were in time replaced by Drs Cashman, Duffy and Carr. Our aim was to maintain the Trust funds, grow the collections, catalogue and make all material available to both members and others via digital formats. This latter goal was quite challenging due to the minimal resources available but due to the hard work of our previous Archivists; Mesdames Haegeny, Morrison and Goodman and our current Archivist, Ms Stokes-Blake, the project has accelerated so that the collection now has digital status and can be viewed online:

create a digital archive well underway, I can now resign as a Trustee. With funds secure, the collection moving into the modern era; volunteers and intern programs established; and cataloguing proceeding, the responsibility can now be passed on to the next generations. My thanks are given to my fellow Trustees, particularly Drs Bourne, Carr, Cashman, Kitchener and White.

www.ehive.com/collections/5079/ trainor-owen-collection

All donations offered by Fellows and others are gratefully accepted and go towards maintaining the archives keeping our archivist busily employed on your behalves. I urge you to contribute to maintain this valuable asset to our professional heritage.

Having seen the change from humble beginnings to taking the first steps to

Dr Peter Duffy

The College wishes to extend their gratitude to Dr Duffy for his many years of service as a JP Trainor Trustee.

Should you wish to know more about the archives, please contact College Archivist, Eva StokesBlake archives@ranzcr.com

Visit our online museum www.ehive.com/collections/5079/ trainor-owen-collection

Volume 13 No 3 I June 2017

General Interest

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

All College standards, policies and guidelines are available on the College website here: Clinical Radiology: www.ranzcr.com/ fellows/clinical-radiology/professionaldocuments Radiation Oncology: www.ranzcr.com/ fellows/rad-onc/professional-documents All College position statements and submissions are available on the College website here: www.ranzcr.com/our-work/advocacy/ position-statements-and-submissions If you have any enquiries about professional documents, please contact the College on: ranzcr@ranzcr.com or phone: +61 2 9268 9777

RANZCR Supporters Bayer Australia Ltd www.bayer.com Deutsch Medial Pty LTD www.deutschmedical.com.au Everlight Radiology www.everlightradiology.com.au I-MED Radiology Network www.i-med.com.au Integral Diagnostics www.integraldiagnostics.com.au Lightbox Radiology Education www.lightboxradiology.com Sectra www.sectra.com/medical TNI Pty LTD www.tni-australia.com Varian Medical Systems www.varian.com Wiley Publishing www.onlinelibrary.wiley.com

Being a RANZCR Supporter entitles you to the following benefits: • Discounted advertising opportunities. • A RANZCR Supporter logo to display on your website • A RANZCR Supporter listing on the College website, in Inside News and in the Annual Report • The College’s quarterly newsletter - Inside News • The College’s bi-monthly scientific journal - Journal of Medical Imaging and Radiation Oncology • The College’s monthly electronic newsletters – Faculty of Clinical Radiology and Faculty of Radiation Oncology and other associated electronic newsletters • The College’s Annual Scientific Meeting brochure • An electronic version of the College’s Annual Report

Inside News

General Interest

Australasian Meetings 2017

International Meetings 2017

July

September

ANZSNR ASM Darwin, NT 6-9 July 2017 www.anzsnr.org.au IRSA Conference Port Douglas, QLD 11-13 July www.irsaconference.aot.com.au ANZSHM Conference Melbourne, VIC 11-14 July https://dcconferences.eventsair.com/ anzshm2017/csn RADaim Conference Gold Coast, QLD 28-30 July www.phoenixconf.com/radaim2017

RANZCR Annual Scientific Meeting Dates NZ Branch ASM 2017 4-6 August 2017 Nelson, New Zealand www.ranzcr2017.co.nz ASM 2017 19-22 October 2017 Perth, WA www.ranzcr2017.com ASM 2018 25-28 October 2018 Canberra, ACT

August STARTX Conference Sydney, NSW 4-6 August https://willorganise.eventsair.com/2017startx-conference/info

October ASBD Scientific Meeting Gold Coast, QLD 5-7 October http://asbd.org.au/conference2017.php ANZHNCS ASM Brisbane, QLD 12-14 October www.anzhncs.org RACMA Conference Melbourne, VIC 18-21 October www.racmaconference.com.au

College Meetings 2017 Board 11 August 12 September (telco) 16-17 November Annual General Meeting 19 October 2017 Faculty Council – Clinical Radiology 24 August (telco) 21-22 September 7 Dec (telco)

ISUOG World Congress Vienna, Austria 16-19 September www.isuog.org/WorldCongress/2017 GCMA/VMDA Medical Conference Efate, Vanuatu 21-23 September https://gcma.org.au/Vanuatu-2017Conference.aspx ASTRO ASM San Diego, USA 24-27 September www.astro.org/2017-ASTRO-AnnualMeeting.aspx ASEAN Association of Radiology Congress Kuala Lumpur, Malaysia 28-30 September www.aar2017.com/index.php Ireland Faculty of Radiologists ASM Dublin, Ireland 28-30 September www.radiology.ie/conferences/asm

October IASLC World Conference on Lung Cancer Yohohama, Japan 15-18 October www.wclc2017.iaslc.org Korean Congress of Radiology Seoul, South Korea – 25-28 October www.kcr4u.org/index.htm

Faculty Council – Radiation Oncology 21 July 25 August (telco) 13 October

Volume 13 No 3 I June 2017

Courses and Workshops Classifieds

17th ADVANCED NEURORADIOLOGY COURSE 5 – 6 October 2017 Singapore

3rd Interventional Neuroradiology Workshop 4 October 2017, Time: 8.30am – 5.00pm Fees: S$180 (Inclusive of GST) 17th Advanced Neuroradiology Course 5 – 6 October 2017, Time: 8.30am – 5.00pm Fees: S$330 (Inclusive of GST) Venue Tan Tock Seng Hospital, Theatrette, Level 1 11 Jalan Tan Tock Seng, Singapore 308433 Website: http://www.nni.com.sg Enquires: sin_leong_tien@nni.com.sg Organised by:

�� duca��na� ��urses Brought to you by RANZCR Amora Jamison Hotel, Sydney

REGISTRATION NOW OPEN

Musculoskeletal MR—Commonly Imaged Joints 11-13 August 2017

Neuroradiology—Brain, Head/Neck and Spine 11-13 August 2017 and 14-16 August 2017

Body and Pelvic MR 14-16 August 2017

High Resolution CT of the Chest 18-20 August 2017

Limited places available. Register at www.ranzcr.edu.au/ news-a-events/courses events@ranzcr.edu.au

Advertise your event in Inside News and receive a complimentary online listing on the College website. Email editor@ranzcr.com for more information

~ Death Notices ~ The College notes with regret the death of the following members: Dr Ross Thompson, Fellow, NSW Dr Frederick Schubert, Fellow, Life Member and Past President, QLD Dr Bertel Sundstrup, Fellow and Life Member, TAS Dr Beresford Houghton-Allen, Fellow, VIC Dr Choon Woo, Fellow, NSW Dr Rodger Colbert, Fellow, NZ Dr Peter Geddes, Fellow, NSW

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

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