Volume 14 No 3 / June 2018
Quarterly publication of The Royal Australian and New Zealand College of Radiologists
HARNESSING THE (AI) BEAST
Also Featured in this edition
College Strategy to 2020
MRI
Funding
A Mummy as a Patient?
“The most trusted medical imaging specialists in the world” - that’s our vision. At I-MED Radiology Network, we have a vision. To achieve that vision, we are united under a set of values that include, among other things, teamwork, compassion and communication. Discover what it’s like to work with a world-leading organisation that puts people first. Contact our careers team T: +61 2 8274 1080, E: careers@i-med.com.au www.i-med.com.au/careers
Editor’s Pick 5
Learning About Machines… And Machine Learning
6 8 11 13 15 17
College talks Strategy – to 2020! Crystal Ball Gazing into AI
Introduction to New Assessment Tool
21
Courses, Workshops and Events
25 27
Interpretation in the Age of AI
Targeting Cancer Spreads its Wings InsideRadiology Budget Outcome Opportunity
17
18
Continuing Our Advocacy Work
Advocacy at Work Training Program News
29 33 37
Dispelling the Myths of Women in Interventional Radiology Radiologist Encounters the NotSo-Average Patient
39 41 45
Advocacy, Funding and Informed Decision Making Training Program News Revised Radiation Oncology Practice Standards
47
What are Quality Clinical Indicators?
53
New Zealand Branch News
54
AI – Threat or Opportunity?
Leadership in Telehealth
90% of members have logged into the new MyRANZCR, Portal! Start updating your contact details, login today at www.myranzcr.com Inside News is printed on Titan Satin. Titan is produced in an ISO 14001 accredited facility ensuring all processes involved in production are of the highest environmental standards. FSC mixed Sources Chain of Custody (CoC) certification ensures fibre is sourced from certified and well managed forests.
Editorial Staff Editor-In-Chief Dr Allan Wycherley Sub Editors Sarah Hall Miranda Handke
Submissions The submission of articles, letters and news items is encouraged. Submissions should be sent to editor@ranzcr.com The Editor reserves the right to make literary corrections and to withhold from publication any or part of any material submitted.
All rights reserved. No part of this publication may be reproduced or copied in any form or by any means without the written permission of the publisher. Publication of advertisements and articles submitted by external parties does not constitute any endorsement by The Royal Australian and New Zealand College of Radiologists of the products or views expressed.
Inside News © 2018 The Royal Australian and New Zealand College of Radiologists® (RANZCR®)
MRI - UPPER & LOWER LIMB WORKSHOP WITH PROFESSOR DONALD RESNICK Sydney. October 6-8, 2018. Hong Kong. October 12-14, 2018. Professor Donald Resnick University of California, San Diego. Dr Resnick is Professor of Radiology and Chief of Osteoradiology at University of California, San Diego. A dedicated radiology educator, researcher and lecturer for more than 40 years, he runs one of the largest musculoskeletal radiology training programs in the world.
RANZCR CPD: 40 points may be claimed
Registration and more information www.lightboxradiology.com
Introduction
Learning About Machines… and Machine Learning A Message from the President Dr Lance Lawler
College is keeping a close eye on technology and governments. School children learn about the discovery of X-rays in 1895, a technology so novel and rich with medical potential that contemporary physicians feared the decline of clinical diagnosis itself. Yet, few know of the many milestones which followed in succeeding decades to bring radiology to where it is today. Who is aware of William Coolidge’s invention of the hot cathode tube in 1913, Alessandro Vallebona’s early work on tomography in the 1930s, or Ian Donald’s investigations in medical ultrasound in the 1940s and 50s? The crowded history of technology in radiology and radiation therapies reveals a capacity for interpretation of new technology and subsequent adaptation. It’s something we seem to be good at. Ceaseless innovation in radiological medicine spanning three centuries has acclimatised the profession to technological change and ingrained a forward-looking attitude perhaps more than in any other medical specialisation. This is evident in our own official history, published in 1999, which highlighted an appetite for progress among the College founders. As the software and telecommunications revolution continues to redefine our working relationships with machines, and indeed with the workplace itself and each other, I feel we need to draw on these characteristic qualities more than ever. An active field of research today is centred on the use of neural networks in machine learning models, where
researchers are grappling with the issue of bias in the training data for these models. The bias may be due to statistically unrepresentative datasets or to the cultural prejudices of the humans employed to label the training data. Either way, the bias may be hard to detect and it may reduce accuracy and entrench inequality whenever such models augment human judgement. The technical issues involved in this are already being felt strongly in medicine,
“The role of the radiologist as an interpreter is well demonstrated by the College’s recent developmental work in teleradiology.” where the interpretability of information is seldom clear-cut (see page 11). Unsurprisingly, radiologists will be among the first called upon to develop practical solutions.
maturing and increasing important subspeciality. Further, they help to ensure the maintenance of quality outcomes for patient care at sites dependent on teleradiology. Finally I must draw your attention to some heartening news. In April, the Australian Medical Association released its first comprehensive policy on diagnostic imaging (DI), with the AMA’s national president, Michael Gannon, adding that the imaging role of radiologists was critical to 21st century healthcare and ‘too often undervalued.’ In a media release, Dr Gannon called on the Australian Government to lift Medicare rebates for DI services to ‘realistic’ levels and provide additional funding support for diagnostic services in regional and rural Australia. While the AMA’s release makes no mention of the RANZCR, it is evident from the full statement that the AMA endorses many of our key policy positions. The AMA policy is a most welcome development for our profession and testament to the advocacy work of the RANZCR in our ongoing collaboration with the AMA.
The role of the radiologist as an interpreter is well demonstrated by the College’s recent developmental work in teleradiology (see page 37), culminating in the release last year of its Teleradiology Standards. These standards, which embody the key principles related to image quality, safety, registration, licensing and record-keeping, set the benchmark for a
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Introduction
The College Strategy to 2020 From the Chief Executive Officer
Ms Natalia Vukolova
“ I am also confident that it will allow us to make great strides towards ensuring the College is leading best practice in clinical radiology and radiation oncology for the benefit of our patients and society.”
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Inside News
Members are asked to comment on the College Strategy. The College Board and the two Faculty Councils have been, as in previous years, working diligently to develop a consistent, coherent and integrated strategy for the future of the College. This has taken shape in the form of the College Strategy to 2020, which plots a course for the College’s strategic direction over each of these three years. Members are asked to comment on the College Strategy. As you will see, in an attempt to provide more clarity to our objectives and sharpen our focus, the strategy is based around five key pillars - Engagement, Advocacy, Educational, Clinical Excellence and Organisational Governance and Sustainability. We decided to focus on these key priorities as they are very much aligned with the College’s broader direction and are more sharply defined than the previous strategic plan. We feel that by having these few stated overarching themes, it should make it easier for us to fine tune our programs and activities towards achieving our aim
I firmly believe a successful implementation of this plan will help the College further develop its growing reputation as one of the most progressive, forwardthinking and respected colleges in the health sector. I am also confident that it will allow us to make great strides towards ensuring the College is leading best practice in clinical radiology and radiation oncology for the benefit of our patients and society. That is, when you put all these words and plans aside, what we are here to do. It is – of course – one thing for me to tell you how the Board see things, but your input as members into crafting and shaping this document is vital. The President sent a call for feedback to all our members on Monday, 21 May 2018 with the strategy developed thus far for review. The Strategy summary can be found on the next page. Please contact president@ranzcr.com with any feedback.
STRATEGY TO 2020 AT A GLANCE VISION
RANZCR leading best practice in clinical radiology and radiation oncology for the benefit of our patients and society.
PURPOSE
To drive the safe and appropriate use of radiology and radiation oncology to optimise health outcomes through leadership, education and advocacy.
VALUES
Commitment to best practice Exemplified through an evidence-based culture, a focus on patient outcomes and equity of access to high quality care; an attitude of compassion and empathy.
Acting with integrity Exemplified through an ethical approach: doing what is right, not what is expedient; a forward thinking and collaborative attitude and a patient-centric focus.
Accountability Exemplified though strong leadership that is accountable to members; patient engagement at professional and organisational levels.
Leadership Exemplified through a culture of leadership where we demonstrate outcomes.
01
ENGAGEMENT
Create an environment that delivers highly valued services to our members and encourages proactive involvement by our members in College activities.
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EDUCATION
Deliver best practice medical education programs to ensure our members are safe, competent and current.
02
04
CLINICAL EXCELLENCE
Lead the development and refinement of professional and practice standards in clinical radiology and radiation oncology.
ADVOCACY
Influence decision makers in order to support our members to provide quality outcomesdriven services to patients in a constantly changing environment.
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ORGANISATIONAL GOVERNANCE & SUSTAINABILITY Support effective governance and decision-making through our members and staff working together to grow the College’s capacity.
Features
Crystal Ball Gazing: Artificial Intelligence in Radiology In Thomas Freidman’s book “Thank you for being late”; John E Kelly III, IBM’s senior vice president for cognitive solutions is quoted to have said, “We live as human beings in a linear worldwhere distance, time and velocity are linear, but the growth of technology is on an exponential curve.” The only exponential pace we ever experience is the sudden deceleration of a car or say the taking off of an aeroplane but that is momentary and can yet make us a bit uncomfortable. Would you be willing to take a very long trip in that mode? Perhaps not! But, in terms of technological advancement, that is exactly the trip the human race is currently on. Stepping back in time, there is a famous anecdote connected with Michael Faraday’s discovery of electricity. In the days just following his discovery, Faraday was asked by a senior scientist; “Sir it is good that you can demonstrate the flow of electrons and call this phenomenon electricity…but pray, of what use is it?” To which Faraday replied “Sir, of what use is a new born baby?” And then the often quoted, Tom Watson the IBM Chairman in 1958 who said “I think there is a world market for about five personal computers”. Across ages but more so now, technology has proven to be a ‘dynamic, living, breathing, agile organism’ which defies entrapment in mundane terms like ‘predictability or probability’. No one has the crystal ball or the capacity to accurately read one when it comes to the future of technology. The last two decades have seen more advancement than perhaps the preceding century. We often talk of disruptive innovation but all major inventions have been essentially that - the ubiquitous smart phone and the internet being cases in point.
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Inside News
With any new discovery/invention there is an associated ‘hype curve’ in the initial days (peak of inflated expectations). Within two months of the discovery of X-rays in 1895, there was unbelievable enthusiasm and hope. It was even speculated that every home will have a cathode ray machine which will be able to see “through flesh and bones”. X-rays, of course found their rightful place in medicine eventually. More recently, the first Breast computer-aided detection (CAD) was released 20 years ago and still, there is no perfect mammography solution. Several commercially available artificial intelligence (AI) and CAD tools have shown promising results; however, a
“Is radiology on the verge of extinction to be taken over by computers churning out 300 CT reports every hour with 100 per cent accuracy?” wide variation exists in the sensitivity and positive predictive value. And some CAD systems actually increase the radiologists’ work by highlighting too many false positives. With the exciting promise that AI in radiology holds, huge capital is being invested and data mining from millions of scans in order to teach computers the ‘language’ of radiology is going on at a relentless pace. Despite the hype, what does AI mean for us a profession? Is radiology on the verge of extinction to be taken over by computers churning out 300 CT reports every hour with 100 per cent accuracy?
(something health care administrators would love!). Far from it actually. The biggest fallacy is the idea that radiologists are image readers only. First of all, there is interventional radiology and also ultrasound and fluoroscopy. Then there are other core functions of a radiologist including vetting of scans, suggesting appropriate imaging, protocoling, talking to the referrers about the significance of findings and further options for imaging and/ or management. Add to this the teaching of trainees, multi-disciplinary meetings, preparation for MDTs, audits, administration tasks and radiology education of other craft groups. These ‘non-countable’ activities are often as critical as reporting. Reporting alone accounts for about 60 per cent of the work of the average radiologist. A fact that is often ignored is that technology is expanding not only in the field of AI and Deep Machine Learning (DML) but also in imaging equipment per se MRI, CT, PET-CT etc are constantly evolving faster speeds, more computing power and newer software capable of producing astounding images at the click of a button. What MRI or CT will look like in 50 years’ time or what new imaging modalities will appear in the future - is really anybody’s guess. What cannot be overlooked is also the risk aspect. Imagine the insurance premiums required for say a coronary artery bypass graft (CABG) performed by a robot or an airline flying a pilotless aircraft! Similarly in radiology will computers get sued for a wrong diagnosis or the software writer? Humans will continue to remain decision makers and will bear ultimate responsibility.
Features
Looking at AI in general, it is estimated that full automation of all human labour will occur in about 125 years. The caveat being that technology often delivers ‘under time’. Google’s DeepMind came up with the necessary tech in two years rather than the predicted 12 years. However, whatever the capacity of super computers in terms of computing powers, humans are inherently different in design from computers. Core human elements include creativity, imagination, intuition as well as building and maintaining complex human relationships. These attributes are not easy to be incorporated into computers. What is likely is that computers will take over mundane repetitive tasks. The next few decades will therefore see, not
unemployment, but redeployment of humans into more creative pursuits.
telescopes can see far better than but do not replace astronomers.
Medicine is often compared with the aviation industry. Aeroplane autopilot has been around since 1912 and now it is mandated on all aircrafts with more than 20 seats. The industry is however currently wanting more and not less pilots. With myriad systems in place to avoid collision, navigate and land/take off in bad weather as well as improved air traffic control, it is the combination of man and machine working together which has led to this enviable safety profile for aviation. With long haul travel becoming ‘the norm’ rather than the exception the cockpit has more pilots that ever before. Auto-pilot has not replaced pilots! In a similar vein,
There is a similar crisis in radiology globally. The United States has around 35,000 radiologists for its 327 million population. Australia has about 2,200 for 23 million people. The vast majority of triage and treatment pathways now involve radiology. Nearly 95 per cent of patients entering a hospital will have some form of medical imaging. Scanners are becoming faster and more sophisticated while population (especially the aged) is increasing.
continued over...
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Features
Radiology is able to offer far more in terms of diagnosis as well as therapy. The demand for radiology can only escalate. What will however change significantly is the way radiologists work.
focusing on and trying to deal with lifethreatening injuries, it is easy to overlook a small 8 mm lung nodule, which may turn into cancer a few years down the line. That is where AI will be of use!
Even in terms of diagnosis there are the common ones which AI could eventually ‘predict’ (say picking up haemorrhage on CT Brain), however there is a long list of uncommon but really important diagnoses that cannot be missed. Often the referring physicians rely on us to guide further imaging and management and we are able to provide guidance not only because of our training in pattern recognition but also our ability to synthesise all facts and draw on our experience to come up with a reasonable recommendation. This collective almost becomes a ‘sixth sense or intuition’. Medicine, from the time of Hippocrates, to the current day and age, remains ‘an art and science’!
The other concept is swarm AI. We often seek an opinion from our colleagues on scans which we are not sure about. With swarm AI, the images can be beamed across the world to experts in the field who can then give their collective opinion, thereby improving patient outcomes.
Noriko Arai – a University of Tokyo AI researcher says so eloquently, “Modern AI does not read or understand, it only disguises as if it does”. Computers are brilliant with search and calculations, but with all their amazing abilities they cannot understand. Where AI will be an aid to us will be in search and alert functions. Reformats and volume rendered images will be presented to us readily for reporting. Reporting will involve fewer clicks, hanging protocols will be easily customisable and labelling vertebrae and measuring lymph nodes for instance will be automated. AI may be able to analyse biochemistry, optimise workflow, improve speech recognition, perhaps create a structured pre-analysed preliminary report and present results to referring physicians quickly and efficiently. AI can also help us with ‘data deluge’. Multi-trauma patients generate a few thousand cross sectional images. While we are
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Inside News
There are other significant challenges which the profession faces coming from left field other disciplines getting trained in core ‘radiology’ skills neuro-intervention, cardiac imaging, radiographer reporting of plain films etc. What we as radiologists should be doing is to make a concerted effort to break silos and get out of the ‘dark reporting rooms’. There is a need to participate whole heartedly in the patient journey where needed in a timely manner- using our skills and judgement to influence and effect better outcomes. All of us should make it our mission to create awareness in the community about our role in patient care. AI will compliment or even enhance radiologists, NOT replace them (at least not until ALL ‘ologies’ and indeed all human jobs are replaced). Dr Rajiv Rattan Clinical Director, NSW Health Concillor, Faculty of Clinical Radiology Branch Education Officer, NSW Branch of RANZCR
Further reading Bradley Erickson: The Future of Radiology and Artificial Intelligence Hugh Harvey: Why AI will not replace Radiologists Greg Freiherr: Artificial Intelligence may hold the key to Radiology’s future Thomas H. Davenport and Keith J. Dreyer: AI will change Radiology but it won’t replace Radiologists Dave Pearson: Artificial Intelligence in Radiology: The Game Changer on everyone’s mind Michael Recht and R. Nick Bryan: Artificial Intelligence: Threat or Boon to Radiologists Sanjay Gandhi: The role of computer-assisted detection (CAD), artificial intelligence and machine learning in the medical imaging data overload problem: Current practice, limitations and new developments, http:// bigthink.com/paul-ratner/hereswhen-machines-will-take-yourjob-predict-ai-gurus
Features
Interpretation and Interpretability in the age of Artificial Intelligence What is Artificial Intelligence? Machine learning, sometimes referred to in the media as artificial intelligence (AI), has recently entered the radiological lexicon, with many wondering about its implications for the role of the radiologist in the near future. Specifically relevant to diagnostic radiology are the family of AI models known as convolutional neural networks. Fueled by a rise in digital data and parallel processing capabilities, these convolutional neural network-based models re-entered the computer vision scene to dramatic effect in 2012 when they beat top five error rates from traditional computer vision approaches by an incredible 10 per cent. (Krizhevsky et al. 2017) Since then, their accuracy in processing ‘natural’ imagery have led to their adoption in many fields, often outperforming the state-of-the-art. As the field is still young, technical experimentation far outpaces theoretical underpinnings, and much of what features neural networks learn or how they learn them remains an open question. In fact, leading researchers have difficulty agreeing on what questions to ask—with some preferring to focus upon the accuracy while others hoping to answer more fundamental questions pertaining to the interpretability of these models.
aided diagnosis models is still unclear, one thing is certain—these models are here to stay. As radiologists, we are likely to be the first users of such models and our approach to these models will shape their development for years to come. We must ask of these models that they not only be accurate, but also present interpretable explanations for each study they process. Some in the machine learning community argue that only the final accuracy of the model matters, and that in our day to day lives we seldom question the interpretability of human actions. Others argue that inherent trade-offs occur between accuracy and interpretability, and that we should instead focus on ensuring that models optimise the correct objective. (Weinberger 2018)
What Next?
However, in medicine and radiology, there are several flaws in this argument. In day to day life, the question of interpretability seldom arises as most tasks can be completed with near perfect accuracy. For instance, recognising a stop sign on the road can almost always be achieved from a single image of the driver’s view or a series of such images. In medicine, tasks that can be solved with such accuracy are far and few between. To use the formal definition—the mutual information between the inputs and outputs of a medical task is far lower than day to day tasks.
Many parallels can be drawn between the image classification tasks that convolutional neural networks excel at and the radiological interpretation of images. Companies and researchers scramble to translate daily discoveries into production-ready systems. While the final form of AI powered computer
Without providing explanations for each prediction, it is easy for hidden biases to creep into models. One non-medical example of such a bias can be found in the ‘Nature Conservancy Fisheries Monitoring’ challenge, which aimed to predict the fish species caught by camera images. (Shperber 2017) Naive
models trained on the public challenge data appeared to reach near perfect accuracy, only to fail on the hidden test data, revealing that these models were instead recognising the boats on which the fish were caught. In this challenge, the leakage or confounding variable could be identified from the vast accuracy discrepancy in the development and deployment phases. Due to the inherent uncertainty in medicine, it is likely that confounders such as the presence of pacemakers on chest X-rays when attempting to recognise heart failure, will go unnoticed without further explanation from the model. continued over...
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Features
Our Work We are developing a new approach leveraging recent advances in generative learning a form of unsupervised learning. In our approach, we train models capable of recreating realistic looking input images, and ask it to visualize input images predicted to have disease as though they were healthy, in effect creating a ‘Generative Visual Rationale’ (See figure 1.) that answers the question “How would this patient’s image need to change to appear without disease?” (Seah et al. 2018) This not only lets us discover hidden biases in our data and perform quality assurance, but potentially uncovers novel imaging features that could help advance our understanding of the disease. As a work in progress, newer and better techniques are sure to arise. Radiology is about the science of pattern recognition and the art of explanation and interpretation. As AI models become commonplace, radiologists must use these skills to participate in the development and application of these models, ensuring their accuracy and interpreting their outputs. Dr Jarrel Seah Radiology Registrar, Alfred Health, VIC
Figure 1. Generative Visual Rationales
References Krizhevsky, A., Sutskever, I. & Hinton, G.E., 2017. ImageNet classification with deep convolutional neural networks. Communications of the ACM, 60(6), pp.84–90. Seah, J. et al., 2018. Generative Visual Rationales. Available at: http://arxiv.org/abs/1804.04539 [Accessed May 5, 2018]. Shperber, G., 2017. What I’ve learned from Kaggle’s fisheries competition. Medium. Available at: https://medium.com/@gidishperber/what-ive-learned-from-kaggle-sfisheries-competition-92342f9ca779 [Accessed May 5, 2018]. Weinberger, D., 2018. Optimization over Explanation – Berkman Klein Center Collection – Medium. Medium. Available at: https://medium.com/berkman-klein-center/ optimization-over-explanation-41ecb135763d [Accessed May 5, 2018].
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Inside News
Advocacy
Targeting Cancer Spreads its Wings
Targeting Cancer thanks all those involved (runners and cheer squad!) for their efforts. The fun run helps raise funds for the ESTRO Cancer Foundation and also aims to highlight that it is possible to stay physically active and have an enjoyable life after receiving radiation therapy treatment for cancer.
ASMIRT Annual Meeting
Niluja Thjuru (left), Radiation Oncologist and RANZCR fellow at the UK’s Christie Hospital and Targeting Cancer Clinical Lead Sandra Turner fly the Targeting Cancer flag high at the recent ESTRO conference in Spain.
Estro37 Barcelona Targeting Cancer was well represented at the recent European Society for Radiotherapy and Oncology’s (ESTRO) 37th Annual and Scientific Conference in Barcelona. Presentations at the conference included ‘Patients as Partners in Advocacy, Innovation and Clinical Trials’ which showcased some of the work of the campaign and the value of partnering with patients and patient ambassadors in advocacy and innovation efforts. Targeting Cancer team clinicians were approached by many individual and group supporters, requesting advice and/or partnership status with the Campaign. Targeting Cancer has been heralded by the ESTRO Cancer Foundation/Marie Curie campaign and other international groups as a successful model for raising awareness of radiation therapy across the community.
One of the new Targeting Cancer videos was entered into the ‘Marie Curie 150 Years’ video competition, which aimed to further promote radiation therapy. The video was screened at the ESTRO conference. Check this out via www.targetingcancer.com.au There was a large social media presence for Targeting Cancer at the meeting and the campaign attracted many new followers. Another major positive outcome from the event was a link-up with the radiation oncology community at the Belfast Health and Social Care Trust. This saw representatives from the Trust promote the Targeting Cancer campaign and its key messages on social media outlets after the ESTRO conference. The team from Belfast plan to work with Targeting Cancer on more in-depth promotional activities in the future.
Targeting Cancer also had a presence at the recent Annual Scientific Meeting of Medical Imaging and Radiation Therapy (ASMIRT) held in Canberra. This event, Australia’s leading conference for radiation therapists, radiographers and medical radiation technologists, featured a plenary session run by Targeting Cancer entitled ‘Empathy in Action’. This highly praised panel session featured a radiation therapist, medical physicist, radiation oncologist and MRI radiographer and was hosted by Targeting Cancer campaign ambassador Julie McCrossin.
Social Media and Website Update The Targeting Cancer website attracted a total of almost 11,500 visits in March, which represented a 45 per cent monthon-month increase and a 140 per cent year-on-year increase. Social media plays a vital role in increasing campaign visibility, with the Campaign passing the 900,000 ‘likes’ barrier on Facebook recently. Next stop: one million!
continued over...
An international Targeting Cancer team from Australia, New Zealand, the UK, Spain and the US took part in the 5km ESTRO Super Fun. Even ASTRO President, Prof Brian Kavanagh, joined the team!
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Advocacy
The ESTRO fun run was a terrific chance to spread the Targeting Cancer campaign message!
Targeting Cancer is attempting to boost these numbers through the introduction and use of relevant and engaging content including video, patient stories and news articles. This aims to increase audience awareness of radiation therapy as a potential treatment option, promote the main aims of the campaign and spur other media interest.
Welcome Targeting Cancer welcomes Dr Phil Munro and Lisa Carstairs to their respective roles of Executive Officer and Senior Project Officer with the College’s Faculty of Radiation Oncology. Phil will oversee campaign activities through his role as Executive Officer, working with Clinical Lead A/Prof Sandra Turner, Dr Lucinda Morris (Chair of the Targeting Cancer Working and Advisory Group), other clinical team
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Inside News
members and College staff. Lisa will provide administrative and strategic support to Targeting Cancer, working with related personnel and stakeholders. Phil and Lisa have already made great contributions to the campaign.
How You Can Help If you haven’t yet visited the website or have not been there recently, visit www. targetingcancer.com.au or check out the Targeting Cancer Facebook page and/or follow us on Twitter. Remember, this is YOUR campaign and needs your support. Please share the links with your colleagues and patients. If you are interested in promoting Targeting Cancer at fundraising or other relevant events, or in running a GP oncology education evening, email lisa.carstairs@ranzcr.com who will be
happy to liaise with you. Targeting Cancer has many hard copy patient and GP resources as well as branded merchandise which can be used for promotional opportunities. Please use your imagination and help get the Targeting Cancer messages out there. Let us know of what it happening and we can also help promote your events and educational activities.
Please contact Lisa Carstairs on info@targetingcancer.com.au if you would like to contribute.
Advocacy
InsideRadiology is an Australasian resource on clinical radiology tests, procedures, and interventions, providing up-to-date information to health consumers and health professionals and improving doctor-patient communication. www.insideradiology.com.au
Traffic is continuously increasing on the website with in excess of 175,000 visitors in April alone.
Information on gadolinium contrast remains the top consumer and top health professional information pages. For health consumers, the top three pages (gadolinium contrast, transvaginal ultrasound, and coronary artery calcium scoring) account for a quarter of all traffic to the site.
up-to-date information for their patients without the extra administration.
Nuclear medicine is a high-interest area to both the health consumers and health professionals that visit InsideRadiology. The use of radiopharmaceuticals to diagnose and treat disease is an area of health that many visitors will only have limited, if any, knowledge of. Providing quality information to help inform the health consumer and their communications with both their referring doctor and nuclear medicine staff can assist with informed consent and help reduce anxiety before the procedure.
Referral to the website only accounts for two per cent of our total audience and 3.36 per cent of Australian visitors; however, it accounts for 25 per cent of total visitors from New Zealand. This demonstrates that direct linking currently is an extremely effective way to reach InsideRadiology target audience in New Zealand.
Nuclear medicine studies are frequently used for children, carers, including breast feeding mothers and occasionally pregnant patients, usually in the context of possible pulmonary thrombo-embolism. Visitors not only want to know what happens during the exam and how to prepare beforehand but they also wish to know how long the radiopharmaceutical remains in their system and how long they need to restrict close contact with others including children and even how long to interrupt breast feeding.
Nuclear medicine items are popular amongst both consumers and health professionals, with five of the top ten pages for each group being nuclearmedicine related.
Promote InsideRadiology to Patients and Colleagues
Subspecialty Focus: Nuclear Medicine
Supplementing your Online Presence InsideRadiology encourages its information partners, hospitals, and radiology practices to link directly to the InsideRadiology website so that staff and patients can access trusted information straight from their own website that can easily be printed into a fact sheet. InsideRadiology will continuously update the items as part of an ongoing review strategy so that radiology sites have
Promoting InsideRadiology in your professional networks.
any Recommending topics that could be
considered for inclusion.
Top Australian and New Zealand referring sites: • • • • •
Auckland Radiology Group Spectrum Radiology WA Diagnostic Imaging Pathways Healthdirect Australia Monash Health
Visitor Locations The majority of our target audience hail from large cities with eastern Australian capital cities responsible for over 65 per cent of Australian and New Zealand visitors, however there is still a steady stream of visitors from regional and remote locations including but not limited to Kalgoorlie, Broken Hill and Wanaka.
If you would like to propose a new test or procedure for the InsideRadiology website, please contact the InsideRadiology team.
Don’t forget to follow us on Twitter and Facebook (@InsideRadiology) and refer your patients to the consumer information on the InsideRadiology website. This helps us promote the resource to consumers.
Supplementing your hospital or practice resources using links to InsideRadiology.
Volunteering to assist with content.
Share the InsideRadiology Video.
Volume 14 No 3 I June 2018
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MRI CONTRAST MEDIA
MASTERCLASS 2018
WEBCAST COMING SOON
International Speaker:
DR YAIR SAFRIEL Neuroradiologist, Asst. Clinical Professor at University of South Florida Affiliated Programs and Radiology Associates of Clearwater.
Topic: Translating Advances in Brain Tumor Imaging to Clinical Practice
Liver MRI Speaker:
DR MARK GOODWIN
Interventional Radiologist Austin Health, Melbourne
Topic: How I approach difficult liver scans – with real case examples
Returning Masterclass 2017 Speaker:
CHRISTIAN LIENERTH
Head ol Application Service – Bayer Radiology.
Topics: • Liver Specific MRI Contrast Agent Optimal Workflow Protocols • 1.0M Gadolinium MRI Contrast Agent Optimal Workflow Protocols
Bayer Australia Ltd, ABN 22 000 138 714, 875 Pacific Highway, Pymble NSW 2073. ® Registered trademark of the Bayer Group, Germany. AU.GAD.00020.04.2018
Advocacy
Budget Outcome an Opportunity to Further Improve New Zealand Patient Care The $2.2 billion funding package for New Zealand’s District Health Boards (DHBs) included in the recent 2018 Budget announcement is an opportunity to further support and improve the country’s critical radiology and radiation oncology services, the college has said. The 2018 Budget, which was unveiled in May by New Zealand Minister of Finance, Grant Robertson, included a pledge by the New Zealand Government for $549 million each year over the next four years for the country’s DHBs as part of $2.2 million operational funding allocated by the New Zealand Government. College President Dr Lance Lawler said he hoped the money, part of a series of funding commitments towards Health
contained in the Budget, would help support the delivery of essential medical services for New Zealand patients – including radiation and radiation oncology. “We welcome the prioritising of health funding in this budget, in particular the extra funding to DHBs in New Zealand,” Dr Lawler said. “Radiology and radiation oncology play a vital role in modern healthcare, both in New Zealand and across the world. “There are some incredibly talented and dedicated professionals working in both areas delivering healthcare for New Zealand patients day-in, day-out.” Dr Lawler also said he hoped the funding would lead to new radiation oncology fellowship positions in
New Zealand. “Cancer is the biggest cause of death in New Zealand every year,” he said. “Radiation oncology plays a life-saving role treating various types of cancer, but its workforce faces challenges. It is therefore vital that money is provided for six new radiation oncology fellowships to meet growing demand in New Zealand. “Patient care and accessibility to treatment remains at the heart of everything RANZCR does. RANZCR will continue to advocate for greater funding to allow more New Zealand patients to benefit from and have access to radiation oncology services.” Details of the Budget can be found at www.budget.govt.nz
Continuing Our Strong Advocacy Work Utilisation rates for radiation oncology and ongoing funding issues for treatment provision were among the subjects discussed by College representatives and Shadow Labor Health Minister, Catherine King at a recent meeting. Future telehealth provision and the issue of indexation rebates for radiology were also among the issues discussed in the ‘Health Summit’, which was hosted by Oxley MP, Milton Dick. Other attendees at the summit, which took place in Brisbane, included representatives from the Royal Australian General College of Practitioners (RACGP), the Australian Diagnostic Imaging Association (ADIA) and representatives from local health organisations.
College President Dr Lance Lawler said April’s event was another important step to promote radiology and the efforts of radiologists. “This is another example of our College’s strong advocacy work in the area of political engagement,” Dr Lawler said. “This was a great opportunity to help once again highlight the important role radiology and radiation therapy plays in modern day healthcare.” “We were delighted RANZCR representatives could attend this event and thank everyone involved for their time and involvement.”
RANZCR Senior Advocacy Officer Kate Scott-Murphy (second left) held discussions at the recent ‘Health Summit’ in Brisbane with (from left) Queensland Labor MP for Jordan Charis Mullen, Shadow Health Minister Catherine King, Oxley Labor MP Milton Dick and Dr Brigid Hickey.
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Education
New Registrar Assessment Tool Pilots An Update from the Training and Assessment Reform RADIATION ONCOLOGY Contouring and Plan Evaluation (CPE) Assessment A new assessment tool has been designed to assess the developing competency of trainees in contouring and plan evaluation as they progress through Phase 1 and 2 of training. An important component of the tool is the ‘Entrustability Scale’, which reflects how ready the clinical supervisor feels the trainee is for independent clinical practice. It is expected for example, that in the early phases of training, a trainee will be operating at Level 1 or 2. However, towards the final years of training and particularly before sitting the Phase 2 exam, it is expected that a trainee would be assessed as meeting Level 3 or Level 4. A detailed rubric on what knowledge and behaviours are expected at each level has been developed to assist clinical supervisors in making this assessment. (see table on page 19) The overarching aim of this tool is to improve the quality of feedback between clinical supervisors and Directors of Training (DoTs), and provide guidance to trainees, in conjunction with other feedback elements. For trainees, the anticipated benefits are encouraging engagement, from early stages of training in the practical aspects of contouring, plan evaluation and ensuring full competence in these day-to-day activities of radiation oncology practice before sitting the Fellowship exam. The CPE Assessment tool is being piloted in a number of training sites across Australia and New Zealand. Thanks to all the training sites involved in the piloting of these exciting new initiatives. We will seek feedback from those training sites in July/August and make modifications as required. If you have any questions or require further information about this
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Inside News
Entrustability Scale
Description
Level 1
Major supervision required. Little understanding of underlying theory, supervisor recommends trainee able to function as an observer only. Early learner
Level 2
Supervision required in most areas of practice. Some understanding of theory, major corrections needed to deliver appropriate treatment
Level 3
Supervision required in some areas of practice. Coherent understanding of theory, corrections impact on proposed treatment
Level 4
Supervision not required. Comprehensive understanding of theory, corrections make no substantial impact to proposed treatment
N/A
Not applicable to this case
tool, or if your department is interested in becoming involved with future pilots, please contact Legend Lee, Educational Developer at the College on legend.lee@ ranzcr.com
CLINICAL RADIOLOGY Key Conditions Assessment The Competencies for Early Training program will capture the foundational clinical skills required by trainees in their first year. As part of this program, the College has launched a pilot Key Conditions Assessment, which trainees will complete prior to participating in an after-hours roster. Details of the new assessment tool will be provided in the next edition of Inside News. In the meantime, if you need any information about this assessment tool, please contact Julie Blanchard, Educational Developer at the College on julie.blanchard@ranzcr.com.
The Training and Assessment Reform Project has been progressing well for both specialities in the last few months. All 15 program working groups are reviewing the current curriculum to bring it up to date with current practice by determining learning outcomes for the program, evaluating existing assessments aligned to the program and developing the most appropriate assessment tools to measure performance against the learning outcomes. The College would like to thank all members who are involved in this project for the valuable time, commitment and expertise that has been provided.
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Education
Rating Scale Levels Contouring
Prescription and treatment planning
Plan Evaluation
1.Major • Very limited understanding of what constitutes GTV, CTV supervision required in all and PTV aspects of practice • Unable to name critical Little understanding OARs of underlying • Delineation of target theory, supervisor volumes and/or OAR recommends requires complete change / trainee able to major revision function as an • Very limited understanding observer only of image fusion or relevant
• Very limited ability to articulate options for modality/technique/energy
• Lacks organisation
Early learner
options
• Unable to articulate dose/fractionation schedule or articulates incorrect or unsafe dose/fractionation
• Very limited understanding of target coverage goals or OAR dose constraints
• Unable to justify choice of dose/ fractionation regimen
• Cannot identify need for revision
• Omits critical OARs, very limited understanding of safe OAR dose constraints
• Cannot explain changes needed to improve plan quality
• Very limited understanding of image guidance
2. Supervision • Some understanding of what • Articulates an option for a suitable required in most constitutes an appropriate modality/technique/energy, but limited ability to discuss alternative techniques aspects of practice GTV, CTV PTV Some understanding of theory, major corrections needed to deliver appropriate treatment
• Able to name some OARs • Errors in delineation require significant revision
• Articulates options for dose/fractionation schedule but makes incorrect selection, difficulty justifying choice
• Incorrect selection of image fusion options
• Articulates some OAR and dose constraints but misses some
3. Supervision • Largely correct understanding • Articulates pros/cons of various required in some of GTV, CTV, PTV modality/technique options with aspects of practice • All critical OARs identified appropriate selection but minor OARs missed • Selects appropriate dose/fractionation Coherent schedule with discussion of options understanding of • Delineation of target relevant to clinical scenario theory, corrections volumes and OARs impact on requires some revision • Critical OAR dose constraints specified proposed treatment • Understands image but uncertain about other OARs
4. No supervision • Detailed understanding required in all of rationale for all target aspects of practice volumes and OARs relevant to the plan Comprehensive • Delineation of all target understanding of volumes and organs at theory, corrections risk requires no or minimal make no substantial revision impact to proposed • Selects and justifies treatment appropriate image fusion
• Understands image guidance options but makes incomplete/inappropriate selection of strategy • Articulates pros/cons of various modality/technique options with appropriate selection
• Identifies faulty plan but unable to suggest improvements
• Structured plan analysis • Correct appraisal of target coverage and dose constraints • Identifies most important issues but misses minor issues • Identifies faulty plan and suggests some improvements in limited detail • Well-structured analysis • Thorough understanding of target volume coverage goals and OAR dose constraints
• Selects appropriate dose/fractionation schedule and able to justify choice applicable to clinical situation • Correctly identifies all relevant OARs and provides appropriate dose constraints • Outlines appropriate image guidance strategy
• Incomplete appraisal of target coverage and OAR dose constraints
• Despite prompting still misses some important issues
• Demonstrates some understanding of image guidance options
fusion options with some deficiencies
• Limited organisation
• Identifies all important issues and most minor issues • Recommends and describes plan improvements
Volume 14 No 3 I June 2018
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Education
RANZCR Courses and Workshops Melbourne Hosts a Successful ESTRO Basic Clinical Radiobiology Workshop In conjunction with the European Society of Radiotherapy and Oncology (ESTRO) the College hosted the Basic Clinical Radiobiology Course from 10–13 May at the Radisson on Flagstaff Gardens, Melbourne. Attended by radiation oncologists, medical physicists and radiation therapist professionals, the course immersed the 90 delegates in the world of radiobiology and emerged the other side with a greater appreciation of the past, present and future of this fascinating discipline. The four-day course was delivered by outstanding international faculty Prof Michael Joiner, Prof Wolfgang Dorr, Prof Karin Haustermans, Dr Bradly Wouters and local experts Dr Eric Hau and Dr Andrew Potter who educated the attendees on the underlying principles, latest developments and practical application of clinical radiobiology. The College would like to thank the very generous support to our Gold Sponsor AstraZeneca and Trade Sponsor Menarini, and to extend its thanks to the Faculty and College staff for their time to run the course.
Trainees Prepare for their Final Exams at the Phase 2 Exam Preparation Course The College hosted 25 trainees at the Phase 2 exam preparation course held from 18-19 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. A special thanks to Workshop Convenor, Dr Jonathon Tomazweski.
Day one provided trainees with an understanding of how exams are developed and marked, and the examiner’s perspective of what is required to pass the exams. Strategies were shared to help trainees optimise their performance, with guest speaker Dr Patsy Tremayne focusing on performance enhancement for accredited medical trainees to study and pass major exams often under difficult and stressful situations. Practice written questions were provided for trainees to undertake, with the answers workshopped with the examiner’s during the session. Day one ended with a cocktail reception, which was a good opportunity for trainees and facilitators to unwind. Day two’s program simulated sitting the viva exam with trainees allotted to streams and rotated through exam stations, each receiving feedback immediately afterwards. The College would like to extend its 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 2019. 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.
The Breast Imaging Boot Camp with Tomosynthesis course has had over 2,000 participants at the ACR Education Centre in Reston, Virginia and with this being the first time it will be held in Australia, this is a not to be missed education opportunity. Musculoskeletal MR of Commonly Imaged Joints 10–12 August 2018 Abdominal Imaging 13–15 August 2018 Breast Imaging Boot Camp with Tomosynthesis 17–19 August 2018 Each course offers training in an environment nearly identical to your daily practice: • Challenging cases and full DICOM data sets on state-of-the-art workstations • Unparalleled case-based training experience - punctuated with cuttingedge didactic lectures • Low faculty-to-attendee ratio ensures you get one-on-one time with the experts to help you master the difficult cases • And even guidance on optimising your reporting for improved efficiency All courses are in high demand and almost sold out. Register now to secure your place.
ACR Educational Courses Brought to you by RANZCR – Limited Places Available! The College in partnership with the American College of Radiology (ACR) will be offering educational courses on Musculoskeletal MR of Commonly Imaged Joints, Abdominal Imaging and Breast Imaging Boot Camp with Tomosynthesis at the Amora Hotel Jamison, Sydney.
For further information on each of the courses and to register visit www.ranzcr.com/whats-on/events or contact the RANZCR Conferences and Events Team on events@ranzcr. com or +61 2 9268 9777.
Volume 14 No 3 I June 2018
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exhibitors scientific Program international sPeakers WorkshoPs
RANZCR CANBERRA 2018
25 - 28 October National Convention Centre
6 9 t h A N N uA l S C i e N t i f i C M e e t i N g
netWorking events 1000+ delegates social Program RAdiAtioN oNCology KEyNotE SpEAKERS:
CliNiCAl RAdiology KEyNotE SpEAKERS:
Assoc. Professor Sean Collins
Dr Mary Roddie
Georgetown University Hospital, Lombardi Cancer Center, Washington, D.C, USA
Imperial College Healthcare NHS Trust, London, UK.
Dr Chris Crane
Professor Clyde Helms
Memorial Sloan, Kettering Cancer Center, New York, USA
University of New Mexico, Albuquerque, NM, USA
Assoc. Professor Heiko Enderling
Dr Claude Sirlin
H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida, USA
Professor and Vice-Chair (Translational Research), Dept. of Radiology; Director, Liver Imaging Group, UC, San Diego, USA
Professor Bruce Minsky
Professor Richard Gunderman
MD Anderson Cancer Center, Houston, Texas, USA
Indiana University, Indianapolis, Indiana, USA
Professor Birgitte Offersen Aarhus University, Copenhagen, Denmark
Early Bird Registration Now Open
www.ranzcr2018.com
Education
RANZCR 2018 ASM: Our Place in the Universe
New Initiatives and Ideas in place for Canberra Registrations are now open for RANZCR’s 69th Annual Scientific Meeting, with early bird savings available until 6 July. Canberra will be the centre of the universe for clinical radiology and radiation oncology specialists as they meet for the 2018 ASM to be held 25–28 October at the National Convention Centre, Canberra. This is the first time the College’s ASM has been held in the nation’s capital. This year’s committee is developing a program that will challenge thinking and deliver new initiatives to the ASM not previously seen. With so many politicians in Canberra for sitting week, the committee could not miss the opportunity to include a political forum within the program. Stay tuned as further plans develop around the forum and who will be joining us.
Planning is well underway with more than 260 abstracts submitted across clinical radiology and radiation oncology disciplines. Our thanks go to all abstract reviewers for their expertise and recommendations to help manage this process.
The Meeting Place for Brilliant Minds The clinical radiology and radiation oncology programs will have an impressive number of international speakers travelling to Canberra for the 2018 ASM, including Cyberknife expert on prostate radiotherapy and published widely, Dr Sean Collins from MedStar Georgetown University Hospital. Dr Collins joined Georgetown in 2006 after completing his residency in radiation oncology at MedStar Georgetown and the Lombardi Comprehensive Cancer Center and previously, a surgical internship at the
Hospital. In addition to his medical degree, he also holds a doctorate in Biological Chemistry, both from the University of Michigan’s Medical Scientist Training Program. His work has appeared in the American Journal of Clinical Oncology, Radiotherapy and Oncology, International Journal of Radiation Oncology Biology Physics, Cancer Journal and many other scientific publications. He also serves as a reviewer or editorial board member for numerous others, including the New England Journal of Medicine.
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Education
Canberra – On Show Complementing the diverse meeting program, that the social program will showcase Canberra and provides delegates with an opportunity to explore our nation’s Capital. Functions will be held at a number of venues including the National Gallery of Australia, the acclaimed Boat House Restaurant, the Australian War Memorial and the Australian Institute of Sport.
Also joining the Radiation Oncology International Faculty, Associate Professor of Integrated Mathematical Oncology and Radiation Oncology, Heiko Enderling from the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida. Dr Enderling graduated with an applied computer engineering degree from the University of Magdeburg, Germany in 2003 and completed his PhD in Mathematical Biology at the University of Dundee, Scotland in 2006. His work focusses on using pretreatment tumor growth dynamics to identify optimal radiation dose and dose fractionation for individual patients, and to evaluate tumor response data for adaptive therapy. Additionally, his work evaluates synergy of radiation with systemic agents including immunotherapy for improved patient responses and treatment outcomes. Two FALCON EduCase Contouring workshops will be held one on Breast Cancer facilitated by Professor Birgitte Offersen and the other being on Lung Cancer. These workshops are suitable
24
Inside News
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. The Clinical Radiology Committee has secured a number of additional international speakers to provide further insights into Our Place in the Universe including Dr Raju Sharma, Professor of Radiology at the All India Institute of Medical Sciences; and Dr Jadranka Stojanovska, Assistant Professor and Director, Cardiac MRI at Michigan Medicine, University of Michigan. These speakers will complement previously confirmed speakers Dr Claude Sirlin, Dr Mary Roddie, Professor Clyde Helms and Professor Richard Gunderman. Clinical Radiology Trainees will have an opportunity to participate in a mock MCQ, meet up close with some of our acclaimed international speakers and be presented with VIVA cases all to assist in helping prepare for exams.
Delegates will have the opportunity to experience a private tour of the Australian War Memorial before concluding in the iconic ANZAC Hall for the Annual Ceremony Reception on the Friday evening. The Gala Dinner sponsored by Canon Medical Systems will transport delegates to the Australian Institute of Sport for a night to acknowledge achievements and dance the night away. With so much on offer at the 2018 ASM, we encourage you to embrace the opportunity to travel to Canberra and be part of Our Place in the Universe.
Clinical Radiology
Advocacy at Work: Radiology Funding and MRI A Message from the Dean Prof John Slavotinek
Influencing Government
Budget 2018
I regularly reflect how far the College has come in terms of our advocacy efforts. While not every decision goes in our favour, our members are working tirelessly on various committees and advisory groups to ensure that the College’s voice for patients remain heard by government and stakeholders
I was very pleased to hear that in its recent Budget response Labor announced $80m funding to boost the number of eligible MRI machines. Approval of 20 new licences was also announced as part of an overall commitment to provide improved access to MRI scans. As well as providing ‘highlevel’ recognition of the critical role that imaging plays in modern healthcare, it underlines the issues the College raised in the recent senate inquiry regarding the availability and the under-utilisation of MRI and other diagnostic imaging procedures in Australia.
Much of our recent work continues to focus on the Medicare Benefits Schedule (MBS) and the listing of new items which are assessed by Medical Advisory Services Committee (MSAC), the government committee responsible for considering new services to be listed on the MBS. These include vital imaging services which we believe should be made accessible to patients such as Prostate, Breast and Liver MRI to name a few. The College continues to proactively engage with the government to both achieve our objectives and further position the College as the ‘go to’ organisation for clinical radiology issues. Recently we have seen both successes and setbacks in this area. While the latter are disappointing, it is important to note our successes outweigh the setbacks and that by engaging regularly with government, we will have greater influence in the future.
Whilst the above is welcome news, the College is willing to work with all sides of the political spectrum to support access to quality radiology services and achieve optimal healthcare for patients.
Prostate MRI Labor’s announcement was particularly uplifting given that the 2018 Federal budget had some positive gains but was also disappointing from the perspective of progress on indexation. One bright spot was the unveiling of funding for prostate MRI from 1 July 2018. The new Medicare rebate means that patients will have access to funding to help detect diagnose and monitor prostate cancer.
During the MSAC application process, the Federal Government considered whether providers of prostate MRI should require a formally registered credential under the auspices of a conjoint committee to access Medicare funding (similar to CTCA). The government was keen to ensure that MRI providers have the requisite skills, that patients receive high
“The College will continue to keep advocating for patients’ rights, where appropriate and to oppose unfair measures.” quality services and saw scan-specific credentials as a means to help ensure this. We were able to provide an alternative solution to government that provides guidance and support for radiologists to upskill for this MRI study without going down the road of a formal credential. The College’s Faculty of Clinical Radiology has therefore developed a Prostate MRI Professional Development Guideline to provide recommendations to members involved in the diagnosis and assessment of prostate cancers using MRI. The guideline which is linked to our CPD program is available for viewing at www.ranzcr.com/documents/4662prostate-mri-professional-developmentguideline/file continued over... Volume 14 No 3 I June 2018
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Clinical Radiology
Digital Breast Tomosynthesis (DBT) It was also pleasing to see confirmation in the recent Budget that Australian patients will be able to continue accessing DBT via a new but interim item under the Medicare Benefits Schedule. It has been common practice for DBT providers to claim the service under the Tomography item 60100 in the schedule, as advocated by the College. The Department of Health did not support this claiming practice. After further discussions, an agreement has now been reached and patients will be able to access DBT under a new interim item while an MSAC assessment process occurs.
New Zealand Our advocacy work is not limited to Australia, as a bi-national College we are also actively advocating for patients in New Zealand. In recent times we have been working with the Accident and Compensation Corporation (ACC) to roll out GP referral for MSK MRI. While the health system of each country differs, many of our policies are used to support advocacy in both countries.
ANZSPR 2018 Annual Scientific Meeting Registration is now open to attend the Australian and New Zealand Society for Paediatric Radiology Annual Scientific Meeting 2018. The meeting will be held in the heart of Queensland’s sunny capital, from 29–31 October, 2018 at Rydges South Bank Brisbane.
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Inside News
Recently College President Dr Lance Lawler and Mr Mark Nevin, Senior Executive Officer, gave a presentation to the New Zealand Parliament’s Health Select Committee on the registration of overseas-based doctors providing teleradiology services to patients in New Zealand. The College has been campaigning on this issue for some time now as the Medical Council of NZ has declared they don’t have the powers to register doctors based outside of New Zealand. The Health Select Committee was very receptive to the issues being raised by the College and our position was mirrored by other stakeholders presenting to the committee. This positive progress is a result of our ongoing advocacy efforts to ensure that patients in New Zealand receive safe and high quality medical services.
Taskforce recommendation that patients aged 50 and over become ineligible for a GP-referred MRI scan if they injure their knee was upheld. Instead these patients now have to undergo the cost and delay of seeing another specialist for further assessment before accessing knee MRI. This recommendation is not supported by contemporary clinical evidence and no sound clinical basis has been cited to support the recommendation. The College believes it is wholly unfair that thousands of Australians will now have to pay out of pocket for their scans or go through the costly and time-consuming process of seeing another specialist first. The College will continue to keep advocating for patients’ rights, where appropriate and to oppose unfair measures.
Knee MRI The College was deeply disappointed by the Federal Government’s decision to restrict GP referral for knee MRI for patients aged 50 and over. Despite correspondence under my name to the Chair of the MBS Review Taskforce, the
The scientific program will be conducted over 2 and a half days and will be presented by several renowned international and local speakers addressing the key focus topics of neuroradiology, musculoskeletal and chest/body imaging. South Bank Parklands is located on the Brisbane River and is the pulsing heart of Brisbane’s premier lifestyle and cultural precinct. It encompasses over 17 hectares of restaurants, cafes, parklands, markets, man-made beach, cultural and family friendly venues and is a short
If you have any questions or comments about this article, please contact Melissa Doyle, Executive Officer on fcr@ranzcr.com
walk or ride to the CBD, Kangaroo Point cliffs and Botanical Gardens. All forms of public transport including buses, trains, CityCat and cross-river ferries are at your doorstep making airport transfers hassle free. We are excited to welcome you to Brisbane in 2018. Book early to avoid disappointment. Visit www.anzspr2018.com to register. ANZSPR 2018 ASM Organising Committee
Clinical Radiology
Training Program News Chief Censor in Clinical Radiology
A/Prof Dinesh Varma
The College has a widely held view that the integration of digital, physical and biological technologies will enhance the role of radiologists and shape our human workforce of the future. The role of the Clinical Radiology Education and Training Committee and associated committees and working groups is to consider how artificial intelligence (AI) and deep learning software will impact training in the future. I am optimistic about the future of the clinical radiologist and intrigued about how the training program will be shaped in many years to come based on AI and emerging technologies. AI is currently very topical around the globe and our College is actively involved in discussions with other Colleges and organisations. Whilst there are concerns, scepticisms and uncertainty around its impact on the future of our profession, there is a general view that we have to be prepared to embrace it and utilise the technology to our advantage, such as reduction in errors, increased efficiency, improved triaging and the list goes on. As radiologists, we are best equipped to keep pace with advances in technology and AI is one of those. I would also like to share with you some updates on the current training program and the work being done.
Trainee Well-being The Tri-Nation International Medical Symposium was held in Sydney in March with a focus on doctor wellbeing. The Symposium incorporated a wide range of informative topics on the Health of doctors and doctors
in training, doctor’s health services, optimising medical student’s wellbeing and practical courses around returning to work and Basic Physician Training (BPTOK) presentations. I was pleased to be accompanied in my role as the Chief Censor by the Deputy Chief Censor, Dr Meredith Thomas, Chief Censor of Radiation Oncology, A/Prof Margot Lehman, ROTC Chair, Dr Nicholas Bucknell and College staff. The College is committed to the ongoing health and well-being of all our members and particularly our trainee members. I would like to encourage all members to familiarise themselves with the services available and refer your attention to the ‘Your Wellbeing’ page on the RANZCR website.
Unaccredited Site and RANZCR Trainees Unfortunately, I must use this opportunity to remind all trainees and members associated with training that the College does not support the practice of trainees undertaking employment outside of an accredited training site. A trainee reporting at an unaccredited site has far reaching consequences for the profession of clinical radiology as well as patient safety. Furthermore, it undermines the learning outcomes of the Curriculum to produce a broad skilled, safe general radiologist and the College’s mission statement. The College is required to meet the Standards for Assessment and Accreditation of Specialist Medical
Education Programs and Professional Development Programs by the Australian Medical Council (2015) particularly Standard 8 Implementing the Program – delivery of education and accreditation of training sites.
Specialist Training Program and Accreditation The Australian Department of Health’s (DoH) initiative, the Specialist Training Programme (STP) has recently had two major activities. An audit of current STP training sites to ensure compliance with the aims and objectives of the Departments updated STP Framework and an Expression of Interest (EOI) which was held to identify any training site seeking to increase training numbers or undertake training as a new site with the support of STP funds. The Expression of Interest is now closed. Any unaccredited sites that were approved and added to the STP Reserve Lists from the 2016 and 2018 EOI must contact accreditation@ranzcr.com to obtain their accreditation status and ensure the appropriate paperwork is complete. Furthermore, any applications to increase training numbers must also be provided to the accreditation team. As many of the branches are approaching the recruitment period I would encourage you to submit the paperwork earlier to minimise delays. For more information please contact Chloe Visser, Senior Project Officer STP on chloe.visser@ranzcr.com. continued over...
Volume 14 No 3 I June 2018
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Clinical Radiology
Director of Training (DoT) Workshop Finally, the recent Director of Training Workshop (DoT) in Melbourne covered a range of topics including remediation and supporting trainee progression. It was pleasing to see an increase in attendance at the first DoT workshop of the year and see many new Directors of Training undertaking the role. As part of the DoT Role Description and
the accreditation standards, a DoT is required to attend one workshop per calendar year. If you were unable to join us in Melbourne we look forward to seeing you at either the New Zealand ASM in Queenstown or Canberra ASM. If you have any feedback on DoT workshop content or would like to further information about the role, please contact radtaa@ranzcr.com
Visit www.ranzcr.com/trainees/ general/your-wellbeing to familiarise yourselves with the service and resoures available.
Ignoring Clinical Evidence to Save Money Despite there being no supporting clinical evidence, the federal government has decided to prevent GPs from referring anyone over 50 for a knee MRI. The decision, outlined in the budget, is further proof this government doesn’t value the vital role radiology plays in modern healthcare. It also shows we have a government more interested in listening to financial experts than clinical experts. Indeed, Professor Bruce Robinson who headed the MBS review confirmed to The Age newspaper the decision was not based on scientific evidence, and the money was needed for other parts of Medicare. This uninformed decision that dilutes Medicare for older Australians has been justifiably criticised not just by the Australian Diagnostic Imaging Association (ADIA), but also by RANZCR, the Australasian Musculoskeletal Imaging Group (AMSIG), the Council on the Aging (COTA) and the Consumer Health Forum (CHF).
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Inside News
To cut its expenses, the government will now be forcing older patients to either seek a specialist referral which will cost them money, time, and pain, or fund the entire cost of the MRI themselves. Its arbitrary, unfair nature is stark. Many older people on fixed-incomes will simply opt out of treatment, due to cost. It is a disincentive for older people to keep active and it further penalises patients in rural areas who already have to travel further and wait longer to see specialists. ADIA is now leading a national campaign to inform older Australians of how this decision unfairly discriminates against them. Radiology clinics will be able to help considerably by distributing information to patients, particularly those undergoing knee MRIs, and I urge all radiologists to take an active role. The budget also confirmed the government doesn’t plan to keep its promise to lift the 20-year freeze on rebates. With no
money set aside, the government will maintain its strategy of cost-shifting to patients. Again, we see the glaring gap between this government’s rhetoric and its actions. It said it would ‘make radiology more affordable’, yet it’s taken more money out of radiology. It said it’s ‘guaranteeing Medicare’ but it’s making arbitrary cuts. It must do better. Dr Siavash Es’haghi ADIA President
Clinical Radiology
Let’s Dispel the Myths Tackling the Gender Imbalance in Interventional Radiology Women are representing more of the radiology workforce than ever before, but there are still areas of medicine where obvious gender imbalances exist. This includes Interventional Radiology (IR) and Interventional Neuroradiology (INR), where women often represent the only female in their interventional teams. The College is actively working to change that imbalance. We recognise the importance of female representation and visibility in leadership positions, and the need to better understand the barriers and enablers for women to train and remain in interventional practice. In the coming months, members will see more activity in this space and are encouraged to watch out for surveys and other opportunities to help progress this important work. Inside News spoke to Auckland City Hospital’s Dr Brigid Connor, an experienced Interventional Radiologist, to discover more about this area and why women should consider following this area of radiology.
Why do you think there’s a shortage of women in interventional radiology?
Are there any extra challenges facing female interventional radiologists?
I don’t think there is a simple answer, but role models are important. If people see other people doing something, they believe they can do it. If there are not many women in IR, it becomes a vicious circle.
I think that IR, like any procedural specialty, comes with a potentially heavier call load. There’s also no question that women in general still take on more of the child-rearing and house-keeping responsibilities than men, so, like women in all busy jobs, this can have an impact, but it is not unique to IR. I don’t have children myself and have huge respect for women who have managed to combine having kids with a busy stressful job both in and outside medicine.
It’s also important to dispel some myths around IR. In particular, there’s the myth that women who are pregnant may suffer from radiation exposure working in IR. Really, radiation protection is important for everyone who works in this area. Victoria Marx made a great statement in a presentation of this issue at this year’s APSCVIR conference: “Imagine everyone is pregnant.” I think that’s a terrific philosophy. If a universal culture of safety exists, then everyone is kept safe – pregnant or otherwise.
Is the lack of women entering interventional radiology actually worth worrying about?
that some areas are viewed as ‘less important’ for women? We need to make sure women are represented in all areas [of healthcare]. It’s also important to note that this isn’t a ‘local’ problem. At this year’s APSCVIR there was a presentation from the Cardiovascular and Interventional Radiological Society of Europe which showed this is an issue in others parts of the world. The good news is that there were plenty of men in the audience agreeing there’s a problem that needs addressing. This is not something women can address alone. Everyone in IR needs to work together, but there is some onus on women to step forward and be seen. continued over...
In a word, yes! Like any profession, it’s important that society as a whole is represented. Why would you think
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Clinical Radiology
L-R; Brigid Connor, (Consultant Auckland Hospital), Farah Irani (Consultant IR Singapore Gen Hospital), M Victoria Marx (President SIR 2018 – 19), Susan Sedory (Exec Director SIR), Anne Roberts (Division Chief San Diego Health), Bella Huasen (IR Fellow Auckland City Hospital), Anna-Maria Belli (Past President BSIR, CIRSE).
Do you need to be a particular ‘type’ of person to suit working in interventional radiology? I don’t think so, though there are technical skills involved. Like any procedural speciality, you are using your hands, so you need proficiency in that area. You also need decent hand-eye coordination - it’s not like having a scalpel in your hand and cutting what’s in front of you. You are looking at a screen and using an image to guide your hands. I think you also need to be happy interacting with patients and other clinicians. There’s the old joke that doctors who don’t like dealing with patients go into radiology! In IR you are dealing with people all the time, so your ‘bedside manner’ has to be good.
Does interventional radiology have an ‘image problem’ among the professional overall? Well if it has, no-one’s told me! No, I don’t think so. It’s popular among radiologists who want to pursue subspecialist training. In terms of how it’s viewed outside radiology, that’s harder to say. I do think we suffer from a lack of profile. That’s something we need to work on.
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Inside News
What is the key to being a good interventional radiologist and what are some of the best things about working in interventional radiology? It’s having the mixture of technical proficiency with all of the other skills that make someone a good doctor - good communication, knowledge, empathy, diagnostic radiology skills and the ability to plan for unexpected outcomes, to list just a few. IR itself is a really interactive subspecialty. It’s ‘hands on’ and constantly changing and evolving, and there are many facets within IR. I think people used to talk about the three pillars of oncology – surgical, medical and radiation oncology – and now we talk about interventional oncology as well. It’s a really exciting time for this area.
What advice would you give anyone—male or female— interested in pursuing interventional radiology? Get as much exposure to it as you can. If you are a trainee radiologist and you see a patient having a procedure, ask if you can sit in on it. Likewise, for ward based house officers and registrars, go with your patients to IR if you are interested. Get that exposure so you can learn more and see if it’s right for you.
What’s your own training background? I did my house officer years in Tauranga and then moved to Auckland when I got on the radiology training scheme. At the end of my training I planned to head off overseas but I decided to stay on in NZ when my mother was diagnosed with cancer. Thankfully, she came through surgery and chemo like a star. I locumed my way around the UK, working from as far south as Gibraltar and north to the Western Hebrides. In between jobs, I travelled in Europe and Africa. The call of an interventional fellowship in Auckland - along with family - brought me home and I’ve stayed here since.
Clinical Radiology
What attracted you to pursue interventional radiology as a speciality? I had designs on surgery initially, like most of my class, and flirted with the idea of vascular surgery. The turning point was a radiologist who took us for teaching while I was a house surgeon in Tauranga. She was so knowledgeable and seemed to have this great role of sorting out what was going on in the ‘mystery patient’. I wasn’t sure about moving off the ward so would spend any spare moment I got as a second year hanging out in the department with her. Once I hit radiology and got a taste of interventional radiology, I felt I’d finally found my niche.
What are some of the most challenging aspects of practising modern day medicine? We just seem to keep getting busier and are expected to do more with less. I think the drive to save money has resulted in some great improvements and efficiencies, but I’m not sure there’s any ‘fat’ left in the system. Also, while the public are generally very grateful for the health system, I think expectations have changed as we’ve moved on from our historic paternalistic practise and that brings a new set of challenges. Patients (rightly) are now much more involved in their health and they no longer just accept that the doctor is always right. Sometimes that can be difficult when they are unwilling to accept the advice they are being given, and want something else despite evidence of no benefit, or perhaps harm. To be fair though, in secondary and tertiary medicine we are much more shielded from this than our colleagues in general practice and the emergency department.
What do you love about your job? I know it sounds clichéd, but I really do like helping people. The need to get informed consent for IR procedures means I get a chance to chat to people about their condition one-on-one and sometimes that’s the first chance they feel they’ve had to ask lots of questions. I need to give them some complex information while still making them feel at ease – I’m told my bedside manner’s not bad – and being able to do that in language anyone can understand is something I work hard at. Helping to ease someone’s symptoms or treat their cancer is great – and who doesn’t love a good pus drainage! My job is constantly changing with new technology and equipment. I would love to feel like more of an expert but the goal-posts keep shifting. There are relatively few women in IR and I’d like to be part of the story in terms of promoting the specialty amongst women.
Dr Brigid Connor
For all of the challenges of working in a cash-strapped system, we are at the front line. It’s great to know that you are part of a team that I think does really well when the chips are down.
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What’s in Issue 3? Medical Imaging Original Article: Added value of second biopsy target in screen‐detected widespread suspicious breast calcifications Corresponding author: Dr Glen Lo, Department of Radiology, Sir Charles Gairdner Hospital, Nedlands 6009, WA, Australia. Introduction: There is controversy on the optimal work‐up of screen‐detected widespread breast calcifications: whether to biopsy a single target or multiple targets. This study evaluates agreement between multiple biopsy targets within the same screen‐detected widespread (≥25 mm) breast calcification to determine if the second biopsy adds value. Methods: Retrospective observational study of women screened in a statewide general population risk breast cancer mammographic screening program from 2009 to 2016. Screening episodes recalled for widespread calcifications where further views indicated biopsy, and two or more separate target areas were sampled within the same lesion were included. Percentage agreement and Cohen’s Kappa were calculated. Results: A total of 293317 women were screened during 761124 separate episodes with recalls for widespread calcifications in 2355 episodes. In 171 women, a second target was biopsied within the same lesion. In 149 (86%) cases, the second target biopsy result agreed with the first biopsy (κ = 0.6768). Agreement increased with increasing mammography score (85%, 86% and 92% for score 3, 4 and 5 lesions). Same day multiple biopsied lesions were three times more likely to yield concordant results compared to post‐hoc second target biopsy cases. Conclusion: While a single target biopsy is sufficient to discriminate a benign vs. malignant diagnosis in most cases, in 14% there is added value in performing a second target biopsy. Biopsies performed prospectively are more likely to yield concordant results compared to post‐hoc second target biopsy cases, suggesting a single prospective biopsy may be sufficient when results are radiological‐pathological concordant; discordance still requires repeat sampling.
Medical Imaging Pictorial Essay: MRπ: Inside the Meat Pie Corresponding author: A/Prof John Massie, Department of Respiratory Medicine, Royal Children’s Hospital, Parkville 3052, VIC, Australia. Meat pies have been adopted as one of Australia’s favorite foods, and considered an icon by many. The hand‐held convenience of the pie has made them a culinary necessity while watching sport, also beloved in Australia. An enduring question about the meat pie is what exactly is inside. This can be difficult to ascertain by digital, lingual or oral exploration. In this study, we use MR imaging to study the contents of some of Australia’s best loved pies.
Radiation Oncology Original Article: Ischaemic heart disease following conventional and hypofractionated radiation treatment in a contemporary breast cancer series Corresponding author: Dr Melissa James, Canterbury Regional Cancer and Haematology Service, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand. Introduction: We report the incidence of ischaemic cardiac toxicity in a contemporary cohort of patients receiving conventional (CFRT) or hypofractionated (HFRT) radiation after surgery for early breast cancer and investigate the interplay of cardiac risk factors and fractionation. Methods: Included were patients receiving external beam radiation treatment from 2002 to 2006 at the Christchurch public hospital. Hospital coding databases, oncology databases and medical records were reviewed for baseline characteristics, treatment details and outcomes. The primary outcome was cardiac toxicity (including myocardial infarction, admission for cardiac chest pain, coronary angiogram positivity and ischaemic cardiac death). Kaplan‐Meier methods were used to derive ischaemic cardiac event free and overall survival. Predefined univariate and multivariate analysis was performed to investigate interaction with radiation fraction size, cardiac risk factors, age and side of cancer. Standardised mortality ratios were constructed. Results: Five hundred and one patients were identified, 220 treated with CFRT and 281 with HFRT. The median age was 56 and median follow‐up 10.33 years. The 10‐year breast cancer specific survival was 81.8% (95% CI %.78.1–85.0). The 10‐year freedom from cardiac death was 98.6% (95% CI 96.9–99.4). There were 27 post radiation cardiac events including 5 cardiac deaths and 19 cases of acute myocardial infarction. 265 (53%) had at least one cardiac risk factor. Twenty five of the 27 patients with a cardiac event had cardiac risk factors. On univariate and multivariate analysis, fractionation schedule was not significantly associated with a post radiation ischaemic event, however, there was a significant relationship with age and the presence of a cardiac risk factor. The standardised mortality ratio was 0.89 (95% CI: 0–3.13). Conclusions: Our study has shown a low rate of ischaemic cardiac disease for both CFRT and HFRT in women treated for breast cancer with no evidence of an effect with fractionation schedule. Coexisting cardiac risk factors are common in the population.
Medical Imaging - Radiation Oncology Original Article: Non‐Small Cell Lung Cancer Brain Metastasis Screening in the Era of PET‐CT Staging: Current Practice and Outcomes Corresponding author: Dr. Mauricio E Diaz, Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia. Introduction: Several clinical guidelines indicate that brain metastasis screening (BMS) should be guided by disease stage in non‐small cell lung cancer (NSCLC). We estimate that screening is performed more broadly in practice, and patients undergo brain imaging at considerable cost with questionable benefit. Our aim was to quantify the use and detection rate of BMS in a contemporary cohort staged with 18‐F‐Deoxyglucose‐Positron‐Emission‐Tomography (PET‐CT). Methods: We conducted a retrospective review of prospectively collected data from three major lung cancer referral centres in Brisbane between January 2011 and December 2015. Patients included had a new diagnosis of NSCLC and had undergone a PET‐CT to stage extra‐cranial disease. BMS was defined as dedicated brain imaging with contrast enhanced computed tomography (CE‐CT) or magnetic resonance (MR), in the absence of clinically apparent neurological deficits. Results: 1751 eligible cases were identified and of these 718 (41%) underwent BMS. The majority had CE‐CT imaging (n=703). Asymptomatic brain metastases (BM) were detected in 18 patients (2.5%). Twelve of these patients had concurrent non‐brain metastases. Only 6 patients (0.8%) had BM alone. The rate of detection increased with N‐stage (p=0.02) and overall stage (p<0.001). It was 0.5%, 1%, 1.6% and 7.3% for stage I, II, III and IV respectively. The overall screening rate increased with T‐stage (p=0.001), N‐Stage (p<0.001) and overall stage (p<0.001). Conclusions: NSCLC BMS practices remain at odds with published guidelines. The low number of occult BMs detected supports the existing international recommendations. Rationalising BMS would minimize the burden on patients and the health care system.
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!
Clinical Radiology
Clinical Radiologist Encounters the Not-So-Average Patient CT scans more commonly used on patients have helped conduct a ‘virtual dig’ and unearth secrets of an ancient Egyptian mystery. John Magnussen, Professor of Radiology at Sydney’s Macquarie University, has been assisting archaeologists from the Nicholson Museum at Sydney University discover more about human remains found in a 2,500-year-old Egyptian coffin that was previously thought to be empty. Prof Magnussen, who is a Diagnostic and Interventional Radiologist at Macquarie Medical Imaging, said it had been terrific to use CT scans in such an unusual and helpful way. Prof John Magnussen, who has helped unearth secrets of the 2.500-year-old Egyptian tomb.
Feet of the remains
“It’s been a wonderful counterpoint to the normal clinical scanning as part of ‘everyday’ duties of radiology,” he said. “It is wonderful that the tools we use on the living can be used to discover so about those who are long dead. It also shows that the same techniques we use in radiology and take for granted in modern
medicine are becoming more relevant in other areas.” The coffin had been stored at Sydney University for about 150 years and was initially thought by archaeologists to be empty. After the coffin and its contents were surface scanned to create 3D models, Prof Magnussen and colleagues at Macquarie University were asked to conduct CT scans to help detect any remains and to plan a possible ‘dig’. “We didn’t know if we were dealing with a pile of 2,000-year-old dirt or a mummy,” Prof Magnussen said. “When the scans showed there were two feet intact, it was amazing. There was a crowd of people looking at the scans and the atmosphere was electric. It was hard to hold back the excitement in the room – people were shouting for joy.”
continued over...
The sarcophagus which contained the mummy scanned by Professor John Magnussen and his team
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Clinical Radiology
3D reconstructions showing the contents of the sarcophagus.
As well as feet, ankle bones and a portion of the sacrum, the scans revealed other interesting details about the coffin’s occupant. “The body had been covered in a shawl made of thousands of ceramic beads which had fallen apart,” Prof Magnussen said. The coffin was filled with these beads. “We know this person was an adult because of the appearance of the feet and sacrum. We also believe that – because of the shawl – this person was possibly reasonably rich or at least from a high-ranking background. “Mummification was a common practise, but this would seem to be an important individual.” Hieroglyphics on the coffin’s exterior show it was made for a priestess, but the coffins don’t always hold the remains they were intended for. It’s also believed that tomb robbers had once opened the coffin in an attempt to loot jewels and other valuable artefacts, disturbing the bones. Further research on the remains is being carried out, together with translation efforts on the hieroglyphics to unearth
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Inside News
more details about the person. It is hoped a monograph outlining the entire project will be published in the coming year. Prof Magnussen completed a PHD in Bio-Medical Engineering and Nuclear Medicine and has worked at Sydney’s Prince Alfred Hospital and Macquarie University as well as in private practice during his 15-year career. He has been carrying out scans on antiquities for many years and is now preparing to work on other historical projects, including examining remains from the Neolithic period from Malta and pottery dating back to the Roman Empire. “This has been such an exciting project and it is far from over,” he said. “Radiology has helped bring me into wonderful areas. If I hadn’t followed this career path then I wouldn’t have the skill to offer an archaeological study like this. More than anything, I am lucky to work with a team who are open-minded and willing to try new things.” Prof John Magnussen Macquarie Medical Imaging
Feet of the remains
Clinical Radiology
Clinical Radiology Trainee Matters The Luddite Trainee As a trainee in medicine’s most tech forward specialty I need to be cognisant of how new technologies will shape my career. How will I stay relevant as a radiologist in the future? Particularly as image acquisition becomes more easily available and accessible, and image interpretation may become more automated. There seems little doubt that artificial intelligence (AI) will play a role in future diagnostic image interpretation. Currently, this technology is relatively ‘boutique’ in radiology and so not part of the training curriculum. This means it will be left to all of us practicing now to learn and engage with it in our own way. I am hoping I can find a way to achieve this and not become a Luddite. However, the Luddite rebellion of 1811 England gives us several lessons that we can learn today about our engagement with a technology that has the very real potential to change the way we practice. The Luddite rebellion was not the first and certainly not the last rebellion against new technologies (Elon Musk, tech entrepreneur, has famously said that AI is the greatest risk to humanity, which sounds a bit like a call to the barricades), but is probably the most famous. It involved textile workers and weavers protesting against the increasing mechanisation of the garment industry. This stemmed from laws being repealed in 1809 against mechanisation (which was occurring despite the laws). These laws dated back to the invention of the stocking frame in 1589, which lead Queen Elizabeth I to declare “I have too much love for my poor people who obtain their bread by the employment of knitting to give my money to forward an
invention that will tend to their ruin”. By contrast in 1812 laws were passed which would see you hanged for damaging a textile machine. Whilst the Luddites are remembered for destroying machines and factories and are now synonymous with those who oppose technological advancement, it is not actually the technology that they were protesting against. In essence their protest was about protecting their craft and the standards of their industry. Mechanisation meant that garments took less skill to make and were often of lower quality. In addition, workers were brought in to operate the machines who had not been properly apprenticed in the industry and so not trained to the same levels as the craftsman. This meant the wages of the Luddites were pushed lower and lead to the fear that the many hard years of learning their craft would be wasted. The Luddites’ demands centred around maintaining training standards to ensure the work was done properly and safely, maintaining the quality of garments and not being forced to produce substandard products, fair wages and working hours, and ensuring mechanisation did not replace more jobs than it created. These demands all seem quite reasonable and easily parallel with AI and radiology.
increased demand, thus increasing the labour output and creating employment to replace those that are lost. AI or some other technology may change my role as a radiologist in the future, but it will not happen overnight. There will likely be time to adapt and enjoy the challenge of our dynamic speciality. I may have to learn new skills different from traditional radiology, maybe to become the trainer of the AI, maybe to interpret AI outputs (and artefacts). Or, if part of my role becomes automated I may have more capacity to move further up the value adding curve, particularly as medicine continues to become more complex and more geared towards superspecialisation. Who knows what the future holds. Maybe radiologists will be the masters of medical AI! Until at least the Technological Singularity, after which we can put our feet up and watch the machines do all the work. Dr Anthony Cardin Chair, Clinical Radiology Trainees Committee
Overall the mechanisation of the textile industry created more jobs than it eliminated in the long run, and lead to the development of new industries and jobs. The term Luddite fallacy is used by economists in reference to the fear that technology will cause unemployment, but instead ultimately leads to lower cost of production and lower competitive prices, which in turn cause
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Clinical Radiology
Latest Clinical Workforce Census Report Released The 2016 Clinical Radiology Workforce Census Report: Australia has been released and is available for viewing on the College website. The report provides a snapshot of the working lives of radiologists and is based on data compiled as part of the four-year census undertaken by the College. It showed that in 2016, the average radiologist worked approximately 46 hours per week, an increase from 42 hours per week in the 2012 census and significantly above the 2016 Australian national working week average of 34.6 hours. Figures in the census report reveal an increase in the average retirement age of radiologists over the
last 20 years. The average retirement age for radiologists between the period 2013 and 2016 was 71.1, compared with 66.4 between 1993 and 1997. “These figures are a testament to the hard work and dedication of radiologists towards their chosen career,” College President Dr Lance Lawler said. “Radiologists are not only staying in the profession longer, they are working longer hours to ensure patients receive the care they deserve.” The report showed that clinical activities made up 89 per cent of a radiologist’s work activity. The remainder of their time is spent on teaching, research and administration. A total of 67 per cent of work activity is spent reporting on medical images. The report also showed that in 2016, there were 2,013 practising radiologists, a 14 per cent increase since 2012 and a 75 per cent increase since 2000. Twothirds of practising radiologists were Australian medical graduates and nearly three-quarters undertook their specialist training in Australia.
Cardiac CT Training 2018
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Participants eligible to claim 117.5 RANZCR CPD points for the 5 day course and 67 RANZCR CPD points for the recertification course. Maximum allowable course based live and library cases for ANZ credentialing.
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Clinician led teaching by high volume operators.
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State of the art low dose, High Definition imaging.
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Unrivalled venue and catering optimises the learning experience.
5 Day Level A Course 14th - 18th June 2018 3 Day Refresher Course 16th - 18th June 2018 AICC ULAR CT
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The report can be viewed at www.ranzcr.com/search/2016clinical-radiology-workforcecensus-report-australia
Melbourne International Joint Breast Congress 4th World Congress on Controversies in Breast Cancer (CoBrCa)
Breast Surgeons of Australia & New Zealand (BreastSurgANZ)
Melbourne, Australia • October 11-13, 2018 Key Dates Abstract Submission Deadline July 10, 2018
Early Fee Deadline August 15, 2018
Radiation Oncology Experts and Program Highlights Reshma Jagsi, USA Professor, Deputy Chair, and Residency Program Director in the Department of Radiation Oncology and Director of the Center for Bioethics and Social Sciences in Medicine at the University of Michigan.
Lori Pierce, USA Professor with tenure of Radiation Oncology at the University of Michigan School of Medicine and Vice Provost for Academic and Faculty Affairs of the university.
ASC
Content overview: This workshop promises to be an excellent opportunity with world-renowned international radiation oncologists in breast radiotherapy teaming up with local radiation oncologists and drilling down into three controversial topics in breast cancer management. 1. Current controversies of regional nodal management in early and advanced breast cancers 2. Technical challenges and recent radiotherapy trends to reduce radiotherapy long term consequences, with the focus on cadiotoxicity 3. Overview of the options, timing and potential complications of radiotherapy and breast reconstruction Target audience: Trainees and practicing clinicians who manage patients with breast cancer in multidisciplinary settings.
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This component of the training program has a focus on rural and private settings and illustrates the College’s ongoing commitment to growing the workforce in areas where it is needed most.
Radiation Oncology Workshop
2018 COURSE DATES:
For more information and online registration log on to: www.aicct.com.au or contact us at: info@aicct.com.au
In addition, as part of the Commonwealth Department of Healthsupported Specialist Training Program (STP), the College is working towards almost doubling this subset of trainee radiologists and radiation oncologists working in Australia over the next three years from 42 to 82.
Australasian Society for Breast Disease (ASBD)
We go beyond simply meeting training requirements: l
There were a total number of 454 trainees in the Australian arm of the RANZCR Radiodiagnosis Training Program at the time of the 2016 census, compared with 404 in the 2012 survey. An average of 85 trainees enter the specialist workforce every year.
D TE OF CAR
www.melbournebreast2018.org
info@melbournebreast2018.org
Clinical Radiology
Leadership in Telehealth
Mark’s presentation outlined the process by which the standards were developed, how the working group met professional regulation challenges and how the standards can be used to enhance patient care. “The standards are about ensuring sustainable care is delivered while establishing defined parameters to guide this new process,” Mark said.
Senior Executive Officer Mark Nevin discussed leadership in the telehealth space at the recent Australian Telehealth Conference, organised by HISA.
The College’s prime role in fostering leadership in the telehealth space and demonstrating the way forward for other healthcare organisations were among the main talking points from a presentation by Senior Executive Officer Mark Nevin at the prestigious Australian Telehealth Conference. The recent event, convened by the Health Informatics Society Australia (HISA), featured presentations from representatives of major health organisations from across Australia and overseas and explored the evolving world of technological developments and virtual care. Mark’s presentation, entitled Fostering Sustainability in Telehealth, described how the College had converted telehealth policies into a coherent and practical set of standards for the benefit of professionals and patients alike. “I wanted to share how RANZCR’s Teleradiology Standards set the benchmark to ensure that clear quality
parameters are in place for the delivery of patient care delivered from sites using teleradiology,” Mark said. “The standards have formed a coherent set of rules for the administering and implementation of telehealth services.
“RANZCR has shown foresight and a proactive stance to introduce these standards. Other organisations in the healthcare sphere can learn valuable lessons from the way we have embraced this facet of patient care.” Other speakers at the two-day conference, which took place in Sydney in April, included Australian Digital Health Agency CEO Tim Kelsey and Professor Sabe Sabesan, Director of Oncology at the Townsville Cancer Centre.
For more information, visit www.hisa.org.au
“RANZCR has demonstrated proactive leadership in this area and a willingness to embrace telehealth that supports patient access when there is no clinical radiologist available on site.” In December last year, the College issued a new set of standards governing teleradiology, encapsulating 13 key principles covering issues including image quality, safety, registration and licensing of reporting practitioners and record-keeping procedures. The standards set the benchmark for this maturing subsection of practice and to ensure that clear quality parameters are in place for patient care delivered from sites using teleradiology.
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Radiation Oncology
Advocacy, Funding and Informed Decision Making in Prostate Cancer A Message from the Dean A/Prof Dion Forstner
Training Responsibilities Our trainees are the future of your profession and your College. It is inspiring to see the high calibre of trainees we have and to see them progress from being an applicant for a training position through to awarding of fellowship and then transition into independent specialist practice. More than ever we are aware of the challenges they face and the need to ensure their wellbeing. Both informal and formal feedback suggests the vast majority receive outstanding training and are provided with a supportive training environment. It is disappointing to be contacted by trainees who feel unsupported in their training environment and especially where they have a sense of no one to turn to. The same applies to the Directors of Training (DoTs) who have one of the most challenging roles within a department, they need to be well supported. The workplace culture needs to ensure there is strong pastoral care of the trainee and in turn such support for DoTs. Only this way will we have the reputation for training that will attract the best to be our next generation of radiation oncologists. If you see a trainee or colleague struggling, please offer support.
For those of us where our training experience was long ago we must not forget contemporary medical specialist training is far removed from what many of us experienced a decade or more ago and we must not model today’s training on that. I am aware of busy centres where the service focus remains the highest priority and the balance of service with training is concerning—I would hope that in those departments there is a strong push to improve resources to provide
Advocating for Radiation Oncology
“Our trainees are the future of your profession and your College.”
The recent Australian Budget saw a win for cancer patients, prostate MRI for cancer detection is being funded after making its way successfully through the MSAC process. We also secured a win to ensure that patients continue to have access to digital breast tomosynthesis. The Government tried to cut access to that through the MBS Review, which we opposed for two years and they relented in the end to give interim funding as it went through MSAC.
the appropriate balance. The training site accreditation standards (www. ranzcr.com/search/radiation-oncologyaccreditation-standards-and-criteriafor-training-networks-and-sites) set out the requirements. RANZCR has a responsibility to trainees that we will not compromise on. We have standards set by the AMC we must meet. Each training clinical supervisor must accept the responsibility that comes with having trainees.
Advocacy efforts remain a high priority for the Faculty. Representatives from the sector, including FRO, have now held two successful Roundtable meetings with senior Commonwealth Department of Health officials. The President, Dr Lance Lawler, and CEO, Ms Natalia Vukolova, met with the New Zealand Minister for Health, Dr David Clark, in April. Amongst the topics discussed was the New Zealand radiation oncology workforce.
Earlier this year, the Federal Health Minister established a Ministerial Advisory Committee on Out-of-Pocket Costs to address concerns from the community about this issue. The committee is consulting with specialties represented on the committee, as well as others that are not—including ours. This is an opportunity to ensure patients have access to transparent medical costs. continued over...
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Radiation Oncology
Informed Decision Making in Prostate Cancer The Faculty has developed a position statement that supports all men approaching active treatment for prostate cancer to be fully informed of their treatment options—including men speaking with both urologists and radiation oncologists. Members and stakeholders were given the opportunity to provide their feedback on this. This statement was formally launched on 12 June, coinciding with Men’s Health Week. I request members to take full advantage of opportunities that arise to promote this statement and try and improve the situation for prostate cancer patients in New Zealand and Australia.
Funding for Radiation Oncology The final report from the Oncology Clinical Committee (OCC) of the MBS Review was released for targeted consultation at the end of May. The Faculty is collating feedback received from members and, at the time of writing, starting to draft a response to go back to the Department. Given the importance on any proposed changes on the future delivery of radiation therapy, we will be arguing for piloting/ modelling of these to ensure there are no unintended adverse consequences for either the government, the sector, or patients. In addition to the work of the OCC, the Urology Clinical Committee (UCC) has now been formed and is meeting to review items around prostate cancer. The Faculty, along with the Prostate Cancer Foundation of Australia (PCFA) and Urological Society of Australia and New Zealand (USANZ) were invited to speak at the first face-to-face UCC meeting in April.
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Quality Practice Since the launch of the Radiation Oncology Practice Standards (ROPS) in 2011, we have received many positive comments from members, colleagues, and bureaucrats. The Tripartite Committee have recently reviewed these and in March, they were republished as Part A: Fundamentals and Part B: Guidelines (see article on page 45). These documents have been designed to be read in conjunction with each other. The challenge that we now face is in advocating for mandatory compliance with the ROPS. Mandatory compliance will ensure that all radiation therapy facilities offer quality services to our patients. Until this occurs, I encourage all facilities to undertake the self-audit tool (found in Part A of the ROPS).
Patient Charter The Faculty has also produced a Radiation Oncology Patient Charter. Developed by the Canadian Association of Radiation Oncology (CARO), the patient charter was modified for local context and has been endorsed by our key partner organisations—NZIMRT, ASMIRT, ACPSEM and CNSA. The charter, available from www.ranzcr.com/ search/radiation-oncology-patientcharter, should be clearly visible in all facilities’ waiting rooms.
Staffing In the last Inside News, I noted that we had seen our key College staff members move on to new and exciting roles. I am now pleased to report that we are again fully supported and welcome Mark Nevin (Senior Executive Officer, Faculties of Clinical Radiology and Radiation Oncology), Philip Munro (Executive Officer), and Lisa Carstairs (Senior Projects Officer).
If you have any questions or comments about this article please contact Philip Munro, Executive Officer, on faculty@ranzcr.com
Radiation Oncology
Training Program News Chief Censor in Clinical Radiology
A/Prof Margot Lehman
Artificial intelligence (AI) has the potential to revolutionise every area of our life. Healthcare will not be immune. Many pundits believe we are in the midst of the fourth industrial revolution. The media is full of dire predictions regarding the impact of AI on jobs traditionally undertaken by humans. So, does this mean that radiation oncologists will be replaced by robots?
Therefore, as a profession, we should not feel threatened by AI but rather embrace it. We need to understand what AI can do for us and work with the vendors to ensure we drive technological advancements for the betterment of our profession and out patients. Ultimately, complex algorithms driving high powered hardware will enhance our performance of core skills.
This seems unlikely. The occupations most at risk from AI have a significant component of repetitive activity that can be replaced by automation. The work of a radiation oncologist involves a high volume of daily complex human to human interactions which cannot be replaced by an algorithm. However, in the diagnostic, patient management and technical aspects of our profession, AI has the potential to enhance our work, improve efficiency and lead to better patient outcomes.
In the final paragraphs, I would like to highlight some of the work occurring in the educational sphere.
Some examples of how AI can and is being employed include: the use of knowledge-based auto contouring to aid in contour delineation; and the use of big data analytics and machine learning to create high quality evidence and predictive models that will assist in decision-making. In the latter area, radiation oncology is uniquely positioned as the quality of data (as recorded in oncology information and record and verify systems) is far better than in many other fields of medicine. IBM has already created a special program for oncologists to aid in decision making as part of their IBM Watson question and answer computing system.
SMART Workshop Another successful workshop was held in conjunction with the TROG meeting in Hobart. I would particularly like to thank Trang Pham for convening this workshop and to extend my thanks to all the facilitators and invited speakers whose enthusiastic contribution continue to make these workshops a success. 1. Oncology Sciences Workshops An initiative of the Oncology Sciences working group, led by Dr Matthew Seel, is the development and introduction of network based oncology sciences teaching workshops. The aim of these highly interactive workshops is to compliment topics covered in the clinical assignments. The plan is for the workshops to be delivered at the network level using material developed by the Oncology sciences working group. Three workshops are planned over a two year cycle, along with the existing Foundation
and Phase 1 teaching course. Trial workshops were held for the New Zealand network and for the southern zone NSW Network in February. The teaching faculty included radiation oncologists, medical physicists and radiologists and the format involved question and feedback sessions (using pre-prepared questions) alongside didactic sessions. There was plenty of opportunity for discussion and it was very gratifying to see the engagement of the trainee. To date the feedback has been overwhelmingly positive. The workshops will be rolled out in 2019. Further information will be provided at the Training Network Director Forum (TNDF) and Director of Training (DoT) meeting. 2. Anatomy, Contouring, Plan Evaluation Tool. This tool has been developed to facilitate trainee involvement in the core activities of our specialty, namely contouring and plan evaluation, from an early stage of training. This tool is being piloted in a number of centres throughout Australia and New Zealand with further information and feedback being presented at the TNDF and DoT meetings.
continued over...
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Radiation Oncology
Examinations Series 1 of the Phase 2 Examination cycle was held, for the first time, at Westmead Blacktown. I would like to thank A/Prof Verity Ahern for allowing us to use the clinic space, Dr Trang Pham for on-site co-ordination and all Westmead Radiation Oncology clinicians who assisted by providing excellent cases.
Lung News The Faculty of Radiation Oncology Lung Interest Cooperative (FROLIC) held a successful workshop in conjunction with the Australian Lung Cancer Conference (ALCC). The workshop was oversubscribed and attended by other lung cancer clinicians as well. We had two international speakers. Dr Jose Belderbos spoke about the future of radiation therapy treatment for Stage III non-small cell lung cancer (NSCLC) and A/Prof Justin Gainor summarised what every radiation oncologist needs to know about immunotherapy for NSCLC. Dr Prunella Blinman spoke on the field of geriatric oncology and the screening tools available for use in this population. The workshop concluded with a discussion on challenging cases and it was beneficial to get input from nonradiation oncologists in the audience. The FROLIC executive will decide on whether to continue this liaison with the ALCC.
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Inside News
I would also like to acknowledge Dr Carminia Lapuz who, along with Dr Claire Hardie, is leading the Phase 1 examination series, following Dr Marcus Dreosti stepping down from this role. I would particularly like to thank Marcus for his very significant contribution over many years.
FROLIC will hold a Lung Contouring Workshop on Friday 26 October, as part of the College ASM in Canberra. This being convened by Dr Eric Hau and Dr Jeremiah De Leon. This will involve delineation of volumes before and during the conference with input from expert speakers. We especially encourage trainees to attend this event.
Prof Shalini Vinod has stepped down as Chair of FROLIC and handed over the baton across the Tasman to Dr Louis Lao. Please contact us if you have any ideas of what we should be doing in regards to promoting best practice in the radiotherapy treatment of lung cancer and other thoracic malignancies.
Radiation Oncology
Radiation Oncology Trainee Matters
This Inside News edition highlights the increasing importance of technology and artificial intelligence (AI) in enhancing our ability to care for our patients. Training in radiation oncology is demanding as we care for patients who are facing a lifethreatening cancer diagnosis. We provide a highly technical treatment in which medical errors can lead to devastating consequences. AI will enable us to improve outcomes by providing more accurate and effective local treatments with significantly less toxicity. In many centres throughout the world, AI is already improving treatments for our patients through knowledge based planning. Expansion of AI into our daily practice has the potential to significantly reduce the risk of medical errors such as the geographic miss of tumours or deviations from clinical protocols through decision support tools. It will reduce the time trainees will spend on easily automated tasks such as administration. This will enable us to increase the time spent with our patients, improve interactions with our colleagues and enhance our own personal and professional wellbeing.
Improving trainee wellbeing is a major focus of our committee’s work. I was fortunate to recently attend a symposium on how to improve doctors’ health and wellbeing. Mentoring was identified throughout the forum as an effective strategy and this is a driving force behind the mentorship project. Life as a trainee can be difficult. Finding a balance between family, work, relationships, study, research, exercise and a social life is a constant juggling act. It is common to drop a few balls along the way especially when other stressors enter our life. Our workplaces have a responsibility to provide us with a supportive training environment and I encourage any trainee who is feeling overwhelmed, stressed or not supported to access the support available to you via your Director of Training, Network Director, Training Liaison Officer (Chris Bartley) and/or myself or the other ROTC members.
KEY DATES Trainee Forum at the RANZCR Annual Scientific Meeting 2018: 25-28 October 2018, Canberra Phase 1 Exams: 7 September 2018. Applications due prior to the 20 July Phase 2 Exams (series 2): Written – 16-17 July 2018. Vivas 20-22 August. Applications due prior to 6 June Contacts Trainee Liaison Officer: Chris.Bartley@ranzcr.com Trainees Committee Chair: ROTC@ranzcr.com
Finally, well done to those that have sat the exams recently. Thank you for all of the time and effort put in by the dedicated college staff and fellows who have provided trainees with both formal and informal education preparing for these exams or at other educational activities such as the recent ESTRO Radiobiology course.
Mentorship Program Update As many of you are aware, the ROTC has been working with the Faculty of Radiation Oncology Mentoring Working Group (FROMWG) since early 2017 to develop a mentoring program for trainees and junior consultants. This has been a large undertaking that has also had the input of the PostFellowship Education Committee, the Education and Training Committee and the Economics and Workforce
Committee. We have recently conducted a survey to gauge the interest of mentees and mentors in conducting a pilot program. There has been an overwhelmingly positive response from both potential mentors and mentees indicating a real need and interest in a mentorship program. Thanks to all who responded. After reviewing best mentoring practices, evaluating other mentoring
programs offered by specialty training programs and the offerings of external vendors we are in the final stages of developing the mentoring framework. This enormous undertaking would not have been possible without the efforts of both Mr Philip Latham (Manager, Professional Practice at the College) and Dr Carol Haddad (Chair FROMWG) in leading this project.
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Radiation Oncology
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Radiation Oncology
Our Revised Radiation Oncology Practice Standards The updated Radiation Oncology Practice Standards (ROPS) Part A: Fundamentals and Part B: Guidelines, which represent a standard for radiation therapy service provision, have been published following a recent review. Both documents, taken together, provide a vital framework of requirements to assist radiation therapy facilities and achieve best practice across a range of important domains, are the result of dedicated efforts by the Radiation Oncology Tripartite Committee. With members from our College, the Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) and the Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM), the Committee represents a key forum for collaboration between the radiation therapy professions in the areas of quality, standards, workforce and public interest. It also acts as an important liaison point for the Department of Health and its committees and working groups and helps communicate key sector priorities to the Government and the public. The ROPS Fundamentals and Guidelines help ensure that patients receive the levels high-quality, safe treatment which they both expect and deserve and
Practice Standards
support a culture of ongoing quality improvement in radiation therapy service provision. They were first published in 2011 and received positive feedback, underlining the success of the group’s work. Queensland Health adopted the ROPS as the quality standards for both public and private radiation therapy centres across the state. Agreement was reached in 2016 to review the ROPS to ensure they continued to meet the growing demands of the profession and ensure patients continue to receive the highest standards of care. The Tripartite Standards Working Group, which was formed as part of the review, has now produced the updated documents. The ROPS have also been updated to be inclusive of New Zealand and thus truly bi-national standards. Part A now includes a ROPS Self-Audit Tool, which will help centres evaluate their compliance with the Standards. This includes 16 measurements developed for practices, allowing individual centres to self-assess themselves against the ‘required evidence’ guidelines for minimum requirements in the important areas of Facility Management, Treatment Planning and Delivery and Safety and Quality Management. The Standards have been developed to assist radiation oncology facilities to achieve best practice through the provision of a framework of requirements. It is important to note that regard should be given to local needs and these, together with clinical judgement, should govern how the Standards are implemented. Facilities may choose to set additional standards relevant to their individual circumstances. Compliance with legislative and jurisdictional requirements is mandated.
It is important to note that Part A and Part B are interrelated and must be considered as a whole. Each standard is also supported by a number of criteria and explanatory commentaries to assist with their interpretation. Members are encouraged to download the updated versions and disseminate them amongst their networks. The Standards can be found here (www. ranzcr.com/search/radiation-oncologypractice-standards-part-a-fundamentals) and here (www.ranzcr.com/search/ radiation-oncology-practice-standardspart-b-guidelines)
What are they A standard for radiation therapy service provision. Taken together, they aim to provide the framework to assist radiation therapy facilities and help achieve best practice.
Who Created Them The ROPS were initially created by the Radiation Oncology Tripartite Committee. A first version was initially published in 2011.
Why Were They Created They were established to ensure patients receive access to high-quality, safe treatment and to provide a standard for radiation therapy facilities to meet.
Why Have They Been Updated To meet the ever-changing demands on the profession and to ensure patients receive the standards of care which they deserve and expect
Why Are They Important To support a culture of ongoing quality improvement in radiation therapy service provision and set the quality standards for both public and private radiation therapy centres to attain.
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Radiation Oncology
Clinical Indicators in Radiation Oncology:
Revision of the Australian Council on Healthcare Standards Set What are quality clinical indicators, and what can they do for me and my patients? Do we even have them in Radiation Oncology and anyway, who says these indicators say anything about quality? If you have ever wondered this, then we have some answers for you. The Australian Council on Healthcare Standards (ACHS) introduced a set of clinical performance measures, called Clinical Indicators (CIs), into its voluntary accreditation program in 1993. The objectives were to ensure a health care organisation (HCO), which is accredited, had appropriate clinical processes and patient outcomes, and also to increase clinician interest in quality activities within their respective institutions. Subsequently, specific discipline indicators were developed with the cooperation of the various medical colleges and associations and by 2016 data were being received from more than 800 HCOs on over 300 CIs across 20 sets1. In return, the HCOs received a six monthly and an annual trend report containing aggregate and, most importantly, peer comparative data.
Radiation Oncology Clinical Indicators A draft set of indicators in Radiation Oncology, developed by a combined working party of the ACHS and the College was trialled in 1997-98. As well as a waiting time indicator it included indicators addressing the survival rates for treatment of glottic and prostate cancer. However, the follow-up rates for patients treated was so low that the percentage of patients treated for these two cancers having a follow-up became the indicators.
Version 4
Revision of Version 4
Several revisions of the set have occurred and Version 4, the current set of six CIs in three areas (shown in Table 1), was introduced in 2014. In 2016 only 13 HCOs reported data,1 probably reflecting just over 15 per cent of activity in the relevant indicator areas. There were desirable trends in CIs 1.1 (waiting period), 1.2 (number of patients in trials) and 2.2 (letter to referring practitioner or GP), and no undesirable trends. The aggregate rates are also shown in Table 1.
The revised set of nine indicators was achieved through group consensus, incorporating current technological and research advances in radiation therapy, highlighting the importance of a multidisciplinary approach and appropriate treatment planning in improved health outcomes, and continuing to address the delays involved in the management process. The revised indicator set is shown in Table 2. Following approval by the College’s Faculty of Radiation Oncology and the ACHS, the set was introduced for data collection from January 2018.
Despite the small number of HCOs reporting data, a survey revealed that in 2016 the exercise had stimulated six educational programs, three further quality activities and two procedural changes.
continued on page 48...
Table 1 Radiation Oncology Clinical Indicators - Version 4 Area
Clinical Indicators
2016 Aggregated Data
Consultation Process
1.1 - Waiting time > 28 days
8.8 per cent
1.2 - MEBR patient in trials
26 per cent
Treatment Process
2.1 - Staging annotation
87.7 per cent
2.2 - Letter to referring MO & GP
98.6 per cent
Outcome Process
3.1 - IMRT for nasopharyngeal cancer
95.2 per cent
3.2 - EBTR for prostate cancer
85.7 per cent
Table 2 Radiation Oncology Clinical Indicators - Version 5 Area
Clinical Indicators 1.1 - Waiting time for radical treatment > 28 days
Consultation Process
1.2 - Waiting time for palliative care > 14 days 1.3 - Multidiciplinary meeting involvement 2.1 - Staging annotation
Treatment Process
2.2 - Treatment prolongation 2.3 - Treatment plan peer review 3.1 - Single fractionation for bone metastases
Outcome Process
3.2 - Motion management 3.3 - Androgren deprivation therapy
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Radiation Oncology
Quality Assessment in both Oncology and Radiation Oncology Quality and safety issues have always been an important focus in oncological care. In past decades, various oncology quality indicators (QIs) have been developed and widely used to measure quality, monitor performance and facilitate quality improvement in cancer treatment.2-4 Given the complexity of cases and treatments in oncology, most QIs designed are tumour specific or treatment specific. Continuous advances and the application of new treatments as well as the multidisciplinary nature of oncology make it more difficult to develop valid and up-to-date measures in the field.4,5
Recommendations Given the essential role and potential uses of indicators in quality improvement, the College and ACHS recommend the use of ACHS Radiation Oncology Clinical Indicators Version 5, and urge radiation oncologists to take an active role in implementing and monitoring clinical indicators to drive improvements in radiotherapy practices. Prof Jeremy Millar1, Dr Brian Collopy2, Dr Han Zheng3
Contacts 1. Alfred Health, 55 Commercial Rd, Melbourne VIC 3004, Jeremy.millar@monash.edu 2. The Australian Council on Healthcare Standards, 5 Macarthur Street, Ultimo NSW 2007, briancollopy@ bigpond.com 3. The Australian Council on Healthcare Standards, 5 Macarthur Street, Ultimo NSW 2007, hzheng@ achs.org.au
Radiation oncology is a highly technical speciality. The rapidly emerging new technologies have provided more precise treatments to patients, while complicating the development of QIs that reflect current advances and quality of care in the field.5,6
APROSIG Update
health professionals who were to come to Australia in 2018 on an Australia Awards-funded programme designed by APROSIG and to discuss their goals. (More on this in the next issue of Inside News).
The Asia-Pacific Radiation Oncology Special Interest Group (APROSIG) aims to develop interaction with and support for radiation therapy professions in lowincome and middle-income Countries in the Asia-Pacific region.
Iain and Craig then joined Simon Downes and Garry Arthur from the ACPSEM AsiaPacific Special Interest Group (APSIG) in Ho Chi Minh City, where we had been invited to the Conference on Cancer Control and Prevention to speak on image guidance.
In November 2017, Drs Jayasingam Jayamohan “JJ” and Iain Ward travelled to Phnom Penh with Craig Opie (radiation therapist) to support the new National Cancer Centre at Calmette Hospital and Australian volunteers Kate Rogl (radiation therapist, Cairns) and Nikki Shelton (radiation oncology medical physicist, Melbourne). We were able to advise on equipment, staffing and commissioning of the Centre’s first linac and brachytherapy unit, assist in the development of protocols and provide teaching to registrars. We met a number of the Cambodian oncology
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Inside News
References 1. Australasian Clinical Indicator Report. 2009-2016: 18th Edition. ACHS, Sydney, Australia (in press) 2. Albert JM and Das P, Quality Assessment in Oncology, Int J Radiat Oncol Biol Phys 2012; 83:773-781. 3. Khare SR, Batist G and Bartlett G, Identification of Performance Indicators across a Network of Clinical Cancer Programs, Curr Oncol 2016; 23(2):81-90. 4. Uphoff E, Wennekes L, Punt C and et al., Development of Generic Quality Indicators for patient-Cantered Cancer Care by Using a RAND Modified Delphi Method, Cancer Nursing 2012; 35(1):29-37 5. Albert JM and Das P, Quality Indicators in Radiation Oncology, Int J Radiat Oncol Biol Phys 2013; 85(4):904-911. 6. Hendee WR, Improving Patient Safety in Radiation Oncology, Med Phys 2011; 38(1):78-82.
Radiation oncology is well-established in Vietnam, but there is a very wide range in the sophistication of techniques. Major centres offer SBRT, IMAT and IGRT, but many smaller hospitals treat with cobalt units without any imaging for treatment verification. Even major hospitals use much less treatment verification than is standard in Australasia. We were hosted by the Ho Chi Minh City Oncology Hospital. Patient numbers are staggering by Australasian standards. The linacs treat from 5am to 9pm in three consecutive shifts treating 45
patients/shift/linac. The brachytherapy section treats 25 HDR patients daily. We also visited Cho Ray Hosital, which has longstanding relationships with Australia through Dary Lim Joon (Austin Hospital/ Olivia Newton John Cancer Centre) and Tom Shakespeare (North Coast Cancer Institute). We are eager to hear from College fellows and student members who would like to contribute to supporting radiotherapy in our region. If you wish to join us, email Iain Ward (IainW@cdhb. health.nz) or Philip Latham at the College Office (philip.latham@ranzcr.com).
A linac treating 130 patients per day at Ho Chi Minh City Oncology Hospital
Radiation Oncology
Varian’s Velocity 4.0 Setting New Standards in Cancer Imaging Software
As the global leader in cancer imaging software, Varian provides the Velocity™ system for large-scale archival image storage and management and to serve as a centralized repository for all diagnostic, planning and delivery information. Varian has now enhanced Velocity’s already extensive capabilities with Velocity 4.0. Velocity 4.0 provides several new features that make it easier to retrieve and review images, treatment plans and dose information, and better enable collaboration and shared decisionmaking. Among the system’s new features is Velocity M3i multi-modality motion imaging, which can simultaneously
display and contour on up to ten imaging studies and encompasses CT, MR, PET, SPECT, ultrasound and conebeam CT imaging. The M3i system includes 4DCT and deformable image registration using information from multiple secondary volumes. Also new is Velocity ARIA® Sync, which offers automatic synchronization of approved objects from Varian’s ARIA oncology information system and Eclipse™ treatment planning system. Velocity’s adaptive radiotherapy capabilities have been augmented with Velocity Tumor & Dose Tracking, which offers image-based tumor and radiotherapy dose tracking across multiple treatment courses and therapy modalities. The enables clinicians to verify both volumetric tumor change and the cumulative dose history for cancer patients Velocity 4.0 also incorporates Rapidsphere™, a module for Y90 Selective Internal Radiation Therapy (SIRT) dosimetry analysis. Rapidsphere offers the ability for cancer care teams to better understand tumor response
and normal-tissue toxicity for individual patients receiving SIRT. “At Varian, we are focused on providing clinicians with powerful and comprehensive solutions that enable them to provide personalized cancer therapy for patients,” says Kolleen Kennedy, president of Varian’s Oncology Systems business. ‘Patient-specific 3D imaging and dosimetry for targeted cancer therapy delivery is important for predicting the tumor’s response to therapy.” Among the significant regional departments to select the Velocity system is the Peter MacCallum Cancer Centre (Peter Mac) in Melbourne. Peter Mac recently announced it planned to install Varian’s Eclipse™ cancer treatment planning system to replace existing planning systems across all five of its sites. As part of this major replacement project, Velocity was selected for its adaptive radiotherapy capabilities.
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RANZCR NZ ASM Millennium Hotel 3-5 August 2018 Radiology Invited Speakers
Radiation Oncology Invited Speaker
Howard A. Rowley, MD
Farzan Siddiqui, MD
Professor (Tenure), Department of Radiology University of Wisconsin, School of Medicine and Public Health Madison, USA
Vice-Chair, Radiation Oncology Director, Head and Neck Radiation Oncology Henry Ford Health System Detroit, USA
Claude Sirlin, MD Professor of Radiology, UC San Diego Health Co-Director of the Cancer Imaging Program at Moores Cancer Center San Diego, USA
Kirsten Gormly Consultant Radiologist Chair, Abdominal Radiology Group of Australia and New Zealand (ARGANZ) Adelaide, Australia
Key Dates
22 February 2018 - Abstract Submissions Open 9 April 2018 - Earlybird Registrations Open 1 July 2018 - Abstract Submissions Close 1 July 2018 - Earlybird Registrations Close
www.ranzcr2018.co.nz
Radiation Oncology
TROG Cancer Research TROG ASM 2018
New brain cancer study
TROG Trek Triumph
More than 270 people attended the TROG 2018 Annual Scientific Meeting (ASM) in Hobart, Tasmania from 1922 March. The ASM was the 30th for TROG and attendees included oncologists, radiation therapists, physicists, study coordinators and data managers.
Recruitment of patients has begun for a new brain cancer trial. The TROG 15.02 (ROAM) trial investigates whether radiation therapy is a better approach to treating atypical meningioma (a tumour that arises from the lining of the brain) than surgical removal. This study will be run at 11 hospitals and cancer centres across Australia and New Zealand. The trial chairperson is Dr Gail Ryan. The trial aims to recruit 30 patients, with accrual completion expected to be complete in October 2019.
The inaugural TROG Trek has raised more than $10,000 for TROG’s cancer clinical trials. The group of volunteers took on a five-day 50 kilometre trek in the spectacular Bay of Fires region in north east Tasmania in March.
Farewell Joan Torony
The charity challenge was part of TROG’s efforts to increase its fundraising activity and income. A Direct Marketing Appeal featuring TROG Ambassador and radio broadcaster, Julie McCrossin is also underway for June.
Delegates heard from a host of engaging and knowledgeable speakers including Dr Walter Curran, Radiation Oncologist at Winship Cancer Institute of Emory University in the US and Professor Andreas Adam from the Interventional Radiology Department of Radiology from King’s College in the UK. For the first time, a poster session was held as part of the meeting, which allowed delegates to share and promote their research achievements. Another highlight was the Clinical Research Education Workshop (CREW) and the Technical Research Workshop (TRW), which were both well attended. The CREW workshop provided a forum for professional development for clinical trial coordinators, data managers and other related disciplines, while the TRW focused on radiation oncology technologies, advancements and clinical trials. The 2019 TROG ASM will be held during March in Melbourne, Victoria.
TROG Cancer Research CEO Joan Torony has recently resigned due to ill health. TROG Board President Farshad Foroudi said Joan had been instrumental in growing TROG Cancer Research to 1500 members, with 16 open clinical trials and 10 new proposals in 2018.
Each of the team members either held fundraising events or activities, or were sponsored by friends, family or colleagues to raise the $2,000 required to able to take part in the trek. A big thank you to everyone who supported the TROG Trek Team!
“She has been a driving force in implementing the TROG strategic plan and diversifying our income away from government funding. Working in partnership with the TROG Cancer Research Board and the Central Office team, she has overcome many challenges over the past six years.” The TROG Board has appointed Research Manager, Renee Swanson to the position of Acting CEO. A recruitment campaign is underway for a permanent CEO for TROG Cancer Research.
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News from the Professions
Abdominal Radiology News The 10th Annual ARGANZ meeting was held in Melbourne in March with over 300 delegates experiencing world class lectures from Prof Anwar Padhani and Prof Paul Sidhu from London. The concurrent sessions on Saturday enabled a larger program to be offered and the gynae imaging session was particularly popular. The urology ‘Mock MDT’ included a local surgeon, oncologist and radiation oncologist and provided useful insights into the issues discussed in the MDT setting and the relevant imaging points for the clinicians. As part of our commitment to research, the Mendelson Research prize is awarded to the best oral presentation given by a trainee. This is eligible for the RANZCR Part 2 project and also provides the finalists with the opportunity of presenting to a large audience. We were delighted to award this year’s prize to Dr Danielle Richmond from Melbourne. This generous prize sends Danielle to an upcoming ESGAR meeting. 2018 saw the inclusion of paper posters for the first time and in 2019, this section will be open to all radiologists (so start planning now for next year’s submissions!).
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Inside News
At the AGM we said farewell to Prof Rob Gibson and A/Prof Andrew Little from the ARGANZ Executive and recognised their enormous contributions to the development of ARGANZ. I would like to thank ongoing executive members Dr Joe Feltham, Dr Tom Sutherland, Dr James Seow, Dr Warwick Thomas and Dr Jessica Yang for their tireless ongoing efforts and welcome new executive members Dr Sonja Gustafson, Dr Sarah Skinner and Dr Gabriel Lau.
looking at ways of promoting CT colonography (CTC) to our referrers. CTC is a highly underutilised examination in Australia when compared with New Zealand and the rest of the western world and has an important place in investigating patients for suspected colorectal carcinoma. ARGANZ will be communicating further with our members on suggested ways to improve awareness of the benefits and role of CTC.
During the past 12 months, ARGANZ has been identifying more ways to be involved in supporting abdominal imagers. We provided feedback for the ‘Prostate MRI Professional Development’ document to the College prior to its wider circulation and gave comment on the criteria for the proposed Liver MRI Medicare rebate.
In 2019 we will be crossing the Tasman for the first time with the 11th ARGANZ meeting to be held in Auckland on 9-10th March 2019. We have two expert speakers from the USA who will complement the Australasian faculty to provide you with a stimulating learning experience. We hope you will join us in NZ.
In our efforts to promote collaboration with our clinical colleagues, we have actively engaged with GESA (Gastroenterological Society of Australia) and have an ARGANZ representative on the panel to develop a ‘National consensus statement for the management of HCC’ as well as facilitating the inclusion of other radiologists on this panel. We are
If you wish to hear more about ARGANZ activities or receive updates in your areas of interest, please visit our website at www.arganz.org and register as a user. Dr Kirsten Gormly ARGANZ Chair
General Interest
New Zealand Branch News
Dr Gabes Lau
In the last issue of Inside News, I included a reminder to participate in the survey being conducted by the New Zealand Radiology Education Trust (NZRET) on the future of the New Zealand Annual Scientific Meeting (NZ ASM). I had the pleasure of attending NZRET’s meeting recently and am happy to report that the survey results provided an excellent foundation for the discussion on how to refresh the format and content of the NZ ASM. It was noted that many of you enjoy the NZ ASM but there is room for improvement, particularly around making the content more relevant to CPD and training requirements and finding a way to make the NZ ASM relevant in the face of increasing subspecialisation. An additional planning session is in the works to progress a new strategy for the NZ ASM. I would like to take this opportunity to thank those of you who responded—I understand NZRET will be releasing the survey results soon. On that note, I would like to encourage Fellows to lock in their diaries the date for the NZ Branch meeting this year which will be held in Queenstown 3-5 August. Parliament released the proposed Health Practitioners Competence Assurance Act Amendment Bill consultation document – with submissions closing on 5 April. This Bill is the first proposed amendment to the Act since it was implemented in 2003. The College endorsed the submission of the Council of Medical Colleges (CMC) and made its own submission. The College also presented to the Select Committee Health on 16 May.
The CMC’s response covered a range of issues related to the proposed Bill, including increased obligations on the regulatory authorities (ie Medical Council of New Zealand) to inform interested parties about decisions, health examinations may be performed by assessors other than a medical practitioner (ie a psychologist), regulatory authorities will need to have naming policies posted on their websites, implementation of regulatory authority performance review and amalgamation of regulatory authorities.
“I would like to encourage Fellows to lock in their diaries the date for the NZ Branch meeting this year which will be held in Queenstown 3-5 August.” The College’s written and oral submissions were focused solely on asking for a further amendment to the Act requiring regulation for telehealth and teleradiology. Currently, there is no requirement for regulatory oversight of those who are treating New Zealand patients from overseas. A change to the Act is required to rectify this and ensure patients in New Zealand are being treated by fit and competent practitioners. The Branch’s Musculoskeletal Reference Group (MSK) has been engaging with ACC on a number of issues, including:
drafting an MOU, the High Tech Imaging Contract which is up for renewal this year and the MRI GP Referral Trial. Feedback on MRI GP referrals to ACC has included: suggestions that radiologist not be required to suggest treatment, additional training for GPs, taking care that the eReferral system allows for patient choice of caregiver and that it works to reduce the risk of human error. We have recently concluded the centralised recruitment round for 2018. We had 37 applications to fill 21 clinical radiology training positions and nine applications to fill seven radiation oncology training positions. We are always seeking high quality applicants into the College’s training programmes. Many thanks to those registrars who supported a booth to lift the profile of the radiation oncology training programme at the New Zealand Medical Students Association (NZMSA) conference held in Wellington on 28 April. The College has employed Maureen Gillon as the New Zealand Branch Manager. Maureen originally trained as a nurse and has completed a Bachelor of Arts and a Masters of Social Science Research. She has extensive experience working for medical colleges (RNZCGP and RACP) including policy and advocacy. Her start date was on 21 May and we are pleased to have her join us. Dr Gabriel Lau New Zealand Branch Chair
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General Interest
Artificial Intelligence: Threat or Opportunity? “Should I still consider a career in radiology?” asked a junior doctor after a panel debate at the RANZCR 2017 ASM on the advance of Artificial Intelligence (AI). It’s not difficult to understand why this has become a real and growing concern for the profession with headlines claiming radiologist-level performance of machine learning algorithms in the interpretation of images. Ezekiel Emanuel, an American bio-ethicist, went so far as to predict the end of radiology as a speciality within the next decade in his keynote at ACR in 2016. My view is less stark, and I believe that AI could be vastly empowering for radiology. As a speciality we have always been pioneers of new technology, and AI
should be no different, but we must be leaders and not followers in this rapidly advancing field. In the opening plenary of this meeting, I commented on how automation in aviation has not led to pilotless passenger aircraft but has instead improved the economy, efficiency and safety of flying. Why should radiology be any different if AI enables us to focus our expertise where it is most productive? My group’s research in the UK (digital-heart.org) on using machine learning to predict patient outcomes in heart failure has shown how advanced image analysis can extend the role of radiology to deliver high-precision
Dr Declan O’Regan
individualised prognoses that surpass conventional risk factors. Deep learning algorithms trained on vast populations can produce near-instantaneous analysis of complex biomedical data on a desktop computer. However, the reality behind the hype is that many AI “successes” in healthcare are narrow image classification tasks without real world validation. These claims don’t benefit patients, distort perceptions of the performance of AI and fail to acknowledge the importance of radiologists in providing actionable clinical advice. Not all fields in radiology are equal and the arguments may shift in favour of AI for screening programs. If automated scoring improves accuracy at lower cost, there will be a strong case for its adoption. I sensed many in the auditorium were relieved that this nascent revolution will befall the next generation of radiologists! As the 2017 Rohan Williams Travelling Professor, I was fortunate to be invited to teach cardiac radiology at several centres across Australasia following the RANZCR meeting and to compare notes with clinical colleagues. I was impressed by the purpose-build facilities, up to date equipment and forwardlooking strategy of departments. The idiosyncrasies of reimbursement mean that cardiac MR is less widely available than in the UK but there is clearly pent-up demand for what is a pivotal investigation in many patients. Compressed sensing technology is on the horizon and may completely shift the cost-benefit ratio in favour of cardiac MR when 20-minute exams become the norm. Similarly, cardiac CT is increasingly a first line test for stable chest pain placing unprecedented demand on already stretched services in both countries. As is the case in the UK, some trainees are hesitant about pursuing a career in cardiac imaging due to the perceived threat from other specialties. Overall I think these concerns are largely unfounded, at least in my experience, continued over...
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and a collaborative environment works to the benefit of both clinicians and patients. Even those not considering sub-specialising welcomed a refresher of pathology and normal variants not to miss on chest CT as this is often a blind spot for general radiologists. November was a wonderful time to visit and the scent of Jacaranda blossom is instantly redolent of Australian springtime. Egged-on by my children I left with a phone full of Quokka-selfies, but I shall also miss wandering through the markets at The Rocks, catching the CityCat on the Brisbane River, and
RANZCR Research Strategy Update The Board of Directors have formally approved the RANZCR Research Strategy and both the Clinical Radiology Research Committee (CRRC) and the Radiation Oncology Research Committees (RORC) have identified actions within the Strategy to act on as a priority. Currently the RORC are considering options on funding the RANZCR-TROG Research Fellowship and Indigenous Research Grant and the CRRC has established a working group to further develop a Clinician Scientist Pathway. CRRC also have a vacancy on the committee for a New Zealand Representative and therefore encourage members to get involved. Please visit www.ranzcr.com/ fellows/general/get-involved/ current-opportunities for more information.
exploring the glorious coastline of North Island. A statue on Wellington waterfront called “Solace in the Wind” depicts a figure embracing the elements and for me that captures the magic of this beautiful continent. My only regret had been missing out tickets for the Ashes, but that turned out to be something of a blessing in disguise. I’d like to thank the RCR and RANZCR for making this visit possible and to all my colleagues across Australia and New Zealand who were so generous with their time and made a peripatetic radiologist feel welcome. E noho rā.
Dr Declan O’Regan Consultant Radiologist, MRC London Institute of Medical Sciences, Imperial College London. @DrDeclanORegan.
Consultant Radiologist, MRC London Institute of Medical Sciences, Imperial College London. @DrDeclanORegan.
Thank you to A/Prof Jennifer Cawson A/Prof Jennifer Cawson MBBS, FRANZCR, MPH, MD stepped down from the College’s Breast Imaging Advisory Committee (BIAC) on 27 February 2018 after almost 30 years. Jenny has made an enormous contribution to the College and in particular, breast imaging. Jenny joined the, then Breast Imaging Reference Group (BIRG) in 1988, at the same time as screening commenced at the Victorian Pilot Breast Screening Program at Essendon Hospital in Melbourne where Jenny was Senior Radiologist. In the early days of the committee, there was major input into establishing the College’s Mammography Quality Assurance Program (MQAP) and in developing standards for BreastScreen Australia. In 1993, Jenny became Director of St Vincent’s BreastScreen, where she remained until 2012, combining a clinical workload with her passion for research and teaching. Since founding the Special Interest Breast Group of the College in 1994, (BIG of RANZCR), Jenny has been involved in organising multiple highly successful two yearly meetings which have attracted great international and local speakers and excellent attendance. Jenny has also contributed to many other Breast Imaging and BreastScreen Groups including the Board of BreastScreen Victoria, Chairing the BreastScreen Victoria Quality Group for many years
and being a member of the National BreastScreen Q Group, National Evaluation Group and the BreastScreen Australia National Quality Management Group. Jenny’s interest is research has led her to publishing over 50 scientific papers, but she is best known for her work on Radial Scars, which earned her an MD at Melbourne University in 2003. Teaching has always been a special interest, not just local registrars and Fellows but in particular, Jenny developed an Association of South East Asian Nations (ASEAN) Training Fellowship for young south-east Asian radiologists to develop expertise in the region. In 2009 Jenny became a Life Member of the College in acknowledgement of her huge contribution to the College and breast imaging in Australia. Jenny is a friend and mentor to many past and present members of the BIAC. We will all miss her wisdom and academic rigor in our meetings. Although she will be missed at the BIAC, she continues to work in clinical roles at St Vincent’s BreastScreen, so we know more radiologists will benefit from her expertise. Thank you Jenny! Members of the Breast Imaging Advisory Committee
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FROM THE RANZCR ARCHIVES MYSTERY OBJECTS
YOUR COLLEGE NEEDS YOU!
Can you name any of these objects or describe their use? Scan the QR codes to submit your comments or see RANZCR staff to share information MISCELLANEOUS SET 2016.16
MISCELLANEOUS SET 2016.19
MISCELLANEOUS SET 2016.37.1
MISCELLANEOUS GAUGE 2016.42
MISCELLANEOUS OBJECT 2016.45
MISCELLANEOUS OBJECT 2016.40
X-RAY CONTROL PANEL 2016.73
FLUOROSCOPY DOSE WHEEL H28
MISCELLANEOUS OBJECT H4488
MISCELLANEOUS OBJECT H13196
These objects can all be found in the RANZCR Archives online museum at www.ehive.com/collections/5079/trainor-owen-collection
DO YOU HAVE ANY INDUSTRY OBJECTS OF SIGNIFICANCE?
Contact archives@ranzcr.com
General Interest
Australasian Meetings 2018
RANZCR Annual Scientific Meeting Dates NZ Branch ASM 2018 3-5 August 2018 Queenstown, New Zealand www.ranzcr2018.co.nz
July ANZUP ASM Sydney, NSW – 8-10 July www.anzup.org.au ANZHNCS & ISMR Joint Meeting Melbourne, VIC – 26-28 July www.anzhncs-ismr2018.com
October
ASM 2018 25-28 October 2018 Canberra, ACT ASM 2019 October 2019 Auckland, New Zealand
ANZSPR ASM Brisbane, QLD – 29-31 October www.anzspr2018.com
International Meetings 2018 August Sri Lanka College of Radiologists Conference Colombo, Sri Lanka – 25-26 August www.radiologist.lk/index.php
September AOSPR & ISPR Combined Meeting Chandigarh, India – 14-16 September www.aospr2018.com CIRSE Annual Meeting Lisbon, Portugal – 22-25 September www.cirse.org
College Meetings 2018 Board 17 August 28 August FAC and Board 22 November Annual General Meeting 26 October Faculty of Clinical Radiology 23 August (telco) 13-14 September 19 November 6 December (telco) Faculty of Radiation Oncology 24 August (telco) 19 October
Intelligence 18: AI in Healthcare Wednesday, 21 November 2018 • Doltone House Hyde Park, Sydney, NSW RANZCR is excited to announce Intelligence 18, an all-new summit that will present artificial intelligence in healthcare and how it will benefit, disrupt and affect our industry. Featuring presenters from a wide array of industries, Intelligence 18 will cover Artificial Intelligence, Machine Learning, Ethics in AI, Big Data and Enabling Tech.
Save the date and more information to shortly follow.
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Cardiac CT Training 2018 We go beyond simply meeting training requirements: Participants eligible to claim 117.5 RANZCR CPD points for the 5 day course and 67 RANZCR CPD points for the recertification course. l Maximum allowable course based live and library cases for ANZ credentialing. l Clinician led teaching by high volume operators. l State of the art low dose, High Definition imaging. AICC l Unrivalled venue and catering optimises the learning experience.
~ In Memoriam ~
l
The College notes with regret the death of the following members: Dr George Margieson, Fellow, NSW
DI
OV
TITU
I
NS
ASC
AUSTRALIAN
2018 COURSE DATES:
ULAR CT
T
Dr Donald Simmons, Fellow, SA
TE OF CAR
5 Day Level A Course: 14th - 18th June 2018 3 Day Level A Course: 16th - 18th June 2018 For more information and online registration log on to: www.aicct.com.au or contact us at: info@aicct.com.au
Professional Documents and Publications Professional documents are developed by the College to support the specialties of clinical radiology and radiation oncology in Australia and New Zealand. They define the standards of training and practice that guide the provision of quality and safe patient care. The documents are reviewed regularly to ensure they reflect best practice. The College also releases major reports and other publications that inform governments, healthcare organisations and members of the public.
All College standards, policies and guidelines are available on the College website here: Clinical Radiology www.ranzcr.com/fellows/clinical-radiology/professional-documents Radiation Oncology www.ranzcr.com/fellows/rad-onc/professional-documents All College position statements and submissions are available on the College website here:
If you have any enquiries about professional documents, please contact the College on: ranzcr@ranzcr.com or phone: +61 2 9268 9777
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College Wide www.ranzcr.com/our-work/advocacy/position-statements-andsubmissions
Supporting excellence in Regional Health
Great career with a terrific lifestyle A challenging career as a radiologist in regional Victoria is just the beginning. Keystone Radiology is an independently owned radiology group providing high quality services in both public hospital and private practice settings in regional Victoria. As a young, collegiate and supportive group, Keystone Radiology has a strong emphasis on professional development. With the stimulation and challenges found in big cities combined with the lifestyle benefits of living in some of Victoria’s largest regional centres, it’s a great way to really get your career moving. Our group is rapidly growing, so opportunities for career progression are excellent. Call us on 03 4333 0311 or email hr@keystoneradiology.com.au for an obligation free discussion.
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