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Volume 15 No 3 / June 2019

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

RADIATION THERAPY front and centre at Horizon Summit

Also Featured in this edition

Silicosis:

A looming healthcare crisis

Phase II exam tips

2019 Australian Federal Election

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Editor’s Pick 5 6 7 8

An agenda for the ages A doctor's tale New Zealand News Branch News/ News in Brief

9 11

Radiation therapy front and center at New Zealand Parliment Silicosis: A looming health crisis

AI algorithm to compete in junior radiologist image quiz

14 15

Changes to your medical registration requirements 2019 Australian Federal Election Update

What are your thoughts?

16 17 21 23 25

Choosing wisely

RANZCR 2019 ASM heads Back to the Future

InsideRadiology - IR in focus Workshops

27 28 29 37

46 51

Targeting Cancer

Exploring New Assessment Tools in Radiation Oncology Phase II exam tips

From the Faculty of Clinical Radiology

Radiation Oncology Quality Corner Acquiring formal speciality recognition – Interventional Radiology News from the professions Accreditation, entering the final stretch

53 55 57

From the Faculty of Radiation Oncology

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

Building a portfolio investment when you are time poor Uploading diagnostic images to My Health Record - What you need to know

Creative solutions to remote medicine – from the archives

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

Inside News is printed on Sovereign Silk. Sovereign Silk is produced in an ISO 14001 accredited facility ensuring all processes involved in production are of the highest environmental standards. FSC mixed Sources Chain of Custody (CoC) certification ensures fibre is sourced from certified and well managed forests.

Editorial Staff Editor-In-Chief Dr Allan Wycherley Sub Editor Mark Grzic

All rights reserved. No part of this publication may be reproduced or copied in any form or by any means without the written permission of the publisher. Publication of advertisements and articles submitted by external parties does not constitute any endorsement by The Royal Australian and New Zealand College of Radiologists of the products or views expressed.

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Introduction

An agenda for the ages The President on the work of the College board

Dr Lance Lawler

When it meets, the RANZCR Board, like boards of directors the world over, works to a prepared agenda. Yet the more important job for any board is not agenda-following, but agenda-setting, by which I mean our planning for, and anticipation of, the bigger and longerterm issues facing our members. In our working lives, almost all of us find it hard to devote the time we need for long-term planning, and for asking the big questions, such as ‘What contribution can I make to the healthcare system’? or ‘What is the future of radiology and radiation oncology?’ And so it is for elected representatives of our profession. The College has its strategic planning days and horizon scanning exercises, but these are never enough. We also have our Strategy to 2021 to guide us in principle but such documents are almost out-of-date before the ink is dry. The College needs a continuous approach on at least two strategic fronts: the aspirational (‘What is the best we can do?’) and the existential (‘How do we remain relevant?’) If the Board does not tackle this task adequately and actively seek answers to the hard questions, how can we reasonably expect this of our members? We just have to do it. Consequently, the role of the RANZCR Board has in recent years begun to evolve. I did not start the change but I am determined to see it continue and build while President. The change began with decisions to prioritise specific issues such as the impact of artificial

intelligence (AI) and, more generally, to devote increased resources to the College’s role as an advocate, primarily to government. Those key decisions are now bearing fruit.

“The College needs a continuous approach on at least two strategic fronts: ... 'What is the best we can do?' and ...‘How do we remain relevant?’” We all know AI offers many opportunities in imaging and therapy, but it also constitutes a major threat to patients and practitioners alike if implemented poorly. To address the issues, the College has developed a draft set of ethical principles for AI in medicine and today it leads the debate on how clinical radiology and radiation oncology, and healthcare generally, will manage a digital health future. In government advocacy, an intensified effort—which has included over 20 submissions in 2018 alone—has resulted in governments and agencies regularly consulting with the College for its expertise, insight and input on policy-related and other matters. These have included recent government or

opposition announcements on MRI access and the cost to patients of radiation therapies for cancer. Thanks to a cultural shift in how we represent our members, RANZCR is now widely recognised as the peak body for clinical radiology and radiation oncology in Australia and New Zealand, and a respected voice elsewhere. Increasingly it is evident that, as the pace of change in our professions accelerates, the Board cannot allow itself to over-focus on standards of education and practice. These are important functions best managed by the Faculty Councils and the senior management of the College. If it is to fully live up to its role as the peak deliberative body within the organisation, I firmly believe the Board must be focused on the big picture, looking to the future, asking the harder questions and tackling the broader issues. As for our membership, they need to understand the role of their Board and have confidence the Board is doing the right thing. This does not mean members need agree with the Board over any specific policy or decision, only to be confident the process is strong and we are headed in the right general direction. That’s an agenda for all our coming meetings.

Volume 15 No 3 I June 2019

Introduction

A doctor's tale The Chief Executive Officer discusses storytelling

Ms Natalia Vukolova In brief: Doctors underestimate the power of their stories. Storytelling is a weapon of mass impact and doctors must seize it for the benefit of patients, health systems and society. In my experience, clinicians feel more comfortable talking about the science of medicine or its politics than about the raw emotions of conversations with patients or the personal impact that they had on someone’s life. Perhaps this unemotional approach is a way to deal with the difficulties of being a doctor and delivering tough news, or a way to show that your judgement is based on facts and science, may be it is anachronistic - from a time when medicine was a masculine field defined by stoicism. Whatever the case may be, I often find that doctors minimise the impact that they have on their patients’ lives by speaking of their work in an impenetrable jargon-filled language. Storytelling is a powerful tool. Storytelling grabs at our imagination, it is memorable, it has a chance to genuinely influence the listener. And the world needs influencing. Strong, educated, ardent voices are much needed now to battle the rise of pseudo-science, health cuts masquerading as health policy, and the constant noise of the demagogues on social media. Doctors remain one of the most trusted professions1. Where others’ perceived worthiness has been steadily declining, doctors are trusted, respected

Inside News

and, in many cases, still revered. Doctors must repay patients and the public for this trust by recasting themselves from an expert to an advocate, a storyteller, an influencer. For many specialist doctors, this is anathema – after a lifetime spent specialising and valuing technical expertise above all else, it must be hard to recast yourself as a public figure. Why change, you ask? In my view, it is because an expert can help hundreds, but an advocate can help hundreds of thousands. You become specialists, not because it is easy (as any VIVA candidate will attest), but because it is worth it. This is no different. An effective advocate combines their expertise and facts, with powerful stories from the frontline of healthcare. They work with patients to help them find their own voice. Healthcare stories are relatable – who hasn’t suffered or seen a family member struggle with their health? As a trusted profession, a doctor’s audience is primed to be impressed. Medicine, after all, is like magic to most members of the public. Clinical radiologists and radiation oncologists just need to work a bit harder than other specialties to get their stories heard – which is why the College invests so extensively in our advocacy work: with politicians, referrers and the public. If you are ready to rise to the challenge, then find your own story and become an advocate for better healthcare and society.

References 1 http://www.roymorgan.com/findings/7244roy-morgan-image-of-professionsmay-2017-201706051543

News

New Zealand Branch News

Dr Gabes Lau

Hello All. The year is now well underway and I hope this finds you well.

Health and Disability Review At the April NZ Branch meeting, the Health and Disability Review was discussed at length. The Terms of Reference are broad (only four areas are excluded from the review, including ACC and private health insurance) but the scope of the review is focused on equity of outcome and ensuring resources are best utilised in the future. It is expected that significant changes to New Zealand’s health system will be based on the Review’s final recommendations.

Therapeutic Products Bill The Ministry of Health has been consulting on the Therapeutic Products Bill, which is proposed to replace the Medicines Act. On the horizon is increased regulation for devices, including the technology dear to the hearts of radiologists and radiation oncologists. Members can also look forward to the regulation of radiopharmaceuticals. The passing of this bill into law remains a way off. The College will provide further information as the final version of the new legislation becomes more concrete and we can better advise on the impact to your practice.

PHARMAC In other consultation news, PHARMAC, the New Zealand Pharmaceutical Management Agency, is consulting on PHARMAC managing medical devices in the same way it does medications for the public sector. During discussion, the New Zealand Branch Committee was concerned about how PHARMAC might rationalise available devices, as well as unreasonable delays making new

devices available to the public health system. New Zealand could fall behind international best practice without the availability of current technology.

Horizon Summit I want to take this opportunity to congratulate our NZ radiation oncology colleagues on a wonderful event at Parliament to raise the profile of radiation oncology in New Zealand.I would like to express my appreciation to all involved in this landmark event, which follows on from the Cancer Crossroads event held earlier this year.

College accreditation The AMC (and MCNZ) accreditation process has begun. The process will include site visits in New Zealand. The accreditation panel is headed by Dr Andrew Conolly (a New Zealander and former Chair of the Medical Council of New Zealand).

There is an often-misguided perception that AI may lead to the death of radiology. As we did last year, the College is sponsoring a booth at the 2020 New Zealand Medical Students Association Conference. We hope to counteract these rumours and generate interest in both radiology and radiation oncology amongst medical students. However, College members shouldn’t be shy about correcting colleagues. We certainly expect that AI will change the work we do but it will not negate the need for radiologists.

2020 New Zealand ASM The 2020 ASM for New Zealand is expected to be held in Wellington. An EOI is going out. I would like to extend an invitation to radiologists and radiation oncologists in the Wellington region to be involved and to showcase their expertise in the region. Please email nzbranch@ranzcr.org.nz or telephone (04) 472 6475 if you have any questions.

Meeting with ACC The Musculoskeletal Group recently met with ACC. ACC has recently undergone a significant restructure and staff turnover so there were many new faces. The focus of the meeting was to rebuild the relationship that we have worked hard to build with ACC over the last 15 years. Two additional meetings are scheduled for this year.

Registrar recruitment As I write this, the annual recruitment round for College registrars in New Zealand (radiology and radiation oncology) is closing. Disappointingly this year has seen a record low in the number of applications for radiology.

Getting involved at the College The College is currently seeking a Training Network Director (radiation oncology) and Branch Education Officer (radiology). This is a great opportunity for some new perspectives to come on board from Fellows and Educational Affiliates in the Branch. Please contact nzbranch@ ranzcr.org.nz, telephone (04) 472 6475 or visit the College website for more information.

Volume 15 No 3 I June 2019

News

News in Brief

Australian Branch News

Prof David Ball published in Lancet.

Queensland Branch news

The former Editor-In-Chief of the Journal of medical Imaging and Radiation Oncology, Prof David Ball has had a paper recently published in The Lancet Oncology pages. Stereotactic ablative radiotherapy versus standard radiotherapy in stage 1 non-small-cell lung cancer (TROG 09.02 CHISEL): a phase 3, open-label, randomised controlled trial was published in February.

Opportunity to take up a Clinical Fellowship in the UK We are very excited to announce that applications are now open for 2020/21 Windeyer Fellowship. The Windeyer Fellowship enables a trainee (post Phase 2 Examination), or junior Fellow in Radiation Oncology to undertake a Clinical Research Fellowship at the Mount Vernon Cancer Centre, Northwood, London, United Kingdom. The Fellowship involves a wide- ranging clinical experience working with a number of senior clinical oncologists, within several subspecialty sites. Overall supervision will be provided by Professor Peter Hoskin. There will be a focus on participation in clinical research activities. For further information, please refer to the Awards and Prizes page of the College website.

Inside News

Attention Trainees! 2019 Varian Medical Systems Educational Grant application period extended! Each year Varian Medical Systems offers several grants to radiation oncology trainees to assist in their attending the RANZCR ASM. Held in Auckland this year, these grants assist first and second year trainees with the cost of registration and other expenses. If you would like further information, please refer to the Awards and prizes section of the College Website.

It was a great start to 2019 with the Queensland Branch holding their first Academic Evening on 12th February at St Lucia Golf Links in Brisbane. The house was packed with nearly 70 members to enjoying a good meal and listening to presentations on a range of topics including: • Dr John Grieve - Changing role of IR in trauma • Dr Jason Zhang - Spectral CT in daily practice - Abdominal Imaging • Dr Patricia Deonarie - Imaging of adnexal lesions and their mimics It was a very enjoyable evening with an opportunity to network with colleagues, earn CPD points and to catch up with old friends over some fantastic food and wine. It is great to see college members getting value out of their membership and supporting the Queensland Radiologist community.

Features

Radiation therapy front and centre at New Zealand Parliment RANZCR CEO, Natalia Vukolova and several other subject matter experts on issues including the need to improve access, the future of radiation oncology, workforce constraints and the cost effectiveness of radiation treatment.

Dr Madhavi Chikuri with Minister of Health, the Hon Dr David Clark and Dr Carol Johnson Improving access to potentially lifesaving radiation therapy for thousands of New Zealand cancer patients was the key message delivered by the Royal Australian and New Zealand College of Radiologists at the first-ever Radiation Oncology Horizon Summit, on 9 May at New Zealand’s Parliament. Hosted by New Zealand Health Minister, the Hon Dr David Clark, the Summit brought together stakeholders from across government, industry, and consumer representatives to discuss improving access to radiation therapy. The event emphasised the current underutilisation of this lifesaving treatment and has kick-started the process of developing policy that ensures patients are always made aware of their choices when it comes to treatment. The College acknowledges Minister Clark for sponsoring the Summit and recognising the importance of radiation therapy in the fight against cancer. Cancer continues to have a huge impact on the lives of thousands of New Zealanders every year and outcomes are worse for Maori and marginalised

groups. Participants at the Summit were pleased to hear the Minister’s commitment to equity of outcomes for all cancer patients and the Government’s aim to reduce the incidence and impact of cancer. RANZCR has been a driving force in advocating for cancer patients to have access to the most effective and appropriate treatment for their circumstances. The Summit was the first event of its kind in New Zealand and the turnout demonstrated that decision makers are taking the need for reform seriously. As cases of cancer continue to grow in New Zealand, the Summit shed light on the importance of radiation therapy in helping to combat the disease. Today, Cancer is the most common cause of death in New Zealand, responsible for nearly a third of all deaths and is a leading cause of morbidity.

The Summit was highly successful, with those in attendance formulating a number of key outcomes. This included a commitment to collaborate and consult on the national cancer plan, specifically the future location of facilities, and a recognition of the need to urgently implement and invest in a new funding structure and identify and promote solutions to workforce shortage issues and trainee retention. Another key priority identified from the Summit was to work with medical schools to increase medical students’ awareness and understanding of a career in radiation oncology. The Horizon Summit was an important step toward raising awareness of radiation therapy in New Zealand and creating a plan to improve access for those that would benefit from the treatment. The College will continue to work with decision makers, health professionals, consumer representative and the Ministry to ensure high quality, safe, affordable and accessible radiation treatment for all who need it.

If you would like further information, please contact Steve Williams at Steve.Williams@ranzcr.org.nz

Speakers on the day included Chair of the New Zealand Radiation Oncology Executive Committee, Dr Carol Johnson, RANZCR Faculty of Radiation Oncology Dean, Dr Madhavi Chilkuri,

Volume 15 No 3 I June 2019

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Features

Silicosis:

A looming health crisis Silicosis is caused by the inhalation of respirable crystalline silica dust contained in manufactured stone products used to make kitchen and bathroom benchtops. The condition is progressive, with patients suffering lung inflammation and fibrosis. Silicosis can be prevented but there is no known cure and lung transplantation is currently the only treatment option. Manufactured stone contains up to 95% crystalline silica while natural stone such as marble or granite contains between 5 to 50% crystalline silica (WorkCover Queensland, 2018). Manufactured stone is much cheaper that natural stone, considered easier to work with and is subsequently used in high volumes by the industry and tradesmen. Products containing silica are readily available in leading hardware stores across Australia and New Zealand, exposing the home handyman to the risks associated with the product.

Rising incidence Following the identification of several silicosis cases in Queensland throughout 2018, an audit of the stonemason industry in Queensland and screening program of workers ensued. To date, more than 800 workers have been screened, of whom 116 have confirmed silicosis diagnosis. Similar incidence rates are expected in other jurisdictions, with the advent of screening. In the interim, one of the first workers diagnosed with silicosis died in March this year, aged 36 years.

Diagnosis of silicosis There are no current imaging guidelines for the diagnosis of silicosis. The Queensland OIR screening program involved a radiograph, read by a NIOSH B-reader to ILO standards. The HRCT chest was included if recommended by the radiologist, if the worker was symptomatic or had an abnormal spirometry. Referral to a respiratory physician or occupational physician then occurred as required.

What is the College doing to respond? It is paramount that the College responds effectively and efficiently to provide recommendations for accurate, reliable and timely diagnosis of silicosis.

upskilling radiologists, we plan to build relationships with key organisations and medical professionals with whom we can devise a collaborative, patientcentered and ongoing strategy for the management of silicosis and other pneumoconiosis. We will be keeping our members informed as our work in this space evolves, and we will be relying on you to provide feedback as we make proposals and develop training and educational materials. If you have any contributions, thoughts or comments, please contact Amy Young, Standards Unit at professionalpractice@ranzcr.com

We are currently working with members of our Professional Practice Committee (Please see the article on page 32 of this issue) and the Australian and New Zealand Society of Thoracic Radiology (ANZSTR) who are tasked with developing recommendations regarding training requirements for radiologists and diagnostic pathways for ‘at risk’, symptomatic and asymptomatic workers. The College is committed to identifying radiologists with an interest in occupation dust lung diseases and providing opportunities for them to be educated and upskilled accordingly. The College is currently engaged with the OIR, providing recommendations and support to their Silicosis Medical Working Group of which we have representation on. Complimentary to our commitment to educating and

Volume 15 No 3 I June 2019

Features

AI algorithm to compete in junior radiologist image quiz An AI algorithm could help radiologists prioritize the review of critical cases It’s a cold and frosty day in Vienna as junior radiologists sit down for the annual junior image interpretation quiz. It’s one of the main attractions at the European Congress of Radiology (ECR) and this year is no exception. Six experts in the field each present a case to the young radiologists in the room – one more complex than the other – and four possible diagnoses for every case. The audience then casts votes on the diagnoses they believe to be correct.

“It’s not a question about whether the radiologist is better than the AI or vice versa,” said Mathias Goyen, chief medical officer at GE Healthcare, who presented the AI case. “If there’s a patient with a pneumothorax in the middle of the night when there’s only a few radiologists on call, each one with their hands full, having a smart computer that can flag that a patient is in need of acute care could be the difference of life and death”.

But this year presented a twist. There was a seventh case. One that had been assessed by Artificial Intelligence (AI), rather than a radiologist. The scan on the screen showed a pneumothorax – a collapsed lung which impacted more than 9,000 people in the UK in 2011[1] and can be deadly if not diagnosed quickly and accurately. A lung can collapse if air leaks into the space between the lung and the chest wall and pushes on the outside of the lung. It can be caused by trauma, cigarette smoking, certain lung diseases, or by complications from surgery.

Today, patients who present symptoms associated with the condition receive a chest X-Ray, which can take radiologists anywhere between two to eight hours to read[2]. If the condition isn’t treated fast enough, the patient can develop tension pneumothorax, or an enlarging pneumothorax[3], potentially leading to fatal consequences if not treated quickly.

74.8% of the radiologists located the pneumothorax correctly.

Inside News

In such cases, patients would receive a “STAT” chest X-ray which is reserved for potentially life-threatening circumstances. STAT portable chest X-Rays can attribute to more than 60 percent of a radiology center’s mobile chest X-ray volume, almost double that of routine exams[4].

That’s why clinicians are looking for opportunities to read STAT chest X-Rays faster and in a more prioritized manner to enable a quicker diagnosis. One such opportunity is the Critical Care Suite* on Optima XR240amx, which is designed to identify cases with the critical condition of pneumothorax at point-of-care to enable prioritization of image review. “I think the idea and concept about an on-device alert really gets to the heart of early warning detection technology,” said Dr. Rachael Callcut, Associate Professor of Surgery at the University of California, San Francisco (UCSF) Medical Center and Director of Data Science for the Center for Digital Health Innovation, who worked with GE Healthcare to develop the Critical Care Suite. “There are many opportunities to use early alerts and early warnings and it’s very clear that the sooner the clinician knows of a potential life-threatening or major finding, the more likely they are to be able to do a timely intervention that could perhaps change the trajectory of a patient.” Critical Care Suite will employ a suite of AI algorithms, such as pneumothorax detection, designed to identify this potentially life-threatening condition in chest X-Rays with high accuracy (>0.95 AUC). The AI algorithm is hosted on the mobile X-Ray system – a first of its kind AI-embedded imaging device – designed to share the output through an onscreen notification. Critical Care Suite on Optima XR240amx is powered by Edison – a next generation intelligence platform that helps accelerate the development and adoption of AI technology and empowers providers to deliver faster, more precise care.

Features

When a pneumothorax condition is identified, the point-of-care notification alerts the clinical team, enabling prioritization of image review. The AI results are sent to PACS for review of the critical findings by a radiologist. An AI algorithm could help radiologists prioritize the review of critical cases and bring confidence when diagnosing difficult cases.

*510(k) pending at FDA. Not available for sale. Not CE marked References [1] https://statistics.blf.org.uk/lung-disease-uk-bigpicture [2] Rachh, Pratik, et al. “Reducing STAT Portable Chest Radiograph Turnaround Times: A Pilot Study.” Current problems in diagnostic radiology (2017). [3] Lorenz, Jonathan, and Matthew Blum. “Complications of percutaneous chest biopsy.” Seminars in interventional radiology. Vol. 23. No. 2. Thieme Medical Publishers, 2006 [4] Rachh, Pratik, et al. “Reducing STAT Portable Chest Radiograph Turnaround Times: A Pilot Study.” Current problems in diagnostic radiology (2017).

“AI has the potential to transform the way we diagnose and deliver care,” said Goyen. “I think future radiologists will have more tools like these in their arsenal, helping them meet the increased radiology demand and ultimately, treat patients faster”. by Pernilla Mello, GE Healthcare

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Volume 15 No 3 I June 2019

Features

CHANGES TO YOUR MEDICAL REGISTRATION REQUIREMENTS ARE YOU PREPARED?

Professional Development

Remediation

Wellbeing

Attention Radiation Oncology Fellows: Are you aware that your CPD requirements changed on 1st January this Year? From 1st January this year, the CPD requirements for Radiation Oncology Fellows changed. The changes have been instituted to accommodate incoming reforms from the Medical Board of Australia (MBA) and Medical Council of New Zealand. These reforms will see a shift from the usual educational activities such as conferences, courses and workshops to include multiple modalities as follows;

Transition to reforms

Resources to help you

The Radiation Oncology Post Fellowship Education Committee (PFEC) have agreed to progressively adopt the new CPD requirements, to allow Fellows the opportunity to adapt to the reforms. This means, that effective 1 January 2019, all Radiation Oncology Fellows must comply with the following CPD requirements;

The College has created a CPD Toolbox, which holds a range of resources to assist radiation oncology Fellows meet the new CPD requirements. Links to these resources are provided below;

1. Educational activities e.g. lectures, conference, courses, reading, supervision and workshops

• Participate in at least one ‘Measuring Outcomes’ activity within triennium (2019-2021) • Participate in at least one ‘Peer Review’ activity in triennium (20192021) • Participate in at least on Educational activity in the triennium (2019-2021) • Accrue a minimum of 180 points for the triennium with the following caveats; o Points must be accrued from a minimum of 3 or the 7 RANZCR CPD categories o Individuals much accrue a minimum of 50 points per year Further, members are being encouraged to have an annual Professional Development Plan in place that outlines the individual learning needs and demonstrates alignment to their scope of practice.

2. Reviewing performance e.g. peer review, performance appraisal, peer review of medical records, case conference, multi-source feedback 3. Measuring outcomes e.g. Clinical audit, review of medical records, review of clinical indicators/standards, comparison of comparative data sets, audit of medico-legal reports, reflection on professional outcomes, participation in clinicopathological correlations meetings Further information regarding the reforms is available on the RANZCR website the RANZCR website and in the 2019-2021 CPD handbook.

Inside News

RO Scope of Practice • Professional Development Plan Template • Clinical Audit Tool • Peer Review Audit Tool • Patient Satisfaction Survey Tool • Journal Reading Recording Template

If you have any questions or concernsabout the upcoming changes to your Australian medical registrationrequirements, please send them to cpd@ranzcr.com

Features

2019 Australian Federal Election Update

On Saturday, May 18, Australians went to the polls to vote in the 2019 federal election. The Coalition government under the leadership of Prime Minister Scott Morrison was re-elected to lead the country for another three years. The College congratulates the Coalition on their win and looks forward to continuing our work with the Government and Opposition over the next parliamentary term. Throughout the campaign, healthcare was a feature of each party’s platform and as such, prior to the national vote, the College secured a number of election commitments from all the major parties. For clinical radiology, the Coalition has pledged to work with RANZCR to develop a comprehensive strategy to prepare Australia for the adoption of AI in healthcare. Considered to be one of the most influential factors on the delivery of healthcare into the future, we feel that RANZCR’s involvement in this area will ensure that the College maintains a strong voice in delivering future outcomes. The Government also reiterated its previous announcement to expand MRI access by investing $375m in Medicare covered MRI scans. Further commitments were made by the Coalition, to working with RANZCR to evaluate the impact of its recent delivery of 53 new MRI machines. They also outlined how they had delivered indexation to 92% of all diagnostic imaging services (commencing July 2020), and invested $32m or MRI and PET scans for breast cancer patients. For radiation oncology, the government has committed $63.4 million for radiation therapy centres in regional Australia and supported the introduction of a national incident reporting and learning system to improve the overall safety and quality of radiation therapy. The Coalition also committed to working with RANZCR on the implementation of several of the MBS Review recommendations.

College President Prof Lance Lawler and College CEO between meetings at the Parliament House in Canberra

This included modelling for the new radiation oncology schedule and the radical prostatectomy guidance note in Medicare, which encourages a discussion of treatment options with radiation oncologists. Finally, RANZCR received support from all major and minor parties for the development of a nationally coordinated plan for particle therapy, to encourage strong collaboration between States and Territories and ensure access to eligible patients. We feel that this support is a testament to efforts of the College in building our reputation as strong, clarion voice in matters of healthcare backed up with a professional team that is able to follow through on our promises.

The College has developed strong relationships with influential decision makers in the Coalition including Health Minister Greg Hunt. This was evident in the strong response we received to our election priorities. Though there may be some changes in the weeks ahead, RANZCR will continue to maintain these relationships, seek new ones and hold the Government to account for their commitments to the electorate during the recent election and push for the best patient outcomes possible.

Volume 15 No 3 I June 2019

Features

Robert “Bob” Hawke 1929 – 2019 Australian Prime Minister Malcolm Fraser's government during their subsequent period in office.

Bob Hawke gives the Inaugural Kingsley Laffer Lecture photo courtesy of the University of Sydney Archives Robert James Lee Hawke was born in Bordertown, South Australia, on December 9 1929, the younger of two sons of Clem Hawke, a Congregationalist minister, and his wife Ellie In 1969, Hawke was elected ACTU president, receiving the left’s support in what turned out to be a closely fought contest. During the 1970s, he became a towering figure in national political and industrial life. Hawke was also ALP president from 1973 until 1978, and he

Choosing Wisely Choosing Wisely was first launched in the United States in 2012 and has grown into a global initiative with over 20 countries and campaigns now in places such as Australia, New Zealand, Canada, the UK and parts of Europe. Campaigns encourage health professionals and Consumers/Patients to engage in evidence-based conversations about what tests, treatments and procedures may not benefit them and could cause harm.

Inside News

served as a governor of the Reserve Bank from 1973 until 1980. In 1983 he toppled the then Labor party leader, Bill Hayden to become the leader of the party and thirty-five days later, led the party to an election win against the Fraser Liberal Government. In February 1984 Hawke announced Medicare. It was an updated version of Gough Whitlam’s Medibank program which had been originally introduced by Whitlam but partially dismantled by

More isn’t always better Unnecessary tests, treatments or procedures can be harmful and costly. By making sure your patients are well informed, you can make the best decisions about their health care, together. Choosing Wisely campaigns are led by clinicians, but one of their primary objectives is to engage health consumers in making decisions about their own medical care. Consumers are encouraged to consider and ask the following questions: 1. Do I really need this test, treatment or procedure? 2. What are the risks? 3. Are there simpler, safer options? 4. What happens if I don’t do anything? 5. What are the costs?

In 1979 Medicare benefits were limited to the difference between $20 and the scheduled fee. And in 1981 access to free hospital and medical care was restricted to pensioners with health care cards, sickness beneficiaries, and those meeting stringent means tests. The transformation of Medibank into Medicare as we know it, came into operation on 1 February 1984, following the passage in September 1983 of the Health Legislation Amendment Act 1983. It differed from the original Medibank program only in matters of detail but despite this at the time the legislation was considered a radical social reform that would create a health insurance system that was simple, fair and affordable. It became Australia’s first affordable and universal health insurance system and is still going strong today.

Both Choosing Wisely Australia and Choosing Wisely New Zealand provides specific resources, developed with specialist colleges, including RANZCR, to help professionals and health consumers alike. To access these resources and to find out more, visit Choosing Wisely Australia www.choosingwisely.org.au Choosing Wisely New Zealand https://choosingwisely.org.nz

Education

RANZCR 2019 ASM heads Back to the Future. Embracing the classic 80’s cult movie Back to the Future, delegates will be transported back in time to look back at the core elements of where we have come from and where we will be heading as Clinical Radiologists and Radiation Oncologists. The Organising Committee have been working on an engaging and thoughtprovoking program. Complemented by insights into College activities with input from the special interest groups and working committees they promise a holistic program to engage members and affiliated groups. Artificial Intelligence will also be a hot topic addressed at the ASM. There will be a number of social program highlights in the 2019 program, but the stand out event will be the RANZCR Gala Dinner, where we are encouraging you to channel your inner 80’s spirit and dress in theme as we dance the night away to some iconic 80’s music. It will be a night not to be missed! Be sure to add some extra time on your visit to Auckland, either pre or post ASM, to explore New Zealand and its serenity.

Radiation Oncology: In with the old and new! With the theme this year being Back to the Future we have secured three amazing keynote speakers Dr David Beyer, Dr Drew Moghanaki and Dr Arjun Sahgal. Some of the key topics we plan to cover include management of brain metastases, stereotactic ablative radiotherapy and treatment of oligometastases, re-irradiation, post ablative radiotherapy imaging, artificial intelligence, dealing with physician burnout and social media in medicine. Dr David Beyer is the past president of ASTRO and the American Brachytherapy Society. He will be sharing with us insights into management of Genitourinary malignancies. Drew Moghanaki requires no introduction for those of you who are on twitter, Drew is an expert on lung and Genitourinary malignancies and will be sharing with us his experience on social media as well as SABR for lung malignancies. Dr Arjun Sahgal is an international authority on management of brain and spine malignancies and is the director of the Sunnybrook Cancer Ablation Therapy program. He will be sharing his insight on management of brain metastases and spine metastases using stereotactic ablative radiotherapy.

Dr Drew Moghanaki

Dr David Beyer

As always we will have an action packed social program and the meeting will be a great opportunity for you to network with your peers and develop new collaborations and relationships. Auckland is a great city with lots of things to do and explore, we look forward to welcoming you in October. Louis Lao & Ramesh Arunachalam 2019 Radiation Oncology Co-Convenors Dr Arjun Sahgal continued over...

Volume 15 No 3 I June 2019

Education

Clinical Radiology: Highly regarded educators and specialists joining together in Auckland. Clinical Radiology welcomes leading experts from the United Kingdom and United States to present at this year’s ASM including Dr Paula Woodward, Professor of Radiology at the University of Utah and holds the David G. and Marcia R. Bragg Presidential Endowed Chair in Oncologic Imaging. In 2014 she was given the honor of Educator-of-theYear by the RSNA. Her area of research and clinical focus is pelvic and fetal imaging and she holds appointments in both the Department of Radiology and Department of Obstetrics and Gynaecology. Interventional Radiologist from Reading Hospital, USA, Dr David Sacks has authored/co-authored over 120 scientific publications and book chapters. He has had an interest in the interventional treatment of stroke for nearly 20 years and created an interventional stroke treatment program at Reading Hospital in 2001. He has authored or co-authored numerous papers on physician training and performance standards for carotid stenting and stroke interventions, and chaired an international writing group to create outcome benchmarks for intra-arterial stroke therapy. He is currently president of the Intersocietal Commission for the Accreditation of Carotid Stenting Facilities and serves on the board of the Intersocietal Accreditation Commission. He also serves on the board of the interventional stroke registry, INSTOR. He was co-chair of the Society of Interventional Radiology CLOTS interventional stroke training course, and created a stroke training course for the Interventional Radiology Society of Australasia in July 2017. Consultant musculoskeletal radiologist and Honorary Associate Professor to the University of Leeds, Dr Andrew Grainger will also look to join us in Auckland. Dr Grainger works closely with a team of seven other musculoskeletal radiologists providing MSK imaging services across all modalities. Within the sub-speciality he has particular interests in sports imaging and imaging arthritis and has been involved in imaging

Inside News

amateur and professional athletes from a wide variety of sports across the UK. He was involved in the development and provision of sports imaging services for the London 2012 Olympics, Manchester Commonwealth Games and World Indoor Athletics (Birmingham). Radiology 6th Edition. Dr David Panicek serves as Vice Chair for Faculty Affairs in Radiology at Memorial Hospital, and Professor of Radiology at Cornell University Medical College and is a recipient of the E. Robert Heitzman Award for Teaching Excellence (from radiology residents at SUNY Health Science Center at Syracuse) and the Robin C. Watson Award for Excellence in Radiology Teaching (from radiology residents at New York Hospital/ Cornell). He was principal investigator on a National Cancer Institute multiinstitutional grant that compared CT and MR imaging for staging of musculoskeletal tumours. Dr Panicek lectures around the world, and is a two-time recipient of the Outstanding Teacher Award in musculoskeletal imaging courses at annual meetings of the International Society for Magnetic Resonance in Medicine. Dr Michelle S. Ginsberg, is Vice Chair for Education and Director of Cardiothoracic Imaging in the Radiology Department at Memorial Sloan Kettering Cancer Center. She is a Professor of Radiology at Weill Cornell Medical College. Dr Ginsberg was named the 2018 New York Roentgen Society Distinguished Radiologist and served as President of the New York Roentgen Society and has been named Castle Connolly Top Doctors, New York Metro Area for the past 8 consecutive years and Top Doctors, New York Magazine for the past 4 years. Dr Ginsberg’s research focuses on detection, characterization and measurement of thoracic malignancies and improving techniques to assess tumour response. She has authored more than 133 original peer reviewed publications, invited reviews and chapters. Gabes Lau Clinical Radiology Convenor

Dr Paula Woodward

Dr Andrew Grainger

Dr David Sacks

Education

Dr Michelle S. Ginsberg

Trainee Learning Days The Clinical Radiology and Radiation Oncology Trainee Learning Days will be held Saturday 19 October to encourage as many trainees and registrars to attend the day. The Clinical Radiology day will once again focus on VIVA’s and preparation for exams, whilst the Radiation Oncology program will look at Fellowships and Leadership/ Mentoring programs as part of the day’s proceedings. The day provides an opportunity for both disciplines to meet with fellow Trainee’s and gain insights into preparation for examinations and share experiences and networks. Anna Gubbins, Radiation Oncology Trainee Representative Acrane Li, Clinical Radiology Trainee Representatives

Dr David Panicek

FLINDERS MEDICAL CENTRE PATHOLOGY COURSE 15 & 16 FEBRUARY 2020 The Division of Medical Imaging at Flinders Medical Centre will offer a two day Pathology Course, consisting of lectures and “pots” sessions to be held on Saturday 15 and Sunday 16 February 2020 at the Adelaide Convention Centre. The course will be of particular value to registrars and candidates preparing for the Part II FRANZCR examination. It will also provide an overview of pathology for practising radiologists who are encouraged to attend. Closing date for registrations is: Friday 29 November 2019 For registration form and further information please contact Helen Sainsbury: helen.sainsbury@sa.gov.au / (08) 8204 4405

Volume 15 No 3 I June 2019

SPEND WINTER SPEND WINTER SPEND WINTER WORKING WORKING ON WORKING ONON THE GOLD COAST THE GOLD COAST THE GOLD COAST

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• ••environment Collegiate Collegiate environment Collegiateenvironment environment Collegiate Collegiate environment • •• opportunities Fellowship Fellowship opportunities Fellowshipopportunities opportunities Fellowship Fellowship opportunities (MSK, (MSK, Breast, Breast, NucMed) (MSK, Breast,NucMed) NucMed) (MSK, Breast, NucMed) (MSK, Breast, NucMed) • Specific working working arrangements • Specific• working arrangements • Specific Specific workingarrangements arrangements • Specific working arrangements negotiated negotiated negotiated negotiated negotiated • • • •

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Advocacy

Targeting Cancer under an Italian Sun

Targeting Cancer at the European Society for Radiotherapy and Oncology Conference 2019 The European Society for Radiotherapy and Oncology Conference (ESTRO) met in the historic, beautiful and stylish city of Milan, Italy in late April. There was a significant Australia and New Zealand radiation oncology presence at the conference, showcasing research from our region, our College’s contribution to global leadership development and of course the widely acclaimed Targeting Cancer campaign.

ESTRO/CARO/RANZCR Leadership Course RANZCR, ESTRO and CARO have collaborated to put together an interdisciplinary Foundations of Leadership course for RO trainees/ junior ROs, RTs and physicists. 36 participants from over 20 countries were in attendance. The Leadership course ran for its second year at ESTRO, with a program covering leadership theory and styles, personal and relational awareness, effective team building and change management as well as skills in quality improvement and communicating a vision for change. A series of interactive teaching sessions and group activities over 3 days are tailored to the specialty of radiation oncology with relevant case studies to bring the theoretical concepts to life.

With Course Director A/Prof Sandra Turner and Dr Lucinda Morris part of the international teaching faculty, the College is well represented in this important area. The course is being presented in Sydney for the first time this August. Find our more about it on page 25 of this issue.

Volume 15 No 3 I June 2019

Advocacy

Joint Symposium RANZCR and ESTRO also collaborate by co-hosting joint symposia in alternative years at our respective scientific meetings. This year it was ESTRO’s turn to host, with two European speakers and two from our region. The topic of radiotherapeutic management of oligometastatic disease was chosen due to the rapid and broad acceptance of it in recent years. FRO Dean Dr Madhavi Chilkuri chaired the session alongside Prof Yolande Lievens from Belgium. A/Prof. Jarad Martin from NSW presented first on use of SBRT for oligometastatic prostate cancer. He was followed by Dr Suresh Senan from the Netherlands who covered SBRT for oligometastatic non-small cell lung cancer. Next up, Prof. Tomas Kron, a medical physicist from Melbourne provided an overview of challenges of SBRT in physics and related clinical issues to watch out for. The final speaker, Prof. Ruggero Ruggieri, provided hints on optimal dose and fraction number from lung SBRT. RANZCR looks forward to welcoming ESTRO to our ASM in Auckland this year and to the next joint symposium at the 2020 ASM.

Inside News

Targeting Cancer – International Reach The Faculty of Radiation Oncology Dean, and clinical leads on Targeting Cancer, A/Prof Turner and Dr Lucinda Morris met with representatives from the European Cancer Foundation (ECF), a charity established by ESTRO to help ensure that all cancer patients who need radiation therapy receive it. RANZCR attendees provided an overview of how the strategy behind Targeting Cancer has evolved over its first five years and outlined resources that both organisations could share. The ECF campaign focuses on removal of barriers to treatment, including perceptions or lack of awareness and adequate resourcing of care. The ECF last year launched the Marie Curie Legacy initiative with a resulting white paper calling on governments, policymakers, health professionals, patients and societies to help address the gap in radiation therapy access.

FRO members are encouraged to take a look at the Marie Curie Legacy initiative from ESTRO. If consumer advocacy is something you would like to get involved in locally, please contact Phil Munro of the Targeting Cancer team at faculty@ranzcr.edu.au.

Fun Run ESTRO’s annual fun run buzzed with excitement and featured a large New Zealand and Australian presence. Twelve relay teams made up of RANZCR members, international friends and supporters competed together under the Targeting Cancer banner. Branded gear and temporary transfer tattoos ensured that the Targeting Cancer message was heard in Milan and was spread far and wide across social media.

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 Subspecialty Focus: Interventional Radiology Interventional radiology is an exciting area of modern medicine delivering precise targeted treatment for complex diseases and conditions throughout the body. Using minimally invasive imageguided techniques, interventional radiologists provide high quality care often with lower risks and costs than many surgical alternatives. A high-interest area to both the health consumers and health professionals that visit InsideRadiology, the use of interventional procedures to diagnose and treat injuries and diseases is an area of health that many visitors will only have limited, if any, knowledge of. Providing health consumers with this high quality information can assist with their communication with both referring doctors as well as hospital or practice staff. It can also assist with their informed consent and reduce anxiety before the procedure by giving more detailed information of what is involved. Interventional radiology is practiced across a spectrum, from basic procedures performed by clinical radiologists through to complex vascular, oncological and neurological interventions performed by versatile specialist radiologists with advanced skills in IR and interventional neuroradiology (INR).

Promote InsideRadiology to Patients and Colleagues

Continuing advances in technology means the range of conditions that can be treated by interventional radiology is continuing to expand and the InsideRadiology editorial team will continue to expand the information to reflect this.

Supplementing your Online Resources InsideRadiology encourages its information partners, hospitals, and radiology practices to link directly to the InsideRadiology website so that staff, patients and referrers 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 up-to-date information for their patients without the extra administration. Further information about InsideRadiology can be found at www.insideradiology.com.au/aboutradiology/about-insideradiology/ Please help us promote InsideRadiology by following us on Twitter and Facebook (@InsideRadiology) If you need further information please contact insideradiology@ranzcr.edu.au

InsideRadiology currently covers the following interventional procedures: • Angioplasty and Stent Insertion • Ascitic Tap • Biliary Drainage • Bursal Injection • Carotid Stenting • Carpal Tunnel Ultrasound and Injection • Image Guided Cervical Nerve Root Sleeve Corticosteroid Injection • Image Guided Liver Biopsy • Image Guided Lumbar Epidural Corticosteroid Injection • Image guided lumbar nerve root sleeve injection • Inferior Vena Cava Filters • Joint Injection • Nephrostomy • Pleural Aspiration • Radiofrequency Ablation • SAH Vasospasm Endovascular Treatment • Selective Internal Radiation Therapy [SIRT]: SIR-Spheres® • Spinal Cord Embolisation (AVM/ DAVF) • Thyroid fine needle aspiration (FNA) • Transarterial Chemoembolisation (TACE) • Uterine Fibroid Embolisation • Varicose Vein Ablation • Vascular Closure Devices • Venous Access • Vertebroplasty

InsideRadiology is a conduit of communication between the College, health consumers, and health professionals; further promoting the role and value of clinical radiology and clinical radiologists in patient care. It has been online since 2009 and covers close to 100 topics, with specific information targeted at both consumers and referring clinicians for most items.

Volume 15 No 3 I June 2019

What’s in Issue 3? Medical Imaging Pictorial Essay: Common and uncommon imaging features of abdominal tuberculosis Corresponding author: Dr Pankaj Gupta, Department of Gastroenterology, Postgraduate Institute of Medical Imaging and Research (PGIMER),

Chandigarh 160012, India.

Despite the advances in the medical care, tuberculosis (TB) remains an important health problem. This is particularly relevant to the developing countries as well as the immunocompromised population in the developed world. Multidrug resistance poses another challenge and may be responsible for increasing incidence of TB, to some extent. The respiratory system is the most commonly involved, although any organ system may be affected. Abdominal involvement occurs in 11–12% of the patients with extrapulmonary TB. The clinical features of abdominal TB are nonspecific. Imaging plays an important role in the diagnosis of abdominal TB. Although a few imaging features strongly favour the possibility of TB, abdominal TB is a greater masquerader. In this review, we highlight the entire spectrum of the manifestations of abdominal tuberculosis (excluding the genitourinary involvement) with an emphasis on imaging findings.

Medical Imaging Original Article: Diagnostic reference levels for 18F‐FDG whole body PET/CT procedures: Results from a survey of 12 centres in Australia and New Zealand Corresponding author: Mr Essam M Alkhybari, Faculty of Health Sciences, Discipline of Medical Radiation Science, The University of Sydney, NSW

2006, Australia.

Introduction ‐The aim of this work is to report diagnostic reference levels (DRLs) for hybrid positron emission tomography and x‐ray computed tomography (PET/CT) exams in Australia (AU) for Queensland (QLD) and Western Australia (WA) (AU QLD/WA) and New Zealand (NZ). Methods ‐Two‐structured booklets were designed to collect dose information, patient demographics, equipment details and acquisition protocols for fluoride‐18 fluorodeoxyglucose (18F‐FDG) PET/CT procedures, and any additional diagnostic CT routinely performed as part of 18F‐FDG whole‐body examination. The DRL was reported based on the 75th percentile and achievable dose for 18F‐FDG, CT dose index volume (CTDIvol) and dose length product (DLP). The effective dose and total effective dose were reported for 18F‐FDG whole‐body PET/CT examination. Also, the effective dose was reported separately for identified additional diagnostic CT. Results‐ The findings of this study show that the current DRL for 18F‐FDG in AU QLD/WA and NZ was 333.75 MBq and 332.87 MBq, respectively. The reported AU QLD/WA CTDIvol and DLP associated with 18F‐FDG whole‐body PET/CT examinations from vertex to thigh (VT) was 4.41 mGy and 474 mGy.cm. In NZ, the reported VT CTDIvol and DLP was 13.07 mGy and 1319.05 mGy.cm. The effective dose for 18F‐FDG and CT component was 5.6 mSv and 4.7 mSv for AU QLD/WA. For NZ, the effective dose was 5.7 mSv and 10.9 mSv for 18F‐FDG and CT component. The total effective dose delivered from the 18F‐FDG whole‐body scan from the AU QLD/WA PET/CT centres (10.44 mSv) were lower than the radiation doses delivered from the NZ (16.65 mSv). Conclusions ‐ The current DRLs were proposed for AU QLD/WA and NZ for 18F‐FDG whole‐body PET/CT examinations. Variations existed in the current practice of AU QLD/WA and NZ PET/CT examinations. There is a need to optimize the radiation doses delivered from PET/CT examinations.

Radiation Oncology Original Article: Referral rates to multidisciplinary team meetings: Is there disparity between tumour streams? Corresponding author: Dr Daisy Atwell, Icon Radiation Oncology Centre, 60 Wises Road, Maroochydore, Qld 4558, Australia. Introduction ‐ The multidisciplinary team meeting (MDTM) approach is accepted as standard of care to optimise treatment for patients diagnosed with cancer. This retrospective audit reviews the proportion of patients whose care is being discussed at cancer MDTMs within the Sunshine Coast Hospital and Health Service (SCHHS). Methods ‐ Patients included were those diagnosed with cancer within the SCHHS between 2010 and 2015, and subsequently referred to a public MDTM for discussion. Data were extracted from the Queensland Cancer Control Analysis Team (QCCAT) database regarding the incidence of breast, lung, upper gastrointestinal (GI), colorectal, genitourinary and malignant haematological cancers and the number of patients referred to the corresponding MDTM. Results ‐ Data from 2015 show referral rates to MDTMs as follows: lung 100%, upper gastrointestinal 100%, colorectal 64%, breast 60%, malignant haematology 40% and genitourinary 28%. Of the genitourinary presentations, 70% were prostate cases and 14% bladder cases. Review of genitourinary MDTM outcomes found that, of the patients with prostate cancer discussed, 30% were metastatic, 19% were poor surgical candidates and 15% had biochemical recurrence. Conclusion ‐ This audit demonstrates variable utilisation of MDTMs between tumour streams. Our study shows a high and increasing referral rate to all tumour stream MDTMs except for genitourinary. This suggests a possible underutilisation of genitourinary MDTMs to discuss treatment options for patients with genitourinary cancer. Collaborative research is warranted to further investigate whether this is a local or widespread issue.

Radiation Oncology Original Article: Contouring experiences amongst Australian, New Zealand and Singaporean radiation oncology trainees. Is it enough? What next? Corresponding author: Associate Professor John Leung, GenesisCare, 352 South Terrace, Adelaide, SA 5000, Australia. Introduction ‐ This paper reports the key findings of the first survey of Australian, New Zealand (ANZ) and Singaporean radiation oncology trainees on contouring and planning. Methods ‐ The survey was conducted from May to July 2018 using a 35‐question instrument. It was emailed to all ANZ and Singaporean trainees on the Royal Australian and New Zealand College of Radiologists (RANZCR) database with at least 6 months experience. The questions related to demographics, time spent on contouring, most difficult sites to contour, most useful atlas, feedback on contouring, interaction with radiation therapists, plan reviews, stereotactic radiation therapy (SBRT), brachytherapy and suggested areas of improvement. Respondents were assured that their responses were anonymous. Results ‐ The response rate was 50% (54/108). Most respondents were from New South Wales (31%) with nearly all working full time (96%) and a large majority in public practice (89%). All respondents had at least one other accredited trainee at their site. The large majority (75%) spent at least two hours per week contouring, but nearly 80% had to spend some time out of hours contouring with 10% performing all their contouring out of hours. Two‐thirds of respondents indicated there was insufficient time for contouring with over half having no allocated time for this activity. All respondents could independently contour by their consultants and could do radical and palliative cases. The most difficult cases to contour were head and neck and the upper gastrointestinal sites with the RTOG atlas the most useful guide. All trainee respondents received feedback on their contouring which was most often face to face. Interaction with radiation therapists was valuable and more interaction was desired. Two‐thirds (67%) of respondents had the opportunity to review treatment plans with consultants with one to two cases per week being the most common numbers reviewed, but this was usually not done (87%) on an allocated time in the roster. The large majority (90%) had the opportunity to be involved in brachytherapy, but this dropped to 60% for SBRT. Three quarters (73%) of respondents felt that there was not enough time spent on contouring, planning and evaluation of plans. Conclusions ‐ This initial detailed survey of ANZ and Singaporean trainees on contouring and planning indicates that dedicated protected time without interruption is required for this integral activity with current hours spent on this activity inadequate. Optimisation and improvement in several areas is required. Feedback from this study should be adopted by sites and networks. Feedback could also be considered as the Faculty of Radiation Oncology transitions into programmatic assessment.

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!

Education

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

Course Topics: • High Resolution CT of the Chest: 9-11 August – SOLD OUT • Prostate MR: 10-11 August – SOLD OUT

RANZCR/ACR Education Center Courses RANZCR is pleased to be offering educational courses in partnership with the American College of Radiology (ACR) again this August. Each course will be delivered by leading specialists to provide intensive, interactive and targeted training to attendees. The courses will take place on various dates between Friday 9 August and Sunday 18 August at the Pullman on the Park, Melbourne.

• Body and Pelvic MR: 12-14 August – SOLD OUT • Neuroradiology – Head and Neck: 1618 August – SOLD OUT • Prostate MR: 17-18 August (please note this is the same course content as the earlier course.) There are limited places still available, secure yours today at www.acrcourses. ranzcr.com/

Please contact events@ranzcr.edu.au to be placed on a waitlist for the sold-out courses.

continued over...

Clinical Radiology Keynote Speakers: Dr Michelle S. Ginsberg Memorial Sloan Kettering Cancer Center, New York, USA

Dr Andrew J Grainger Leeds Teaching Hospitals and Honorary Clinical Associate Professor University of Leeds, UK

Radiation Oncology Keynote Speakers: Dr Drew Moghanaki

Dr David Panicek

US Department of Veterans Affairs, USA

Memorial Sloan Kettering Cancer Center, New York, USA

Dr David Sacks Reading Hospital, West Reading, Pennsylvania, USA

Prof Arjun Sahgal

ranzcr2019.com

ENCA0012 RANZCR HALF PAGE AD 170x115mm-V1.indd 1

Dr Paula Woodward

University of Toronto, Toronto, Canada

University of Utah, Salt Lake City, Utah, USA

29/3/19 4:49 pm

Volume 15 No 3 I June 2019

Education

Upcoming Workshops – Until 30 September 2019 RADAIM 2019, Gold Coast QLD, 26 – 28 July Radiology Review Course 2019, Melbourne VIC, 27 – 28 July The Faculty of Radiation Oncology Genito-Urinary Group 2019 Workshop, Cairns QLD, 8 – 10 August 2019 RANZCR & ACR Education Centre Courses, Melbourne VIC, 9 – 18 August Renner: Musculoskeletal MR Made Simple Workshops in Oz, Australia Wide, 17 – 18 August Foundations of Leadership in Radiation Oncology, Sydney NSW, 30 – 31 August The World Congress for Ultrasound, Melbourne VIC, 6 – 9 September ESTRO School FALCON Workshop – Prostate Cancer, Australia Wide, 12 – 19 September These events are subject to change. Please visit the RANZCR Events page for further details.

Musculoskeletal MR

Made Simple

Join us for this fun and interesting Musculoskeletal MR Workshop with Dr. William Renner. “Renner’s Rules” breakdown complex topics into simple components make reading MSK MR exams easy to understand. Practical interpretation of scans is emphasized. Included is an up-to-date 130-page MSK MR Workbook and a MSK MR Cases Workbook. Two-Day Agenda

CPD Points RANZCR

2019 Meetings:

July 27-28 Auckland, NZ Aug 3-4 Sydney Aug 17-18 Melbourne Aug 24-25 Brisbane Aug 31-Sept 1 Adelaide

High Resolution Chest CT Made Simple Workshop

2019 Meetings:

July 29 Auckland, NZ Sept 7 Melbourne – “In Memory of Dr. Ben Felson”

One-Day Agenda

CPD Points RANZCR

Go to www.MSKMR.com for more information and to register.

Inside News

Education

Exploring New Assessment Tools in Radiation Oncology A major recommendation of the ACER-Prideaux review was a move towards programmatic assessment for both Clinical Radiology and Radiation Oncology. The foundation of programmatic assessment is assessment for learning (in addition to assessment of learning). Programmatic assessment describes a strategy that contains several assessments that mirror the work activities that a Radiation Oncologist is expected to do each day (termed work-based assessments or WBAs). Through the use of WBAs across the training program, a detailed picture of the trainee’s competencies develops. It allows decisions to be made about trainee competency on aggregate information (from real-world assessments) rather than based on one high-stakes exam. The Radiation Oncology Steering Committee has developed a number of work-based-assessment tools which are currently being piloted in some training sites. These tools help to track the progression of the Radiation Oncology trainee in developing competencies in various areas as they progress through the training program. They identify areas where the trainee is not progressing, so that appropriate support and remediation can be provided in a timely manner. Included in the new assessment tools are: Contouring and Plan Evaluation Tool (CPET) The CPET focuses on facilitating trainee’s involvement and participation in all aspects of treatment planning commencing from their entry into the training program. Feedback will be provided by Clinical Supervisors on a trainee’s performance in all aspects of treatment planning.

Patient Encounter Assessment Tool (PEAT) The PEAT focuses on providing feedback to trainees on their ability to obtain a history and conduct a physical examination, interpret patient’s investigations or order additional investigations as required. Once done, they are required to synthesise this information into a management plan. The trainee may be observed while consulting with the patient and will be assessed on their ability to use patientcentred interviewing skills, explain the management plan in a way the patient can understand, and their overall professionalism. The observation allows an assessor to evaluate how the trainee integrates their medical expertise into their intrinsic roles. Case Report Discussion Tool (CRDT) The case report discussion tool is a twostep formative assessment focused on building a trainee’s knowledge around care of patients with specific tumours. Firstly, the trainee completes the case report which requires them to comprehensively document all aspects of a case they worked independently on. After reviewing the trainee’s case report, the assessor has a discussion with the trainee about their approach to the case and the rationale for their decision making.

outcomes were circulated to College members for feedback. Thank you to all the members who have taken time to review the document and provided valuable comments and feedbacks. The Radiation Oncology Steering Committee will consider all the feedback and update the learning outcomes as and where appropriate, before it goes out to external stakeholders for additional feedback. The Clinical Radiology Steering Committee is in the process of finalising the new learning outcomes and workbased-assessment tools, which will be introduced in the near future. If you would like more information or have any questions regarding the project, please contact Legend Lee, Educational Developer at the College at legend.lee@ranzcr.edu.au.

Would you like to know more? The tools are available on the College website https://www.ranzcr. com/our-work/other-initiatives/ training-assessment-reform, along with instructions on how to use the tools. If you are interested in being a piloting site, please contact ROtraining@ranzcr.edu.au.

This assessment refers to how the trainee tailored the care specifically to that patient and how they collaborated with colleagues to optimise patient care. The management plan will need to be evidence based and the trainee will need to succinctly discuss the justification for the chosen treatment. Written communication skills are also assessed. During April and May of this year, the revised Radiation Oncology learning

Volume 15 No 3 I June 2019

Education

Phase II exam tips

The Phase II RANZCR FRO examination series was without a doubt, the most difficult, stressful and challenging undertaking of my career so far. It was also one of the most rewarding experiences. It is only with hindsight now that I can appreciate the necessity for such a gruelling process- we emerge as specialists in our unique field, with the breadth and depth of knowledge required to operate as competent Radiation Oncologists. I don’t believe that there is a magic formula to passing although many a night I did wish for a spell or potion that would infuse all the required knowledge into my brain. So, until I receive my letter for Hogwarts, here are my top tips on how to survive the exam process. 1. Play the long game These exams are not a cram the night before effort. Preparing adequately will take time as there is a lot of content to master. Set up a study timetable spanning 6-12 months in the lead up, making sure you factor in your other commitments. This way you can enjoy time out from studying knowing you’re putting in a consistently solid effort. 2. Study Buddy Up Some people prefer solo studying but if possible, I highly recommend finding other trainees to study with. There is so much to be gained from sharing your knowledge and experience. Furthermore, we don’t treat our patients in isolation so the earlier you engage in discussing cases, the better. Not to mention, the solidarity and support you provide each other will be crucial.

Inside News

3. Get involved and be the boss

7. Get organized

Immerse yourself into every task and opportunity at work. From seeing patients in clinics, deciding on management plans, running MDTs, voluming and critiquing plans, to presenting at journal clubs and teaching juniors– the list goes on. Every one of these skills are integral to preparing for exams. If you approach these as if you were the consultant, they will eventually become second nature, and this will in turn ease the entire exam experience.

This is crucial to enable you to balance all your competing demands- work, study, training requirements, family, friends and most importantly YOU.

4. Engage with your network Don’t be afraid to ask other trainees, fellows or consultants who you’ve worked with for advice, exam tips, viva practice or even a pep talk. Everyone has gone through this process and will likely have had similar fears and uncertainties. 5. Practice, practice, practice Sit down with past papers and practice under exam conditions. Try to do a couple of past papers in a row to simulate the exam day. Get these papers marked for feedback. Do as many viva practice sessions as possible. Make up viva cases for your study group. The more familiar you are with writing your knowledge down or speaking it out loud the better. Time is precious in the exam so practice being clear, succinct and confident. 6. See the big picture It is so easy to become completely enmeshed in the exam process and in the lead up close to ‘D-Day’ it is necessary to a degree. Remember this is only one step in your career- passing or failing it won’t define who you are as a person or as a Radiation Oncologist.

8. Yourself, Family and Friends Look after yourself during this processmake time to do things you enjoy. Refresh with exercise or a coffee with a friend. Visit family for a chat about something completely unrelated to work or study. I could not have gotten through my training and exams without the unconditional support of my loved ones. Make sure you remember them and thank them for this. Most importantly, be kind to yourself during this incredibly tough and important task that you are undertaking. Good Luck! Dr Gina Hesselberg

Clinical Radiology

Raising our Profile as Clinical Radiologists A Message from the Dean

Clin A/Prof Sanjay Jeganathan The American poet and writer Mark Van Doren once said that the art of teaching is the art of assisting discovery. While he probably didn’t have radiology in mind at the time, his thoughts are applicable to RANZCR’s ongoing attempts to teach the public more about the critical role radiology and radiologists play in modern healthcare. In doing so, they can discover more about our work. Back in 2014 RANZCR’s Role and Value of the Clinical Radiologist – Position Paper included a pledge to improve the public recognition of the value of radiologists. As a radiologist of more than 20 years’ standing myself, I am aware of the lack of understanding of our hugely important role. Despite our years of training, our willingness to adapt and integrate new techniques and technologies, and our huge contribution to patient care, we represent one of medicine’s most important but least acknowledged medical specialties in terms of the value we add to patient care and health outcomes. Crudely put, no-one is blowing our trumpet and highlighting the great work we do dayin, day-out. On a daily basis, members complain about lack of understanding by patients and other medical colleagues of the contribution we make to patient care. We should also work hard to move away from a commodity provider concept and demonstrate the clinical value we bring. In some areas such as interventional radiology and breast imaging, radiologists are leading the way in providing a more patient-centric model of radiology.

RANZCR is to remedy this situation by taking a more pro-active approach to generating positive media coverage. In addition, one of the pillars of RANZCR’s own Strategy to 2021 is Advocacy, boosting awareness of RANZCR, radiologists and our work through media coverage. This goes hand-in-hand with the College’s work to engage more with the Australian and New Zealand Governments and other important stakeholders, ensuring that RANZCR’s voice is heard when vital decisions are made. During the lead up to the 2019 Australian federal budget and federal election both the Government and Opposition have made substantial commitments to clinical radiology. We are now seen as an important stakeholder and the government is listening and responding to the needs of our sector. This positive interaction comes off the back of several years of promoting the value radiology brings to patient care and the benefits it provides to the healthcare system overall. Recently RANZCR has been working to promote its work in the area of artificial intelligence and technological developments. This has included interviews with RANZCR’s AI Working Group Chair Prof Liz Kenny on respected outlets including the ABC Health Report and New Zealand Doctor. Through this, RANZCR has been able to highlight its terrific work in understanding and harnessing the anticipated effects of AI on radiology and position itself as a thought-leader in this space, a point underlined by the terrific attendance

at last year’s Intelligence18: AI in Healthcare Summit. RANZCR has also been keen to push victories of its members through the media. Late last year we highlighted the Medicare listing of Liver and Obstetric MRI for patients and more recently Breast MRI. These listings, which represented a great win for patients, were driven by clinicians A/Prof Tom Sutherland and Prof Stacy Goergen. In the case of Breast MRI, breast surgeon Prof Christabel Saunders championed this cause tirelessly, creating awareness of the important role Breast MRI plays for breast cancer patients. RANZCR also uses the platform of the annual ASM to publicise the work of our members. Last year, for example, the efforts of WA-based Clin A/Prof Donna Taylor in using Contrast Enhanced Spectral Mammography to help detect breast cancer attracted significant media attention. RANZCR has achieved plenty over the past few years to increase public awareness and knowledge about radiology and the work of the College. While there are risks in taking a more visible role in media activity, these must be balanced by the advantages such efforts bring. I firmly believe RANZCR must continue to promote the specialty of radiology and the terrific work of our members. We have made great strides but there is still much more to do, and I am eager to play a role in these efforts during my tenure as Dean.

Volume 15 No 3 I June 2019

Clinical Radiology

Training Policies begin to take shape Chief Censor in Clinical Radiology

Dr Meredith Thomas

We have achieved a great deal in the Clinical Radiology Specialty Training Unit in the first quarter of 2019, with the progression of the Training and Assessment Reforms, and in the lead up to Examinations and the Director of Training (DoT) Workshop. This is a testament to the commitment and hard work of the Fellows who volunteer their time on various committees, review panels and working groups. I would also like to thank the Directors of Training, particularly those who attended the DoT Workshop in Sydney, our largest attendance on record. For those who were unable to attend I look forward to your attendance at the DoT Workshop at the Auckland ASM.

Training Policies There are a number of RANZCR Clinical Radiology policies which relate to training and which set out the appropriate standard of behavior or actions expected by the College. These policies are continually reviewed and revised to ensure that they meet the needs of trainees and trainers. The following policies have recently been revised: The Part 1 Examination Policy and the Part 2 Examination Policy have been released to consolidate information relating to the respective exams, enabling trainees and Directors of Training to refer to one document for examination information. They replace a number of previous policies, their purpose being to describe the examination requirements and to achieve coordinated and consistent examination practices across RANZCR.

Inside News

The policies apply to all trainees undertaking the current Radiology Training Program, irrespective of the date they commenced training, and the Part 2 Examination Policy additionally applies to all specialist International Medical Graduates (IMG’s) undertaking the Part 2 exams. The Performance and Progression (Clinical Radiology) Policy allows the identification, support and management of trainees who are not performing and/ or progressing at an expected level, prioritizing person and patient safety, fairness, equity, and confidentiality. It facilitates the development of a training site collaborative action plan, identifying issues, actions and intended outcomes, to enable the trainee to progress. The Remediation in Training (Clinical Radiology) Policy may be utilised when trainees fail to progress with local support or may be used primarily for a trainee experiencing more significant performance or progression difficulties. It facilitates the creation, implementation and monitoring of remediation plans within training, pausing training time to enable assistance and supports to be put in place. The Withdrawal from Training (Clinical Radiology) Policy recognises that trainees withdraw or are withdrawn from training for a variety of reasons and identifies under which circumstances it is appropriate for a trainee to be readmitted to the training program. With an increased focus on supporting trainee wellbeing, the Performance

and Progression, Remediation in Training and Withdrawal from Training Policies recognise the need for a more structured process for identifying trainees in need of extra support. Additionally, the policies provide greater guidance to the site on how to manage trainees that are placed on a remediation in training plan. The College recognises that early intervention and support for struggling trainees greatly increases their overall chances of successfully navigating the training program. Directors of Training with concerns for their trainees are strongly encouraged to contact the College to discuss the available support mechanisms.

Training and Assessment Reform (TAR) There is continuing progress on the TAR, with the planned implementation date fast approaching. The curriculum document is almost complete, with work now focusing on blueprinting, finalizing and documenting learning activities and assessments. We continue to liaise with the IT team to ensure that the new LMS and examination platforms are able to deliver our training requirements. A more comprehensive Clinical Radiology update will be provided in the September Inside News.

Continued on page 48...

Clinical Radiology

Clinical Radiology Trainee Matters

All trainees need to support each other so if you know a fellow trainee who is struggling perhaps suggest they discuss their options with their director of training, as often we aren’t aware of what the college offers or at least to be made aware of their options. More details are available on the RANZCR website, or feel free to contact a trainee committee member or Chris Bartley at chris.bartley@ranzcr.edu.au.

Dr Ben Addison

I’m sitting here on ANZAC day writing this article and it’s a poignant reminder of how Australia and New Zealand can come together as one to serve the greater good. Looking at what’s going on in the healthcare systems of our two nations, there are many different challenges being faced by both our health systems. These changes highlight the differences but also the similarities of the struggles, such as the ongoing battle for funding and the increasing need to regulate and protect the rapidly growing technologies, interventions and techniques. For example, clot retrieval has been making a lot of headlines in Australia, with interventional neuro radiology having a huge demand, and many different specialties putting their hats into the ring as providers. Growing pains like this are to always be expected with such a revolutionary and life-saving procedure. It’s important all RANZCR members support the college and get involved in these discussions. Another important issue that has arisen in Australia and will likely become an issue in New Zealand, and that’s the resurgence of silicosis. This has been driven by the manufactured stone industry, trainees and consultants alike

need to be aware of potential pitfalls if reporting films/ scans related to a stone worker etc. For the trainees, those of you sitting the exams will be in a fever pitch of viva preparation, hopefully it’s all going well, and you all crush it! (In fact, by the time you read this you should have your results, so I hope you all did amazingly well!). If there are trainees out there struggling with the exams and training in general, I wanted to highlight the benefits of RANZCR’s remediation during training policy. This came online in November 2018 and is designed to identify trainees who are struggling and offer a program during training to address areas of weakness/ consolidate strengths and give them the best chance of completing the training program. This is a program worked out by the trainee and local Director of training/ Network Director, and is tailor made for the trainee.

On a lighter note the training committee has been in negotiation with emergency departments across Australasia regarding the building and funding of “Matt’s wall”*. While ED has agreed to it on principle, they are concerned by the immobility of the wall, and while they don’t have IV access, yet they’d like to request a CTPA to rule out PE……. Sigh. Warmest Regards, Dr Ben Addison

*For more details of the ongoing saga of "Matt's wall" see previous issue - Ed

This is a much more proactive approach and offers a better chance at getting through exams, rather than failing to pass a crucial milestone and having to do post training remediation and reattempting exams if you are offered an opportunity.

Volume 15 No 3 I June 2019

Clinical Radiology

Chief of Professional Practice Practice’. However, it is likely to have had a different meaning to the one held by the College. For practices, hospitals or health districts across Australia and New Zealand, a Scope of Practice defines the work that an individual practitioner will perform, under the terms of their employment. This scope is influenced by many factors such as the profile of the surrounding population, infrastructure in place or funding available. For the College, defining a Scope of Practice will outline areas of practice that a new Fellow is deemed capable of delivering. A/Prof Dinesh Varma

In 2018, there were 125 radiology trainees who successfully graduated from the College speciality training program. There are a further 77 trainees currently working towards graduating this year. The incoming membership accounts for more than 5% of all radiology Fellows, a significant proportion of the Australian and New Zealand workforce. This, together with the rising trend of sub-specialisation has urged the College to ensure the capabilities of all Fellows is captured and defined. Articulating these capabilities will help to regulate and protect the professional standards for our profession and assure high quality and safe practice.

Our First Step… The Professional Practice Committee’s (PPC) first step is to define the capabilities of new Fellows. We plan to do this by putting in place a Scope of Practice. Being able to articulate the extent to which a new Fellow can practice is considered core to good clinical governance. What ensues beyond the baseline can be captured by appending or augmenting the Scope of Practice. Most members are likely to have encountered the term ‘Scope of

Inside News

Why is Scope of Practice so important? The value of having a scope of practice for clinical radiology in place is endless. It offers a benchmark for safe practice, provides transparency for radiologists, employees and patients, whilst offers a structure for quality assurance and continuous improvement for individuals through activities such as CPD. A working group was established by FCR Council last year to draft a Scope of Practice. Their progress is now being integrated by the PPC into a final document. Once complete, members will be asked for feedback through a consultation period. We urge you to review and provide feedback during this process.

What the PPC is doing to support post-fellowship education. There are 3,912 active radiology Fellows within the College. To maintain medical registration with the Medical Board of Australia (MBA) or Medical Council of New Zealand (MCNZ), all 3,912 radiologists must demonstrate compliance with the CPD requirements of the College. Both the MBA and MCNZ have announced reforms to CPD, which are scheduled to commence from 2021. These changes are aimed at improving public safety, better identify and manage risk, whilst tailor CPD

to the scope of practice of individual practitioners. The PPC will play an active role in advising FCR Council on matters relating to the CPD reforms, focusing on a seamless transition for radiologists from the current CPD requirements to the new ones. We plan to focus on supporting radiologists with meaningful instruments to implement the reforms such as resources for a feasible and acceptable learning portal that meets the needs of members, in addition to providing specific tools to meet the new requirements such as clinical audits, and peer reviews.

The role of College assets There are now six Special Interest Groups (SIG) within the Faculty of Clinical Radiology. These focus on special areas of radiology practice including; Paediatric, Emergency, Rural, Abdominal, Thoracic and Breast Imaging. SIGs are one of many College assets and offer the opportunity to capture valuable information around a particular area of practice. The PPC hopes to benefit from the knowledge of SIGs by creating pathways for two-way communication between work occurring at the College, and SIGs. It is early days, but we have recently engaged some members of the ANZ Society of Thoracic Radiology (SIG) to develop training requirements for radiologists screening for silicosis. You can read information about the work occurring in this area on page 11 of this edition. I will look forward to providing an update of our work in the next edition of InsideNews. Yours sincerely, Dinesh Associate Professor Dinesh Varma Chief of Professional Practice Faculty of Clinical Radiology

Clinical Radiology

Clinical Radiology Accreditation Update Understanding the Radiology Network Training Policy For accreditation of Clinical Radiology Training Sites, they are assessed and monitored to ensure a training site is able to deliver the Clinical Radiology (Radiodiagnosis) Curriculum. To support the training program, the Radiology Network Training Policy was first approved in July 2014 and was amended in September 2018. It is designed to aid The Royal Australian and New Zealand College of Radiologists with the following: • The Australian Medical Council (AMC) and Medical Council of New Zealand (MCNZ) endorsed the move towards a network model for specialist medical postgraduate training in Australia and New Zealand • Currently, there are existing Clinical Radiology Training networks in place in some Branches, both in full or in part with the aim for all Clinical Radiology Training to move to a Network based model in the next few years. • The Branch Education Officer represents their branch at the Clinical Radiology Education and Training Committee (CRETC) which is responsible for Clinical Radiology Training and Accreditation. Branches are diverse population wise and geographically, which differentiates solutions to network training between branches. A Branch is defined as a Wide Area Network (WAN) which consists of 1 or more Local Area Networks (LAN). The WAN is chaired by the Branch Education Officer and overseen by the network governance committee (NGC). The LAN is chaired by the Network Training Director (NTD) and overseen by local governance committee (LGC).

LAN rotations are determined by the LGC. At recruitment, trainees are informed they may be required to work at any site in the LAN with all rotations planned with at least 6 months’ notice for those requiring relocation. New training sites are accredited individually as well as part of the network for a specified amount of accredited positions. To become part of a LAN, any new site must be supported by the LGC and NTD. Appointing trainees outside of the Network Training Policy requirements has been an issue raised and discussed by the CRETC at their meeting in February 2019. It was agreed that all training sites that are part of training networks must comply with the RANZCR Training Policy which are endorsed by the AMC and MCNZ.

The Policy does not differentiate between new trainees and existing trainees, noting that trainees are not "accredited", rather training sites and training positions are accredited. As such, all trainees, irrespective of stage of training, are required to be recruited through a centralised process to a Training Network as per the Policy. If you have any questions about accreditation, please contact Bettina Brooke at Bettina.Brooke@ranzcr.edu.au

Dr Mark Phillips Clinical Radiology Chief Accreditation Officer

The Policy states that training sites are under the governance of the Local Area Network, responsible for operational delivery of the curriculum by managing trainee allocations and rotations, and the Wide Area Network responsible for centralised recruitment and education strategic planning. The Policy States as below: • 5.2.1 - "trainees will be hired into network", and • 5.2.3 clearly states that "a single site cannot recruit trainees independent of a network." • 5.3.3 states that the WAN will be responsible for "the selection, recruitment and allocation of training terms and trainees across the network", noting at 7.6 that "the Local Governance Committee (of the LAN) is to have a role in the selection, recruitment and allocation of training terms and trainees across the network."

Volume 15 No 3 I June 2019

Clinical Radiology

A note of thanks not addressing the Medicare freeze has been well and truly clear to the politicians. We’ve used every effort to remind our politicians of the real pain being felt by our patients. This included television, print, online, social media, billboards, editorial and materials in practices. We targeted governments, parties and, where necessary, individual local MPs. We haven’t been backward about coming forward – because of what’s at stake.

Health is a common battleground during Federal Elections, and 2019 was no different. But, this year, ADIA – together with radiology practices around Australia and with the support of RANZCR – achieved something that will live on well after the dust has settled on another heady few months of promise and counterpromise. In March, the Morrison Government announced that Medicare rebates for ultrasound and x-ray services would join CT scans in being indexed from 1 July 2020. This measure was included in the Budget, ensuring it will be implemented regardless of which party is in government at the time. This is a huge win for our profession and our patients. Ultrasound, x-ray and CT account for 80% of services by value and more than 90% by volume. The end of the freeze will help alleviate cost pressures on patients and practices, making quality healthcare more accessible to all Australians.

Inside News

Crucially, this measure finally recognises the indispensable role of radiology in modern healthcare and introduces funding settings necessary for its sustainability. This achievement hasn’t been easy. Large investments by Government are fundamentally driven by politics rather than policy. Throughout the many phases of our campaign, ADIA has ensured that the political cost of

Following the Government’s announcement in the Budget, Labor announced a substantial election commitment on MRI access and cancer imaging. For the first time, the major parties are running on platforms of increased investment in radiology – a demonstration of the political muscle our sector has when we present a united voice. To radiologists who participated in the campaign at any level – thank you. Successful advocacy is not just about a national campaign led by a peak body, but local action to win support of local politicians. And the results clearly speak for themselves.

Clinical Radiology

Abdominal News The 11th ARGANZ Meeting in March was the first to cross the Tasman and we were delighted at the success, with over 250 delegates gathering in Auckland. There was a focus on pancreas and liver imaging by our two expert international speakers from the USA, A/Prof Koenraad Mortele and A/Prof Alessandro Furlan. Backed by a team of strong local speakers, delegates enjoyed two days of all things abdominal and many also participated in the Friday workshop on liver, MRE and rectal imaging. The pancreas MDT and other sessions involved non-radiological colleagues to ensure a clinical perspective. The winner of the 2019 Mendelson trainee research prize was Dr Michael Chan for his presentation on HCC screening using abbreviated MRI for high risk patients. He receives a trip to the 2019 or 2020 ESGAR Meeting. Second prize went to Dr Jonathan Dillon. This year sixteen paper posters were also presented, now welcomed

from all radiologists. In addition to the annual meeting the executive is continuing to focus on ways to further the aims of ARGANZ. Over the past year we have provided feedback to RANZCR on abdominal related matters, lobbied for CTC availability, seen the success of the liver MRI rebate, initiated a new MSAC application for CTC, joined the working party for the Australian HCC Guidelines led by the Gastroenterological Society of Australia and had radiologists acknowledged as members of the Australasian Gastrointestinal Trials Group (AGITG). We have formed an affiliation with ESGAR and are currently working with the Society of Abdominal Radiology (USA) to bring more educational benefits to our members. LIRADS webinars are now available via the ARGANZ website, along with an MRI Prostate teaching resource offering. We are also collaborating with Radiology Across Borders to bring abdominal

Dr Michael Chan receives the 2019 Mendelson trainee research prize

imaging education to neighbouring nations. Please visit the website at www.arganz. org to learn more and join us in Brisbane for the 2020 meeting, where ARGANZ will also be hosting a full day ESGAR liver imaging workshop. Dr Kirsten Gormly, Chair ARGANZ

Volume 15 No 3 I June 2019

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Radiation Oncology

Cancer treatment comes to the fore in 2019 Federal Election A Message from the Dean Dr Madhavi Chilkuri

A focus on cancer

New Zealand Horizon Summit

ESTRO38 – Milan, Italy

For members in Australia, and those with an interest in politics in particular, there have been some interesting developments with the 2019 Federal election. The 2019 Federal Budget and Budget Reply set the tone for the election. The Government’s budget committed $63 million to the development of additional cancer centres, whilst cancer was clearly to the fore of Bill Shorten’s Budget Reply—in which Labor announced a $2.3 billion Medicare cancer plan.

The New Zealand Minister of Health, Dr David Clark, recently hosted a New Zealand Horizon Summit. The aim of this was to raise awareness about radiation therapy in New Zealand, dispel myths around the treatment and how it works, and highlight issues, including workforce and patient access. A more comprehensive summary of the day is on page 9 of this issue.

Our Faculty was well-represented at the European Society for Radiotherapy and Oncology (ESTRO) annual conference, held in Milan. Along with some very interesting and topical presentations, the Faculty had an opportunity to have a number of meetings with our European colleagues, including discussions on the continued relationship between ESTRO and FRO. More information about ESTRO38 can be found on page 21 of this issue.

The College has worked closely with all sides of politics to ensure that, whatever the outcome, we have an understanding of the direction either party likely to form government would take with regard to cancer care. The four main parties, with representation in both houses, were supportive of the College’s election asks and provided responses to our survey (see https://www.ranzcr. com/whats-on/news-media/325-federalelection-2019-survey-responses). We are now well prepared to continue our advocacy efforts and working with the incoming government. I would like to take the opportunity to recognise all the behind-the-scenes work of the College secretariat and office bearers including Dr Lance Lawler (President), Natalia Vukolova (CEO), Mark Nevin (Senior Executive Officer), and Leila Stennett (Manager, Advocacy and Media). A tremendous amount of effort has gone into the College’s advocacy in this election— preparing briefing papers, scheduling and attending meetings, and the development of our election asks survey.

This event would not have happened without the leadership and drive of Dr Carol Johnson (Chair, New Zealand Radiation Oncology Executive) and other members of the Executive, and the support of College staff, particularly Jenna Howell (Projects Officer, New Zealand) and Leila Stennett (Manager, Advocacy and Media).

Training and Assessment Review (TAR): Revised Radiation Oncology Learning Outcomes

Faculty Council meeting The Faculty Council will be meeting in Brisbane at the end of June. As mentioned in the eNewsletter, there will be an opportunity the evening before for those in and around Brisbane to come along and meet the Council over some informal drinks and canapes. I hope to see as many members at this inaugural event as possible.

Thank you to all members who provided feedback on the draft revised learning outcomes. The learning outcomes reflect what we want from our future radiation oncologists at the completion of their training. The membership will continue to be kept abreast of the developments as the TAR project continues. I am grateful to A/Prof. Margot Lehman (Chief Censor) and all those involved with the TAR for the energy that is being put into this project.

Volume 15 No 3 I June 2019

Radiation Oncology

Draft training programs approach milestones Chief Censor in Radiation Oncology

A/Prof Margot Lehman

Training and Assessment Review The Training and Assessment Review (TAR) and subsequent development of a new training program has been a major piece of work occurring over the last three years. A decision has been made by the Taskforce overseeing the TAR to launch the new training program in 2021, with a key milestone being completion of the draft training programs by August 2019.

1. Learning outcomes – stakeholder review Learning outcomes (statements that describe the knowledge and skills trainees should acquire by the end of the training program) have been reviewed and updated. I would particularly like to acknowledge the significant contribution of members of the working groups and Specialty Interest Groups to this work. The learning outcomes have now been edited and consolidated into one document. The content layout of the new document differs from previous iterations in order to reflect patientcentred care. In addition, while some sections of the curriculum have minor updates (e.g. Oncology Sciences), other sections have been transformed or additional content added. I would particularly like to thank Dr Tanya Holt and Dr Mark Pinkham for their major contribution to the expanded section on symptom control and palliative care. The document was made available to all College members for comment during

Inside News

April and May, and feedback received is being considered by the Steering Committee.

2. P rogrammatic Assessment – Piloting of Work Based Assessment Tools A major recommendation of the TAR was a move towards programmatic assessment. The foundation of programmatic assessment is assessment for learning (in addition to assessment of learning). Programmatic assessment describes an assessment strategy that contains several assessments that mirror the work activities that a Radiation Oncologist is expected to do each day (termed workbased assessments or WBAs). Through the use of WBAs at various points along the trainee’s progression through the training program, a detailed picture of the trainee and their competencies develops and allows decisions about trainee competency to be made on aggregate information (from realworld assessments) rather than one high-stakes assessment. You can read more about this in the Training and Assessment Review article on page 27 For WBAs to be successful they need to be easy to use and not burdensome for supervisors or trainees, they need to reflect what is done in everyday practice and they should facilitate feedback to trainees. Regular, short observations that facilitate a conversation about “here is where you are, this is what you can do better, this is what you have done better

“add up to high level performance training in context. Members of working groups, with oversight from the Steering committee, have developed several WBAs. These include: Contouring and Plan Evaluation Tool, Patient Encounter Assessment Tool, Case Report and Case Report Discussion Tool, and a Communication Skills Assessment Tool. Most of those tools are now being piloted in Training Networks throughout Australia, New Zealand and in Singapore.

3. Director of Training Meetings I encourage DOTs and Clinical supervisors to attend DOT meetings. In our most recent meeting, updates around the new training program were discussed. A major focus was on the content and expectations of the Phase 1 and Phase examinations. This session was led by the Chief of Examinations and the Phase 1 and Phase 2 leads, with the aim of ensuring DOTs and clinical supervisors had up to date knowledge in order to assist their trainees in preparing for these examinations. In future sessions, we plan to focus on how to have difficult conversations with trainees, especially around breaking bad news.

Radiation Oncology

Radiation Oncology Trainee Matters part of their training pathways.

Dr Mihir Shanker I ran into a colleague from medical school in the hospital recently who had just started internship. While discussing the trials and tribulations of the transition from medical school to junior doctoring, we reached the topic of the importance of engaging in clinical research. A particularly striking statement was mentioned which stuck with me; “If I wanted to do research, I wouldn’t have done medicine”. This notion seemed to drive the point home that practicing as a modern clinician is perceived to be largely separable from performing clinical research. There has been a paradigm shift in medicine over the past few decades where junior clinicians are increasingly engaging in research activities from an earlier and earlier phase of their career. Often used as a means of being competitive for entry into training, to build networking with senior colleagues or due to genuine passion and interest in medical academia. The importance of research is increasingly being recognised with the majority of accredited training programs encompassing research requirements as

The culture of research in radiation oncology encompasses the large and yet unknown fundamental radiobiology of healthy and malignant tissue to ongoing clinical trials which influence our daily practice. As a specialty which is inherently technologically based, adaptability is a prerequisite hallmark of the nature of rapidly changing understanding in the science which drives our profession. The safe and effective practice of modern medicine draws on the outputs of health and medical research and a commitment to evidence-based clinical decisionmaking. As trainees, we must engage in research as a means to understand the published peer-reviewed literature which is highly integrated and fundamental to our work. We must learn to be critically analytical about new data which impacts our patients lives and as trainees, we progressively combine and integrate new research with our own knowledge and experience create better outcomes for our patients.

RANZCR ASM 2019 The 70th RANZCR ASM will be held from 17-20th October in Auckland, New Zealand. Our ROTC ASM representative Dr Anna Gubbins is developing a fantastic program for the Trainee Forum which will be held on Saturday 19th October. Please apply for leave early for all those who are attending.

I encourage all trainees who require any guidance with the research component or any aspect of the training program to seek support via myself and/or other members of the ROTC, your Director of Training, Network Training Director or Liaison Officer (Chris Bartley). 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. Best wishes, Dr Mihir Shanker ROTC Chair

Volume 15 No 3 I June 2019

Advertorial

Patient engagement through Noona Varian’s technology ecosystem is taking a significant leap in the area of patient engagement, thanks to the company’s recent acquisition of Noona, developer of a cloud-based mobile service that captures cancer patient-reported outcomes (PROs). According to Jani Ahonala, co-founder of Noona, randomized controlled trials have shown that the implementation of digital patient-reported outcomes tools in cancer care can result in survival benefits for patients. Other benefits that have been documented include: efficiency in the clinic (as patients use Noona in advance of their scheduled visits), improved patient satisfaction, more accurate symptom assessment, and better symptom management between visits.1 “I believe that more widespread use of PROs technology will speed up the paradigm shift from reactive to proactive care,” said Ahonala. “PROs have the potential to become a real driving force in cancer treatment decision making.” At the Helsinki University Hospital Comprehensive Cancer Center, over 100 nurses and doctors use Noona to stay in touch with patients between visits during their treatment journey. According to Tiia Ollikainen, oncology nurse, the biggest benefit of Noona has been time saved. “I used to get up to 10 phone calls a day and they would last about 10-15 minutes each. Replying to [a patient’s] messages via Noona takes 2-5 minutes, and the patient receives all the necessary information quickly. This saves as much as 30-60 minutes per day.” Patients of all ages, including elderly patients, quickly become active Noona users, Ollikainen said. “Age is not a barrier. The average age of users is 64. Noona helps us get a more accurate picture of what’s going on with our patients than we get from what they say during visits. They often try to convey a more positive picture of how they felt

Inside News

between treatments than was actually the case. When we ask them about something they reported in Noona, they often admit that maybe they haven’t been feeling so well between visits.” “We are excited to add the Noona technology and team to Varian as we continue to focus on finding ways to improve patient care,” said Corey Zankowski, senior vice president of Oncology Software Solutions at Varian. “The Noona app will allow oncologists to capture real-time PROs and monitor and proactively manage their patients’ symptoms. Sustained engagement with patients may help oncologists detect early signs of potential recurrence or progression of disease.”

“The combination of Noona with Varian is a natural fit,” said Ahonala. “By becoming part of Varian, we have the opportunity to expand the global availability of the Noona technology and elevate the voice of the patient in cancer care.”

Bennett AV, Jensen RE, Basch E. Electronic patientreported outcome systems in oncology clinical practice. CA Cancer J Clin 2012;62:336-347.

The information captured herein represents the genuine experience of the attributed individuals and may not necessarily represent the views of Varian or the above referenced institutions. Individuals were not compensated for their participation. A version of this article previously appeared in the January 2019 issue of the Association of Cancer Executives Update.

Radiation Oncology

Precision radiotherapy delivers survival gains in inoperable lung cancer A new clinical trial by TROG Cancer Research has shown for the first time that a new radiotherapy technique produced greater survival rates in early stage inoperable lung cancer patients, compared to conventional radiation treatment. The TROG 09.02 CHISEL study aimed to investigate if Stereotactic Ablative Body Radiotherapy (SABR) is more effective than standard radiotherapy for patients with non-small cell lung cancer (early stage lung cancer). SABR is a new, highly-targeted technique for delivering very high radiotherapy doses targeted at a patient’s tumour. The high doses ensure patients complete their treatment sooner than for conventional radiotherapy, as the required dose can be given over fewer trips to hospital. The CHISEL study was a Phase III clinical trial involving 101 patients with inoperable early-stage Non-Small Cell Lung Cancer, from Australia and New Zealand, and who were randomised to

Patient Maureen Chrul volunteered for the CHISEL study with Professor David Ball.

receive either SABR or conventional radiotherapy. Professor David Ball, who headed the trial, said the results were practicechanging. “Our trial found that for patients with early-stage lung cancer, SABR was more effective in controlling cancer growth, resulting in longer life expectancy and is just as safe as traditional radiotherapy. We found that 89% of cancers were controlled two years after SABR treatment and this compared to 65% for conventional radiotherapy, and there was also a clear benefit in overall survival.” After two years, 77% of the patients who received SABR treatment were surviving compared to 59% of those who received conventional radiotherapy. Conventional radiotherapy for this cancer requires the patient to return to hospital regularly over six or seven weeks to receive their required radiation dose in small amounts. With SABR, the same treatment is delivered in a more

concentrated dose - and in a highlytargeted way - requiring only three to four visits to hospital over around two weeks. “As the SABR technique is much more precise, only the cancer is treated and the surrounding healthy tissue is unaffected,” Professor Ball said. “Not only is the treatment more effective, but it is more convenient with fewer hospital attendances which is a significant bonus.” The trial, which began in 2010, is the first to demonstrate a survival benefit from SABR in non-small cell lung cancer. This trial was a collaboration involving TROG Cancer Research and the Australasian Lung Cancer Trials Group (ALTG). The trial was funded with grants from Cancer Australia, The Cancer Society of New Zealand and the Cancer Research Trust New Zealand. Maureen Chrul, was one of the patients who signed up to participate in the CHISEL trial. The 76 year old received the new SABR technique to treat her lung cancer. Maureen has also experienced conventional radiation therapy for an earlier cancer treatment. “I didn’t have any side effects with the SABR technique and I had just three treatments, which was much better than the six weeks of radiation treatment I had to treat another lung tumour. With the traditional treatment I felt much more tired with that treatment and had some burning to by chest and back,” said Maureen.

Volume 15 No 3 I June 2019

Radiation Oncology

Radiation Oncology Accreditation Update An ongoing issue that has become apparent and remained a longstanding problem is protected time for our trainees. The standards mandate four hours per week where trainees have uninterrupted time with teaching sessions/ research time or other activities that they can pursue. Unfortunately, the last two censuses have revealed that there are 15% of trainees having no protected time at all and another 38 % having only one hour per week. Accreditation visits have confirmed many sites struggle to give trainees protected time. There seems to be little improvement over the last several years despite widespread knowledge that this should occur. Accreditation visits have taken trainees protected time, which is an important requirement, into account when assessing the overall status of the site/ network. Protected time for trainees is inextricably linked to other crucial areas such as adequate teaching for trainees, ability to complete research activities, other assessments, etc. If the site is performing well overall, however, it may be that the emphasis of the site visit has not been solely on protected time but on other standards measured against the Radiation Oncology Accreditation Standards and Criteria for Training Networks and Sites. You can read the standards and criteria document on the College website. Contouring time and evaluation of plans by trainees is being emphasised more with a recent study revealing that although the majority of trainees being able to independently contour, evaluation of plans could be improved as this was often done on an ad hoc basis rather than having a structured format. Contouring and plan evaluation

Inside News

should have protected time rather than being done on an ad hoc basis with constant interruptions and should be done within working hours. Directors of Training (DoTs) should be acknowledged for their pivotal role and should also be given adequate protected time to do the job. This role is often taken by younger colleagues, but this does not mean that they are solely responsible for training. Sites often have one engaged clinician who is the DoT. More input from clinical supervisors would be beneficial and lessen the responsibility for our DoTs. Inpatient management has become an issue recently with accreditation standards mandating this must occur for a site/ network to be accredited. There has been some debate about this with opponents indicating they are unable to keep up with developments in general medicine or have little interest in this area. However, proponents argue that if radiation oncologists are to be regarded as clinicians rather than as technicians, then this must continue to occur. This was reaffirmed in the last census when the large majority of respondents thought we should continue to manage inpatients. The mechanism of how this occurs e.g. whose bed card the patient should be under remains to be sorted out. Finally, workplace culture has become a focus of visits. What does this mean? It is perhaps best described as the environment you create for all your staff. It has a powerful role in determining work satisfaction, relationships and progression. The organisation's leadership, values, traditions, beliefs, behaviours and attitudes all contribute to this. It is important as it creates an

environment for healthy development; drives engagement; attracts and retains talented staff; and, helps contribute to satisfied employees. It does not necessarily refer to direct bullying, harassment or discrimination although this may be part of it. It also does not necessarily relate to how busy a department is as some very busy sites have excellent workplace culture and are able to thrive. If you have any questions about accreditation, please contact Bettina Brooke at Bettina.Brooke@ranzcr.edu.au A/Prof John Leung Radiation Oncology Chief Accreditation Officer

Radiation Oncology

Radiation Oncology Quality Corner Radiation therapy is the most complex treatment modality provided in the Australian and New Zealand Health services, and for a common and toooften-fatal disease. Fundamentally, Quality is central to that which all stakeholders—funders, regulators, servicecommissioners, heathcare-service providers, healthcare workers, and most importantly patients and their families— expect from radiation therapy. The College and the Editor of “Inside News” immediately recognised the value of promoting and discussing Radiation Oncology Quality when the FRO Quality Improvement Committee (QIC) suggested a regular “Quality Corner” in the “Inside News” earlier this year. So this is the first of a regular vital part of the College’s communications with members. Each edition will have words from invited radiation oncologists

on aspects of Quality in radiation oncology. Of course “Quality” is a slippery concept and may be defined by the know-it-when-I-see-it US Supreme Court description of something else.[1] To get a grip on the slippery thing the Institutes of Medicine have codified six domains of Quality: safe, effective, patientcentred, timely, efficient, and equitable. [2] And these would seem to pretty well capture the elements of Quality that we would be concerned about in radiation oncology. The QIC hopes that a regular reflection in the “Inside News” will help in keeping this ineffable idea central to how we think about our what we do. What applies to motorcycle maintenance applies to radiation oncology: “Care and Quality are internal and external

aspects of the same thing. A person who sees Quality and feels it as he works is a person who cares. A person who cares about what he sees and does is a person who’s bound to have some characteristic of quality.” [3] I hope we all care. Prof Jeremy Millar

1. Jacobellis v. Ohio, 378 U.S. 184 (1964) 2. Institute of Medicine (IOM). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C: National Academy Press; 2001. 3. Pirsig, R. Zen and the Art of Motorcycle Maintenance William Morrow and Company, 1994

Genito-urinary News The Executive is convening the 2019 FROGG Workshop “The Art of Genitourinary Radiation in 2019 – Bladder, Prostate & Beyond” in Cairns on 8-10 August. Featuring keynote presentations from Prof Ananya Choudhury (The Christie/Manchester Cancer Research Centre) and local faculty, interactive case discussions and planning workshops. Registration is available at www.frogg2019.org.au We look forward to seeing you there. In preparation for the workshop - a survey regarding patterns of practice in the management of bladder cancer will be circulated to fellows shortly; results of the survey will assist in the development of draft consensus guidelines on the radiotherapeutic management of bladder cancer, which will be discussed and developed further at the workshop.

We encourage all who receive the survey to complete it. The FROGG executive wishes to extend its thanks to A/Prof Dion Forstner for his support and engagement for prostate cancer advocacy issues during his term and welcomes Dr Madhavi Chilkuri as incoming Dean. The committee is looking for enthusiastic members to join FROGG and be involved in our committees/ workshops/education/advocacy programmes. If you would like to be involved or have any enquiries, please email Tan.Nguyen@ranzcr.com, or any of the executive members. An invitation for expressions of interest currently appears on the RANZCR website under Volunteering Opportunities. We encourage you to visit the website to

see how you can become more involved. We are also interested in feedback from fellows on the role of FROGG as a RANZCR Special Interest Group, and what activities or resources would be valuable to the GU community – please get in touch. Executive Committee: Dr Amy Hayden (Chair), Tanya Holt (Deputy Chair), Andrew Kneebone, Guiseppe Sasso, Mark Sidhom, Thomas Shakespeare, David Christie,

Volume 15 No 3 I June 2019

SUPPORT THAT’S AS INDIVIDUAL AS THEY ARE *

*Helping to meet the needs of patients with prostate cancer and healthcare professionals through initiatives such as patient support materials and supporting educational activities.

Zoladex is indicated for:1 Palliative treatment of metastatic ( M+ ) or locally advanced prostate cancer where suitable for hormonal manipulation. Adjuvant and neoadjuvant therapy in combination with radiotherapy for the management of locally advanced prostate cancer in men suitable for hormonal manipulation.

Before prescribing please review full Product Information available on request from AstraZeneca on 1800 805 342 or at www.astrazeneca.com.au/ PI PBS Information: Zoladex 10.8mg. Restricted benefit for locally advanced

( equivalent to stage C ) or metastatic ( equivalent to stage D) carcinoma of the prostate. Zoladex® 10.8 mg Implant ( goserelin acetate ) Minimum Product Information. Indications: Metastatic ( M+ ) or locally advanced prostate cancer; adjuvant and neoadjuvant therapy in combination with radiotherapy for locally advanced prostate cancer. Contraindications: Hypersensitivity to LHRH, LHRH agonist analogues or any components of ZOLADEX. Precautions: Not indicated for use in females or in children; patients with metastatic cancer at risk of developing ureteric obstruction or spinal cord compression - use of ZOLADEX should be carefully considered and monitored closely in the first month; injection site injury, including pain, haematoma, haemorrhage and vascular injury, care with patients of low BMI and /or receiving full anticoagulation medications; bone pain; serum testosterone concentrations may rise if implant is omitted or delayed; loss of bone mineral density; hyperglycaemia and increased risk of developing diabetes – periodically monitor blood glucose and /or glycosylated haemoglobin ( HbA1c ). Androgen deprivation therapy may result in prolongation of QT/QTc interval- consider benefits versus risks in patients with congenital long QT syndrome, congestive heart failure, frequent electrolyte abnormalities or taking drugs known to prolong the QT interval. Correct electrolyte abnormalities. Monitor for symptoms and signs of development of cardiovascular disease and manage appropriately. Effects on fertility – see full PI. Adverse reactions: Very common ( ≥10% ): decreased libido, hot flush, abnormal blood pressure, hyperhidrosis, erectile dysfunction, gynaecomastia, breast tenderness, paraesthesia, decreased bone mineral density; Common ( ≥1% to <10% ): impaired glucose tolerance, spinal cord compression, incontinence/urinary frequency ( post-radiotherapy ), rash, bone pain, arthralgia, injection site reaction, cardiac failure, myocardial infarction, increased weight, mood swings; For less common adverse reactions, see full PI. Dosage: One implant ( 10.8 mg ) injected subcutaneously into anterior abdominal wall every 3 months. Caution should be taken while inserting ZOLADEX into the anterior abdominal wall due to the proximity of underlying inferior epigastric artery and its branches. Use extra care when administering ZOLADEX to patients with a low BMI and /or who are receiving full anticoagulation medication. Date of first inclusion in the ARTG: 22 May 1996. Date of most recent amendment: 16 May 2017. References: 1. Zoladex 10.8 mg Approved Product Information. Zoladex® is a registered trademark of the AstraZeneca group of companies. Registered user AstraZeneca Pty. Ltd. ABN 54 009 682 311. 66 Talavera Road, Macquarie Park, NSW 2113. www.astrazeneca.com.au. For Medical Information enquiries: 1800 805 342 or medinfo.australia@astrazeneca.com. To report an adverse event: 1800 805 342 or via https://aereporting.astrazeneca.com. AU -5913, WL302306, April 2019

General Interest

Acquiring formal speciality recognition Interventional Radiology Interventional Radiology (IR) is one of the fastest growing areas within radiology, and its emergence as a clinical specialty presents unique opportunities across the full spectrum of Clinical Radiology. The expansion of IR is generating new therapeutic, diagnostic, technological and clinical frontiers that will benefit both Interventional and Diagnostic Radiology (DR) alike and consolidate the role of the radiologist in modern clinical practise. By emphasising clinical practise, training, standards and research, interventional radiology has earned the right to promote its status as a clinical specialty; The College’s Faculty of Clinical Radiology via the Interventional Radiology Committee (IRC) is currently working towards acquiring formal specialty recognition for IR in Australia and New Zealand.

Fears about fragmentation of radiology ignore the fact that good interventional radiologists must possess high-level diagnostic radiology skills alongside advanced procedural ability; similarly, diagnostic radiologists are increasingly required to perform image-guided procedures to provide comprehensive radiology services. Professional recognition of interventional radiology will also help to ensure that training and practise standards set by RANZCR are applicable to all clinicians performing image-guided procedures.

Specialty recognition would help to secure the future of interventional radiology in many ways: by expanding its clinical footprint; promoting an identity for interventional radiologists; setting training, practise and professional standards; strengthening quality-assurance and quality-control protocols; pursuing more rigorous workforce planning, and many more much-needed developments.

Specialisation of IR also need not diminish the crucial role that other radiologists play in performing imageguided procedures, whether basic (Tier A) or a subset of advanced interventional procedures (Tier B). The two concepts are not mutually exclusive, with similar precedents existing in other specialty colleges. It is possible to have IR fully recognised as a specialty in its own right, and still preserve the important contribution from radiologists who may not have completed fellowship-level training across the full-spectrum of IR. This highly trained and competent workforce currently contributes enormously to the collaborative, collegiate and professional delivery of interventional radiology services across Australia and New Zealand.

However, the broader significance for Clinical Radiology in achieving these milestones should not be underestimated. Far from being a divisive step, specialty recognition for IR would be an important advance for all of radiology and enshrine the roles of clinical radiologists who both perform image-guided procedures and interpret the increasingly complex imaging that accompanies these. This will lead to greater influence for radiologists, through legitimised representation in clinical pathways and treatment guidelines, and better imaging services across the board.

Thus, the futures of IR and DR are inextricably linked, with a mutual reliance on high quality image acquisition, interpretation, intervention and decision-making to direct patient management. Perhaps the greatest example of this is the critical interaction between diagnostic and interventional neuroradiologists in assessing stroke patients for possible endovascular clot retrieval – a process that often involves radiology registrars, fellows and consultants working together after-hours. Similarly, through better integration of radiology as a clinical specialty, it is possible for some trauma

patients to proceed from the emergency room to the angiography suite and eventual discharge without ever having to go to a traditional operating theatre. When IR is respected as a distinct and valuable clinical specialty, all of radiology is strengthened. For this reason, it is important that specialty recognition for Interventional Radiology be supported, and that by standing shoulder to shoulder both diagnostic and interventional radiologists can benefit each other. Dr Nick Brown, Chair IRC A/Prof Dinesh Varma, Chief of Processional Practice

Dr Nick Brown

A/Prof Dinesh Varma

Volume 15 No 3 I June 2019

General Interest

Neuroradiology and Head & Neck News ANZSNR held a very successful meeting in Adelaide from the 21st to 24th March. Thanks to convenors Dr Steve Chyrssidis and Dr Christian Barras. International guests Dr Alexandra Borges, Dr Fergus Robertson and Dr Indran Davagnanam, comprehensively covered head and neck radiology, diagnostic neuroradiology, and interventional neuroradiology. A highlight of the meeting was the presentation of the first Gold medals of our society to three outstanding recipients who contributed to the formation and development of the ANZSNR, Professors, Mick Sage, Brian Tress and Mark Khangure. My congratulations to incoming President elect Dr Con Phatouros,

Secretary-General Dr Steve Chryssidis, and councillors, Dr Tim Phillips (WA), Dr Andrew Cheung (NSW), and Dr Elaine Lui (VIC). The society has been extraordinarily well served by outgoing members of the executive, Prof Alan Coulthard who served as State representative from 2006-2012, President 2012-2016, and Past President 2016-2019, and Dr Catherine Mandel, who served as State representative from 2012 to 2016, and Secretary General from 2016 to 2019. Our thanks for their service to the Society. ANZSNR continues to actively engage with RANZCR in areas relevant to our members. Currently we are engaging with the RANZCR Interventional

Radiology Committee to review issues relating to the provision of stroke services in Australia and New Zealand, an issue of potentially great significance to both interventional and diagnostic neuroradiologists. CCINR maintenance of certification is underway, with members on the register reminded to complete the necessary applications and documentation. Prof Peter Mitchell President ANZSNR

Healthcare Imaging Services UK Trust Fellowship Program Call for applications:

Queen Elizabeth Hospital Birmingham

Healthcare Imaging Services, one of Australia’s largest imaging providers is pleased to announce our UK Trust Fellowship program. The program is for radiology trainees and recent graduates of RANZCR. Applications are encouraged from any interested radiology trainees and recent RANZCR graduates (3 years). The Trust fellow program matches Australian/NZ junior radiologists with training consultant positions in the UK. Fellows will: • Be employed and paid as an associate specialist radiologist in their UK department • Be fully registered with UK General Medical Council • Be sponsored by their NHS Trust for a full working visa

Inside News

Sub Specialties available include: • MSK • Neuroradiology • Emergency • Abdominal • Chest

• Be under a named supervisor in their subspecialty • Be able to take a full part in the clinical and academic activities of the host department • Receive a Healthcare Imaging Services educational grant of $100,000 at

For further information Please contact

Successful applicants can choose a hospital location in the UK: • Bristol • Birmingham • Central London • Leeds • Liverpool • Salisbury • Worcester

Dr Tom Snow FRANZCR Clinical Director of Imaging M: +61 432 207 558 E: thomas.snow@qdi.com.au

• Interventional • Women’s Imaging

the beginning of their year in the UK, to defray rental and relocation costs, and to help provide a good standard of living in the UK • Receive business class airfares from Australia to the UK for themselves and their partner

Sue Pohlmann

National Clinical Education Manager M: +61 435 961 559 E: sue.pohlmann@healthcareimaging.com.au

General Interest

Interventional Radiology News

The Interventional Radiology Society of Australasia (IRSA) annual scientific meeting is fast approaching. This will be held in Uluru, NT on 9-11th July and registration can be made online at http://helloworldevents.com.au/ irsaconference/ If you are asked for a username and password to access the site please use these details username: IRSA, password: IRSA2019. Given the location IRSA strongly recommends early registration and to book flights and accommodation early given the few flights and hotels available. The 2019 EBIR will be held just before the 2019 ASM on the 8-9th July. Applications can be made at www.cirse. org/ebir Registration is filling quickly so if you are intending to sit the EBIR it is recommended that you apply soon. IRSA was invited to organize 2 sessions at the Society of Interventional Radiology (SIR) ASM in Austin, Texas in March. IRSA organized a session on ‘AI and robotics in IR’ which was so popular that there was standing room only and ‘controversies down under’ which was also well received. IRSA met with the SIR leadership and discussed many items including IR specialist registration and the future co-operation of IRSA and SIR. We will be making an announcement shortly regarding forming closer ties with SIR. IRSA representatives were present at the Asia Pacific CardioVascular and Interventional Radiology (ASPCVIR) ASM in Bali, Indonesia in February. The meeting was an excellent regional meeting and many speakers nominated by IRSA gave some excellent presentations representing Australia and New Zealand.

There was a great response to the expressions of interest for speakers at future meetings. IRSA have nominated many speakers who participated at ASPCVIR and SIR and we are continuing to nominate speakers at many other conferences (such as the Asia Pacific Society of Interventional Oncology) strengthening the reputations of IRs from Australia and New Zealand. IRSA continues to grow and we are in the final stages of appointing Amplexa Consulting as the professional management company to assist our secretariat in delivering the vision of the IRSA executive committee. Amplexa is a professional medical consulting company that has employees that have previously worked with RANZCR and they have a thorough understating of the needs of IRs and IRSA. There are many exciting projects to come in various areas including education, advocacy and research to name a few. Further details will be presented at the IRSA AGM.

IRSA has been involved with various stakeholder feedback issues such as the Vascular MBS review (where we listed over 10+ suggestions most of which were considered), faculty of pain management, pain MBS review and feedback on the RANZCR IR white paper document. IRSA is continuing to work with the Interventional Radiology Committee (IRC) and slow but steady progress is being made towards building the foundations for recognition of IR as a specialty in Australia and New Zealand. Representatives of the IRC and college have been invited to the IRSA ASM for an open discussion forum and I would encourage IRSA members to attend. Dr Gerard Goh

ANZSVS Conference 2019 Friday 16 – Monday 19 August 2019 Adelaide Convention Centre, Adelaide, Australia

VASCULAR SURGERY 2019: TECHNOLOGY, TECHNIQUE AND TRAINING

asc.anzsvs.org.au

Volume 15 No 3 I June 2019

General Interest

JOB ALERT! APROSIG Update: Papua New Guinea Continued from page 30...

New Lead Examiners Recently, the College opened an expression of interest for new lead examiners in Abdominal Imaging and Pathology to become members of the Clinical Radiology Examination Review Panel (CRERP). CRERP is responsible for overseeing the setting, marking and monitoring of the Part 2 Clinical Radiology Exams. The Expression of Interest for the Pathology Lead Examiner is still open. If interested please contact Shane Bryan at the College to discuss this opportunity.

CRCAC new members

The cobalt teletherapy unit at Lae Papua New Guinea is looking for a longterm radiation oncologist locum or a series of short-term locums to maintain the radiotherapy service for its eight million people. Cancers of the oral cavity, cervix and breast are common and many present too late for cure with surgery alone. For many years there has been cobalt teletherapy and LDR brachytherapy at the National Cancer Centre in Lae, however there has been no radiation oncologist since early 2017, so this equipment is not able to be used. If a locum radiation oncologist can be identified, the cobalt unit can be serviced and be operational within a few months. In the meantime, Port Moresby General Hospital is also planning a new linacbased radiotherapy centre. The main challenge will be staffing. While there is a locally trained radiation therapist workforce and a medical physicist is completing clinical training, radiation oncologists will need to be appointed

Inside News

from overseas. Two PNG doctors with registrar level experience will need supervision and there is the opportunity to develop a local training programme with the local School of Medicine and Health Sciences. The Asia-Pacific Radiation Oncology Special Interest Group (APROSIG) aims to promote the safe and effective use of radiotherapy in our region. If you are a radiation oncologist with an interest in supporting cancer services in our neighbouring countries, please contact Iain Ward (IainW@cdhb.health.nz). This is an opportunity, not only to treat people, who would not otherwise have access to radiotherapy, but also to influence the future of cancer services in PNG through training local doctors. Lae is a 45 minute flight from Port Moresby, itself a 90 minute flight from Cairns. A generous package for a locum has been developed.

Thank-you to all the members who submitted an expression of interest in joining the Clinical Radiology Curriculum Assessment Committee (CRCAC). The EOIs are currently progressing through the committee approval process and once completed, an election of a new Chair will be undertaken, which incorporates the role of Deputy Chief Censor of Clinical Radiology. The new Chair and CRCAC will have a key role in overseeing the implementation and monitoring of the reforms to the curriculum and work place based assessments in 2019-2020 and beyond.

General Interest

Emergency Radiology News ANZERG and Oman Radiological and Molecular Imaging Society (ORMIS) held a successful two day scientific conference in Muscat, Oman on April 12 and 13, 2019. The conference was attended by about 200 delegates predominantly from the Middle East and provided a great opportunity to promote the subspecialty in that region. The scientific program covered a length and breadth of radiological and clinical conditions on this subspecialty. The Organising Committee had invited eminent speakers from the region as well as from UK and ECR, who supplemented the ANZERG faculty. Speakers included Diagnostic Radiologists (Rajiv Rattan, Dinesh Varma) Interventional Radiologists (Gerard Goh, Nicholas Brown) and Prof Mark Fitzgerald, Director of Trauma Services and National Trauma Research Institute, The Alfred Hospital, Melbourne. The highlight was a panel discussion session on complex clinical conditions with participation by radiologists, Emergency physicians and Trauma Services from across the globe. The ANZERG faculty including Prof Fitzgerald also met His Excellency Dr Ahmed Mohammed Obaid Al Saidi, Minister of Health of the Sultanate of

Meeting his Excellency Minister of Health, Oman

Oman. There was discussion around collaborative work towards developing national trauma services in Oman which will also include integrating Emergency and Trauma Radiology and we hope this can progress further as the Minister in principle agreed to support this. ANZERG could play an important role in upskilling Omani diagnostic and interventional radiologists. ANZERG has put together a proposal to hold a session at the 2019 RANZCR ASM in Auckland and if approved by the Organising Committee, we will be required to construct a program and source speakers. The ASM is an important event not only for ANZERG but other SIG’s to contribute to relevant and important topics and run dedicated subspecialty sessions that will be of good educational value to general and subspecialty radiologists. ANZERG has also been invited to contribute to the British Society of Emergency Radiology (BSER) annual scientific meeting being held on 10 - 11 June 2020 at Sheffield, UK. There is a strong desire from the Emergency and Trauma Radiologist across the globe to establish the World Federation of Emergency Radiology (WFER) and I am

ANZERG faculty with Vice President (L) and Secretary (R) ORMIS working closely with other leaders to get this off the ground at the 2020 BSER conference. I will keep you updated on the concepts, ethos and principles on which WFER will operate. It will certainly not affect the existing Societies and SIG’s but hopefully provide a platform to work together to promote the subspecialty and the care of the patients that we so passionately look after 24/7 along with our colleagues in this space. ANZERG is still looking for a fellow from New Zealand to fill the vacancy on its Committee. Please send your nominations to anzerg@ranzcr.edu.au

National, ANZERG and other international faculty

Volume 15 No 3 I June 2019

General Interest

Paediatric News ANZSPR ASM 2018 Report The 2018 ANZSPR ASM was held at the Rydges Hotel in Southbank, Brisbane from the 29th to the 31st October. The focus for the meeting was Musculoskeletal, Chest and Neuroimaging with invited speakers including Professor Paul Guillerman (Texas Children’s Hospital), Dr Mahesh Thapa (Seattle Children’s Hospital), Dr Carl Merrow (Cincinnati Children’s Hospital) and Dr Avrum Pollock (Children’s Hospital of Philadelphia). The successful meeting and dinner was well attended by Members and Registrars alike.

ANZSPR ANNUAL SCIENTIFIC MEETING 2019 The 2019 ANZSPR ASM is to be held in Hanmer Springs, a resort town 90 minutes from Christchurch on the South Island of New Zealand. The town is well known for its thermal pools, hiking, mountain biking and seasonal ski slopes. Areas of interest for this year’s meeting include Non accidental injury imaging with musculoskeletal, neuroradiology and medicolegal updates along with fetal and neonatal imaging, including fetal MRI updates.

As in recent previous years, there will be a VIVA session for attending Registrars who are interested. This year’s invited speakers include; Dr Beth Kline-Fath (Chief of Fetal and Neonatal Imaging, Cincinnati Children’s Hospital) Dr Neil Stoodley (Consultant Neuroradiologist, North Bristol NHS Trust) Dr Katherine Halliday (Paediatric Radiologist, Clinical Lead, Nottingham University Hospitals NHS Trust) Dr Patrick Kelly ONZM (Paediatrician, Clinical Director Te Puaruruhau, Starship Childrens Hospital Child Protection Service) Dr Padma Rao (Director, Medical Imaging Department, Royal Childrens Hospital, Melbourne) You can find further information on the conference website at www.anzspr2019.com Registration is currently open, and we look forward to seeing all those with an interest in Paediatric Imaging there. Dr Helen Bird ANZSPR Secretary

ANZSPR Executive Update

Upload your anonymous resume to the RANZCR job board and let your next job come to you!

An interested employer will contact you via our messaging system with job information

Either accept or reject the job. If accepted, the employer will get your contact info. If rejected, you remain anonymous

Increase the chances of landing your dream job Upload your resume at jobs.ranzcr.com/resumes today

50 RANZCR_Quarter Inside NewsPage_v2.indd

President- Dr Michael Guandalini Secretary- Dr Helen Bird

How does it work?

Upload your resume to RANZCR job board and choose “public” (your contact information will remain private)

Following the most recent ANZSPR executive election last year, the current ANZSPR executive is as follows:

18/03/2019 11:24 PM

Executive Committee- Dr Michael Mason, Dr Peter Shipman, Dr Murthy Chennapragada

General Interest

Accreditation, entering the final stretch All members know that the College is accountable to the Australian Medical Council (AMC). In 2019 the College will be re-accredited by the AMC. Why is that important, who are the AMC and what does it mean are the questions I want to address in this article.

Why is the College doing the AMC accreditation? The College must be accredited if it wants to provide specialist training and assessment programs and Continuing Professional Development (CPD) programs that allow our members to be registered as Specialists. • The Health Practitioner Regulation National Law Act 2009 makes the accreditation of specialist training programs a part of approval of programs for the purposes of specialist registration.

of the Medical Council of New Zealand.

What do the AMC expect? • Specialist medical programs and education providers that produce medical specialists who can practice unsupervised in the relevant medical specialty. • Medical specialists who are providing comprehensive, safe and high-quality medical care that meets the needs of the Australian and New Zealand health care systems, • Medical specialists who are prepared to assess and maintain their competence and performance through continuing professional education, the maintenance of skills and the development of new skills. Practically, the AMC expects that its 10 standards are met or substantially met.

• The Medical Board of Australia's (MBA) registration standards indicate that AMC accreditation is a requirement for continuing professional development (CPD) programs.

What is new in the AMC Standards for Colleges?

• The Medical Council of New Zealand (which combines the functions of the AMC and the MBA) uses AMC accreditation reports to make decisions about recognising medical training programs in New Zealand.

• Enhanced focus on patient safety

Who is the AMC? AMC is the standards and assessments body for Medicine. It is a company limited by guarantee and managed by a Board of Directors. The AMC puts together an Assessment Team made up of experts in medical specialist education to review the accreditation of each College. RANZCR’s Assessment Team in 2019 will be Chaired by Dr Andrew Connolly, BHB, MBChB, FRACS, Head of Department, Department of General Surgery, Middlemore Hospital. Dr Connolly is an experienced AMC assessor and the immediate past Chair

Significant changes to the standards include: • Enhanced focus on trainee wellbeing • New standards concerning Indigenous health. • Standards concerning continuing professional development have been revised in line with the Medical Board of Australia and Medical Council of New Zealand guidelines.

What are the consequences of non-compliance? The most likely consequences are a range of onerous reporting obligations and compliance activities, plus reputational damage, as assessment findings are public. • It is theoretically possible for the College to be disaccredited by the AMC; if that happens, then another provider will need to be found to

deliver training and CPD programs (such as another College or a new organisation) • A bad outcome from the review may include additional full-scale reviews or shorter accreditation timeframes (such as a second AMC visit within 12 months), increasing costs and time investment from the College. • Every review expects to get a number of conditions and recommendations as the process is meant to help continuous improvement.

What is the process? • Written report by the College – submitted by early May 2019 • AMC attends College examinations – April and May 2019 • Site visits by the AMC team to training sites; survey of trainees May-June 2019; Monday 16th September to Friday 20 September • Visit by AMC team for 1 week to Sydney office and interviews with key office bearers, committees and staff – September 2019 • AMC preliminary statement of findings to the College – end of September 2019 • Accreditation report to the College – early December 2019 • Final report and assessment outcome made public – by 31 March 2020 Natalia Vukolova RANZCR CEO Editor's Note - Due to the importance of accreditation, we have reprinted the CEO's message from our March Issue

Volume 15 No 3 I June 2019

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General Interest

Building a portfolio investment when you are time poor – What you need to know In a recent Australian royal commission into the financial services industry, one of the main questions raised was about how people seek and implement investment advice. It emerged that even people with some financial knowledge can find it difficult to determine which, of a range of possible solutions best suits their needs. One fundamental decision is whether an investor should use a large superannuation provider, such as an industry or retail super fund, or form a relationship with a dedicated advisor to build a unique portfolio. A dedicated portfolio has the advantage of being able to adapt to an individual’s specific needs, changing circumstances and attitudes towards risk, all of which can lead to a better outcome. By contrast, whilst large industry and retail super funds may be perceived to be more secure due to their size, they cannot design an investment portfolio to suit an individual’s circumstances.

• An appreciation of how returns are achieved. Equity markets have enormous diversity i.e. a utility company is vastly different from a bank and a software provider. Each company has a distinct profile in its likely capital gain, volatility and income distribution. Similarly, fixed income asset returns do not always reflect their apparent simplicity of generating a regular interest stream. • An understanding of what determines return. Equity returns are not based only on stock price gains, but also include dividend payments. The chart shows return for the ASX200 index, as well as the same index based on share price moves plus reinvested dividends (ASX200 accumulation index). The third line is the market capitalisation index, which implies participation in all capital raisings.

• Risk. Taking a higher risk may result in higher returns, but there may be a greater likelihood of losses in a weak market. Investors who choose an advisor to manage their portfolio should be willing to accept recommendations from the advisor. The investor should be clear that any asset allocation changes that are made are in line with the portfolio’s overall investment objectives, rather than based on knee-jerk reactions to short term events, such as a sudden fall in share markets. This again comes back to how well the initial groundwork is laid in terms of understanding the investor’s objectives and goals. continued over...

If deciding on the portfolio option, the next obvious question to ask is how much time does an investor need to initially spend with an advisor? Whilst there is no hard and fast rule regarding time, a successful relationship is often built on the advisor having a clear understanding of the investor’s goals and needs. Investors are asked to consider issues that will affect the construction of their portfolio, importantly the goal - be it capital preservation, the generation of income or capital growth. Each of these has trade-offs and establishing the priority is important. For an investor considering the appointment of an advisor to manage their portfolio, there are several key principles they should understand.

Volume 15 No 3 I June 2019

General Interest

The next consideration is the construction of an investment portfolio including the selection of investment solutions. Individual investors are moving away from investing in only large, high-profile companies, such as the banks, Telstra and Woolworths. Newer growth companies are clearly making gains in many areas. These are predominantly listed in overseas markets, think Amazon or Google. To access these investments, an advisor can assist through a direct investment in these offshore companies, or via international managed funds. Increasingly, investors who partner with an advisor are doing so via a ‘separately managed account’, where a professional fund manager oversees a selection of stocks on behalf of the investor, generally for a portion of the portfolio. To ensure that the investor has manager

diversification, the separately managed account should be complemented with a blend of other managed funds. Importantly, the investor maintains the benefit of direct ownership. They can clearly see what stocks are in the portfolio, they receive the dividends directly and are taxed individually on any capital gains. Essentially, there is no ongoing decision required when investing via a separately managed account. A selection of managed funds can then be used to complete the portfolio. Each managed fund should fulfil the objectives of the overall portfolio, whether this is to achieve a high capital gain or to generate income. There is no need for an investor who chooses a dedicated advisor to allocate a large amount of time to

the ongoing management of their investment portfolio. There is, however, an obligation to understand what decisions are being made and why. It is well documented that infrequent but meaningful changes to asset allocations will have the best overall outcome. Making small changes here and there, on the other hand, rarely matters. A bespoke portfolio can be key to both strong investment performance and meeting the requirements of each investor. Most importantly, these can be achieved with limited involvement if so desired. Amanda Fong Giselle Roux Escala Partners

College Life – Behind the scenes 13 Special Interest Groups, 197 Committees, Councils and Working Groups. Five Social media accounts; several websites and platforms, training courses and general day to day management of member needs are just some of the roles undertaken by College staff. These are their stories… The role of the College’s Senior Education Officer for International Medical Graduates is an unusual one. Unlike most Faculty related positions, Wendy Frazer reports to both the Radiation Oncology and Clinical Radiology Faculties and deals with graduates from all around the world. Having been at the College for almost seven years, Wendy’s role is to ensure that International Medical Graduates are assessed for comparability to RANZCR trained specialists in line with any local jurisdictions, including the Australian Medical Council and the Medical Council New Zealand. Sometimes working within the international medical community can be difficult, as there are cultural nuances that need to be navigated along with

Inside News

the usual time zone issues. Assessing applicants can be tricky depending on where the come from and when they apply. Some applicants for instance, have found it hard to understand why the college doesn’t do more testing over the Christmas break, and others are unable to participate during our scheduled times due to their own cultural and religious activities. It’s all about, balance, patience and flexibility. Fortunately for Wendy, over the years she has spent a great deal of time living and working overseas so she has an appreciation for those challenges. The work though, still provides its challenges. The number of enquiries from overseas doctors can spike for the strangest of reasons, sometimes with little or no warning. One recent spike in enquiries came as the result from a Canadian Politician making a statement on Twitter, this was then responded to by the Iranian Government and the next day, as a result, there was a jump in enquiries in doctors looking at options in Australia and New Zealand. Brexit has prompted its own share of enquiries and the next spike could come from anywhere.

Wendy Frazer

Wendy’s role, in her own words, is a great job because the work matters. The requirements for each of the faculties is very different. Their needs and approaches to looking after overseas doctors vary, yet they have very similar desires in creating positive outcomes and providing optimal patient care from all practicing specialists. For Wendy though working with passionate people is fun and rewarding, so long as everyone stays off twitter…

General Interest

Uploading diagnostic images to My Health Record – What you need to know Clear, timely and effective communication of imaging results with patients and referring practitioners continues to be an important aspect of radiology practice. Lack of access to previous results, reports being lost or falling through the cracks and the potential for patient harm is an ongoing concern. Some radiology practices are already making images and reports available directly to patients, and diagnostic imaging reports can now be added to a My Health Record (MHR) and accessed by patients. Access via MHR presents opportunities for radiology practices, but it is important to be aware of what this means, particularly in terms of privacy and communication.

Uploading reports to MHR Once diagnostic imaging practices are registered and set up with MHR the default position is that imaging reports will upload unless you actively take steps to prevent this. It is important therefore to check the imaging referral to see whether there is a request that reports not be uploaded. This may be because the patient is concerned about uploading the report, but in some cases, the referring practitioner may have requested reports not be uploaded if they believe uploading is not in the patient’s best interests. If the patient or referring doctor has requested that a report not be uploaded, they should let you know this by: • checking the "Do not send reports to My Health Record" check box in the referring doctor’s practice management software, or • checking the "Do not send reports to My Health Record" check box on the paper request form,

• writing "Do not send reports to My Health Record" on the request form and/or

However, the patient will be able to access the reports seven days after they are uploaded.

• the patient telling staff at the diagnostic imaging centre directly that they do not want the report uploaded.

This delay in access was intended to allow referring doctors time to receive, consider and recall the patients to discuss the results before they were available on the MHR.

Such a request applies to all reports on that referral form.

Does the patient need to consent to every report being uploaded? It is not necessary to obtain a patient’s express consent to upload each individual document to MHR, since patients provide a standing consent for doctors to upload documents to their MHR. The authority to upload information is provided for in the legislation. However, the patient can choose to withdraw consent or ask that a report not be uploaded at any time before it is uploaded to their MHR. If the patient does indicate they do not want the report uploaded, the healthcare provider must not upload information or reports to the patient’s MHR.

Accessing previous reports As one of the patient’s healthcare providers you can also access previous imaging reports available in the patient’s MHR to assist in providing care to the patient.

It is important to factor this timeframe into your processes for communicating with referring practitioners – particularly so that they are aware of and can manage recalls for patients with any particularly sensitive or urgent results. And, while patients may already have access to reports, the fact that many more patients may now have access reports directly through the MHR makes it even more important to consider the wording used in reports.

More information • Avant My Health Record FAQs • My Health Record diagnostic imaging reports • My Health Record in diagnostic imaging and pathology • My Health Record - viewing and uploading information • My Health Record list of providers uploading to My Health Record Georgie Haysom - Head of Research, Education and Advocacy, Avant and

Patient recall and follow up Your responsibility to communicate results to referring practitioners is unchanged. A MHR is the patient’s record. A referring doctor is not expected to know about results purely because they have been uploaded into a MHR, so you should continue to communicate with referring doctors as per your existing practice and organisation’s protocols.

Kate Gillman, Head of Medico-legal Advisory Service, Avant

Volume 15 No 3 I June 2019

General Interest

In Memoriam

ALBERT HOI-KING LAM 1945 – 2019

Prof Albert Hoi-King Lam

“A fleeting glance at the image from the far end of the room, and he calls the diagnosis!” This was my first impression of Prof Albert Lam, as his fellow: a lasting impression that held true over the many years that I have known and worked with him. Albert Hoi-King Lam was born in 1945 in China. Born into an affluent family, he had to flee China at a young age due to the changing political situation. Moving to Hong Kong he completed his schooling and went on to obtain his medical degree from the University of Hong Kong. He pursued Radiology training as a Registrar at Auckland Hospital, New Zealand. He undertook a fellowship in Paediatric Radiology at the Children’s Hospital at Los Angeles and the University Medical School of Southern California. In 1979, Albert left the USA to take up the position of Radiologist at the Royal Alexandra Hospital for Children in Sydney (now known as the Children’s Hospital, Westmead). Albert

Inside News

was instrumental in establishing and developing a paediatric ultrasound service at the hospital. His pioneering work in the areas of cranial ultrasound, hip sonography, GIT ultrasound and Doppler imaging paved way for the expansion of applications of the technique, thus significantly influencing the practice of paediatric medicine at the time. During this period he also became an active member of the Australian Society of Ultrasound in Medicine. His efforts were influential in not only bringing national and international recognition to the service but also helping to develop a strong training and mentorship program for sonographers, and for radiology trainees, both locally and internationally. In addition to being an excellent diagnostician, Albert was also an accomplished clinical researcher. He authored 65 original articles and 11 review articles that can be found in peer-reviewed journals and has numerous abstracts of presentations listed to his credit. He also contributed many chapters to books on paediatric radiology. He was a Clinical Professor of Radiology with the Faculty of Child health and Adolescent Medicine at the University of Sydney and was an invited lecturer both at home and abroad In recognition of Albert’s work in paediatric radiology, he was awarded Senior Membership of the American Institute of Ultrasound in Medicine (AIUM), Honorary Fellowship of the Australasian Society of Ultrasound in Medicine (ASUM) and Honorary Fellowship of the Indonesian Society of Ultrasound in Medicine. Albert was one of the founding members of the Asian Oceanic Society of Paediatric Radiology (AOSPR) and was elected Vice-President of AOSPR in 2009. He was also one of the founding

members of the Australasian Society of Paediatric Imaging (ASPI), the precursor to the modern ANZSPR. He received Life Membership from the Royal Australian New Zealand College of Radiologist in 2012. In 2017 Albert Lam received the Order of Australia for his outstanding service to paediatric radiology particularly in the field of ultrasound. ‘Prof’ as he was affectionately called by many of his junior colleagues and staff in radiology and other departments at the Children’s Hospital, Albert displayed unwavering dedication to his profession and to the children’s hospital. Mary Lin one of the sonographers at the Children’s Hospital at Westmead most aptly encapsulated his entire persona in one phrase: “You want me? I come! “ This strikes profound resonance with all of us who have known Albert a gentle, wise, helpful, and encouraging mentor. An excellent teacher, supportive colleague and a kind human being, Albert is fondly remembered for his wisdom, sense of humour, affection towards his friends, and above all, for the great sense of care and compassion with which he treated his patients at the children’s hospital. His loss leaves a huge void in the world of paediatric radiology and ultrasound. Albert is survived by his wife Cathy, his son Brian, his daughter-in-law Irene and his grandchildren Angie and Zac. - S Murthy Chennapragada

General Interest

Creative solutions to remote medicine Teleradiology before the internet Improving the quality of remote medicine with solution focused, unconventional, multi-disciplinary thinking is a unique experience that is not for the faint hearted. Sending vast amounts of data over vast distances barely warrants a second thought in this modern age however as recently as the 1970’s this presents a serious impediment to the provision of modern medicine in remote areas. The question of how-to bring radiology practices to an area of 24,000km² was investigated by Dr Pratten in the early 1970’s. Initially focused on the implementation of full-time services for south-west Western Australia and it wasn’t long before he was on call 365/24. Not satisfied by solely bringing medical services to this corner of the country, Dr Pratten took a radical step to increase the radiological reporting range to include the 20,000km tropical seaboard of the West Australian coast, convincing the Western Australian Medical Board, he could develop and deliver reports with a 24 hour turn around. For ten years the logistics worked; smaller outposted hospitals would fly x-ray film to Perth, and from Perth film was delivered to Dr Pratten. He would report on the film and return to the films the following morning. As demand for the service grew and technology improved, more pressure to turn around a greater number of films was experienced. To further improve the service, Dr Pratten had to navigate a few minor obstacles: • Microsoft wasn’t formed until 1983 • Graphical user interfaces were not commercially available until early 1990’s • 25KB disks were the largest available format for transporting data • Anything remotely resembling the modern internet was still at an experimental stage

While persisting with this he conceived the idea of sending the x-ray images via telephone line using digital transmission. He thought this would allow almost immediate consultation and reporting without the cost of transport. Dr Pratten’s brother Jon, owned a company working with electronic engineers developing software control systems for power stations, rail and road traffic. They discussed this together. Having decided it could be feasible, Peter seconded one of Jon’s software engineers, Mike Chuda to work on the project. The first system used DEC 1173 computers with the input recorded on analogue TV cameras, using large zoom lenses for detail, converted to digital using Canadian built Matrox cards, transmitted on phone lines by 2 synchronised tandem modems. They were received at the other end by similar modems, converted back to analogue, and displayed on high resolution television type cathode ray tubes. It was tested and proven to work between Port Hedland Regional Hospital and St. John of God Hospital, Bunbury. By 1995 it was possible to use a central computer “exchange”, automatically diverting the images to the radiologist at the station where he was currently working. This was very successful, constantly running in 9 sets of rooms around Perth, each equipped with diagnostic ultrasound, and with a total of 6 CT scanners operating. Some standard report phrases and word processing were added to speed the reporting directly by the radiologist. Because of the known limitations in resolution, and the slight possibility of missing fine linear calcification, mammograms were never reported on this system.

Over time, optical scanning replaced the need for television studios, other commercially viable software became more obtainable, then the internet arrived, and technology never looked back. To learn more about Dr Pratten and advances made to industry simply by thinking broadly when faced with challenges, visit the archives at https:// ehive.com/collections/5079/trainorowen-collection

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

Volume 15 No 3 I June 2019

General Interest

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Inside News

The College notes with regret the death of the following members: Dr Michael Ti, Fellow, VIC Dr James Stackpool, Fellow, NSW Dr Fred Jensen, Life, TAS Dr Albert Hoi-King Lam, Life, NSW

2019 COURSE DATES:

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~ In Memoriam ~

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