Inside News June 2022 RANZCR

Moral Injury: An Iliad of Injury in the Age of Covid

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

A Message from the President: A Critical Time for Caring About Contribution

A Message from the CEO

An Iliad of Injury in the Age of Covid

RANZCR Trailblazers: The Role of the Expert

The Integrated Rural Training Pathway: The Townsville Experience

It’s Time to Reflect, Revive and Reimagine!

College Governance 2022 Training Program Evaluation

The Advantages of Open Access Publishing

RANZCR Workshops, Courses and Events 2022

InsideRadiology

Centralised Learning Program National Reconciliation Week

From the Faculty of Clinical Radiology: Digital Health

Chief Censor for the Faculty of Clinical Radiology: Developments in Training

Chief of Professional Practice Update Clinical Radiology Trainee Committee

ARGANZ Meeting 2022

From the Faculty of Radiation Oncology: CPD and Code of Ethics

Chief Censor in Radiation Oncology: New Working Groups

Radiation Oncology Trainee Committee

Chief of Professional Practice for the Faculty of Radiation Oncology

Centralised Radiation Oncology Incident Reporting

Dr Bruce Kynaston’s Gift to the College 1978

Interventional Radiology Committee Member Spotlight

News from New Zealand

CPD: Professional Development Plan

What are your thoughts?

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

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Editor-In-Chief

Dr Allan Wycherley

College In-House Editor

Lindy Baker

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Inside News © 2022 The Royal Australian and New Zealand College of Radiologists® (RANZCR®)

In my last message, I quoted the famous line from John F. Kennedy's inauguration speech in 1961 and implied that, in a time of crisis and heightened need, we as a group of medical practitioners ought to be asking themselves what we can do for others, not what others may do for us.

Coming from the elected head of an elite medical college—one that devotes significant resources advocating in the professional interests of its members— the message might appear a little mixed in its sentiment. It's undeniable, we spend a lot of time talking to government and other stakeholders about what we believe they should be doing for us. And we will continue to do so, especially with a new government and parliament in Canberra. So let me explain and, in doing so, give the Kennedy quote more clarity and purpose than one of mere sentiment.

When President Kennedy made his famous speech the world was in the chilly grip of the Cold War, just months before the Cuban missile crisis in which the superpowers flirted with all-out nuclear war and potentially the greatest man-made catastrophe in our history. In a short speech devoted chiefly to the protection of freedom, he spoke not only of his adversary in Moscow but also of the poor, the miserable and the ill throughout the world who craved the ‘wonders of science’ to give them ‘a more fruitful life’. At a time of deep crisis, Kennedy and his advisers sensed the opportunity at hand to make the world anew. At the same time, he felt the burden for this historic vision lay not

A Message from the President

A critical time for caring about contribution

so much in the hands of the government he led but in the hands of his fellow citizens—hence his exhortation ‘Ask not what your country will do for you; ask what you can do for your country’.

Today we find ourselves in the grip of a deadly global pandemic, at the doorstep of a new cold war which is disrupting trade, food security and vital medical supplies. Once again we are acutely aware of the continual struggle, as was JFK, against the common enemies of ‘tyranny, poverty, disease, and war itself.’ In the 21st century we might add climate change to that list. The antidote for these woes is a united effort in the interests of the common good. As highly-trained clinicians, we have the power to save or improve individual lives; and, as active members of an elite international organisation, we have influence enough in high places to promote a better future for all. When the College advocates on behalf of its members, it seeks not just to improve our working conditions and standards, it also seeks to deliver the best health care to the greatest number of people, and to enlist the brightest minds in a culturally diverse society to join our cause.

The word ‘crisis’ has a medical origin: a turning point, the time to decide what to do. In contemplating the task to ‘undo the heavy burdens’ of the world, Kennedy simply said, ’Let us begin’. My message to my medical colleagues is simple enough too: there's never been a better time to step up and make a contribution to lessen the burden on others. You can decide for yourself just

how you make a contribution, but ask me if you're looking for inspiration. It may be through participation (your time), it may be through donation (your money), it may be through application (your abilities). It's important to make a difference, however small. And it's important to set an example to others and help each of us and those who will follow us in our profession to be the best citizens we can be. To do any less is to forfeit our clinical conscience and concede much of our role to the increasingly clever machines that deign to replace us. I hope you agree.

Finally, on the theme of contribution, a regrettable postscript: fees for our trainees are to rise significantly from 1 July this year and in 2023. This was a painful decision for us. But no organisation is immune to the impacts of the challenging times, including our College, which has incurred substantial costs associated with the disruption caused by the pandemic. This has been especially so in our training programs, which were completely redeveloped for their safe delivery and for the assessment of trainees in a postpandemic world. The new investments have drawn heavily on the College's reserves and are not sustainable without some replenishment from the membership. Any member or trainee at risk of financial hardship as a result of the increases should contact College staff for information on obtaining assistance in paying their fees.

Clin A/Prof Sanjay Jeganathan

With most of the world moving out of its COVID-lockdown phase, there is a welcome return to people being able to connect and reconnect with each other. While COVID has accelerated the evolution to meeting via video and this has been remarkably successful, there remains a need to balance this with person-to-person meetings. We recently held our first in-person Board and Council meetings in two years, enabling our members to engage and interact with each other and to debate a number of critical issues.

As part of this reopening of society, this is a welcome return of the New Zealand Aotearoa and Australian ASMs for 2022. The ASMs offer the opportunity to connect with friends and peers, welcome new graduates, meet distinguished international guests, and to learn about the latest developments in your profession.

The New Zealand ASM will take place in Queenstown, New Zealand, from 5–7 August 2022. This is a must-attend event, with a solid program and tickets selling strongly. Queenstown is a scenic destination venue that offers excellent conference and accommodation options, plus a range of sightseeing and adventure opportunities.

The 72nd Australian ASM will be held in Adelaide, South Australia, from 27–30 October 2022. This event promises to take delegates on a three-day journey that will challenge their thinking and expand their knowledge. Adelaide is a beautiful city with a relaxed ambience and a world-renowned food and wine culture. For the first time, we are running the “Little Rascal’s” club to give the

A Message from the CEO Return of the New Zealand and Australian ASMs

children of our delegates an experience they will remember for a long time, and to allow families the opportunity to attend this event. The ASM will also feature amazing displays from our industry partners, who are eager to showcase their latest to our members and guests.

Lib-Nat Coalition providing the most comprehensive response.

The Coalition re-iterated their MRI budget announcement of MRI deregulation for MMM 2-7 (rural and regional areas) achieved after sustained College advocacy work over an extended timeframe; and a continuation of STP funding.

Pleasingly, a Medicare Review Advisory Committee has been established to undertake a continuous Medicare review process, in line with the radiation oncology MBS review priority of the College. Additional funding of $6.9 million has been allocated to Cancer Australia for further work to consider the feasibility issues required for the implementation of a national lung cancer screening program. The College is aware that this is currently taking place as we have had discussions with some of their committees. There was no clear commitment to the particle therapy or Australian Incident Register 2.0 priorities.

Advocacy and Policy news

The College’s Policy and Advocacy team was active in the lead up to the recent election, publishing an 'Election Asks' paper and distributing it to the major and minor political parties and MPs. We received responses from the Coalition, Labor, Greens and One Nation. The United Australia Party (UAP) was contacted with no reply.

Responses were varied with Labor committing to respond to our priorities if elected, the Greens and One Nation supporting all our proposals and the

Post-election, the College is planning to meet with the new Health and shadow Health Ministers and party health spokespersons to further press our issues. The College will continue to advocate for the MRI deregulation of MMM1 (metropolitan) areas.

The College has recently been in the news to discuss the world-wide shortage of non-ionic contrast media. Our College President Sanjay Jeganathan has given numerous interviews on this topic, offering a rational and considered voice with robust options for dealing with this shortage. At last count, the College had a media reach of over 41 million people (measured by the audited population reach of each media outlet per story), the most media exposure ever recorded by the College.

Duane Findley

“As part of this reopening of society, this is a welcome return of the New Zealand Aotearoa and Australian ASMs for 2022. The ASMs offer the opportunity to connect with friends and peers, welcome new graduates, meet distinguished international guests, and to learn about the latest developments in your profession.”

An Iliad of Injury in the Age of Covid

The terms ‘moral injury’ and ‘moral distress’ in a medical context date from the 1980s when the ethics philosopher Andrew Jameton wrote of the psychological impact on nurses in situations where they were constrained from acting in accordance with their moral beliefs—that is, in doing what they believed was right. Jameton felt that nurses, not doctors or medical administrators, occupied the moral centre of the healthcare profession; this was because of the extended time they spent with the patient, their concern with non-medical factors in the patient's health and their interactions with the patient's family. Situations in which Jameton observed moral distress were characterised by the ethical dilemmas faced by nurses compelled to perform painful but futile procedures on dying patients or provide intensive care to premature babies who were not expected to survive.1

The terminology was adopted in the 1990s by the psychiatrist Jonathan Shay in an entirely different context— that is, in the treatment of Vietnam War veterans suffering post-traumatic stress disorder (PTSD). Drawing on the depiction of Achilles in Homer's Iliad, Shay perceived an undescribed psychological condition at the heart of the veterans' PTSD, that of a moral injury resulting not from a single traumatic event but rather from feelings of betrayal of what is right by their commanders and the onset of a berserk state in which the soldier experiences profound grief, rage and disconnection from humanity. Shay saw in these veterans not just a psychiatric illness but what he described as an erosion of ‘good character’.2

In more recent times, moral injury has been applied widely and indiscriminately in medical contexts as a descriptor for the psychological distress, dissatisfaction and burnout felt by clinicians working under extreme stress due to any number

of factors, including long hours and lack of efficacy, autonomy or resources. According to Google's Ngram Viewer, use of the term ‘moral injury’ in English texts grew almost five-fold between 2010 and 2019, partially a reflection of its rising usage in military-related literature, but also as a result of heightened recognition of the condition among healthcare workers.3 In this context, observers speak of potentially morally injurious events (PMIEs) that may affect the mental and physical health of workers, symptomatically as ‘exhaustion, frustration, helplessness, guilt, shame and worry’, and ultimately leading to burnout or moral injury.4

It's worth noting that some researchers describe moral injury as a sustained form of moral distress,5 while others formally distinguish the causes, describing moral distress as the condition that may arise from the health worker being required to violate an external set of ethical rules such as a code of conduct, in contrast to moral injury which may arise from a violation of the health worker's internally-held personal beliefs about

behaving morally.6 What is generally agreed is that, following Shay, moral injury is marked by an erosion of trust in self and others.

Expanded use of the term in medical contexts has tended to blur or weaken the individual's ethical or moral standpoint in the described condition in preference for a generalised notion of ‘what is right’. For example, in 2018, the American plastic surgeon Simon Talbot and psychiatrist Wendy Dean argued in an influential opinion piece that moral injury arises from a ‘broken healthcare system’ which fails to ‘consistently meet patients' needs’, and from ‘conflicts of interest’—such as financial considerations, business metrics and the threat of litigation—which combine to influence a doctor's decision-making in a way that may in some instances actively harm a patient. Here, they claim, the moral content of the injury experienced by the physician is the fact of ‘being unable to provide high-quality care and healing.’

The result is not burnout, although the symptoms are similar, but rather the

physicians are cast as ‘the canaries in the healthcare coalmine’ with their injuries alerting the health authorities to a systemic crisis.7

However, Talbot and Dean fail to address the relativism inherent in this conception of moral injury. The quality of healthcare systems varies enormously across jurisdictions, health sectors and disciplines, yet participation in one system is not rendered a PMIE for simply being inferior or limited in its quality of care, compared to that of another system with more resources or better health outcomes.

Being unable to provide high-quality care depends on what the health worker understands to be of a high quality and the particular reasons for the available care falling short of this benchmark. Hence, systemic conceptions of moral injury tend to raise more questions than they answer.

In general, it is theorised that at least some forms of moral injury in health care arise when the individual's personal (and often rigid) morality comes into conflict with the (often more morally flexible) utilitarian judgements of the organisation in which the individual is employed.8

Unsurprisingly, as with any novel stress on a healthcare system, the COVID-19 pandemic has brought added attention to the impact of changed clinical practices, policies and work-related stress on health workers. Examples in the literature dealing with moral injury have typically focused on shortages of life-saving equipment such as ventilators, escalation-of-care decisions in triage and restrictive visitation policies for families of COVID patients.

In countries with healthcare systems acutely affected by the pandemic, a few health workers have been forced to make fateful decisions over whether to provide a particular patient with a bed— and, in doing so, condemn another to likely death.

Locally and more commonly, the impact has been of a chronic nature made worse by the pandemic. In this context, Yee Leung, head of department at the Western Australian Gynaecologic Cancer Service at King Edward Memorial Hospital in Perth, lists administrative burdens, overcomplicated rules and budget cuts among the chronic factors

that undermine goodwill and manifest in disengagement, conflict with colleagues and anger towards managers. Adopting a broad interpretation of moral injury, he says the ‘incessant pressure to cut services’ in a system seemingly at odds with providing the best health care ‘creates a workplace that potentially promotes moral injury in these workers’.9

Prof Leung's article in an online newsletter attracted some startling comments, including one from a GP who claimed that pre-pandemic Australian doctors enjoyed ‘a vastly superior working life’ compared to their counterparts in the UK's National Health Service. Another comment described medical administration (presumably in Australia) as ‘corrupt, inept and ignorant’; a third blamed the adoption in the 1980s of American models of nursing and hospital administration and ‘the burden of paperwork’ which keeps nurses and doctors from their patients.

Tachi Zhong Hu, a radiation oncologist at Liverpool Hospital in Sydney, says the pandemic has severely tested the resilience of healthcare workers and increased the likelihood of moral injury in the medical workforce. ‘We had to rotate to work in the COVID ward to relieve our colleagues who have been working tirelessly since the beginning of the pandemic, often working 12-hour shifts without breaks to ensure patients are attended closely and reviewed,’ with limited availability of BiPAP ventilators, and while enduring headaches, sweating and skin irritations from full-body PPE and N95 masks.

Dr Zhong said the tight visitor rules and the need to use phone or video for oncological conversations made communication with patients' families very difficult, especially when the oncologist had bad news to deliver. ‘It definitely added to the family's or patient's frustration over the delivery of care and it impacted on the rapport between patient and healthcare workers.’ He is aware that some doctors, nurses and paramedics suffered burnout symptoms and were forced to reduce hours or take a break to recover from the stress they felt over the last two years.

On a personal level, Dr Zhong struggled as a College trainee during the early months of the pandemic. ‘I had to sit for my phase 1 exam in 2020 and it was difficult juggling work, dealing with

COVID, studying, adapting to work rule and policy changes and mentally facing the uncertainties in general. Although I passed my exam, I felt very burnt out and depleted through the journey.’ Other trainees were in a ‘similar or worse position than me,’ he said.

For Dana Tipene-Hook, a consultant radiologist at Taranaki Radiology in Auckland, an individual's propensity for moral distress or injury is influenced by their world view and cultural background—in her case, living and working as a Māori doctor ‘in a system that is already geared against Indigenous peoples.’

“Dr Zhong said the tight visitor rules and the need to use phone or video for oncological conversations made communication with patients' families very difficult, especially when the oncologist had bad news to deliver. ‘It definitely added to the family's or patient's frustration over the delivery of care and it impacted on the rapport between patient and healthcare workers.”

Noting the arrival of a ‘veritable tsunami of moral injury’, Dr Tipene-Hook views the condition and the psychological impact of the pandemic through the prism of racism. ‘Disadvantaged, susceptible populations (Māori, Pacifica, Aboriginal and Torres Strait Islanders) disproportionally bear the brunt of disease’. Consequently, the shortcomings in the healthcare system when health services are being rationed, delayed or denied due to a pandemic, fall most heavily on the Indigenous cohorts.

She has experienced this at a personal level, in the ‘overt, casual or unconscious racism from patients and colleagues’, as well as in observing the impacts on whānau (extended family) members, associates and friends. ‘Being witness to and a player within the racist system is morally injurious . . . and the risk for moral injury that existed pre-pandemic is now obviously more intensified and prevalent,’ she said.

In general, measures to identify, assess and treat cases of moral injury are hampered by a lack of precision in definition, its causes and its overlap with burnout and latent psychiatric illness— all three often share similar symptoms, including fatigue, depression, depersonalisation and suicidality.10 Resilience training is not considered an effective treatment or preventative for moral injury—indeed resiliency training programs, although popular in health organisations and elsewhere, appear to lack any reliable level of efficacy for the improvement of mental health.11

References

Suggestions for the prevention of moral injury include shorter working hours for residents and ethical guidelines promulgated by professional associations to support clinicians to refuse to comply with a direction that might entail moral injury.12 Referring to the approach outlined in the Australian Commission on Safety and Quality in Health Care (ACSQHC) comprehensive care standard, Prof Leung has called for a collaboration by clinical heads and health administrators to achieve a ‘balance between fiscal accountability and maintaining safety and quality’ in health care.

susceptible populations (Māori, Pacifica, Aboriginal and Torres Strait Islanders) disproportionally bear the brunt of disease.”

Dr Tipene-Hook advocates more Indigenous representation in the College and the clinical workforce. And, mindful of pandemics beyond COVID-19, Dr Zhong hopes the College will continue to modernise its examination methods and policies to minimise the impacts of future public health crises.

Notwithstanding these suggestions, the responsibility for maintaining mental health returns eventually to the clinicians themselves, although not for each clinician alone in a private purgatory. To this end, psychologists have put forward a raft of first-aid measures for mending moral wounds incurred in the pandemic.13 Unsurprisingly, they depend heavily on collegiality, showing respect for each other's work, staying connected even in disagreement, and remaining united in common professional purpose. It is too easy for a sense of common purpose to falter and fall under the wheel of careworn criticism of decisions or policies that rankle or frustrate. The recommended measures include the acknowledgement of stress and pressure at all levels in the workplace, ‘leaning’ on colleagues and talking about your ethical concerns. Williams et al. highlight the value of building ‘routines that emphasize mutual understanding of each other's struggles and contributions’. And, finally, they advise health workers to find ways to connect emphatically with patients—to remind yourselves, even in the midst of a crisis, why you are doing this job, and in helping others, to kindle some selfkindness.14

Brett Wright BA (Hons.) PhD is an independent historian with research interests in science, technology and medicine. He is currently writing a history of Bendigo Hospital.

1 Andrew Jameton, Nursing Practice: The Ethical Issues. Englewood Cliffs, NJ, USA: Prentice-Hall, 1984.

2 Jonathan Shay, Achilles in Vietnam: Combat Trauma and the Undoing of Character. New York: Scribner, 1994.

3 Google Books Ngram Viewer, https://tinyurl.com/wffzs543 [accessed 30 May 2022]

4 Roger D. Williams, Jessica D. Brundage and Erin B. Williams, “Moral Injury in Times of Covid-19,” Journal of Health Service Psychology, vol. 46, 65–69. https://doi. org/10.1007.s42843-020-00011-4

5 Ibid.

6 For example, Philip Day et al., “Physician Moral Injury in the Context of Moral, Ethical and Legal Codes,” Journal of Medical Ethics, published online first: 21 July 2021, https://doi.org/10.1136/medethics-2021-107225

7 Simon G. Talbot and Wendy Dean, “Physicians aren’t ‘burning out.’ They’re suffering from moral injury,” STAT, July 26, 2018, https://www.statnews.com/2018/07/26/ physicians-not-burning-out-they-are-suffering-moral-injury/ [accessed 30 May 2022]

8 F. Akram, “Moral Injury and the COVID-19 Pandemic: A Philosophical Viewpoint,” Ethics, Medicine and Public Health, vol. 18, 2021, article no. 100661, https://doi. org/10.1016/j.jemep.2021.100661

9 Yee Leung, “Crisis time for morally injured health care workers,” InSight+, no. 1, 25 January 2021, https://insightplus.mja.com.au/2021/1/crisis-time-for-morally-injuredhealth-care-workers/

10 A 2019 review of 116 relevant studies found a lack of consensus over definition, absence of a ‘gold-standard’ in its measurement and ‘unclear mechanisms of therapeutic effect’. Brandon J. Griffin et al., “Moral Injury: An Integrative Review,” Journal of Traumatic Stress, vol. 32. no. 3, 2019, 350–362, https://doi.org/10.1002/ jts.22362

11 Aaron L. Leppin et al., “The Efficacy of Resiliency Training Programs: A Systematic Review and Meta-Analysis of Randomized Trials,” PLOS One, vol. 9, no. 10, 2014, article e111420, https://doi.org/10.1371/journal.pone.0111420

12 Jane McCredie, “Moral Injury in Clinicians concerning in COVID-19 ‘War’,” InSight+, no. 28, 2 August 2021, https://insightplus.mja.com.au/2021/28/moral-injury-inclinicians-concerning-in-covid-19-war/

13 Williams et al., “Moral Injury in Times of Covid-19.”

14 Ibid.

“Disadvantaged,

RANZCR TRAILBLAZERS

The Role of the Expert

A large body of expertise and knowledge resides in the membership of the College, gained over many, many years of scientific research and on-theground practice. Inside News is pleased to highlight this expertise and introduce the ongoing series RANZCR Trailblazers We start the series with excerpts from three oral history interviews made in 2015 by the then College archivists, Ms Eva Stokes-Blake and Ms Michelle Goodman.

Experts and expertise have been in more demand than ever during the pandemic experienced in all corners of the globe; as has the crucial sharing of expertise, most clearly demonstrated in the collective ‘race’ to develop a vaccine for the SARS-CoV-2 virus that has dominated health care since early 2020. Expertise is fed by specialisation, long experience, the pleasure of collaboration and fundamental curiosity for your subject. “Consider, for instance, the way in which [these] reflections help us to see the need to abandon the orthodox view that experts are those blessed with incontrovertible truths, as if they are substitutes for priests and shamans, and instead to re-imagine experts as specialists who know from long experience some of the worst mistakes that can be made in their field. […]

Experts, seen in this new way, operate as contrarians. They are specialists in contrapuntal reasoning. […] It is much better to see experts as people who know that they do not fully know. Experts have a strong sense of wonder about the world. They are aware that

their judgments always teeter on the brink of error.”1

As one of the 2015 interviewees, Professor Mark Khangure, notes, “I fundamentally believe that you start off with information then you have knowledge, then you have wisdom. Your final practice is knowledge and wisdom, it is not all information, I think the information is hidden in there. It's been applied, it's been gained. This is experience which you actually can't get on a short-term basis.”

Read on for a few thoughts from three College trailblazers and access the full recordings for much more history of the professions and the College here.

Associate Professor Nina Sacharias

We thank Michelle Goodman and Eva Stokes-Blake for laying the ground with their extensive work. We would also like to invite your expressions of interest to actively participate in clinicianto-clinician interviews of RANZCR Trailblazers (of your nomination), more details are available soon on our website. Interviews can be made faceto-face at RANZCR2022 ASM or now in your home city or via an online meeting.

Eva Stokes-Blake interviews

Associate Professor Nina Sacharias

ESB: Throughout the course of your career I believe you have specialised in breast and breast cancer awareness, and recently had a breast cancer clinic named in your honour?

NS: A pink bus.

The Royal Australian and New Zealand College of Radiologists

“I decided I want to specialise.[…] In general practice, you'd know something about everything, and I would rather know a fair bit about a particular thing.”

ESB: Throughout the course of your career, I believe you have specialised in breast cancer and breast cancer awareness, you recently had a breast cancer clinic named in your honour?

NS: A pink bus.

ESB: Could you tell me little bit more about how you got involved in breast clinics?

NS: I seemed to get involved because they needed someone. Breast screening was coming on in Australia and of course in Melbourne, I had a senior radiologist there, Dr Colin Lang, who had seen mammography in the States, with Dr Robert Egan of Houston. He came and grandfathered me. We did mammography, quite slowly. It was very fortuitous really, because the first patient was sent by a surgeon because he thought she had a malignant lump and we did our mammogram and thought it was a cyst. So that was win number one. Win number two was the same surgeon sent a patient to query many cysts, and there were some cysts but there was also a small cancer. So this man was convinced there was a place for it (mammography).

We gradually grew up and changed from film, industrial film which Dr Egan used, we then used xerography which was a blue picture, and then xerography was a bit high in dosage as was the first film, so we changed back to film, as film was safer, or digital now, everything is digital now.

Then something else came along because you get tired of one thing. So then I embraced angiography (blood vessel radiology of both the venous line and arterial line) the arteries were there,

“Sometimes you look at a chest film and see nothing, you do it again and you see something that’s not quite right then you do another film and then there is something. Now that takes three times as long. You need to push harder.”

“I was very careful in what I did, I didn’t ever push it, so if I was inside a patient and things weren’t as expected, then I came out and thought about it for a couple of days, then put it to the patient, that’s what we’ll do, are you prepared to take the risk? So perhaps, I was never afraid to show, I don’t know and would do something about it. Most people were happy to accept it and I had very few complications.”

and I had to do something with them, some you could dilate, some you could block and so I got a good result. Then I particularly liked the work in the head. I got into screening in a bigger way, then I had this lovely, well, pink bus made… two of them go around the country areas in Victoria and do mammography there for ladies who cannot travel too far into town.

ESB: With your teaching both within the College and in the hospital environment, is there anything you would like to reflect on? Maybe some students that stick in your mind or how the process of education has changed over the years?

NS: I think the process progressed with the equipment, there’s no doubt that once you had a different machine, you would use it, even if you don’t have to. The field of machines was much wider, and then I guess it really became more interesting. I really think the change of the equipment made all the difference because in the good/bad days, we had plain film and barium, barium work and started angiography. I think it was 1968 I saw the first carotid angiogram in Adelaide hospital. I saw it in the field that you could use these various things and it grew from there, then I put up a list of what was correct for what disease, you find that there’s a bit of help from each one of them. You do plain films, it might be good, or you might do a CT and then no, I must have MRI, no neurosurgeon works without an MRI and that’s how it goes and then there’s various sorts of nuclear expressions of the science. There’s all these things to do, you can’t just do one to get a diagnosis.

ESB: Recently you were honoured with the Order of Australia, congratulations again, would you like to reflect on and

share your memories around receiving the highest honour in Australia?

NS: It was a surprise. In fact, I never ever, ever, thought about that. All I did, I did because I thought I could do it, because it was there to do. I think people thought I was a bit different because I stayed with the students.

ESB: Is there any achievement that stands out in your mind?

NS: I was in some respects doing things and procedures that other people weren’t. What’s this thing about doing things where angels fail? Don’t tread…

I was very careful in what I did, I didn’t ever push it, so if I was inside a patient and things weren’t as expected, then I came out and thought about it for a couple of days, then put it to the patient, that’s what we’ll do, are you prepared to take the risk? So perhaps, I was never afraid to show I don’t know and would do something about it. Most people were happy to accept it and I had very few complications.

ESB: As an industry mentor, do you have any advice for upcoming radiologists?

NS: I think radiology is a fantastic area or field because its embraces anything that happens to the body and it has found a place in everything that happens. I think you need to be grateful and embrace it with joy. So much to do. I think nowadays the pressure in getting work done, in private, just as much as public, is a little bit against quality. Sometimes you look at a chest film and see nothing, you do it again and you see something that’s not quite right then you do another film and then there is something. Now that takes three times as long. You need to push harder.

as a trainee

I was a first-year resident medical officer (RMO); we weren’t called interns then. I decided I want to specialise.[…] In general practice, you'd know something about everything, and I would rather know a fair bit about a particular thing.

[…] I found radiation therapy straightforward because it was only a first part and a second part with a couple of subjects in each. And so, it was a matter of knuckling down, which I did immediately. And that's where I remember the first part was anatomy and physics. And of course, one has to study while being, as I was, a second year RMO and just married, you had to knuckle down and you worked till midnight two nights a week and the weekends, one weekend in three or one weekend in four, and you had to do a night round every day of the week except Saturday, which meant you couldn't do that till after 10 pm. So, one had to work in the remaining available time.

And for the second part, which used to be radiotherapy and pathology, I took 18 months over that and I was assisted greatly by the people at the Radium Institute in particular Dr Kevin Mead who helped me with the more detailed matters. He was an expert clinician and Dr Keith Mohar who was the deputy director was very good on general principles.

So between the two of them, I slotted in well and so I became a radiotherapist after just two and a half years of study. A far cry from what happens now.

And his time as an examiner

I was an examiner for a long time with Dr David Green who was senior examiner until 1985 and he was a really excellent examiner but I don't know if candidates now realise how few candidates there were. You would sometimes have one; two or three would be the norm. On one occasion we got to six, the heavens nearly burst but Dr Green felt and I agreed with him when you have so few candidates that stand if you change the membership of the examination it would be very hard to keep the standard the same for candidates through the years.

So it then remained just David and myself with observers. I want to say that because some people might say, well, it's not right to have so many examiners but normally if you are conducting an exam and you have 20 candidates, the results should form a bell curve and if nobody's answering this [question] or has a clue what it’s about, you can use the pool to see if your standard is right but you can't make a bell curve out of one candidate or even three.

Professor Mark Khangure

I have been a great advocate that the radiologists should be specialists, should articulate the fact that he or she is a specialist doctor and not a technician who only provides the imaging. […] I think personally also there's been a great lack of initiative on part of the radiology fraternities, not just in Australia, right around the world, in not shouting from the rooftops of what radiology has achieved.

Michelle Goodman: What sort of pass rate was there? Did people tend to pass or did it vary from year to year? They were quite difficult exams.

If you only had two candidates and one failed, it was a 50 per cent pass rate, you see. Well there was a significant failure rate almost always, but not always. Though they would get through the next time. So it wasn't a given that the person would pass and I’ll just say that some candidates were much better than others.

If you look at all of the major advancements in medicine and surgery, they actually hinge on an initial discovery or development in radiology. […] Yet most of the patients actually say my doctor, you know, treated me with this, it’s not the radiologists. And I when I was doing interventional neuroradiology, I made it absolutely quite clear that I had an outpatients’ clinic; we actually saw the patient, saw all of the relatives, saw the follow up, had equal admitting rights with neurosurgery for patients who were admitted to the ward or to the intensive care unit because I think that we really have to be clinicians first and foremost.

[…] I think that really from the point of view as being the sort of professional side of the equation, other than to maintain every step of the way that the patient comes first, we actually have to have the quality and standards. And if you can't do something, you're not trained to do it, it's appropriate to say no rather than actually do something half-hearted and damage the patient.

Dr Robert (Nobby) Bourne

Dr Robert (Nobby) Bourne recalls his days

Professor Mark Khangure

“I mean, nobody knows everything. So sometimes you have an inkling that you really want other opinions and this allows other opinions to be sought very rapidly.”

GET INVOLVED: SPECIAL INTEREST GROUPS

The College’s Board establishes Special Interest Groups in areas of specific interest to the membership within clinical radiology and radiation oncology

Contact us to find out more and join a Special Interest Group www.ranzcr.com/contact

Clinical Radiology Special Interest Groups

Australian and New Zealand Society of Thoracic Radiology (ANZSTR)

ANZSTR has been established to provide a networking platform for members with an interest in advancing knowledge, learning or clinical expertise in the area of thoracic radiology to communicate, meet and/or organise conferences to further this interest.

Australian and New Zealand Society for Paediatric Radiology (ANZSPR)

ANZSPR is a professional society for doctors with an interest in the medical imaging of children in Australia, New Zealand and neighbouring countries.

Abdominal Radiology Group Australia and New Zealand (ARGANZ)

ARGANZ is a not-for-profit group uniting radiologists from Australia and New Zealand who have a special interest in imaging and image guided treatment of patients with the diseases of abdominal organs.

Australian and New Zealand Emergency Radiology Group (ANZERG)

ANZERG is a network of members interested in emergency and trauma radiology.

Australian and New Zealand Rural Radiology Special Interest Group (ANZRRSIG)

ANZRRSIG is a network of members interested in rural and remote radiology across Australia and New Zealand.

Obstetrics and Gynaecology Special Interest Group (OGSIG)

OGSIG is a network of RANZCR members who are interested in O&G imaging. It aims to promote best practice for the performance and reporting of O&G imaging in Australia and New Zealand.

Radiation Oncology Special Interest Groups

Australian and New Zealand Palliative Radiation Oncology Group (ANZPROG)

ANZPROG is a group of radiation oncologists who advocate and promote the role of radiation therapy in palliative care. It allows members to share the clinical experience of radiation therapy provision in the palliative oncology setting.

Breast Interest Group Faculty of Radiation Oncology (BIG-FRO)

The aims of the BIG-FRO are to promote best clinical practice for the management of breast cancer, and to enhance the profile of radiation oncology in the setting of breast cancer.

Faculty of Radiation Oncology Genito-Urinary Group (FROGG)

FROGG aims to promote good radiotherapeutic and oncological practice as part of multidisciplinary patient management.

Gynaecological Oncology Radiation Oncology Collaboration (GOROC)

GOROC aims to facilitate and promote best-practice radiation therapy in gynaecological cancers through establishment of clinical guidelines for practice in this area; and to raise the profile of brachytherapy for gynaecological cancers.

Faculty of Radiation Oncology Lung Interest Cooperative (FROLIC)

FROLIC aims to facilitate best-practice radiation therapy treatment of patients with lung cancers and other thoracic malignancies (including thymic tumours and mesothelioma) with a particular emphasis on educational and quality assurance activities.

Faculty of Radiation Oncology Paediatric Group

The Paediatric Group aims to maintain a network of radiation oncologists who manage paediatric patients in Australia and New Zealand to ensure the best quality of care by radiation therapy for children.

Asia-Pacific Radiation Oncology Special Interest Group (APROSIG)

APROSIG aims to develop interaction with and support for radiation oncologists and their staff in Lowincome and Middle-income Countries (LMCs) in the Asia-Pacific region.

Faculty of Radiation Oncology Particle Therapy Special Interest Group (PTSIG)

PTSIG aims to bring together radiation oncologists to investigate and promote the role of particle therapy in the treatment of cancer, to ensure particle therapy is introduced in a coordinated way through a collaborative approach –to ultimately benefit patients.

[…] The next development after MRI was PACS. You now have a situation where you can have a conversation with colleagues interstate, overseas and they can look at the same dataset so you have this real speed and expertise in providing for your patients. I mean, nobody knows everything. So sometimes you have an inkling that you really want other opinions and this allows other opinions to be sought very rapidly. And I think that's also allowed radiology to subspecialise, whether it's a hospital or private practice, solo practices now are virtually non-existent, you have got a group, you've got a group with several different skills, it's only the hands-on procedure that requires the radiologists on site. You can supervise but if you're looking at the imaging study as an opinion, PACS allows it to be seen anywhere. That is wonderful. That has made a huge change into the specifics of patient management.

My next thought process is whether the training structure in the College needs to change as people start looking at more in the way of subspecialisation. You take three body areas where you spend your three, two years and that's what you're examined on and that's your scope of practice. After those three, you might do a fellowship in one, so you are really highly specialised in one, you're really good at two, you don't do the rest. I think you need three at least in order to cover the on call and coverage hospital and in private

practice. We're already looking at a separate body interventional cover from neuro interventional cover from general radiology cover. So basically, there's already a process because the person at the other end to whom you're reporting wants value add, he doesn’t want a generalist. He's asking you, he or she is asking you, for a specialist opinion, and I'm afraid I've yet to meet a radiologist who's a specialist in the entire field of medicine, surgery, obs and gyn, paediatrics and psychiatry, it just does not happen.

I think the next step might be recertification. And the question is, how do you do that? I mean, if you ask people to resit the exam, you know, you fail because you are not a generalist anymore. I mean, I fundamentally believe that you start off with information then you have

knowledge, then you have wisdom. Your final practice is knowledge, and wisdom is not all information, I think the information is hidden in there. It's been applied, it's been gained. This experience, which you actually can't get on a short-term basis. So the College has changed, is changing and it's going to change further. I think, you know, radiology has a huge future if we grasp it.

References

1 Keane, J. Thoughts on Uncertainty, Journal of Social and Political Philosophy 1.1 (2022): 1–13 DOI: 10.3366/ jspp.2022.0003

Cardiac CT Training

“So the College has changed, is changing and it's going to change further. I think, you know, radiology has a huge future if we grasp it.”

“[…] I think that really from the point of view as being the sort of professional side of the equation, other than to maintain every step of the way that the patient comes first, we actually have to have the quality and standards. And if you can't do something, you're not trained to do it, it's appropriate to say no rather than actually do something half-hearted and damage the patient.”

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The Integrated Rural Training Pipeline and College Training Posts

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 fills five 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 genuine commitment to working rurally or regionally post fellowship.

The Townsville Experience

In the final of our series of articles about the rural training pipeline, we hear from trainee Dr Winona Crooks and Gary Kershaw, Director (Radiographer), Medical Imaging Services at Townsville University Hospital (TUH).

Establishing an IRTP training post

The training site perspective

The recruitment process was aligned and integrated with the Queensland Radiology Training Network (QRTN) recruitment process and involved targeting applicants who met the rural and regional background criteria for IRTP appointment. The TUH representative to QRTN received exceptional support from the network to establish the position and identify candidates.

The applicant pool for the QRTN is quite large with several applicants emerging with rural and regional backgrounds relevant to the IRTP principles. The successful candidate, Dr Winona Crooks, emerged on merit from the interview and application process.

What measures were put in place to prepare for the training post?

TUH has had extensive involvement as a RANZCR-accredited training site for more than a decade, working in conjunction with the three QRTN Training LAN sites—Royal Brisbane and Women’s Hospital (RBWH), The Princess Alexandra Hospital (PAH) and the Gold Coast University Hospital (GCUH).

Based on this prior experience all of the basic requirements were available to support the IRTP posts and Dr Crooks as the first IRTP trainee. Further review and planning to enable Dr Crooks to complete her training were mapped out and gaps identified, and options developed to ensure the best level of support possible could be provided.

Specific efforts were made to confirm placements for our trainee—for the five years—were established to align to the IRTP requirements. Liaison with GCUH for elements of the offsite training were in place for an initial period while development of the full plan was completed.

“The applicant pool for the QRTN is quite large with several applicants emerging with rural and regional backgrounds relevant to the IRTP principles. The successful candidate, Dr Winona Crooks, emerged on merit from the interview and application process.”

A comprehensive weekly teaching program was enhanced to support the trainees and TUH radiologists all provide support and continuously develop the range of clinical teaching sessions available. The team then worked with feedback from the trainees to evolve these further.

How has the experience been for the practice?

Dr Crooks assimilated to the medical imaging team very quickly and consistently participates, professionally and socially, with the multidisciplinary groups within and around medical imaging. She is active with feedback to improve and develop our systems and enhance our service quality and standards.

The IRTP placement specifically means Dr Crooks will be a member of the radiology team for a longer period than other trainees rotating from the metro training sites.

This fact has meant Dr Crooks’ level of engagement in quality and systems development provides a level of consistency and constancy which is very positive for our service and her colleagues.

What are the advantages of training and/or practising in Townsville?

TUH radiology practice provides a unique experience for College trainees. We support an array of tertiary services with a diverse patient cohort referred from a vast geographic footprint, from Sarina in the south, Mt Isa to the west and north to the Torres Strait.

The range and complexity of our patient cohort is referred from a broad spectrum of clinical specialty which offers trainees an extraordinary opportunity to develop their radiology skills and knowledge base. The imaging department is well equipped with access to all imaging modalities to enable clinicians with a full array of radiology options to support patient care.

Having a relatively small team of committed radiologists and engaged trainees creates a very positive vibe for the medical imaging service which gives rise to a high-quality imaging service for patients and the referring teams. The long-term goal is, of course, to develop and sustain the radiology workforce to TUH and the north Queensland region, with trainees remaining or returning to TUH and other NQ sites as the next generation of radiologists.

The trainee perspective

Are there any advantages and/or disadvantages in your opinion of training at a large regional hospital compared to a metropolitan hospital?

I feel truly fortunate to be undertaking my radiology training at an IRTP post at TUH. The hospital as a tertiary referral centre in regional North Queensland

has its unique advantages. I get the best of both worlds—working in a regional hospital setting (fostering close working relationships both within our department and with referrers) while also being exposed to specialty care. TUH has a wide referral catchment area (spanning as far north as Cape York Peninsula and the Torres Strait Islands and west to Mount Isa and the Gulf of Carpentaria). Our busy department sees an array of interesting pathologies. This provides a strong foundation for core radiology training while offering exposure to cases unique to rural and tropical areas. The short commute with minimal traffic and free parking is an absolute bonus!

I started off my training on external rotations in metropolitan hospitals in Southeast Queensland. I miss my radiology registrar colleagues that I started training with and sat Part 1 exams with. Developing relationships, supports and study buddies on the training program is so important. However, I am lucky in Townsville as there are other trainees (who are preparing to sit Part 2 exams) and shortterm rotating registrars from other sites.

Is there anything you think that the site is doing in the IRTP training post that is of particular help to you in your training?

I am grateful that my department highly values teaching— both on an ad hoc on-the-job basis but also with dedicated formal teaching. Pretty much every morning before work there is one hour of teaching run by a radiology consultant. These teachings are based on local cases and are great Viva practice. I am also actively encouraged to use the IRTP funding for learning resources (such as courses, textbooks, online programs, etc.). My roster is also thoughtfully formulated by my Director of Training and balances exposure to procedures and diagnostic reporting over all modalities both in and out of hours to maximise learning.

Townsville University Hospital New INR Service | Bi Plane DSA

What advice would you give to a trainee commencing training in an IRTP position?

Keep in touch with trainees at other training sites!

What would you recommend to get the most out of this type of training experience?

Be as proactive as you can. There are more learning opportunities unique to your department than you realise! Take the time to get to know your department and take advantage of these opportunities (such as linking in with your regional physicist or skilled sonographers or reviewing interesting cases with consultants who have a special interest in that area, etc.). I also

recommend looking into what study resources are out there and what suits you that can be obtained using the IRTP funding.

What advice would you give a hospital/practice looking to start an IRTP position?

The IRTP is such an exciting opportunity for regional hospitals to train their own registrars. I am a North Queensland local and am still pinching myself that I get to undergo specialty training in a place I call home and want my career to develop in. I advise selecting an IRTP trainee that is passionate about your region and will embrace the unique training opportunities it will offer.

More Information on the Australian Government Department of Health Specialist Training Program

The STP aims to positively influence 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:

Specialist Training Placements and Support (STPS)

Integrated Rural Training Pipeline - STP Training More Specialist Doctors in Tasmania (Tasmanian Project)

The College administers funding on behalf of the Department for training posts across all three initiatives in clinical radiology and radiation oncology. Colleges receive a set allocation of training posts under individual agreements. Training sites must apply for the program through a New Post Process, which is managed by the Department in conjunction with each state jurisdiction and colleges. Successful posts are placed on the College’s reserve list and must be accredited to fill vacant positions.

The College currently funds 15 regional STPS posts in clinical radiology, with an additional five shared with public metropolitan training sites. 10 regional STPS posts are also funded in radiation oncology.

To find out more about the program and funding opportunities, please contact the STP team at STP@ranzcr.edu.au.

References

1

Australian Government | Department of Health | Specialist Training Program: https://www1.health.gov. au/internet/main/publishing.nsf/Content/work-spec

“The IRTP is such an exciting opportunity for regional hospitals to train their own registrars. I am a North Queensland local and am still pinching myself that I get to undergo specialty training in a place I call home and want my career to develop in. I advise selecting an IRTP trainee that is passionate about your region and will embrace the unique training opportunities it will offer.”

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It’s Time to Reflect, Revive and Reimagine!

2022 ASM

With just over four months until the College’s flagship event, the Annual Scientific Meeting will be held in Adelaide 27–30 October 2022. 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. Delegates will also be given the opportunity to participate in a number of hands-on workshops across both disciplines before and after the ASM.

The scientific committee, chaired by A/Prof Christen Barras (clinical radiology), Dr Ram Govindaraj and Dr Laurence Kim (radiation oncology), are delighted to invite you to the meeting, an eagerly anticipated opportunity to meet face-to-face once again, for the first time in three years.

The College is pleased to announce the introduction of new initiatives at this year’s ASM including the Everlight 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, including a special focus on doctor health and wellbeing

Early bird registrations rates are now open and available until Friday 1 July 2022. A record number of new Fellows will be celebrated and acknowledged in the traditional Annual Ceremony held on Friday 28 October at the Adelaide Convention Centre. The celebrations will continue with the Dean’s Reception overlooking the River Torrens.

RANZCR2022 will officially begin with the opening plenary session on Thursday 27 October 2022 and see Dr Richard Harris SC OAM, 2019 Australian of the Year, present the Nisbet Oration. Dr Harris played a crucial role in the rescue of 12 young boys and their soccer coach trapped in a flooded cave in Thailand and has an inspirational story to share with delegates.

The Committee is finalising an exciting program of subspecialty sessions

designed to showcase clinical radiology and radiation oncology research, providing unparalleled opportunities for interaction between the College faculties with combined sessions in rectal imaging and prostate imaging, and a chest MDT session.

A/Prof Melissa McCradden, a bioethicist from The Hospital for Sick Children, Toronto, Canada presents on ‘Hype, hope, and high stakes: ethical issues for radiologists using artificial intelligence’, crucial to us all as AI technologies reach the clinical coalface.

Prof Sujal Desai from the Royal Brompton Hospital, UK, joins us in person to deliver expert talks in chest radiology.

Dr Asif Saifuddin, Senior Musculoskeletal Radiologist at the Royal National Orthopaedic Hospital, UK, renowned authority in bone tumour imaging, will be joining us online.

Prof Perry Pickhardt, Chief of Gastrointestinal Imaging at University of Wisconsin-Madison joins us to present on liver imaging, challenging cases, peptic ulcer disease and more.

In anticipation of the opening of the Southern Hemisphere’s first proton beam therapy facility, currently under construction at the Australian Bragg Centre, we welcome international expert Dr Anita Mahajan from Mayo Clinic, to discuss its revolutionary impact on cancer treatment for adults and children, soon to be available to Australians. Head-and-neck radiation oncology expert Dr Nancy Lee joins us from Memorial Sloan Kettering Cancer Centre.

Prof Tarek Yousry, Head of the Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, London, will visit in person, an expert in neuroanatomy, advanced imaging of tumours and functional MRI.

Space radiology research and innovations will be highlighted in a brand new ASM session bound to excite and inspire you, a fitting offering from the home of the Australian Space Agency. Visit the Australian Space Discovery Centre while you’re here!

Trainees can look forward to a dedicated teaching day, organised by peers and special social events.

All this and much more is in store for you at RANZCR2022, which will be delivered as a hybrid event: in person, virtual and on demand.

Our ultimate goal is to engage with as many delegates in person to meet together in Adelaide and reconnect with a quality program and social activities you can’t afford to miss.

See you in Adelaide!

Join us in Adelaide for the RANZCR

“The scientific committee are delighted to invite you to the meeting, an eagerly anticipated opportunity to meet face-to-face once again, for the first time in three years.”

Caution advised over heart screening tests

Dr Jane Deacon - Manager, Medico-legal Advisory Services, MDA National

Ms H was a 43 year old woman, mother of two young children, and a successful business executive and she was invited by her employer to undergo a ‘cardiac health assessment’ in March 2019.

The ‘cardiac health assessment’ consisted of a coronary artery calcium score and CT coronary angiogram.

Ms H had no history of cardiac problems but was encouraged by her workplace to undergo the assessment. Dr T was the radiologist in attendance on the day Ms H attended the radiology practice for the procedures, and was the only doctor on site. Unfortunately, Ms H suffered a severe allergic reaction when the Omnipaque dye was administered intravenously. Resuscitation was commenced on site, an ambulance called and Ms H was taken to hospital, but she died about a week later without regaining consciousness.

The cause of death was multisystem organ failure and hypoxic/ischaemic encephalopathy due to anaphylactic reaction to CT contrast medium.

The scan report showed that Ms H had a calcium score of 0 and normal coronary angiogram.

Ms H’s death was the subject of a coronial inquest 1. Ms H’s family requested the inquest, noting that a number of factual issues required investigation and that there were important public health implications, ‘including the process of company employees being tested, the failure to be seen by a doctor prior to an invasive test and the management of her anaphylactic reaction’.

The Inquest Outcome

The inquest lasted over two weeks, involving sixteen witnesses and six expert witnesses.

The coroner found that the impetus for the ‘cardiac health assessment’ program had arisen from the best of intentions after a worker for Ms H’s employer had suffered but survived a cardiac arrest. Following this, the managing director wanted to give his staff the opportunity to have ‘the best private medical assessment program for heart health’ at the company’s cost, and he asked one of his managers to develop a suitable program.

The coroner investigated the complex arrangements of business entities and individuals involved in the development and implementation of the ‘cardiac health assessment’ program.

The coroner determined that Ms H died as a result of substandard clinical judgement from doctors at the beginning and end of this program, combined with a misalignment of incentives amongst the various business entities that facilitated the process. The inquest heard evidence about an industry putting profits over patients.

The ‘cardiac health assessment’ program had been developed without obtaining formal and considered medical advice on the risks of the tests, or whether these two tests were the

most suitable or whether there should have been a preliminary assessment by a medical practitioner.

The radiology request forms were affixed with Dr S’s electronic signature, although he had never seen or spoken to the people undergoing the tests, and he considered his role was to receive the results and have a discussion with the participants about their results.

The coroner considered that Ms H had not fully given her consent as she did not know the true nature of the procedure, and possible alternate pathways, and had not discussed the procedures with either the referring doctor, or the radiologist.

Ahpra notifications

The referring doctor, Dr S, was referred to Ahpra. The coroner was critical that Dr S had allowed his signature to be used for referrals for patients he had not reviewed, and that Dr S failed to apply ethical standards as he considered himself to hold a lesser obligation to persons who he considered to be ‘clients’ or ‘candidates’ rather than ‘patients’.

The radiologist, Dr T, was also referred to Ahpra, with the coroner finding that the CT scan was performed on the basis of a referral with insufficient clinical detail, and that Dr T failed to recognise and manage Ms H’s anaphylaxis appropriately.

Recommendations

Extensive recommendations were made by the coroner with many relating to improving the recognition and management of severe contrast reactions and anaphylaxis. Other recommendations include that:

The Royal Australian and New Zealand College of Radiologists (RANZCR) prepare a joint position statement with the Cardiac Society of Australia and New Zealand regarding when ‘screening’ is an acceptable indicator for a CT angiogram or other invasive cardiac tests.

RANZCR update its standards and guidelines regarding both clinical requests and consent procedures to address the increasing prevalence of ‘screening’ requests, and to ensure that imaging procedures are not performed for ‘screening’ when lower-risk alternatives might achieve the same end.

the Royal Australian College of General Practitioners (RACGP) and the Australasian Faculty of Occupational & Environmental Medicine (AFOEM) prepare a joint position statement on the appropriateness of a practitioner authorising, or otherwise allowing, their signature to be used in referring individuals (whether ‘patients’, ‘clients’ or ‘candidates’) for tests when neither the patient, nor any information specific to the patient, has been reviewed.

College Governance 2022

This year we welcomed several new office bearers to the Board.

President: Clin A/Prof Sanjay Jeganathan

FCR Dean: A/Prof Gerard Goh

Elected Fellow: Dr Peter O' Brien

In the Faculty Councils, we also welcomed Dr Carol Johnson as the inaugural Chief of Professional Practice for the Faculty of Radiation Oncology and Dr Barry Soans as Chief Censor for the Faculty of Clinical Radiology.

In addition to an already full agenda, the Board and the Councils will continue to steer the College through the aftershocks of the pandemic, following on from the considerable work of these bodies since 2020 and from the College’s (now-disbanded) COVID-19 Taskforce.

Some of the embedded effects of the pandemic are being felt keenly now with supply chain disruption and clinician fatigue, and there is no shortage of challenges for office bearers, new and established.

The College is committed to equal representation for all in its governance bodies. The present Board is all male, this is not by design. It has not always been the case in the past and there is no reason why it would be in the future.

We encourage all members to nominate for governance roles to maintain the committed, engaged, energetic work of committee and Board members on which the membership and the College jointly rely.

Nominations closed on 1 June for one member-elected Board of Directors position for a three-year term from January 2023.

All current opportunities can be viewed at www.ranzcr.com/fellows/general/getinvolved/current-opportunities.

Consider nominating via an expression of interest or consider nominating a peer in the instances where peernomination is requested.

We would like to thank everyone who participated in the recent survey on the volunteer work members contribute to the College and the professions.

Whether you are currently a volunteer, have never volunteered, or have previously volunteered, your views are important. Your feedback will make a significant difference to the volunteering experience.

Currently we are reviewing the survey outcomes and will keep members informed of all progress. We anticipate improvements in recruitment processes, recognition, training, communication and access to resources.

Volunteering is important to the professions, and we welcome you to become involved as a volunteer, providing additional feedback to us, or keeping in touch with current opportunities.

L-R Prof Alan Coulthard, Dr Gabriel Lau, Prof Vin Massaro, Dr Christian Wriedt, A/Prof Gerard Goh, Dr Peter O’Brien, Clin A/Prof Sanjay Jeganathan, Dr Keen-Hun Tai, Duane Findley CEO

Training Program Evaluation

The College commissioned a review of its training programs in 2015 to evaluate the quality and sustainability of its training, assessment, and examination activities, and to recommend strategies for improvement.

The Clinical Radiology and Radiation Oncology Training Programs were revised in accordance with the recommendations of the review. Changes were made to learning outcomes, learning experiences, work-based assessments (WBAs), and examinations.

Since the launch of the revised Training Programs in February 2022, the Clinical Radiology and Radiation Oncology Implementation Working Groups (CRIWG and ROIWG) have been developing an evaluation strategy to determine whether the training programs are achieving the expected outcomes and continuing to meet the needs of the community and employers.

It is intended for the training program evaluation to be conducted annually in a tiered approach. This will allow the College to capture specific feedback

and suggestions for improvement on key areas of the training programs such as curriculum content, teaching and learning, supervision, WBAs, examinations, trainee progression and training program outcomes.

When will the evaluation take place?

The first stage of the evaluation cycle will open in the second half of 2022, with the intention to present the results to committees towards the end of 2022. This evaluation will cover WBAs within the training programs, specifically focusing on ePortfolio functionality, assessments number and types within each phase of training as well as reviewing the entrustability scaling.

How to provide your feedback?

There will be a Work-Based Assessment Evaluation Survey open for trainees and supervisors in the training program. Members will be notified via email when these surveys will be open.

In addition to this, members are encouraged to provide feedback through the regular College communication channels:

Clinical Radiology CRTraining@ranzcr.edu.au

Radiation Oncology ROTraining@ranzcr.edu.au

Trainee Help Desk +612 9268 9777 College enquires + 612 9268 9700

Or via:

• Annual Director of Training Survey

• Annual Trainee Survey

• Local Networks

• College Committee members

• Workshops and Training Program Webinars

“Since the launch of the revised Training Programs in February 2022, the Clinical Radiology and Radiation Oncology Implementation Working Groups (CRIWG and ROIWG) have been developing an evaluation strategy to determine whether the training programs are achieving the expected outcomes and continue to meet the needs of the community and employers.”

The Advantages of Open Access Publishing Increase Your Readership and Citations

The number of open access articles and journals published by Wiley has grown exponentially over the last ten years. We are committed to an open access future and are supporting the ongoing transition to open access in a number of ways. One such way is through our negotiation of country-level agreements combining access (reading) and publishing on large scales.

After first negotiating and signing deals in the Netherlands (VSNU) and Austria (KEMO), our position as a leading open access publisher was cemented by the landmark agreement with Projekt DEAL in Germany at the start of 2019. Transformational agreements with the UK (Jisc), Norway (Sikt), Hungary (EISZ), Sweden (Bibsam), and Finland (FinELib) quickly followed suit throughout 2019 and 2020.

2021 saw Wiley expand our transformational agreements outside of Europe, with our first partnership in North America with Iowa State University. More recently our partnerships extended to MALMAD (Israel), Carolina Consortium (USA), and NST (Republic of Korea). Importantly for the College and JMIRO, an agreement was also reached with the Council of Australian University Librarians (CAUL), covering 52 institutions across Australia and NZ.

Every one of Wiley’s transformational agreements, whether for hybrid or gold journals, includes read access, which allows researchers at participating

institutions full access to content published within our entire portfolio of journals. But unlike traditional journal subscriptions, transformational agreements also enable those covered by them to publish open access in Wiley’s titles with no direct cost to the author.

This means that for CAUL-affiliated authors publishing in JMIRO, you can take advantage of this new agreement and select to publish open access when submitting your next paper. Open access will see your work being made freely available immediately upon publication, while you retain copyright and publish under a Creative Commons license. Wiley’s own research shows that open access articles in hybrid journals such as JMIRO can attract up to 3.2x the readership and 1.5x the citations of nonopen access articles.

For more details about this research and to see additional results gathered from a collection of more than 150,000 papers, please see Demonstrating the advantage of publishing open access with Wiley, our white paper available to download at www.wiley.net

To learn more about the open access advantage for JMIRO, visit Online Library | Open Access Advantages

To learn more about the CAUL-Wiley agreement and check your eligibility, visit Read and Publish | Wiley

To learn more about Wiley’s other transformation agreements around the world, and to check your eligibility under these, visit Wiley | Open Access

“Every one of Wiley’s transformational agreements, whether for hybrid or gold journals, includes read access, which allows researchers at participating institutions full access to content published within our entire portfolio of journals. But unlike traditional journal subscriptions, transformational agreements also enable those covered by them to publish open access in Wiley’s titles with no direct cost to the author.”

What’s in Issue 4?

Medical Imaging

Pictorial Essay: Part 1: Imaging findings of common immune checkpoint inhibitor-related adverse effects

Corresponding author: Geertje Noe, Department of Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria, 3000, Australia

Summary: Over the last decade or so, immunotherapy and in particular immune checkpoint inhibitors have become common in the treatment of numerous cancers and have revolutionised oncology. The unique mechanisms of these agents has resulted in novel tumour response patterns and also new drug-related toxicities, both of which can have specific findings on imaging. The widespread and increasing use of these agents means these findings are now encountered across many radiology practices beyond just specialist oncology units. This pictorial essay aims to describe and illustrate imaging findings associated with common and important immune-related adverse events as a result of treatment with immune checkpoint inhibitors.

Medical Imaging

Pictorial Essay: 18 F-FDG PET/CT features of immune-related adverse events and pitfalls following immunotherapy

Corresponding author: Martin H Cherk, Department of Nuclear Medicine & PET, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, 3004, Australia

Summary: 18 F-FDG PET/CT scanning is routinely performed to stage and evaluate the treatment response in many malignancies. Immunotherapy is a rapidly growing treatment option for many cancers, and both clinicians and imaging specialists need to be familiar with 18 F-FDG PET/CT imaging characteristics unique to patients on this type of treatment. In particular, many immune-related adverse events (irAEs) can be detected on 18 F-FDG PET/CT and early accurate identification is critical to reduce treatment related morbidity and incorrect interpretation of malignant disease status. This pictorial essay reviews frequently encountered irAEs in clinical practice and their appearances on 18 F-FDG PET/CT along with a brief discussion on pseudoprogression and hyperprogression.

Radiation Oncology

Review Article: Irradiation immunity interactions

Corresponding author: Ben JC Quah, John Curtin School of Medical Research, Australian National University, 131 Garran Road, Acton, Canberra, ACT 2601, Australia

Summary: The immune system can influence cancer development by both impeding and/or facilitating tumour growth and spread. A better understanding of this complex relationship is fundamental to optimise current and future cancer therapeutic strategies. Although typically regarded as a localised and immunosuppressive anti-cancer treatment modality, radiation therapy has been associated with generating profound systemic effects beyond the intended target volume. These systemic effects are immune-driven suggesting radiation therapy can enhance anti-tumour immunosurveillance in some instances. In this review, we summarise how radiation therapy can positively and negatively affect local and systemic anti-tumour immune responses, how co-administration of immunotherapy with radiation therapy may help promote anti-tumour immunity, and how the use of immune biomarkers may help steer radiation therapy-immunotherapy personalisation to optimise clinical outcomes.

Radiation Oncology

Review Article: Role of radiomics in predicting immunotherapy response

Corresponding author: Gargi Kothari, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre Building, 305 Grattan Street, Melbourne, Victoria, 3000, Australia

Summary: Immunotherapies have revolutionised cancer management. Despite their success, durable responses are limited to a subset of patients. Prediction of immunotherapy response in patients has proven to be difficult due to a lack of robust biomarkers. Routinely collected imaging may offer an additional information source to personalise patient treatment, with advantages over tissue-based biomarkers. Quantitative image analysis or radiomics, which involves the high-throughput extraction of imaging features, has the potential to non-invasively predict cancer histology, outcomes and prognosis. This review evaluates the value of radiomics in patients undergoing immunotherapy, with a summary provided of the performance of radiomics models in predicting immunotherapy response and toxicity, as well as immune correlates. Much of the literature focussed on clinical endpoints and correlates to tissue biomarkers, particularly in lung cancer, while few studies investigated association with immune-related adverse events. Strengths of the studies included more frequent use of clinical trial datasets, homogenous patient cohorts and high-quality diagnostic scans. Limitations of the studies include heterogeneity in study methodology, lack of well-defined homogenous imaging datasets, limited open publishing of imaging datasets, coding and parameters used for radiomics signature development and limited use of external validation datasets. Future research should address the above limitations, as well as further explore the relationship between radiomics and immune-related adverse effects and less wellstudied biological correlates such tumour mutational burden, and incorporate known clinical prognostic scores into radiomics models.

Access your College journal online

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

- Go to www.ranzcr.edu.au

- Log in using your College username and password

= FREE access to all JMIRO current and digitised backfile content from volume 1, 1957!

There

A bit about the research

A bit about the research

RANZCR Workshops, Courses and Events 2022

Clinical Radiology Centralised Learning Program

New lecture released by the last Sunday of each month, check www.ranzcr.com/clp for more information and see page 30 for full details of the current schedule.

TROG SMART Workshop, Gold Coast, QLD 30 June 2022

Webinar: Optimal Tissue Acquisition and Optimal Pathology Outcomes: Sharing Best Practice for Oncology Patients in the Era of Personalised Care | Supported by AstraZeneca 21 July 2022

RANZCR New Zealand Branch ASM, Queenstown, NZ 5–7 August 2022

FROGG, Prostate Cancer Workshop, Hobart, TAS 8–10 September 2022

RANZCR ASM, Adelaide, SA 27–30 October 2022

Annual Ceremony 2022

The Annual Ceremony followed by the Dean's Reception will be held at the RANZCR 2022 ASM in Adelaide. The ceremony celebrates all New Fellows, College Honours, Awards and Prizes recipients awarded in the period from 4 September 2019 to 9 September 2022.

To find details and register for these events, visit the RANZCR What’s On page by scanning the QR code here:

For regular updates, in addition to the website listings, simply like and follow our RANZCR social media accounts:

If you have any questions relating to any College events, please contact the Conference & Events team at events@ranzcr.edu.au

Events are a great way to gain CPD hours!

www.insideradiology.com.au

The mission of InsideRadiology is to be the leading 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.

Originating from a College project commissioned in 2006 and previously funded by the Commonwealth Department of Health, InsideRadiology has been designed to fill the gap in health literacy of the general public around clinical radiology tests, procedures and professions. It has been found that anxiety is reduced and better managed by patients if they have prior knowledge of the procedure. InsideRadiology has been a flagship consumer resource for the College since its launch in 2009.

InsideRadiology has two key audiences: • health consumers (patients, their families and friends); and • health professionals (referring clinicians and allied health professionals).

Information is based on the Australian and New Zealand health systems although InsideRadiology attracts an international audience with just shy of 2 million visitors annually.

By providing a link between health consumers, clinical radiology referrers and the profession, InsideRadiology has been meeting the demand for highquality information. It is an important advocacy tool for transparency in clinical radiology, as well as the promotion of the role and value of the profession. InsideRadiology is a collaborative project that brings together clinical radiologists, referring clinicians and consumers, with the ultimate aim of improving the quality of medical imaging services through the provision of accurate, current, and criticallyreviewed information.

This information is written for both referring clinicians and healthcare consumers and goes through a rigorous editorial process, with each topic being reviewed by a second content

expert, a clinical radiologist, a general practitioner, and a consumer advisor. Information topics are also edited by a team of specialised consumer writers to ensure that they are easily understood by health consumers, while the general practitioner review ensures that there is correctly targeted information for referrers. Information is used as reference material for informed consent protocols, imaging accreditation, medical student education and enhancing links with other medical information websites (e.g. HealthDirect).

InsideRadiology is also an important contributor to rational, evidence-based ordering of diagnostic imaging in primary health care. It provides the referring clinicians not only with resources to support their patients' queries but also answers some of their own questions about clinical radiology, including prerequisites, contraindications, and alternative tests and procedures for each information item. InsideRadiology currently hosts more than 180 information items covering 92 different topics ranging from general X-ray to nuclear medicine and interventional radiology procedures to general information around radiation risks of medical imaging. Topics also introduce members of the medical imaging team and their role within the team.

“InsideRadiology has been an important contributor to rational, evidencebased ordering of diagnostic imaging

in primary care in Australia. I have welcomed the opportunity to work with the Editorial Team and appreciated the robust way in which all contributors have approached their task. RANZCR should be proud of the team’s willingness to incorporate consumer and general practice perspectives into the resource. Consumers, governments and members of health professions should feel confident that who use InsideRadiology will be both better informed and more confident about clinical decisions made in this ever expanding field.” (Prof Grant Russell, InsideRadiology GP Advisor 2013–2018, Monash University)

“Diagnostic and interventional radiology plays a vital and pivotal role in our health system. Despite the fact radiology has been this vital part of our health system for so long, or perhaps because of it, consumers take radiology very much for granted and it has become the invisible part of the journey through illness and injury. InsideRadiology has provided consumers with the opportunity to access the expertise of radiologists firsthand. InsideRadiology has, since its inception in 2008, been unique and innovative in providing accurate, up-to-date information from a credible source to meet the high demand for high quality information from today’s consumers.” (Ms Ann Revell, InsideRadiology Consumer Advisor)

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.

Centralised Learning Program

In February 2022, we launched the new e-lecture series, the Centralised Learning Program (CLP), to support clinical radiology trainees.

Due to popular demand, access to this educational program was extended to all College members with CPD points also available. If you have yet to access it, we would like to encourage you to check out our first five sessions from the College’s webcast library:

Neuroradiology A Neuroradiology B Head and Neck Spine

Musculoskeletal System A

There will be future sessions on Musculoskeletal Systems B, Chest, Cardiac and Vascular, Procedural

Radiology, Interventional and Neurointerventional Radiology. We would like to extend the invitation to College members and their colleagues interested in presenting on these or others topics to please contact us via centralisedlearning@ranzcr.edu.au

It is a great opportunity to access our College member base.

Thank you to all the members who have engaged with the CLP thus thus far. We hope hope that you continue to find this a valuable resource.

Dr Sally Ayesa

Dr Jane McEniery

Co-Convenors

Centralised Learning Program

Check out our upcoming session schedule below.

National Reconciliation Week

Recognising the Gap in Accessing Radiation Therapy

We were delighted to launch our most recent video conversation during National Reconciliation Week 2022 (27 May–3 June). This work presents our Targeting Cancer Campaign Ambassador Julie McCrossin AM together with Lynne Thorne, an Aboriginal Cancer Health Practitioner in Adelaide to underscore the issues that affect Indigenous patients and contribute to inequality in accessing radiation therapy.

The theme of National Reconciliation Week 2022, “Be Brave. Make Change.” is a challenge to Australians—individuals, families, communities, organisations and government—to Be Brave and tackle the unfinished business of reconciliation so we can Make Change for the benefit of all Australians.

The radiation oncology community is taking up the challenge to recognise the gap that the Indigenous population has in accessing radiation therapy for cancer treatment.

When asked if Aboriginal cancer patients are struggling to get the radiation therapy they need, Lynne Thorne said: “Yes, these cancer patients have to leave their home and travel far to receive treatment. Land is very spiritual for them and leaving their home feels like losing their spirit.”

“The most important thing is to have an Aboriginal hub where we will help support them for their cancer journey in a culturally safe environment.”

The video launch in National Reconciliation Week 2022 is one step on the multi-faceted journey to deliver on the College's Action Plan for Māori, Aboriginal and Torres Strait Islander Health since its launch in 2021.

In addition, the College has also secured funding under the Commonwealth government’s Flexible Approach to Training in Expanded Settings Measure to support Australia’s first Indigenousled initiative to provide peer and collegiate support to non-GP doctors in training.

The College is proud to partner with the Australian Indigenous Doctors’ Association which will lead the development of its non-GP Specialist Trainee Support Program (STSP). It is central to have Aboriginal and Torres Strait Islander perspectives and views if we are to achieve the goals set and deliver a successful program.

With this program, we will open the way for Aboriginal and Torres Strait Islander doctors to enter and navigate training pathways, examination preparation, clinical training, providing a network of peer support, professional

development, cultural development, and the opportunity to be mentored by Aboriginal and Torres Strait Islander Fellows.

The program will also help build the capacity of non-Indigenous Fellows to provide culturally safe supervision and mentoring support. It will augment the recruitment and retention of Aboriginal and/or Torres Strait Islander doctors who wish to commence or are currently undertaking non-GP specialist medical training.

To learn more: Indigenous Health and Engagement | RANZCR

IvyannaRoselyn,RundleMall,Adelaide

Digital health is a high priority for the Faculty of Clinical Radiology. As radiologists we understand what digital systems need to be put in place to ensure that clinical information can seamlessly flow between radiologist, referrer and patient. We need to continue to be leaders in digital health technology deployment to ensure that any system developed maximises the value radiology provides to the health system.

As articulated in the white paper developed in partnership with the Australian Diagnostic Imaging Association (ADIA) and titled Towards Interoperability: Clinical Radiology: Forging the Path Ahead our priorities are: standardised terminology, the establishment of an eReferral system, access to historic images and the development of imaging guidelines.

We have established a Digital Health Working Group (DHWG) which reports to the Faculty Council to lead this important work. We also collaborate with ADIA via a Joint Informatics Advisory Committee (JIAC).

Our vision for digital health has been recognised by the Government and work has commenced on the priorities. In March 2021, the College and ADIA collaborated with Federal Government funding on the first project, the Radiology Referral Set. The government funding was to undertake a landscape analysis of current terminology sets in use internationally and within Australia. The landscape analysis determined that there was no perfect product available but on

Digital Health

Faculty

of Clinical

Radiology A Message from the New Dean

balance SNOMED CT is the most suitable terminology catalogue for use in Australia. Following the successful landscape analysis, it is full steam ahead in 2022 with the next phase of the Radiology Referral Set. The College has again been funded by the Australian Digital Health Agency in collaboration with ADIA to develop guidance materials and a small subset of 20 Radiology Referral Set terms for use in a proof-of-concept. The College engaged the CSIRO’s Australian e-Health Research Centre to assist in this work. From this work a standards-based approach was agreed.

The most important point is that the Radiology Referral Set has been developed by radiologists and radiology providers who understand the importance of the best practice ways in which the Radiology Referral Set needs to work.

In May 2022, following on from the development of the guidance material and 20 terms, the College and ADIA led a workshop with the Australian Digital Health Agency and the Department of Health to agree the next steps for the full implementation of the Radiology Referral Set. This was important for both government areas to hear from radiology and understand exactly how the radiology referral will work, what it will enable, and the full scope and resources needed to deliver a quality product.

As the saying goes it never rains but it pours—this is true both literally in recent times along the eastern coast of Australia and also figuratively for digital health. While our Digital Health Working Group has been focused on delivering the Radiology Referral Set project the Digital Health Agency have established another project called the Modernisation of Diagnostic Imaging (MODI).

A Land of Promise and Risk

Gerard Goh

“In March 2021, the College and ADIA collaborated with Federal Government funding on the first project, the Radiology Referral Set. The government funding was to undertake a landscape analysis of current terminology sets in use internationally and within Australia. The landscape analysis determined that there was no perfect product available but on balance SNOMED CT is the most suitable terminology catalogue for use in Australia. ”

MODI’s aim is to develop a solution to enable the digital transfer of requests, referrals and results as an alternative to current paper and hard-copy image processes, so basically to develop an eReferral system. The Radiology Referral Set work will connect with the MODI work as it will utilise the 20 radiology test terms for a proof-of-concept pilot.

The MODI working group consists of many stakeholders who come from different sectors with different perspective that don’t always align with our vision of what will work for the radiology sector. This is an area that requires active participation by College members to ensure that the voice of radiology is at the forefront of decision-making.

We are also focused on the New Zealand health landscape and are

looking forward to working with the New Zealand government to ensure our recommendations related to interoperability from the Health and Disability Review are advanced. Implementation of the new healthcare system is progressing. On 1 July 2022, New Zealand’s District Health Boards will be dissolved and replaced by a new organisation: Health New Zealand. In a parallel stream of work, the Ministry of Health’s data and digital team has begun a largescale interoperability project. This is an excellent opportunity for the College to influence the process and ensure that the needs of the radiology sector in New Zealand are met.

Our Digital Health Working Group members, including both Australian and New Zealand members, have been

doing an outstanding job representing the perspectives of our sector, dedicating many hours each week to this work with considerable impact on both their work and private time. It is only with the dedication of member volunteers such as those on the working group that we can ensure that digital health outcomes support the practice of radiology instead of impeding it. Our digital health work needs more support from our membership in both Australia and New Zealand. Volunteers don’t need to be an expert but just willing to step forward and help contribute to this important work. For those interested, please consider the current call for expressions of interest to join this working group on the website to support your colleagues who have been supporting you.

With more than 250 clinics across metropolitan, regional and remote Australia, I-MED Radiology is a national medical imaging network where you can create a career to align with both your professional and life goals.

As Australia’s largest radiology provider we strive to deliver high quality healthcare to every patient, every time. With a focus on technology, innovation and continuous learning, our team of 4,500 individuals is building the radiology network of the future.

As a member of the radiologist community we invite you to start a conversation with us about your career aspirations. We have clinic locations, flexible structures and remote reporting opportunities to match to the lifestyle you’re looking for.

Come and work with us!

For a confidential discussion please contact Skye Cracknell (skye.cracknell@i-med.com.au) or call 0456 664 360.

“MODI’s aim is to develop a solution to enable the digital transfer of requests, referrals and results as an alternative to current paper and hard-copy image processes, so basically to develop an eReferral system. The Radiology Referral Set work will connect with the MODI work as it will utilise the 20 radiology test terms for a proof-of-concept pilot. ”

Since the launch of the new Clinical Radiology Training Program in February 2022, we have been finalising the remaining outstanding implementation tasks. All trainees have now transitioned into the new training program and new ePortfolio System. All training assessments completed in the ‘dark period’ (1 October 2021 to 31 January 2022) have been uploaded into the ePortfolio System. The Clinical Radiology Implementation Working Group (CRIWG) is in the final stages of developing the cycle of evaluation for the Training Program.

I would like to thank all members involved in the Clinical Radiology Training Program for their understanding throughout the transitioning period. We have received valuable feedback to continue to develop and improve our training requirements and systems. One of these is the Reporting Work-Based Assessment (WBA), which is currently under review and is being rebuilt in the ePortfolio System to ensure it is fit-for-purpose.

As mentioned in the March 2022 edition of Inside News, we have launched a new e-lecture program to support Clinical Radiology trainees—the Clinical Radiology Centralised Learning Program (CLP). Feedback we have received from members so far has been very positive and that the CLP is a valuable resource to complement the training program. Since launching there have been a total of 1,070 views across the first three lecture sessions. Future sessions will include a session on Non-Clinical Skills. If you have not yet had an opportunity to view, I recommend that you check out the CLP Webcast Library Channel.

Developments in Training Chief

Censor in Clinical Radiology

The College’s new IMG policy came into effect from Monday 2 May 2022 along with the launch of the IMG Area of Need (AoN) Upskilling Program. Under the Upskilling Program, IMGs will undertake 6–24 months of upskilling in a RANZCRaccredited training site, or in a RANZCRaccredited private training site. IMGs will have access to teaching and supervision as well as the ePortfolio to complete their WBAs before sitting the College’s examinations.

The written exams for Phase 1 and Phase 2 were completed recently including conducting the Radiology MCQ and Pathology exams for the first time using virtual proctoring. A late change to e-Film format was necessitated by external IT challenges beyond our control however our tireless exams team worked hard to find an alternative solution to deliver the exams successfully a week later. In an environment where many Colleges are finding it challenging to conduct exams and transition to alternative digital formats, we appreciate their hard work facilitating the exams and ensuring trainee progression.

2023 will see the launch of the new Phase 2 exams which will enhance the process of assessment, with greater breadth and depth across the curriculum. They will better reflect authentic radiological practice. These exams will be robust, enhance the rigour of the assessment process, and better align with the new curriculum. The collection of more nuanced assessment data will also allow for the provision of more targeted feedback to improve learning.

New item formats will improve the validity and reliability of the entire assessment process. The different case lengths in the Case Reporting Exam will better allow for the assessment of candidate proficiency in a range of different imaging modalities, and also allow for a good balance of simple and complex cases in any one exam. The additional mapping of questions to domains other than the topic areas in the OSCERs will ensure blueprinting and constructive alignment to the curriculum learning outcomes and will better measure more nuanced aspects of radiological practice.

The College launched its Indigenous Action Plan in 2021. The Action Plan is overseen by the Māori Aboriginal Torres Strait Islander Executive Committee (MATEC) which reports directly to the College Board. The RANZCR Indigenous Action Plan articulates a range of outcomes that the College will meet throughout 2022. One of these actions is to increase cultural awareness of members and trainees. The College has secured an arrangement with the Royal Australian College of Physicians (RACP) to share their cultural awareness resources. Please follow the instructions on how to access the RACP learning portal.

Dr Barry Soans

Radiation Oncology

Chief of Professional Practice Update

The Professional Practice Committee (PPC) has started the year off with a flying start. Although there are still a number of external factors impacting upon the work of the College, the PPC are still progressing with planned work. Fortunately, the committee has been able to hold two robust virtual meetings, with a face-to-face meeting planned in the coming months—the first in more than two years! I have also enjoyed reconnecting with many of you at recent events. Some of the key pieces of work that are being undertaken include:

Special Interest Group (SIG) engagement

The PPC have slowly commenced engagement with the Clinical Radiology Special Interest Groups. Several meetings have been held in the past couple of months. The College SIGs play a vital role in providing subject matter expertise in the various areas of clinical radiology and provide representation on behalf of the College at a number of external stakeholder events.

The PPC are currently determining the next steps after the recent series of meetings and look forward to actioning these in the coming months.

CPD Program update

2019–2021

triennium final reminder

If you are still not compliant for the 2019–2021 triennium, please send your CPD entries to the College as soon as possible—these are now overdue. College staff are needing to manually process past CPD entries and report compliance. Members must meet the College CPD program requirements as a requirement of your medical registration with the Medical Board of Australia (MBA) and Medical Council of New Zealand (MCNZ). If you are not compliant, you also risk termination of your Fellowship with the College. If you require assistance with your CPD, please contact the College on cpd@ranzcr.edu.au

Have

completed

Professional Development Plan (PDP)?

The Professional Development Plan is a new requirement of the College’s CPD program commencing this year. Members have the option to complete the template in the CPD ePortfolio or use a PDP that they may have already

done, for example, with their employer. Members can also enter this as a CPD activity and claim a maximum of two hours toward their CPD. If you haven’t yet completed your PDP, I encourage you to do so as soon as possible. The College has a resource to support members in entering their PDP into the CPD ePortfolio How to Complete your Professional Development Plan

In closing, if you have any questions regarding the work of the Professional Practice Committee please get in touch via professionalpractice@ranzcr.edu.au.

I hope to be able to catch up with you at upcoming events in the future. I look forward to bringing you further updates on the work of the PPC as we move through 2022.

Yours sincerely, Dinesh Associate Professor Dinesh Varma

Chief of Professional Practice

you

your

Prof Dinesh Varma

Clinical Radiology Trainee Committee

the first sitting of the new Part 1 exam format. Similarly, we had the second ever sitting of the Vivas in digital format. Considering the difficulties associated with implementing a new exam, I think overall it went quite smoothly. This is entirely due to the tireless work of the examiners, exam and education committees, and the College staff who went above and beyond to make these exams a success during ‘unprecedented times’. Although, there is a small seed of bitterness within me that these young whippersnappers never had to learn to read tiny thumbnails of CT and MRI printed on acetate.

any topics covered, feel free to let us know and we can pass it on.

clinicalradtc@gmail.com

I know October seems like forever away, but the CRTC and the ASM Committee are deep into planning mode for the ASM. We’d love to know what you’d like to see on the trainee day. Do you want Viva/exam tips? Fellowship information? Help on transitioning to a consultant? Breakfast? Please let us know!

Hello everyone,

The year has well and truly started and what a busy quarter it has been. We’ve seen devastating floods, reopening of international borders, and a federal election just to name a few.

In the training space we’ve undergone some major events as well. The new curriculum is underway and with that

The Centralised Learning Program has also kicked off with some fantastic lectures so far. We’ve started off with neuroradiology and have had highyield topics such as brain tumours, top three diagnoses in the head and neck spaces, and inflammatory white matter conditions. This will be an invaluable resource available to all trainees coming up to their exams and looking to brush up. The lecture series undergoes constant updates so if you would like

Abdominal Radiology Group of Australia and New Zealand

The ARGANZ hybrid meeting was held at the Sydney International Convention Centre on 26–27 March, with 380 onsite and virtual delegates. Our international speakers Prof Perry Pickhardt, A/Prof Ania Kielar and Asst Prof Michael Hartung gave superb lectures virtually, and we were very fortunate to have Prof Alberto Vargas flying in from New York to deliver his excellent lectures in person. They were supported by an outstanding local faculty and it was a vibrant and enthusiastic atmosphere at the

convention centre and many welcomed the opportunity to listen to and interact with live speakers and connect with colleagues again.

This year also saw the return of the onsite ARGANZ workshop, where delegates had individual workstations. The workshop had limited numbers to enable more interaction and discussion of the cases. The topics covered were MRI rectum, oncology and pancreaticobiliary/MRCP.

Before you know it, nominations for next year’s CRTC will open. Being a part of the CRTC for the past three years, I can tell you it is an incredibly rewarding experience advocating for trainees and also being involved in shaping the future of our College. I would encourage anyone who is remotely interested to apply—no experience necessary!

Until next time, Dr Sarah Robertson Chair, Clinical Radiology Trainee Committee

Dr Sarah Robertson

Next year the ARGANZ meeting will be in Adelaide (25–26 March), with onsite workshops the day prior (24 March). ARGANZ is excited to bring the ESGAR liver workshop to Australia, with eminent ESGAR liver imaging speakers Prof Valérie Vilgrain and Prof Giuseppe Brancatelli. There will be a separate workshop featuring international prostate and genitourinary imaging expert Dr Jonathan Richenberg. During the year, ARGANZ hopes to continue to host online workshops. Please watch out for registration details as these workshops are popular and places will fill up quickly.

Collaboration, advocacy, education and research

ARGANZ continues to build upon its relationship with international abdominal imaging societies (such as ESGAR and SAR) and forge collaborations with Australian and New Zealand clinical specialty groups and societies. ARGANZ frequently provides expert opinion and advice to the College and government bodies on relevant scientific and policy matters. ARGANZ actively promotes and supports research through scientific poster displays and prizes at our meeting, the annual Mendelson Research Prize, as well as the ARGANZ research and education grant. Trainees are engaged through registrar oral presentations and the School of ARGANZ. Congratulations to Dr Huey Ming Seah (Royal Adelaide Hospital) for winning the 2022 Mendelson Research Prize and congratulations to Dr Amer Mitchell (Concord Hospital) for being awarded the ARGANZ research and education grant.

Check us out and get involved

I would like to thank the incredible team of executive members who make ARGANZ possible, Dr Kirsten Gormly, Dr Joe Feltham, A/Prof Tom Sutherland, Dr James Seow, Dr Gabriel Lau, Dr Teng Han Tan, Dr Sarah Skinner and Dr Won Kyung Sung. A very special thank you to Dr Warwick Thomas who retired from the executive after serving on the committee for six years, four of those as treasurer. We welcome Dr Dean Rabinowitz and Dr Arj Somasundaram as new executive members.

Becoming an ARGANZ member is free, and there is a wealth of resources on our website www.arganz.org, including reporting templates, scanning protocols and access to prior years' meeting content.

Stay updated by following us on Twitter (@arganz_online) and Facebook (@arganzradiology), so we can inform you promptly of new government policy

such as new Medicare rebate items and the publication of new imaging guidelines. ARGANZ hopes to formally establish subspecialty focus groups, bringing together those who have an interest in a particular area (e.g., pancreas imaging) for networking and collaboration, so stay tuned for this.

Dr Jessica Yang | ARGANZ Chair

The first step in advancing cancer care is to make advancements that are miles ahead.

A cancer care ecosystem that’s creating a world free from the fear of cancer.

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Our College has defined what makes us radiation oncologists. Through the training and assessment program with a strong curriculum, continual assessments of competency and the examination process as well as our ethos of continuing professional development, we set a high standard for ourselves. It is a well-respected standard among our peers worldwide.

When we exercise that right to practise radiation oncology, there are many other standards that we continually need to be aware of as we undertake safe practice with the highest regard for our patients as well as our professional practice during interactions with our colleagues in a wide inter-disciplinary manner. Continuing Professional Development (CPD) is vital, especially in sub-specialisation.

Our College has been our CPD home and with the new electronic platform, our Standards team has been working hard to ensure all of us have a relatively fuss free changeover from the old to the new system.

Change is never easy and while there have been some queries, it appears that many of us have had a successful changeover. This first year of the new platform is also a changeover year for the way the regulatory bodies are mandating CPD.

This process allows us to modify the platform and content as users provide feedback and suggestions. In addition, the eligible activities available to be recorded will also expand.

Professional Practice: Continuing Professional Development and Code of Ethics

A Message from the Dean

CPD is not the only facet that defines what we are in professional practice. The College has well-defined statements and documents on how we deliver our professional practice in our interactions with our patients, our colleagues in the workplace and society we belong

In addition, there are also clear imperatives on the behavior of medical practitioners as declared by regulatory bodies in the Code of Conduct of the Medical Board of Australia and the Standards of the Medical Council of New Zealand. The breath of expectations is very wide and helps us to understand what we as individual medical practitioners should be mindful of.

One of the many aspects is how we interact with our colleagues in the workplace. One hears of comments about 'behaviour' that someone has opined as 'unprofessional'. There are complex reasons around all of these instances and our Code of Ethics, Principle Nine 'Clinical radiologists and radiation oncologists must uphold the integrity of the medical profession' can provide us with some perspective on how we should judge ourselves and others.

to. This is clearly stated in our Code of Ethics where we declare our values of Commitment to Best Practice, Acting with Integrity and Accountability. Indeed, these values are also re-iterated in the recently released College Strategic Plan 2022–2024 where we clearly state our Purpose and define our Values that also encompass Inclusivity.

In addition, our Strategic Plan defines Inclusivity: 'We foster an inclusive workplace and clinical environments for people of Australia and New Zealand'. We are expected to comply with current laws and contemporary standards of society. In so doing, we should be respectful of a colleague, the College and the profession in providing for the best interests of the patient. Encompassing all such considerations is the need for cultural awareness and cultural safety.

Dr Keen Hun Tai

“When we exercise that right to practise radiation oncology, there are many other standards that we continually need to be aware of as we undertake safe practice with the highest regard for our patients as well as our professional practice during interactions with our colleagues in a wide inter-disciplinary manner.”

Within Principle Eight of the Code of Ethics '…have a duty to attend to the health and wellbeing of their colleagues, including trainees, students and also of themselves,' we are reminded that bullying, harassment, isolating or excluding is unacceptable.

This is applicable within our profession and to all others in the multi-disciplinary environment that we all work in. In addition, patients and their carers, staff members, students and all other nonclinical individuals are counted in this principle.

Reflecting on one’s own interactions and those of others in an objective manner can be instructive in building a harmonious workplace. However, there are instances where reporting of undesirable behaviour will be required: whether this is to the managers of the workplace or to other authorities.

Working together as a team of radiation oncologists with our colleagues in other disciplines ensures that our standard of care is optimised for the patient who ultimately is our collective responsibility. The risks of injury to a patient due to breakdown in the team approach to care is minimised when we are collegiate.

The consequences of not doing so are not only significant for the patient but also to the organisation we belong to; and to us as individuals. Reputational harm is another facet of the lack of such care.

Reflecting on the standards we set for ourselves in Professional Practice and in our Code of Ethics, it is pleasing to note that instances of complaints to the Faculty of Radiation Oncology are relatively uncommon.

Lung disease is an alarmingly common phenomenon in Australia. It can be difficult to detect early on and often progresses without symptoms until it reaches the incurable late stage where treatments are almost impossible.

Our objective at Lungscreen is to provide much-needed diagnosis and follow up services for individuals who may develop lungrelated illnesses such as Pneumoconiosis, Silicosis, or Lung Cancer. We aim to save lives by early detection and robust diagnostic follow up, preventing further lung damage before it’s too late.

With the successful launch of the new Radiation Oncology (RO) Training Program in February 2022, we transition from an era of development and implementation into a new age of evaluation, readjustment and retraining.

It is crucial that the new training program be analysed. This will evaluate whether it has achieved its intended outcomes and assess its relevance in meeting the requirements of the community that it serves and the respective employers. An evaluation framework is therefore being formulated for this purpose. This comprehensive appraisal plan will be aligned to the College’s Evaluation Framework and the first stage of evaluations in 2022 will concentrate on work-based assessments (WBA), utilising a WBA survey.

Ongoing formal feedback of the training program and other supportive documents, such as the RO Handbook and Learning Outcomes resource will be conducted via an annual cycle. This cycle will include the collection of information received (both formally and informally) from various sources including:

• annual Directors of Training (DoT) and trainee surveys

• issues raised at the Radiation Oncology Trainee Committee (ROTC), Network Governance Committee (NGC) and Training Network Directors Committee (TNDC) meetings

• ad hoc feedback communicated to the College.

All this data will be carefully collated and categorised into an Issues Register. Although the Radiation Oncology

New Working Groups

Chief Censor in Radiation Oncology

“It is with great pleasure that I announce and welcome Dr Apsara Windsor in her position as Chair of the newly formed Phase 1 Examination Panel (P1EP). Dr Windsor was previously a Phase 1 Examination Lead and a Phase 1 Foundation and Examination Preparation Course convenor. She brings with her a wealth of experience and knowledge and I look forward to her leadership in chairing the P1EP, coordinating and developing the content and format of the Phase 1 examinations, in particular the transition to a digital format on the College’s Practique system.”

Implementation Working Group (ROIWG), chaired by Dr Lisa Sullivan (Chief of Training and Assessment), has been providing oversight in implementing the new training program and ironing out the creases arising thereof, it has been recommended that a separate working group be formed to assist with the ongoing evaluation and review of the training program following the anticipated dissolution of the working group at the end of 2022. Based on this ongoing evaluation and review, the training program will continue to be fine-tuned so that it remains contemporary, effective and fit-for-purpose.

The launch of the ePortfolio system, in conjunction with the new training program, expectedly encountered glitches when it went live. Reported issues have included difficulties in translating certain

user-profile approval rights, inability to complete certain application forms and minor omissions in the migration of trainee data. The Specialty Training Unit has been working incredibly hard to manage these and other issues in a timely fashion and my sincere thanks go out to all the members of this team who have supported us in this transition.

Ongoing training/support reinforces key concepts and essential features of the new training program. The program also provides valuable operational feedback for and from our indispensable DoTs. Training/support and feedback will both continue throughout the year.

Dr Yaw Chin

The first DoT induction webinar occurred in March and the long-anticipated face-to face DoT workshop was held in Sydney on 3 June. May I encourage all DoTs to attend all current and future workshops in person if possible as this will be an amazing opportunity for DoTs young and old to meet up and support one another after two years of carrying the burden of supervising and supporting our trainees in isolation.

The current Radiation Oncology Accreditation Standards and Criteria for Training Networks and Sites document

Ongoing efforts continue within the examination space. It is with great pleasure that I announce and welcome Dr Apsara Windsor in her position as Chair of the newly formed Phase 1 Examination Panel (P1EP). Dr Windsor was previously a Phase 1 Examination Lead and a Phase 1 Foundation and Examination Preparation Course convenor. She brings with her a wealth of experience and knowledge and I look forward to her leadership in chairing the P1EP, coordinating and developing the content and format of the Phase 1 examinations, in particular the transition to

The Statistical Methods, Evidence Appraisal and Research for Trainees (SMART) workshop has been upgraded to a mandatory requirement in the new training program. This event is usually held annually and due to logistical convenience is coupled with the Trans-Tasman Radiation Oncology Group (TROG) Annual Scientific Meeting.

With the change in this event to an obligatory prerequisite of the training program, it is imperative that there is oversight of the logistics, content and delivery of the SMART workshop. This is

PROF

Radiation Oncology Trainee Committee (ROTC)

We Will Always Be Here to Help

colleagues is not a new concept, this topic has come to the forefront due to overburdened healthcare systems during COVID. Arguably, it is trainees who are facing the largest burden among doctors. In addition to managing workload and personal commitments, trainees face the added burden of attending to training requirements in a COVID modified context. In the last few months, I have received multiple reports speaking to the fact that many of us are stretched beyond our limits. The proportion of trainees affected by burnout is more than we realise. It is a hidden epidemic.

"When we are no longer able to change a situation, we are challenged to change ourselves”, Victor Frankl wrote this in his story of self-discovery "Man's Search for Meaning" while interned in a WW2 concentration camp. Many of his fellow prisoners were killed during their internment. However, many more were ‘broken inside’, as they had lost the will to live. Frankl attributed his survival to applying a positive attitude while enduring endless physical and psychological harm. He associated his positive mindset with gaining an understanding of what gave meaning to his life: wanting to survive to see his wife, helping the people around him by using his medical skills and dedicating his life to his spiritual beliefs. While it is difficult to accept that someone’s ‘attitude’ while in a Nazi concentration camp is what helped them live–this was Frankl’s experience. In later life he became a psychiatrist, and a well-known speaker in the areas of mental health and resilience.

In recent weeks, every major media outlet has commented on the growing crisis of doctors facing ‘burnout’. Although burnout among our

From a personal perspective, burnout is something I have faced recently. What enabled me to keep working was accepting my limits. Although I have a duty to advocate for my patients, my colleagues, and my profession; my first duty is to look after myself. I took up yoga, meditation, and paid more attention to my physical health. I placed limits on what I was comfortably able to commit to in my professional and personal life. For me this meant training part-time.

I am endlessly thankful for being in a training program and working in a centre where part-time arrangements are supported.

A major realisation I made was understanding that there are many things which are within my control–such as the way in which I work. But there are things which I do not have full control over such as the perceptions of others, workplace politics and training policies. While I continue to try to change some of these things, I accept that change may not come. Although I cannot change the outcome of everything I face, I do have control over myself and over my attitude. “Everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances, to choose one’s own way.”

This message is not to underplay the experiences any of us face while training. And there are situations, particularly when it is beyond burnout, where the support of a mental health professional is required. Hearing the stories of my colleagues, and having experienced burnout myself, I get it. And although organisations, employers and our colleagues have a duty to support our wellbeing, it is ourselves that we must look to if we want lasting change. In addition to attempting to change the situation around us, we must also learn to change ourselves. I hope all of you are well. We will always be here to help.

“A major realisation I made, was understanding that there are many things which are within my control–such as the way in which I work. But there are things which I do not have full control over such as the perceptions of others, workplace politics and training policies. While I continue to try to change some of these things, I accept that change may not come.”

Shaping the future of oncology through Transformative Intelligent Cancer Care™

Today, we are on the cusp of another new era of innovation—this one energized by our recent combination with Siemens Healthineers. “It’s simple, together as one company we believe we can help more patients beat cancer than we ever could as two separate companies,” said Toth. “To make this a reality, we see significant opportunities for new tools, technologies, and services that help our customers manage multidisciplinary care across the entire continuum from screening, early detection, and diagnosis to treatment, follow-up, and survivorship.”

“As our company evolves, so too does our approach to Intelligent Cancer Care,” said Kevin O’Reilly, president, Radiation Oncology Solutions. “Our combination with Siemens Healthineers allows us to expand our vision of Intelligent Cancer Care to incorporate a fourth pillar—one that helps our customers and their patients shorten the time from diagnosis to treatment to survivorship, accelerating the path to treatment—because we know that delays between diagnosis and treatment can have a negative impact on outcomes.”

Varian has been focused on finding new ways to bring intelligence to the fight against cancer. Some of the resulting products have included:

RapidPlan® knowledge-based planning helps clinicians around the world take treatment planning to new levels of consistency, efficiency, and quality. Using machine learning, it was designed to break through productivity barriers by enabling clinicians to use standard

models as a guideline and starting point for developing high-quality treatment plans. This can reduce or even eliminate the need for multiple, time-consuming iterations.

The Halcyon® family of linear accelerators simplifies and enhances virtually every aspect of image-guided radiotherapy, reducing the workflow to nine simple, machine-guided, pushbutton steps that can be completed in as little as six or seven minutes. Halcyon offers fast, sharp iterative CBCT image capture. Eclipse™ software produces high-quality treatment plans for Halcyon, characterized by excellent dose conformality and low dose to organs-at-risk.

HyperArc® high-definition radiotherapy optimizes the planning of stereotactic radiosurgery (SRS) treatments using noncoplanar arcs and enables delivery with a single button press. In some cases, patients with multiple brain metastases can be treated with a single isocenter within 10-15 minutes including imaging, which is a significant improvement in efficiency over other types of SRS.

The Ethos™ therapy system combines an image-guided radiation therapy (IGRT) powerhouse with adaptive capabilities in one system for highthroughput, AI-driven precision medicine. Ethos enables daily adaptation to change in patient anatomy within a typical 15-minute treatment time slot. AI segmentation expedites the automated creation of new, adaptive plans during a treatment session.

The Bravos® afterloader provides workflow and safety efficiencies that simplify brachytherapy treatment. Its touchscreen features customisable tool that provide clinicians with guidance for completing crucial steps in the process.

A version of this article previously appeared in Red Journal in August 2021.

Greetings. The Faculty of Radiation Oncology (FRO) Professional Practice Committee (PPC) recently held its second meeting since commencing operations in January this year and our current focus is on the three key priorities identified by the committee. These are:

• FRO CPD program for 2022 and 2023 onwards

• Māori, Aboriginal and Torres Strait Islander Executive Committee priorities

• Special Interest Group engagement.

FRO CPD program update

2019–2021 triennium

reminder

final

While most of you have submitted returns and are compliant there are a few who are not. If this is you, please send your CPD entries to the College as soon as possible (yesterday!) as these are now overdue. Due to the change in platform, College staff are now needing to manually process past CPD entries and to report on compliance within the College. All members must meet the College CPD program requirements as a requirement of your medical registration with the Medical Board of Australia (MBA) / Medical Council of New Zealand (MCNZ). If you are not compliant, you also risk termination of your Fellowship with the College. If you require assistance with your CPD, please contact the College on cpd@ranzcr.edu.au

2022 CPD program

Please do not wait until the end of the year to try out the new CPD ePortfolio. We are half-way through the year.

Faculty of Radiation Oncology Chief

of Professional Practice

How are you doing? Have you recorded at least half the required activities? Do you have any queries? Let us know if you have concerns.

2023 CPD program

As you may be aware, the Medical Board of Australia (MBA) and Medical Council of New Zealand (MCNZ) recently announced changes to their CPD regulatory standards. The College is currently in the final stages of aligning our College CPD program to ensure compliance with the regulators.

Please be aware that from 2023 onwards, members need to meet a minimum requirement of CPD hours in each of the three broad categories. This includes:

• 12.5 hours (25 per cent) of hours recorded under Educational Activities.

• 25 hours (50 per cent) of hours recorded across Reviewing Performance and Reflecting on Practice and Measuring and Improving Outcomes (with a minimum of five (5) hours for each category) For example, five (5) hours in reviewing performance and 20 hours in measuring outcomes.

• the remaining 12.5 hours (25 per cent) distributed across any of the three CPD categories.

The CPD ePortfolio will be set up to reflect these changes, with the progress charts and tables clearly indicating to members how they are tracking against requirements. Keep an eye out for the 2023 CPD Handbook, which will include additional information, as well as new resources to support members in understanding these changes. In addition, upcoming information sessions will be held at the New Zealand ASM in August and College-wide ASM in October, with the opportunity to ask staff any questions you may have. In the meantime, if you have any questions about the CPD program, please contact the team on cpd@ranzcr.edu.au

MATEC priorities

The College councillors have had a training session focused on cultural safety—we are all responsible for setting time aside for our greater understanding and awareness. You may have work-based opportunities and education to develop your awareness, however we will be making resources available via the CPD ePortfolio.

Special Interest Group (SIG) engagement

As the Chief of Professional Practice, I recently held a meeting with the Faculty of Radiation Oncology Special Interest Group Chairs. There are currently eight FRO SIGs in total; quite different in size, health and activities. This meeting focused on how the College can further support the SIGs, as well as establish processes for SIG operations as outlined in the (first) SIG manual that was released last year. As a first step, we are exploring the type of additional support SIGs are looking for and how this might be achieved. This was the first of ongoing meetings I will have with these important groups and I look forward to engaging on a regular basis.

If you have any questions or suggestions regarding the work of the FRO Professional Practice Committee, please get in touch via

professionalpractice@ranzcr.edu.au.

I look forward to bringing you further updates on the work of the FRO PPC in coming editions.

Yours sincerely, Carol

Dr Carol Johnson Chief of Professional Practice Faculty of Radiation Oncology

Dr Carol Johnson

Quality Corner Centralised Radiation Oncology Incident Reporting

Inadvertent administration of radiation doses other than those intended occurs in all radiation therapy settings. The occurrence and consequences can be minimised by systematic reporting and analysis of radiation incidents and so-called near misses, with feedback to radiation therapy professionals. Legislation and professional standards, such as the Radiation Oncology Practice Standards produced by the Radiation Oncology Alliance, require radiation therapy providers to have systems for this.

Although reporting of major incidents to the Australian Radiation Incident Register or the New Zealand Office of Radiation Safety is a legal requirement, there is no national system for the reporting of events involving lower radiation doses and near misses. Such national systems would enhance shared learning and improve the quality of radiation therapy. Some countries, including the United Kingdom and Canada, already have such systems. Several international bodies also provide systems for incident reporting, such as the International Atomic Energy Agency SAFRON system and the European Society for Therapeutic Radiation and Oncology ROSEIS system.

There are initiatives in both Australia and New Zealand to broaden national reporting of radiation incidents. The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) has established an Australian Radiation Incident Register Development Committee to develop requirements for data sharing and collection; guide development of an agreed set of reporting fields; and guide the software and database development for a prototype 'Australasian Radiation Incident Register 2.0'. The College

is represented on this committee. In New Zealand, a National Incident Reporting Steering Committee has made recommendations to the Radiation Oncology Working Group on the requirement for a National Incident Reporting and Learning System. Work has commenced on incorporating this into the new Ministry of Health Common Regulatory Platform.

Data fields should be the same as those in international systems or should have the potential to be mapped to them, to allow comparison with other jurisdictions and international benchmarking. It is particularly important that the data collected in Australia and New Zealand are compatible, given our shared professional bodies, professional standards and radiotherapy culture. Ultimately, a binational database may be feasible.

Ideally all incidents will be reported, including near misses, as there is just as much to be learned from potential and minor events as from those that have significant consequences for patients. We should not have to wait until a patient is harmed before drawing lessons from the failure of our systems. Furthermore, the inclusion of minor events will increase the number available for analysis and the potential of the register to deliver useful information to improve safety. In order to minimise the burden of reporting large numbers of events, it will be important to link national registers with intradepartmental reporting systems where they are already captured.

Key requirements for successful systems include independent governance, anonymised patient data, protection of the privacy of radiation treatment providers, regular analysis of data to identify trends, and regular reporting of important findings to contributors. Reporting of events (other than that required by existing legislation) should be voluntary. The ability of contributing institutions to analyse their own data and to benchmark against data of other providers would enhance the learning value of the system and encourage participation.

Radiation safety is essential in all that we do as radiation oncologists and the national collection of incident data will improve the quality of care that we provide.

Dr Iain Ward Quality Improvement Committee

“Although reporting of major incidents to the Australian Radiation Incident Register or the New Zealand Office of Radiation Safety is a legal requirement, there is no national system for the reporting of events involving lower radiation doses and near misses.”

Dr

Kynaston

Please see JMIRO for a full obituary by Dr Robert (Nobby) Bourne

In 1978, the recently deceased Dr Bruce Kynaston presented the College with a cross-stitch crest of his own making, which still hangs in the College's Sydney office, 44 years later.

By means of a record in the College archives, Dr Kynaston recounts the making of his extraordinary gift pictured on 10 June 2022.

“Not too long before this time, the College had acquired the lease of the property at 37, Lower Fort St in Millers Point, Sydney, for its home.

The Executive invited members to consider if there was some small thing that an individual might wish to do towards this end. I was so bold to offer to work the College arms in cross stitch for a cushion cover for the presidential chair for the proposed Council Room. The Executive Secretary, Miss Brenda Richardson, quietly indicated to me that it would be more appropriate for such a work to be hung on the wall than be hidden under the president, or words to that effect. My response was that I should like to contemplate the matter further as the class of work would have to be much better. I duly offered, and was accepted without any real review of my capacity, which was at that stage rather limited.

It proved an interesting challenge. Progress colour slides were sent to the office from time to time and at no stage did Executive shriek: Enough! So, after some 400 hours of spare time (time was logged just to see what was involved) the work was completed. Consultation with Dr John Masel, President for 1977–78 year and a Queenslander resulted in permission to seek and ultimately purchase a pair of paintings

Dr Gerard Adams, Dr Tuan Ha, Dr Lucinda Morris and Dr Keen-Hun Tai (L–R)

proved an interesting challenge. Progress colour slides were sent to the office from time to time and at no stage did Executive shriek: Enough! So, after some 400 hours of spare time (time was logged just to see what was involved) the work was completed. ”

in matching frames so that the 24 inch square canvas could be duly mounted in old framing. That eventually found was probably produced early this century and my father was certain a German process of impressing the pattern on the timber with a roller had been involved as in one place the process went off course a trifle. It looked like a carved/machined pattern.

The Queensland Branch resolved to meet the expenses and a grateful patient of mine, a furniture maker, assembled the framing after trimming the long sides of both original frames. My wife, Gwyn, who had done a wood finishing course, assisted with the

coating of the new frame. At the formal session of the Annual General Meeting in Sydney in 1978, the finished product was unveiled and the details of the Crest, the Arms, the Supporters and the Motto were explained. In all, the final result was well received and I was pleased with it. I had learned much on canvas embroidery during the ’process’.”

“It

Well, it’s been a busy few months at OGSIG!

In late March 2022, OGSIG hosted a successful virtual meeting with nearly 200 delegates registered for the event. Many thanks to the fabulous Dr Virginia Saxton who convened the meeting— she gathered a wonderful group of radiologists and sonologists to speak at the event.

I would also like to thank Dr Peter Duffy who has worked tirelessly over the last two years on behalf of the College with the Australian Society for Ultrasound in Medicine (ASUM) which has released a document regarding Communication in Obstetric Ultrasounds. It is essentially about the communication of unexpected and/or adverse findings

detected in obstetric imaging (i.e., the 'bad news' which is unfortunately so common in everyday clinical practice e.g., miscarriage, fetal anomalies etc). The guidelines are also about supporting our patients and colleagues (e.g., sonographers) in what is an incredibly difficult aspect of our job. There is new suggested language that we should be using (e.g., 'pregnancy loss or miscarriage', rather than 'missed abortion'). I urge anyone who reports O&G ultrasounds to read the guidelines available on the ASUM website. Otherwise, please email me and I would be happy to send you a copy. See opposite page for Appendix C of the guidelines (page 24 of the document) for some suggested ways to better communicate adverse findings to patients, and in radiology reports.

OGSIG will be hosting a session at the RANZCR2022 ASM in Adelaide this year; there will be talks aimed at the general radiologist dealing with tricky O&G imaging situations such as soft signs, an update on the use of O-RADS in MRI, and a practical talk how to perform HSGs and HyCoSys well. There will also be a talk about the new ASUM guidelines (as discussed above). I hope you will be able to join us there.

As always, best wishes

Dr Emmeline Lee Chair of OGSIG

emmeline@westernultrasound.com.au

Terminology Considerations

It is acknowledged that every situation must be assessed on a case-by-case basis, due to variations in parents’ personalities, clinical history, and sonographic results. Therefore, consideration of the parent’s health literacy and ability to understand the words used in an explanation must be selectively worded to avoid any distress and misinterpretation of the findings.

Clear, unambiguous terms should be verbalised and, in some situations, written down to assist in the explanation, with careful consideration of the terms used to avoid psychological trauma.

The replacement of some words as recommended below are a guide only and ultrasound practitioners are encouraged to adapt the situation to ensure parents are satisfied and understand the findings. If an interpreter is needed this should be done as a priority before beginning any explanation.

Cautionary terminology Replacement Options

Bad news

Unexpected finding

Failed pregnancy Pregnancy loss

Embryo or fetus Baby

Your baby has died (when used in isolation this is confronting and needs to be said in a supportive context)

I’m sorry, there is no heartbeat, this means that your baby has died.

Abortion Pregnancy loss or miscarriage

Stigmatising terms like abnormality, malformation, problem, hole, faulty, wrong, defect and adverse finding in the case of variations.

Value-free terms like anomaly, difference, variation,

Risk Chance, probability or likelihood

Leading the unexpected news with an apology for an anomaly by saying “I’m sorry” or “Unfortunately”

Empathise with the parents

Missed abortion

Pregnancy loss or miscarriage Products of conception Pregnancy tissue

Avoid anything that minimises a pregnancy loss – e.g., “at least it happened early in the pregnancy”

“At least you already have another baby”

I’m sorry you are experiencing this loss, there are support organisations available that we recommend you get in touch with.

By using the words difference/unexpected, it moves away from the value-laden language of abnormality/defect. Similarly, by using the actual condition or anomaly name, the parent is able to go away and do some reading and find support groups. Ambiguous or clinical explanations on areas beyond the scope of the ultrasound practitioner should be avoided.

The Australian and New Zealand Society of Neuroradiology (ANZSNR)

ASM 2022

The ANZSNR had a great start to 2022, following the successful staging of our Annual Scientific Meeting (ASM) which was held from 10–13 March at the Hilton Hotel, Sydney.

On behalf of the society’s Executive and Council, we would like to acknowledge the Organising Committee for their excellent work and commitment in convening such a successful ASM.

Special thanks go to the Convenors, Andrew Cheung and Nathan Manning. And a huge thank you also to the members of the scientific committee: Scott Davies, Graham Dunn, Jennifer Gillespie and Kevin Tay.

You assembled an excellent education program which extended over three and a half days with concurrent sessions for diagnostic neuroradiology, headand-neck radiology, and interventional neuroradiology.

Successful abstract submissions now published in JMIRO

Congratulations to the 2022 ANZSNR ASM successful abstract submissions that have now been published in Journal of Medical Imaging and Medical Oncology (JMIRO).

View the publication here.

ASM 2023

We are pleased to announce that the location for the 2023 ASM will be Victoria. Victorian-based Council members, Dr Ronil Chandra and Dr Elaine Lui, will convene the meeting which is currently being planned for late March 2023.

We look forward to announcing the chosen venue and date over the coming weeks.

Join now

The ANZSNR is open to all radiologists with an interest in neuroradiology, interventional neuroradiology or headand-neck radiology and welcomes new members. The ANZSNR has several categories of membership, including:

Full members – RANZCR Fellow radiologists practising in Australia and/ or New Zealand.

Student members – RANZCR trainees in accredited training positions, including those holding relevant fellowship training positions either in Australia and New Zealand or overseas.

As a not-for-profit organisation, we offer affordable membership fees. This membership gives you access to a range of members benefits and the opportunity to connect and collaborate with other radiologists with interests in neuroradiology, head-and-neck and interventional neuroradiology.

To join us, complete the short application form here: www.anzsnr.org. au/member-application

Interventional Radiology Society of Australasia

Annual Scientific Meeting 2022

On behalf of the Interventional Radiology Society of Australasia (IRSA) it is with great pleasure that we invite you to join us at the QT Hotel, Queenstown, New Zealand, for the 2022 Annual Scientific Meeting

The ASM will run from Tuesday 9 August to Thursday 11 August 2022. IRSA is once again planning an excellent educational and sociable meeting where delegates interact throughout the scientific and social program.

As well as interventional radiologists (IR) we encourage attendance from College trainees and anyone with an interest in pursuing a career in IR.

We are delighted to announce our two international keynote speakers:

• Dr Gerard O' Sullivan, Ireland

• Dr Scott Trerotola, USA

They will be joined by a range of national speakers who will provide diverse experience and expertise in presenting on our main theme for 2022: Venous Access and Intervention. The program is available to view here: www.irsaasm.com/program

Registrations are NOW OPEN –to avoid missing out, get in early and register. Please visit: www.irsaasm.com/registration

We look forward to welcoming you to Queenstown.

Call for Abstracts NOW OPEN

Registrars/IR Fellows are invited to submit abstracts on original work, for consideration for presentation at the ASM.

This is a great opportunity for College registrars who need to complete their Project 2 requirements.

We are pleased to advise that the winning presentation will receive:

• free registration to the CIRSE 2022 Congress a ticket for the CIRSE Party at the Congress

• return economy flight and hotel accommodation.

To submit an abstract by 24 June, please visit the IRSA ASM website for more information: www.irsaasm.com/registrar-fellow

Interventional Radiology Committee Member Spotlight Murray McLachlan

people affected by cancer, working to improve the cancer experience of the 50,000 people who are diagnosed in NSW each year.

I joined the Interventional Radiology Committee (IRC) in 2017 as its consumer representative, an opportunity that came about as a result of my involvement with Cancer Voices NSW. I am also a director of the board of Health Consumers NSW, the peak health consumer organisation in the State, and the consumer representative on the Trans Tasman Radiation Oncology Group Cancer Research Board.

My involvement in consumer representation and advocacy is to help ensure that the voices of those affected by cancer, and a range of other health conditions, are heard, listened to and incorporated as an integral element of health service provision.

My direct experience with cancer began in 2006 when my long-term partner was diagnosed with pancreatic cancer. He made the decision to forgo chemotherapy after the cancer metastasised to his liver and died in 2007. I was diagnosed with prostate cancer in early 2009 and had a successful radical prostatectomy soon after.

After leaving full-time work in 2011, after 35 years in the NSW public service, I became involved with Cancer Council NSW on a voluntary basis as the Policy and Advocacy Officer on the NSW Central Coast.

Following a mild stroke in early 2014 (that didn’t involve an interventional neuroradiologist performing clot retrieval!) I reassessed my voluntary work and pulled back on my previous consumer advocacy commitments.

However, as the effects of the stroke were relatively minor, I took up an opportunity in 2016 to join the Executive Committee of Cancer Voices NSW (CVN).

This totally voluntary organisation provides the independent voice of

CVN’s focus is on prevention, diagnosis, information, treatment, research, support and care, survivorship and policy. We do this by working in partnership with decision-makers and service providers, ensuring the patient perspective is heard from planning to delivery. I am currently the CVN Deputy Chair and Secretary.

It is only through genuine participation and involvement, at decision-making levels, that the needs of people who have had an experience with a lifechanging medical condition (be they a patient, survivor, carer, family member or friend) can be met.

The health consumer movement in Australia has a significant history, dating back at least to the changes that occurred in patient advocacy as a result of the HIV/AIDS crisis in the 1980s.

Since that time, significant improvements have occurred across broader health areas that have meant that there is now an acceptance that patients have to be listened to as those who know best about their health condition. However, there is still a need for patients and consumers to be involved, from the initial stages of all health-related policy and program development, as knowledgeable and informed partners.

Murray McLachlan

“I joined the Interventional Radiology Committee (IRC) in 2017 as its consumer representative, an opportunity that came about as a result of my involvement with Cancer Voices NSW. I am also a director of the board of Health Consumers NSW, the peak health consumer organisation in the State, and the consumer representative on the Trans Tasman Radiation Oncology Group Cancer Research Board.”

My involvement with the IRC provides the opportunity to learn from the extraordinary interventional radiologists and interventional neuroradiologists who are dedicated to their specialties through involvement with the committee.

I am regularly awed by the commitment of these people to their profession, and more importantly to the health and wellbeing of their patients. The IRC’s work, particularly its focus in the last two years on achieving specialty recognition for IR and INR, is central to the College as a whole and, more so, to the significant benefits that will come about for patients from recognition.

My contributions, I hope, are always based on two fundamental questions:

• What is this piece of work designed to achieve?

• How will it be benefit patients?

As a former teacher of English, I’m often able to look at written documentation with a view to helping to ensure that it is well-expressed, is spelt and punctuated correctly (!), and is both accessible and useful to its audience.

Having worked in the NSW public sector for all of my working life, I am also able to contribute an understanding of, and appreciation for, the processes that are necessary to achieve change in how health services are delivered. Such changes, given the nature of the Australian health environment, are often complex and difficult to achieve. They require an ongoing commitment to bring about continual improvements in the options and choices available to those affected by a range of health conditions.

It’s in this context that the achievement of specialty recognition is such an important aspect of the current work of the IRC.

There will be reason to celebrate when IRs and INRs are recognised as the highly-skilled, amazing people that they are, and I will be proud to have been involved in that achievement.

COURSE

Presented by Associate Professor Marc Agzarian With MRI progressing rapidly, a sound understanding of the physics, technology and equipment is required to fully exploit MRI’s potential. MRI safety, image quality, artefacts and optimisation strategies are covered throughout the course.

With all original, vendor neutral content, this course will benefit radiologists, radiology registrars, radiographers, radiation therapists, neurologists, cardiologists, neurosurgeons, researchers and medical physicists wanting to gain a better understanding of MRI.

13 & 14 August 2022

Comfort Inn Regal Park 44 Barton Terrace East North Adelaide, SA.

eligible to claim 117.5 RANZCR CPD points for the 5 day course and 67 RANZCR CPD points for the recertification course.

Maximum allowable course based live and library cases for ANZ credentialing.

Clinician led teaching by high volume operators.

State of the art low dose, High Definition imaging.

Unrivalled venue and catering.

“My involvement with the IRC provides the opportunity to learn from the extraordinary interventional radiologists and interventional neuroradiologists who are dedicated to their specialties through involvement with the committee.

I am regularly awed by the commitment of these people to their profession, and more importantly to the health and wellbeing of their patients.”

Kia Ora. In sports Manchester City pipped Liverpool for the Premiership, but we have the Carabao (old League) Cup and FA Cup in the bag, and at the time of writing we still have the Champions League final to play. But who’s counting?

Implications of Budget 2022

The NZ Budget was released in May. Notably, the government has committed one third of the total budget to health spending.

Much of this will be absorbed by the transition to Health New Zealand but one feels cautiously optimistic by the evidence that the government is aware the system needs some TLC.

We can also be somewhat encouraged that the government is moving to 2–3 year funding cycles for health to allow for longer-term investment and planning.

If done right, this could be good news for radiology and radiation oncology given our expensive equipment and workforce shortages.

An additional $191 million is going to Pharmac over the next two years.

Some of funding is almost certainly going to be used to purchase currently unfunded cancer drugs. Immediately after the budget announcement Pharmac undertook a two-week consultation process on:

• expanding access to trastuzumab emtansine (Kadcyla) for people with early breast cancer; and

New Zealand Branch News

• gemtuzumab ozogamicin (Mylotarg) for people with newly diagnosed, CD33-positive acute myeloid leukaemia (AML) through a provisional agreement with Pfizer New Zealand Limited (Pfizer); and

• expanding access to obinutuzumab (Gazyva) for people with relapsed/ refractory marginal zone or follicular lymphoma; and

• expanding access to azacitidine for treatment related myelodysplastic syndromes (MDS) and AML.

These drugs are probably just the start. According to Te Aho o Te Kahu (Cancer Control Agency):

In terms of the comparison with Australia, 20 medicine-indication gaps across nine solid tumour cancer types (lung, breast, bowel, liver, kidney, bladder, ovarian, melanoma, and head and neck) were identified that are likely to be significant, based on ESMO-MCBS scores indicating substantial clinical benefit. There are likely to be other significant gaps for blood cancers.

Funding these drugs will be good news for patients. It will, however, increase service demand for the College’s New Zealand members as additional imaging and radiation therapy will be needed for these patients.

NZ is experiencing a workforce crisis with services in NZ unable to meet current demand for radiation therapy.

This is set to get worse by the end of the decade as Fellows retire. And many radiology services around the country are already struggling to provide

surveillance and screening services, as well as non-cancer related care. Additional funding for training and equipment must be made available so that patients can receive all the necessary care that is part of long-term and curative cancer treatment. Funding the drugs is not enough.

NZ Branch Committee Election

As I write, nominations are open for the NZ Branch Committee. We will announce the new members at the Annual General Meeting being held on the Saturday of the NZ ASM. If we have more nominations than positions, voting will happen electronically. Please keep an eye out for emails about the election.

NZ ASM

The 2022 NZ ASM is scheduled for Queenstown 5–7 August. Wellington’s 2021 event had record attendance. I hope that Queenstown is as popular and I look forward to seeing all of you there.

Highlights include a talk from the Health and Disability Commissioner, a presentation and discussion on CPD with the MCNZ, a joint MDM session on Sunday morning and dinner at the Skyline.

Kia kaha. Stay safe, vigilant and strong.

Dr Gabes Lau

Professional Development Plan

Have You Completed Yours?

As a part of the 2022 CPD program, all members are required to complete a Professional Development Plan (PDP). A PDP is a planning document that can guide a doctor’s future CPD and educational activities throughout your career. It ensures a focus on those activities that will provide most benefit to a particular doctor, based on identified development needs, the identification and integration of professional and personal (non-work) objectives.

PDPs are most effective when they incorporate specific goals that are achievable, time-based and appropriate to the doctor’s actual work and the setting they work in. Having a written plan helps to define and motivate achievement.

The PDP is a working document that is revisited and updated regularly to reflect areas still to be addressed, and where things have been achieved. The PDP can be developed either before or after CPD activities and an annual conversation have been completed, using data gathered to inform future learning and activities.

College members have the option to use the PDP template available through the CPD ePortfolio or upload a completed PDP template—this may be one done through their employer. Members are also able to record the completion of their PDP as a CPD activity—a maximum of two hours can be claimed for this activity.

If you have not completed your PDP, we encourage you to do this as soon as possible, ideally, the PDP process should be completed at the beginning of each annual CPD cycle.

Structured Annual Conversation New Zealand Members only

College members registered to practise in New Zealand will also need to complete a structured conversation on an annual basis. This takes place with a peer, colleague or employer about their clinical practice.

The goal of this activity is to facilitate reflection on developmental and personal needs, professional goals and your intended CPD activities for the coming year. Like the PDP, the structured annual conversation can be recorded as a CPD activity, under the reviewing performance and reflecting on practice category, a maximum of two hours can be recorded. You may complete you structured annual conversation on the template available in the CPD ePortfolio or by uploading a completed template done through your employer.

Questions?

If you have any questions regarding the College’s CPD program requirements, please contact the CPD team on cpd@ranzcr.edu.au or 02 9268 9777.

In addition, the College website has a wide range of information and resources available, including CPD handbooks, CPD ePortfolio user guides and program requirements.

“A PDP is a planning document that can guide a doctor’s future CPD and educational activities throughout your career. It ensures a focus on those activities that will provide most benefit to a particular doctor, based on identified development needs, the identification and integration of professional and personal (non-work) objectives.”

The College’s Member Rewards Program

FINANCE AND LENDING FOR MEMBERS IN AUSTRALIA

Starting with a complimentary mortgage review service by a specialist adviser, Medical Wealth Advisory aims to identify ways for you to structure loans to reduce taxation, improve your interest rates, strengthen your equity position and fund new investments.

Through Member Rewards, you can look forward to:

• Complimentary Service: No fees or charges for using our mortgage lending service.

• Specialist Lending Solutions: Customised solutions utilising products and services from a range of lenders.

• Extended Service Hours: After-hours services that allow you to book a day and time that suits you.

• Dedicated Relationship Manager: Single contact point to handle your entire lending needs.

• Cash Back Offer: In addition to any lender promotional offer.

To find out more:

• Call: 1300 41 81 61

• Visit: www.medicalwealthadvisory.com.au

• Email: ranzcr@medicalwealthadvisory.com.au

HOME AND INVESTMENT LOANS

Home Loan Solutions for Great Rebates

College members across Australia can choose Home Loan Solutions—a team of finance professionals to assist with all types of lending such as home loans, investment loans, commercial loans, SMSF loans, motor vehicle loans or personal loans.

When a College member establishes a residential home loan through Home Loan Solutions, either a purchase or refinance, the following rebates will occur:

• Home Loan Solutions will rebate the member up to 50 per cent of Home Loan Solutions’ Up-Front Commission*. College members will be paid 50 per cent of their rebate when Home Loan Solutions receive the commission (approximately two months after settlement) and the remaining 50 per cent 18 months after settlement if the loan is still in place.

• In addition, if a College member refers a successful application to Home Loan Solutions, that is someone who is not a College member, Home Loan Solutions will give the College member a referral fee of $500.

• Home Loan Solutions will rebate 10 per cent of Home Loan Solutions’ UpFront Commission* to the College.

*Note that the commission is calculated on the amount Home Loan Solutions receives less GST. Lenders pay different percentages in commission, but for an example on a $1.5M loan a College member could receive approximately $3,750 in rebated commission.

Home Loan Solutions can:

• Review your current lending and offer tailored advice to suit your circumstances.

• Filter through a huge range of products from multiple lenders with you, so you can choose a product that is right for you and not have to research alone. They are paid by the lender, so do not charge their clients for their services.

• Provide details of various grants or lender’s specials.

As Finance Brokers, Home Loan Solutions have an obligation to act in your best interest and will educate you to ensure you understand the loan you are applying for.

Contact Home Loan Solutions directly here

FINANCE AND LENDING FOR MEMBERS IN NEW ZEALAND

Financial planning for medical professionals

Medical Financial Advisory Services Ltd (MFAS) provides specialised financial planning advice to health professionals across New Zealand and have been doing so for over 20 years. They have a comprehensive understanding of the opportunities and hurdles that College members may encounter throughout their career.

MFAS offers members a comprehensive range of services including:

• Investment advice and management

• Personal and business insurances

• Home loan lending and mortgages.

MFAS know one size does not fit all, so they tailor strategies to specific goals, ensuring each strategy will work in a simple but effective manner. The MFAS team includes specialists in investment, insurance and mortgage finance to deliver a professional friendly approach to optimise efficiency.

There are three easy ways to access this offer:

• Simply send your details to MFAS and they will contact you

• Email your details to MFAS

• Call MFAS on 0800 379 325

Visit our full Member Rewards Program here

Brisbane, Australia, October 13-15, 2022 www.aib-congress.org

~ In Memoriam ~

The College notes with regret the death of the following members: Dr Bruce Kynaston Life Member QLD

Australasian International Breast Congress (AIBC)

Forge your radiologist career with Qscan Group

We have opportunities available for doctors to join our Hobart team in 2022. Be part of a tight-knit community and join an organisation with a vision and reputation of uncompromising quality radiology.

Qscan Group is a doctor-led practice with over 80 clinics across Australia. Each clinic encompasses a wide range of modalities with platforms to support strong collaboration with subspecialist peers across Australia and on-site radiologists, and nuclear medicine physicians.

Why join Qscan Group?

Lifestyle

Work with the beautiful Kunanyi (Mount Wellington) as your backdrop

Support

Backing of the Qscan Group Executive and a collegiate doctor network across Australia

Growth

Market competitive remuneration and eligibility for equity

Innovation

Access to a broad clinical case mix and state-of-theart imaging equipment