Volume 17 No 3 | June 2021
Quarterly publication of The Royal Australian and New Zealand College of Radiologists
STARTING A CAREER IN A PANDEMIC: VIVA VOCE
Also Featured in this edition
Integrated Rural Training Pipeline:
The Ballarat Experience
The Taskforce that Navigated the College’s Pandemic Response
RANZCR Research Grants in Action:
An Interview with Frank Galliard
“We innovate and adapt” At I-MED Radiology, we have a vision: to be the most respected and trusted medical imaging specialists in the world. And at the heart of that vision is our commitment to innovation. If you are interested in finding new and improved ways of doing things, if you have the courage to adapt and deal with change, then come and talk to us. Discover what it’s like to work with a world-leading organisation with innovation in its DNA. Contact our careers team T: +61 2 8274 1080 E: careers@i-med.com.au www.i-med.com.au/careers
Editor’s Pick 5 7
A Message from the President A Message from the CEO
9 13 19 22
Viva Voce and the Virus: Interviews with the Very New
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The Integrated Rural Training Pipeline and College Training Posts The Taskforce that Navigated the College’s Pandemic Response RANZCR Research Grants in Action: An Interview with A/Prof Frank Galliard
Targeting Cancer RANZCR2021: It’s Time to Reconnect
What are your thoughts?
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RANZCR Statement of Intent for Māori, Aboriginal & Torres Strait Islander Health
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From the Faculty of Clinical Radiology
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Chief Censor in Clinical Radiology: Program Evaluation
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Clinical Radiology Trainee Matters
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From the Faculty of Radiation Oncology
Examinations in 2021/ Introducing the New Training Program Radiation Oncology Trainee Matters Vale Dr Sharlyn Knag
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 is encouraged. Please email any submissions to editor@ranzcr.edu.au
50 51
Vale Professor David Lamb A Round Up of MBS Review Taskforce Recommendations for IR and INR
55 57 58 59 61 62
New Zealand Branch News
Asia-Pacific Radiation Oncology Special Interest Group Australian Branch News Abdominal Radiology Group Australia and New Zealand Great Savings and Rewards for Members Have Your Circumstances Changed since July 2020?
Have you moved recently? Log into the MyRANZCR portal and ensure your contact details are up to date at www.myranzcr.com
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Introduction
A Message from the President Radiology 101 – Back to Basics Dr Lance Lawler
Given the extraordinary events of the last year, one may be forgiven for pondering existential questions such as What are we here for? or Where am I going?—I write this while waiting for a plane flight—or, more to the point of my message for this issue, What is the role of our medical college? It is never a waste of our precious thinking time to ask the simple questions again, to plumb the depths of our purpose and stay focused on the basics. So this is the result of my airport musings. Our College has two main roles or responsibilities (and one which is ancillary to these). First, and most importantly, is the delivery of competent, qualified medical specialists and a mechanism for them to maintain and demonstrate their competency (both pre- and post-Fellowship). Having FRANZCR after your name is a licence to practise clinical radiology and radiation oncology—see how far you get without one! The second role is in setting the quality standards of practice for the safe delivery of care in our specialties. The legal authority for these two roles is delegated from our national regulators, bodies such as the Medical Board of Australia and the Medical Council of New Zealand (MCNZ), and with it we set and uphold the educational training and rules for the profession. Funnily enough, we do not have any power to enforce these—that must be done by the various regulators.
To ensure that our voices as experts are heard and taken notice of in this regulatory space, the College has developed a strong advocacy arm. This is the ancillary role but still a crucial one, a role which involves a lot of meetings with our stakeholders, especially in government, and a strong commitment to communication, private and public (for example, Targeting Cancer and InsideRadiology). If we didn't do this, our voices would be drowned out by the other colleges and competing organisations. We have other roles too, but these are the most important. Of these, the advocacy role is the most difficult to resource and manage. The end result of a successful advocacy campaign for us is to be viewed as the trusted advisor— that is, the first people asked for advice on all medical imaging and radiation oncology matters. The key word here is trust. If we were to lose this all our hard work would be undone. This brings me to what the College is not, and my hope here is to help dispel a few misunderstandings which come up often. Here are three: First, the College is not a trade association for private practice. It can be difficult for our members to make this distinction in the heat of discussions, but it is vital that we are seen to give principled value-based opinion that always puts the patient at the centre of our deliberations.
Second, we are not a bank to fund any and every scheme or idea a member comes up with, and our members do provide ideas, which is something to feel positive about because it demonstrates a high level of engagement. But not all ideas, even the good ones, are feasible. We are a small college, with limited funds which come mostly out of our members' pockets. We have many checks and balances in place to manage our funds. This can be a source of irritation for some but there are sensible reasons for it. Finally, the College is not a policeman to act on allegations of poor practice. We are here primarily to assist members in their work. Yes, we may be asked by the regulators to provide a view or opinion on instances of poor care (although not very often, this is usually managed through other channels). It is only in the most difficult of cases that we may be drawn in. We have processes to follow that our regulators oversee but, as a memberbased organisation, it's our job to support our members, not cajole, threaten or bully. Everyone has their master though, and he who pays the piper calls the tune. My plane is now boarding . . .
Volume 17 No 3 I June 2021
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Your calling. Your career. Your life. . Advance your career while improving your own quality of life . Choose the location and work patterns that suit your lifestyle and family needs . Join a radiology team trusted to provide critical care to over 1.5 million patients last year
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Introduction
A Message from the CEO Career and Life Journeys Mark Nevin, CEO
In my seven years at the College, I have partaken in countless committee deliberations about the evolving roles of clinical radiologists and radiation oncologists. Conversations with leaders in the professions have also illuminated how much you learn and develop throughout your career. Moreover, the skills our trainees graduate with need to equip them for lifelong learning. I feel fortunate to have had the option of re-training into another discipline. I was arguably too young to decide what to study at university at the age of sixteen. Based on my interests in geography and science, I applied for degrees in architecture and optometry. I was offered both and weighed up the options, narrowly favouring a path into eye care. The content was fascinating to study, however in the end, the day-today role felt too routine with little option for diversification, I decided to embark on a career change.
happenstance, my CV was passed to the optical representative bodies in London and I was hired in a senior role in policy and advocacy, working between London, Dublin and Brussels. I also began my journey into leadership, committee governance and complex stakeholder management. My partner (who hails from Melbourne) and I moved to Australia in 2014 with a view to exploring this side of the world. I was hired by the College in that year when we created the Policy and Advocacy Unit. Induction was a steep learning curve: learning about systems of government in Australia and New Zealand, the rough and tumble of Canberra politics, our internal processes and member priorities. My brain felt like it was learning a whole new language. In fact, I remember being perplexed by some common terms: why call a service bulk-billed?!
Rather than go calling back to the bank of Mum and Dad, I worked part-time as a locum while I completed degrees in Economics and later European Politics and Governance. After which, I undertook a research internship at an EU thinktank publishing papers on the operation of the Eurozone and principles underpinning the EU budget. After a couple of years of that, work as an optometrist paid the bills during the GFC, I pondered what I might do next.
Notwithstanding, I continue to be amazed at how useful my healthcare training, and reasonable understanding of physics have been in my career at the College. My time at the College has provided fantastic exposure to new ideas, working in new cultures and allowed me to significantly broaden my leadership experience. I feel that I have benefitted greatly from lifelong learning and unexpected paths and opportunities, not least in my time at the College.
With hindsight, I had completely neglected to do any networking at senior levels of eye care. Almost by
Looking to the future, both clinical radiology and radiation oncology continue to advance. I feel that our
members underappreciate their agility and ability to embrace changes in technology and their roles in the healthcare system. You have done this admirably through your career and will no doubt continue to do so. As CEO I am giving consideration to how the College can play its part in supporting members by delivering a workforce that is: • flexible and adaptable to the needs of the healthcare system, and • representative of the populations they serve, particularly regional, Aboriginal, Torres Strait Islanders and Māori peoples. COVID has illustrated that we must adapt to emerging circumstances and provided an opportunity to reflect on future directions in life and our careers. For the future, the healthcare system will need AI experts, researchers, or clinicians to deliver care in emerging areas such as theranostics, precision medicine and screening for emerging disease. Our members are very well placed to do this, and the College will continue to support your journey through life. continued over...
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Introduction
Statement of Intent on Indigenous Health As you may know, the College’s Māori, Aboriginal and Torres Strait Islander Executive Committee (MATEC) has focused its efforts this year on developing a RANZCR Action Plan for Māori, Aboriginal and Torres Strait Islander Health. Prof Greg Phillips from Abstarr is facilitating this work and has been working closely with MATEC since it had its inaugural meeting in October last year. The development of this Action Plan has created the opportunity to reflect as an organisation, to learn to accept the discomfort it can generate and consider how we can meaningfully participate in systematic reform to improve health inequities for Māori, Aboriginal and Torres Strait Islander Peoples.
Our key objectives as an organisation are to enable our members to provide culturally safe care and to grow our Indigenous clinical radiology and radiation oncology workforces. We recognise the many opportunities to be gained from actively working and partnering with Māori, Aboriginal and Torres Strait Islander Peoples and their communities. We can publicly communicate our objectives, commitments and values via a RANZCR Statement of Intent for Māori, Aboriginal and Torres Strait Islander Health and we want to be held accountable. I am proud of our work in this area and encourage you to read our Statement of Intent on page 30.
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Features
Viva Voce and the Virus: Interviews with the Very New 2020 was a year like no other in living memory. Next to a pandemic, only war brings such a wholesale dislocation and reorganisation of our social and economic life—and so it was with the COVID-19 assault on the human population. Indeed, the impact of the current global health crisis has been psychologically more profound than any military battle because the enemy moves invisibly and tirelessly among us with no regard for the accepted rules of engagement in a deadly conflict. The College membership as a whole has played a valuable role in coping with the crisis and helping to maintain the healthcare system under less-than-ideal field conditions. Yet, as with war, it is unsurprising to note that, in the defence of a nation's (or nations') health from a novel threat, the disruption to normality tends to fall heavily on those who arrive at the front just as the first wave hits. So it was for our trainees and recent graduates last year and today.
Dr Michael Chan
The completion of final examinations and the contemplation of what lies beyond them are challenging enough in business-as-usual circumstances, let alone on the cusp of, or in the midst of, the pandemic. This uncomfortable thought led Inside News to ask six of the newly-arrived cohort at the start or in the early phase of their careers to tell us of their recent experiences.
“The completion of final examinations and the contemplation of what lies beyond them are challenging enough in business-as-usual circumstances, let alone on the cusp of, or in the midst of, the pandemic.”
As could be expected, the responses were mostly the stuff of bad dreams or, if not truly nightmarish, unsettling enough to induce a serious loss of sleep. Yet, despite the pain, the persistent sentiment among the interviewees was positive or at least self-deprecating—about the impact of the crisis on self and family, their workplaces, and on their future careers. As one was adamant to remind us, “my experiences with COVID are minor compared to the death of a loved one due to the infection.” Nonetheless, disruptions to both training and work were widespread. Sally Ayesa, a clinical radiologist in Gosford, completed her second year of nuclear medicine advanced training in 2020. “I had planned to pick up some casual radiology work in 2020 but the plans fell through.” With the pandemic, patients were getting fewer scans and, with a downturn in demand, a private practice appointment and two locum positions she had been offered at public hospitals failed to result in any work. “It was a frustrating and uncertain time in my career,” she recalled. However, one of the hospitals kept in touch with “open and honest communication” and eventually got her on board. “I ultimately decided to settle long-term at the hospital that had offered me the best support through the times of uncertainty,” she said. Cara Odenthal completed a hybrid fellowship in abdominal and pelvic imaging in Brisbane last year and now works for a large private radiology clinic and two breast clinics in the public and not-for profit sectors. During her fellowship, she experienced a significant drop-off in caseload and ability to attend multidisciplinary team meetings, conferences and courses, as the pandemic took hold. But the setback had its compensations, she recalls. continued over... Volume 17 No 3 I June 2021
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Features
“I witnessed an increased sense of camaraderie and collaboration between the radiologists and with other staff. And although the cases did reduce in number, I had greater opportunity to pick my supervisors’ brains during the initial slowdown,” she said. Shivraj Saini, a trainee who began a preparatory course at Westmead Hospital in 2020 for the Part I applied imaging technology (physics) examination, found it hard to adjust to the online delivery of lectures, partly due to technology issues in video conferencing. He was also enrolled in an anatomy course at UNSW, but the course switched to self-directed learning after only a couple of lectures, which increased the challenges facing him. “To learn this much anatomy in such detail requires help from someone who is senior and able to help with tips and tricks for memorising [the detail],” he said. Dr Saini's work at two Sydney hospitals was also disrupted. “It was almost impossible due to COVID restrictions to introduce myself in person to the radiology departments”. And, as a nuclear medicine registrar, the holding of all meetings online limited his interaction with consultants. Yet, despite these experiences, he still sees considerable benefit in online meetings
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Inside News
and conferences that allow him to “tune in remotely during a lunch break”. In New Zealand, Sarah Benson-Cooper, a clinical radiologist in Auckland, lost, due to the lockdowns, much of the value of an MRI fellowship and the ability to travel overseas for an interventional course to complement her body imaging fellowship, which she is completing at present.
“However, despite continuing uncertainty and disruption, she feels trainees have coped remarkably well with the added stress. “They have shown incredible determination and commitment to training.” Prior to the pandemic, she had planned to take a year off from study, work flexible hours in Queenstown for a
teleradiology company and spend more time with her family. “However, after the pandemic hit, there was job uncertainty, especially for full-time work, and with travel options limited, it was better to secure a position straightaway” in Auckland. Uprooting her three young children during a pandemic to pursue a fellowship overseas no longer seemed wise. From her discussions with other trainees it seems that often they too chose to stay close to home during the pandemic. This has increased competition for highly-sought-after NZ and Australian fellowships and complicated their efforts to secure posttraining jobs and experience. Dr Benson-Cooper is aware that trainees sitting their examinations in 2021 have been adversely affected by a loss of “traditional exam preparation time”. This is due to the delayed 2020 examinations for the previous trainee cohort. The delay has meant that the bulk of teaching and viva practice was understandably focused on the preexam trainees over a longer period, not on upcoming trainees who, as a consequence, have received less supported preparation time. However, despite continuing uncertainty and disruption, she feels trainees have
Features
coped remarkably well with the added stress. “They have shown incredible determination and commitment to training,” she said. Sam Dickson, a radiation oncologist in Newcastle, had planned to apply for a fellowship in Adelaide at the end of his examinations in early 2020. When the viva component was delayed until December due to COVID restrictions, the interstate opportunity was lost, but that wasn't the worst of it. The loss of certainty around the training program and the exam timetable worsened the “huge amount of guilt” he had felt for the previous 18 months. “When I was studying, I felt guilty I wasn't spending time with my family; and when I spent time with my family, I felt guilty I wasn't studying enough.” These challenges are normally manageable because the trainee knows when it will end. In 2020, that knowledge and the comfort it gives were absent. “When the certainty around the timeline was removed, it became a lot harder for all involved,” he said. But then he got lucky—a one-year contract covering for a radiation oncologist on maternity leave became available at Calvary Mater Newcastle as he was completing his examinations. “So I have managed to transition to being an RO at the centre where I did the majority of my training.” However, he continues to feel the impact of the pandemic, with staggered start times and longer treatment hours to help maintain social distancing, and a workplace that has been scattered over different hospital floors to make room for a COVID testing clinic. Practices have changed as well, with online meetings, visitor limits, postponements for non-urgent radiotherapy, and the use of hypofractionation whenever safely possible.
Dr Sally Ayesa
Michael Chan finished his clinical radiology examinations in 2019 and obtained a fellowship in 2020 working across three hospital campuses in Toronto, Canada. He encountered a highly supportive working environment in Toronto, but, with three extended lockdowns to date, personnel and resources have been stretched. “A lot
“A lot of fellows had delayed starts from the pandemic and the previous academic year's fellows had left early—this put pressure on those fellows who had turned up on time to do more on-call.” of fellows had delayed starts from the pandemic and the previous academic year's fellows had left early—this put pressure on those fellows who had turned up on time to do more on-call”. Dr Chan will return to Australia at the end of his fellowship but in the meantime he has keenly felt the absence of his wife and family and friends, especially on his wedding
anniversary and for Christmas and birthday celebrations. “Multimedia communication is far better today than it was a decade ago, but it cannot fully replace the social interactions we took for granted pre-pandemic,” he said. All the interviewees saw some positive outcomes arising from their experiences of the pandemic. Of these, the most endorsed sentiment was that the scramble to move communication and teaching online has created lasting benefit for the profession. Sally Ayesa, who was involved in radiology registrar teaching and exam preparation, was suddenly forced “to become familiar with Zoom very quickly,” develop electronic teaching materials to replace film-based tutorials and record lectures for virtual conferences. Today she is again using film in face-toface tutorials but also keeping with the electronic materials she developed in 2020. “I was able to run a practice viva with a candidate in New Zealand while sitting at my desk in Sydney—it was incredible to be able to connect and learn in that way,” she said.
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News
“Looking back over the last year or so, it is evident that COVID-19 dealt a body blow to the healthcare systems of Australia and New Zealand, and the impact of that blow was felt strongly throughout the medical colleges as they sought to maintain their education and training programs.” Sarah Benson-Cooper sees a clear benefit today in continuing to allow some consultant radiologists to report from home, so as to maintain a healthy work-life balance, reduce travel commitments or continue to work despite having mild coryzal symptoms or children home sick. “This is something that could be utilised more in our profession, although it needs to be balanced with staffing, supervision and teaching requirements,” she concluded. Looking back over the last year or so, it is evident that COVID-19 dealt a body blow to the healthcare systems of Australia and New Zealand, and the impact of that blow was felt strongly throughout the medical colleges as they sought to maintain their education and training programs. In its early months, the pandemic stressed the College’s management and educators almost as much as the trainees who were coping as best they could with examination delays and format and venue changes.
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Inside News
We acknowledge that, while examination dates in 2020 and arrangements for 2021 were determined and communicated as quickly as possible, the complexity and fluidity of circumstances created by the pandemic brought unprecedented pressure on our processes and ability to manage the flow of information uniformly. At one point it seemed as if the entire exam timetable for 2020 might be cancelled—that this did not happen was a win for us as an organisation. However, it is now clear there remains room for improvement in the timeliness of critical communications with trainees, and the methods used for these, and we undertake to do better in future.
Sam Dickson's experience in receiving exam-related information from the College is a reminder even small decisions may have big impacts. He recalls receiving an email from the College about the postponement of his viva about 10 days before the examination. The email was sent and received about midday on a Saturday. “They could have easily waited until the next business day, Monday, to send that email. But once I got it, I immediately put the books down and spent a wonderful day and a half with my family without any feeling of guilt about not studying—something I hadn't done for 18 months. It made a massive difference to me.”
As Cara Odenthal concluded in her comments, “any additional transparency regarding College exam decisions would go a long way to abating the stress levels of exam candidates.”
Dr Cara Odenthal
Dr Samuel Dickson
Features
Learnings on the Integrated Rural Training Pipeline The Integrated Rural Training Pipeline (IRTP) was established in 2015 as part of the Specialist Training Program (STP) in an effort by the Department of Health to extend vocational training for specialist registrars into settings outside traditional metropolitan teaching hospitals, including regional, rural and remote and private facilities. The aim in creating the IRTP is to help build a sustainable Australia-trained future workforce for regional, rural and remote communities. The College now fills four IRTP training posts within Victoria and Queensland, Australia. Training sites need to meet different eligibility requirements to the traditional STP model to participate in the IRTP. Namely enabling a trainee to complete the majority of their training—66 per cent—within a rural or regional location and making sure that the trainee selected has shown a real commitment to working rurally or regionally post fellowship. In the first of a series of articles chronicling our connection to the training pipeline, for this edition of Inside News we hear back from site and trainee at one of the Victorian training posts: Dr Richard Ussher, former Director of Training, and Dr Scott Robson, IRTP trainee, at Base Imaging Group (Ballarat Health Service).
The Ballarat IRTP Experience Firstly, Dr Richard Ussher spoke to us about the experience of establishing an IRTP training post from a practice perspective. “When the IRTP post at Ballarat Health Service was established in 2017/18, the site was already an accredited training site, having level A partial accreditation linked to the Royal Melbourne Hospital. The training site was pleasantly
Dr Scott Robson with Dr Simon Ussher (current Director of Training)
surprised to receive 50 applications for this regionally modelled post, which was advertised ahead of the metropolitan teaching hospitals’ recruitment.”
What measures were put in place to prepare for the training post? It was imperative to the success of this model that an assigned radiologist was responsible for the management of the trainee to ensure appropriate supervision could be met. The training schedule was also carefully prepared to ensure that the trainee had satisfactory exposure across a range of modalities in the regional setting. Clinical meetings were also reviewed to determine which sessions would be most suitable for registrar involvement and at what stage of training.
In addition to educational resources in the hospital library and online resources such as StatDX and UptoDate, the site applied for funds to purchase an electronic teaching file for its PACS (Intelerad), as part of the Private Infrastructure and Clinical Supervision Allowance. This additional funding is available through the traditional STP model, which the site is also involved in.
The site offers involvement in a shared educational program with weekly teaching sessions dedicated to the trainees, and in the practice peer review/ journal club which runs monthly. continued over...
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What’s in Issue 3? Medical Imaging Original Article: Quality of radiology training and role of Royal Australian and New Zealand College of Radiology in supporting radiology trainees in NSW: Results of the first radiology trainee survey Corresponding author: Merribel M Kyaw, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia. Introduction: The Royal Australian and New Zealand College radiology training programme is a 5‐year programme with a vast curriculum including reporting and research requirements. Undertaking training can be stressful for trainees who must balance their educational needs and work responsibilities. We undertook the first independent survey of New South Wales (NSW) radiology trainees to evaluate their perceptions about the quality of their training. Methods: Focus groups with trainees from multiple NSW training sites were conducted to construct a survey which was then distributed to all NSW Radiology trainees (n = 118). Data from the survey were analysed, and factors correlating to the overall satisfaction with the programme were explored using Spearman’s correlation. Results: Survey response rate was 70.3%. Eighty‐nine per cent of trainees were satisfied with their career choice, and 73% were satisfied with the training programme. Majority felt they had a good exposure to cases, modalities and access to resources to complete their training. Trainee satisfaction significantly correlated with a supportive work environment (rs = 0.83, P < 0.0001), which involved supportive consultants (rs = 0.75, P < 0.0001), good peer support (rs = 0.60, P < 0.0001) and their training site respecting work/life balance (rs = 0.62, P < 0.0001). As trainees progressed through the training programme, they became less satisfied, with trainees in years 3 and above being the most dissatisfied. Conclusion: NSW radiology trainees are generally satisfied with their training programme and career choices. Trainee satisfaction correlated most strongly with supportive work environment, good consultant support, peer relationships and good work/life balance; satisfaction decreased for senior trainees.
Medical Imaging Review Article: The global epidemic of thyroid cancer overdiagnosis illustrated using 18 months of consecutive nodule biopsy correlating clinical priority, ACR‐TIRADS and Bethesda scoring Corresponding author: Stewart Paul Hawkins, Middlemore Hospital, Auckland 2025, New Zealand. Low thyroid cancer mortality worldwide has not been altered by decades of increasing radiological, pathological and surgical intervention for thyroid nodules. Ultrasound‐based risk stratification of thyroid nodules, such as TIRADS, has been introduced to reduce intervention for the ‘global epidemic’ of thyroid cancer ‘overdiagnosis’. This article illustrates the use of TIRADS at a New Zealand tertiary centre, during its introduction, with all nodules undergoing fine‐needle aspiration biopsy (FNAB) correlated with clinical referral priority and cytological Bethesda score. The correlation between TIRADS and Bethesda score was not significant but cytology had a strong association with clinical priority. Accuracy of TIRADS was poor though the risk of malignancy for TIRADS 5 nodules was 5.1 times those rated as TIRADS 3. After TIRADS was introduced, there was no significant trend in the proportion of malignant nodules diagnosed by FNAB. Despite an incomplete TIRADS programme, the ACR targets of malignancy rates were achieved. The number of patients, as well as the number of nodules per patient, referred for FNAB continues to rise. Changing papillary thyroid cancer nomenclature and other control measures by health policymakers, such as adjustments to payment systems, may be justified. Radiologists are wasting precious health resources that can be better deployed. The use of TIRADS is expensive and a symptom of health policy failure. Clear recommendations from professional societies to not report incidental small thyroid nodules may be a useful start. Whether TIRADS merits continuing use and promotion should be further investigated.
Radiation Oncology Original Article: Neoadjuvant radiotherapy for locally advanced and high‐risk breast cancer Corresponding author: Phoebe Chidley, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, VIC 3084, Australia. Introduction: Neoadjuvant radiotherapy (NART) as part of a multi‐modality approach for locally advanced breast cancer (LABC) requires further investigation. Importantly, this approach may allow for a single‐staged surgical procedure, with mastectomy and immediate autologous reconstruction. Multiple other potential benefits of NART include improved pathological downstaging of breast disease, reduced overall treatment time, elimination of time period with breast tissue deficit and improved patient satisfaction. Methods: This is a retrospective multi‐institutional review of patients with LABC and high‐risk breast disease undergoing NART. Eligible patients sequentially underwent neoadjuvant chemotherapy (NACT) with or without HER2‐targeted therapy, NART, followed by mastectomy with immediate autologous breast reconstruction (BR) 4‐ to 6 weeks post‐completion of radiotherapy. Patient and tumour characteristics were analysed using descriptive statistics. Surgical complications were assessed using the Clavien–Dindo Classification (Ann Surg 2004; 240: 205). Results: From 3/2013 to 9/2019, 153 patients were treated with NART. The median age was 47 years (IQR 42–52), with median body mass index of 27. Eighteen patients experienced Grade 3 acute surgical complications. This included 13 Grade 3B breast‐site events and 9 Grade 3B donor‐site events, where further surgical intervention was required for management of wound infection, wound dehiscence, flap or mastectomy skin necrosis, haematoma and internal mammary venous anastomotic thrombosis. No autologous flap loss was observed. Conclusion: Neoadjuvant radiotherapy facilitates a single‐stage surgical procedure with mastectomy and immediate autologous BR, eliminating the delay to reconstructive surgery and thus shortening a woman’s breast cancer journey. The findings of this review support the use of NART, with comparable rates of surgical complications to standard sequencing.
Radiation Oncology Original Article: Stereotactic body radiotherapy in the management of hepatocellular carcinoma: An Australian multi‐institutional patterns of practice review Corresponding author: Howard Yu-hao Liu, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia. Introduction: Stereotactic body radiotherapy (SBRT) is an emerging, therapeutic option in the management of hepatocellular carcinoma (HCC). A multicentre Liver Ablative Stereotactic Radiation (LASR) database was established to provide a collaborative platform for Australian institutions to define the practice of liver SBRT for HCC. This study explores the patterns of SBRT practice amongst Australian institutions. Methods: This was a multi‐institutional retrospective study of patients treated with SBRT for HCC at 10 institutions between January 2013 and December 2019. Patients’ demographics, disease characteristics and SBRT details were evaluated. Results: Three hundred and seventeen patients were evaluated with a median age of 67 years (range, 32–90). Liver cirrhosis was present in 88.6%, baseline Child‐Pugh score was A5/6 in 85.1% and B7/8 in 13.2%. Median size of HCC treated was 30 mm (range, 10–280). 63.1% had early‐stage disease (Barcelona clinic liver cancer (BCLC) stage 0/A) and 36% had intermediate/advanced‐stage disease (BCLC B/C). In 2013/2014, six courses of SBRT were delivered, increasing to 108 in 2019. SBRT was prescribed in five fractions for 71.3% of the cohort. The most common dose fractionation schedule was 40 Gy in five fractions (24.3%). Median biologically effective dose (BED10) delivered was 85.5 Gy for early‐stage and 60 Gy for intermediate/advanced disease, respectively. The most common prescription range was 100–120 Gy BED10 (32.8%). Conclusion: SBRT utilisation for HCC is increasing in Australia. There was wide variation in size of tumours and disease stages treated, and prescription patterns. Uniform reporting of clinical and dosimetric details are important in refining the role of liver SBRT.
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Who was the successful candidate and how has the experience been for the practice? Dr Scott Robson commenced in January 2018 and will complete his training with us after his present rotation to Melbourne. Over the last two and a half years, Dr Robson has become a very competent third year registrar, passing the Part 1 examination at first sitting. A number of radiologists are involved with training and teaching, and to date Dr Robson has completed a research project which looked at predicting the likelihood of pneumothorax post lung biopsy, as well as doing a number of journal club reviews. We regard the experience as very successful, to be recommended. Postscript from the site: We are pleased to further report that Dr Robson successfully passed all components of his Part 2 examination on his first attempt. Congratulations, Scott!
The Trainee Perspective Dr Scott Robson offers his insights into the IRTP experience and his return to Ballarat where he grew up.
Are there any advantages in your opinion of training at a large regional hospital compared to a metropolitan hospital? Naturally as you work with a consultant for a long period, they become aware of your strengths and weaknesses, and know your diagnostic and procedural limitations. As I was working with a smaller group of consultants for a longer period this meant that comfort with me performing procedures was fast tracked, leading to significantly more experience. Dilution of training, as the only registrar, or in Ballarat’s case one of two, you get to see all the interesting cases and take part in all the interesting procedures where usually there would be more senior registrars and fellows diluting this experience. I perhaps didn’t realise until coming to Melbourne, but the number of studies and procedures performed in Ballarat is likely equivalent to or in some areas greater than metropolitan hospitals due
Lake Wendouree in the centre of Ballarat
to the large outpatient department. This means that there are no issues with the volume of studies for registrars to report or the number of procedures they perform.
Facts & figures - Ballarat Population: 101,578 (City of Ballarat shire), Victoria’s third-fastest growing city
I have ties to Ballarat with both family and friends having grown up there. Completing my training here has allowed me to move back five years earlier than I otherwise would have and spend time with nieces and nephews and reconnect with friends in a location where I ultimately plan to set up my life.
Distance from Melbourne: 110 km north west
Are there any disadvantages in your opinion of training at a large regional hospital compared to a metropolitan hospital?
Art galleries: the oldest and largest regional art gallery in Australia www.artgalleryofballarat.com.au
Post-operative imaging, as Ballarat does not have a Neurosurgical or Cardiothoracic unit, therefore I have not seen the common follow-up scans that these patients undergo. Meaning I have less confidence in this area. This is a deficit I will rectify during my metropolitan rotation. With only two registrars it can be difficult at times to gauge how you are progressing in training and be aware of upcoming events and deadlines for the College. I was lucky to be supported by the Royal Melbourne trainees and Director of Training with this and so quickly became part of their extended cohort.
Universities: Australia’s Federation University and the Australian Catholic University’s Ballarat Campus Hospitals: Ballarat Base Hospital (Ballarat Health Services) and St John of God Ballarat Hospital
Festivals: the biggest regional winter festival in Australia, visit the 2021 Ballarat Heritage Festival www. ballaratwinterfestival.com.au Main towns: Ballarat (main suburbs Wendouree, Buninyoung, Learmonth), nearby are Creswick, Smythesdale and Clunes Geographic features: Mount Buninyong, Mount Warrenheip and Lake Wendouree Climate: Moderate, prone to cold winters with light snow falling on local mountains Fascinating facts: Home of the Eureka Stockade and Steve Monaghetti, and the location for ABC TV series The Doctor Blake Mysteries continued over... Volume 17 No 3 I June 2021
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Magnetic Resonance 4D FreeBreathing
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Features
Dr Scott Robson with Dr Alicia Wang at one of the practice social functions
Is there anything you think that was done particularly well in the IRTP? Co-location is very important; being in the same room with the consultant was invaluable to me especially in the early period. All of the consultants that I worked with were approachable and happy to be interrupted by me for questions and clarifications. This led to a fast tracking of my knowledge in the first several months with a tight efficient feedback loop. On call practice taught me a great deal about being a safe radiologist, satisfaction of search and when to call for help. A good mix of procedural and diagnostic work in all modalities meant that I had an excellent well-rounded early training period. There are several other areas that were done particularly well in Ballarat. I remember often in the early phase when approaching procedures I was asked “do you want me to scrub in?” this changed to “do you want me in the room?” to “I’ll be here if you need me don’t hesitate to let me know if you have any issues.” This meant that I had great support but was also given a great deal of trust to perform procedures with a level of independence that I felt comfortable with.
All of the consultants throughout have been great at asking how things were going, regularly checking in, and asking if there were areas I felt deficient in. This led to a lot of focused impromptu teaching or the loan of texts in areas I was struggling with. I was always encouraged to step out of my comfort zone and report the studies that I found difficult or attempt the procedures that made me nervous. The consultants were always willing to look through them with me in real time or after to help work out what to do better in future
What advice would you give to a trainee commencing training in an IRTP position? Get involved with your colleagues at your sister hospital. The first part exam requires a significant degree of book learning both for the physics and anatomy sections that is not necessarily all that related to radiology or your day-to-day job. Getting involved with the registrars at a sister hospital will get you access to a physicist for tutorials and anatomy resources that will help you pass the exam. At the same time, being around the others will encourage a little extra study.
Have a go! Most consultants in the regional setting are happy for you to attempt a procedure with their supervision. The more you put yourself outside your comfort zone (safely) the faster you will learn. Enjoy the social side; get to know the people you work with whether they are consultants, other doctors, radiographers, nurses or receptionists. In a small department it makes work an enjoyable place to be.
What advice would you give a hospital/practice looking to start an IRTP program? The person you pick is important. The program is designed to favour a registrar who wants to settle in the country and enjoys being there rather than one who sees it as time in purgatory until they can get back to the city. The right pick makes a big difference. The IRTP program builds a relationship for life—it may be difficult and timeconsuming to train a registrar especially in the first six months, but ideally it builds a strong relationship that means the registrar wants to return to work the rest of their career at the practice. The practice has had the chance to train them just the way they like.
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Features
More information on the Australian Government Department of Health Specialist Training Program
each state jurisdiction and colleges. Successful posts are placed on the College’s reserve list and must be accredited to fill vacant positions.
The Specialist Training Program (STP) aims to have a positive influence on future workforce distribution and quality. In 2010, the STP became the single Commonwealth grants support program for specialist training in Australia. The program now encompasses three complementary streams:
The College currently has 27 clinical radiology regional training sites (19 posts are STP-funded) and 13 radiation oncology regional training sites (10 posts are STP-funded).
• Specialist Training Placements and Support • Integrated Rural Training Pipeline • Tasmanian Project
\
To find out more about the program and funding opportunities, please contact the STP team at STP@ranzcr.edu.au
The College administers funding on behalf of the Department for training posts across all three initiatives in clinical radiology and radiation oncology.
The famous Pinnacles rock formations in Grampians National Park
Colleges receive a set allocation of posts under individual agreements. Training sites must apply for the program through an expression of interest process, which is managed by the Department in conjunction with
The Mining Exchange Gold Shop Building at 8 Lydiard Street North
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Inside News
Reference 1. Australian Government | Department of Health | Specialist Training Program: https://www1.health. gov.au/internet/main/publishing.nsf/Content/ work-spec
Features
The Taskforce that Navigated the College’s Pandemic Response COVID-19 presented many challenges over the past 18 months and was disruptive for all areas of the College’s work. The College Board responded quickly to the pandemic by forming a COVID-19 Taskforce on 9 March 2020 with the aim of coordinating a wholeof-College response to COVID-19 in a timely manner to the rapidly changing health environment.
The Taskforce members were:
The Taskforce ensured that the College’s response encompassed all key precautions, information and professional support for members and their patients.
• Dr Johann Tang, Councillor FRO
• Dr Meredith Thomas, Chief Censor Faculty of Clinical Radiology • Dr Yaw Chin, Chief Censor Faculty of Radiation Oncology • Adj Clin Prof Stacy Goergen, Chair Safety and Quality Committee FCR • Dr Lisa Sorger, Councillor FCR • Prof Liz Kenny, Councillor FRO • Prof Alan Coulthard, Director nominated by the Board
• Dr Sharyn MacDonald, Chair Australian and New Zealand Society of Thoracic Radiology (ANZSTR) and New Zealand representative • Ms Natalia Vukolova/Mr Mark Nevin, RANZCR CEO (Chair) • Ms Lucy Hutton, RANZCR Senior Media and Communications Officer It is thanks to the dedication, patience and tireless efforts of the Taskforce that the College was able to navigate numerous challenges and continue to deliver high-quality services to members. continued over...
Dr Meredith Thomas
Dr Yaw Chin
Adj Clin Prof Stacy Goergen
Dr Lisa Sorger
Dr Sharyn MacDonald
Prof Liz Kenny
Prof Alan Coulthard
Ms Natalia Vukolova
Mr Mark Nevin
Dr Johann Tang
Volume 17 No 3 I June 2021
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LIVE
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Early Bird Registration Closes Friday 18 June ELYSIUM: DIAGNOSTICS AND THERAPEUTICS (NOW AND THE FUTURE) WITH AI
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Features
At the end of March 2021, the College Board discussed the College’s move towards a ‘new normal’ and the accompanying significant decrease in the need for rapid decision-making. For this reason, the Board decided that governance oversight of decisions relating to COVID-19 will revert to the College’s usual governance processes through Faculty Councils and their subordinate bodies. On behalf of the Board, College President Dr Lance Lawler thanked the Taskforce for their invaluable contributions which were critical in so many areas including:
Rapidly delivering considered guidance material to members The Taskforce continually monitored emerging pieces of literature relevant to radiology and radiation oncology members. At the peak of the pandemic these were numerous and released every few days. The resources were quickly identified and shared with College members. They included key links to educational material on imaging findings, clinical advice and links to information on how members could prepare their service or practice to cope with the challenges brought by the pandemic. These materials continue to be reviewed and emerging literature will continue to be shared with members on the College website at: www.ranzcr.com/our-work/coronavirus/ resources-and-useful-links
examiners and staff to deliver successful examination series for clinical radiology and radiation oncology trainees. It is our College’s purpose to drive optimum health outcomes by leading, training and sustaining our professions to provide excellent care for patients. Our world-leading training and assessment program is at the core of that work. The contributions by all involved in examinations in 2020 ensured that our next generation of clinical radiologists and radiation oncologists will provide the services that patients require, averting a potential future workforce gap.
Prioritising the health and wellbeing of members, trainees and IMGs Issues relating to wellbeing, work-life balance and burnout are always at the forefront of the College’s mind, but usual stresses and burdens were only intensified by COVID-19. The Taskforce led work to provide a suite of practical information and useful resources to support the health and wellbeing of College members, especially trainees and IMGs who were faced with unprecedented challenges to continue their training and in many cases, being isolated from their families and friends overseas. These resources are available on the College website here: www.ranzcr.com/fellows/general/ your-wellbeing
Averting a potential future workforce crisis by assisting preparations for examinations
Advocating on key issues including access to PPE and ensuring patient access to regional radiology services
COVID-19 was perhaps most disruptive for the College’s examination timetables and processes. The Taskforce was able to assist the examination committees,
The College joined with the Australian Diagnostic Imaging Association (ADIA), the Australian Society of Medical Imaging and Radiation
Therapy (ASMIRT), the Australasian Sonography Association (ASA), the Medical Imaging Nursing Association (MINA), the Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM), and the New Zealand Institute of Medical Radiation Technology (NZIMRT) to release the position statement COVID-19 Essential role of clinical radiology services in March 2020. It highlighted concerning reports that radiology departments and practices were experiencing difficulties accessing personal protective equipment (PPE) and formed the basis of strong advocacy to governments. Other critical statements were developed on ensuring patients continued to have timely access to radiology services during lockdown; artificial intelligence and COVID-19; the appropriate use of CT during the pandemic; and safely resuming services as restrictions eased across Australia and New Zealand.
Reassuring patients that it was safe to continue with their tests and treatments During the peak of COVID restrictions in Australia, radiation oncologists were concerned that cancer patients were not attending their required consultations or discontinuing their treatment after making incorrect assumptions about the safety, availability or capacity of clinical services. The Taskforce assisted the Faculty of Radiation Oncology to develop a media campaign encouraging cancer patients to continue treatment and reassuring them that special provisions were in place to make services safely accessible.
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Education
RANZCR Research Grants in Action An Interview with Associate Professor Frank Galliard
A/Prof Frank Galliard
What is your current role/s? I am currently a consultant neuroradiologist and Director of Research of the Radiology Department Royal Melbourne Hospital, and a clinical associate professor in the Faculty of Medicine, Dentistry, and Health Sciences at the University of Melbourne. Additionally, I am the founder and Editor in Chief of Radiopaedia.org.
What are your research interests? My research interests are varied, primarily investigating how novel computer visualisations can be used to make routine imaging tasks faster and more accurate. I have a small grantsupported lab that has been working on this since 2015, with the bulk of the work so far on multiple sclerosis. My additional research interests are in tumour radiomics and perceptual learning as a way of training radiologists (in collaboration with the University of Melbourne psychology department).
Are there any big unanswered research questions in this area? In recent years, an enormous amount of interest and effort is being expended in artificial intelligence/machine learning applications. Although many of these are fascinating, in many instances they
22
Inside News
“In recent years, an enormous amount of interest and effort is being expended in artificial intelligence/ machine learning applications. Although many of these are fascinating, in many instances they provide an AI solution to a problem that doesn’t really exist. In contrast, little innovation in how traditional imaging is shown has occurred since moving from printed film to PACS.” provide an AI solution to a problem that doesn’t really exist. In contrast, little innovation in how traditional imaging is shown has occurred since moving from printed film to PACS. In fact, other than scrolling through stacks and performing multiplanar reformats, we largely present imaging in a way very reminiscent of printed film. We hang studies side by side to compare them and we present them in near identical ways regardless of the specific clinical question. Furthermore, most PACS viewers present imaging in a similar way regardless of context; the view shown
to diagnostic radiologists is very similar to that shown on the ward, or in the outpatient setting. There is no a priori reason to believe that this is optimum, and we believe there is a lot of ‘low hanging fruit’; improvements in how routine imaging is presented can have significant impact on outcomes. We have demonstrated this multiple times within the context of MRI for the follow-up of multiple sclerosis: see www.github.com/mh-cad
In 2019, you received RANZCR Research Grant funding for your project “MRI brain 4D time-lapse viewer.” Can you tell us a bit more about this project? Brain tumours, along with many other conditions, are followed up for extended periods of time in an effort to visualise gradual growth and to assess for alterations’ rate of change. This can be challenging especially as the interval between follow-up studies is variable and patient positioning can subtly vary. Moreover, these features are even harder for a patient to appreciate in the outpatient setting and the ability to fully understand the nature and progression of their condition can play a vital role in empowering them to make decisions. To this end, we have created an application which presents a longitudinal view of all available scans allowing radiologist, clinicians and patients to navigate not only through three spatial dimensions (as is usual) but also through time in a manner reminiscent of timelapse photography. See Figure 1: 4D Viewer Interface Additionally, we are working on implementing an MRI equivalent of ultrasound M mode that we are all familiar with; showing change in signal intensity along a line drawn in a particular location. See Figure 2: M mode
Education
Our initial aim was to use this visualisation in selected patients in the neuro-oncology multidisciplinary meeting at the Royal Melbourne Hospital. This meeting typically presents six patients in a 30-minute time slot, each patient often having over a dozen prior MRI scans, making it challenging to present their imaging over time. Formal feedback obtained from this meeting confirmed that this visualisation was felt to be intuitive and ‘better’ or ‘much better’ than the traditional way to show cases.
Additionally, we are looking at exploring novel ways of presenting this data, both by interpolating the non-imaged time points to create a smoother and more granular animation of change over time, as well as finding ways to present these findings in the Augmented Reality (AR) and Virtual Reality (VR) setting. To this end, we have an industry-funded grant to create a 4D viewer for multiple sclerosis scans and to present a proof of concept in AR/VR.
Time-lapse video: https://youtu.be/bH1q7WGb35Y @Radiopaedia
What have been the key learnings from this project? Why are the results so important? The heterogeneity of scans, even from the one institution, is challenging. Normalising position and signal intensity such that parts of the images that are not changing appear stable whereas those that demonstrate pathological change remain visible is a core nontrivial part of this project and continues to be a relative weakness. The other challenge is to perform the necessary steps automatically on dozens of studies quickly enough so that the results are potentially available at the time of reporting. This requires dedicated hardware and optimised imaging pipeline.
Figure 1: 4D Viewer Interface
The most important key lesson we are learning in each of our visualisation projects is that there is a great deal of potential in optimising how routine imaging is presented and that these changes can have a significant impact in the efficiency and accuracy of clinical interpretation.
The research has been the foundation around which a number of other projects are taking shape. Where to next for this project and your research team? Taking these lessons forward, we are planning to further improve the platform and assess it in the outpatient setting. We believe patients will be interested in seeing how their conditions change over time in an intuitive way and that this in turn will have benefits to how engaged they are in their management.
See Figure 2: M mode
“To this end, we have created an application which presents a longitudinal view of all available scans allowing radiologist, clinicians and patients to navigate not only through three spatial dimensions (as is usual) but also through time in a manner reminiscent of time-lapse photography.”
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Advocacy Advocacy
Raising Awareness Targeting Cancer and Reaffirming Commitments to Patients The Targeting Cancer Committee has been busy planning for the next year’s activities to promote the Targeting Cancer campaign. The Committee has identified a need to develop more New Zealand content in general, as well as content for Māori, Aboriginal and Torres Strait Islander consumers. We are on the hunt for a New Zealand Targeting Cancer ambassador, as well as New Zealand clinicians along with their patients who would be willing to make patient videos to put onto the website. We would be more than happy to assist any clinician who would be willing to participate. Ask During February, the Cancer Targeting Cancer any of the Targeting Committee campaign onceparticipated again supported members who in the World Day and itsrewarding #ICan&IWill COVIDCancer video about how campaign. The annual event ontheir 4 the experience was in making February is a global initiative led by the own videos. Union for International Cancer Control If you are interested in making (UICC). The day, which marked its 21st a video this please anniversary year,contact raises worldwide Tan Nguyen | Projects Officer at awareness and aims to increase access faculty@ranzcr.edu.au to life-saving cancer treatment. To mark World Cancer Day, radiation oncologists from across Australia and New Zealand united to stand up, speak out and take action to raise awareness of radiation therapy as a safe and effective cancer treatment. Embracing the theme of ‘I Am and I Will’, members of the Targeting Cancer Management Committee shared their personal commitments to help cancer patients in a series of videos. The videos explain the symptoms and treatment options for a number of cancer types including lung cancer, skin cancer, bowel cancer, head and neck cancer, and prostate cancer. The Targeting Cancer campaign also collaborated with cancer agencies and other stakeholders including the Australian Society for Medical Imaging and Radiation Therapy (ASMIRT), the Clinical Oncology Society of Australia
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Inside Inside News News
In the March 2021 Inside News Targeting Cancer update, we introduced you to the beginning of Lex’s cancer journey as he was preparing to undergo radiation therapy with Dr Madhavi Chilkuri in Townsville. Lex has completed treatment and we have received information that he has recovered well and has also shown complete response to treatment. Lex is keen to share each step of his story to help other patients in the same predicament. We are pleased to announce the production of the next video detailing Lex’s journey through his treatment and the outcome of his treatment. This is an exciting addition (COSA), Lung Foundation Newof Zealand to the consumer-facing library videos and andon Skin thatthe we Melanoma currently have theCancer Targeting Advocacy Network to spread Cancer page of the(MSCAN) College website. awareness of radiation therapy as a vital Our very proactive Targeting cancer treatment across their Cancer social Ambassador, Julie McCrossin, has media accounts. also been busy in production of a We would like to thank all our aimed series of webinars on YouTube members whopatient sharedexperience their #ICan&IWill at improving in commitments across socialHer the head and with neckus cancer space. media in the up to and on webinars arerun aimed at the Firstday Nations the day itself. You can watch and share the video series on the Targeting Cancer website, www.targeting.cancer.com
Watch the beginning of cancer patient Lex’s treatment journey Targeting Cancer recently produced a video to share the inspiring story of Queenslander, Lex, who has begun his radiation therapy treatment journey after Lex was diagnosed with a 4cm cancerous tumour at the back of his tongue. Lex and his wife Tricia live in Mackay but stayed in Townsville—a four-hour drive away from their home—for seven weeks while Lex underwent radiation therapy. The couple were relieved that they didn’t have to travel to a bigger city to access treatment. Tricia said, “I’m actually glad that we’re not in a major city because I think that
would add more pressure and stress. It’s people; children, adolescents and young amazing thatinformation you can getabout the same kind adults; and proton of care that here as you would therapy andyou theget experience for patients get a bigger andinfamilies. Ascity.” a cancer survivor herself she is able to capture valuable patient Radiation oncologist, Dr Madhavi insights into the cancer journey through Chilkuri, emphasised the importance to the other side of treatment. of highly skilled and dedicated multidisciplinary A significantteams pieceworking of work together that the to provide holistic care. Targeting Cancer Committee has commenced is the review of all the Dr Chilkuri said, “These patients require resources, articles and research a very coordinated, multidisciplinary that are currently on the Targeting approach to their treatment and to have Cancer website. The website needs timely access to all the specialists and to remain current and relevant in all the health workers that might make a today’s environment. New and difference in their outcomes, not only for better equipment, technologies and cure but also for function.” knowledge are progressing in leaps and bounds so it is important that the information on our Targeting Cancer website keeps abreast of all these changes to keep patients informed.
“I’m actually glad that we’re not in a major city because I think that would add more pressure and stress. It’s amazing that you can get the same kind of care that you get here as you would get in a bigger city.”
Lex and Tricia expressed their heartfelt thanks to all involved in their care and felt fully supported by their treatment team. Tricia said, “The wonderful thing along the way is the people that have come into our path—the people that have supported us every step of the way and guided us. I think that’s what is getting us through.
Education 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 InsideRadiology is a conduit of communication between the College, health consumers, and health professionals; further promoting the InsideRadiology a conduit of role and value ofisclinical radiology and communication between the College, clinical radiologists in patient care. health consumers, and health professionals; further promoting the Web activities role and value of clinical radiology and Since the New Year in wepatient have had an clinical radiologists care. increased number of visits to the site resulting in the highest volume of traffic Web activities in the last seven months. The Computed Since the newpage year attracted we have had Tomography the alargest steadily increasing number of number of visits so far this yearvisits withto the resulting in the highest volume 558 site followed by Gadolinium Contrast of traffic in thethe lastMIBG year. Scan The Gadolinium Medium and pages. Contrast Medium page attracted the largest number of visits so far this year Computed Tomography followed by Transvaginal Ultrasound and In honour of our most popular page for Interventional Radiology. 2021 so far:
X-ray tubes rotate around the patient at high speed and up to 320 axial slices of the body can be obtained per rotation. This produces a large amount accurately report on how your of data which is analysed usingbody powerful is working algorithms and whether is any computer tothere produce images disease or be abnormality which can viewed inpresent. any anatomical plain or reconstructed into three Gadolinium contrast media consist of dimensional rotatingarrangements images. All body complex molecules, of structures be visualised and this can atoms heldcan together by chemical bonds. be enhanced with the use of intravenous The chemical bonds are made between contrast medium. aiodinated gadolinium ion and a carrier molecule (a chelating agent). A of chelating agent The rapid acquisition data from prevents toxicity of gadolinium CT meansthe that accurate images andwhile maintaining its contrast properties. information can be obtained without Different brands of gadolinium contrast being degraded by patient movement, medium use different chelating be it physiological (such as cardiac or molecules. contrast medium is an respiratory)The or unexpected (such as injected intravenously uncooperative patient).(into a vein) as part of an MRI scan, and eliminated from the bodylocations through the kidneys. Visitor
Gadolinium Contrast (CT) Medium Computed Tomography is a
with eastern Australian capital cities responsible for more than 65 per cent of Australian and New Zealand visitors, however there is still a steady stream Supplementing your and online of visitors from regional remote locations. resources We encourage you—our information Supplementing online partners, hospitals,your and radiology resources practices—to link directly to the InsideRadiology so that InsideRadiology website encourages its staff, patients and referrers can access trusted information partners, hospitals, and information that can easily be printed radiology practices to link directly to the into a fact sheet straight a website InsideRadiology website from so that staff, built for them. patients and referrers can access trusted information straight from theirupdates own InsideRadiology continuously website can easily be printed into a the itemsthat as part of an ongoing review fact sheet. strategy so that radiology sites have up-to-date information for your patients InsideRadiology will continuously update without the extra administration. the items as part of an ongoing review strategy thathelp radiology sites have We needso your to promote up-to-date information their patients InsideRadiology: follow for us on Twitter without the extra administration. and Facebook (@InsideRadiology).
Trans-Tasman visitors account for 21 Visitor locations high-resolution using X-ray In honour of ourtechnique most popular page per cent of the total activity on the Please help us promote InsideRadiology technology Trans-Tasman visitors forare 21 for March: to generate images of any site, while 40 per centaccount of visitors by following us on Twitter and Facebook area of the body. Patients are placed per cent of the total activity on the accessing the website from the US What a patientX-ray will read: (@InsideRadiology) on a moveable table Gadolinium which then If you need further information site, while 40cent per cent are and ten per from of thevisitors UK. The contrast media (sometimes calledon MRI enters the CT gantry. Depending the or need want to provide feedback, accessing from the US and majority ofthe ourwebsite Trans-Tasman audience If you further information please contrast media, agents ‘dyes’) are two equipment used, one ororsometimes contact the team at 10 cent from The majority areper accessing thethe siteUK. from large cities, contact insideradiology@ranzcr.edu.au chemical substances used in magnetic insideradiology@ranzcr.edu.au of our Trans-Tasman audience are resonance imaging (MRI) scans. When accessing the site from large cities, injected into the body, gadolinium with eastern Australian capital cities contrast medium enhancescurrently and for over 65 per cent ofprocedures: InsideRadiology coversresponsible the following interventional improves the quality of the MRI images Australian and New Zealand visitors, (or pictures). This allows the radiologist however there is still a steady o Angioplasty and Stent Insertion o stream Pleural Aspiration (a specialist doctor trained to examine of visitors from regional and remote the images andTap provide a written report o Ascitic o Radiofrequency Ablation locations. to your doctor or specialist) to more o Biliary Drainage
o SAH Vasospasm Endovascular Treatment
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o Selective Internal Radiation Therapy [SIRT]: SIR-Spheres®
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o Image Guided Cervical Nerve Root Sleeve Corticosteroid Injection Promoting Promote o Image Guided Liver Biopsy InsideRadiology in your InsideRadiology professional networks. o Image Guided Lumbar Epidural Corticosteroid Injection too Patients Image guided lumbar nerve root sleeve injection Recommending any and Colleagues o Inferior Vena Cava Filters
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Volume 2021 Volume17 17No No23 I I March June 2021
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Education
It’s Time to Reconnect! Join Us in Melbourne for the RANZCR2021 ASM In just over three months the College’s flagship event—the Annual Scientific Meeting—will be held in Melbourne from 16–19 September 2021. The program promises to be the largest to date with more than 200 presenters across clinical radiology and radiation oncology presenting over the three days of the main meeting. The fourth day will see the opportunity for delegates to participate in a number of hands-on workshops across both disciplines. With last year’s restrictions and the rescheduling of our 2020 ASM, a record number of new Fellows will be celebrated and acknowledged in the traditional Annual Ceremony held on Friday 17 September at the Melbourne Convention and Exhibition Centre. The celebrations will continue with the Dean’s Reception to be held on the banks of South Wharf. The College is excited to announce the introduction of new initiatives at this year’s ASM including the Everlight
“With last year’s restrictions and the rescheduling of our 2020 ASM, a record number of new Fellows will be celebrated and acknowledged in the traditional Annual Ceremony held on Friday 17 September at the Melbourne Convention and Exhibition Centre.”
Radiology Little Rascals Creche, breakfast sessions presented by major partners, workshops and an industry exhibition that will engage, inform and nourish delegates’ appetite to reconnect. RANZCR2021 will showcase emerging trends in radiology and radiation oncology AI software, hardware, regulatory, industry perspectives, impact on health care, expenditure, revenue and patient outcomes with AI. A varied and engaging program of international and national speakers and an interactive program will highlight the opportunities in radiology and radiation oncology in the future. There will be a series of multidisciplinary sessions to discuss current clinical topics, an increased number of international experts and collaboration with affiliated organisations to deliver captivating sessions. We are fortunate to have support from our global radiology partners to include world renowned speakers at RANZCR2021. The Radiological Society of North America (RSNA) are supporting a Thoracic-AI speaker (TBD). The American Society of Neuroradiology (ASNR) are supporting the legendary Anne Osborn and Ramon Gil Gonzalez. The European Society of Neuroradiology (ESNR) are supporting
renowned experts Majda Thurnher, Johan Van Goethem and Turgut Tali to speak at our meeting. There will also be speakers in other specialist areas including the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) and expert AI speakers. An innovative radiation oncology program with a range of national and international speakers is planned. International speakers will cover a range of sites including: Fiona McDonald (Royal Marsden, lung and stereotactic radiotherapy and adaptive radiotherapy); Desiree van den Bongard (Amsterdam UMC, breast and oligometastic disease); Andrew Loblaw (University of Toronto, prostate and GU cancers); and Clifton David Fuller (MD Anderson, head-and-neck and functional imaging). RANZCR2021 will be delivered as a hybrid event—in person, virtual and on demand—and affords us the opportunity to pivot the ASM to a virtual conference if we are required to. Our ultimate goal is to engage with as many delegates in person to meet together in Melbourne and reconnect with a quality program and social activities you can’t afford to miss. Register now: www.ranzcr2021.com Volume 17 No 3 I June 2021
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Education
Continuing Professional Development (CPD) changes from 2022 The Medical Board of Australia (MBA) and Medical Council of New Zealand (MCNZ) announced proposed reforms to the regulatory requirements for registration in Australia and New Zealand, which will commence being rolled out from the beginning of 2022.
Key changes to 2022 RANZCR CPD requirements • Moving from triennium to an annual cycle From 2022, trienniums will be replaced with an annual cycle where members will need to accrue 50 hours of CPD annually. • Points to hours In 2022, CPD activities will be measured in hours, instead of points as has been traditionally done.
• Kaizen E-Portfolio (replacing the current CPD Learning Portal)
CPD activities in the three new categories
The Kaizen e-Portfolio will be replacing the current CPD Learning Portal platform at the beginning of the 2022 annual cycle. The Kaizen e-Portfolio will make it easier for members to log CPD hours, download certificates (for example, showing CPD participation) and will include a function to log multi-source feedback and reflective practice activities.
The MBA and MCNZ have developed three categories which CPD activities fit into. Members are required to undertake a spread of activities across the three categories. These are:
The new platform will be mobilefriendly, allowing members to log their CPD activities and upload evidence from a smartphone or tablet. The overall contemporary design will also allow members to interact with the platform more easily. We are looking forward to rolling out Kaizen e-Portfolio in January 2022. We hope to be demonstrating this platform at the upcoming Australian and New Zealand ASMs (dependent on travel restrictions due to COVID-19).
Most of the activities that fall under the above three categories will be similar to your current CPD allocations. Below is an example of CPD activity types and where they fit under the three categories:
• Educational Activities • Reviewing Performance and Reflecting on Practice • Measuring and Improving Outcomes.
Educational Activities • Self-directed learning
• Teaching, training and supervision
• Conferences and meetings
• Publications and presentations
• Professional and clinical governance
• Research
• Miscellaneous activities - e.g., mentoring; guideline development; preparing patient education materials
Reviewing Performance and Reflecting on Practice • Participation in clinical governance activities
• Professional development plan
• Medical services survey/review
• Multi-source feedback
• Multidisciplinary team meetings
• International governance
• Evaluation of performance
• Reflective diary
• Direct observation of practice
• Accrediting/auditing practices, hospitals, training sites
• Practice profile
• Patient experience survey
• Medico-legal work
• Peer review meetings
• Workplace performance appraisal Measuring and Improving Outcomes
• Audit
• Quality improvement projects
• Incident reporting
• Database logbook
• M&M meetings and case conference
• Assessing incident reports
• Patient experience survey
• Multidisciplinary team meetings
• Leading, analysing, writing reports on healthcare outcomes
• Root cause analysis activities
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continued on page 34... Inside News
Education
RANZCR Workshops, Courses and Events 2021 RANZCR Webinar Series The Sponsorship and Events team is excited to have a calendar of events for the remainder of 2021. Further dates and topics will be released shortly.
2021 Series Thursday 10 June FROGG Genitourinary Sessions for Radiation Oncology Trainees - Presenting partner Eligard (Mundipharma) Professor Vedang Murthy Thursday 10 June 7.00–8.30pm AEST Thursday 22 July Expanding the role of MRI in Radiation Oncology - Presenting partner Philips Thursday 22 July 7.00–9.00pm AEST Registrations opening soon Wednesday 14 July Applications of Artificial Intelligence in CT & MR Imaging - Presenting partner GE Healthcare Australia & New Zealand Dr Daniel Cornfeld, Matai Medical Research Institute, Gisborne, New Zealand Dr Peter Brotchie, St Vincent's Hospital, Melbourne, Australia Evening webinar/start time to be confirmed. On Demand If you miss any of the live sessions, you can watch them on demand via the College’s webcast library: webcast.ranzcr.com/Mediasite/Showcase/ If you would like to suggest a webinar topic, email us at events@ranzcr.edu.au
RANZCR/ACR Education Center Courses To be confirmed Due to current border closures we are unable to fly in our expert faculty from the US. We are working with ACR on alternative methods for 2021. We will communicate any updates as soon as we have them.
Radiation Oncology Trainee Phase 1 Course 19 June 2021 The Phase 1 Course is designed for trainees within their first six months of training and to assist trainees as they approach their Phase 1 exams. This course will be run in an online format for 2021. For more information on this event please visit our website: www.ranzcr.com/whats-on/events/phase-1-course
NZ Branch Annual Scientific Meeting 6–8 August 2021 InterContinental Hotel, Wellington For more information please visit our website: www.ranzcr2021.co.nz
RANZCR Annual Scientific Meeting 16–19 September 2021 Melbourne Convention and Exhibition Centre For more information please visit our website: www.ranzcr2021.com If you have any questions relating to any College events, contact the Conferences and Events team at events@ranzcr.edu.au
Volume 17 No 3 I June 2021
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RANZCR acknowledges the Traditional Owners of Country throughout Australia. We recognise the continuing connection of Aboriginal and Torres Strait Islander people to lands, waters and culture and we pay our respect to their Elders past, and present and emerging. RANZCR acknowledges Māori as tangata whenua and Treaty of Waitangi partners in Aotearoa New Zealand.
RANZCR Statement of Intent for Māori, Aboriginal & Torres Strait Islander Health PURPOSE The Royal Australian and New Zealand College of Radiologists (RANZCR) is committed to supporting the professions of clinical radiology and radiation oncology to contribute to equitable health outcomes for Māori, Aboriginal and Torres Strait Islander Peoples. This work is central to the strategic objectives of the College and will be reflected in the next iteration of the Strategic Plan. MATEC To support the College’s work in achieving its commitment, the Board has established the Māori, Aboriginal and Torres Strait Islander Executive Committee (MATEC) as a bi-national peak committee to provide authoritative advice to the Board, the Faculty of Radiation Oncology, the Faculty of Clinical Radiology and other key committees, on how to significantly reduce disparities in health outcomes for Māori, Aboriginal and Torres Strait Islander Peoples. VISION Our vision is equitable health and workforce outcomes for Māori, Aboriginal and Torres Strait Islander Peoples. OBJECTIVES We will honour our commitment to Indigenous health by: Increasing the number of Māori, Aboriginal and Torres Strait Islander Peoples in the clinical radiology and radiation oncology workforce; Ensuring cultural safety is an essential component of clinical safety, and aligns with best practice and the accreditation standards of the Australian Medical Council (AMC) and Medical Council of New Zealand (MCNZ); Building and maintaining sustainable relationships with the Indigenous health sector; THE FOUR PILLARS RANZCR’s work in this area is grounded in four key pillars for change: ONE
Education a) Trainees (curriculum) b) Fellows and Educational Affiliates (Continuous Professional Development)
TWO
Networking, relationship-building and collaboration
THREE Selection of trainees FOUR
Mentorship of our Indigenous trainees, Educational Affiliates and Fellows.
The Board encourages members to embrace learning and change in this area, including the discomfort of confronting and understanding the potential for one’s own unconscious biases, racism or discrimination.
VALUES Our values in relation to this work are: Indigenous Worldview—to respect and embed Indigenous worldviews throughout the College and its spheres of influence. Integrity & Courage—to renew organisational policies and systems to remove any potential barriers to optimal health, wellbeing and safety outcomes for Māori, Aboriginal and Torres Strait Islander Peoples. Ethics—to adopt an ethical approach by doing what is right, not what is expedient; with a forward thinking, collaborative attitude and a patient-centred focus. We will consult appropriately when at the limits of our knowledge and be transparent about our own capacity and capability to enable self-determination for Māori, Aboriginal and Torres Strait Islander Peoples. Accountability—to be accountable to our members and the Indigenous patients and communities we serve. Leadership—to enable and embed Indigenous leadership and self-determination to ensure best practice in delivering more equitable health outcomes. Māori, Aboriginal and Torres Strait Islander Peoples have the right to make decisions about their health and wellbeing, workplace safety and cultural practices. CULTURAL SAFETY - DEFINITIONS Cultural safety is defined by the Australian Health Practitioner Regulation Agency and the National Health Leadership Forum of Aboriginal and Torres Strait Islander health peak organisations (in consultation with the MBA and AMC) as follows: ‘Cultural safety is determined by Aboriginal and Torres Strait Islander individuals, families and communities. Culturally safe practice is the ongoing critical reflection of health practitioner knowledge, skills, attitudes, practising behaviours and power differentials in delivering safe, accessible and responsive healthcare free of racism.’ ‘Patient safety for Aboriginal and Torres Strait Isander Peoples is the norm. We recognise that patient safety includes the inextricably linked elements of clinical and cultural safety, and that this link must be defined by Aboriginal and Torres Strait Islander Peoples.’ (AHPRA, 2020) Cultural safety is defined in the New Zealand context as: ‘Cultural safety requires doctors to reflect on how their own views and biases impact on their clinical interactions and the care they provide to patients… The Medical Council has previously defined cultural competence as “a doctor has the attitudes, skills and knowledge needed to function effectively and respectfully when working with and treating people of different cultural backgrounds”. While it is important, cultural competence is not enough to improve health outcomes, although it may contribute to delivering culturally safe care.’ (MCNZ, 2019) THE JOURNEY BEFORE US RANZCR acknowledges the many years of tireless work and advocacy undertaken by Indigenous Elders, Ancestors and Indigenous leaders who precede us. This legacy has resulted in The Treaty of Waitangi (introduced into NZ Legislation) and the Uluru Statement from the Heart (endorsed by Aboriginal and Torres Strait Islander communities, but not the Australian government). The status of these historic documents reflects the differences between New Zealand and Australia on their paths to better relationships between Indigenous and non-Indigenous peoples. In addition, and relevant to this Statement from the Heart, RANZCR acknowledges the Australian government’s Closing the Gap policy framework and associated targets to reduce life expectancy gaps within a generation, and New Zealand’s equivalent Māori health strategies and frameworks. While some progress has been made, many indicators show little or no change, or in some cases, worse outcomes than originally benchmarked. It is everyone’s responsibility to address these failures at every level.
Developed by ABSTARR Consulting on behalf of RANZCR
If you would like to get in touch to discuss this Statement of Intent or if you have any ideas, suggestions, feedback or potential initiatives we can consider which you think would provide better support to our Indigenous trainees, members and/or consumers please get in touch. To do so, or to ask any questions about this work, please contact Madeleine d’Avigdor at madeleine.davigdor@ranzcr.edu.au
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Clinical Radiology
Getting Things Done! A Message from the Dean
Clin A/Prof Sanjay Jeganathan The Italian poet Dante Alighieri said, “The secret of getting things done is to act!” With Australia and New Zealand settled into a COVID normal we are ‘getting things done’ and ‘acting’ on our many priorities. It is an exciting time for clinical radiology on both sides of the Tasman, with the New Zealand Health and Disability Review bringing radical change to the health system, an Australian federal election looming and our digital health strategy coming to fruition, to name just a few of our activities.
Radiology Referral Set and digital health Digital health remains a strategic priority for FCR Council with work in this area now really gaining traction. The College has developed a white paper, articulating our priorities for digital health: standardised terminology; the establishment of an eReferral system; access to historic images; development of imaging guidelines; and the managed roll-out of artificial intelligence (AI). We see standardised terminology as a building block which all the other priorities will interconnect with and something that needs to be put in place in order to progress. In conjunction with Australian Diagnostic Imaging Association(ADIA), we have been tasked by the Federal Government to run a landscape analysis of the current terminology sets available and make a recommendation on which set will best support the digital exchange of diagnostic imaging information in the Australian healthcare context. A report will be submitted to government by the end of June.
The 2021 Federal Budget included funding for digital health to progress an eReferral system for diagnostic imaging and we look forward to engaging with government in this important work.
NZ Health and Disability System Review The New Zealand Government recently released the results to its review into the health and disability system. The College was actively engaged in the review process, making two submissions and meeting with Heather Simpson, chair of the review. The NZ Government’s announcement made clear that this is a work in progress and there will be more decisions and announcements forthcoming. The major changes covered so far are: • The elimination of District Health Boards (DHBs) and the introduction of Health New Zealand, a health authority with operational oversight of NZ’s healthcare system • The introduction of a Māori Health Authority—an independent body with joint decision-making rights for healthcare strategies and policies which affect Māori • The Ministry of Health will remain in overarching control of the health system, however it will not be responsible for running hospitals or commissioning healthcare spending, instead focusing explicitly on providing policy advice to the Government • The Public Health Authority will be brought into the Ministry to enable a new focus on prevention.
From a College perspective, NZ members can feel cautiously optimistic. One health authority will be well placed to enable the changes that we are asking for, particularly around workforce planning, training and retention and digital health infrastructure. We will continue to be actively engaged with decision-makers as these changes are rolled-out to ensure that our role and the value that clinical radiology brings to patient care is well understood and appropriately resourced.
Māori, Aboriginal & Torres Strait Islander health In recent years the College has been increasing our efforts to improve health outcomes for Māori, Aboriginal and Torres Strait Islander Peoples. Our key objectives with this work are to enable our members to provide culturally safe care and to grow our Indigenous clinical radiology and radiation oncology workforces. I am pleased to announce that we have recently published a Statement of Intent for Māori, Aboriginal & Torres Strait Islander Health (please refer to page 30 to read our Statement) which outlines the College’s commitments, values and directions in addressing Māori, Aboriginal and Torres Strait Islander health and workforce outcomes. In addition, we have reached out to the Australian Indigenous Doctors Association to understand the programs that they are developing to address specialist trainees. continued over... Volume 17 No 3 I June 2021
33
Clinical Radiology
We are currently developing the RANZCR Action Plan for Māori, Aboriginal and Torres Strait Islander Health, which is now open for consultation. The Action Plan comprises a series of considered and targeted activities and is central to the strategic priorities of the College. I invite you to review the draft Action Plan (available on the ‘our consultations’ page on the College’s website) and email us your feedback. I hope that you can all take the time to read and reflect on our Statement of Intent, review our draft Action Plan and submit feedback if you have something to contribute to this very important body of work.
Australian budget and election asks The Australian Federal Government recently announced its budget for 2021. It was pleasing to see a range of measures directed at clinical radiology, including development of an integrated electronic diagnostic imaging referral system, funding to improve the LSPN registration system and one-off funding
for rural and remote practices to assist private practices with the replacement costs of older equipment. There was a mixed bag in relation to MRI. The good news is that MRI Items will be indexed from 1 July 2022, however the Bulk Billing Incentive for MRI is being reduced to 95 per cent, in line with other imaging modalities. These measures will result in an overall saving to the Government of $107 million over four years. We are concerned about any reduction in funding and will be advocating for any savings to be reinvested in the sector. We are now gearing up for the next Australian federal election and we will use the opportunity to advance our advocacy strategy. Deregulating the complex MRI licensing system continues to be one of the most important issues that impact patient access and something that is a priority for members. Workforce is also an important issue for us to highlight to government, both from a rural and regional supply perspective and also to ensure support for training into the future.
In the coming months I will communicate with members on the details of the issues above and any other ‘asks’ that we will advocate for to political parties in the lead up to the election.
Artificial Intelligence (AI) The College continues to be at the forefront of preparing for the implementation of AI into clinical practice. Following the successful publication of our Ethical Principles for Artificial Intelligence in Medicine, and Standards of Practice in Artificial Intelligence, the AI Committee is moving on to the next project, developing a position paper on regulation of AI. The key focus for us is to ensure that governments consider the implications of AI to patient safety and develop appropriate regulations to address these risks. This will provide a platform for advocacy with the Therapeutic Goods Administration (TGA) and other government agencies. The regulation position paper will soon be published for member consultation and I encourage you to provide feedback when it is released.
continued from page 28...
2022 RANZCR CPD requirements Members are required to: • complete a minimum of 50 hours of CPD per year with a spread of activities across: o educational activities o reviewing performance and reflecting on practice o measuring and improving outcomes • complete a Professional Development Plan (PDP) annually • all CPD must be relevant to the doctor’s scope of practice and based on a personal Professional Development Plan (PDP) completed each year • if reporting MRI, eight CPD hours are required annually (clinical radiology only) • if reporting Mammography, four CPD hours are required annually (clinical radiology only)
Australian Health Practitioner Regulation Agency (AHPRA) requirements The Australian Health Practitioner Regulation Agency (AHPRA) requires that all registered medical practitioners participate in CPD that is relevant to their scope of practice in order to enhance their knowledge, skills and performance to ensure that they deliver high-quality and safe care. When renewing their registration all medical practitioners must make a declaration that they have participated in CPD and met the CPD Registration Standard. Further details can be found in the CPD Registration Standard on the AHPRA website at: www.medicalboard. gov.au/Registration-Standards.aspx
Medical Council of New Zealand (MCNZ) requirements The MCNZ requires that all New Zealand Fellows, Educational Affiliates, IMGs and CPD participants meet the requirements of an approved CPD program, which includes recertification, to receive an annual practicing certificate. The requirements of the MCNZ include: • a minimum of one audit activity each year (to be recorded under the measuring and improving outcomes category); • a mix of CPD activities specifically those that involve: reviewing and reflecting on practice; measuring and improving outcomes; • a structured annual conversation with a peer, colleague or employer; and • cultural safety and a focus on health equity must be reflected in CPD activities.
• no CPD hours will be carried across years or into the next annual cycle. For more information regarding the upcoming CPD changes, please contact cpd@ranzcr.edu.au
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Inside News
Clinical Radiology
Program Evaluation Chief Censor in Clinical Radiology
Dr Meredith Thomas
As we move toward implementation of our much anticipated Training and Assessment Reforms (TAR) in February 2022, it will become vital to evaluate the new training program to ascertain that it is operating as we intend it to, that it is achieving the desired outcomes, and that there are no unintended consequences. While much effort has been spent considering new learning outcomes, developing the learning activities and experiences to align to these outcomes, and creating work-based assessments and examinations to make sure competences are achieved, it is inevitable that we will need a process of continual evaluation and reform, and ongoing refinement. This will mean that the characteristics and merits of the program are and remain sound. Program evaluation will also determine future educational strategies for curriculum, teaching and learning and assessment. The delivery of specialist medical education is overseen by the Australian Medical Council, and the College is accredited to deliver training in accordance with the Standards for Assessment and Accreditation of Specialist Medical Programs and Professional Development Programs by the Australian Medical Council 2015. Standard 6.2 is “Evaluation” and incorporates the following: • 6.2.1 The education provider develops standards against which its program and graduate outcomes are evaluated. These program and graduate
outcomes incorporate the needs of both graduates and stakeholders and reflect community needs, and medical and health practice. • 6.2.2 The education provider collects, maintains and analyses both qualitative and quantitative data on its program and graduate outcomes. • 6.2.3 Stakeholders contribute to evaluation of program and graduate outcomes. In accordance with our recent AMC accreditation, we will be finalising our overarching evaluation framework and responsibilities for monitoring and evaluation activities this year, recognising that we currently have multiple assessment tools to evaluate our training program. These are not just from trainees, but also from our teachers, Clinical Supervisors, Directors of Training (DoT) and future employers. An important part of our framework will be considering the timing of these evaluations, and ensuring that evaluation findings are fed back into the system and acted upon. Equally important is managing subsequent change. One of the commonly used models and approaches to program evaluation is Kirkpatrick’s hierarchy, first described in 1967 as a series of levels on which to base evaluation processes. The further up the hierarchy, the more credible the findings are in relation to the impact of the program on healthcare outcomes. Unfortunately, the higher up the hierarchy, the more difficult the evaluation.
The lowest level of the hierarchy is evaluation of reaction, which measures the level of satisfaction with teaching and learning, or the level of happiness of the learner or teacher. This is probably the easiest and most commonly utilised level to evaluate, and includes such things as: • Trainee Assessment of the Training Site (TATS), which the trainees complete every six months. TATS is a simple rating online assessment where a trainee is asked to rate the training location and training experience on a range of dimensions, and is also invited to comment on any particular strengths or weaknesses of the training site. • Trainee feedback surveys • Trainee Liaison officer feedback • Accreditation site visits • Trainees committee feedback. Similarly, Director of Training and Clinical Supervisor feedback is collated via: • DoT surveys • DoT workshop evaluations • Accreditation site visits • Examiners’ feedback survey - targeted group feedback. The second level of Kirkpatrick’s hierarchy is evaluation of learning, or an evaluation of the acquisition of knowledge and skills. This is relatively easy to measure at summative assessment level by analysing our examination results, and my last Inside News report detailed the results of the Series 2 2020 examinations in the 2020 Series 2 Examination Report, with continued over... Volume 17 No 3 I June 2021
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36
Inside News
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Clinical Radiology
comparative results across jurisdictions. Harder to evaluate (but easier going forward with the TAR changes) is the impact of educational resources and learning activities on trainee progression through the training program, although we do collect data on the number of examination attempts and remediation activities. Evaluation of behaviour, the third level of the hierarchy, relates to transfer of learning to the workforce—how good is our training program at equipping trainees with the knowledge, skills and behaviours required to be successful practising radiologists? Very valuable information is collected in the Clinical Radiology Completion Survey and in the New Fellows Survey, the latter overseen by the Clinical Radiology Workforce Committee. This includes training program satisfaction information but also information regarding skill confidence in the various system components of training. The Member Engagement Survey, while not specifically about the training program, captures information about maintenance of standards of practice and ethics, accessing learning resources, keeping up-to-date with
industry developments, as well as the understanding of government legislation and policy. This could perhaps be referenced in relation to the higher level of Kirkpatrick’s hierarchy, being evaluation of results, an evaluation of the transfer of impact of the training program on society. Going forward, as we implement the TAR reforms, it will be essential to continue to evaluate the impact of these reforms on our training program and to make sure that we meet our training aims: to provide a broad range of learning experiences across
the range of learning outcomes to train young radiologists to be experts in image interpretation and image guided diagnosis and therapy. We have the opportunity to revise our evaluation framework to make certain it is comprehensive, particularly at the higher levels of the evaluation hierarchy around transfer of learning to the workplace and impact on society, and to enable broad stakeholder involvement. Most importantly, we need to ensure that evaluation findings are fed back into the system to improve our training processes.
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Clinical Radiology
Clinical Radiology Trainee Matters
I hope you are incredibly proud of yourself for enduring the countless hours spent studying rather than being with your friends or family or other similarly enjoyable activities. The sacrifice truly is enormous and at times almost unbearable.
Dr Sarah Robertson Dear trainees, Not to sound too clichéd but I simply cannot believe it’s already June. I hope everyone’s first half of the year has gone well despite the peppering of minilockdowns and associated stressors. By the time this update is released, the Series 1 exams will have been completed in both Australia and New Zealand. I want to congratulate each trainee who took part in this examination sitting.
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Regardless of results, I hope you can take the time to reflect on how far you’ve come since the start of training and can look to the future with optimism. I would like to thank, on behalf of all trainees, every consultant involved in training. We are incredibly appreciative of all the time you spend (much of it unpaid) on ensuring not only we pass these exams but become excellent radiologists. I am so grateful that we as a profession place such a high value on collegiality, continued education, and excellence— traits that are reflected in our Fellows. Luckily while I’ve been mildly distracted by the pesky Part 2 exam, the CRTC has been in full swing bringing a trainee perspective to College decisions. High on our agenda have been: • Curriculum/assessment reform and plans for a new examination platform • Integration of research into the new curriculum
• Registrar after-hours workload • Rural workforce shortage and barriers preventing registrars from training in regional/rural settings • Development of the interventional radiology standards/curriculum. The CRTC has also been heavily involved in the ASM committee, particularly regarding the Trainee Day. It’s looking like there will be a stellar lineup of speakers and sessions covering exam preparation, fellowships, research, and much more. Get yourself a ticket and join us there! As always, we would love to hear from you about anything traineerelated. Don’t hesitate to email us at clinicalradtc@gmail.com. Until next time, Sarah Robertson Chair Clinical Radiology Trainee Committee (CRTC)
Clinical Radiology
A Word from the Chief of Professional Practice
A/Prof Dinesh Varma
2021 is in full swing, with the work of the Professional Practice Committee (PPC) progressing at a great pace. I am proud to announce that the Clinical Radiology Range of Practice has been published on the College website following member consultation and approval by Faculty Council. This was a big project of the PPC and I would like to personally thank Dr Andrew Cheung and Prof John Slavotinek for their time and clinical input on this document, it was invaluable to the College. A key piece of work which has featured in my updates over the past 12 months is the Recertification and Revalidation changes from the Medical Council of New Zealand and the Medical Board of Australia. The PPC have been meeting frequently to go over the changes to the Continuing Professional Development Program that will be effective from January 2022, most notable being the move from points to hours and from a triennium to annual cycle. We are currently on track to introduce the new program at the ASM in September, for implementation in January 2022. Further information regarding how the changes will affect your CPD can be found in this edition of the Inside News on page 28. The change to the CPD program will coincide with a change to the platform through which members record their CPD activities. The new platform provides all the same features of our current platform, but with an improved user experience and mobile-friendly interface. The new platform will also be ready for demonstration at the 2021 ASM in Melbourne.
Consultations related to Clinical Radiology Professional Practice The PPC has recently developed and requested Council’s approval for consultation of two new documents, the RANZCR Lung Cancer Screening Position Statement and the Certification Policy. The Lung Cancer Screening Position Statement outlines the College’s position in relation to a national cancer screening program for Australia and New Zealand in response to the changing needs within our communities. The College strongly supports the extension of the current national cancer screening program in both Australia and New Zealand to include lung cancer screening. The RANZCR Lung Cancer Screening Position Statement outlines the support of the College for a national lung cancer screening program across Australia and New Zealand, that is effective, equitable and fully funded. This consultation closes on 21 June 2021. The Faculty of Clinical Radiology Certification Policy provides the information and processes to support decisions in the area of post-Fellowship education. Specifically, it provides a structure for decisions as to whether certification above and beyond the RANZCR Fellowship is required for performance and/or practices in clinical radiology. The policy also supports decision-making about the degree and nature of further education and/or training requirements.
I would encourage all Fellows of the Faculty to review this document as it will be highly influential to our profession as new imaging practices develop that may require assessment to establish the required upskilling to ensure safe practice. This consultation closes on 28 June 2021. Both consultations and feedback instructions can be found on the College website under ‘Our Work’. I would like to thank all members of the PPC for their continued hard work and commitment to ensuring the highest level of clinical radiology is practised by Fellows of the Faculty of Clinical Radiology, it is encouraging to see the ongoing support and enthusiasm you bring to the projects within the PPC remit. I look forward to the second half of 2021, and if circumstances permit, meeting more Fellows of the Faculty at the upcoming ASM. Wishing you all the very best for the months ahead, A/Prof Dinesh Varma Chief of Professional Practice Faculty of Clinical Radiology
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Radiation Oncology
Equity and Perspective in Our Work A Message from the Dean
Dr Keen Hun Tai
Within the Faculty of Radiation Oncology, all our work includes strategic goals and work plans largely focused on training, education, advocacy and standards. We continually review how we sustain all these activities through governance structures and our directions are always guided by regulatory requirements. Many of our Fellows, trainees and Educational Affiliates provide the professional impetus supported by the College secretariat and interactions with other organisations. While we have demonstrated resilience over the past 12–15 months, there has been much stress on our systems and normal business. Despite these challenges, there is always a need to consider equity in all of our work. Equity has different meanings for different people and to various aspects of our work. Access to continued operation of our training program has been strained but we continue to move forward with contingencies being built into our systems to allow for potential adverse external events. To maintain equity of access, much has been changed to a digital format. As we deliver a curriculum and a training program, we should always remind ourselves that we deal with real patients who also expect equity of access to high-quality clinical care through a robust and fair system. Equity of outcomes for our patients is integral to an equitable access to a training program.
Access to radiation oncology services similarly must also be equitable. We continue to work with governments to ensure that this continues to improve. We recognise that the proportion of patients who have access to radiation therapy is still below the optimal utilisation rates of approximately 50 per cent.1 As well as the development of radiation therapy facilities to improve access, patients must have equitable access to high standards of care and outcomes. Problems with access exist especially in the regional and more rural areas.
“Equity has different meanings for different people and to various aspects of our work.” Working through our alliances with other organisations, FRO has clearly indicated the need also for equitable outcomes for access to a stable and vital multi-disciplinary workforce to deliver these services to patients in the regional and rural areas.2 We will continue to engage and work with governments to ensure these considerations are properly factored into developing and yet-to-bedeveloped radiation therapy services; while still acknowledging that not all has been equitable in currently provided services.
In Australia, the Federal Government continues to fund the promise to increase the location of radiation therapy facilities in regional areas. In New Zealand, the recently announced changes to healthcare structures including the formation of a new Māori Health Authority focus on improving the equitable access and outcomes for all patients. Vital to these changes and improvements will be the continuing work that FRO must do to ensure that equitable access and equitable outcomes are synonymous. Government policies in all jurisdictions and health services and agencies like Cancer Australia and Te Aho o Te Kahu (Cancer Control Agency) influence healthcare decisions that must be integrated for optimal care. FRO has working relationships with both of these organisations to strengthen and reiterate our message that optimal radiation oncology services be accessible with equity in both countries. Equitable outcomes in Indigenous health are also part of the work of FRO and the College. Last year, the College awarded the inaugural prize for the FRO Indigenous Health Research Prize to “promote research and publication to increase awareness and understanding of Indigenous Health issues in cancer care.” The Māori, Aboriginal and Torres Strait Islander Executive Committee (MATEC) is developing an Action Plan that will inform how the College as a whole will address issues of equity in Indigenous health.
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Radiation Oncology
Equity encompasses many aspects of the work we do. Acknowledging our achievements allows us to recognise that success can be re-produced in other areas. We should be mindful of others who share our journey and those whom we would like to bring along too, with the best interests of our patients at the forefront; as this will always have overall societal benefits. In radiation therapy health care, we are all at different levels of self-reflection and perspective of inequity or equity.
Participation at the workshops held by the Leaders in Indigenous Medical Colleges Network (endorsed by the Medical Deans of Australia and New Zealand) is helping to guide our College. These will be positive actions to change some of the systemic problems that confront all educational institutions. However, there is much an individual can and must do. Self-reflection on one’s own thinking, attitudes and behaviours is an important but still small step towards addressing these issues. It allows the recognition of the past and where we are now and what the gaps and where the barriers are to change. As progress occurs, the aspects of reflection must also evolve to take into account what has been achieved and where work must still be done: the goalposts should and will change.
As we take this journey, it is worthwhile to pause and ask ourselves from time to time “whose perspective of equity applies at this point?”
“Self-reflection on one’s own thinking, attitudes and behaviours is an important but still small step towards addressing these issues. It allows the recognition of the past and where we are now and what the gaps and where the barriers are to change.”
References 1 Barton M B et al Radiotherapy & Oncology 112 (1): 140–44. doi:10.1016/j.radonc.2014.03.02 2 RANZCR position statement - Establishing and Sustaining Regional and Rural Radiation Therapy Centres December 2016
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Radiation Oncology
Examinations in 2021 / Introducing the New Training Program at the ASM Chief Censor in Radiation Oncology
Dr Yaw Chin
As we hit the mid-year mark in 2021, we are intermittently brought back to earth and reminded of how easy our relatively normal lifestyles can be abruptly disrupted by sporadic cases of COVID-19 infection. Nevertheless, plans for education and training matters continue unabated as we cannot live stuck in limbo. The Phase 1 foundation and examination preparation course (which were cancelled last year) will be combined and held virtually. Because of the need to change the format of the course, it will now consist of pre-recorded lectures in Physics and Radiation and Cancer Biology, made available four weeks prior to and four weeks after the live course on Saturday 19 June 2021. The live course on 19 June will consist of a series of webinars that will include: • information on the Phase 1 exam process • tips on answering exam questions • information about the Anatomy component of the exam • live question and answer sessions with presenters in Physics and Radiation and Cancer Biology. Ongoing tasks are being completed as per the timelines determined for the Phase 1 examinations to ensure that it will be delivered in the normal paperbased format on Friday 10 September 2021. It gives me great pleasure to report that the casual vacancy created when Dr Sean Brennan stepped down as Chief of Examinations has now been filled with the appointment of A/Prof John Leung
into this position. A/Prof Leung is a well-respected and senior examiner with many years of assessing trainees under his belt. He will be assisted in leading this year’s Phase 2 examination series by another experienced and insightful examiner, Dr Rahul Mukherjee. I am extremely grateful for their willingness to take over the reins during this uncertain time and look forward to working alongside them to ensure that the radiation oncology examinations continue to be delivered with the highest of standards. The Phase 2 examination applications were made available online and communicated to trainees on 23 April 2021. Applications will close on 20 May 2021. The written examination dates have been confirmed for Monday 5 July and Tuesday 6 July 2021.The viva examination dates are confirmed to be held from Wednesday 25 August to Friday 27 August 2021. As previously communicated, the viva examinations will continue to be delivered virtually this year to mitigate the risks of any snap border restrictions and lockdowns caused by potential outbreaks of COVID-19. There will be no live patients and all patient cases will be replaced with prompt-based questions. Candidates will need to travel to their local Clifton Centres for the examinations. Work on the Training and Assessment Reform continues to progress behind the scenes with near completion of two significant documents—the learning outcomes and the RO Training Program Handbook. The final draft of the learning
outcomes document is now awaiting ratification by the RO Education and Training Committee and RO Faculty Council. I am confident that this significant document will be released before my next report so that trainees can have ample time to peruse and familiarise themselves with the learning outcomes for the new training program commencing in 2022. The other noteworthy document, which is also on track to be finalised and released, is the RO Training Program Handbook—a comprehensive manual outlining the entire new training program. Specifically, the ‘what, why and how’ of assessment tools to be used in the programmatic assessment of trainees are outlined. This includes workbased assessments, structured learning experiences, monitoring and feedback and examinations. Additionally, progression rules, variations in training time and research requirements will also be clearly articulated in this one-stopshop for all things related to the new training program. I would like to take this opportunity to encourage trainees and Fellows alike to register and attend this year’s 71st RANZCR Annual Scientific Meeting to be held in Melbourne from Thursday 16 September–Sunday 19 September 2021. Structured sessions will be organised to introduce the new training program so that both trainees and Clinical Supervisors will be sufficiently trained and empowered to run with it glitch-free as soon as it starts. continued over... Volume 17 No 3 I June 2021
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Radiation Oncology
The bi-faculty, bi-national Selection Review Working Group was formed in early 2021 to inform both Radiation Oncology and Clinical Radiology Education and Training Committees on appropriate and robust trainee selection approaches, processes and methods. This is to ensure recruitment and selection of doctors into the College training programs is standardised and conducted in a consistent, sustainable, valid and reliable manner in line with Australian Medical Council (AMC) standards. The Working Group includes trainee representatives from both faculties. After initial preliminary consultative meetings with two external consultants,
Dr Anthony Llewellyn (AdvanceMed) and Mr Ben Hainsworth (OPRA Consulting), the working group has now officially met twice. Current models of post-graduate trainee selection were reviewed and two high level approaches which optimally serve the College’s requirements are now being considered. In particular, there is the need to fulfil specific AMC recommendations for the College to support and facilitate: a) an increase in the recruitment and selection of Aboriginal and Torres Strait Islander and/or Māori trainees b) an increase in the recruitment and selection of rural origin trainees and trainees from other underrepresented groups.
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Inside News
This is an exciting piece of work and I look forward to seeing the evolution of a more streamlined and effective trainee selection framework. This will no doubt involve increased collaborative efforts between the College and local training networks so that the latter can more ably select and recruit doctors, who will ultimately be responsible for shaping the future of radiation oncology.
If you have any questions or comments about this article please contact Brendan Grabau | Senior Training Advisor | Training Programs on radtaa@ranzcr.edu.au
Radiation Oncology
Radiation Oncology Trainee Matters In this edition of Trainee Matters we will be hearing from two of our ROTC members; Dr James Gallo and Dr Ta-chi Zhong Hu, to give us some insight into their involvement and updates from the Radiation Oncology Education and Training Committee (ROETC) and Radiation Oncology Research Committee (RORC) respectively. Dr Chamitha Weerasinghe Chair Radiation Oncology Trainee Committee (ROTC)
Dr Chamitha Weerasinghe Trainees matter. I have tried to resist that pun for as long as possible, but I’ve recently stopped eating bread to slim down for my wedding so all my resistance is being used on that front at the moment. I really do mean it though, trainees matter. Their access to educational opportunities, adequate supervision and support is important, particularly now that we are slowly but surely returning to normal with clinical work and examinations. If you have any ideas for improvement or any training-related issues please talk to your ROTC representatives. The ROTC exists to advocate on behalf of radiation oncology registrars, we can only advocate effectively if we know what’s going on so please talk to us.
Radiation Oncology Education Training Committee (ROETC) It is a great privilege to be a part of the ROETC in 2021. The committee has been working hard to facilitate examinations, support training networks and provide a strong policy framework to ensure equity, transparency and timely communication to trainees. With the Enhanced Training Program slated for implementation in 2022, it is important that we do our best to stay up-to-date with our training requirements to ensure a smooth transition to the new assessment structure. Details of this transition will be available later this year. My sincerest thanks go to Dr Sean Brennan, the outgoing FRO Chief of Examinations and a tremendous advocate for trainees. Recognising the significant challenges in delivering robust and fair trans-Tasman examinations in the midst of a global pandemic, the Faculty has committed additional resources to this goal.
I am very grateful to have Ms Julia Snedic now assisting with the provision of the 2021 examination series. Julia is a Senior Project Officer and veteran of the College, with a wealth of experience that will make her invaluable to the examinations team—Julia is happy to be contacted by trainees with exam-related enquiries (julia.snedic@ranzcr.edu.au), as are Ms Senice So, the Trainee Liaison Officer (senice.so@ranzcr.edu.au), and myself (james.gallo@uqconnect.edu.au). The written Phase II examinations are scheduled for 5 and 6 July 2021. Vivas will be held virtually between 23–27 August 2021. Applications close Thursday 20 May 2021. Phase I written examinations will be held on Friday 10 September 2021. Applications have not yet opened. Unfortunately, there will not be a Phase II exam preparation workshop prior to the upcoming Phase II exams. With this in mind I would like to implore all networks, trainees and fellows to reach out and find ways to support our Phase II candidates. Be it facilitating leave, staging mock exams, marking exam questions or just providing some encouragement and solidarity through this stressful time; your colleagues will not forget your efforts. I wish you all every success in training, your careers and your lives outside of work. Dr James Gallo Trainee Representative, ROETC 2021
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Protect your health, access our wellbeing resources www.ranzcr.com/fellows/general/your-wellbeing
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Radiation Oncology
Radiation Oncology Research Committee (RORC) The Radiation Oncology Research Committee (RORC) promotes research in radiation oncology. As the RORC representative I work in conjunction with the rest of the research committee to promote research experience among radiation oncology trainees, develop strategic plans and partnership, assess trainees’ research progressions as part of the Clinical Pathway Program, and review applications for research grants and awards. I encourage my fellow trainees to review the categories and criteria for the research grants and awards as they embark upon their research activities, the 2021 RANZCR Research Grants are now open.
Within my role on the Radiation Oncology Trainee Committee (ROTC), I have engaged in specific smaller projects within the College to improve advocacy for our trainees, I am also the secretary for the ROTC and assist with recordkeeping and supporting my fellow committee members. Should you wish to present or include an agenda item for the ROTC to review please reach out to any of the ROTC members. If you have any specific inquiries about my role, research, or any other issues about your training, please feel free to approach myself or any of the members of the ROTC, drop us an email, and we will be delighted to support you at our best capabilities. Dr Ta-chi Zhong Hu Trainee Representative (NSW-S), RORC 2021
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Radiation Oncology
Quality Corner Radiate Safety, Irradiate Safely (RSIS) To quote the surgeon, writer, and public health leader Atul Gawande, “medicine has become the art of managing extreme complexity—and a test of whether such complexity can, in fact, be humanly mastered”. All radiotherapy departments today carry a panoply of technology and our patients have enjoyed greatly improved efficacy and reduction in toxicity from treatment. Alongside the rapid growth in technical complexity, time taken to learn and implement new technology and techniques, plan or deliver treatment is often longer, yet patients rightly expect their cancer treatment to start without delay. The vast majority of radiotherapy is delivered safely and time is a very precious resource. Time pressures can lead to patient delays, haste and mistakes and ultimately can lower the overall quality of care that is delivered to the patient. The College has published a number of documents that help guide departments in Australia and New Zealand towards the common goal of patient safety. The most important of these documents, the Radiation Oncology Practice Standards (ROPS) Parts A and B, stand out as a framework for quality, standards, workforce and public interest in Australia and New Zealand, through collaboration between the College, The Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) and the Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM). The Faculty are continuously working to improve these documents and an update of the practice standards is due shortly. In a further piece of work, the Quality Improvement Committee is drafting a document—tentatively titled 'Radiate Safety, Irradiate Safely' (RSIS) aimed to assist departments to put the ROPS into practice, elaborating on the ROPS.
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A major addition in this update is that RSIS recommends emphasis on checklists. A checklist specifies the minimum necessary steps to carry out a task, written down and ticked off when each step is done, yet it leaves room for craft and judgement for solving complex problems. The fundamental structure of radiotherapy requires
“The fundamental structure of radiotherapy requires every step to be done correctly, in the right sequence, and in a timely manner, similar to the aviation industry where checklists are routinely used before take-off.” every step to be done correctly, in the right sequence, and in a timely manner, similar to the aviation industry where checklists are routinely used before take-off. Checklists overcome the fallibility of human memory and distraction. They do not require extra staff, require minimal extra time, and have been proven in other areas of medicine to improve performance. Many radiotherapy departments are already employing checklists in some parts of their workflow. The purpose of RSIS is to create some uniformity in checklists between departments, ideally with
departments learning from each other and improving these checklists with time. The RSIS also supports ongoing investment in staff training. This is especially important when new techniques are implemented in departments or when new technology is installed. This training can be gained by attachment to a centre that has already implemented this new technique or technology. This training should include what errors to look out for and this leads to more efficient practice. By reducing errors, the initial cost of training is recuperated very quickly. Quality and safety is an ever-evolving cycle. With the hospital’s most complex treatment modality, regular review and re-evaluation of any checklists within departmental workflows are imperative to ensure ongoing relevance with technological improvements. Over time, new technologies will require new and specific quality and safety measures to overcome new challenges. Efficiency in delivering treatment is a key component of quality, and the challenge for the future is to streamline activities that add value. Safety and quality that is also efficient and effective is ultimately the goal. Our patients deserve no less. Dr Suki Gill Quality Improvement Committee
Radiation Oncology
Vale Dr Sharlyn Kang, FRANZCR 1981 – 2021
Dr Sharlyn Kang completed her radiation oncology training in 2010. Her passion for learning led her to complete a fellowship at The Princess Margaret Hospital, Toronto, Canada, before taking up a staff specialist position at the Wollongong and Nowra Cancer centres in 2011. Sharlyn cared for her patients with unwavering compassion and kindness. Her goal was not only on the best standards of medicine, but the best patient care. This dedication to her patients was not only confined to the clinic room. Living in the community she served and raising a young family there, it was a frequent occurrence to encounter her patients in public, where she would provide solace to patients and families. Her focus on complete patient care and advocacy was something she instilled in all who worked with and trained under her. During Sharlyn’s courageous five-year battle with lung cancer, her desire to help those around her continued. She worked tirelessly on colorectal cancer research in the Illawarra and Shoalhaven, with that work leading to publications that laid a foundation for improved patient care.
Sharlyn was also an active leader in the Exon 20 Group of the International Cancer Advocacy Network, which supports patients and families diagnosed with this form of lung cancer. She continued to be an invaluable fulltime member of the Illawarra and Shoalhaven Cancer Services throughout these five years. Outside of work to those fortunate enough to call her a friend, she is forever remembered as a woman of grace and elegance, a true foodie with a love of fine chocolate and coffee, a fan of a woman’s best friend….designer handbags, someone who was extremely generous with her time and practical advice, and the rarest of people who always looked after others first.
Dr Sharlyn Kang’s impact on the Illawarra and Shoalhaven Cancer Service and the care of cancer patients in the community now and into the future is immense, grounded in compassion and dedication that will continue to drive this work forward. Her impact on her friends is immeasurable. We share memories of laughter clouded by tears. Her memory will be profound, meaningful, and enduring.
Even during her tougher days in her battle, it was often Sharlyn comforting those who came to comfort her. Above all this though, Sharlyn is remembered as a devoted wife to Adrian, loving mother to Ava and Anara, adored younger sister and beloved daughter. Her love for her family is seen in the way she fought, giving everything she had, exploring every possible avenue no matter how hard, all not for herself but rather for the ones she loved the most—her family.
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Radiation Oncology
Vale David S. Lamb, FRCR; FRANZCR; ONZM 20.05.51–30.04.21
It is with sadness we note the peaceful passing of David after six months of illhealth and fitting that we acknowledge his enormous contribution to the College, our colleagues, our profession and our patients. His name is known to many in the College—but maybe not his story. He obtained his basic medical education in the UK, training as a registrar in New Zealand before returning to the UK as a research fellow under Prof Stan Dische at Mount Vernon followed by training in Mount Vernon and Middlesex Hospitals obtaining first his FRCR (winning the Rohan Williams medal) then his FRANZCR. His training afforded him the wonderful opportunity to rub shoulders with renowned researchers including Prof Jack Fowler, Prof Juliana Denekamp and Dr Anthony Jelliffe. This experience and their influence no doubt stimulated David to pursue a clinical career underpinned by scientific research. Returning to New Zealand and recognising the lack of clinical trials in radiation treatment to be found there, he became one of the co-founders of TROG ( the Trans-Tasman Radiation Oncology Group) and helped steer it to become the well-recognised and productive research group that is today. From convening the first meeting he served in many capacities including as Chair, as Board and Executive member and chaired the Scientific Committee, establishing processes to ensure the high standards that we equate with TROG studies. His personal research involvement migrated from head and neck and oesophagus to prostate and
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he was the Principal Investigator for TROG 96.01 and the NZ chair of the RADAR trial—both highly successful, frequently cited and internationally recognised trials. His contribution was recognised by TROG, he received Life Membership in 2017. His own personal research programme continued in prostate cancer across a breadth of topics facilitated by establishing the Prostate Cancer Trials Unit, Wellington School of Medicine, and receiving Adjunct Professorships at both the University of Otago and Victoria University. He did not restrict his non-clinical activities to research. He had governance and advocacy roles heading both the radiation service and the entire unit at the Wellington Blood and Cancer Centre. He served on advisory committees to the Ministry of Health and outside of the Ministry of Health he continued to advocate for cancer services through Cancer Control New Zealand, as Chair of the Cancer Registry as well as involvement in many nongovernment organisations. His contribution to the Cancer Society of New Zealand was recognised in 2011 when he was awarded Life Membership (Wellington Division). His contribution to health services in New Zealand was recognised in 2011 when he became an Officer of the New Zealand Order of Merit. He enjoyed his responsibility towards education—whether medical students, registrars or radiation therapists. He was an accreditation officer for the College
and a member of the Board of Studies for the Bachelor of Health Science (Radiation Therapy). He served on the Faculty of Radiation Oncology RANZCR as a Board member from 2006–2010. For his contribution to the College he received Life Membership of RANZCR in 2017. Despite these many and varied commitments, he established the Wellington Prostate Brachytherapy Group for the provision of permanent iodine-125 seed implantation for early prostate cancer, treating more than 1,000 patients. He published prolifically using research and audit data to raise public awareness. Of his 89 publications he has 22 first author publications to his name. He ‘retired’ from public practice five years ago but never fully retired. His latest paper, for which he was quite justifiably ‘chuffed’, was published in Brachytherapy earlier this year. Such a full and productive career was no doubt made possible by the support from Bettina and a life balanced by the joys of trout fishing and a good pinot. Bettina, Peter and Andrew we are saddened for your loss. We are grateful for all we have gained.
Interventional Radiology
A Round Up of MBS Review Taskforce Recommendations for IR and INR On 30 June 2020, the Medicare Benefits Schedule (MBS) Taskforce (the Taskforce) concluded its review of more than 5,700 items on the MBS which commenced in 2015. Throughout this process the College has strongly advocated on multiple fronts and across numerous clinical areas, including several relating to Interventional Radiology (IR) and Interventional Neuroradiology (INR). The College’s submission was informed by recommendations from the Interventional Radiology Committee (IRC). Over the last 12–18 months we have responded to a number of requests from the Department of Health regarding IR and INR aspects of the MBS Review Taskforce recommendations. A large portion of the College’s advocacy efforts has focused on: - responding to recommendations made by the Vascular Clinical Committee - proactive advocacy, such as through the development of the RANZCR UFE position statement: in response to Vascular Clinical Committee recommendations.
Vascular Clinical Committee report The majority of recommendations in the Vascular Clinical Committee (VCC) report relevant to IR and INR were supported, in principal, by the College pending further consultation and economic modelling to assess their impact on patient care, service provision and patient access. In May 2020, the Taskforce endorsed 40 recommendations from the VCC report.
The MBS Review Taskforce published its final report on 14 December 2020 comprising information from 60 clinical reports and containing more than 1,400 recommendations across four key goals: • affordable and universal access • best practice health services • value for the patient • value for the health system.
The implementation of these recommendations is now up to the Department of Health at the discretion of the Health Minister. Some of the recommendations, relevant to IR and INR are yet to be implemented by the Government, however the College will continue to track their progress and advocate for implementation at the earliest possibility opportunity. The Taskforce final report can be found here: www.health.gov.au/resources/ publications/medicare-benefitsschedule-review-taskforce-final-report
Other clinical committee reports IR and INR MBS items have also been considered by other clinical committees in the MBS review, such as the General Surgery Clinical Committee1, for which the College provided feedback. The table on page 53 highlights where implementation by the Government has commenced. continued over...
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NEW ZEALAND ASM AUGUST 6 - 8 2 021
NZ Annual Scientific Meeting Intercontinental Hotel, Wellington 6 - 8 August, 2021
I N T E R N AT I O N A L I N V I T E D S P E A K E R S
Radiology
Radiation Oncology
Professor Laurie A. Loevner
Dr Corinne Doll
Chief, Division of Neuroradiology Professor of Radiology, Neurosurgery, Otorhinolaryngology: Head & Neck Surgery and Ophthalmology University of Pennsylvania Health System Philadelphia, USA
Tom Baker Cancer Center President of Canadian Association of Radiation Oncology Calgary, Canada
Associate Professor Bruno Giuffrè
Advanced Center for Treatment Research and Education in Cancer / Tata Memorial Center Mumbai, India
University of Sydney at Northern Clinical School Radiology Department, Royal North Shore Hospital Sydney, Australia
Professor Vedang Murthy
www.ranzcr2021.co.nz
Interventional Radiology
Pathological indication Liver
Recommendation 47
MBS item 30602, 30603, 30605
MBS changes
Taskforce recommendation
(1 July 2021)2
Combine three items into one with changes to the descriptor. New remuneration.
New Item: 30771 Porto-caval, meso-caval or selective spleno-renal shunt for portal hypertension (combines 30603, 30602, 30605). Item descriptor: Portal hypertension, porto-caval, meso-caval or selective spleno-renal shunt for (Anaes.) (Assist.).
Liver
52
50950
Broadens the descriptor for item 50950 by removing limitations to radiofrequency and microwave ablation.
Amended item: Providing for flexibility in percutaneous ablation approach. Item Descriptor: Unresectable primary malignant tumour of the liver, destruction of, by percutaneous ablation (including any associated imaging services), other than a service associated with a service to which item 30419 or 50952 applies (Anaes.).
Liver
30431
Drainage of liver abscess providing for open or minimally invasive approach.
Implementation to be announced.
Oncology
30419
Revised to provide flexibility in ablation approach for liver tumours.
Implementation to be announced.
MBS digital subtraction angiography schedule The College recently provided advice on the MBS structure for digital subtraction angiography in response to the Vascular Clinical Committee recommendations. This provided the College with an opportunity to advocate for improved IR services and fairer, more cost-effective and sustainable access to the MBS Angiography schedule for diagnostic and interventional purposes. Advancing angiographic and fluoroscopic practices for IR and INR procedures is key to this work. The College’s support will be contingent upon rigorous and extensive analysis of clinical practice and economic modelling to safeguard against unintended consequences on patient access to important clinical services.
College UFE position statement: in response to vascular clinical committee recommendations The College developed this statement in response to the MBS Review recommendation number 24, MBS item 35410, “Allow non-gynaecologistreferred uterine embolisation”. The position statement supports attempts to improve patient awareness of, and access to, uterine fibroid embolisation as an effective, minimally invasive treatment for symptomatic fibroids. The statement supports the recommendation to remove the requirement for gynaecologist referral so that general practitioners and other specialists are able to refer patients for uterine embolisation, following clinical assessment and consultation.
What’s next? The College will continue its advocacy work with the Department of Health to improve the MBS for IR and INR services, and to implement existing recommendations. The IRC will continue to provide subject matter expertise and seek member feedback towards modernising the MBS so that it more accurately reflects and aligns to current and future clinical practice. Achieving this is a key component of ensuring that IR and INR are recognised as clinical specialties, and to ensuring patients can receive high value IR and INR care within an advanced health system, delivered by specialist clinicians able to practise at the top of their profession. Your say: we welcome all feedback from the College membership, please contact us at interventional@ranzcr.edu.au
References 1 Medicare Benefits Schedule Review Taskforce. Taskforce Report for General Surgery Items, 2019. 2 Australian Government Department of Health. Changes to liver procedures MBS services – Reference Guide. 10 February 2021 3 Health. Changes to Oncology MBS services – Reference Guide. 10 February 2021
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Western Australian Branch News The WA Branch Meeting was held at the Perth Convention and Exhibition centre on Saturday 20 and Sunday 21 March 2021 as a Musculoskeletal Imaging Update. It was an in-person only meeting with approximately 160 people in attendance.
vascular malformations. A hip session covered clinical and radiological features of dysplasia and femoroacetabular impingement, as well as paediatric hip conditions.
Dr James Linklater from Sydney and A/Prof David Connell from Melbourne— both Australasian Musculoskeletal Imaging Group (AMSIG) past presidents among numerous other professional accomplishments—were the special guest speakers and gave an excellent and informative series of presentations on various aspects of sports imaging and intervention, in addition to great presentations from numerous local speakers.
“For all of the speakers it had been a longerthan-usual process made more difficult, I realise, by changing dates and ongoing uncertainty, and I sincerely thank you all for making the meeting what it was.”
Topics included several different aspects of muscle and tendon injuries, current approaches to image guided injections and radiofrequency denervation, as well as ACL reconstruction, tendon pathologies around the knee and MRI of elbow injuries. Updates were provided on the use of EOS, dual energy CT, the evolving role of MRI for diagnosis for sacroiliitis and CT skeletal survey for myeloma. There were talks on paediatric ankle and elbow fractures, soft tissue masses and diagnosis and interventional radiological treatment of
It was a long road getting there after last year’s postponement due to COVID-19. David and James are to be especially thanked for the effort they made to come across given the ever-changing border restrictions with the Victorian border opening
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only five days before the meeting. We are aware of the uncertainty and frustration that the changing WA border conditions cause for people trying to visit our state and are most grateful that David and James were willing to come across nevertheless. For all of the speakers it had been a longer-thanusual process made more difficult, I realise, by changing dates and ongoing uncertainty, and I sincerely thank you all for making the meeting what it was. It was a great opportunity to catch up with everyone in person, many of us hadn’t seen each other for a long time due to the restrictions of the previous year and a greater proportion of online contact coming into play for regular meetings even after restrictions had been raised. We are all looking forward to getting back to more of our College’s educational experiences, whether online or in person, after the disruption of last year. The theme for the 2022 WA Branch Meeting will be neuroradiology, with convenors Simon Khangure and Rob Brazel. It will most likely be held in March, pending dates of other nearby meetings to avoid clashes.
FLINDERS MEDICAL CENTRE PATHOLOGY COURSE 12 & 13 FEBRUARY 2022 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 12 and Sunday 13 February 2022 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: Tuesday 30 November 2021 For registration form and further information please contact Helen Sainsbury: helen.sainsbury@sa.gov.au / (08) 8204 4405
News
New Zealand Branch News
Dr Gabes Lau
Kia Ora. The Trans-Tasman bubble has gotten off to a good start. In early May, I had my first trip across the ditch. After more than a year of ‘telcos’, it was finally good to meet the new members of Board and staff in the Sydney office.
NZ ASM Early bird registration for the NZ ASM has opened. I encourage everyone to register and attend. The programmes look fantastic and Diana Sarfati, Chief Executive of Te Aho o Te Kahu (Cancer Control Agency), will be speaking at the combined session on Saturday. I look forward to seeing everyone in August.
NZ Branch Committee May 2021 meeting The NZ Branch Committee met in early May. It was the Branch Committee’s first face-to-face meeting since the 2019 ASM in Auckland. Some of the discussion included: • the College’s paper on ethical referrals. The draft was meant to be ready for consultation in March but there were a few delays. By now, however, you all will have received a notification about the consultation, and I hope the College receives plenty of feedback. • an update on the new Recertification (CPD) programme. The College is making good headway getting ready to launch the new programme, complete with a new IT platform. I encourage everyone to take note of the College’s communications on these changes. I understand there will
be some opportunity at the NZ ASM to get up to speed. • registrar recruitment for 2021. The Wellington office received a record number of applications, which may be linked to limited international mobility but may also be linked to increased efforts over the last few years to raise the profile of the College’s training programmes. There were 56 applications for clinical radiology and 12 for radiation oncology. Interviews take place in June. Training sites will look forward to meeting the new trainees in 2022. • The College sponsored the Otago medical students’ conference at the end of April. The College’s booth was well attended. I can report firsthand that many a chocolate fish were handed out to students along with information about radiation oncology and clinical radiology. Drs Cameron Simmers and Tivanka Senanayake ran workshops that generated plenty of positive feedback. Ka pai team. The College is also set to run a booth in Auckland for the NZMSA conference.
current capacity in our healthcare system and to build new capacity. And we have started to communicate a need to invest in technology and build interoperable systems that allow for good data creation, storage, transfer and usage. The Government’s announcement is ambitious, in scale and timeframes, but one does feel cautiously optimistic that Health New Zealand might be well placed to achieve the above goals— dare I say better placed than the current 20 DHBs. Contact us The College’s Wellington office is still working primarily from home. Members are encouraged to make contact with the office if you have any concerns or questions. Please email nzbranch@ranzcr.org.nz You are welcome to provide a number if you want someone to give you a ring. Kia kaha. Stay safe, vigilant and strong @GabesLau
Health and Disability Review announcement I won’t use this space to rehash Andrew Little’s announcement on 21 April. Most of you will be familiar with the highlights. I would like, however, to point out that the College has been working for a number of years to address workforce issues. We have advocated for the need to train more radiation oncologists and clinical radiologists. The College has advocated for the need to maximise
Otago Medical School Conference, Dunedin Volume 17 No 3 I June 2021
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Wine, Dine & Learn 2022 Annual Scientific Meeting www.anzspr2022.com Australian and New Zealand Society of Paediatric Radiology (ANZSPR) We are pleased to announce details for the rescheduled ANZSPR ASM. The conference will now take place from the 12–16 February 2022 at the Yarra Valley Lodge in Victoria. It will be a combined Victorian-South Australian meeting that will replace the 2021 and 2022 ANZSPR meetings which traditionally takes place in October each year. We are aiming for a hybrid meeting to allow for both on-site and remote attendance. The Yarra Valley Lodge is situated in the beautiful tranquil surrounds of the Yarra
Valley in Victoria, less than one hour’s drive from Melbourne city centre. The program features eminent international and national speakers who will cover a wide range of topics and deliver an array of state-of-the-art presentations. The program will also incorporate a fetal imaging workshop. The social program will include a welcome reception and a conference dinner, with additional opportunities to sample some of the amazing food and wine that the Yarra Valley has to offer.
We look forward to hosting a successful meeting and to welcoming our international and national speakers both on-site and virtually. We will abide by any future government directives pertaining to COVID-19 restrictions. Please check your cancellation policy before booking flights and transfers. The organising committee: Dr Padma Rao, Dr Gill Whiteley, Dr James Stegeman, Dr Rachel Evans, Dr Ajay Taranath and Dr Rebecca Linke.
Registration and abstract submissions will be open soon. Please check the website for registration fees: www.anzspr2022.com
~ In Memoriam ~ The College notes with regret the death of the following members: Dr Keith Chapman, Life Member, NSW Dr Sharlyn Kang, Fellow, NSW Professor David Stephen Lamb, Life Member, NZ 56
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News
Asia-Pacific Radiation Oncology Special Interest Group (APROSIG) APROSIG leads International Atomic Energy Agency Virtual Tumour Board Project
Twenty to 56 radiation and clinical oncology participants from 13 to 16 countries have joined each VTB.
We all know how important it is to be able to discuss challenging cases with colleagues, no matter how experienced we are as radiation oncologists. In many Low and Middle Income Countries (LMICs) in our region, our colleagues do not always have such opportunities. Some work in large busy hospitals, where there is limited access to peer review. Others work in small isolated departments that may be the only radiation therapy providers in the country.
In the first six VTBs, 21 cases from India, Indonesia, Malaysia, Mongolia, Nepal, Pakistan, the Philippines and Sri Lanka have been discussed. Presenting clinicians were surveyed and all felt that the discussion helped their decisionmaking; the management of nine cases was changed as a result.
In order to improve peer support, APROSIG is leading the International Atomic Energy Agency project RAS6096 to establish Virtual Tumour Boards (VTBs) to discuss difficult cases. AsiaPacific Radiation Oncology Network (ASPRONET) VTBs are held on the first Wednesday of each month using MS Teams. Typically three or four cases are presented over an hour, with an emphasis on radiotherapeutic management.
As well as supporting specialist oncologists, trainees from Pakistan and the Philippines have been participating. The educational component will be expanded later this year with the introduction of software to support contouring and plan comparison. It is also envisaged that parallel sessions will commence for medical physicists and for radiation therapists. Planning for this project commenced in 2017. The COVID-19 pandemic has increased the professional isolation of oncologists in LMICs, so the commencement and roll-out of the VTBs in November 2020 was especially timely.
“Planning for this project commenced in 2017. The COVID-19 pandemic has increased the professional isolation of oncologists in LMICs, so the commencement and roll-out of the VTBs in November 2020 was especially timely.”
If you are interested in participating as a subsite expert, please email iain.ward@cdhb.health.nz for more information.
“In the first six VTBs, 21 cases from India, Indonesia, Malaysia, Mongolia, Nepal, Pakistan, the Philippines and Sri Lanka have been discussed. Presenting clinicians were surveyed and all felt that the discussion helped their decision-making; the management of nine cases was changed as a result.” Volume 17 No 3 I June 2021
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News from the Obstetric and Gynaecology Special Interest Group (OGSIG)
2021 has been a busy year for OGSIG. I am happy to report that OGSIG’s first Scientific Meeting took place in March. It was a virtual meeting given the current circumstances. It attracted more than 200 delegates from around Australia and New Zealand, comprising of a mix of radiologists, trainees, Fellows and sonographers. A/Prof Simon Meagher was the keynote speaker, and he was ably supported by OGSIG members. The meeting was extremely well received, with excellent feedback from the attendees. I would like to thank Dr Ekaterina Alibrahim for her immense efforts in convening this inaugural meeting, and the ARGANZ Executive, for their unwavering support.
Image credit: Dr Glen Lo
“I would like to thank Dr Ekaterina Alibrahim for her immense efforts in convening this inaugural meeting, and the ARGANZ Executive, for their unwavering support.” Given the success of this meeting, we are planning to hold another in 2022. Please diarise Friday 25 March 2022. More details to come. We would also like to remind radiologists who report First Trimester Screening that the Nuchal Translucency Online Screening Program has been revised, with new images, diagrams and interactive elements. It consists of eight modules and is suitable for all practitioners involved in the reporting of First Trimester Ultrasound. Visit www.elearning.nuchaltrans.edu.au for more information. CPD points can be claimed for completing this: eight in total.
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A reminder also regarding the International Evidence-based Guidelines for the diagnosis of Polycystic Ovarian Syndrome (PCOS) published in 2018. For imaging diagnosis of Polycystic Ovarian Morphology (PCOM), this has superseded the Rotterdam and AFS Criteria. Radiologists should be aware of the new criteria for the diagnosis of Polycystic Ovarian Morphology (PCOM) is 20 or more follicles of 9mm (transvaginal approach preferable) and/ or ovarian volume of 10cc (excluding dominant follicles/corpus luteum). The guidelines also caution against the imaging diagnosis in girls < 8 years post-menarche as they frequently have multifollicular ovaries and TV ultrasound
may not be able to be performed. More information can be obtained here: www.monash.edu/__data/assets/ pdf_file/0004/1412644/PCOS_EvidenceBased-Guidelines_20181009.pdf As always, I would be happy to be contacted with any questions or comments. Best wishes to all. Dr Emmeline Lee OGSIG Chair emmeline@westernultrasound.com.au
News
Abdominal Radiology Group Australia and New Zealand (ARGANZ) The ARGANZ Annual Meeting was held on 27–28 March at the Brisbane Convention Centre as a hybrid meeting which attracted more than 400 delegates with a satellite hub in Auckland. The international speakers comprised Prof Claude Sirlin, Prof Seong Ho Park and Dr Jonathan Richenberg who focused on liver, rectal and prostate/scrotal imaging respectively. They were supported by local experts who thoroughly covered a variety of topics with speakers frequently paired with a radiologist discussing the imaging and a clinician providing their unique insights and perspectives. Feedback from the meeting was overwhelmingly positive and the option of virtual attendance embraced with around 30 per cent of delegates attending the meeting for the first time and discovering why ARGANZ has a regular returning audience. A survey conducted during the meeting examined various work practices and has revealed some interesting results. For example, over two thirds of delegates indicated that they routinely use dynamic contrast images for prostate MRI. Of concern however, 60 per cent of radiologists reporting prostate MRI state that they ‘never’ or ‘rarely’ receive feedback regarding their reports. While the reasons for lack of feedback were not explored, feedback will in part rely on a relationship with the referring doctor and access to biopsy and prostatectomy reports. This lack of histologic correlation is an educational obstacle and shows a clear need for high quality, clinically relevant resources that radiologists can easily access.
For these reasons ARGANZ intends to offer a higher frequency of workshops targeting areas such as prostate and rectal MRI. Dates for these will be announced on the ARGANZ website and social media as well as email notification to ARGANZ members. All College Fellows are welcome to join ARGANZ, membership is free and gives access to educational events, protocols, reporting templates as well as links to other abdominal societies.
ARGANZ 2022 will be held in the International Convention Centre in Sydney on 26–27 March. The Executive committee is currently putting together an exciting program with a variety of speakers designed to appeal to both abdominal subspecialist and general radiologist delegates. @arganz_online
The use of Liver Imaging Reporting and Data Systems (LIRADS) has been increasing with around 40 per cent of delegates using it routinely, although the majority still use one of the many other diagnostic systems. Prof Sirlin’s talk on LIRADS was excellent and he demonstrated the superior specificity and reliability of LIRADS compared with many other guidelines, and so it will be interesting to see if this leads to wider adoption in the future. Sixty-three per cent of delegates indicated that they attend one or fewer abdominal multidisciplinary meetings (MDMs) per fortnight. These MDMs provide a valuable educational opportunity to hear from other specialists and keep abreast of evolving practice. A mock MDM has become a staple feature of the ARGANZ program allowing the audience to hear from surgeons, oncologists, radiation oncologists as well as expert interventional and diagnostic radiologists. These sessions are always rated highly by delegates, are entertaining and will continue to be part of future ARGANZ programs.
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The Australian and New Zealand Society of Neuroradiology (ANZSNR) ANZSNR ASM 2022 The ANZSNR Executive are excited to announce that the 2022 ASM will be held in Sydney in early March. The Convenors for the ASM are Dr Andrew Cheung and Dr Nathan Manning. They will be supported by ANZSNR members who will form the scientific committee to develop a strong scientific program. As in previous years we plan three streams— Head-and-Neck/ENT, Interventional Neuroradiology and Diagnostic Radiology. There will be sessions suitable for trainee radiologists and junior Fellows. If any members are interested in participating in the local faculty, please contact the convenors via the secretariat. The appointed Events Manager, NC Events, is currently sourcing suitable venues in Sydney, with an announcement confirming the location and dates expected shortly.
Having postponed the ASM this year, we are looking forward to a national face-to-face interaction along with representatives from industry, with international speakers likely presenting virtually. We look forward to welcoming you in Sydney next year. Please check the website for updated details.
ANZNSR’s focus for the next 12 months The ANZSNR recently held the 2021 Annual General Meeting via Zoom. We are very excited to be growing in member numbers and with a reviewed constitution we look forward to focusing on the following key initiatives over the next 12-month period: • Development of Terms of Reference for the Council in line with the constitutional updates
• Not for profit status attainment • Social media participation • Review of Council structure and roles • Planning for 2022 and 2023 ASMs • Ongoing international society collaboration with reciprocal educational opportunities for members.
How to join To join ANZSNR and benefit from a list of opportunities, please visit our website for more details and to access the application form: www.anzsnr.org.au/join-anzsnr If you are a radiology registrar note that you can now join without the need for endorsement by an existing member, making it an easier process.
• Statements of Purpose for the society
Interventional Society of Australasia (IRSA) Registrations are open for the 2021 IRSA ASM. The ASM is being held at the JW Marriott Hotel, Gold Coast, from Tuesday 29 June– Thursday 1 July 2021. The JW Marriot is a newly renovated and centrally located hotel featuring state-of-the-art conference and social facilities. The theme for this year’s meeting is Interventional Oncology, the youngest and most rapidly growing offshoot of interventional radiology. The Scientific program is packed with an excellent faculty of local and international speakers. Our keynote international speakers will be joining us virtually: • Professor Thierry de Baere, Head of the Interventional Radiology Unit at Institut Gustave Roussy Cancer Center in Villejuif,
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France, the largest European cancer hospital. • Professor Afshin Gangi, the Head of Department at Strasbourg University Hospital. The program includes a live case cross from Auckland City Hospital and a dedicated nurses and radiographers section. Interventional radiologists planning to sit the EBIR are encouraged to attend to take advantage of our EBIR preparation session. To register your attendance and book your accommodation, please head to: www.irsaasm.com/ We hope to see you on the Gold Coast in June.
NZ ASM Hub For the first time ever, the IRSA ASM Organising Committee are pleased to advise that for New Zealanders unable to travel, an ASM hub will be located at the QT Hotel, Queenstown. The hub will allow New Zealand delegates to attend the main ASM, virtually, in real time. There will be a mini exhibition of sponsors and two social dinners for delegates to attend. We hope that this interactive hub will facilitate networking and connection among participants at the hub, but also to the main ASM on the Gold Coast. To find out more about your accommodation options in Queenstown and to register, visit: www.irsaasm.com
General Interest
Great Savings and Rewards for Members
New College partnership: finance/ lending and financial planning The College’s Membership Rewards Program is proud to announce our newest partnership for Australian members with Medical Wealth Advisory. Members across Australia can now receive substantial benefits and discounts in the areas of finance/lending and financial planning services. As a specialist service for medical professionals, Medical Wealth Advisory provides a wide range of innovative and integrated financial solutions.
Finance and lending Medical Wealth Advisory offers a comprehensive range of finance and lending services including: • Home Loans • Investment Property Loans • Commercial Property Loans • Business Lending • Self-Managed Super Fund (SMSF) Loans. With loan products available from many lenders, our focus is on selecting and delivering the best solution for each member, rather than offering lending products from just one financial institution. For College members, finance solutions are also available for: • motor vehicles • medical equipment • office fit-out • business cashflow. Medical Wealth Advisory provides access to numerous lenders offering bespoke solutions adaptable to individual members’ requirements.
Financial planning Medical Wealth Advisory develops and implements specialist financial planning advice covering investment advice and management, business advisory and entity structuring, tax planning, personal insurances, superannuation and SMSF management and estate planning. What sets Medical Wealth Advisory apart from other firms is their Fusion program. Through multiple complimentary consultations, College members will have the opportunity to explore the specialty advice services available, quantify the value that can be delivered by the service and understand the process involved in implementing them.
NobleOak Life Insurance: EOFY special offer for RANZCR members Our Life Insurance partner NobleOak are offering College members two months free with two or more covers* if you apply before 30 June 2021. NobleOak offer Life cover, Income Protection, Trauma cover and Total and Permanent Disablement Insurance. Members will also receive a 10 per cent lifetime discount on Life cover.* Call NobleOak on 1300 108 490 or visit the dedicated RANZCR members page to get a quote online www.quote.nobleoak.com.au/ranzcr
Members who proceed with these services receive exclusive discounts on any implementation or ongoing advice fees applicable to these services. Contact To learn more about what’s available and how to access the offers visit www.ranzcr.com/ college/member-rewards or www. medicalwealthadvisory.com.au/ ranzcr/ or phone Medical Wealth Advisory on 1300 41 81 61.
Other Member Rewards offers We also have unique Member Rewards offers from Tesla, The Accommodation Brokers, Unsworth Legal, BUPA, Mercedes Benz, Europcar, and BMW/Mini. Access our full Member Rewards Program: www.ranzcr.com/college/memberrewards
Volume 17 No 3 I June 2021
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General Interest
Have Your Circumstances Changed since June 2020? As we approach the end of the financial year, remember to update any changes to your personal circumstances that may be relevant to your membership for 2021–2022. We understand that during your career, there may be times when things change. Whether you’re reducing your work hours, taking a break from practice entirely, or moving overseas to pursue a new opportunity, we encourage you to inform the College, as you may be entitled to a reduced rate of membership fees.
Fellows and Educational Affiliates Break-in-practice
status, attaching evidence such as an employer letter or contract. If you then return to full-time practice, please ensure you inform the College.
Moving overseas? If you are moving away from Australia or New Zealand, you too may be entitled to a reduced membership rate.* Simply update your home and work address on the MyRANZCR member portal and email members@ranzcr.edu.au with the date you intend to move and an expected return date (if you have one). If/when you move back to Australia or New Zealand please ensure you update your details on the member portal.
Going on extended leave, parental leave, or experiencing health issues that will stop you from working for 6–12 months? You may be entitled to a reduced membership fee.
*Applies to Fellow members only
To apply, email the College at members@ranzcr.edu.au providing evidence such as an employer letter or medical certificate, the date you will be taking your leave and intended date of return to practice. Remember, a request for a refund or credit can only be made prior to or within 30 calendar days from the commencement date of a break-inpractice.
If you are taking a break-in-training (including parental leave) you may be eligible to a reduced rate on your membership and training fees. You must submit a request for a break-intraining through the Trainee Information Management System (TIMS) for approval, in order to be eligible to apply for a reduced fee. Remember, a request for a refund or credit can only be made prior to or within 30 calendar days from the date of College approval of an interrupted training period.
Taking a break for longer than 12 months? You can apply each year for an extension of your break-in-practice, up to a maximum of three years. Please note: members who are on a breakin-practice are still required to submit their pro rata CPD points. For further information please contact cpd@ranzcr.edu.au.
Part-time Are you practising 20 hours or less per week? If so, you may be entitled to a reduced rate of your membership subscription, provided you inform the College in writing of your part-time
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Student Members Break-in-training
Part-time If you are training part-time at 0.65 FTE or less, you may be entitled to a reduced rate of your membership subscription. You must report all changes of your training status (full-time/part-time) through the Trainee Information Management System (TIMS) to be eligible for a reduced rate of fees.
We’re here to help you Each of our members, and your personal circumstances, is unique. So, if you have questions or need further information please do not hesitate to contact us:
Fellows and Educational Affiliates Contact the membership team today at members@ranzcr.edu.au or +61 2 9268 9777, or check out the fees page on the website for more information and the latest RANZCR Fees Policy.
Student Members Refer to the Interrupted and Parttime Training Policy on the College website or contact the Specialty Training Unit at radtaa@ranzcr.edu.au for clinical radiology students and ronctaa@ranzcr.edu.au for radiation oncology students. Please note: Fee reductions can only be applied for the current or future financial year; and cannot be applied for fees billed in a previous financial year.
Useful links and documents Membership Fees and Fees Policy: www.ranzcr.com/college/ membership/ fees Interrupted and Part-Time Training Policy: www.ranzcr.com/ documents/4525-interrupted-andpart-time-training-policy/file
DEVELOP YOUR PROFESSION WITH THE QSCAN GROUP The Qscan Group’s growing national network offers Radiologists opportunities for career development and earning potential. By partnering with our doctors, we encourage individual professional aspirations and provide market competitive, flexible avenues to join our team.
Why join the Qscan Group?
• Career opportunity customised in line with your skillsets and ambitions; • The ability to be part of a supportive and strong collegiate doctor network; • The very latest in cutting-edge technology;
• Assured access to a broad clinical case mix including tele-reporting which can provide flexibility or additional hours to expand your earning potential. We currently have opportunities for Radiologists, Nuclear Medicine Physicians and Dual-Trained Radiologists for various regions across Australia. Flexible workloads including private practice, public hospital work and teleradiology are available.
Trusted Analysis | Excellence | Compassionate Care
Qscan Fellowships are also available including: • Hybrid Fellowship - 12 months;
• Sub-specialty Fellowship programmes (Musculoskeletal, Body Imaging, Cardiac/Thoracic imaging, Breast imaging and Paediatric); • Dedicated Nuclear Medicine/PET sub-speciality Fellowship.
Your employment offer with Qscan can include: • Above market-rate remuneration package; • Significant sign-on bonus; • Equity opportunities;
• Relocation assistance.
For more information or a confidential discussion please call our Qscan General Manager, Matthew Bellairs on 0412 939 200 or email matthew.bellairs@qscan.com.au
qscan.com.au
Become part of the future, be your own boss! Full Service Teleradiology Platform for rent.
Unique Opportunity Established 12 years, PRO has built a fully integrated teleradiology platform to service its clients and now has spare capacity. We are offering a limited number of opportunities for Radiologists to run their own business on our teleradiology platform. PRO will provide the following services – • • • • • • •
Integrated RIS/PACS with InteleViewer and VR reporting; All IT install and trouble-shooting issues managed by PRO; Full-Service administration support for your clients; Billings, collections, banking and payments managed by PRO; Assistance with legal agreements and client management; Standby locum service to allow you to take a break; Additional overflow reporting from PRO’s regular business to supplement your own Teleradiology reporting business.
Offer is limited. Be your own boss and take control of your lifestyle and your future today. Email us at: info@ProXrayManagement.com Professional Radiology Outcomes Pty Ltd ACN 135 526 680